premature infant|premature baby|infant premature

ABC of preterm birth Epidemiology of preterm birth

2010-02-19T11:13:00.000-08:00

ABC of preterm birth
Epidemiology of preterm birth
-------------------------------------
Janet Tucker, William McGuire
source:
http://www.amchp.org/MCH-Topics/H-N/Documents/Infant%20Mortality%202004
/bmj.preterm.birth.pdf

Preterm birth is a major challenge in perinatal health care. Most
perinatal deaths occur in preterm infants, and preterm birth is
an important risk factor for neurological impairment and
disability. Preterm birth not only affects infants and their
families—providing care for preterm infants, who may spend
several months in hospital, has increasing cost implications for
health services.
Definitions
Preterm birth is the delivery of a baby before 37 completed
weeks’ gestation. Most mortality and morbidity affects “very
preterm” infants (those born before 32 weeks’ gestation), and
especially “extremely preterm” infants (those born before 28
weeks of gestation).
Over the past 20-30 years advances in perinatal care have
improved outcomes for infants born after short gestations. The
number of weeks of completed gestation that defines whether a
birth is preterm rather than a fetal loss has become smaller. In
1992 the boundary that required registration as a preterm live
birth in the United Kingdom was lowered from 28 completed
weeks’ gestation to 24 weeks’ gestation. This boundary varies
internationally, however, from about 20 to 24 weeks. Some
classification of fetal loss, still birth, and early neonatal death for
these very short gestations may be unreliable.
Gestational age versus birth weight
Even in developed countries, there is often uncertainty and
incomplete recording of estimates of gestation. In most of the
United Kingdom data on birth weight data but not on
gestational age are collected routinely.
Although some concordance exists between the categories
of birth weight and gestational age, they are not
interchangeable. The categories for birth weight are:
x Low birth weight ( < 2500 g)
x Very low birth weight ( < 1500 g)
x Extremely low birth weight ( < 1000 g)
Only around two thirds of low birth weight infants are
preterm. Term infants may be of low birth weight because they
are “small for gestational age” or “light for date” infants. These
infants are usually defined as below the 10th centile of the
index population’s distribution of birth weights by
gestation—that is, in the lowest 10 per cent of birth weights.
Preterm infants may also be small for gestational age. They
may have neonatal problems additional to those related to
shortened gestation, particularly if they are small because of
intrauterine growth restriction.
Perinatal problems related to intrauterine growth restriction
include:
x Perinatal death
x Fetal distress
x Meconium aspiration syndrome
x Hypoglycaemia
x Polycythaemia or hyperviscosity
x Hypothermia
----------------------------------------------------
Clinical review
Incidence
Over the past 20-30 years the incidence of preterm birth in
most developed countries has been about 5-7% of live births.
The incidence in the United States is higher, at about 12%.
Some evidence shows that this incidence has increased slightly
in the past few years, but the rate of birth before 32 weeks'
gestation is almost unchanged, at 1-2%.
Several factors have contributed to the overall rise in the
incidence of preterm birth. These factors include increasing
rates of multiple births, greater use of assisted reproduction
techniques, and more obstetric intervention.
Part of the apparent rise in the incidence of preterm birth,
however, may reflect changes in clinical practice. Increasingly,
ultrasonography rather than the last menstrual period date is
used to estimate gestational age. The rise in incidence may also
be caused by inconsistent classification of fetal loss, still birth,
and early neonatal death. In some countries, infants who are
born after very short gestations (less than 24 weeks) are more
likely to be categorised as live births.
With the limited provision of antenatal or perinatal care in
developing countries, there are difficulties with population
based data. Registration of births is incomplete and information
is lacking on gestational age, especially outside hospital settings.
Data that are collected tend to give only estimates of perinatal
outcomes that are specific to birth weight. These data show that
the incidence of low birth weight is much higher in developing
countries than in developed countries with good care services.
In developing countries, low birth weight is probably caused
by intrauterine growth restriction. Maternal undernutrition and
chronic infection in pregnancy are the main factors that cause
intrauterine growth restriction. Although the technical advances
in the care of preterm infants have improved outcomes in
developed countries with well resourced care services, they have
not influenced neonatal morbidity and mortality in countries
that lack basic midwifery and obstetric care. In these developing
countries, the priorities are to reduce infection associated with
delivery, identify and manage pregnancies of women who are at
risk, and provide basic neonatal resuscitation.
Causes of preterm birth
Spontaneous preterm labour and rupture of membranes
Most preterm births follow spontaneous, unexplained preterm
labour, or spontaneous preterm prelabour rupture of the
amniotic membranes. The most important predictors of
spontaneous preterm delivery are a history of preterm birth
and poor socioeconomic background of the mother.
Interaction of the many factors that contribute to the
association of preterm birth with socioeconomic status is
complex. Mothers who smoke cigarettes are twice as likely as
non-smoking mothers to deliver before 32 weeks of gestation,
although this effect does not explain all the risk associated with
social disadvantage.
Evidence from meta-analysis of randomised controlled trials
shows that antenatal smoking cessation programmes can lower
the incidence of preterm birth.Women from poorer
socioeconomic backgrounds, however, are least likely to stop
smoking in pregnancy although they are most at risk of
preterm delivery.
No studies have shown that other interventions, such as
better antenatal care, dietary advice, or increased social support
during pregnancy, improve perinatal outcomes or reduce the
social inequalities in the incidence of preterm delivery.
-----------------------------------------
The rate of preterm birth varies between ethnic groups. In
the United Kingdom, and even more markedly in the United
States, the incidence of preterm birth in black women is higher
than that in white women of similar age. The reason for this
variation is unclear because differences remain after taking into
account socioeconomic risk factors.
Multiple pregnancy and assisted reproduction
Multifetal pregnancy increases the risk of preterm delivery.
About one quarter of preterm births occur in multiple
pregnancies. Half of all twins and most triplets are born
preterm. Multiple pregnancy is more likely than singleton
pregnancy to be associated with spontaneous preterm labour
and with preterm obstetric interventions, such as induction of
labour or delivery by caesarean section.
The incidence of multiple pregnancies in developed
countries has increased over the past 20-30 years. This rise is
mainly because of the increased use of assisted reproduction
techniques, such as drugs that induce ovulation and in vitro
fertilisation. For example, the birth rate of twins in the United
States has increased by 55% since 1980. The rate of higher
order multiple births increased fourfold between 1980 and
1998, although this rate has decreased slightly over the past five
years. In some countries two embryos only are allowed to be
placed in the uterus after in vitro fertilisation to limit the
incidence of higher order pregnancy.
Singleton pregnancies that follow assisted reproduction are
at a considerable increased risk of preterm delivery, probably
because of factors such as cervical trauma, the higher incidence
of uterine problems, and possibly because of the increased risk
of infection.
Maternal and fetal complications
About 15% to 25% of preterm infants are delivered because of
maternal or fetal complications of pregnancy. The principal
causes are hypertensive disorders of pregnancy and severe
intrauterine growth restriction, which is often associated with
hypertensive disorders. The decision to deliver these infants is
informed by balancing the risks of preterm birth for the infant
against the consequence of continued pregnancy for the
mother and fetus. Over the past two decades improved
antenatal and perinatal care has increased the rate of iatrogenic
preterm delivery. During that time the incidence of still birth in
the third trimester has fallen.
Outcomes after preterm birth
Broadly, outcomes improve with increasing gestational age,
although for any given length of gestation survival varies with
birth weight. Other factors, including ethnicity and gender also
influence survival and the risk of neurological impairment.
The outcomes for preterm infants born at or after 32 weeks
of gestation are similar to those for term infants. Most serious
problems associated with preterm birth occur in the 1% to 2%
of infants who are born before 32 completed weeks' gestation,
and particularly the 0.4% of infants born before 28 weeks'
gestation. Modern perinatal care and specific interventions,
such as prophylactic antenatal steroids and exogenous
surfactants, have contributed to some improved outcomes for
very preterm infants. The overall prognosis remains poor,
however, particularly for infants who are born before 26 weeks'
gestation.
The outcome for preterm infants of multiple pregnancies
can be better than that of singleton pregnancies of the same
gestation. In term infants the situation is reversed. The
improved outcome for preterm infants of multiple pregnancies
has been attributed to closer surveillance of the mother and

The United States is working on reducing the incidence of premature birth

2010-02-16T02:39:00.000-08:00

The United States began a pilot program to determine the reasons for the escalation of cases of premature birth at the steady and significant during the past two decades.
The Acting Surgeon General of America, Steven Galson, who opened the conference, it takes two days to develop a national strategy developed to prevent preterm birth, "We need to redouble our efforts in this context."
The United States sees half a million births a year earlier, according to the Agency Saedy.
It is noteworthy that the full load take between 38 weeks to 42, and premature births are born before Aktmalhm the 37 week of pregnancy.
The indicators of worrying that caesarean section is not necessary to play a significant role in perhaps the increasing incidence of late preterm birth, who are born in the period between the 34 weeks of pregnancy and the 37.
The data of the Organization, "March of Deims March of Dimes" under the name "card the brain - brain card" that the weight of the brain was born in week 35 of pregnancy, a two-thirds (2 / 3) weight of the fully entered its fortieth session.
In most cases, the growth of that category is completed normally, except for some who develop problems, including behavioral or education later.
May cause premature birth as well as in respiratory problems among children and breast-feeding premature.
A d. Jennifer House, director of "March of Deims" that "most women do not know really the big difference he would make a week or two in the growth of a full-born."
A study published in April that about a quarter of children who are born before shall mislead them (premature) appear to have early signs of autism.
The study, which was prepared at the University of Micguil that "premature babies face a greater risk of infection with autism than previously thought in the past."
The researcher Catherine Impripuls in a children's hospital in Boston, said the study "suggests that the risk of autism is still significant when trying to revive the children who are born before shall mislead them."
Also showed the largest scientific study on the long-term consequences of premature birth to premature babies are more likely to die in childhood, the study also suggested the possibility of injury infertility in adulthood.
Experts described the study as the task to follow the case of 1.2 million Norwegian births over the past several decades, during the period from 1967 to 1988, and it raised questions about future risks that might be exposed to small birth size, who have had the life thanks to modern medicine.
The results come as an addendum to familiar risks that may be exposed premature, for example, lung disease, disability, and mental disability, told The Associated Press.
D commented. Gita Swami, from the "University Medical Center Swamy of Duke", in this regard, saying "we were able to improve the chances of survival but that comes at the expense of significant problems in the future

Mother's milk helps premature babies to survive

2010-02-16T02:01:00.000-08:00

According to a new study, the most tiniest premature infants who received breast milk from their mothers at the hospital had achieved significant results in tests of mental development later in life compared with those who drank milk industry.
This research shows the first of its kind, the benefits of breast milk for premature infants who were born with weights less than 2 pounds, 3 ounces. Thanks to medical advances, many hospitals were able to preserve the lives of these babies, especially those who were born earlier than three months shall mislead them.

Said study co-author Dr. Betty Brown, Ms Fuhr from the Faculty of Medicine, "For these children, the development of the brain which usually occurs in the uterus during the third trimester of pregnancy, is in intensive care for preterm infants in the hospital."
She added, "working components of breast milk, which contains in particular the fatty acids, to assist in the development of the brain properly."
Ms Fuhr says, "Feeding the premature infants born early, unnecessary for the state special education expenses later."
The study appeared in the number of the month of July of the journal Pediatrics. A separate study also reported that breast-feed the child for more than three months at least helped the children to non-injury situation Allaradi urinate in bed later in childhood.
The researchers tracked 1,035 children with very low weights in the 15 hospitals. And received about three-quarters of these babies some breast milk in the hospital. While only a quarter were fed artificial milk.
The researchers found that even when they picked up the educational level and income of the people into account, children who have been fed on breast milk score higher on tests of mental development, aged 18 months compared with children who drank milk industry.
The grades go up the longer the child was the mother's milk. Mother's milk does not have an effect on cases of cerebral palsy, blindness, or hearing problems.
It recommends the American Academy of Pediatrics feeding premature infants, and low-weight, mother's milk. The pump can be used to get milk from the chest in the case of some of these children are not able to suction after, and based most of the mixtures of industrial milk cow's milk, according to Dr. Sheila Giraghty, responsible for breast-feeding program at Children's Hospital in Cincinnati. She added, "We are the only organisms that feed on other animals milk." However, "We desperately need to mother's milk in early childhood."

