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Updated: Aug 19, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Towards improved neonatal outcome: future strategies
1Academic Unit of Obstetrics and Gynaecology, Clarendon Wing D-Floor, Leeds General Infirmary, Leeds LS2 9NS, UK. hilde.logghe@lth.nhs.uk
Insights
Predicting and preventing preterm birth (PTB) requires understanding genetic susceptibility and environmental factors. Current antenatal care and predictive markers for PTB are insufficient, necessitating new strategies.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Genetics and Genomics
Background:
- Maternal and fetal infections/inflammation are significant contributors to neonatal mortality and morbidity.
- Current predictive studies for preterm birth (PTB) primarily focus on high-risk phenotypes.
- Existing antenatal care strategies have not achieved primary prevention of PTB.
Purpose of the Study:
- To explore the genetic susceptibility of preterm birth (PTB).
- To investigate the combined influence of environmental/lifestyle factors and genotype on PTB causation.
- To evaluate the efficacy of current predictive markers and secondary prevention strategies for PTB.
Main Methods:
- Analysis of genetic susceptibility in relation to PTB.
- Integration of environmental and lifestyle risk factors with known genotypes.
- Review of predictive technical markers (e.g., fibronectin, cervical length, uterine activity).
- Assessment of secondary prevention methods including tocolytics and antibiotics.
Main Results:
- Predictive technical markers for PTB remain largely unproven.
- Tocolytics offer minimal benefit and should not prolong infected preterm pregnancies.
- Antibiotics in preterm premature rupture of membranes can prolong pregnancy and reduce neonatal morbidity.
Conclusions:
- A comprehensive understanding of PTB causation requires integrating genetic, environmental, and lifestyle factors.
- Current antenatal care and predictive markers are insufficient for primary PTB prevention.
- Anti-inflammatory therapies targeting intra-amniotic inflammation show promise for future treatment options.
Abstract:
The role of the obstetrician is to help predict and prevent maternal/fetal infection/inflammation related to neonatal mortality and morbidity. Predictive studies have mainly focused on the high-risk phenotype. Currently, there is a scientific drive to analyse the genetic susceptibility of preterm birth (PTB). Studies of the combination of environmental and lifestyle risk factors with the known genotype may result in a better understanding of the causation of PTB. Predictive technical markers such as fibronectin, cervical length measurement and home uterine activity remain largely unproven. Current antenatal care has not achieved primary prevention of PTB. Tocolytics and antibiotics constitute the two key elements of secondary prevention. Tocolytics have a minimal benefit but should not be used to prolong an infected preterm pregnancy. The use of antibiotics in preterm premature rupture of membranes can prolong the pregnancy with a decrease in neonatal morbidity. Anti-inflammatory cytokines, cytokine inhibitors and soluble cytokine receptors are promising treatment options that could modulate the intra-amniotic inflammatory process.
