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PubMed2001

Congenital cytomegalovirus infection in preterm and full-term newborn infants from a population with a high seroprevalence rate.

BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital infections in humans. Prematurity occurs in as many as 34% of infants with symptomatic congenital CMV infection. OBJECTIVE: To determine the clinical presentation and frequency of congenital CMV infection among preterm infants and full-term infants from a population with a high seroprevalence rate. DESIGN/METHODS: A total of 289 preterm infants (median gestational age, 34 weeks; median birth weight, 1,757 g) and 163 term infants (median gestational age, 39 weeks; median birth weight, 3,150 g) sequentially born were included in the study. Serum IgG antibodies to CMV were measured in all mothers. One urine sample was collected within the first 7 days of age from all newborns. Virus isolation in urine samples was performed by tissue culture, and viral DNA was detected by a multiplex PCR. CMV infection was diagnosed in infants with virus excretion detected by both methods on at least two occasions within the first 3 weeks of life. RESULTS: Maternal CMV seropositivity rate was 95.7%. Congenital CMV infection was detected in 6 of 289 (2.1%) (95% confidence interval, 0.84 to 4.68) preterm infants and in 3 of 163 term infants (1.8%) (95% confidence interval, 0.48 to 5.74) (P > 0.05). Four of 6 preterm infants with congenital CMV infection were symptomatic, but none of the term infants was symptomatic (P = 0.16). CONCLUSION: The frequency of congenital CMV infection in preterm newborn infants from mothers with a high seropositive rate was similar to that found in term infants. No significant difference was found between the proportion of symptomatic infants among preterm and term infants. Our finding of symptomatic congenital CMV infection underscores the need of further evaluation of correlates of congenital symptomatic infection in highly immune populations.

Adult↗

PubMedDate not supplied

Development of preterm infants: feeding behaviors and brazelton neonatal behavioral assessment scale at 40 and 44 weeks' postconceptional age.

The purpose of this study was twofold: (1) to explore potential changes in the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) from 40 to 44 weeks postconceptional age (PCA) and (2) to determine the relationship between the BNBAS scores and feeding behaviors in preterm infants at 40 and 44 weeks PCA. The BNBAS and sucking behavior measurements were completed on 104 preterm infants at 40 and 44 weeks PCA. The Orientation (p = .001), Motor (p = .001), Range of State (p = .001), Autonomic Regulation (p = .01), and Reflexes (p = .00) clusters were significantly more mature at 44 weeks PCA than at 40 weeks. Infants that were extremely early born (n = 24) had a significantly larger change in BNBAS scores over time as compared to the more mature preterm infants (n = 77), largely catching up with their more mature preterm counterparts. At 40 and 44 weeks PCA, the BNBAS cluster scores for orientation (p = .02), motor (p = .048), range of state (p = .048), and regulation of state (p < .001) were significantly related to the average maximum pressure, adjusted for gestational age and weeks PCA. Significant neurobehavioral maturation takes place between 40 and 44 weeks PCA in preterm infants, with the greatest changes occurring in the most preterm infants. These findings highlight the relationship between neurobehavioral maturation and feeding behaviors.

Child Development↗

PubMed2006

Maternal antiretroviral drugs during pregnancy and infant low birth weight and preterm birth.

OBJECTIVE: To determine the relationship between maternal antiretroviral regimens during pregnancy and adverse infant outcomes [low birth weight (LBW) and preterm birth]. The a priori hypothesis was that protease inhibitor (PI)-containing regimens are associated with an increased risk of LBW and preterm birth. DESIGN: Prospective cohort study of HIV-1-infected women and their infants (NISDI Perinatal Study). METHODS: Data were analysed from 681 women receiving at least one antiretroviral drug [in order of increasing complexity: one or two nucleoside reverse transcriptase inhibitors (1-2 NRTI), two NRTI plus one non-nucleoside reverse transcriptase inhibitor (NNRTI) (HAART/NNRTI), or two NRTI plus one PI (HAART/PI)] for at least 28 days during pregnancy, and who delivered live born, singleton infants with known birth weight and gestational age by 1 March 2005. Multivariable logistic regression modeling was used to assess the relationship of maternal ART with LBW and with preterm birth, adjusting for covariates. RESULTS: The incidence of LBW and preterm birth, respectively, was 9.6% and 7.4% (1-2 NRTI), 7.4% and 5.8% (HAART/NNRTI), and 16.7% and 10.6% (HAART/PI). There was no statistically significant increased risk of LBW [adjusted odds ratio (AOR), 1.5; 95% confidence interval (95% CI), 0.7-3.2] or preterm birth (AOR, 1.1; 95% CI, 0.5-2.8) among women who received HAART/PI compared with women receiving 1-2 NRTI. CONCLUSIONS: Among a population of HIV-1-infected women in Latin America and the Caribbean, maternal receipt of PI-containing ART regimens during pregnancy was not associated with a statistically significant increase in risk of LBW or preterm birth.