The following story proves the validity of this study:

Mother's Milk A Lifesaver For premature infant?

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Mother's Milk A Lifesaver For premature infant?

2010-02-16T01:56:00.000-08:00

CBS Evening News: UCSD Doctors Say Breast Milk Can Mean Difference Between Life And Death For Premature Babies:

(CBS) Kathie Robinson is thrilled that her daughter Naomi, born 2-1/2 months early, is well enough to be home. But her family isn't complete - yet.

"Here we are, we're still going through the journey," Kathie told CBS News contributing medical correspondent Dr. Sanjay Gupta.

It's been a difficult journey for Naomi's twin brother, Caldwell. He's had three operations and remains in a neo natal intensive care unit. Kathie and her husband Whit believe that giving him breast milk, even through a feeding tube, is helping him recover.

"You can't be there all the time so it was my way to be able to be there for them all the time," Kathy said. "I'm providing for them."

Kathie is part of a new program at UC San Diego Medical Center that encourages mothers of premature babies, even babies who can't swallow, to commit to breastfeeding rather than formula. It's not easy.

"It's hard for them," said Dr. Lisa Stellwagen. "They're sick, they're tired, they're often afraid their baby isn't going to survive."

Only 45 percent of preemies go home on breast milk as compared to 74 percent of full-term babies. Doctors here believe that for babies born weighing only a few ounces, human milk means the difference between life and death.

"The premature infant is experiencing one of the worst nutritional crises in their life," said Dr. Jae Kim.

It's a crisis on two fronts. These tiny babies expend huge amounts of energy fighting life-threatening illnesses while at the same time doctors are desperate for them to gain weight.

"If we were trying to put on the same amount of growth as the smallest premature infants that we're dealing with, it would be something on the order of two or three pounds per day," Dr, Kim said.

Mother's milk may be as important as all the technology in the NICU.

"We're just starting to discover the power of what's in human milk," Dr. Kim said.

So it's good for babies, that's understood. But there's still some mysteries here. For one, not all breast milk is identical, even if that breast milk comes from the same mother.

So part of the program here involves analyzing the nutritional value of each mother's milk - and the results have been surprising.

"We're seeing a lot of variation based on whether she pumps in the morning, or at night, or depending on the day she pumps, we're seeing a 20-30 percent difference in her samples," said Dr. Charles Sauer. "For a preterm baby that can be a big difference."

One huge difference the program has made is a significant decrease in one life-threatening complication of prematurity - a gastrointestinal infection called necrotizing enterocolitis, or NEC. Of the half million premature babies born every year, between 5-10 percent of them develop it and a third of those die.

Before this program started, the rate of NEC in this hospital was 5.8 percent; last year it was less than 1 percent.

A new public health tool to reduce the burden of malaria in infants

2010-02-16T01:06:00.000-08:00

IPTi is under review by the WHO to be issued as a recommendation for the control of malaria in infants in areas of moderate to high malaria transmission.

IPTi has been investigated in 8 double-blinded randomised-controlled clinical trials in Tanzania, Ghana, Mozambique, Kenya and Gabon, and is being implemented on a pilot basis by UNICEF in Ghana, Malawi, Madagascar, Benin, Mali and Senegal.

IPTi is being investigated in Papua New Guinea and results are expected in mid 2010.

For further information contact:
Àlex Argemí, IDIBAPS - Hospital Clínic Scientific, +34 93 227 57 00
Emma Griffiths, Weber Shandwick, +44 20 7067 0230
Malaria Control Method Could Prevent 6 million New Infant Cases
The Lancet publishes new findings showing 30% reduction in babies under 12 months using a
WHO-recommended approach, but few African countries have adopted it
BARCELONA, 17 September 2009 — A third (30%) of malaria cases can be avoided in African
infants using a safe, affordable and simple tool called Intermittent Preventive Treatment of malaria in
Infants (IPTi) with the medicine sulphadoxine-pyrimethamine (SP), which can be delivered alongside
existing childhood vaccination programmes.i Results of a meta-analysis examining six clinical trials in
Africa for the malaria intervention which the World Health Organization already recommends are
published online today in the medical journal, The Lancet. Research experts say if IPTi-SP were
expanded in other African countries, 6 million cases of malaria could be prevented each year in those
most vulnerable to the disease.ii,iii
“These results confirm the potential for IPTi using SP, which can be easily and rapidly implemented
via existing WHO immunisation programmes, saving tens of thousands of lives every year across
Africa,” commented Dr Pedro Alonso, a principal investigator, head of the Secretariat of the IPTi
Consortium, associated with University of Barcelona, Spain. “IPTi provides a valuable addition to
efforts to fight malaria and so international policy-makers and heads of national Malaria Control
Programmes should consider its immediate adoption and integration into existing programmes,” he
added.
Organised by the IPTi Consortium and supporting partners – a unique collaboration of more than 20
organisations in Africa, Europe and the United States – the pooled analysis of six randomised,
placebo-controlled trials of IPTi-SP in Africa provides the best evidence to date that this approach is
effective in preventing malaria in infants. The study analysed results from nearly 8,000 infants, in four
African countries, over nine years, between 1999-2008. The efficacy results were re-analysed by the
statistician of each of the six trials, and an independent panel made up of experts in safety and
pharmacovigilance in Africa conducted an analysis of the safety. The IPTi Consortium is supported by
the Bill & Melinda Gates Foundation.
UNICEF’s Operational Research Coordinator, Dr Alexandra de Sousa, stated “UNICEF supports IPTi
implementation scale up in Africa, a new intervention in the control of malaria with the potential to
significantly reduce child illness”.
A separate study in Northern Tanzania shows that in areas of very high resistance to the medication,
IPTi with SP is not efficacious and alternative anti-malarial drugs are needed. The long-acting
medicine mefloquine was seen to reduce the incidence of clinical malaria in infants in the first year of
life by 38%.iv For the long term, it is important that research is accelerated to develop additional drugs
for use with IPTi in different settings and in different circumstances, especially in areas where parasite
resistance is a problem.
Malaria represents an important public health burden in Africa, disproportionately affecting the
youngest and most vulnerable. Of the 247 million cases of malaria worldwide in 2006, 86% occurred
in Africa.ii African infants are most at risk of the worst forms of malaria, every 30 seconds an African
child dies from malaria.v
# # #

Notes to Editor
About IPTi
IPTi is the administration of an anti-malarial tablet to infants, two or three times in the first year of life,
deliverable alongside established vaccination programmes such as WHO’s Expanded Programme for
Immunisation. It is inexpensive (each dose costs between USD $0.13 - $0.23)vivii and cost effective.
IPTi with SP has been reviewed by a committee of the US National Academy of Sciences’ Institute of
Medicine and the World Health Organization’s Technical Expert Group – these committees
recommend that it should be considered for implementation in areas of moderate to high levels of
malaria transmission and low to moderate levels of parasite resistance to SP.viii,ix
About the trials in the pooled analysis
Trials were conducted in Mozambique, Gabon, Tanzania and Ghana involving the following
organisations in Africa and Europe: Barcelona Centre for International Health Research, Spain;
Centro de Investigação em Saude de Manhiça, Mozambique; University of Tübingen, Germany;
Ifakara Health Research Development Centre, Tanzania; University of Witwatersrand, Johannesburg,
South Africa; Institute of Tropical Medicine and International Health, Charité, University Medicine
Berlin, Germany; Kintampo Health Research Centre, Ghana Health Service/Ministry of Health,
Ghana; London School of Hygiene and Tropical Medicine, London, UK; Albert Schweitzer Hospital,
Lambaréné, Gabon; Ministry of Health/Ghana Health Service; Bernhard Nocht Institute for Tropical
Medicine, Hamburg, Germany; Swiss Tropical Institute, Basel, Switzerland.
About the trial in Northern Tanzania
The trial was conducted in two sites in northern Tanzania, Korgewe and Same, by the following
organisations; Department of Infectious and Tropical Diseases, London School of Hygiene and
Tropical Medicine, London, UK; the National Institute for Medical Research, Tanga Centre, Tanga,
Tanzania; and the Kilimanjaro Christian Medical College, Moshi, Tanzania.
About the IPTi Consortium
The IPTi Consortium's Secretariat was the Barcelona Centre for International Health Research,
Hospital Clinic, University of Barcelona, headed by Dr Pedro L. Alonso. The IPTi Consortium consists
of leading centres of malaria research in Africa, Europe, United States and Papua New Guinea
including the Albert Schweitzer Hospital, Lambaréné, Gabon; Barcelona Centre for International
Health Research, Hospital Clinic, University of Barcelona, Spain; Case Western Reserve University,
Cleveland, USA; Centers for Disease Control and Prevention, Atlanta, USA; Ifakara Health Research
and Development Centre, Ifakara, Tanzania; Institut de Recherche pour le Développement, Dakar,
Sénégal; Kenya Medical Research Institute, Kisumu, Kenya; Kilimanjaro Christian Medical Centre,
Moshi, Tanzania; London School of Hygiene and Tropical Medicine, London, UK; Manhiça Health
Research Centre, Manhiça, Mozambique; National Institute for Medical Research, Amani, Tanzania;
PNG Institute of Medical Research, Goroka, Papua New Guinea; Swiss Tropical Institute, Basel,
Switzerland; Université Cheikh Anta Diop de Dakar, Dakar, Sénégal; University of Copenhagen,
Copenhagen, Denmark; University of Tübingen, Tübingen, Germany; Walter and Eliza Hall Institute of
Medical Research, University of Melbourne, Australia; World Health Organization (WHO); United
Nations Children's Fund (UNICEF).
i Aponte John J, Schellenberg David, Egan Andrea, et al. Efficacy and safety of intermittent
preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis
of six randomised, placebo-controlled trials. Lancet (To be published 17 September 2009)
ii WHO. World Malaria Report 2008. World Health Organisation, Geneva Switzerland, 2008.
iii Based on calculations from 212 million cases of malaria in Africa provided by the World Malaria
Report 2008 (ref ii), of which about 10% are episodes in infants provided by Professor Tom Smith, at
the Swiss Tropical Institute and of which 30 % of cases could be averted by IPTi provided by the
research paper on Efficacy and safety of intermittent preventive treatment with sulfadoxinepyrimethamine
for malaria in African infants: a pooled analysis of six randomised, placebo-controlled
trials (ref i)
iv Gosling Roly D, Gesase Samwel, Mosha Jacklin F, et al. Protective efficacy and safety of three
antimalarial regimens for intermittent preventive treatment for malaria in infants: a randomised,
placebo-controlled trial. Lancet (To be published 17 September 2009)
v 10 Facts on Malaria.World Health Organisation, March 2009. (http://www.who.int/features/
factfiles/malaria/en/index.html, accessed 7 September 2009)
vi Hutton Guy, Schellenberg, David, Tediosi Fabrizio, et al. Cost-effectiveness of malaria intermittent
preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania. Bull
World Health Organ 2009;87:123–129
vii Manzi Fatuma, Hutton Guy, Schellenberg Joanna, et al. From strategy development to routine
implementation: the cost of Intermittent Preventive Treatment in Infants for malaria control. BMC
Health Services Research 2008, 8:165
viii WHO. Report of the Technical Consultation on Intermittent Preventive Treatment in Infants (IPTi),
Technical Expert Group on Preventive Chemotherapy, 23-24 April 2009 – World Health
Organisation, Geneva, Switzerland, Room D46025, 2009.
ix Assessment of the Role of Intermittent Preventive Treatment for Malaria in Infants: Letter Report. US
National Academy of Science, 2008. (http://www.nap.edu/catalog.php?record_id=12180, accessed
7 September)

Press release for the medical and scientific community

"Meta-Analysis Demonstrates that Intermittent Preventive Treatment in Infants with Sulfadoxine-Pyrimethamine Reduces Malaria Episodes by 30%"
Results published in The Lancet extend earlier findings on safety and efficacy of novel malaria control tool

Making pregnancy safer

2010-02-16T00:43:00.000-08:00

Every day 1500 women die due to complications in pregnancy or childbirth. 10 000 babies per day die within the first month of life and an equal number of babies are born dead. Skilled care around the time of birth would greatly reduce the number of these needless deaths.
The WHO Department of Making Pregnancy Safer (MPS) helps to improve maternal health, assists countries to ensure skilled care before, during and after pregnancy and childbirth and strengthen national health systems in order to achieve Millennium Development Goals 4, 5 and 6. The main goal is to reduce newborn mortality and maternal mortality significantly by 2015.
:: Do you want to know more?

