Talk:Birth - Preterm

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<pubmed>20943598</pubmed>

• The surprising composition of the salivary proteome of preterm human newborn PMID 20943598 "Saliva is a body fluid of a unique composition devoted to protect the mouth cavity and the digestive tract. A quantitative label-free MS analysis showed protein levels altered in relation to the postconceptional age and suggested coordinate and hierarchical functions for these proteins during development. In summary, this study shows for the first time that analysis of these proteins in saliva of preterm newborns might represent a non-invasive way to obtain precious information of the molecular mechanisms of development of human fetal oral structures."

2012

Preterm Birth and Psychiatric Disorders in Young Adult Life

Arch Gen Psychiatry. 2012 Jun 1:610-617. doi: 10.1001/archgenpsychiatry.2011.1374. [Epub ahead of print]

Nosarti C, Reichenberg A, Murray RM, Cnattingius S, Lambe MP, Yin L, Maccabe J, Rifkin L, Hultman CM.

Abstract

CONTEXT Preterm birth, intrauterine growth restriction, and delivery-related hypoxia have been associated with schizophrenia. It is unclear whether these associations pertain to other adult-onset psychiatric disorders and whether these perinatal events are independent. OBJECTIVE To investigate the relationships among gestational age, nonoptimal fetal growth, Apgar score, and various psychiatric disorders in young adult life. DESIGN Historical population-based cohort study. SETTING Identification of adult-onset psychiatric admissions using data from the National Board of Health and Welfare, Stockholm, Sweden. PARTICIPANTS All live-born individuals registered in the nationwide Swedish Medical Birth Register between 1973 and 1985 and living in Sweden at age 16 years by December 2002 (n = 1 301 522). MAIN OUTCOME MEASURES Psychiatric hospitalization with nonaffective psychosis, bipolar affective disorder, depressive disorder, eating disorder, drug dependency, or alcohol dependency, diagnosed according to the International Classification of Diseases codes for 8 through 10. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. RESULTS Preterm birth was significantly associated with increased risk of psychiatric hospitalization in adulthood (defined as ≥16 years of age) in a monotonic manner across a range of psychiatric disorders. Compared with term births (37-41 weeks), those born at 32 to 36 weeks' gestation were 1.6 (95% CI, 1.1-2.3) times more likely to have nonaffective psychosis, 1.3 (95% CI, 1.1-1.7) times more likely to have depressive disorder, and 2.7 (95% CI, 1.6-4.5) times more likely to have bipolar affective disorder. Those born at less than 32 weeks' gestation were 2.5 (95% CI, 1.0-6.0) times more likely to have nonaffective psychosis, 2.9 (95% CI, 1.8-4.6) times more likely to have depressive disorder, and 7.4 (95% CI, 2.7-20.6) times more likely to have bipolar affective disorder. CONCLUSIONS The vulnerability for hospitalization with a range of psychiatric diagnoses may increase with younger gestational age. Similar associations were not observed for nonoptimal fetal growth and low Apgar score.

PMID 22660967

Chloride Balance in Preterm Infants during the First Week of Life

Int J Pediatr. 2012;2012:931597. Epub 2012 Mar 8.

Iacobelli S, Kermorvant-Duchemin E, Bonsante F, Lapillonne A, Gouyon JB. Source Neonatology and NICU, GHSR, CHR, BP 350, 97448 Saint Pierre Cedex, Réunion, France.

Abstract

Objective. To describe the chloride balance in infants born 25-32-week gestation, analyze the association of chloride changes with hydroelectrolytic status and their relationship with perinatal conditions, morbidities, and neurological outcome. Methods. For 7 days after birth, sodium and chloride balance, plasma potassium, phosphate, and total carbon dioxide (tCO(2)) were prospectively determined and strong ion difference (SID) calculated. Three multivariate regression analyses were performed to identify factors associated with high plasma chloride concentration, low SID, and low tCO(2). Results. 107 infants were studied. Plasma chloride concentration was significantly positively associated with plasma sodium concentration. Higher plasma chloride and lower SID were significantly associated with lower plasma tCO(2). Chloride intake was the main independent factor associated with high plasma chloride, low SID, and low plasma tCO(2), with lesser contribution of sodium intake and low gestational age (GA). Also, patent ductus arteriosus and birth weight loss were independent factors affecting plasma chloride and SID. Neither high chloride levels nor low SID were associated to impaired neurological outcome. Conclusions. In preterm infants, chloride balance is influenced by GA and by interrelationship between sodium and chloride intake. High chloride levels are associated with metabolic acidosis but not related to increased risk of impaired neurological outcome.