Adult↗

PubMed2004

Transmission of parentally shared human leukocyte antigen alleles and the risk of preterm delivery.

OBJECTIVE: Our objective was to examine our hypothesis that the transmission of parentally shared human leukocyte antigen (HLA) alleles to offspring increases the risk of preterm delivery. METHODS: A population-based family study with participating children and their parents was conducted in Kaiser Permanente Medical Care Program, an integrated healthcare delivery system, in the Northern California Region. A total of 234 participants from 78 families with early preterm deliveries (35 weeks of gestation or greater) and 60 participants from 20 families with full-term births were included in the study. Buccal cells were collected from the first-born preterm cases and their parents to determine HLA-B (class I) and DRB1 (class II) types and the transmission of parental alleles to the offspring. The buccal samples were also collected from full-term deliveries to rule out possible segregation distortion at the studied HLA loci. RESULTS: Compared with the expected transmission probability based on Mendel's laws (25%), transmission of parentally shared HLA-B or DRB1 alleles from both heterozygous parents to offspring (48% of 23 heterozygous parents) was associated with a more than 5-fold increased risk of preterm delivery (odds ratio 5.5; 95% confidence interval 1.2-51). Transmission of parentally shared HLA alleles from heterozygous mothers (83%) appears to be more important in the etiology of preterm delivery than transmission from fathers (57%). The transmission pattern of parentally shared HLA alleles in our full-term controls was almost identical to the expected pattern based on Mendel's laws and demonstrated no segregation distortion at those HLA loci. CONCLUSION: Our findings provide evidence that the transmission of parentally shared HLA alleles may be an underlying mechanism for preterm delivery.

Alleles↗

PubMed2005

Preterm premature rupture of membranes: is there an optimal gestational age for delivery?

OBJECTIVE: To characterize neonatal and maternal morbidity and mortality rates in pregnancies complicated by preterm premature rupture of membranes (PROM) and determine whether there is an optimal delivery gestational age. METHODS: We reviewed maternal and neonatal outcomes of women with PROM 24 weeks or more that resulted in delivery at less than 37 weeks at our institution from August 1998 to August 2000. Standardized management included the use of antibiotics, betamethasone at less than 32 weeks, and expectant management until 24 weeks or more. Outcomes evaluated included neonatal mortality, composite major and minor neonatal morbidity, individual major and minor neonatal morbidity rates, maternal infection morbidity, and maternal and neonatal length of stay. Gestational age-specific maternal and neonatal outcomes were compared with a referent group of pregnancies complicated by preterm PROM that delivered between 36 0/7 and 36 6/7 weeks of gestation. RESULTS: During the study interval, 430 women with preterm PROM were identified. Composite major neonatal morbidity was significantly higher among pregnancies delivered at 33 weeks of gestation or less after preterm PROM as compared with those who delivered at 36 weeks. Composite neonatal minor morbidity was significantly higher among pregnancies delivered at 34 weeks or less after preterm PROM as compared with those who delivered at 36 weeks. However, there was no improvement in the composite major and minor neonatal morbidity rates for those pregnancies delivered beyond 34 weeks of gestation. Both maternal and infant length of stay were significantly longer for cases of preterm PROM delivered at 34 weeks or less as compared with those who delivered at 36 weeks. CONCLUSION: Our findings suggest that expectant management of women at 34 weeks and beyond is of limited benefit.