Malaria and Newborn Health in The World

2010-02-16T00:23:00.000-08:00

Malaria
"Reducing the spread of malaria is critical for child health and survival, and development, particularly in Africa. And will help to reduce the spread of malaria achieve the Millennium Development Goals." Ann Veneman at White House Summit on Malaria, December 2006

Nurse explains how to deal with mosquito net insecticide to prevent malaria, Rwanda.
Kills a child somewhere in the world every 30 seconds from malaria. And infects between 350-500 million people with the disease every year, and kills a million people, mostly children in Africa. He spoke for 90 percent of deaths from malaria in Africa, and is attributable to the disease five child mortality. The disease also contributes significantly to anemia in children - the main cause of poor growth and development. Is associated with malaria infection during pregnancy with severe anemia and other diseases in the mother. And contributes to low birth weight among newborn infants - one of the main risk factors for infant mortality and optimal growth and development.
Malaria has serious economic impacts in Africa, and slowing economic growth and development and perpetuating the vicious cycle of poverty. Malaria is truly a disease of poverty - afflicting primarily the poor who tend to live in rural areas prone to malaria in poor housing construction - which provides, if any, barriers against mosquitoes.
It can be prevented and treatment of malaria, have already been Ttoiraleduat preventive and therapeutic effects.
The reports indicate that sleep under insecticide-treated nets can reduce child mortality by 20 percent. There is evidence that the use of insecticide-treated bednets, consistently and properly, can lead to save the lives of six children each year for every thousand children sleeping under them.
It also works Prompt access to effective treatment to reduce mortality. Can lead intermittent preventive treatment of malaria during pregnancy significantly reduce the proportion of low birth weight and maternal anemia.
It is indeed regrettable that malaria still kill many children, particularly in Africa. This was due to not sleep under insecticide-treated mosquito nets, and their inability to obtain life-saving treatment within 24 hours of onset of symptoms. The latest data on household use of insecticide-treated nets for low coverage rates of up to about 5 per cent across Africa. However, it may contribute to recent efforts to expand the coverage of the significant progress in many countries.
Increasing resistance of the malaria parasite to chloroquine and sulphadoxine sulfadoxine - pyrimethamine - more anti-malaria treatments used previously - sixty-eight countries to change national treatment protocols for the integration of the combination therapy based on artemisinin, a group of innovative new treatments, and the most effective.
There is increasing evidence on the interaction of malaria with HIV when exposed to injury of both. Exacerbated HIV by increasing viral load in adults and pregnant women from malaria may lead to accelerate the progression to AIDS; and increases the risk of transmission of HIV among adults, and between a mother and her child. Symptoms of malaria are also increasingly worse among adults living with HIV who suffer from low blood cell count cd4, and pregnant women.
Objectives
In accordance with the Millennium Development Goals, the Abuja Declaration on Roll Back Malaria in Africa, the goals set forth in the Final Document of the UN Special Session on Children: "A world fit for children", and the last update of the objectives set forth in the Strategic Plan for Roll Back Malaria, 2005 -2015, UNICEF aims to helping to ensure that:
By 2010, particularly in the lowest two economic quintiles:

    * Protection of 80 per cent of people at risk of malaria. And will credit this to the appropriate local methods of disease vector control such as insecticide-treated mosquito nets, and, where appropriate, indoor residual spraying in some places, environmental measures and other biological;
    * Diagnosis and treatment of 80 percent of malaria patients using medications that are effective anti-malarial drugs, for example, combination therapy based on artemisinin, within one day of onset of illness;
    * The possibility that 80 per cent of pregnant women on intermittent preventive treatment in areas with stable transmission of infection;
    * Reduction of the burden of malaria by 50 percent compared with 2000.
By the year 2015:

    * Reduction of morbidity and mortality from malaria by 75 per cent compared with 2005, not only by national aggregate but also extends in particular to include Ashidalmjmoat poorer in all affected countries;
    * Achieving the Millennium Development Goals related to malaria, not only by national aggregate but also extends in particular to include Ashidalmjmoat poorest in all affected countries;
    * Universal and equitable coverage of effective interventions.
How does UNICEF help?
UNICEF is a founding partner with the World Health Organization and the United Nations Development Program and the World Bank, Roll Back Malaria initiative, a global partnership that was launched in 1998 and aimed at reducing the world's malaria burden by half by 2010.
In recognition of its role as one of the biggest killers of children in Africa, is the prevention interventions and control of malaria an integral part of a minimum package of high-impact interventions, UNICEF for the survival of parent and child. And uses this type of integrated programs existing systems with relatively high utilization by target groups, including the expanded program on immunization and integrated management of childhood illness and neonatal, child health days for children under the age of five, and prenatal care for pregnant women.
Insecticide-treated bednets

UNICEF is the largest global procurer and deliverer of insecticide-treated mosquito nets, has purchased more than 24 million nets in 2006.
Has made major efforts have been made recently for the advancement of services providing insecticide-treated bednets in Africa, impressive results. Have shown some of the countries with new coverage data made remarkable progress already. For example, the percentage of coverage of insecticide-treated mosquito nets in Togo, from 2 per cent to 54 per cent over five years (preliminary results of the study of multiple indicator cluster survey 0020 CDC / MOH 2005). Works of many other countries, including Kenya, Rwanda, Malawi and increasingly in the distribution of the number of Cbrmn insecticide-treated mosquito nets recently, and are therefore expected to make significant progress towards achieving the Abuja targets for expansion in the coverage of insecticide-treated bednets.
UNICEF works together with its partners, the distribution of insecticide-treated mosquito nets through routine health services and campaigns. UNICEF is working with ministries of health and non-governmental organizations, as well as working in the field of health care in villages and communities, to develop local distribution networks.
Intermittent preventive treatment
The intermittent preventive treatment in pregnant women receiving at least two doses of antimalarial drugs currently available, sulfadoxine - pyrimethamine, in each scheduled antenatal visit after the first three months of the situation, whether they show symptoms of malaria or not. Has been shown that such a preventive treatment to reduce substantially the risk of maternal anemia, low birth weight at birth.
The work of UNICEF as a partner in the initiative to make pregnancy safer, and national services on prenatal care, to ensure that women and their newborns access quality antenatal care and reproductive health services. Including intermittent preventive treatment for malaria control and insecticide-treated bednets.
Research shows that it may be intermittent preventive treatment for infants effective in reducing the incidence of anemia and clinical malaria in young children. There may be providing in the near future as part of routine immunization services. It is noted that UNICEF is a member of the Federation of intermittent preventive treatment for infants, which is currently conducting research on the possibility of introducing this additional intervention in Africa.
Effective treatment for malaria vaccine
Means six hours of waiting for treatment, a matter of life or death for a child with malaria. And through programs of integrated child survival, UNICEF supports national governments and partners, the adoption of the new combination therapy based on artemisinin in health facilities, and increasingly for the treatment of malaria in the home as part of imnci. UNICEF works with governments and communities to improve the immediate and effective management of malaria cases and strengthened, and ensure children's access to medications within 24 hours of the onset of the disease.
UNICEF is also involved in the purchase and supply of new combination therapy based on artemisinin. In 2006, including procurement services, UNICEF supply of 7,3 million doses of malaria treatment in Ethiopia, were distributed 3,9 million of them already through the public health system.
Malaria and HIV Alepeshripalmkzb / AIDS
UNICEF and partners to support improved communication on the increased risks from malaria in people living with HIV and the need to intensify efforts for the prevention and treatment, including the provision of insecticide-treated nets through routine services for people living with HIV, and in particular pregnant women. Recent evidence suggests that to give co-trimoxazole Brovilaaksz for all people with HIV as part of a package of basic care as well as insecticide-treated mosquito nets to have the ability to reduce mortality and morbidity and to delay the need for treatment anti-retroviral.
Global partnerships for the prevention and control of malaria
UNICEF's leadership role in global partnerships and regional and Alqatripvi tackling malaria.
UNICEF also participated in the founding of the Roll Back Malaria partnerships. It is also a key member of the board of the plan this initiative. The RBM partnership includes governments of countries affected by the disease, and representatives from the private sector, research institutions and non-governmental organizations and others. Furthermore, UNICEF is also working to strengthen partnerships with the World Bank and the initiative of the President of the United States for malaria, the Global Fund to Fight AIDS, TB
and malaria, and no malaria.
On April 25, 2000, the Heads of State and senior representatives from 44 African countries that suffer from malaria in Abuja, Nigeria, to attend the Summit on Malaria. Day is celebrated Africa Malaria every year on April 25 to focus world attention on the challenges and responses. The theme for Africa Malaria Day 2007 on leadership and partnership in order to achieve results, and focus on the need to work in partnership to reverse the progression of malaria and make a significant impact in endemic countries.
It is estimated that the cost of prevention and control of malaria in all parts of the world (World Malaria report) requires that your three billion U.S. dollars annually. The donors include the Global Fund, the World Bank, bilateral agencies such as the U.S. Agency for International Development; and specialized United Nations agencies and international non-governmental organizations and institutions, and major multinational companies and individuals with high incomes. Include other sources of funding, local funding through national budgets and the integration of malaria control strategy papers to national needs for poverty reduction and the sectoral approach and comprehensive basic health care packages. Have been made available during the past few years, significant resources for malaria prevention and control through a number of major initiatives.
UNICEF is supporting the efforts of advocacy and partnership through the promotion of its own resources and results to ensure that women and children the center of national and international development and funding. UNICEF has recently entered into a "partnership with Malaria No More, an umbrella organization that acts as a central clearinghouse for donations from individuals and private organizations in order to provide insecticide-treated mosquito nets to every family that needs to in sub-Saharan Africa.
UNICEF is partnering with the Global Fund and the World Health Organization in order to get funding from unitaid to support the purchase of anti-malarial medications, and in particular, combination therapy based on artemisinin.
It will strengthen the international initiative to raise the tax on air tickets - to buy medicines to treat HIV / AIDS, Tuberculosis and Malaria. Raise funds of up to U.S. $ 600 million annually. It is noted that the initiative launched at the Paris Conference as a new and innovative financing for development.
And UNICEF is also involved in the initiative, the U.S. President's malaria, which was launched in June 2005 and pledged to increase funding of malaria prevention and treatment by more than $ 1.2 billion over five years.

New global partnership calls for immediate action to help women and children Survive

2010-02-15T23:44:00.000-08:00

NEW YORK, 12 Sept 2005 – As world leaders gather in New York for this week’s World Summit at the United Nations, an unprecedented coalition of governments and health organizations joined together today to underscore the critical importance of reducing child and maternal deaths as part of the overall campaign to achieve the Millennium Development Goals (MDGs).
To accelerate progress in reducing millions of deaths that are preventable, leading advocates for women and children launched The Partnership for Maternal, Newborn & Child Health today. The new partnership unites the world’s leading organizations on maternal, newborn and child health to galvanize global efforts and scale up the resources, strategies and political commitments needed to reduce maternal and child mortality.

