Neonatal complications following preterm birth

Abstract

Improvements in neonatal intensive care during the last 20 years have increased the survival of the most immature newborns at 23 weeks from 0% to 65% at some centres, although rates vary widely among neonatal care centres. University of Utah, USA data show that each week in utero after week 23 raises survival by 6-9%, to 90% by 27-28 weeks and 95% by 33 weeks. Provision of care in specialised centres to provide high-risk obstetric and neonatal intensive care, prenatal treatment with corticosteroids, postnatal treatment with surfactant and nitric oxide, and improvements in respirators and equipment to care for extremely immature infants all contribute to these changes. The increased rate of survival for extremely premature newborns has not been accompanied by an increased rate of severe intraventricular haemorrhage or neurological impairment, such as cerebral palsy. Regardless, intraventricular haemorrhage remains a significant problem, especially if associated with post-haemorrhagic hydrocephalus, leading to long-term neurological impairment and decreased survival. Necrotising enterocolitis (NEC) is more common in premature than in term newborns and is the most frequent cause of short bowel syndrome in infancy. Survival after surgery for NEC has improved during the last two decades, but complications of nutritional support produce many long-term problems. Retinopathy of prematurity (ROP) remains a frequent cause of neurosensory impairment for extremely premature newborns. Laser photocoagulation for advanced ROP is more effective than cryotherapy for preventing retinal detachment and improving visual outcomes. Despite prenatal corticosteroid treatment and postnatal surfactant administration, many extremely premature newborns still develop bronchopulmonary dysplasia. Abnormal pulmonary function may persist into adulthood, but newer ventilators and management schemes appear to be reducing this long-term morbidity. Many changes in neonatal care occur each year, but carefully controlled outcome studies are needed to evaluate the effectiveness of these newer styles of neonatal intensive care.

Smoothelin-like 1 Protein Is a Bifunctional Regulator of the Progesterone Receptor during Pregnancy

“…The phenotypic changes in this phase are modulated by mechanical stimuli and sex-related hormones, such as progesterone and estrogen. The molecular mechanisms regulating the transition of the USM through these different stages are limited, and investigation of these mechanisms is of great importance given the fact that preterm labor is still the leading cause of neonatal morbidity and mortality (5,6).…”

Neonatal predictors of cognitive ability in adults born very preterm: a prospective cohort study

“…5 The same is true for neonatal complications such as bronchopulmonary dysplasia 6 that are associated with an increased risk of brain injury. 7 Treatments such as mechanical ventilation may adversely affect cognitive development, 8 while nutritional support may help improve neurodevelopmental outcomes.…”

e Brazelton Neonatal Behavioral Assessment Scale: A validity and reliability study in a Turkish sample

“…Correlation between items and factor is explained by factor loading value (factor coefficient) and factor loading needs to be a minimum of 0.40 for any item to be assumed within the scope of a factor (13). In this direction, items of the scale in terms of factor loadings were as follows: items 23,22,14,15,2,24,21,12,10,7,9,1,13,11,4,3,25,6,5,8,16,26, and 18 were in the first factor and items 33, 31, 30, 32, 34, 35, and 29 were in the second factor. In accordance with analysis results, items receiving loadings from factors of the BNBAS were examined and the first factor consisting of 23 items was named the "Behavior Subscale" and the second factor consisting of 7 items was named the "Support Subscale".…”

“…The survival rate of newborns has increased as a result of the developments in science and technology (1,2). However, this leads newborns to stay in the hospital for a long term in neonatal intensive care units (NICUs) due to various health problems (respiratory, cardiovascular, gastrointestinal, etc.).…”