Adult↗

PubMed2005

Prenatal risk factors for cerebral palsy in very preterm singletons and twins.

OBJECTIVE: To identify the main prenatal risk factors for cerebral palsy in very preterm singletons and twins. METHODS: The data were from the Epipage study, which included all very preterm children (< 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83% of the surviving children). The risk factors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out for singletons and generalized estimating equation models used for twins. RESULTS: The proportion of cerebral palsy was 8% in singletons and 9% in twins. For singletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-6.7), preterm premature rupture of membranes (PPROM) with short latency (adjusted OR 4.9, 95% CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7, 95% CI 1.4-5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these pregnancy complications and cerebral palsy in twins. For twins, a monochorionic placenta (OR 1.9, 95% CI 1.0-3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95% CI 0.8-3.4). CONCLUSION: In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension.

Cerebral Palsy↗

PubMed2005

The heritability of preterm delivery.

OBJECTIVE: To study the heritability of preterm delivery. METHODS: Women who delivered a singleton infant at less than 36 weeks of gestation were asked about their family history. Twenty-eight families were identified in which the proband had at least five first- or second-degree relatives with preterm delivery. An extensive genealogy database (GenDB) was constructed using more than 9,000 genealogy sources in the public domain (records before 1929). GenDB documents the relationships between more than 17.5 million ancestors and 3.5 million descendants of approximately 10,000 individuals who moved to Utah in the mid 1800s. This database was searched for the names, birth dates, and birthplaces of the four grandparents for each of the 28 probands. Pairwise coefficients of kinship were determined for the 93 preterm delivery grandparents identified, and for sets of 100 individuals born in the 1920s who were randomly selected from the population database. RESULTS: Probands had a mean of 3.3 grandparents included in this database. The average coefficient of kinship for controls was 1.5 x 10(6) (standard deviation = 0.6 x 10(6)). This measure agrees with previous calculations for the Utah population. The coefficient of kinship for familial preterm delivery grandparents was more than 50 standard deviations higher (3.4 x 10(5) [P < .001]). CONCLUSION: This study confirms the familial nature of preterm delivery. On average, gravidae randomly selected from our population are 23rd degree relatives, while these preterm delivery probands are eighth-degree relatives. A genome-wide scan using these affected families is underway.

Adolescent↗

PubMed2005

Paternal age and preterm birth.

BACKGROUND: There is growing evidence that advanced paternal age can be a reproductive hazard. METHODS: We studied couples and their first children using nationwide registers in Denmark between 1980 and 1996. We restricted the analysis to mother's age 20-29 years. We estimated odds ratios (ORs) of preterm (< 37 weeks gestation) and very preterm birth (< 32 weeks) as a function of paternal age using logistic regression to adjust for potential confounding variables. RESULTS: The risk of preterm birth increased with paternal age, almost entirely resulting from an association for very preterm birth. Compared with fathers age 20-24 years, ORs for very preterm birth were 1.3 (age 25-29), 1.4 (age 35-39), 1.7 (age 40-44), 1.6 (age 45-49), and 2.1 (age 50+) (test for trend: P = 0.01). CONCLUSIONS: Risk of very preterm birth increases among older fathers, perhaps as a result of a paternal placental effect.

Adult↗

PubMed2006

Combined effects of prepregnancy body mass index and weight gain during pregnancy on the risk of preterm delivery.