While some countries have made substantial progress, at the current rate of progress the majority of developing nations will fall well short of achieving the 2015 MDGs for maternal and child health. MDGs 4&5 call for reducing the rate of child death by two thirds and the ratio of maternal death by three fourths by 2015 from 1990 baselines.
“Each year over half a million women die in pregnancy or childbirth and 10.6 million children die before their fifth birthday,” said Ann M. Veneman the Executive Director of UNICEF, kicking off the event. “To accelerate progress, we need to integrate our efforts at the global, national and community level.”
The Global Alliance for Vaccines and Immunization (GAVI) is an example of a partnership created to address health issues that cannot be resolved by individual organizations operating independently. Launched in 2000, GAVI is a public-private partnership with the goal of reducing the number of children dying from vaccine-preventable diseases. Today GAVI announced that the Alliance's efforts have expanded access to new and under-used vaccines in the poorest countries, immunizing 78 million children with under-used vaccines (such as hepatitis B, yellow fever and Hib) and averting one million premature deaths over the life time of children born between 2001-2004.
“Only a focussed, coordinated effort can bring women, newborns and children the health care they need during pregnancy, delivery, the early weeks of life and in childhood,” said Joy Phumaphi, Assistant Director-General of the World Health Organization. “Working with countries on integrated initiatives like this has the potential to transform millions of lives and make critical progress."
Millions of children and women have yet to be protected against preventable causes of death. Little or no health care for mothers during pregnancy, inadequate birthing conditions and the lack of skilled attendants during deliveries cause the largest proportion of all child and maternal deaths. Acute respiratory infections, diarrhoea, malaria and measles are major killers of children under-five years. Malnutrition, unsafe or inadequate water and sanitation also contribute to more than half of child deaths. Two thirds of these deaths could be prevented or treated with low-cost, existing interventions.
“Despite affordable and available life-saving interventions, countless mothers, babies and children continue to die each day simply because of where they are born and live,” said Alpha Oumar Konaré, Chairperson, Commission of the African Union. “This not only represents an unacceptable disparity but shows that we are not even meeting the first benchmark of development – keeping children and women alive.”
The World Health Organization’s World Health Report 2005 estimates that meeting the promises made for maternal and child health, during the Millennium Summit in September 2000, will require an additional US $9 billion on average per year from now until 2015.
However, millions of women and children in the poorest environments can be saved with an integrated approach involving available low-technology; low-cost interventions based on family care and community outreach programs. Things as simple as prevention of malaria and tetanus; keeping the newborn warm; exclusive breastfeeding; early recognition of illness and seeking care can make huge inroads with modest resources.
The Partnership for Maternal, Newborn & Child Health brings together national leaders, donors, UN agencies, professional associations, academic institutions, and non-governmental organizations. It will immediately begin to work on accelerating integrated action for maternal, newborn and child health at national and global levels, based on the MDGs
A unification of efforts cannot move forward without greater ownership from all those involved. The world summit this week holds an unparalleled opportunity for world leaders to follow through on existing promises and take immediate action to prevent countless numbers of maternal and child deaths.
“Greater political leadership coupled with increased financial resources is needed at international and national levels if we are going to meet these goals,” said Konaré. “Investment in maternal, newborn and child health is not only a priority for saving lives, but it is also critical to advancing other goals related to human welfare, equity, and poverty reduction.”
Attention Broadcasters: B-roll on maternal, new-born and child health initiatives and footage of the launch will be made available copyright-free and free of charge on September 9 and September 12 respectively via the following outlets:
1. UNIFEED on APTN's Global Video Wire at 2145-2155 GMT (with a repeat at 0245-0255 GMT on September 13). For script and shotlist information: http://www.un.org/unifeed/
2. www.TheNewsMarket.com – Packages will be available for download in FTP and/or ordering

For more information or interview requests please contact:
Erica Kochi, UNICEF, +1 212 326 7785,
Mob: +1 646 226 6361 ekochi@unicef.org
Nicole King, GAVI, +1 202 478 1041,
Mob: 202 297 2386, nking@vaccinefund.org
Brooke Girard, The Partnership for Maternal, Newborn & Child Health,
+41 79 477 4100, girardb@who.int
Background
The Partnership for Maternal, Newborn & Child Health unites the world’s leading organizations on maternal, newborn and child health and will be hosted by the World Health Organization in Geneva. The Partnership unites developing and donor countries, UN agencies, professional associations, academic and research institutions, foundations, and NGOs to intensify and harmonize national, regional and global progress towards the UN Millennium Development Goals 4 & 5. For more information, visit www.pmnch.org
The Global Alliance for Vaccines and Immunization was formed in 2000 to harness the strengths and experience of multiple partners in immunization. It is an historic alliance between the private and public sector committed to the mission of saving children's lives and protecting people's health through the widespread use of vaccines. A new type of public-private partnership, GAVI brings together governments in developing and industrialized countries, established and emerging vaccine manufacturers, nongovernmental organizations (NGOs), research institutes, UNICEF, the World Health Organization, the Bill & Melinda Gates Foundation and the World Bank. For more information, visit www.vaccinealliance.org

A new approach to child survival that puts the needs of the family in the center

2010-02-15T23:31:00.000-08:00

Bentos Cynthia gave birth to her

child before birth to 13 weeks, but was

able to stay in the place

of residence free of charge

under a special program for

mothers with their children at risk.

By: Thomas Nybo
Buenos Aires, Argentina, July 20, 2009 - Stella Benitez recently gave birth to her first baby which is in good health and in April called Delfina.
A resident of the neighborhood vibe Buedu Buenos Aires, where they benefit from a new model of care during and after childbirth in a hospital Ramon account. The program gives the hospital a great deal of attention to the needs of the family.
The husband was Ms. Benitez welcomed in every step of this process, including delivery, and great efforts are being made to strengthen their relationship with their daughter in April
"At the moment they left April, and placed on my body to be able to be and Odmha accept it, and then let my husband that portable, even before the umbilical cord cut."

Reforms in the area of birth
In the hospital, encourage mothers to breast-feeding and parents can see the new baby newborn for 24 hours. And identify special days to allow other family members to meet with a newcomer to the family. Prior to meet members of the family children, are kept informed on what to expect, especially when dealing with premature infants or children who suffer from severe health problems.
The work of Dr. Miguel Arguia in the hospital for 40 years, a person responsible for this new approach.
"The concept of hospitals that focus on the family a real difference, because we now know that expectant mothers and their children, before and after birth, are the owners of the house, not doctors or health workers."
Vulnerable
In order to reduce levels of child mortality, the hospital dedicated a large part of its resources for preterm infants and infants at risk.
Cynthia gave birth to a boy Bentos prematurely at 13 weeks. He spent one and a half month in the incubator, which is suffering from an injury windpipe, but in good condition now.
She said: "We have dealt with this situation well, because all the doctors were sincere and very honest with me and they tell the truth. Did not leave me alone, never."
Since Cynthia lives in the place take on a trip from the hospital, it benefits from the program here allows for mothers with children at risk to stay alive in the particular place of residence free of charge, to be directed by their children from the hospital. The mothers and free meals, and helps a team of volunteers. A place for 38 mother, stay two months in the Mediterranean. The big picture

An effective new approach
UNICEF is working to replicate this successful program on a large scale.
"This form includes practices that have proved effective in preventing neonatal deaths," said Zoulma Ortiz, competent health in UNICEF, said, "and each of them based specifically on the relationship between mother and son or daughter and also the whole family, so the idea is to promote implementation of this strategy in all parts of the world. "
Can prevent the deaths of two thirds of newborns and young children - more than six million deaths each year. The support of such programs as a means of cost-effective to help children to stay alive.

Longer training session in Kenya, a landmark in the community care of newborn children in Africa

2010-02-15T23:23:00.000-08:00

By: Victor Chinyama
Nairobi, Kenya, June 26, 2007 - do not know Evelyn Katungye, which amounts to twenty-year-old, the reason that led to the deaths of her two children. In April 2005, gave birth to twins, a boy and a girl, assisted by skilled birth at her home in Majengo, a large slum near downtown Nairobi. However, the joy was not completed when the first child died a few hours after her birth, and soon other child died. Evelyn and Sculpture, which collapsed completely blame the midwives, but they are not confident of doing so, the lack of facts to have to prove it.
And repeated the ordeal inflicted on Evelyn in all parts of Africa, every day the equivalent of 3000 times. Die more than a million children a year are in the first five months of age, for reasons attributable to diseases such as pneumonia, birth asphyxia, and premature births, low birth weight. And not necessarily that such diseases are fatal, but most mothers in Africa give birth at home without medical assistance expert. This leads to the death of newborns in catastrophic levels.
Lessons learned
It was possible to save the children and children Evelyn millions of other women in Africa using simple, proven and cost-effective. In November 2006, UNICEF sponsored by a group of key decision makers in Ethiopia, Kenya, Uganda, Zambia, Malawi, Mozambique and Madagascar, to visit the region Gadashierule Maharstra in the state, in western India, where they studied the pioneering work by Dr. Abhay Bang on the care of children newborns.
Through the NGO he founded, "Society for Education, Action and Research in Community Health", Dr Pang able to successfully reduce the number of neonatal mortality by two thirds during the first month of life in 40 rural communities in poor Gadashierule. Was commended in their own way as a strategy feasible and cost-effective for poor communities in Africa.
The program provides basic health care for children who are born in the house. Are trained health workers in the village on the diagnosis of some complications such as pneumonia and premature infants, birth asphyxia, and is equipped with a basic medical valued at $ 60, consisting of a sleeping bag for the child, and a bag and mask recovery, and antibiotics.
Landmark
In late June, UNICEF brought together 30 master trainers from 10 African countries to conduct training course on community-based newborn care period of eight days. This is the course a milestone in UNICEF's efforts to help Governments to provide newborn care by using health workers and workers in the field of health promotion and other key personnel.
It was among the participants a number of senior paediatricians, and trained health workers, officials from the health programs for maternal, newborn and children.
The aim of this training course to assist in promoting the integration of newborn care with other health programs that address the health of maternal and infant at the community level. The quote curriculum developed by UNICEF of the curriculum that it applies "Society for Education, Action and Research in Community Health", in India. The communication materials have been adapted from Bolivia.
Action is required
"This training is exactly what we need to support the introduction of community care for newborn children," said Dr. Mary Ngoma, a pediatrician at the hospital advisory university education in Zambia. Available with the Ministry of Health of Zambia plans to introduce community-based care for newborn children in two districts. And will be training of health workers in the community to identify the diseases that affect newborns in the house and addressed.
Said Mark Tomlinson, a researcher at the health systems in the Medical Research Council in Cape Town, South Africa, "The platform will be used to develop a manual on community-based care for newborn children. He added: "We can now adapt the training curricula for UNICEF, rather than reinvent the wheel again."
He said UNICEF Regional Director, Per Ingebak, that there was no excuse for us to fail in the care of newborn children, now that the knowledge and evidence and tools readily available. "All we need now is to begin to improve the degree of our interventions, as they do now Malawi and Ethiopia," he said, "It is our duty to give birth a chance to live."

Transfer of preterm infants from incubator to open cot at lower versus higher body weight

2010-02-14T11:34:00.000-08:00

Transfer of preterm infants from incubator to open cot at lower versus higher body weight

New K, Flenady V, Davies MW/

read more......

Dates
Date edited: 14/11/2007
Date of last substantive update: 31/08/2007
Date of last minor update: / /
Date next stage expected 02/10/2009
Protocol first published: Issue 2, 2003
Review first published: Issue 2, 2004
Contact reviewer
Karen New
Neonatal Nurse
Grantley Stable Neonatal Unit
Royal Brisbane & Women's Hospital
Butterfield Street
Herston
Brisbane
Queensland AUSTRALIA
4029
Telephone 1: +61 7 3636 8918
E-mail: karennew@optusnet.com.au
Contribution of reviewers
Conceiving the review - KN, MWD
Data collection for the review - KN, VF, MWD
Designing search strategies - KN, VF, MWD
Undertaking searches - KN, VF
Screening search results - KN, VF
Organising retrieval of papers - KN
Screening retrieved papers against inclusion criteria - KN, VF, MWD
Appraising quality of papers - KN, VF, MWD
Extracting data from papers - KN, VF
Writing to authors of papers for additional information - KN
Entering data into RevMan - KN, VF
Analysis of data - KN, VF, MWD
Interpretation of data - KN, VF, MWD
Writing the update of the review - KN
Revising review - VF, MWD
Providing general advice on the review - VF, MWD
Internal sources of support
Grantley Stable Neonatal Unit, Royal Brisbane & Women's Hospital, Brisbane, AUSTRALIA
Centre for Clinical Studies, Mater Mothers' Hospital, South Brisbane, AUSTRALIA
Dept of Paediatrics and Child Health, University of Queensland, Brisbane, AUSTRALIA
External sources of support
Commonwealth Department of Health and Ageing, Canberra, Australian Capital Territory, AUSTRALIA
What's new
This updates the review "Transfer of preterm infants from incubator to open cot at lower versus higher body weight", published in The Cochrane Database of Systematic Reviews Issue 2, 2004 (New 2004).

