Preterm Birth

The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

Each year in the United States approximately 440,000 babies are born premature. These infants are at greater risk of death, and are more likely to suffer lifelong medical complications than full-term infants. Clinicians and researchers have made vast improvements in treating preterm birth; however, little success has been attained in understanding and preventing preterm birth. Understanding the complexity of interactions underlying preterm birth will be needed if further gains in outcomes are expected. The Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine sponsored a workshop to understand the biological mechanism of normal labor and delivery, and how environmental influences, as broadly defined, can interact with the processes of normal pregnancy to result in preterm birth. This report is a summary of the main themes presented by the speakers and participants.

This splendid volume presents numerous aspects of preterm labor and delivery, from its fundamental mechanism to clinically focused approaches. The incidence of preterm delivery is 6-7% in Japan, while globally up to 10% of pregnancies with preterm labor result in premature delivery. The rates of overall survival and intact survival of the premature infants are also excellent in Japan. Thus Japan’s approach to preterm labor and delivery has long attracted attention. In each chapter, experts describe specific issues unique to conditions in Japan, including diagnosis, tocolytic agents, definition of clinical chorioamnionitis, treatment of bacterial vaginosis, role of amniocentesis, management of preterm premature membrane rupture and also placental pathology, presenting definitive evidence of the reduced incidence of preterm delivery in Japan. This book benefits not only obstetricians, pediatricians and gynecologist, but also midwives, nurse practitioners, and medical and associated staffs in the field of obstetrics, pediatrics, as well as neonatal and perinatal medicine who are involved in delivery.

A troubling study of the role that medical racism plays in the lives of black women who have given birth to premature and low birth weight infants Black women have higher rates of premature birth than other women in America. This cannot be simply explained by economic factors, with poorer women lacking resources or access to care. Even professional, middle-class black women are at a much higher risk of premature birth than low-income white women in the United States. Dána-Ain Davis looks into this phenomenon, placing racial differences in birth outcomes into a historical context, revealing that ideas about reproduction and race today have been influenced by the legacy of ideas which developed during the era of slavery. While poor and low-income black women are often the “mascots” of premature birth outcomes, this book focuses on professional black women, who are just as likely to give birth prematurely. Drawing on an impressive array of interviews with nearly fifty mothers, fathers, neonatologists, nurses, midwives, and reproductive justice advocates, Dána-Ain Davis argues that events leading up to an infant’s arrival in a neonatal intensive care unit (NICU), and the parents’ experiences while they are in the NICU, reveal subtle but pernicious forms of racism that confound the perceived class dynamics that are frequently understood to be a central factor of premature birth. The book argues not only that medical racism persists and must be considered when examining adverse outcomes—as well as upsetting experiences for parents—but also that NICUs and life-saving technologies should not be the only strategies for improving the outcomes for black pregnant women and their babies. Davis makes the case for other avenues, such as community-based birthing projects, doulas, and midwives, that support women during pregnancy and labor are just as important and effective in avoiding premature births and mortality.

"Sarah DiGregorio delves deeply into the fraught world of premature birth. With bracing honesty, she recounts her own story and the stories of other women who draw on the power of love and meld it with cutting-edge science, as they struggle to save the lives of their newborns. This book opens our minds and hearts to a world that is rarely seen with such clarity."--Jerome Groopman, MD, Recanati Professor at Harvard Medical School and author of The Anatomy of Hope The Neonatal Intensive Care Unit (NICU) is a place made of stories--where humanity, ethics, and science collide in dramatic and deeply personal ways, as parents, physicians, and nurses grapple with sometimes unanswerable questions raised by premature birth. When does life begin? When and how should life end? And what does it mean to be human? For the first time, journalist Sarah DiGregorio explores the fascinating evolution of neonatology and its significant breakthroughs--modern medicine can now save infants at five and a half months gestation who weigh less than a pound, when only fifty years ago there were few effective treatments for premature babies. Weaving her own story and those of other parents and NICU clinicians with in-depth reporting, DiGregorio examines the history and future of one of the most boundary-pushing medical disciplines: how the first American NICU was set up as a sideshow on the Coney Island boardwalk; how modern advancements have allowed viability to be pushed to a mere twenty-two weeks; the political, cultural, and ethical issues that continue to arise in the face of dramatic scientific developments; and the clinicians at the front lines who are moving to new frontiers. Eye-opening and vital, Early uses premature birth as a window into our own humanity.

