Premature Birth: Medical And Social Consequences
This Systemic Review takes a closer look at what are the medical and social consequences of preterm birth. It is hypothesized that families with preterm babies who have any morbidities have a lot of need for medical treatment which in the long run will disturb the process of having attachment postnatally and thus this will have an impact on the parental stress, and parent-child-relationship, and quality of life of the family. This systemic review will also look at the what are the mental and physical child developmental delays a preterm individual face (e. g. school performance, comorbidities) during the time of life, and how does this shape their outlook on their quality of life.
Abstract
Hypothesis: This Systemic Review takes a closer look at what are the medical and social consequences of preterm birth. It is hypothesized that families with preterm babies who have any morbidities have a lot of need for medical treatment which in the long run will disturb the process of having attachment postnatally and thus this will have an impact on the parental stress, and parent-child-relationship, and quality of life of the family. This systemic review will also look at the what are the mental and physical child developmental delays a preterm individual face (e. g. school performance, comorbidities) during the time of life, and how does this shape their outlook on their quality of life.
Methods: Data from various studies was compiled to determine the medical and social consequences of preterm birth. There was a separate search to determine the mental and physical developmental delays for individuals who are born preterm. Another search was conducted to find out about various social outcomes that individuals who are preterm born face. Databases used in this meta-analysis included PubMed, Google Scholars, NCBI, Columbia University Database and ProQuest.
Results: Data showed that individuals born preterm will have a different outlook on life compared to their full-term birth peers. Apart from the medical aspect of being born preterm, research has shown that individuals can have cognitive delays, developmental delays, and lower social economic status and overall lower quality and satisfaction with life when compared to full term birth adults.
Conclusion: Preterm birth rate is significantly declining in many developing countries, currently, about one in every eight infants in the USA is born prematurely. There are substantial consequences of preterm birth such as higher rate infant morbidity and mortality, increased risk of long-term complications and neurodevelopmental impairment. Preterm birth is also associated with family stress and a significant amount of societal cost. The prevention of preterm birth is a public health priority.
Keywords: Preterm Birth; Social Consequences; Medical Consequences; Developmental Delay; Cognitive delays.
Introduction
The prevalence of preterm birth in the United States forms a public health problem, but unlike many health problems that are present, the rate of preterm births have increased in the last decade ("Preterm Birth. " 2018). According to the Center for Disease Control premature birth (before 37 weeks of pregnancy) is the leading cause of death of infants in the United States ("CDC National Health Report Highlights. "). Every year there is an estimated 15 million babies born preterm and this number is escalating. Infants born preterm are at greater risk than infants born at term for mortality and variety of health and developmental problems ("Preterm Birth. " 2018). Children born prematurely today are more likely to survive without serious disability than those born years ago, but they are still in danger of developmental delays. Complication from preterm birth is one of the leading causes of death among children under 5 years of age (Lui, Li; 2016). Those infants who do survive preterm birth have a greater risk of developmental disabilities, health, and growth problems than infants born at full term, despite the advances in perinatal and neonatal care. Children who survive preterm birth can have serious and lifelong health conditions such as acute respiratory (breathing problems, asthma), gastrointestinal (jaundice), immunologic, central nervous system (e. g. cerebral palsy and intellectual delays) according to the March of Dimes ("The Global Problem of Premature Birth").
The birth of preterm infant can also bring considerable emotional and economic cost to families. A 2006 report from the Institute of Medicine estimated the annual cost of preterm birth in the United States to be $26. 2 billion or more than $51,000 per premature infant ("Preterm Birth: Causes, Consequences, and Prevention. " 2007). Health disadvantages, cost of health care and cost of living become major factors for families with preterm birth babies, this, in the long run, affects the preterm individuals into their adult life, affecting their quality of life. This Systemic Review takes a closer look at what are the medical and social consequences of preterm birth. It is hypothesized that families with preterm babies who have any morbidities have a lot of need for medical treatment which in the long run will disturb the process of having attachment postnatally and thus this will have an impact on the parental stress, and parent-child-relationship, and quality of life of the family.