Updated search conducted 12/4/2007.
Included new reference Gray 2004.
One additional study found West 2005 - excluded as not an RCT.
Moved pending study Heimler 1981 to included. Recontacted the author of this study - no response to date.
Sutter was unable to provide any additional requested information.
Removed Analysis 01.02: Sutter 1988 daily weight gain as authors reported weight gain as (g/day); included data for weight gain from Heimler 1981 as reported in g/kg/day.

Results remain unchanged.
Dates
Date review re-formatted: / /
Date new studies sought but none found: / /
Date new studies found but not yet included/excluded: / /
Date new studies found and included/excluded: 12/04/2007
Date reviewers' conclusions section amended: / /
Date comment/criticism added: / /
Date response to comment/criticisms added: / /
Text of review
Synopsis

There is not enough evidence on whether to transfer preterm infants from an incubator to an open cot at a lower body weight.

For preterm infants to be discharged home from nurseries, they must be able to maintain their temperature in an open cot. The timing of the transfer from the incubator to an open cot is important because, if an infant is not able to maintain his/her temperature and is cold, then this could affect weight gain and delay the infant's discharge from hospital. Usually infants are transferred when their weight is around 1700-1800 grams. Earlier transfer at a lower body weight may have benefits of better access to the baby by the family and earlier discharge from hospital. Due to the poor quality of the trials in this review, there is not enough evidence to show whether transfer is better or worse at a lower body weight than at a higher body weight. Good quality trials are needed to address this issue.

Abstract

Background

The use of incubators in helping to maintain a thermoneutral environment for preterm infants has become routine practice in neonatal nurseries. As one of the key criteria for discharging preterm infants from nurseries is their ability to maintain temperature; the infant will need to make the transition from incubator to open cot at some time before discharge. The timing of this transition is important because, when an infant is challenged by cold, the infant attempts to increase its heat production to maintain body temperature. The increase in energy expenditure may affect weight gain. The practice of transferring infants from incubators to open cots usually occurs once a weight of around 1700 - 1800 g has been reached; however, this practice varies widely among neonatal units. This target weight appears to be largely based on tradition or the personal experience of clinicians, with little consideration of the infant's weight or gestational age at birth.

Objectives

The main objective was to assess the effects on weight gain and temperature control of a policy of transferring preterm infants from incubator to open cot at lower versus higher body weight.

Search strategy

Searches were undertaken of MEDLINE from April 2007 back to 1950, CINAHL from April 2007 back to 1982 and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007). The title and abstract of each retrieved study were examined to assess eligibility. If there was uncertainty, the full paper was examined.

Selection criteria

Trials in which preterm infants were allocated to a policy of transfer from incubators to open cots at a lower body weight versus at a higher body weight.

Data collection & analysis

Quality assessments and data extraction for included trials were conducted independently by the reviewers. Data for individual trial results were analysed using relative risk (RR) and mean difference (MD). Results are presented with 95% confidence intervals (CI). Due to insufficient data, meta-analysis could not be undertaken.

Main results

Five studies were identified as potentially eligible for inclusion in this review. Three studies were excluded as neither random nor quasi-random allocation to the exposure was employed. Two small quasi-randomised studies, involving 74 preterm infants are included in this review. These studies compared the transfer of infants to open cots at 1600 - 1700 g vs. 1800- 1900 g, and 1700 g vs. 1800 g. Data for only two prespecified outcomes could be included in this review. No statistically significant difference was shown for either return to incubator [one trial (N = 60) RR 2.00; 95% CI 0.40 to 10.11] or daily weight gain measured in g/kg/day [one trial (N = 14) MD 1.00 g/kg/day; 95% CI -2.89, 4.89]. Due to insufficient data, meta-analysis was not performed and effects on clinically important outcomes could not be adequately assessed.

Reviewers' conclusions

There is currently little evidence from randomised trials to inform practice on the preferred weight for transferring preterm infants from incubators to open cots. There is a need for larger randomised controlled trials to address this deficiency.

Background

Preterm infants are cared for in a neutral thermal environment to prevent thermal cold stress so that minimal energy is expended, thereby minimising oxygen and energy consumption. Since improved survival of small infants cared for in warmer environments was demonstrated over 40 years ago (Silverman 1957; Silverman 1958; Silverman 1963), maintaining a thermoneutral environment for preterm infants with the use of incubator care has became routine practice in neonatal nurseries. However, at some point during hospitalisation, the infant will need to make the transition from incubator to open cot. One of the key criteria for discharging preterm infants from nurseries is their ability to maintain temperature once transferred to an open cot. The timing of this transition is important because when an infant is challenged by cold, the infant attempts to increase its heat production to maintain body temperature. Vasoconstriction occurs as the infant attempts to conserve body heat and brown adipose tissue is metabolised. The increase in energy expenditure may affect weight gain. Exposure of growing preterm infants to a subthermoneutral environmental temperature in the late neonatal period results in a slowing of growth through an increase in energy expenditure (Glass 1969).

The practice of transferring infants from incubators to open cots varies widely among neonatal units, with no clear indication as to when or how this transition should take place. The usual practice is to transfer infants to open cots once a weight of around 1700 - 1800 g has been reached. This target weight appears to be largely based on tradition or the personal experience of clinicians with little consideration of the infant's weight or gestational age at birth. The main factors determining the preterm infant's post natal thermal stability are: (i) degree of prematurity - the more immature the infant, the thinner the skin, the less subcutaneous fat and the greater the surface area/weight ratio; (ii) birth weight - small for gestational age or lower birth weight also results in less subcutaneous fat for insulation and thermogenesis and the greater the surface area/weight ratio; (iii) postnatal age - thermostability increases with postnatal age (McManus Kuller 1998).

Delaying transition to an open cot on the basis of not reaching a certain arbitrary weight criterion may result in longer hospitalisation than necessary, thus increasing the cost of care provided (Wilson 1998). Maternal perceptions of their infants may influence infant development (Watt 1989). Maternal perceptions may be more positive when infants are cared for in an open cot due to ease of access promoting autonomy for parents and improving parent-infant attachment, which may improve breast feeding rates. Nursing staff may perceive that caring for infants in open cots reduces workload and that better care may be provided due to increased accessibility.

While there may be benefits of earlier transfer to an open cot, there may be potential risks. Transferring infants from an incubator to an open cot before an infant is ready may result in the infant's inability to maintain temperature, leading to weight loss, resulting in extended hospitalisation and adding to the cost of care (Wilson 1998). The need for an infant to return to an incubator after making the transition to an open cot may also result in increased stress and anxiety to the parents and family.

A number of measures have been suggested to assist in the maintenance of body temperature when transferring infants from incubators to open cots. These measures have included a gradual weaning process in which infants are dressed in clothing and the incubator air temperature is reduced, thus thermally challenging the infant prior to transfer to an open cot (Wilson 1998), the use of heated water-filled mattresses and heated nurseries (Gray 2003; Gray 2004).

Open cots are relatively inexpensive compared to the cost of air-heated incubators. If it could be demonstrated that transfer of an infant to an open cot at a lower body weight could be achieved without adverse outcome, considerable economic benefit could result in both developing and developed countries.

Objectives

Primary:
To determine the effects of a policy of transferring preterm infants at lower versus higher body weight on the outcomes of weight gain and temperature control. Secondary outcomes included duration from transfer to cot to discharge home (days); postnatal age at discharge (days); cost; not breast feeding at hospital discharge; parental satisfaction; parental anxiety; death.

Secondary:
To conduct subgroup analysis to determine if the effects of a policy of transferring preterm infants from incubators to open cots at lower versus higher body weight differ for those infants who were:

i. born less than 1000 g or greater than or equal to 1000 g
ii. born at less than 34 weeks gestational age or greater than or equal to 34 weeks gestational age
iii. less than or greater than or equal to seven postnatal age at the time of transfer

Subgroup analysis will also be conducted to determine if the results differ with the use of co-interventions:
i. use of additional heating measures i.e. heated water filled mattresses, heated nurseries, overhead heating device
ii. use of thermal challenging prior to transfer (i.e. gradual reduction the incubator temperature with increasing the infants clothing)

Criteria for considering studies for this review

Types of studies

Trials in which infants were randomised or quasi-randomised to a policy of transfer from incubators to open cots at a lower body weight versus at a higher body weight.

Types of participants

Preterm infants being nursed in incubators

Types of interventions

Transferring or weaning of preterm infants from an incubator to an open cot at a lower body weight compared with higher body weight.
"Lower" is defined as transfer before reaching 1700 g, and "higher" is defined as transfer after reaching 1700 g or more.

Types of outcome measures

Primary:

    * Weight gain (g/kg/day)
    * Episodes of cold stress (e.g. temperature < 36.3 degrees C) or requiring assistance with heating (i.e. overhead heater)
    * Requiring to be returned to incubator

Secondary:

    * Duration from transfer to cot to discharge home (days)
    * Postnatal age at discharge (days)
    * Length of hospital stay (days)
    * Cost
    * Not breast feeding at hospital discharge
    * Parental satisfaction
    * Parental anxiety
    * Death (by 28 days or prior to hospital discharge and also by 12 months if reported)

Search strategy for identification of studies

The standard search strategy for the Cochrane Neonatal Review Group was used. See: Neonatal Review Group search strategy. This includes searches of electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), CINAHL (1982 - 2007) and MEDLINE (1950 - 2007).

In addition to the neonatal review group searches, searches of the electronic databases were based on the following search terms:

The MeSH terms 'Infant, Newborn' OR 'Nurseries, Hospital' OR 'Intensive Care Units, Neonatal'

AND
The MeSH terms 'Skin Temperature' OR 'Body Temperature' OR 'Body Temperature Regulation' OR the text word 'Therm*' OR 'Temperature'

AND
The MeSH term 'Incubators, Infant' OR the text words 'Cot' OR 'Crib' OR 'Isolette' OR 'Incubator' OR 'cot-nurs*'

AND
The highly sensitive search strategy developed by Kay Dickersin to identify RCTs (Dickersin 1994)

Previous reviews including cross-references, abstracts, conference and symposia proceedings, expert informants, journal hand searching in the English language were also sought. No other language restrictions were applied.

The title and abstract of each retrieved study was examined to assess eligibility. If there was uncertainty, the full paper was examined.

Methods of the review

Standard methods of The Cochrane Collaboration (Higgins 2006) and its Neonatal Review Group were used to assess the methodological quality of the trials.

Quality assessment:
Two of the three reviewers worked independently to search for trials for inclusion and all reviewers independently assessed methodological quality. Study quality was assessed using the following key criteria: blinding of allocation, blinding of intervention, completeness of follow up and blinding of outcome measurement, assigning a rating of 'Yes', 'No' or 'Cant tell' for each. Data were extracted independently by the reviewers. Differences were resolved by discussion and consensus of the reviewers.

Methods used to collect and synthesise data from included studies:
Two of the three reviewers independently extracted data, then compared and resolved differences. The authors of the two included trials (Heimler 1981; Sutter 1988) were contacted for further information concerning outcomes and exclusions. Sutter 1988 responded to the enquiry, but was unable to provide additional data requested. At the time of this update, no information was forthcoming from Heimler 1981.

