Preterm birth

Question 1

What is the definition of preterm birth?

Answer 1

• Birth at or before 37 weeks of gestation
• Moderate to late preterm birth is defined as 35-37 weeks
• Early preterm birth is defined as 32-34 weeks
• Very early preterm birth is defined as prior to 32 weeks
• Extremely preterm birth is defined as 28-32 weeks
• Micro preterm birth is defined as prior to 28 weeks
• Significant risk to health and development from micro preterm all the way to late preterm birth

Question 2

Prevalence of preterm birth

Answer 2

• 7-8% of all UK births are estimated to be preterm births
• Globally it is hard to get accurate as access to antenatal care varies massively by nation and economic status making dating a pregnancy problematic
• Preterm birth is evident globally, making preterm birth relevant for the UN, and the WHO

Question 3

What are the factors affecting preterm prevalence?

Berkowitz et al (1998)

Answer 3

Many spontaneous preterm births are idiosyncratic, and the cause of the early labour are not identified

Research has highlighted several risk factors for preterm birth:

• Previous preterm pregnancy
• ART pregnancy (IVF etc)
• Maternal physical illness
• Maternal perinatal mental illness
• Age of parents
• Maternal gestational condition (e.g. preeclampsia)
• Poverty
• BAME
• Multiparous birth (twins, triplets etc)

Question 4

Why is preterm birth considered a challenge to development?

Answer 4

• In earlier stages of gestation the organs, tissues, and skin are developing; lungs are among the last organs to fully develop
• In the later stages of gestation growth continues of the now formed foetus, and the lungs/eyes/ears/brain begin to prepare for the onslaught of stimuli they are going to encounter following birth
• Preterm birth is still the leading global cause of infant mortality and morbidity in children under 5 years of age

Question 5

Effects of preterm birth on development?

Answer 5

• Survival rates of infants born preterm, and their birthing parents, have massively improved in recent decades
• Survival rate improvement in down to antenatal care, improved specialist neonatal intensive care units, equipment, and drugs
• Survival rates in the UK for infant born at 22 weeks or earlier is around 0. By 23 weeks survival rates jump to 19%, by 24 weeks its 40%, at 25 weeks its 66%, and at 26 weeks its 77%
• Survival rates vary based on location –> in Sub Saharan Africa 990% of extremely preterm babies die within days of birth
• Complications from preterm birth remains the leading cause of child mortality for children under 5
• 25% of infants born 26-27 weeks have long lasting disability, with 50% having behavioural disorders/developmental delay

Question 6

What are the immediate physical challenges to preterm birth?

Answer 6

• Retinopathy of prematurity (visual impairment associated with prematurity)
• Hearing impairment
• Stroke
• Lung disease
• Gastrointestinal disease

Question 7

Development in preterms: Language

Answer 7

• Guarni et al (2016) studied language development in 60 children born preterm and 60 children born term
• Standardised assessments scored children on cognitive, memory, and language
• Preterm children showed delays specially in comprehension, production, and grammar
• Van Noort-van der Spek (2012) in their review found that preterm children’s language development was found to be delayed even when no other domains of development were present, and even when social economic status was controlled for.
• Recommendation was to focus on early intervention to support the foundations of language learning

Question 8

What are the theories relevant to developmental change?

Answer 8

1. Neuroconstructivism –> can be applied to consider the effects of challenges to development
2. Ecological theory –> considers the different levels of a person’s ecological system that may directly or indirectly affect them
3. Attachment theory –> focuses on the importance of early experience for forming the foundational early social bonds

Question 9

Theories of preterm development: Neuroconstructivism

Answer 9

• Argues that child development occurs by experience-dependent changes to neural structures, that lead to changes in neural functions, cognitive processes and behaviour
• No domain of development (e.g. motor, language, or social-emotional) develops in isolation, so something that impacts motor development may indirectly impact language

Question 10

Theories of preterm development: Ecological model

Answer 10

• Biological vulnerabilities of the prematurely born infant are compounded by the physical environment of the NICU, inhibited parent-infant contact and feeding, increased parent mental illness post preterm birth, increased challenge to family economy, and will also be affected by health and education policies and the period of time in which children are born