Running head: POPULATION AT RISK: PREMATURE INFANTS
Population at Risk: Premature Infants
April K. Greene Ferris State University
POPULATION AT RISK: PREMATURE INFANTS
2 Information found within an article on MedlinePlus, titled Premature Births, states that every year, approximately 500,000 infants, or 1 in every 8 babies, are born prematurely. A pregnancy is considered to be full-term at 40 weeks gestation; anything before 37 weeks is considered premature. Although these babies can be born mostly healthy, they are often not. Because important growth and development occur throughout the entire pregnancy, this can be halted by the early birth. Preterm infants, or preemies, are at risk for many health and developmental problems. These complications can include low birth weight, disabilities such as cerebral palsy, and in the most tragic situations, death. Premature infants require special care immediately after birth and are required to spend time in a neonatal intensive care unit until their organs are able to fully function on their own (Premature Births, 2015). Demographics The most prevalent rates of premature births are seen in non-Hispanic blacks, with Hispanics having slightly lower rates, and non-Hispanic whites having the lowest rates in the United States. In the US, minor differences from year to in the number of premature births are also found (refer to Appendix A). Rising Preterm Birth Rates, 1989-2004: Changing Demographics or Changing Obstetric Practice?, by Tyler Vanderweele, John Lantos, and Diane Lauderdale, discusses some statistics of premature births. Compared to other countries across the globe, the rates of premature births are rising and occurring more frequently in the United States than in any other country. Some epidemiologists attribute this to changing demographics within the American culture. There are higher rates of infertility, multiple births, and older mothers, which can be a risk for early birth. Other researchers believe this change is attributed to the change in obstetrics practice (VanderWeele, Lantos & Lauderdale, 2012).
POPULATION AT RISK: PREMATURE INFANTS
3 Health Concerns The website for the organization The March of Dimes discusses the health concerns associated with premature birth. The most common conditions to occur in premature infants include respiratory distress syndrome, chronic lung disease/bronchopulmonary dysplasia, apnea and bradycardia, retinopathy of prematurity, and jaundice. Not only can premature birth cause immediate and imminent health problems in the newborn, it can affect the health of the individual throughout life. The earlier the baby is born, the more likely health issues are going to occur. Preterm birth can affect intellectual and developmental growth, lung maturity and breathing, intestinal maturity, immune system functioning, vision, dental, and hearing. Communication with others, self-care, interpersonal relationships, learning, physical development, behavior, and neurological development can be delayed or lacking in individuals born prematurely. Bronchopulmonary dysplasia, asthma, hearing loss, and necrotizing enterocolitis are also health concerns that can occur in these individuals. In these instances, it is important to be aware of the complications that can occur throughout the life span so that the problems may be properly addressed (Marchofdimes.org, 2015). Prevalent Disease Process As stated in Prophylactic Phototherapy for Preventing Jaundice in Preterm or Low Birth Weight Infants, by Oksundu, Okoromah, and Shah, bilirubin, a yellow pigment produced during the recycling of aging red blood cells, is supposed to bind and conjugate. About 80% of preterm infants develop hyperbilirubinemia because the bilirubin is unconjugated or unbound. This causes neonatal jaundice. In the occurrence of jaundice, there are various treatment options. Treatment of the underlying cause is pertinent in this case. The use of phototherapy,
POPULATION AT RISK: PREMATURE INFANTS