Due to insufficient data and the units in which outcomes were reported (weight gain as g/day and g/kg/day) it was not possible to conduct a meta-analysis. For individual trials, where possible, mean differences and 95% confidence intervals (CI) are reported for data measured on a continuous scale. For categorical outcomes, relative risk and 95% confidence intervals (CI) are reported.

Description of studies

Five studies were identified as potentially eligible for inclusion in this review. Three studies were excluded as neither random nor quasi-random allocation to the exposure was employed (Medoff-Cooper 1994; Roncoli 1992; West 2005). This review includes the studies of Sutter 1988 and Heimler 1981. In this update, Heimler 1981, previously classified as pending, has been included despite some remaining methodological concerns.

Participants in the Heimler 1981 trial were preterm infants (mean gestational ages 30.0 weeks and 31.5 weeks, mean birth weights 1268 g and 1414 g for the two study groups). Infants were cared for in a single-walled incubator and allocated to one of two study groups: Group A was transferred to an open cot at a weight of between 1600 g and 1700 g and Group B at a weight of between 1800 g and 1900 g. Infants were dressed in a single shirt, diaper, cap and booties throughout the study. Incubator air temperatures were kept between 30 and 32 degrees Celsius and room temperature between 25 and 27 degrees Celsius. Once transferred to a crib, the infant was covered with four blankets. Once infants reached a weight of 1500 g, all were fed outside the incubator. Infants had to be receiving an oral intake of at least 110 kcal/kg/day to be eligible for the trial.

The main outcome measures were body temperature (axillary, rectal and anterior abdominal skin); gross energy intake; weight gain; head growth; length growth and skinfold thickness. Only one outcome measure, weight gain (g/kg/day) was included in this review.

Participants in the Sutter 1988 trial were preterm infants (mean gestational ages 30.1 weeks and 28.6 weeks, mean birth weights 1207 g and 1215 g for the two study groups). Infants were cared for in a single-walled incubator and allocated to one of two study groups: Group 1 was transferred to an open cot at a weight of 1700 g and Group 2 at a weight of 1800 g, following a weaning process. Each infant was weaned gradually by decreasing the incubator temperature by 1oC each hour until the incubator temperature reached 28oC. Infants were clothed in a cotton shirt, with one or two blankets when moved into an open cot. If the infant's temperature dropped to less than 36oC at any time during the weaning process or any time after, the infant was returned to an incubator and weaning could recommence 48 hours later. Nursery temperature was maintained at 22oC. Infants had to be receiving feedings of 120 kcal/kg/day to 150 kcal/kg/day, via breast, bottle or gavage to be eligible for the trial.

The main outcome measures were hypothermia requiring the infant to be returned to the incubator and weight gain (mean 24 hr weight gain). A third outcome, duration (days) from transfer to cot to discharge home, could not be included in this review as day of discharge was defined to be 24 hours after successful weaning from incubator to open cot, due to delayed discharge of some infants for social reasons. The weaning process as described above was deemed successful if the infant's temperature did not drop below 36oC and the weaning process did not need to be stopped.

(For further details on included studies see table, Characteristics of Included Studies).

Methodological quality of included studies

The Heimler 1981 trial used a matched-pairs design for allocation to study group. The first infant of a matched pair was randomised, using card envelope. The next eligible infant matching gestation at birth was allocated to the opposite study group; therefore, the clinical staff knew treatment assignment of the second pair member prior to recruitment. There was inadequate blinding of allocation to treatment group, interventions were unable to be blinded and it is not known whether blinding of outcome measurements occurred. Twenty subjects were entered into the study; however, only data for 14 infants was included in the analysis. Six infants were excluded. Two infants eliminated due to apnoea and feeding problems; one infant withdrawn from the study by the parents; and three infants due to being small for gestational age (< 10 centile) although this was not an exclusion criteria for enrolment into the study. It is not known whether these infants were excluded pre or post randomisation, nor the groups to which they had been assigned.

The methodological quality of this study is considered to be poor.

The second included trial (Sutter 1988) used a matched-pairs design for allocation to study group. Infants were randomised in blocks of two, matched by birth weight in one of four strata (1251 to 1500 g; 1001 to 1250 g; 751 to 1000 g; and less than 751 g). The first eligible subject was randomly assigned to one treatment and the other subject in the pair was assigned to the other treatment when entered into the study. There was inadequate blinding of allocation to treatment group, interventions were unable to be blinded and it is not known whether blinding of outcome measurements occurred. Sixty-two infants were enrolled in the study, but completeness of follow up did not occur as two infants were not included in the analysis as they did not have matching pairs. Four pairs of infants received the opposite treatment to that which was randomly allocated; however, an intention to treat analysis was performed.

The methodological quality of this study is considered to be poor.

Results

The results of two trials are included in this review (Heimler 1981; Sutter 1988). Only two outcome data could be included in this review; return to incubator and daily weight gain. However, as Heimler 1981 has reported weight gain as g/kg/day and Sutter 1988 reports as g/day a meta-analysis could not be performed. No statistically significant difference was found for either return to incubator (Outcome 01.01 Sutter 1988), 30 infants, RR 2.00, 95% CI 0.40 to 10.11 or daily weight gain (Outcome 01.02 Heimler 1981), 14 infants, [MD 1.00 g/kg/day (95% CI -2.89, 4.89)]. While data on weight gain included in the Sutter 1988 study is not included in this review, due to reporting weight gain as g/day not g/kg/day, the authors report the overall mean difference for 24 hour weight gain was 3.3 g (90% CI -4.6 to 11.3). Due to small numbers, effects on clinically important outcomes could not be adequately assessed and planned subgroup analyses could not be undertaken.

Discussion

This review includes two small controlled trials of poor quality involving 74 preterm infants (Heimler 1981; Sutter 1988). Only two outcomes were able to be included, return to incubator and daily weight gain. No statistically significant differences were shown for either return to incubator or daily weight gain for infants transferred from incubators to open cots at a lower body weight versus higher body weight. Heimler 1981 found no harmful effects of earlier weaning on thermal stability or growth rate, but suggest that the thermal environment may play a more important role in smaller babies than those included in this study. Likewise, Sutter 1988 concluded that earlier transfer appeared safe and effective; however, the authors expressed caution was needed for those infants born less than 1000 g due to an increased rate of return to incubator. This conclusion was based on a subgroup analysis of the six infants born less than 1000 g. Due to this small number, planned subgroup analysis of infants born less than 1000 g was not undertaken in this review. Numbers are too small for these findings to be considered reliable.

Due to insufficient data and poor methodological quality, these trials do not provide reliable evidence to support or refute the transfer of preterm infants from incubators to open cots at a lower body weight versus at a higher body weight. Given that transferring preterm infants from incubators to open cots at a lower body weight may result in inability to maintain temperature, greater weight loss, extended hospitalisation and increase in the cost of care, this intervention needs to be assessed in rigorously designed trials.

Future trials should include a sufficient number of infants to address clinically important outcomes including temperature stability, weight gain, parental satisfaction, time to discharge and cost. It is hoped that the trial in progress (New 2003) will address some of these outcomes.

Reviewers' conclusions

Implications for practice

The results of this review do not provide sufficient evidence to guide clinical practice on the preferred weight for the transfer of preterm infants from incubators to open cots.

Implications for research

There is a need for well designed randomised controlled trials to establish if there is any benefit in transferring preterm infants from incubators to open cots at a lower body weight and without significant harm.

Future studies should include sufficient numbers of infants to assess the effects of this intervention on the outcomes of temperature stability, weight gain, parental satisfaction, time to discharge and cost. Studies should also include sufficient numbers of infants born less than 1000 g to adequately assess these effects in this high-risk population.

Acknowledgements

None

Potential conflict of interest

Two of the reviewers (Karen New and Mark Davies) are co-investigators of an ongoing randomised control trial in which preterm infants are transferred to an open cot at either 1600 g or 1800 g.

Characteristics of included studies

Premature Babies / Preemies - Questions & Answers

2010-02-14T11:13:00.000-08:00

Premature Babies / Preemies - Questions & Answers
by Sjona Lindquist

What is the difference between premature babies and preemies?
There is no difference between premature babies and preemies. Both terms are used interchangeably in articles, preemie stores, medical staff, growth charts, or any other medium of communication or reference. However, we have noticed that people in the medical field prefer to use the term "premature babies" and use it more often than the term "preemies".

What are premature babies?
A normal healthy pregnancy lasts between 37 and 42 weeks gestation, and a baby born in this range is considered a full-term infant. These newborns have the best chance of survival as well as the greatest opportunity for health. Premature babies, or preemies, are infants that are born before the bottom safety limit of 37 weeks gestation is reached. This does not automatically mean that a premature infant will have serious health issues or will die. As a general rule, the earlier a baby is born, the more difficulties she will face.

Why do some women have premature babies?
There are many different reasons why women have preemies. Uterine structural abnormalities, infections, hormone imbalance, chronic illnesses, and physical or emotional trauma are some of the unavoidable causes for labor to begin prematurely. There are other explanations such as stress, drugs, smoking, drinking alcohol, poor eating habits, insufficient prenatal care, not enough weight gained during pregnancy, but these can be avoided with a little education and a lot of common sense. If it isn't healthy for you, it may be deadly to your baby. However, despite all of the best intentions of the mother-to-be, some of the reasons for preterm labor are still unknown to the medical world and cannot be eluded.

Who is more likely to have premature babies?
Women all over the world have preemies from all races and in all age ranges, but there are groups of women who have risk factors that are higher than others. Women over 35 years old or under 19 have a larger percentage of preterm births than other women. African-American women have the highest preterm birth rate, Hispanic women come in second, and Caucasian comes in last of the three races studied. Other factors include women pregnant with multiples and previous premature birth.

How are premature babies different than full term babies?
In some ways preemies are not very different than full term babies, but in more ways they are quite individual and require a broadminded mindset from the preemie care provider. Caring for preemies can be quite challenging at times because they require all the care and have all the needs of a full term newborn, yet they have unique needs particular to preemies and then again particular to your specific preemie and her medical analysis. These needs can fluctuate and change quickly or can remain consistent. The difficulties can range from mild to severe and can include respiratory infections, various respiratory problems, hypothermia, anemia, cardiac issues, hemorrhaging in different parts of the body, hypoglycemia, jaundice, developmental delays, eating problems etc. An alert care giver must always be on hand to make sure that medical treatment or whatever else is needed will be implemented quickly.

How often are premature babies born?
There are 1.3 out of every 10 (or almost 13 out of every 100) babies born prematurely in the United States every day. This number has steadily increased since the early 80's. Advanced medical care, cutting-edge infertility treatments, increased numbers of multiple pregnancies, and many other reasons have led to this significant increase. Some preemies are now able to survive despite weighing a little over a half a pound at birth.

Where are premature babies taken care of?
Preemies are taken care of in a special area of the hospital called a NICU - Neonatal Intensive Care Unit. In the NICU, there are special kinds of equipment, medical devices, and comfortable things that are appropriate to the needs of preemies. A special bed for premature babies called an isolette, a neonatal incubator, helps to maintain the proper body temperature, oxygen levels, humidity, and keep drafts away. All of these things help the hospital's medical staff to give preterm infants the best care possible.

To what extent are premature babies affected by prematurity?
Usually this depends on how early a preemie is born because the earlier a baby is born the more medical care she requires, and the severity of the difficulties increases. Preemies can make a full recovery, have minor health issues, major health issues, or death. Prematurity is a serious problem for these tiny infants and can result in lasting consequences throughout their lives.

When can premature babies go home?
Generally preemies are not ready to leave the hospital until they have reached their due date, but this is not always true. There are many other factors that must be considered before the hospital will release each preterm infant. A baby must be able breathe well on her own, maintain her body temperature, to eat and be steadily gaining weight. Her medical condition cannot be too serious or her parents will not have the ability to care for her properly. Preemies released from the hospital need to be seen by their pediatrician on a regular basis to continue optimal care and give them the best chances for continued health.
What problems do premature babies grow out of and what problems are life-long?
Short term problems are usually the ones that require immediate medical care and serious conditions that would require hospitalization for life to continue. Some of these problems are hemorrhaging, sepsis, hypothermia, jaundice, serious heart problems, anemia, hypoglycemia, and severe respiratory distresses. Long term problems associated with prematurity in varying degrees are deafness, blindness, cerebral palsy, learning disabilities, mental retardation, and other minor or major health problems. The needs of preemies are great, but their precious little lives bring us inspiration every day.

