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Preterm Birth: Causes, Consequences, and Prevention
natal care have led to improved rates of survival among preterm infants, including those born when they are as young as a gestational age of 23 weeks. However, surviving infants have a higher risk of morbidity. Neuro-developmental disabilities can range from major disabilities such as cerebral palsy, mental retardation, and sensory impairments to more subtle disorders, including language and learning problems, attention deficit hyperactivity disorder, and behavioral and social-emotional difficulties. Preterm infants are also at increased risk for growth and health problems, such as asthma or reactive airway disease (see Chapter 11 for review).
Although significant improvements in treating preterm infants and improving survival have been made, little success in understanding and preventing preterm birth has been attained. The complexity of factors that are involved in preterm birth will require a multidisciplinary approach to research directed at understanding its etiologies, pathophysiology, diagnosis, and treatments. However, there are barriers to the recruitment and participation of scientists in these investigations. A critical barrier to research is the demand on clinical researchers in academic centers to provide clinical income and other duties that take them away from research. This necessitates the development of new ways to provide support to allow the time to conduct this important research.
The challenge for researchers and clinicians remains to identify interventions that prevent preterm birth; reduce the morbidity and mortality of the mother or the infant, or both, once preterm birth occurs; and reduce the incidence of long-term disability in children in the most comprehensive and cost-effective manner possible.
CONTEXT AND CHARGE TO THE COMMITTEE
The persistent and troubling problem of preterm birth prompted IOM to convene a committee to assess the current state of the science on the causes and broad consequences of preterm birth. This interest was generated by the IOM Roundtable on Environmental Health Sciences, Research, and Medicine, which convened a workshop in October 2001 focused on the role of the environment in preterm birth. In 2003, the Roundtable published a factual summary of this workshop in The Role of EnvironmentalHazards in Premature Birth (IOM, 2003). The Roundtable members, concerned that research into understanding preterm birth was not progressing as fast as was hoped, believed that progress could be made if researchers had an agenda to follow, an agenda that would help focus and direct research efforts for the variety of disciplines needed to address this problem.
With assistance from the study sponsors, the Committee on Understanding Premature Birth and Assuring Healthy Outcomes was established. The sponsors include the National Institute of Child Health and Human