PMID 22505945

Transvaginal sonographic evaluation of the cervix in asymptomatic singleton pregnancy and management options in short cervix

J Pregnancy. 2012;2012:201628. Epub 2012 Feb 22. Arisoy R, Yayla M. Source Department of Obstetrics and Gynaecology, Gole State Hospital, 34660 Ardahan, Turkey.

Abstract

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16-24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.

PMID 22523687

http://www.hindawi.com/journals/jp/2012/201628/

Editorial - Prevention and Management of Preterm Birth

Jacquemyn Y, Lamont R, Cornette J, Helmer H. J Pregnancy. 2012;2012:610364. Epub 2012 Mar 18. No abstract available.

Prevention and treatment of preterm delivery is not one of the success stories of modern medicine, preterm birth constitutes the major determinant of perinatal mortality and morbidity, and the long-term results of being born too early often lead to a shorter, less healthy life and a more difficult school and professional career. Different methods have been introduced to predict the advent of preterm labour in asymptomatic women, including fetal fibronectin and transvaginal ultrasound cervical length measurement. R. Arisoy and M. Yayla present data on the evaluation of the cervix in asymptomatic singleton pregnancies; they also address the most frustrating issue: what measures to take once a short cervix has been detected. They restrict their study to singleton pregnancies; although both cervical length and fetal fibronectin are good predictors of preterm delivery in twins, no intervention has proven useful in twins: vaginal progesteron makes no difference and cerclage even worsens the outcome.

Possibilities for real primary prevention are rare and include treatment of asymptomatic bacteriuria and periodontal disease. O. Huck et al. elaborate this last issue and present an excellent overview on both epidemiologic and pathophysiologic data. Another method proposed for primary prevention of preterm birth is the use of progesteron, including vaginal progesteron and systemic 17-hydroxyprogesterone caproate. Starting progesterone treatment can be based not only on cervical length or vaginal fibronectin but also on past obstetrical history. C. E. Ransom et al. comment on the use of 17-hydroxyprogesterone caproate and the influence of obstetric history.

Some newer methods are on the border of being introduced to clinical practice; one such candidate is near-infrared spectroscopy. K. M. Power and colleagues present the use of near-infrared spectroscopy of amniotic fluid to assess preterm delivery.

Once preterm labour has been established, tocolytics are (all too) often used, and what their exact place in treatment is remains open for discussion. Hubinont and F. Debieve present a concise update on tocolysis. In case preterm delivery seems unavoidable, the optimal mode of fetal monitoring and the mode of delivery have to be chosen. Fetal heart rate monitoring in the preterm period constitutes a special challenge and is further commented by K. Afors and E. Chandraharan, while S. R. Bhatta and C. R. Keriakos discuss the optimal way of delivering the preterm baby in vertex position.

As the articles in this issue demonstrate, preterm labour and delivery constitute one of the major challenges of obstetrics in the 21st century. PMID 22550589

http://www.hindawi.com/journals/jp/2012/610364/

WHO Report

• WHO Report Born Too Soon: The Global Action Report on Preterm Birth

The first-ever country-by-country estimate of premature births finds that 15 million babies a year are born preterm - more than one in 10 live births. Although more than 60% of preterm births are in sub-Saharan Africa and south Asia, they are also a problem for some high-income countries, including the USA and Brazil. Both rank among the 10 countries with the highest number of preterm births. In the USA, about 12% of all births are preterm, a percentage far higher than in Europe or other developed countries. ...

The Partnership (PMNCH) - joins the maternal, newborn and child health (MNCH) communities into an alliance of more than 350 members to ensure that all women, infants and children not only remain healthy, but thrive. Born Too Soon: The Global Action Report on Preterm Birth

http://apps.who.int/datacol/survey_result.asp?survey_id=258&view_id=274&respondent_id=100490

Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study

BMJ. 2012 Mar 1;344:e896. doi: 10.1136/bmj.e896.