Leading cause of premature baby

2010-01-14T12:11:00.000-08:00

In humans, preterm birth refers to the birth of a baby of less than 37 weeks gestational age. Premature birth, commonly used as a synonym for preterm birth, refers to the birth of a premature infant. The child may commonly be referred to throughout their life as being born a "preemie" or "preemie baby". Because it is by far the most common cause of prematurity, preterm birth is the major cause of neonatal mortality in developed countries. Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development. Significant progress has been made in the care of premature infants, but not in reducing the prevalence of preterm birth.[1] The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging proposition.
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Classification

Pregnant mother's body weakness and fatigue resulting overall long travel, or daily commuting from the duty station to the center housing, especially if such a distance away.
In that they continue developing after birth, most animals are not born mature. At birth, a normal human infant is less mature than infants of some other primate species, possibly to allow the disproportionately large head to fit through a pelvis adapted for walking on two legs.

In humans, whereas the usual definition of preterm birth is birth before 37 weeks gestation,[2] a "premature" infant is one that has not yet reached the level of fetal development that generally allows life outside the womb. In the normal human fetus, several organ systems mature between 34 and 37 weeks, and the fetus reaches adequate maturity by the end of this period. One of the main organs greatly affected by premature birth is the lungs. The lungs are one of the last organs to develop in the womb; because of this, premature babies typically spend the first days/weeks of their life on a ventilator. Therefore, a significant overlap exists between preterm birth and prematurity: generally, preterm babies are premature and term babies are mature. Prematurity can be reduced to a small extent by using drugs to accelerate maturation of the fetus, and to a greater extent by preventing preterm birth.
Leading cause of premature baby

Signs and symptoms

Symptoms of imminent spontaneous preterm birth are signs of premature labor; such signs consists of four or more uterine contractions in one hour before 37 weeks' gestation. In contrast to false labor, true labor is accompanied by cervical shortening and effacement. Also, vaginal bleeding in the third trimester, heavy pressure in the pelvis, or abdominal or back pain could be indicators that a preterm birth is about to occur. A watery discharge from the vagina may indicate premature rupture of the membranes that surround the baby. While the rupture of the membranes may not be followed by labor, usually delivery is indicated as infection (chorioamnionitis) is a real threat to both fetus and mother. In some cases the cervix dilates prematurely without pain or perceived contractions, so that the mother may not have warning signs until very late in the birthing process.

Mortality and morbidity

The shorter the term of pregnancy, the greater the risks of mortality and morbidity for the baby primarily due to the related prematurity. Preterm-premature babies ("preemies" or "premies") 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). Worldwide, prematurity accounts for 10% of neonatal mortality, or around 500,000 deaths per year.[3] In the U.S. where many infections and other causes of neonatal death have been markedly reduced, prematurity is the leading cause of neonatal mortality at 25%.[4] Prematurely born infants are also at greater risk for having subsequent serious chronic health problems as discussed below.

The earliest gestational age at which the infant has at least a 50% chance of survival is referred to as the limit of viability. As NICU care has improved over the last 40 years, viability has reduced to approximately 24 weeks,[5][6] although rare survivors have been documented as early as 21 weeks.[1] This date is controversial as gestation in this case was measured from the date of conception rather than the date of her mother's last menstrual period. Gestation appears 2 weeks less than if calculated by the more common method.[7] 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.

Specific risks for the preterm neonate

Preterm infants usually show physical signs of prematurity in reverse proportion to the gestational age. As a result they are at risk for numerous medical problems affecting different organ systems.

    * Neurological problems include apnea of prematurity, hypoxic-ischemic encephalopathy (HIE), retinopathy of prematurity (ROP), developmental disability, cerebral palsy and intraventricular hemorrhage, the latter affecting 25 percent of babies born preterm, usually before 32 weeks of pregnancy.[8] Mild brain bleeds usually leave no or few lasting complications, but severe bleeds often result in brain damage or even death.[8]
    * Cardiovascular complications may arise from the failure of the ductus arteriosus to close after birth: patent ductus arteriosus (PDA).
    * Respiratory problems are common, specifically the respiratory distress syndrome (RDS or IRDS) (previously called hyaline membrane disease). Another problem can be chronic lung disease (previously called bronchopulmonary dysplasia or BPD).
    * Gastrointestinal and metabolic issues can arise from hypoglycemia, feeding difficulties, rickets of prematurity, hypocalcemia, inguinal hernia, and necrotizing enterocolitis (NEC).
    * Hematologic complications include anemia of prematurity, thrombocytopenia, and hyperbilirubinemia (jaundice) that can lead to kernicterus.
    * Infectious include sepsis, pneumonia, and urinary tract infection

Causes

As the cause of labor still remains elusive, the exact cause of preterm birth is also unsolved. Labor is a complex process involving many factors. Four different pathways have been identified that can result in preterm birth and have considerable evidence: precocious fetal endocrine activation, uterine overdistension, decidual bleeding, and intrauterine inflammation/infection.[9] Activation of one or more of these the these pathways may have been gradually over weeks, even months.[9] From a practical point a number of factors have been identified that are associated with preterm birth, however, an association does not establish causality.

Maternal background

A number of factors have been identified that are linked to a higher risk of a preterm birth: low socio-economic or educational standing and single motherhood,[1] as well as age at the upper and lower end of the reproductive years be it more than 35[10] or less than 18 years of age.[1] Further, in the US and the UK Afro-American and Afro-Caribbean women have preterm birth rates of 15–18% more than double than that of the white population. This discrepancy is not seen in comparison to Asian or Hispanic immigrants and remains unexplained.[1]

Pregnancy interval makes a difference as women with a 6 months span or less between pregnancies have a two-fold increase in preterm birth.[11] Studies on type of work and physical activity have given conflicting results, but it is opined that stressful conditions, hard labor, and long hours are probably linked to preterm birth.[1] Patients who had undergone previous induced abortions have been shown to have a higher risk of preterm birth only if the termination was performed surgically but not medically.[12] Adequate maternal nutrition is important. Women with a low BMI are at increased risk for preterm birth.[13] Further, women with poor nutritional status may also be deficient in vitamins and minerals. Adequate nutrition is critical for fetal development and a diet low in saturated fat and cholesterol may help reduce the risk of a preterm delivery.[14] Obesity does not directly lead to preterm birth; however, it is associated with diabetes and hypertension which are risk factors by themselves.[1] Women with a previous preterm birth are at higher risk for a recurrence at a rate of 15–50% depending on number of previous events and their timing.[15] To some degree those individuals may have underlying conditions (i.e. uterine malformation, hypertension, diabetes) that persist. Genetic make-up is a factor in the causality of preterm birth. An intra- and transgenerational increase in the risk of preterm delivery has been demonstrated.[16][17] No single gene has been identified, and it appears with the complexity of the labor initiation, that numerous polymorphic genetic interactions are possible.

Factors during pregnancy

Multiple pregnancies (twins, triplets, etc.) are a significant factor in preterm birth. The March of Dimes Multicenter Prematurity and Prevention Study found that 54% of twins were delivered preterm vs. 9.6% of singleton births.[18] Triplets and more are even more endangered. The use of fertility medication that stimulates the ovary to release multiple eggs and of IVF with embryo transfer of multiple embryos has been implicated as an important factor in preterm birth. Maternal medical conditions increase the risk of preterm birth, and often labor has to be induced for medical reasons; such conditions include high blood pressure,[19] pre-eclampsia,[20] maternal diabetes,[21] asthma, thyroid disease, and heart disease. In a number of women anatomical issues prevent that the baby is carried to term. Some women have a weak or short cervix[19] (the strongest predictor of premature birth)[22][23][24] The cervix may also have been compromised by previous cervical conization or loop excision. In women with uterine malformations the capacity of the uterus to hold the growing pregnancy may be limited and preterm labor ensues.[25] Women with vaginal bleeding during pregnancy are at higher risk for preterm birth. While bleeding in the third trimester may be a sign of placenta previa or placental abruption – conditions that occur frequently preterm – even earlier bleeding that is not caused by these two conditions is linked to a higher preterm birth rate.[26] Women with abnormal amounts of amniotic fluid, too much (polyhydramnios) or too little (oligohydramnios) are also at risk.[1] The mental status of the women is of significance. Anxiety[27] and depression have been linked to preterm birth.[1] Finally, the use of tobacco, cocaine, and excessive alcohol during pregnancy also increases the chance of preterm delivery. Tobacco is the most commonly abused drug during pregnancy and also contributes significantly to low birth weight delivery.[28][29] Babies with birth defects are at higher risk of being born preterm.[30]
[edit] Infection

Infection

Infections play a major role in the genesis of preterm birth and may account for 25–40% of events.[31] The frequency of infection in preterm birth is inversely related to the gestational age.[1] Endotoxins released by microorganisms and cytokines stimulate deciduasl responses including the release of prostaglandins which may stimulate uterine contractions. Further the decidual response may include release of matrix-degrading enzymes that weaken fetal membranes leading to premature rupture.[31] Intrauterine infection appears to be a chronic process.[31] Typical organisms identified in the uterus before rupture of the membranes are genital Mycoplasma spp and specifically Ureaplasma urealyticum. Micro-organisms may reach the decidua in a number of ways, ascending, hematogeneous, iatrogenic by a procedure, or retrograde through the fallopian tubes. From the deciduas they may reach the space between the amnion and chorion, the amniotic fluid, and finally the fetus. A chorioamnionitis also may lead to sepsis of the mother. Fetal infection not only is linked to preterm birth but to significant long-term handicap including cerebral palsy.[1] It has been reported that asymptomatic colonization of the decidua occurs in up to 70% of women at term using a DNA probe suggesting that the presence of micro-organism alone may be insufficient to initiate the infectious response. Bacterial vaginosis has been linked to preterm birth raising the risk by a factor of 1.5 – 3.[32] As the condition is more prevalent in black women in the US and the UK, it has been suggested to be an explanation for the higher rate of preterm birth in this population. It is opined that bacterial vaginosis before or during pregnancy may affect the decidual inflammatory response that leads to preterm birth.[1] A number of maternal bacterial infections are associated with preterm birth including pyelonephritis, asymptomatic bacteriuria, pneumonia, and appendicitis. Also periodontal disease has been shown repeatedly to be linked to preterm birth.[33] In contrast, viral infections, unless accompanied by a significant febrile response, are considered not to be a major factor in relation to preterm birth.

Diagnosis

Helpful clinical test should predict a high risk for preterm birth during the early and middle part of the third trimester, when their impact is significant. Many women experience false labor (not leading to cervical shortening and effacement) and are falsely labelled to be in preterm labor. The study of preterm birth has been hampered by the difficulty in distinguishing between "true" preterm labor and false labor.[9] These new test are used to identify women at risk for preterm birth.

Fetal fibronectin

Fetal fibronectin has become the most important biomarker—the presence of this glycoprotein in the cervical or vaginal secretions indicates that the border between the chorion and deciduas has been disrupted. A positive test indicates an increased risk of preterm birth, and a negative test has a high predictive value. It has been shown that only 1% of women in questionable cases of preterm labor delivered within the next week when the test was negative

Ultrasonography of the cervix

Obstetric ultrasound has become useful in the assessment of the cervix in women at risk for premature delivery. A short cervix preterm is undesirable: At 24 weeks gestation a cervix length of less than 25 mm defines a risk group for preterm birth. Further, the shorter the cervix the greater the risk.[35] It also has been helpful to use ultrasonography in women with preterm contractions, as those whose cervix length exceeds 30 mm are unlikely to deliver within the next week

Prevention

Historically efforts have been primarily aimed to improve survival and health of preterm infants (tertiary intervention). Such efforts, however, have not reduced the incidence of preterm birth. Increasingly primary interventions that are directed at all women, and secondary intervention that reduce existing risks are looked upon as measures that need to be developed and implemented to prevent the health problems of premature infants and children.

