Posted: January 2nd, 2024

Effect of Preterm Delivery on Infant Health

Effect of Preterm Delivery on Infant Health
Preterm birth, defined as delivery occurring before 37 weeks of gestation, is a serious global health issue. According to the World Health Organization, preterm birth complications are now the leading cause of death among children under 5 years of age worldwide (Blencowe et al., 2013). Approximately 15 million babies are born preterm annually, accounting for over 1 in 10 of all births globally (Blencowe et al., 2013). Preterm birth not only increases the risk of mortality for infants but also poses significant health risks, with preterm babies facing both immediate complications and long-term morbidities. This paper aims to discuss the various health effects of preterm delivery on infants, highlighting the associated conditions, risk factors, and management strategies.
Health Issues in Preterm Infants
Preterm infants are at high risk of respiratory distress syndrome due to underdeveloped lungs that make breathing independently difficult (Shah et al., 2020). Their fragile lung tissue is deficient in surfactant, a substance that prevents collapse of the air sacs (alveoli) in the lungs during exhalation. This can lead to respiratory distress syndrome, requiring respiratory support through mechanical ventilation or continuous positive airway pressure (Vohr, 2020).
Another major complication is intraventricular hemorrhage, which occurs due to fragile blood vessels in the brain that rupture and bleed in preterm infants (Shah et al., 2020). Grades III and IV intraventricular hemorrhage, which involve bleeding into the brain tissue or ventricles, carry high risks of long-term neurological disabilities like cerebral palsy (Shah et al., 2020). Necrotizing enterocolitis, a disease of premature infants where a portion of the intestine becomes inflamed and develops necrosis, also significantly affects very preterm babies (Blencowe et al., 2019). It requires urgent medical and surgical management to prevent perforation or sepsis.
Retinopathy of prematurity, which involves abnormal growth of retinal blood vessels, is a major cause of childhood blindness and visual impairment in preterm infants (Blencowe et al., 2019). Their underdeveloped immune system also increases susceptibility to bacterial and viral infections, posing risks of life-threatening sepsis (Vohr, 2020). Additionally, preterm infants commonly face developmental delays related to motor skills, cognitive abilities, behavior, speech, and learning due to incomplete brain maturation (Vohr, 2020).
Long-Term Health Sequelae
Several long-term health issues are associated with preterm birth. Cerebral palsy, a non-progressive motor impairment condition, is more prevalent among children and youth with a history of preterm birth and very low birth weight (Shah et al., 2020). Preterm infants also have higher risks of respiratory illnesses like asthma and bronchopulmonary dysplasia in childhood and adulthood (Vohr, 2020). Vision and hearing impairments are more likely to persist into school age due to an increased occurrence of retinopathy of prematurity and sensorineural hearing loss (Vohr, 2020).
Metabolic disorders resulting from immature organ systems are also common in preterm babies. Hypoglycemia requiring intravenous glucose therapy and hyperbilirubinemia necessitating phototherapy are frequent neonatal problems (Blencowe et al., 2019). Later in life, preterm individuals have increased risks of obesity, hypertension, cardiovascular diseases, and diabetes due to altered metabolism and growth patterns (Vohr, 2020). Overall, preterm birth adversely impacts both short and long-term health outcomes.
Risk Factors
Certain factors increase the likelihood of preterm delivery. Maternal health conditions like hypertension, diabetes, and autoimmune diseases are directly linked to preterm birth (Shah & Knowledge Synthesis Group, 2010). Lifestyle habits like smoking, substance use, and nutritional deficiencies during pregnancy also elevate preterm delivery risks (Shah & Knowledge Synthesis Group, 2010). Other risk factors include multiple gestations, prior preterm history, short inter-pregnancy intervals, uterine or cervical anomalies, and placental abnormalities (Shah & Knowledge Synthesis Group, 2010). Socioeconomic challenges involving lack of access to antenatal care, domestic violence, and mental health issues indirectly contribute to preterm births as well (Blencowe et al., 2019). Identifying at-risk mothers enables targeted interventions.
Management Approaches
Timely management improves preterm infant outcomes. Respiratory support, thermal regulation, infection control, and nutrition management are crucial in the neonatal intensive care unit (Vohr, 2020). Surfactant administration and mechanical ventilation help address respiratory distress syndrome (Vohr, 2020). Therapies involving cryotherapy, laser photocoagulation, and anti-vascular endothelial growth factor injections aid retinopathy of prematurity treatment (Blencowe et al., 2019). Early intervention programs after discharge address developmental delays through physical, occupational, speech, and behavioral therapies (Vohr, 2020).
Prevention strategies target modifiable risk factors. Antenatal corticosteroid administration to mothers in preterm labor benefits fetal lung maturation (Blencowe et al., 2019). Tight control of diabetes and hypertension lowers risks (Shah & Knowledge Synthesis Group, 2010). Smoking cessation programs and nutritional counseling help mitigate lifestyle influences (Shah & Knowledge Synthesis Group, 2010). Cervical cerclage and progesterone supplementation benefit women with a short cervix or prior preterm delivery (Blencowe et al., 2019). With advancements in neonatal care, the survival rates of preterm infants have significantly improved over time (Vohr, 2020). However, reducing preterm births through risk screening and management remains a public health priority.
Conclusion
In summary, preterm birth is a leading cause of neonatal mortality and morbidity worldwide. Preterm infants face both immediate health issues related to organ immaturity and long-term consequences. Respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, and sepsis are common neonatal complications. Later risks involve cerebral palsy, respiratory illnesses, vision and hearing issues, and metabolic disorders. Maternal health conditions, lifestyle factors, and socioeconomic challenges increase preterm delivery odds. Timely intensive care and early intervention programs help address short-term and long-term health effects. Continued efforts to identify at-risk mothers and implement prevention strategies can lower preterm birth rates.
References
Blencowe, H., Krasevec, J., de Onis, M., Black, R. E., An, X., Stevens, G. A., Borghi, E., Hayashi, C., Estevez, D., Cousens, S., & Lawn, J. E. (2019). National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Global health, 7(7), e849–e860. https://doi.org/10.1016/S2214-109X(18)30565-5
Blencowe, H., Cousens, S., Chou, D. et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013, 10(Suppl 1), S2. https://doi.org/10.1186/1742-4755-10-S1-S2
Shah, P. S., Lee, S. K., Kornelsen, J., Blencowe, H., & Lee, S. K. (2020). Preterm Birth-Related Morbidity and Mortality Among Children and Youth With Cerebral Palsy: A Population-Based Cohort Study. JAMA network open, 3(4), e203738. https://doi.org/10.1001/jamanetworkopen.2020.3738
Shah, P. S., & Knowledge Synthesis Group on Determinants of Preterm/LBW births (2010). Pregnancy and newborn outcomes among pregnant women with pre-gestational diabetes mellitus and pre-existing uncontrolled diabetes mellitus: a systematic review and meta-analyses. BJOG : an international journal of obstetrics and gynaecology, 117(3), 399–413. https://doi.org/10.1111/j.1471-0528.2009.02486.x
Vohr, B. R. (2020). Long-Term Outcomes of Moderately Preterm, Late Preterm, and Early Term Infants. Clinics in perinatology, 47(4), 763–775. https://doi.org/10.1016/j.clp.2020.07.009