This systemic review will also look at the what are the mental and physical child developmental delays a preterm individual face (e. g. school performance, comorbidities) during the time of life, and how does this shape their outlook on their quality of life. While this article does not state the risk factors for preterm birth, one must keep those in mind. The exact cause of preterm birth can be difficult to determine and it can be multifactorial. Identifying women at high risk of giving birth early would enable the health services to provide specialized care for these women to delay the birth or make sure they are in the best place to give birth (for example a hospital with a special care baby unit). Many factors including mothers' medical histories as well as smoking, eating and drinking habits during pregnancy can influence the odds of preterm birth or an underweight infant. Methods There is a need for clarity of terminology.
In the research literature, terms characterizing the duration of gestation, fetal growth, and maturation have been applied inconsistently and have been used interchangeably. This factor made it difficult to interpret the data on the causes and consequences of preterm birth, thus differing the results from various studies According to the World Health Organization, Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age: extremely preterm (less than 28 weeks), very preterm (28 to 32 weeks), moderate to late preterm (32 to 37 weeks) ("Preterm Birth. " 2018). Understanding this terminology was crucial to retrieve information from the medical literature. Search strategy The databases MEDLINE and PubMed, Google Scholars, NCBI, Columbia University Database and ProQuest were searched using a prespecified search strategy. US National Library of Medicine Medical Subject Headings (MeSH) terms and/or keywords included preterm birth; low birthweight; premature; social; social interaction; psychosocial; relationships; and behavior. In addition to searching these databases, reference checking and citation searching from identified papers was also carried out. Potentially relevant articles were retrieved and saved in an EndNote library. These studies were then assessed for potential review.
Assessment of Studies
Study selection took a step-wise approach. Article titles and, where available, abstracts were screened to determine whether they fulfilled eligibility criteria. Where abstracts were unavailable, full papers were retrieved for consideration. Papers meeting the full criteria were retrieved for detailed assessment. A flow chart showing the number of studies remaining at each stage was used to document this selection process (Fig. 1). ResultsThe search on databases stated in the introduction of this paper identified a total of 1103 records of which 1060 were excluded based on title and abstract, leaving a total of 43 articles for retrieval and full study assessment. There has been an incredible amount of research that has taken place in analyzing the medical and social consequences of preterm birth. Each study is unique with its preterm infants' criteria and assesses different aspects of medical and social consequences of preterm birth. Studies have shown that premature infants are at greater risk for cerebral palsy, delays in development both physical and social, hearing problems and sight problems.
The earlier an infant is born in the gestational period the greater the risk is present. A study taken place at the University of Cambridge UK analyzed the subjective well-being of adults born preterm. Their method of research was to do an online survey of adult-born preterm and full-term. In this survey, individuals answered questions on their subjective well-being (life, relationship, job satisfaction, and health). The authors concluded as those adults who are born preterm has similar levels of relationship satisfaction, but poorer health, life satisfaction, and job satisfaction when compared to adults who were born full term. Their study also showed that preterm adults were also likely to have developed chronic conditions such as asthma and were more likely to be hospitalized for psychiatric conditions (Winstanley; 2015).
The research at Cambridge University also showed that preterm birth adults were more likely to have a diagnosis of ADHD or autism spectrum disorder and be taking prescription medicine when compared to full term birth adults. They also compared data for preterm adolescents, and they reported as having fewer social interactions than full-term adolescents. In the survey conducted preterm adults also reported as less likely to have children, which was concluded by the study to yield in their lower satisfaction with life (Winstanley; 2015).
