Born Too Soon

Preterm birth is a major world health problem. Statistics show the significant numbers of perinatal deaths due to preterm birth and the disproportionate numbers of children surviving preterm birth who suffer from physical and intellectual impairment. The problem affects countries in both the developed and the under developed world. Although the impact on third World countries differs as the prevalent disease states, malnutrition and limited medical facilities reduce the chances of survival. Since preterm infants usually remain in hospital for many weeks, largely dependent upon their gestational age at birth, costs per preterm infant are high. It has been estimated that the approximate cost of admission of a preterm infant at a London teaching hospital would range from £6,000 per infant at 28 weeks to £20,000 at 24 weeks (Wyatt & Spencer, 1992). In the UK, there is currently a nationwide shortage of neonatal intensive care costs. This problem is particularly acute in London and the South, and is made worse by a shortage of appropriately qualified neonatal intensive care nurses. In 1989, the neonatal intensive care unit of a London teaching hospital refused over 300 requests for admission from other hospitals because of a shortage of intensive care costs. Many of these infants eventually found places in other units, but some did not. The outcome for infants not admitted to a regional neonatal intensive care unit is recognised to be substantially impaired. In the light of a scarcity of resources and pressure on existing facilities some very difficult clinical decisions about intensive care for the preterm infant have to be made. The epidemiology and the causes of preterm birth are considered in this paper. As will be seen there is still much to learn about the causes of early delivery and it is important that more research is conducted in this area to improve our understanding in order that effective prevention programmes might be adopted. However, even with our limited knowledge, countries which have introduced prevention programmes have reduced their rates of preterm birth by as much as 30 per cent. Given the extent of physical and mental impairment among survivors of extremely preterm birth, it has been estimated that 20 per cent of survivors will have significant neurodevelopmental impairment, prevention clearly has an important role to play. Potential preventive efforts include true primary prevention, early identification of preterm labour or its premonitory signs and inhibition of labour. The prevention of preterm birth is discussed in more detail later in the paper.