Boyle EM, Poulsen G, Field DJ, Kurinczuk JJ, Wolke D, Alfirevic Z, Quigley MA. Source Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK. eb124@le.ac.uk Abstract OBJECTIVE: To investigate the burden of later disease associated with moderate/late preterm (32-36 weeks) and early term (37-38 weeks) birth. DESIGN: Secondary analysis of data from the Millennium Cohort Study (MCS). SETTING: Longitudinal study of infants born in the United Kingdom between 2000 and 2002. PARTICIPANTS: 18,818 infants participated in the MCS. Effects of gestational age at birth on health outcomes at 3 (n = 14,273) and 5 years (n = 14,056) of age were analysed. MAIN OUTCOME MEASURES: Growth, hospital admissions, longstanding illness/disability, wheezing/asthma, use of prescribed drugs, and parental rating of their children's health. RESULTS: Measures of general health, hospital admissions, and longstanding illness showed a gradient of increasing risk of poorer outcome with decreasing gestation, suggesting a "dose-response" effect of prematurity. The greatest contribution to disease burden at 3 and 5 years was in children born late/moderate preterm or early term. Population attributable fractions for having at least three hospital admissions between 9 months and 5 years were 5.7% (95% confidence interval 2.0% to 10.0%) for birth at 32-36 weeks and 7.2% (1.4% to 13.6%) for birth at 37-38 weeks, compared with 3.8% (1.3% to 6.5%) for children born very preterm (<32 weeks). Similarly, 2.7% (1.1% to 4.3%), 5.4% (2.4% to 8.6%), and 5.4% (0.7% to 10.5%) of limiting longstanding illness at 5 years were attributed to very preterm birth, moderate/late preterm birth, and early term birth. CONCLUSIONS: These results suggest that health outcomes of moderate/late preterm and early term babies are worse than those of full term babies. Additional research should quantify how much of the effect is due to maternal/fetal complications rather than prematurity itself. Irrespective of the reason for preterm birth, large numbers of these babies present a greater burden on public health services than very preterm babies.

PMID 22381676

Patterns and outcomes of preterm hospital admissions during pregnancy in NSW, 2001-2008

Med J Aust. 2012 Mar 5;196(4):261-5.

Badgery-Parker T, Ford JB, Jenkins MG, Morris JM, Roberts CL. Source Centre for Epidemiology and Research, NSW Ministry of Health, Sydney, NSW, Australia. clroberts@med.usyd.edu.au.

Abstract

OBJECTIVE: To assess the frequency and outcomes of preterm hospital admissions during pregnancy, with a focus on transfers to higher levels of care.

DESIGN: Population-based cohort study using linked population data.

SETTING AND SUBJECTS: Women who were admitted to hospital in weeks 20-36 of pregnancy (preterm) and gave birth to a liveborn singleton infant in New South Wales during 2001-2008.

MAIN OUTCOME MEASURE: Numbers of preterm admissions of pregnant women who were discharged without giving birth, were transferred to higher care, or who gave birth.

RESULTS: 110 439 pregnancies (16.0%) involved at least one preterm admission. After their initial preterm admission, 71.9% of women were discharged, 6.3% were transferred and 21.8% gave birth. Median gestational age at admission was 33 weeks and median time to discharge, transfer or giving birth was 1 day. Most women who were transferred or who gave birth had been admitted for preterm rupture of membranes or preterm labour. Of the women who were admitted or were transferred with suspected preterm labour, only 29% and 38%, respectively, gave birth. Compared with other admitted women, women having a first birth, public patients and those living in areas of low socioeconomic status were more likely to be transferred or to give birth. As gestational age increased, the proportion of women transferred decreased and the proportion giving birth increased. Infants born after maternal transfer had lower gestational age and more adverse outcomes than those born without maternal transfer.

CONCLUSIONS: Preterm hospital admission affects one in six women with singleton pregnancies. Methods that could improve assessment of labour status have a large potential to reduce the burden on maternity services. The increased morbidity for infants born after maternal transfer suggests women with high-risk pregnancies are being appropriately identified.

