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Prematurity

Prematurity. Born too small Born too soon. Development of Young Children with Disabilities #872.514 (61) Carol Ann Heath. What is Prematurity. Preterm delivery is defined as birth occurring from 20 weeks to 36 completed weeks of gestation

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Prematurity

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  1. Prematurity Born too small Born too soon Development of Young Children with Disabilities#872.514 (61)Carol Ann Heath

  2. What is Prematurity Preterm delivery is defined as birth occurring from 20 weeks to 36 completed weeks of gestation Born at/or before the 36th week of gestation (one month before the estimated due date)

  3. Small for Gestational Age (SGA) • Newborn whose weight is below the 10th percentile for gestational age • Sometimes called dysmature, light for dates, or small for dates • Can be full term or premature

  4. Low birth weight (LBW) - infant born weighing less than 2,500 grams • Very low birth weight (VLBW) - infant born weighing less than 1,500 grams • Extremely low birth weight - infants weighing less than 1000 grams • Micropremies – infants weighing less than 800 grams

  5. Incidence • Occurs in 5 to 10% of all pregnancies • Accounts for 60 to 75% of infant morbidity and mortality • Half occurs idiopathically in women with no known risk factors • Health care costs increased by billions

  6. What Happens? Toronto Study • 330,000 live births • 568 born between 23 to 26 weeks gestation • without disabilities at age 2 yr: one born at 23 weeks three at 24 weeks - all required months in neonatal intensive care

  7. What are the Risk Factors? • Socioeconomic factors: teenagers women over 35 yr. women underweight at conception obese women smokers alcohol and substance abusers

  8. Long commutes • Work involving extended periods of standing • Stress: poor social support abusive relationships • Nutritional deprivation

  9. Inadequate prenatal care 30% more likely to have preemies than those with access to care • Poor pregnancy history • History of multiple abortions (spontaneous & elective) • Short pregnancy intervals (< one year )

  10. Medical Factors • Diabetes • Hypertension • Toxemia • Lupus • Daughters of women who took DES • Women with a cone biopsy • Abdominal surgery • 2nd & 3rd trimester bleeding

  11. Causes • Infection • Abdominal trauma • Placenta previa or abruptio • Multiple gestation • Pre-term rupture of membranes

  12. Uterine or fetal anomalies • Uterine fibroids • Cervical incompetence • Maternal Pyelonephritis (kidney infection) • Chronic maternal illness • Preeclampsia

  13. Preterm Birth Derives from one of three mechanisms: - preterm labor - preterm premature rupture of membranes - medical intervention (induced)

  14. Treatment of Preterm Labor • Bed rest & hydration • Tocolytics (beta-adrenergic blocking agents) • Corticosteroids • Home uterine monitoring

  15. Signs of Preterm Labor • Contractions • Abdominal, low back pain • Change in vaginal discharge • Pelvic pressure • Intestinal cramping

  16. Characteristics of Premature Infant Physical Characteristics • Presence of body hair • Reddish skin color • Absence of skin creases, ear cartilage, and breast buds

  17. Neurological Characteristics • Very flopping <28 weeks • Double jointed • Underdeveloped reflexes at birth • Behaviorally disorganized • Sleep mostly

  18. Complications • Respiratory distress syndrome (RDS) • Bronchopulmonary dysplasia (BPD) • Intracerebral insults

  19. Complications cont’d • Patent ductus arteriosus • Apnea and bradycardia • Sudden infant death syndrome

  20. Complications cont’d • Necrotizing enterocolitis • Gastroesophgeal reflux • Retinopathy • Infections

  21. Outcomes of LBW • 1960: survival rate for infants 1,500 to 2,500 grams - 50% 1,000 to 1,500 grams - <30% <1,000 grams - 10% • 1990: survival rate for infants more than 90% 750 to 1,000 grams - 75% 500 to 750 grams - 35%

  22. 1995: survival rate for infants < 500 grams - rare 500 to 749 grams - 47% 750 to 999 grams - 80% >1000 grams - 90% >1500 grams - 95%

  23. Neurodevelopmental Outcomes • 1960 <1,500 grams - <10% survival w/o disability • 1980 incidence of developmental disability for LBW <20% • 1990s -severe disability 6xs more likely in extremely LBW infants than full-term -learning disabilities/ADHD 3xs more likely in VLBW

  24. Microcephaly (head circumference <3rd percentile • Higher incidence of school failure • Greater % in special education • Spastic cerebral palsy (most common)

  25. Common Medical Complications • Respiratory Distress Syndrome (hyaline membrane disease) • Persistent Fetal Circulation • Retinopathy of Prematurity • Intraventricular Hemorrhage • Periventricular Leukomalacia

  26. Correcting for Prematurity • Classic approach- completely correct for gestational age until the child reaches 2 years • Research indicates can miss vision & hearing impairments • Newer approach- assess the rate of development

  27. Academic in Later Life • VLBW infants fare worse in reading & writing development (10th European Conference on Developmental Psychology) • An assessment of 7,505 children showed lower IQ on average at 5 years of age

  28. Early Childhood Longitudinal Kindergarten Cohort (ECLS-K), we assess the relationship between low birthweight (LBW 15001-2500g) and very low birthweight status (VLBW <1500) on a variety of childhood developmental outcomes including (1) academic ratings scales, (2) social ratings scales, (3) motor skills, (4) grade failure, (5) self-reported scales and (6) objective math and reading scores. • Using school and teacher fixed effects models for teacher assessments, population-average logistic regression models for risk of grade retention, and piecewise multilevel growth models for math and reading test scores over time we found the following: (1) At kindergarten entry LBW and VLBW children are rated lower on academic rating scales, but these scores were no longer significant after controlling for background characteristics. (2) VLBW children displayed disadvantages in Social Rating Scales, especially in approaches to learning. (3) LBW and VLBW children have significantly lower levels of motor skills and (4) after controlling for all covariates, there is no evidence that LBW children are more likely to repeat grades. Finally, (5) at kindergarten entry, LBW show significantly lower math scores, although there are no differences in growth rates, in either math or reading. • The evidence from this study suggests that although LBW children tend to have lower performance, most of the difference between those children and normal children are due to other associated disparities. Source: Goosby & Cheadle, 2009

  29. Differences at 8.5 Years • Only 51.5% of VLBW were at grade level compared with 91.2% of control group • 22.8% of VLBW in special schools compared with 1.5% of control group • Nearly 30% of VLBW had reading problems • Nearly 40% of VLBW had writing problems

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