BACKGROUND: The association between excessive gestational weight gain and preterm delivery is unclear, as is the association between low gestational weight gain and preterm delivery among overweight and obese women. METHODS: Using data from the Pregnancy Risk Assessment Monitoring System in 21 states, we estimated the risk of very (20-31 weeks) and moderately (32-36 weeks) preterm delivery associated with a combination of prepregnancy body mass index (BMI) and gestational weight gain among 113,019 women who delivered a singleton infant during 1996-2001. We categorized average weight gain (kilograms per week) as very low (<0.12), low (0.12-0.22), moderate (0.23-0.68), high (0.69-0.79), or very high (>0.79). We categorized prepregnancy BMI (kg/m) as underweight (<19.8), normal (19.8-26.0), overweight (26.1-28.9), obese (29.0-34.9), or very obese (>or=35.0). We examined associations for all women and for all women with no complications adjusting for covariates. RESULTS: There was a strong association between very low weight gain and very preterm delivery that varied by prepregnancy BMI, with the strongest association among underweight women (adjusted odds ratio = 9.8; 95% confidence interval = 7.0-13.8) and the weakest among very obese women (2.3; 1.8-3.1). Very low weight gain was not associated with moderately preterm delivery for overweight or obese women. Women with very high weight gain had approximately twice the odds of very preterm delivery, regardless of prepregnancy BMI. CONCLUSIONS: This study supports concerns about very low weight gain during pregnancy, even among overweight and obese women, and also suggests that high weight gain, regardless of prepregnancy BMI, deserves further investigation.

Adolescent↗

PubMed2005

Fatty acids in early human milk after preterm and full-term delivery.

BACKGROUND: It has been much debated whether fatty acid composition of human milk differs after preterm as compared to full-term delivery. SUBJECTS AND METHODS: Human milk samples were obtained from mothers of preterm (n = 8, gestational age: 28.0 [4.2] weeks, birthweight: 1,235 [420] g, median [interquartile range]) and full-term (n = 10, gestational age: 38.5 [2.7] weeks, birthweight: 3375 [282] g) infants every day during the first week and thereafter on the 14th, 21st, and 28th day of lactation. Fatty acid composition was measured by high-resolution capillary gas-liquid chromatography. RESULTS: Maternal age and body mass index did not differ, and food frequency questionnaire did not reveal significant differences in diet between the two groups. Fat contents of human milk did not differ between the two groups. Values of linoleic acid (C18:2n-6) and alpha-linolenic acid (C18:3n-3) did not differ throughout the study. Values of the metabolites C18:3n-6 and C20:3n-6 as well as C18:4n-3 and C20:3n-3 were significantly higher after preterm as compared with full-term delivery. Values of arachidonic acid (C20:4n-6; e.g., day 4: 0.82 [0.4] vs. 0.44 [0.28]; day 7: 0.61 [0.25] vs. 0.34 [0.25]; day 21: 0.33 [0.18] vs. 0.44 [0.44]; in weight percent, preterm versus full-term, P < 0.05) and docosahexaenoic acid (C22:6n-3; e.g., day 4: 0.33 [0.23] vs. 0.15 [0.14]; day 7: 0.26 [0.16] vs. 0.13 [0.15]; day 21: 0.11 [0.08] vs. 0.21 [0.17]; P < 0.05) were significantly higher in human milk samples of mothers of preterm as compared with full-term infants. CONCLUSION: In this study, percentage contributions of arachidonic and docosahexaenoic acids as well as the those of the intermediary metabolites of essential fatty acid metabolism were all significantly higher in early human milk samples of mothers giving birth to very low birth weight preterm as compared with full-term infants.

Adult↗

PubMed2003

Prevention of preterm birth by cervical cerclage compared with expectant management: a systematic review.

UNLABELLED: Our objective was to review the evidence on the use of cervical cerclage to prevent preterm births compared with expectant management. An OVID, MEDLINE, Cochrane Database, and Science Citation Index search using the medical subject headings and terms "cervical cerclage," "cervical incompetence" and "preterm delivery" was conducted for the period 1966 to 2002. We included all randomized trials that evaluated the effectiveness of cervical cerclage in preventing preterm birth. Using a standardized data collection instrument, we reviewed trial designs, inclusion and exclusion criteria, and maternal and neonatal outcome. Fixed or random effects model were used to pool both dichotomous and continuous outcomes where appropriate. Seven trials were identified; six met our inclusion criteria. A total of 2190 women enrolled into the trials were identified with 1110 receiving cerclage and 1080 managed expectantly. There were a total of 278 of 2190 (12.7%) deliveries before 34 weeks of gestation. The meta-analysis demonstrated a trend toward cervical cerclage preventing preterm delivery at less than 34 weeks (OR 0.77, 95% CI, 0.59, 0.99; P =.049). However, there was no demonstrable improvement in neonatal mortality (OR of 0.0.86, 95% CI, 0.56, 1.33; P =.50). There is a trend toward cervical cerclage reducing preterm births before 34 weeks. The use of cerclage is, however, associated with an increased risk of postpartum fever. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to compare the evidence on the use of cervical cerclage with preventing preterm births and to criticize the various articles evaluating the use of cervical cerclage.

