Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth

Iams, Jay D.; Romero, Roberto; Culhane, Jennifer F.; Goldenberg, Robert L.

doi:10.1016/s0140-6736(08)60108-7

Cited by 406 publications

(333 citation statements)

References 167 publications

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“…Also, in 2007, Mathews TJ and MacDorman MF found a similar trend in the study of national infant mortality statistics in the USA 35 . Therefore, a major strategy in the reduction of neonatal deaths is to reduce the occurrence of preterm deliveries 36 . Moreover, considering both immediate and long-term prognosis, there is a need for extra ethical scrutiny of clinical decisions to resuscitate following deliveries at borderline viability, especially in medicallyunderserved regions.…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcome of preterm deliveries in Mother and Child Hospital Akure, Southwestern Nigeria

Oluwafemi

Abiodun

2016

Sri Lanka J Child Health

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Background: Preterm birth contributes significantly to neonatal deaths. Its burden should be defined to enhance interventions especially in resource-limited settings with poor neonatal health indices. Objectives:To determine the incidence of preterm delivery in the Mother and Child Hospital, Akure, to investigate the outcome and explore the relationship between birth weight and neonatal survival. Method:Demographic and clinical features (gestational age, birth weight and outcome) of consecutive preterm infants were documented for one and a half years. Incidence of preterm birth was computed, using total birth as the denominator. Quarterly incidence of preterm birth was presented graphically. Univariate logistic regression analysis of birth weight as a predictor of preterm death was done. P value <0.05 was considered significant. Results:Of 10,432 births during study period, 1,606 were preterm giving an incidence of preterm births of 15.4%. Among preterm infants, 1,449 (90.2%) had low birth weight (LBW), 123 (7.7%) very low birth weight (VLBW) and 34 (2.1%) extremely low birth weight (ELBW). Most (92.8%) preterm babies were discharged. Prematurity had a case fatality rate (CFR) of 5.6%. Compared to normal birth weight infants, ELBW babies were 250 times and VLBW infants 47.6 times more likely to die. ___________________________________________

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Section: Discussionmentioning

confidence: 99%

Incidence and outcome of preterm deliveries in Mother and Child Hospital Akure, Southwestern Nigeria

Oluwafemi

Abiodun

2016

Sri Lanka J Child Health

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“…To further this discrepancy, antibiotic treatment has never been shown to decrease rates of preterm delivery (10). In one study, antibiotic treatment of at-risk patients caused delivery earlier than that for patients not treated with antibiotics, highlighting a lack of knowledge of the exact mechanism underlying PTB and PEC (11)(12)(13). Although bacterial and viral factors may incite the inflammatory process without evidence of infection by cultures or histology, it is possible that another more sterile process might be at work.…”

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confidence: 99%

TLR9 Provokes Inflammation in Response to Fetal DNA: Mechanism for Fetal Loss in Preterm Birth and Preeclampsia

Scharfe-Nugent

Corr

Carpenter

et al. 2012

The Journal of Immunology

150

157

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Preterm birth, the major cause of neonatal mortality in developed countries, is associated with intrauterine infections and inflammation, although the exact mechanisms underlying this event are unclear. In this study, we show that circulating fetal DNA, which is elevated in pregnancies complicated by preterm labor or preeclampsia, triggers an inflammatory reaction that results in spontaneous preterm birth. Fetal DNA activates NF-κB, shown by IκBα degradation in human PBMCs resulting in production of proinflammatory IL-6. We show that fetal resorption and preterm birth are rapidly induced in mice after i.p. injection of CpG or fetal DNA (300 μg/dam) on gestational day 10–14. In contrast, TLR9−/− mice were protected from these effects. Furthermore, this effect was blocked by oral administration of the TLR9 inhibitor chloroquine. Our data therefore provide a novel mechanism for preterm birth and preeclampsia, highlighting TLR9 as a potential therapeutic target for these common disorders of pregnancy.

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“…r ecent developments in neonatology and improvements in technology to manage preterm neonates have significantly increased the survival of very-preterm neonates (less than 28 wk of gestation) and very-low-birth-weight infants (less than 1,500 g) (1). However, the relative risk of neonatal death is much greater for preterm infants than for full-term infants, and prematurity has become the leading cause of perinatal morbidity and mortality (2,3).…”

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confidence: 99%

Preterm neonates show marked leukopenia and lymphopenia that are associated with increased regulatory T-cell values and diminished IL-7

et al. 2012

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IntroductIon: current advances in neonatology have improved survival among preterm and low-birth-weight infants. however, the risk of neonatal death in preterm infants is much greater than in full-term neonates and is frequently associated with infections. Methods: Little is known about the immune status of preterm neonates; therefore, we analyzed the frequency and absolute counts of different immune populations in 211 cord blood samples taken from very-preterm to full-term neonates. results: We found that absolute counts of all the immune subsets analyzed (i.e., monocytes, granulocytes, B cells, natural killer (NK) cells, cD4 + , and cD8 + T cells) were markedly lower in preterm infants than in full-term infants. surprisingly, we observed that regulatory T cells (Tregs) were the only cell subset that did not decrease in preterm infants, and their frequency was even higher than in full-term infants. dIscussIon: Tregs are crucial to maternal-fetal tolerance, but their suppressive role could be also implicated in the leukopenia observed in preterm infants. We did not observe differences in thymic function, but we found that plasma levels of interleukin (IL)-7 and the frequency of its receptor were significantly decreased in preterm infants. Our results could help to identify leukopenia and to implement immune therapies that significantly diminish mortality in preterm neonates. r ecent developments in neonatology and improvements in technology to manage preterm neonates have significantly increased the survival of very-preterm neonates (less than 28 wk of gestation) and very-low-birth-weight infants (less than 1,500 g) (1). However, the relative risk of neonatal death is much greater for preterm infants than for full-term infants, and prematurity has become the leading cause of perinatal morbidity and mortality (2,3). Along with decreasing gestational age (GA), low birth weight is also associated with increased perinatal morbidity and mortality (4). Among the causes responsible for this increased mortality, neonatal sepsis and bronchopulmonary dysplasia are the most frequent causes of death in premature newborns (3).In fact, the most important factors that predispose to infection are prematurity and/or low birth weight.Little is known about innate immunity in premature neonates and the capacity of their immune systems to fight against infections. Several authors have reported differences in phenotype and function of lymphocytes between healthy newborns, children, and adults (5). The immune response of preterm infants is assumed to be immature, although quantitative data on differences in immune capacity between preterm and full-term infants are scant.The objective of this study was to investigate whether the high incidence of infections in preterm infants could be due to an immunodeficiency and, if so, to identify which immune cell populations are implicated in the absence of an adequate immune response. We performed a comprehensive analysis of the frequency and absolute counts of several cell populations in preter...

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Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth

Cited by 406 publications

References 167 publications

Incidence and outcome of preterm deliveries in Mother and Child Hospital Akure, Southwestern Nigeria

Incidence and outcome of preterm deliveries in Mother and Child Hospital Akure, Southwestern Nigeria

TLR9 Provokes Inflammation in Response to Fetal DNA: Mechanism for Fetal Loss in Preterm Birth and Preeclampsia

Preterm neonates show marked leukopenia and lymphopenia that are associated with increased regulatory T-cell values and diminished IL-7

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