4 administration of immunoglobulins, and exchange transfusion in severe cases are all effective treatment options of jaundice and hyperbilirubinemia. Phototherapy is the number one treatment in cases of jaundice. It decreases the amount of unconjugated bilirubin and leads to photoisomerisation of bilirubin into a water-soluble substance that the kidneys can excrete. Although generally safe, a complication known as bronze baby syndrome can result in water loss and dehydration and can also cause damage to developing retina. Because there is no way to predict a safe level of bilirubin in low birth weight infants, prophylactic therapy is suggested and often used. If jaundice and hyperbilirubinemia is left untreated, permanent brain damage or death can occur (Okwundu, Okoromah & Shah, 2012). According to Mechanisms and Management of Retinopathy of Prematurity, by Elizabeth Hartnett and John Penn, retinopathy of prematurity is another major health concern related to premature births. It is a vision-threatening disease in which there is abnormal retinal vascular development. This only occurs in babies born prematurely and is heavily associated with low birth weight; it has become a leading cause of blindness in children across the world. Frequently examining at risk preterm infants for retinal problems is important. Visual rehabilitation and laser treatment of peripheral avascularity are substantial treatment options in this case. Several causes have been found to be risk factors for retinopathy, with the largest cause being retinal hypoxia (Hartnett & Penn, 2013). Health Policy There are numerous health care policies intended to reduce the number of premature births, as well as reduce the number the health concerns associated with these early births. The PREEMIE Reauthorization Act, or the Prematurity Research Expansion and Education for
POPULATION AT RISK: PREMATURE INFANTS
5 Mothers who deliver Infants Early Reauthorization Act, can be found on the United States Congress website. This policy is broken apart into a number of sections. Section 102 amends the previous act to revise and reauthorize requirements for research on prematurity and preterm births. The Director of the CDC is authorized to conduct epidemiological studies on all factors associated with prematurity, conduct activities to improve tracking efforts of premature births, and to identify opportunities for prevention and the impact on the prevention of preterm births. Section 103 addresses grant funds to establish telehealth networks that provide prenatal care for high-risk pregnancies. Activities to provide information and education to the public, as well as health care providers, on the core risk factors for preterm labor and delivery, treatments and outcomes for premature infants, medically indicated deliveries before full term, the importance of preconception and prenatal care, utilization of evidence-based strategies to prevent birth injuries, and meeting the needs of families during an infants stay in the NICU are all introduced. Section 104 authorizes the Secretary to establish the Advisory Committee on Infant Mortality, and allows development of plans to conduct research, education, and programs on preterm birth through the Department of Health and Human Services (PREEMIE Reauthorization Act, 2015). Conclusion The prevalence of births occurring before 37 weeks is decreasing as medical technology and knowledge is increasing. The complications and health concerns associated with these preterm births can be life threatening, but with proper treatment and management, can be prevented and kept at a minimum. It is important to follow proper prenatal care during pregnancy in order to most effectively prevent complications and to have a healthy happy baby. Although this particular population of individuals is at risk for health concerns, as well as other
POPULATION AT RISK: PREMATURE INFANTS
6 concerns, with proper care and attention, this can be improved and ultimately changed for the better.
POPULATION AT RISK: PREMATURE INFANTS
7 References Cdc.gov,. (2015). Products - Data Briefs - Number 39 - May 2010. Retrieved 9 October 2015, from http://www.cdc.gov/nchs/data/databriefs/db39.htm Civic Impulse. (2015). H.R. 541 113th Congress: PREEMIE Reauthorization Act. Retrieved from https://www.govtrack.us/congress/bills/113/hr541 Hartnett, M., & Penn, J. (2013). Mechanisms and Management of Retinopathy of Prematurity. Survey Of Anesthesiology, 57(5), 239-243. http://dx.doi.org/10.1097/01.sa.0000433219.95127.da Marchofdimes.org,. (2015). Long-term health effects of premature birth | March of Dimes. Retrieved 9 October 2015, from http://www.marchofdimes.org/baby/long-term-healtheffects-of-premature-birth.aspx Nlm.nih.gov,. (2015). Premature Babies: MedlinePlus. Retrieved 9 October 2015, from https://www.nlm.nih.gov/medlineplus/prematurebabies.html Okwundu, C., Okoromah, C., & Shah, P. (2012). Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. The Cochrane Database Of Systematic Reviews, 1. http://dx.doi.org/10.1002/14651858.CD007966.pub2 VanderWeele, T., Lantos, J., & Lauderdale, D. (2012). Rising preterm birth rates, 19892004: Changing demographics or changing obstetric practice?. Social Science & Medicine,74(2), 196-201. http://dx.doi.org/10.1016/j.socscimed.2011.10.031