Primary (aimed at all women)

The prevention of premature births is what needs to be focused on today. That is what the professionals in the health care community are struggling with. “Reasons for this include a lack of universal access to health care for women of childbearing age or pregnant women of any age”. Depression is a leading cause for premature births. Women suffering with this disorder need to make sure they are in continuous treatment in order for their symptoms to be controlled and monitored. Becoming overly stressed and upset can trigger premature labor in an otherwise healthy woman.There needs to be more focus on the decisions pregnant women make and the potential effects on their unborn child, including smoking, drugs, and alcohol. Partaking in any of these activities first and foremost denies the fetus from proper nourishment. Smoking increases the risk of premature births and possibly stillbirths. Abusing alcohol while pregnant has been linked to children with behavioral problems later in life, as well as fetal alcohol syndrome. Illegal drugs attribute to birth defects and premature births. All of the above should be enough for a woman to make better lifestyle changes while she is caring a child, but unfortunately it is not made public enough.

Other than the lifestyle choices an expecting mother can make, there are some cases that a premature birth is not in the mother’s hands. Of all premature births, 40 percent do not have a known cause. There are though four main routes that can lead to a premature birth or spontaneous premature labor. Infections is the first of these four. Usually urinary tract infections or infections involving the genitals can trigger a woman to go into preterm labor. Fetal and maternal stress is the second of the four. CRH, corticotrophin-releasing hormone, which is produced when the mother and or fetus are under unusual stress can cause other hormones to be released which can trigger uterine contractions, resulting in a premature birth.

Placental abruption is the third and can cause bleeding. Multiple births or an abundance of amniotic fluid may cause the uterus to stretch which is the fourth route that is identified in the causes of premature births. This can also lead to chemicals being released that cause uterine contractions. Scientists are and have been working on interventions to prevent premature births, but there is not one final answer to prevent all children from being born prematurely.

copy to http://en.wikipedia.org/wiki/Preterm_birth

Birth|Types|Stages|Troubles|birth early|premature birth

2010-01-08T11:04:00.000-08:00

Premature birth is the birth of the child before they reach the full development of its members, before the expiry of the period necessary in the womb, which was about nine months, normal, or ten lunar months (based on 28 days per month).

And premature birth occurs, usually between the eighth week and twenty-fifth and thirty of pregnancy, or with the other in the seventh or eighth month of pregnancy, because the birth of a child before reaching the seventh month of abortion is not birth, not when a child is capable of living at all.

Brands

Of the signs of premature birth to a baby's skin is thin, slash reddish, and the bones soft and thin, shallow breathing, weak and yelling, and movements generally slow and he does not suckle easily, and body temperature is stable.

The weight of children born prematurely and it is, in most cases less than 2500 grams, and weight usually ranges between kilogram and a half kilo grams, and are more susceptible to the risks and problems and health complications, a large percentage of them die, usually after several days of birth to the incomplete development .

Number and percentages
With the advancement of medical science and the development of inventions of modern equipment and effective drugs, the proportion of prematurely born from about 10% in 1973 to about 3% in 1980, this figure of course includes the civilized countries, and does not include third-world countries and poor ones, where a surge of death young children because of malnutrition and the lack of necessary first aid for the rehabilitation of children who are born prematurely.

I have already and practiced medicine in part in the Lebanese countryside in the early seventies and I realized how much the proportion of neonatal deaths was high due to the shortage.

How is the Being Premature monitored?

2010-01-07T11:23:00.000-08:00

Babies who are born early usually are carefully monitored, especially for the first year. Very premature babies will be seen by eye and hearing specialists. They will be taken care of by development specialists and breathing specialists. Teams of healthcare providers work together to give these babies as much care as they need to help them develop as normally as possible. Any new or worsening symptoms should be reported to the healthcare provider.

Study finds link between depression and premature children

2010-01-07T10:36:00.000-08:00

by Mary Ann Romans

A new study, about premature babies that shows a link between symptoms of depression in pregnant mothers and premature babies, was published yesterday in the medical journal, Human Reproduction.

The study from Kaiser Permanente surveyed hundreds of pregnant patients during their early weeks of pregnancy, using a questionnaire that measured depressive symptoms. Almost half of the women showed severe or significant symptoms of depression.
Depression in women who are expecting is more common than you might think. It is a treatable condition, and women should be aware that ignoring the symptoms may very well lead to to premature delivery, according to the study. Premature babies are at risk from an entire range of health issues. Even a birth a few weeks early can put a baby at risk for conditions such as jaundice and infections.

Pregnant women who shows signs of severe depression are twice as likely to deliver a baby prematurely, compared to women with no sign of depression, the study reveals.
It is not clear how the two conditions are related. Does the depression cause the premature births, or is there some underlying problem that may be leading both to depression and premature delivery? The only thing the study shows for sure is that a link between depression and premature delivery exists.

Pregnant women who suffer depression face a difficult world. Most people expect a pregnant woman to glow and be happy, so when the mood doesn't match the expectation, it can make things worse for the expectant mother. Add in physical symptoms such as morning sickness, exhaustion, and hormone changes. These can all affect the mood of a woman in pregnancy. Concerns about the health of the baby, especially if there is a history of miscarriage can also contribute to the situation.
Women who feel blue or have symptoms of depression during pregnancy should seek medical care. If not for themselves, then for their baby. As mentioned before, depression, even in pregnancy, is very treatable.

Some States Have More Premature Babies Than Others

2010-01-07T10:19:00.000-08:00

by Mary Ann Romans

preemie A new report shows that the odds of you having a premature baby depend on the state in which you live. The report was issued by the March of Dimes organization which tracked premature births and gave a report card on the disparity of premature births by state.

For example, the states with the lowest incidence of premature births tend to be up north. In Vermont, a woman is least likely to have a premature baby. Only 9 percent of all births are premature. Oregon and Connecticut also have low rates of premature births.

When you move down further south of the country, those number rise dramatically. There are a whopping 18.8 percent of premature births in Mississippi, the worst state in the union for premature birth rates. West Virginia, Alabama, Kentucky, South Carolina and Louisiana also have large percentages of premature births.

Overall in this country about one in eight babies is born premature. Prematurity can result in all sorts of conditions and medical issues, from learning disorders to death.

While prematurity is not well understood, the report does give three factors that may play a role in the difference in the premature birth rates across the states:

Lack of insurance leading to lack of prenatal care. Risks for preterm labor can offen be identity and treatment given to women who are at risk.

Smoking. There is a higher incidence of smoking in some of the states that also have the higher premature birth rates. Overall, the report estimates that 17 percent of all pregnant women smoke.

Scheduled C-sections. C-sections may purposely be scheduled ahead of full term (for example to avoid having a large baby), or they may be scheduled without a good understanding of the age of the fetus.

What do you think of this recent news?

Most of premature babies born in Africa and Asia

2010-01-07T06:08:00.000-08:00

It seems that Africa and Asia are highly popular range of diseases and epidemics, and children born prematurely, these statistics show that most of the global preterm infants are born in Asia and Africa.

Geneva - The existence of glaring disparities between developing and developed countries in the opportunities for survival of preterm infants.

Nearly 13 million children are born prematurely across the world each year, according to the first global view of preterm birth, which was published today in the International Journal of Public Health, WHO Bulletin.

Most of premature babies born in Africa and Asia "Nearly 11 million of these babies are born prematurely in Africa and Asia, where many do not have access to effective care," says lead author Dr. Lal say, from the Ministry of Reproductive Health and Research World Health Organization.

"A child weighing less than 2000g (born in about 32 weeks of pregnancy) has little chance of survival if born in a developing country," says Say. "On the other hand, born in 32 weeks in developed countries, the chances of survival and a similar one was born in full term."

An average of 10% of births in all parts of the world that occurs before 37 weeks of pregnancy, in other words is premature, although this rate varies between 3.8% for countries in Central Asia and 17.5% in South Africa. When comparing the high-income areas and North America to have a higher percentage than that (10.6%) of the premature birth of Europe (6.2%).

"Given the enormous increase in premature births over the past 20 years is shown in countries with reliable data, premature birth remains a major health problem. Improve access to effective health care, particularly in developing countries, and must remain a priority ", says Dr. Say.

*And here comes "The question what are the real reasons behind the birth of children prematurely, and whether the scientists have all the facts causing the problem?

Children born by Caesarean section are more likely to have asthma

2010-01-07T02:46:00.000-08:00

According to a study recently published in the United States that the birth attendant risk of caesarean section Probo children when children are born early, while the children who completed their pregnancies exposed to this risk.

The study was conducted under the supervision of a team of University of Washington in Seattle led by Professor Jason as Debeli and published in the month of the magazine "Onalzz Of Olrgi", a scientific journal published by the American College of Allergy, Asthma and Immunology.
Children born by Caesarean section are more likely to have asthma
The study provides the group's new vision of why children born by Caesarean section are more susceptible to asthma.

There were different previous studies on the relationship between method of delivery and asthma, did not take into account the effects of prematurity and maternal asthma, say researchers in this study.

The study was conducted on more than 10 thousand children between the ages of 6 and 12 years using data from the database hospitals and the state of Washington.

And lead caesarean section as is well known to the changes in the bacterial colonies in the abdomen, which occurs naturally after birth and may have a protective effect of exposure to asthma and allergic diseases.

Some researchers say that this change in the abdomen due to caesarean section may reduce the carrying capacity of a child to allergens and increase the risk of having asthma.

In analyzing the relationship in a separate study, Dr. Debeli and his strong relationship between caesarean section and the entry of children born in the early to the hospital because of asthma, while does not occur in children who have reached the stage of pregnancy.

They also said that the mother of asthma increase the likelihood of giving birth early, by Caesarean section, so the risk of asthma for genetic reasons in children born early in a greater risk of infection in children who complete the pregnancy.

Premature infants suffer from respiratory dysfunction

2010-01-06T13:31:00.000-08:00

British research revealed that children who are born before the completion of development in the womb of the mother and placed in incubators during the first weeks of birth to complete their development at risk of chest diseases.

Research has shown that low birth weight are more susceptible to lung disease more than others.

On the other hand to link research for the first time between the speed of weight gain in children during the weeks following the birth and the weakening of the growth of the lungs.

low birth weight are more susceptible to lung disease more than others.

The study was published by the University of Sawthahampton in the journal "American Journal", specializing in respiratory diseases and critical situations.
Chest problems

The researchers measured the study and lung function in 131 healthy children between the ages of 14 weeks and looked at the same time the speed of weight gain in these children.

Some of these children weighing less than normal at birth.

The study revealed that lung function in children who were less weight if they are born and those who increased their weight rapidly during the first weeks of Uladthm was weaker from the lungs of normal children.

Said Dr. Jean Lucas, Professor, Faculty of Medicine, University of Southampton, who led the study: "It seems that the different type of nutrition is not responsible for this effect."

The evidence suggests that the functions of the lungs of children who grow at a faster rate after the birth of this most vulnerable and increase the odds of children who completed their growth in the nursery.

And promote the study guide that "build the foundations for a healthier future may be determined from the stage of the fetus in the womb."

Said Dr. Matt Halsort of the Foundation for Asthma UK, said: "No it comes to their development quickly but the problem is that he was required to be present for the uterus certain degree of growth."

"This means that the lungs of children who were not born yet did not reach the normal size, which contributes to the lack of functions."

At the same time said study co-author John Warner: "We believe that impaired lung function in these children may have implications for the sensitivity of the device for future respiratory disease, especially shortness of breath."

The researchers plan to follow the children through their lives in the future to verify this hypothesis.

A spokesman for the British Institute of lungs: "We know since the breathing problems facing the children are not fully formed growth and young children and we are pleased to participate in this project but we believe that there is a need for further research to explore the relationship between lung disease in children and the risk of further lung problems in the future. "

Says Dr. Halsort said: "The results of this study indicate that early stage in the life essential to the growth of the lungs of the child and the impact of this on the risk of problems such as shortness of breath."

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