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The effects on offspring of premature parturition
1Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Spain. antonio.cano@uv.es
Insights
Preterm birth leads to significant infant morbidity and mortality, with neurological and sensory disabilities remaining prevalent. Recent trends show decreasing mortality without increased disability, offering hope for improved outcomes.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Developmental Pediatrics
Background:
- Preterm birth, defined by early parturition, results in fetal immaturity, a primary cause of neonatal morbidity and mortality.
- Despite advances in neonatal intensive care units (NICUs), survival rates for infants with low birthweight and gestational age remain suboptimal.
- Neurological and sensory sequelae, including cerebral palsy and retinopathy of prematurity, are highly prevalent in premature infants.
Purpose of the Study:
- To review the current understanding of preterm birth complications and associated morbidities.
- To highlight recent trends in preterm infant outcomes, specifically mortality and disability rates.
- To identify potential areas for future research and clinical interventions to reduce the impact of preterm birth.
Main Methods:
- Literature review focusing on preterm birth, neonatal outcomes, and long-term sequelae.
- Analysis of trends in mortality and disability rates in preterm infants.
- Identification of key factors influencing preterm birth incidence and management.
Main Results:
- Preterm birth significantly increases the risk of mortality and long-term neurological and sensory disabilities in infants.
- Recent years have observed a decrease in mortality rates among preterm infants.
- This decrease in mortality has not been accompanied by a detectable increase in the prevalence of disabilities.
Conclusions:
- While survival rates for preterm infants have improved, significant neurological and sensory disabilities persist.
- Emerging trends suggest a potential decoupling of mortality and disability, warranting further investigation.
- Future advancements in understanding uterine contractility, cervical changes, reproductive technologies, and obstetric care are crucial for reducing preterm birth complications.
Abstract:
The time of parturition defines the length of the intrauterine period of fetal life, a requisite to achieve adequate adaptation to the external environment. Immaturity, a condition whose severity is inversely related to the length of pregnancy, is the main determinant of the increased morbidity and mortality associated with preterm birth. Despite great advances in medical technology and expertise, mainly after the introduction of the neonatal intensive care units, only one- to two-thirds of infants from the subsets with lower birthweight/gestational age reach survival at discharge. Distinct major neurological and sensorial sequelae, including cerebral palsy, retinopathy of prematurity, and hearing loss, as well as reduced neuropsychological abilities, leading to deficient academic achievement and deterioration of several aspects of health status, are still highly prevalent among the most immature children. Interestingly, decreasing mortality rates, which are not followed by detectable increases of disability, are being observed in recent years. Future advances may be expected from clinical and basic research on uterine contractility and cervical softening. Also, changes in reproductive technology procedures, a main factor in the incidence of multiple pregnancies, and a more refined approach to obstetric care, compose some of the clinical interventions which may reduce the problem.