PMID 22409693

https://www.mja.com.au/journal/2012/196/4/patterns-and-outcomes-preterm-hospital-admissions-during-pregnancy-nsw-2001-2008

2011

Children's Brain Development Benefits from Longer Gestation

Front Psychol. 2011;2:1. Epub 2011 Feb 9.

Davis EP, Buss C, Muftuler LT, Head K, Hasso A, Wing DA, Hobel C, Sandman CA. Source Women and Children's Health and Well-Being Project, Department of Psychiatry and Human Behavior, University of California Irvine Orange, CA, USA. Abstract Disruptions to brain development associated with shortened gestation place individuals at risk for the development of behavioral and psychological dysfunction throughout the lifespan. The purpose of the present study was to determine if the benefit for brain development conferred by increased gestational length exists on a continuum across the gestational age spectrum among healthy children with a stable neonatal course. Neurodevelopment was evaluated with structural magnetic resonance imaging in 100 healthy right-handed 6- to 10-year-old children born between 28 and 41 gestational weeks with a stable neonatal course. Data indicate that a longer gestational period confers an advantage for neurodevelopment. Longer duration of gestation was associated with region-specific increases in gray matter density. Further, the benefit of longer gestation for brain development was present even when only children born full term were considered. These findings demonstrate that even modest decreases in the duration of gestation can exert profound and lasting effects on neurodevelopment for both term and preterm infants and may contribute to long-term risk for health and disease.

PMID: 21713130 [PubMed - in process] PMCID: PMC3111445 http://www.ncbi.nlm.nih.gov/pubmed/21713130

2009

Differing prevalence and diversity of bacterial species in fetal membranes from very preterm and term labor

PLoS One. 2009 Dec 8;4(12):e8205.

Jones HE, Harris KA, Azizia M, Bank L, Carpenter B, Hartley JC, Klein N, Peebles D. Source Infectious Diseases and Microbiology Unit, Institute of Child Health, London, United Kingdom. h.jones@ich.ucl.ac.uk

Abstract

BACKGROUND: Intrauterine infection may play a role in preterm delivery due to spontaneous preterm labor (PTL) and preterm prolonged rupture of membranes (PPROM). Because bacteria previously associated with preterm delivery are often difficult to culture, a molecular biology approach was used to identify bacterial DNA in placenta and fetal membranes. METHODOLOGY/PRINCIPAL FINDINGS: We used broad-range 16S rDNA PCR and species-specific, real-time assays to amplify bacterial DNA from fetal membranes and placenta. 74 women were recruited to the following groups: PPROM <32 weeks (n = 26; 11 caesarean); PTL with intact membranes <32 weeks (n = 19; all vaginal birth); indicated preterm delivery <32 weeks (n = 8; all caesarean); term (n = 21; 11 caesarean). 50% (5/10) of term vaginal deliveries were positive for bacterial DNA. However, little spread was observed through tissues and species diversity was restricted. Minimal bacteria were detected in term elective section or indicated preterm deliveries. Bacterial prevalence was significantly increased in samples from PTL with intact membranes [89% (17/19) versus 50% (5/10) in term vaginal delivery p = 0.03] and PPROM (CS) [55% (6/11) versus 0% (0/11) in term elective CS, p = 0.01]. In addition, bacterial spread and diversity was greater in the preterm groups with 68% (13/19) PTL group having 3 or more positive samples and over 60% (12/19) showing two or more bacterial species (versus 20% (2/10) in term vaginal deliveries). Blood monocytes from women with PTL with intact membranes and PPROM who were 16S bacterial positive showed greater level of immune paresis (p = 0.03). A positive PCR result was associated with histological chorioamnionitis in preterm deliveries. CONCLUSION/SIGNIFICANCE: Bacteria are found in both preterm and term fetal membranes. A greater spread and diversity of bacterial species were found in tissues of women who had very preterm births. It is unclear to what extent the greater bacterial prevalence observed in all vaginal delivery groups reflects bacterial contamination or colonization of membranes during labor. Bacteria positive preterm tissues are associated with histological chorioamnionitis and a pronounced maternal immune paresis.

PMID 19997613