Every year, 400,000 families in the United States welcome premature babies ... Ten percent of babies born in the U.S. are preemies. But that one word, "preemie," encompasses a range of medical and cultural experiences. There are textbooks, medical-ish guidebooks, and the occasional memoir to turn to ... but no book that collects personal experiences from the many people who have parented, cared for, or been preemies themselves. Until now. In What We Didn't Expect, journalist Melody Schreiber brings together a chorus of acclaimed writers and thinkers to share their diverse stories of having or being premature babies. The stories here cover everything from life-changing tests of faith to navigating the red tape of healthcare bureuacracy; from overcoming unimaginable grief to surviving and thriving against all odds. The result is a moving, heartfelt book, and a crucial and informative resource for anyone who has, or is about to have, the experience of dealing with a premature birth.

Give Your Preterm Baby the Best Possible Start in Life If you have just given birth to a preterm infant, you and your baby both face special challenges. Parents long to help their baby but often feel isolated frightened by hospital procedures. Now there is wonderful news for both babies and parents. Kangaroo Care, a technique pioneered in leading neonatal centers worldwide, gives you a unique role: a special way of holding your infant that provides crucial health benefits—including shorter hospital stays. Based on ground-breaking research, Kangaroo Care is a step-by-step guide to bringing these benefits to your baby—even if your neonatal unit does not yet have a Kangaroo Care program. It explains: • Why Kangaroo Care enhances your baby’s development • How to use the technique even if your infant requires a ventilator or an incubator • How to understand your baby’s signals of distress or comfort—and how to respond • How you can work with the neonatal staff to provide the best for your baby between your visits • How to involve fathers as well as mothers • All the proven results of Kangaroo Care—including a more relaxed, healthier, and contented baby The complete parents’ guide to the revolutionary new treatment for preterm babies: Kangaroo Care

This book examines the toxicological and health implications of environmental epigenetics and provides knowledge through an interdisciplinary approach. Included in this volume are chapters outlining various environmental risk factors such as phthalates and dietary components, life states such as pregnancy and ageing, hormonal and metabolic considerations and specific disease risks such as cancer cardiovascular diseases and other non-communicable diseases. Environmental Epigenetics imparts integrative knowledge of the science of epigenetics and the issues raised in environmental epidemiology. This book is intended to serve both as a reference compendium on environmental epigenetics for scientists in academia, industry and laboratories and as a textbook for graduate level environmental health courses. Environmental Epigenetics imparts integrative knowledge of the science of epigenetics and the issues raised in environmental epidemiology. This book is intended to serve both as a reference compendium on environmental epigenetics for scientists in academia, industry and laboratories and as a textbook for graduate level environmental health courses.

Premature children suffering consequences of their early birth do not grow out of them, and new difficulties may appear as they mature. The sum of negative influences from the time in the Neonatal Intensive Care Unit, eventual problems with interaction, and later a defective or delayed development, can cause continuous problems for premature children. These children can however be protected if we initiate the necessary support. An early effort can prevent the typical consequences of pre-term birth, so that the children will have quite a normal childhood. If the minor difficulties are identified, it is possible to take care of them before they develop into huge problems, and that is just the purpose of this book: to give parents, and professionals close to the child, a possibility to prevent, repair, and rebuild. Born Too Early does not deal with the more usual handicaps but exclusively with the less visible consequences of pre-term birth, which are rarely diagnosed.

Improved conditions of care for premature infants have led to markedly increased survival rates over the last few decades, particularly in very low and extremely low birth weight infants. Nutritional measures play a central role in the long-term outcome, health and quality of life of these premature infants. In this publication, leading experts from all 5 continents present the most recent evidence and critical analyses of nutrient requirements and the practice of nutritional care (with the focus on very low birth weight infants) to provide guidance for clinical application. After the introductory chapters, covering nutritional needs and research evidence in a more general manner, topics such as amino acids and proteins, lipids, microminerals and vitamins, parenteral and enteral nutrition as well as approaches to various disease conditions are addressed. Due to its focus on critical appraisals and recommendations, this book is of interest not only for the researcher who wants to keep up to date, but also for the clinician faced with premature infants in his practice.