A Quantitative Review of Mortality and Developmental Disability in Extremely Premature Newborns

Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, USA.
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 4.25). 06/1998; 152(5):425-35. DOI: 10.1001/archpedi.152.5.425
Source: PubMed

ABSTRACT To summarize the literature on mortality rates and prevalences of major neurodevelopmental disabilities and to examine trends of these outcomes over time in extremely premature neonates.
MEDLINE was used to search the English literature for studies published since 1970 reporting on both mortality and disability in infants born at or before 26 weeks' gestation (extremely immature [EI] cohort), with a birth weight of 800 g or less (extremely small [ES] cohort), or subgroups of these.
Studies were included in the analysis if all of the following were reported: mortality; direct examination of 75% or more of the survivors; and the proportion of patients with at least 1 of the following disabilities: cerebral palsy, mental retardation, blindness, and deafness. Studies reporting cohorts included as a subset of cohorts in another study were excluded. Forty-two studies providing mortality and disability data for 20 cohorts of 4116 EI infants and 38 cohorts of 4345 ES infants born after 1972 met the inclusion criteria.
Data were abstracted from all studies that met these criteria by two of us (J.M.L. and D.E.W.), independently; the data were then cross-checked to ensure accuracy.
Survival averaged 41% for EI infants and 30% for ES infants, and it increased significantly with time. In contrast to mortality, the prevalences of major neurodevelopmental disabilities among survivors have not changed over time. The most common major disability was mental retardation, found in 14% of EI and ES survivors. Cerebral palsy was found in 12% of EI survivors and 8% of ES survivors, blindness was found in 8% of EI and ES survivors, and deafness was found in 3% of EI and ES survivors. Overall, 22% of EI survivors and 24% of ES survivors were classified as having at least 1 major disability. Each 100 EI or ES livebirths yielded 7 children with major disabilities; this prevalence was correlated with survival across cohorts.
The prevalence of disabilities had not changed among EI or ES survivors with increasing survival. However, increasing survival of these infants has resulted in a steadily increasing prevalence of children with disabilities.

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    • "Over three-fifths of the 2.3 million child deaths in India in 2005 were caused by seven conditions: pneumonia, diarrheal diseases, neonatal infections, birth asphyxia, birth trauma, prematurity, and low birth weight (LBW) [1]. LBW remains the leading cause of morbidity and mortality among newborns despite the advances in obstetrical prevention, diagnostics, and therapy [2]. The World Health Organization (WHO 2005) defined LBW as a birth weight of less than 2,500 g [3]. "
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    ABSTRACT: Low birth weight (LBW) is one of the major public health problems in India. Hence, there is a need to identify risk factors that, when modified, will reduce the burden of unhealthy children on the healthcare system. The objective of this study was to determine whether periodontitis among mothers in the rural population of India is a risk factor for LBW babies. A hospital-based case control study was conducted among 340 postpartum mothers. The cases consisted of 170 women who had given birth to babies weighing <2,500 g, while the control group consisted of 170 women who had given birth to babies weighing ≥2,500 g. Details of the mothers were taken from the hospital records and through a personal interview, and a full-mouth periodontal examination was performed postpartum, which included probing depth, clinical attachment level, and bleeding on probing on six sites per tooth. LBW cases had a significantly worse periodontal status than the controls, having an odds ratio (OR) of 2.94 (P=0.01). The multivariate logistic regression model demonstrated that periodontal disease is a significant independent risk factor with an adjusted odds ratio (aOR) of 2.85 for the LBW group (95% confidence interval [CI], 1.62-5.5). Other factors showing significant associations with LBW were pre-eclampsia (aOR, 4.49; 95% CI, 1.4-14.7), preterm labor (aOR, 5.5; 95% CI, 3.2-9.9), and vaginal type of delivery (aOR, 2.74; 95% CI, 1.4-5.2). Periodontitis represents a strong, independent, and clinically significant risk factor for LBW. Periodontal therapy should form a part of the antenatal preventive care among rural women in India.
    Journal of periodontal & implant science 04/2014; 44(2):85-93. DOI:10.5051/jpis.2014.44.2.85
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    • "Advances in neonatal intensive care have resulted in substantial improvements in outcome, in particular the survival of very preterm infants [1]. However, among the surviving population there is a high level of disability [2,3]. "
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    ABSTRACT: Hearing loss in children born before 32 weeks of gestation is more prevalent than in full term infants. Aminoglycoside antibiotics are routinely used to treat bacterial infections in babies on neonatal intensive care units. However, this type of medication can have harmful effects on the auditory system. In order to avoid this blood levels should be maintained in the therapeutic range. However in individuals with a mitochondrial genetic variant (m.1555A > G), permanent hearing loss can occur even when drug levels are within normal limits. The aim of the study is to investigate the burden that the m.1555A > G mutation represents to deafness in very preterm infants. This is a case control study of children born at less than 32 completed weeks of gestation with confirmed hearing loss. Children in the control group will be matched for sex, gestational age and neonatal intensive care unit on which they were treated, and will have normal hearing. Saliva samples will be taken from children in both groups; DNA will be extracted and tested for the mutation. Retrospective pharmacological data and clinical history will be abstracted from the medical notes. Risk associated with gentamicin, m.1555A > G and other co-morbid risk factors will be evaluated using conditional logistic regression. If there is an increased burden of hearing loss with m.1555A > G and aminoglycoside use, consideration will be given to genetic testing during pregnancy, postnatal testing prior to drug administration, or the use of an alternative first line antibiotic. Detailed perinatal data collection will also allow greater definition of the causal pathway of acquired hearing loss in very preterm children.
    BMC Pediatrics 03/2014; 14(1):66. DOI:10.1186/1471-2431-14-66 · 1.92 Impact Factor
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    • "They studied major neurodevelopment disabilities among infants due to preterm delivery. Their results suggest that 14% of EI and ES premature infants suffer from mental retardation, cerebral palsy is observed in 12% of EI survivors and 8% of ES survivors, blindness is found in 8% of EI and ES survivors, and 3% of the EI and ES population suffer from deafness [11]. Lorenz et al. thus concluded " Increasing survival of these infants has resulted in a steadily increasing prevalence "
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    ABSTRACT: Preterm birth is defined as any delivery before 37 complete weeks of gestation. It is a universal challenge in the field of obstetrics owing to its high rate of mortality, long-term morbidity, associated human suffering and economic burden. In the United States, about 12.18% deliveries in 2009 were preterm, producing an exorbitant cost of $5.8 billion. Infection-associated premature rupture of membranes (PROM) accounts for 40% of extremely preterm births (<28 weeks of gestation). Major research efforts are directed towards improving the understanding of the pathophysiology of preterm birth and ways to prevent or at least postpone delivery. Endothelin-1 (ET-1) is a potent vasoconstrictor that plays a significant role in infection-triggered preterm birth. Its involvement in a number of pathological mechanisms and its elevation in preterm delivered amniotic fluid samples implicate it in preterm birth. Sphingosine kinase (SphK) is a ubiquitous enzyme responsible for the production of sphingosine-1-phosphate (S1P). S1P acts as second messenger in a number of cell proliferation and survival pathways. SphK is found to play a key role in ET-1 mediated myometrial contraction. This review highlights SphK as a prospective target with great potential to prevent preterm birth.
    Obstetrics and Gynecology International 05/2013; 2013:302952. DOI:10.1155/2013/302952
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