Cerclage, Cervical↗

PubMed2005

Monocyte chemotactic protein-2 and -3 in amniotic fluid: relationship to microbial invasion of the amniotic cavity, intra-amniotic inflammation and preterm delivery.

OBJECTIVE: To evaluate the presence of monocyte chemotactic protein (MCP)-2 and MCP-3 in cervical and amniotic fluid in women in preterm labor. STUDY DESIGN: Cervical and amniotic fluid was sampled from women with singleton pregnancies (< or =34 weeks) in preterm labor (n = 58). RESULTS: Monocyte chemotactic protein-2 (range: 80-583 pg/ml) and MCP-3 (range: 36-649 pg/ml) were detectable in 7/58 women in preterm labor. Monocyte chemotactic protein-3 was found significantly more often in amniotic fluid of women delivered within 7 days (P < 0.001), <34 weeks (P = 0.002), or with intra-amniotic inflammation (P < 0.001) and microbial invasion of the amniotic fluid (P = 0.003). Women in preterm labor had detectable levels of MCP-2 significantly more often if they gave birth before 34 weeks of gestation (P = 0.038) or had intra-amniotic inflammation (P = 0.042). CONCLUSIONS: The presence of MCPs in amniotic fluid of women in preterm labor was associated with preterm birth before 34 weeks of gestation (MCP-2 and MCP-3), microbial invasion (MCP-3), and inflammation (MCP-2 and MCP-3) of the amniotic cavity.

Adult↗

PubMed1988

Plasma concentrations of C4b-binding protein and vitamin K-dependent protein S in term and preterm infants: low levels of protein S-C4b-binding protein complexes.

We have determined the plasma concentrations of protein S and C4BP in 25 term and 26 preterm infants by radioimmunoassay. Both the total concentration and the concentration of free protein S were quantified. The concentration of C4BP was very low in preterm infants (mean 6% of the adult level). In term infants, the level had increased to a mean of 18%. Total protein S was decreased both in preterm and term infants, 4.0 mg/l and 6.8 mg/l respectively, as compared to the mean adult concentration, 20.6 mg/l. In preterm infant plasma, free protein S was the predominant (85%) form, probably due to the very low C4BP level. In plasma from term infants, free protein S represented 68% of the total protein S, the corresponding value in adult controls being 37%. The plasma concentration of free protein S in preterm and term infants was 3.3 mg/l and 4.6 mg/l, respectively (mean adult value 7.6 mg/l). These results demonstrate that, while the total protein S concentration in preterm and term infants was very low in comparison to the adult level, the difference in the concentration of the anticoagulant, active, free form of protein S between infants and adults was less pronounced.

Adult↗

PubMed2004

Influence of inter-pregnancy interval on preterm delivery.

The influence of pregnancy spacing on preterm delivery (<37 weeks gestation) was examined in a group of mothers attending three Maternal and Child Health centres in three different districts in the city of Alexandria, Egypt between October 2001 and July 2002. All pregnant mothers attending the centres were interviewed or had their medical records reviewed. They were followed up until delivery and were questioned about current and past obstetric history and their medical history; their haemoglobin level was measured. The inter-pregnancy interval was calculated as the number of months between the delivery date of the women's last previous live infant and the date of the last menstrual period before the current pregnancy. There were 1202 pregnant women eligible for inclusion. The inter-pregnancy intervals were divided into five categories: <12, 12-36, 37-48, 49-60 and >60 months. We calculated the rates of preterm deliveries for each inter-pregnancy interval. Unadjusted odds ratios were estimated and stepwise logistic regression analysis was then used to adjust for all confounding factors. The rate of preterm delivery was 9.4%, and the lowest risk occurred in women who had an inter-pregnancy interval >60 months; 7.3% of those women gave birth to preterm infants. The rate of preterm delivery increased with increasing inter-pregnancy interval until 49-60 months; however, the association between inter-pregnancy interval and preterm delivery was not statistically significant whether using the crude or adjusted odds ratios.