The most common neurological impairment in preterm birth children is cognitive function. A very important study on the cognitive development of preterm birth took place in UK and Ireland. This study compared preterm and full-term birth individuals. The study stated that low cognitive test scores in infancy and early childhood reflect adult outcomes. (Linsell L; 2017) Studies conducted up until childhood and young adulthood suggest that individuals born late preterm may be at an increased risk of neurodevelopmental disabilities (e. g. , mental retardation, cerebral palsy), they more often experience school-related problems, and they perform poorer on academic achievement and neurocognitive tests (Heinonen; 2015). Apart from the medical consequences, another aspect to consider is the social consequence of preterm birth. One of the social consequences of preterm birth is the cost of having a preterm infant. There can be a tremendous load on the family, especially considering if the individual is from a low socioeconomic status. There is a substantial amount of research literature related to hospital expenses and medical expenses with preterm birth. One such study conducted in Italy looked at the cost of care and social consequences low birth weight infants.
The study presented that the initial hospitalization accounted for a majority of health care cost during the first 18 months of life for an individual. But if the individual is born preterm their initial length of stay and more readmissions and outpatient visits during the follow-up period resulted in higher health care cost for the reported preterm adults (Cavallo; 2015). There have been only a few studies which focused on the healthcare and non-healthcare cost of preterm infants after the first year of life. There is a considerable amount of evidence that hospitals represent a huge portion of the total cost, individual families with preterm infants or adult individuals who were born preterm can also suffer from direct losses, such as the cost of uncovered drugs, hospital travel costs. These costs are rarely investigated. The last aspect explored in this paper was the relationships of parents to their preterm children. This was considered important because the physical and emotional attachment to the parents that children develop shape their future relationships and life skills.
One such cohort study which was done used administrative healthcare data with patient-reported primary data done in Germany. This study presented with the research stating that long-term problems of preterm delivery can be associated with disturbed parent-child interaction originating at the time of birth (Schmitt; 2016). This study presented several intervention programs that are used in Germany aiming to strengthen the early parent-child relationship. Programs such as FamilieNetz, which is a support and training program for families of sick newborns and preterm infants.
Discussion/Conclusion
Preterm birth rate is significantly declining in many developing countries, currently, about one in every eight infants in the USA is born prematurely. There are substantial consequences of preterm birth such as higher rate infant morbidity and mortality, increased risk of long-term complications and neurodevelopmental impairment. Preterm birth is also associated with family stress and a significant amount of societal cost. The prevention of preterm birth is a public health priority. The existing evidence suggests that those born preterm have higher mortality and suffer more often from medical complications due to immaturity. Individuals born preterm, in their childhood adolescence, show increased risk of medical and neurodevelopmental disabilities. They perform poorer in cognitive test and have lower academic achievements when compared to their full term born peers. Preterm birth individuals also show behavioral, emotional and attention problems. In adulthood, preterm birth adults report lower life satisfaction and poor job satisfaction. A reduced hospital length of stay, a higher gestational age, and an increasing birth weight are likely to result in cost savings and thus improve the cost-effectiveness of care of preterm infants (Cavallo; 2015).
This can eventually help families from the lower Socioeconomic status. Also, further prevention of morbidities during the prenatal period and increased quality of care provided by Neonatal Intensive Care Units (NICU) can significantly reduce the cost of prematurity. To help with the cognitive impairment, a positive behavioral screening in infancy can change the long-term outcome (Linsell L; 2017). The introduction of screening into routine follow-up may help to improve preterm infants’ cognitive development. The association between the level of maternal education and socioeconomic status and cognitive outcome in both term and preterm populations has been frequently reported, yet there was only weak evidence of this association in the research literature obtained. Since some of the long-term problems of preterm delivery are associated with a disturbed parent-child interaction originating in the neonatal period, several intervention programs such as (FamilieNetz) are available aiming to strengthen the early parent-child relationship. FamilieNetz is a Novel support and training program for families of sick newborns and preterm infants. This study has shown that if there is effective/specialized family-centered care, this will minimize the long-term consequences of child development, quality of life and healthcare utilization.
