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Pages 1-30

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From page 1...
... Infants born preterm are at greater risk than infants born at term for mortality and a variety of health and developmental problems. Complications include acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, as well as longer-term motor, cognitive, visual, hearing, behavioral, social-emotional, health, and growth problems.
From page 2...
... Therapies and interventions for the prediction and the prevention of preterm birth are thus needed. Upon review of the literature assessing the causes and conse quences of preterm birth, the diagnosis and treatment of women at risk for preterm labor, and treatments for infants born preterm, the committee proposes a research agenda for investigating the prob lem of preterm birth that is intended to help focus and direct re search efforts.
From page 3...
... Although advances in perinatal and neonatal care have improved the survival for preterm infants, those infants who do survive have a greater risk of developmental disabilities, health, and growth problems than infants born at full term. Whereas the group of infants with the greatest risk of morbidity and mortality comprises those born at less than 32 weeks of gestation, infants born between 32 and 36 weeks represent the greatest number of infants born preterm.
From page 4...
... Great strides have been made in treating infants born preterm and improving survival. However, any significant gains to be made in the study of preterm birth will be in the area of preventing its occurrence.
From page 5...
... These causes are multiple and may vary for different populations. Individual-level behavioral and psychosocial factors, neighborhood social characteristics, environmental exposures, medical conditions, infertility treatments, biological factors, and genetics may play roles to various degrees.
From page 6...
... Study the acute and the long-term outcomes for infants born preterm 3. Study infertility treatments and institute guidelines to reduce the number of multiple gestations 4.
From page 7...
... The objective of these centers will be to focus on understanding the causes of preterm birth and the health outcomes for women and their infants who were born preterm. Consistent with the Roadmap initiative of the National Institutes of Health, these activities should include the following:
From page 8...
... At any given gestational age, there is a distribution of birth weights such that some infants appear to be within the norm for their gestational age, some appear to be relatively light, and others appear to be quite heavy (Battaglia and Lubchenco, 1967)
From page 9...
... The National Center for Health Statistics develops standards for uniform reporting of live births and fetal, neonatal, and infant deaths to national public health databases. Although birth certificates are intended to establish the date of birth, citizenship, and nationality, they contain valuable public health information and are the only national source of birth weight and gestational age data.
From page 10...
... • Perinatal mortality and morbidity should be reported by gestational age, birth weight, and birth weight for gestational age. • A categorization or coding scheme that reflects the heterogeneous etiologies of preterm birth should be developed and implemented.
From page 11...
... , others have provided estimates exclusively by gestational age (Phibbs and Schmitt, 2006) , whereas still others have provided estimates by both gestational age and low birth weight (Gilbert et al., 2003; Schmitt et al., 2006)
From page 12...
... . Preterm birth has historically not been emphasized in prenatal care, in the belief that the majority of preterm births are due to social rather than medical or obstetrical causes (Main et al., 1985; Taylor, 1985)
From page 13...
... • More accurate methods are needed to • diagnose preterm labor, • assess fetal health to identify women and fetuses that are and that are not candidates for the arrest of labor, and • arrest labor. • The success of perinatal care during preterm birth should be based primarily on perinatal morbidity and mortality rates as well as the rate of preterm birth, the numbers of infants born with low birth weights, or neonatal morbidity and mortality.
From page 14...
... The variabilities in the outcome frequencies reported also reflect differences in the population base and in clinical practice. The mortality and neurodevelopmental disability rates for moderately preterm infants with gestational ages of 33 to 36 weeks are higher than those for full-term infants (although they are lower than those for morepreterm infants)
From page 15...
... Specifically, • Outcomes should be reported by gestational age categories, in addition to birth weight categories; and better methods of measuring fetal and infant maturity should be devised. • Obstetrics-perinatology departments and pediatrics-neonatology departments should work together to establish guidelines to achieve a more uniform approach to evaluating and reporting outcomes, including ages of evaluation, measurement tools, and the minimum duration of follow-up.
From page 16...
... In recent years, an unintended consequence of these technologies, multiple gestations and the increased risk for preterm delivery, has become a focus of attention. There is also evidence of an association between the underlying causes of infertility and subfecundity (long time to becoming pregnant)
From page 17...
... Specifically, those conducting work in this area should attempt to achieve the following: • Develop comprehensive registries for clinical research, with particular emphasis on obtaining data on gestational age and birth weight, whether
From page 18...
... 4. Improve the Quality of Care for Women at Risk for Preterm Labor and Infants Born Preterm Beyond the content of prenatal care, little is known about the quality of care throughout the reproductive spectrum.
From page 19...
... This agenda should: • Define quality across the full spectrum of providers who treat women delivering preterm and infants born preterm; • Identify efficacious interventions for preterm infants and identify the quality improvement efforts that are needed to incorporate these interventions into practice; and • Analyze variations in outcomes for preterm infants among institutions.
From page 20...
... . However, the relative risk of neonatal mortality for infants born with very low birth weights was twofold higher in Level II centers than in Level III centers.
From page 21...
... Investigate the Etiologies of Preterm Birth It is clear that the causes of preterm labor are multifactorial and vary according to gestational age. Biological pathways include systemic and intrauterine infections (which are responsible for the majority of extremely preterm births)
From page 22...
... . Nevertheless, the available literature has provided some evidence of a familial or intergenerational influence on low birth weight and preterm birth (Bakketeig et al., 1979; Carr-Hill and Hall, 1985; Khoury and Cohen, 1987; Porter et al., 1997; Varner and Esplin, 2005)
From page 23...
... 2. Study Multiple Psychosocial, Behavioral, Sociodemographic, and Environmental Risk Factors Associated with Preterm Birth Simultaneously Behavioral determinants of preterm birth have been of interest, given the fact that they are subject to change and could reduce the frequency of preterm birth directly.
From page 24...
... Cocaine use is associated with an increased risk for preterm birth (Holzman and Paneth, 1994) , and leisure time physical activity has been associated with a reduced risk of preterm birth (Evenson et al., 2002)
From page 25...
... . Some specific neighborhood-level characteristics that have been associated with birth weight and the risk of low birth weight include indicators of neighborhood economic deprivation and crime (Elo et al., 2001)
From page 26...
... , maternal risk behaviors, prenatal care, maternal infection, maternal stress, and genetics. Findings related to SES suggest that the disparities in the rates of preterm birth between African American and white women persist after attempts to adjust for socioeconomic differences (Collins and David, 1997; McGrady et al., 1992; Schoendorf et al., 1992; Shiono et al., 1997)
From page 27...
... . The effectiveness of prenatal care for preventing prematurity has yet to be conclusively demonstrated (Alexander and Kotelchuck, 2001; Lu and Halfon, 2003; CDC, 2005i)
From page 28...
... Recommendation V-4: Study the effects of public programs and policies on preterm birth. The National Institutes of Health, the Centers for Medicare and Medicaid Services, and private founda tions should conduct and/or support research on the role of social programs and policies on the occurrence of preterm birth and the health of children born preterm.
From page 29...
... CONCLUDING REMARKS Although significant improvements in treating infants born preterm and improving survival have been made, little success has been attained in understanding and preventing preterm birth. The challenge remains to identify interventions that prevent preterm birth, reduce the rates of morbidity and mortality of the mother or the infant once a preterm birth occurs, and reduce the incidence of long-term disability among children who were born preterm in the most comprehensive and cost-effective manner possible.


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