Preterm Birth: Mortality Rates Doubled!
Tuesday, October 03, 2006
Kenneth F. Trofatter, Jr., MD, PhD
Callaghan and colleagues (Pediatrics 2006;118:1566-1573) sought to resolve the discrepancy that, although "two thirds of infant deaths occur among infants born preterm..., only 17% of infant deaths are classified as being attributable to preterm birth..." To accomplish this goal, they examined 27,970 neonatal death records from the year 2002 in the 'linked birth/infant death file,' looking not only for "preterm birth" as a listed cause of death, but complications (e.g., premature rupture of membranes; sepsis; respiratory distress syndrome; intraventricular hemorrhage) clearly related to PTB even if that was not actually recorded as an immediate cause. In their final analysis, they "classified 9,596 infant deaths (34.3% of all infant deaths) as attributable to preterm birth." Furthermore, "ninety-five percent of those deaths occurred among infants who were born at less than 32 weeks of gestation and weighed less than 1500 g, and two thirds of those deaths occurred during the first 24 hours of life." One frightening observation by the authors is that they still consider these estimates to be "conservative."
This study firmly establishes PTB as the irrefutable leading cause of neonatal mortality in the U.S. nearly doubling previous estimates. Let's just hope that convincing information like this helps to bolster support for the multidisciplinary programs that will be necessary if we ever hope to reverse the rising rates of PTB in this country. I look at any dollars spent as an investment in our future and the potential savings should far exceed the up-front costs.
4 Comments:
At Fri Oct 06, 10:32:00 AM 2006,
Anonymous said…
Is there anyway to prevent preterm birth? I just became pregnant and I am older, so the thought of losing this pregnancy due to an early delivery worries me. I take my vitamins, and lead a healthy lifestyle. What kinds of things cause early labor? I am prone to bladder infections.
At Fri Oct 06, 03:48:00 PM 2006,
Kenneth F. Trofatter, Jr., MD, PhD said…
Thank you for writing. There is not a simple answer to your question. One of the first things that would be helpful to know is if you have delivered early before or had frequent miscarriages and any surgical procedures such as D&Cs and LEEP procedures. You say you are older and it would also be helpful to know if you have any medical conditions for which you are undergoing therapy or if you had any trouble conceiving. Women who are older are at greater risk for early delivery, but much of that increased risk is negated if they are healthy, i.e., don't have hypertension, diabetes, infertility problems, autoimmune conditions, or obesity. You say that you have had urinary tract infections and that is clearly a risk for preterm delivery. Pregnancy increases your risk for both bladder and kidney infections. If this has been a chronic problem, your doctor may want to screen you frequently for urinary tract infections even if you have no symptoms of the same. If you do develop recurrent infections of the bladder, or even a single case of pyelonephritis (kidney infection) that you be placed on "suppressive" antibiotic therapy for the duration of the pregnancy.
One thing you must realize is that there are things we can decrease risk for (such as urinary tract infections) and things we cannot. Hopefully, none of the latter will complicate your pregnancy. Risk assessment for preterm labor is an ongoing process in pregnancy. I would strongly suggest that you have "maternal serum screening" (the "quad screen") done around 16 weeks even if you opt for "first trimester screening." These tests not only help reevaluate age-related risks for babies with chromosome problems, but also aid in the detection of fetal abnormalities and "abnormalities of placentation" (an issue I have not yet addressed in my posts on preterm birth) that may lead to early deliveries. Other things are general recommendations: drink plenty of fluids, do not become overly dehydrated, avoid constipation, get plenty of rest, minimize heavy exertional activities as the pregnancy progresses, become familiar with the signs and symptoms of preterm labor, and have a low threshold for asking your doctor questions. Most providers will perform an ultrasound exam on the baby at about 20 weeks and if you have any risk factors, you might ask if they can do a vaginal ultrasound exam of your cervix as well. By the way, if you are a smoker, you need to stop yesterday!
I hope this helps a little. There is no "magic bullet" for treatment or prevention of preterm birth, but you have taken a very important first step in minimizing your risk for this pregnancy. Good luck with things, and if you have any other questions, feel free to write back. Otherwise, let me know how things turn out!
Regards,
Kenneth F Trofatter, Jr., MD, PhD
At Wed Jul 18, 07:53:00 PM 2007,
Gods Angel said…
I have lost two handsome sons in the last year due to preterm labor. The second time around I was taking vitamins, folic acid, baby asprin, and I was going to the doctors every week for alpha 17. And at 12 weeks I had a cerclage put in my cervix. Now the doctors are saying that i might have a bicornuate uterus. I have to have this dye test done before i get pregnant again. I have no insurance nor do I know who to go see or even where to go. I have been pregnant six times and i have no children. I am so scared i don't know where to turn. Please help!!!!!
At Fri Jul 20, 03:04:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
You need to find a specialist in Reproductive Endocrinology and Infertility (REI) who can provide you the most help with the least number of steps. If you might have a bicornuate uterus, that will need to be evaluated and confirmed. You most likely have cervical incompetence as the result of the uterine abnormality. If the uterine abnormality is confirmed, you may need this surgically corrected and, regardless, you will probably benefit from a cerclage with any future pregnancy. You may well need to have a procedure done called an 'abdominal cerclage' if the cervical incompetence due to the Mullerian defect is severe. Since you do not have much funding of your own, I recommend finding the nearest good university medical center that has a residency training program and specialists in both REI and Maternal-Fetal Medicine. They may be willing to help you out at a reduced cost. Best of luck and thanks for reading!
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