Premature birth natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Natural History, Complications and Prognosis

The shorter the term of pregnancy, the greater the risks of complications. Infants born prematurely have an increased risk of death in the first year of life (infant mortality), with most of that occurring in the first month of life (neonatal mortality).Prematurely born infants are also at greater risk for developing serious health problems such as cerebral palsy, chronic lung disease, gastrointestinal problems, mental retardation, vision or hearing loss[1] and are more susceptible to developing depression as teenagers.[2]

Premature infants show physical signs of their prematurity and may develop other problems as well. These include, but are not limited to, the following:

Neurologic

Cardiovascular

Respiratory

Gastrointestinal / metabolic

Hematologic

Infectious

The earliest gestational age at which the infant has at least a 50% chance of survival is referred to as the limit of viability[3]. As NICU care has improved over the last 40 years, viability has reduced to approximately 24 weeks, although rare survivors have been documented as early as 21 weeks.[4] As risk of brain damage and developmental delay is significant at that threshold even if the infant survives, there are ethical controversies over the aggressiveness of the care rendered to such infants. The limit of viability has also become a factor in the abortion debate.

Some of the complications related to prematurity are not apparent until years after the birth. For example, children who were born prematurely (especially if born less than 1,500 grams) have a higher likelihood of having behavioral problems, delays in motor development, and difficulties in school. Specifically these problems can be described as being within the executive domain and have been speculated to arise due to decreased myelinization of the frontal lobes.[3] Throughout life they are more likely to require services provided by physical therapists, occupational therapists, or speech therapists.

References

  1. March of Dimes. The Growing Problem of Prematurity. October 2006.
  2. The Age Depression Linked to Premature Birth. May 2004.
  3. Böhm, Katz-Salamon, Smedler, Lagercrantz & Forssberg: "Developmental Risks and Protective Factors for Influencing cognitive outcome at 5,5 years of age in very-low-birthweight children". Developmental Medicine & Child Neurology 2002, 44: 508-516.




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