Adult↗

PubMed2005

Smoking during pregnancy and preterm birth according to obstetric history: French national perinatal surveys.

The relation between smoking and preterm delivery is not totally known. Our aim was to determine whether smoking during pregnancy was associated with preterm birth among women at different risk according to their obstetric history. The study was based on data from the 1998 French national perinatal survey. Of the 13073 singleton live births, 4.7% were preterm; 15% of the pregnant women were moderate (one to nine cigarettes per day) and 10% heavy smokers (at least 10 cigarettes per day). Smoking heavily was related to preterm birth (crude odds ratio [OR] = 1.35, 95% confidence interval [95% CI]: [1.04, 1.74]). Multivariable logistic regression showed a relation between smoking and preterm birth among multiparae without previous adverse pregnancy outcomes; the associated adjusted ORs (AORs) were 1.25 [95% CI 0.83, 1.87] among moderate smokers and 1.46 [95% CI 0.98, 2.20] among heavy smokers. The corresponding AORs were 0.69 [95% CI 0.46, 1.05]) and 0.96 [95% CI 0.59, 1.56] for primiparae and 1.11 [95% CI 0.63, 1.93] and 0.50 [95% CI 0.25, 0.98] for multiparae with previous adverse pregnancy outcomes. Our study showed a relation between heavy smoking during pregnancy and preterm birth mostly for women with low obstetric risk.

Adult↗

PubMed2004

Trends in place of birth for preterm infants in New South Wales, 1992-2001.

OBJECTIVE: To examine trends in preterm births, especially those less than 33 weeks gestation, occurring in perinatal centres in New South Wales (NSW) from 1992 to 2001. METHODS: Population data were obtained from the NSW Midwives' Data Collection. Trends in the proportion of births in perinatal centres by gestation and by type of preterm birth (spontaneous or elective), and in Apgar scores and neonatal mortality were determined. RESULTS: The preterm birth rate increased from 6.1% in 1992 to 6.7% in 2001. Factors contributing to the increase in preterm births were multiple births and elective preterm deliveries. Births less than 33 weeks gestation in perinatal centres increased from 76% to 83% and for multiple births from 77% to 87%. This coincided with a decrease in 1-minute Apgar scores less than 4 but no significant change in 5-minute Apgar scores or neonatal mortality. CONCLUSIONS: Progress has been made towards the National Health and Medical Research Council guideline that births less than 33 weeks gestation occur in perinatal centres. Preterm births are increasing, creating greater demands for neonatal intensive care unit care and ventilation services.

Apgar Score↗

PubMed2005

Physician counselling practices and decision-making for extremely preterm infants in the Pacific Rim.

OBJECTIVES: This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability. METHODS: A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision-making for extremely preterm infants and demographic information. RESULTS: Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight. CONCLUSIONS: We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision-making and medical factors rather than social or economic factors in each country.

Adult↗

PubMed2005

Development and behavior of non-handicapped preterm children from a developing country.

BACKGROUND: There are many studies, mainly conducted in industrialized countries, concerning developmental and behavioral outcomes of preterm children. However, little is known about the outcomes of preterm children from developing countries. METHOD: Forty-three non-handicapped Turkish preterm children, 15 with very low birth weight and 28 with low birth weight at preschool age, as well as 36 term controls were compared on rates of developmental, emotional and behavioral impairments. Data were collected by review of hospital records and application of various questionnaires and inventories to both children and their parents. RESULTS: Preterm children had significant delays in general development and significant rise in somatic complaints with unknown medical etiologies. The very low birth weight group also had significant delay in language and cognitive development. Parents of the preterm children displayed significantly higher rates of democratic attitudes. Developmental outcome was significantly associated with birth weight and authoritarian parental attitudes where behavioral outcome was significantly influenced by birth weight. CONCLUSION: Presence of developmental delay is in accordance with existing data on the outcomes of preterm children from industrialized countries. An isolated increase in somatic complaints is an uncommon finding which might also be related to cultural factors.

Case-Control Studies↗