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Preterm Birth: Causes, Consequences, and Prevention (2007)

Chapter: Section IV Recommendations

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Suggested Citation:"Section IV Recommendations ." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
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Section IV
Consequences of Preterm Birth

RECOMMENDATIONS


Recommendation IV-1: Develop guidelines for the reporting of infant outcomes. The National Institutes of Health, the U.S. Department of Education, other funding agencies, and investigators should develop guidelines for determining and reporting outcomes for infants born preterm that better reflect their health, neurodevelop-mental, educational, social, and emotional outcomes across the life span and conduct research to determine methods that can be used to optimize these outcomes.


Specifically,


  • Outcomes should be reported by gestational age categories, in addition to birth weight categories; and better methods of measuring fetal and infant maturity should be devised.

  • Obstetrics-perinatology departments and pediatrics-neonatology departments should work together to establish guidelines to achieve a more uniform approach to evaluating and reporting outcomes, including ages of evaluation, measurement tools, and the minimum duration of follow-up. The measurement tools should cover a broad range of outcomes and should include quality of life and the elicitation of outcome preferences from adolescents and adults born preterm and their families.

  • Long-term outcome studies should be conducted into adolescence

Suggested Citation:"Section IV Recommendations ." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
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and adulthood to determine the extent of recovery, if any, and to monitor individuals who were born preterm for the onset of disease during adulthood as a result of being born preterm.

  • Research should identify better neonatal predictors of neurodevelopmental disabilities, functional outcomes, and other long-term outcomes. These will allow improved counseling of the parents, enhance the safety of trials of interventions for mothers and their infants by providing more immediate feedback on infant development, and facilitate planning for the use of comprehensive follow-up and early intervention services.

  • Follow-up and outcome evaluations for infants involved in maternal trials of prenatal means of prevention or treatment of threatened preterm delivery and infant trials of means of prevention and treatment of organ injury not only should report the infant’s gestational age at delivery and any neonatal morbidity but also should include neurological and cognitive outcomes. Specific outcomes should be tailored to answer the study questions.

  • Research should identify and evaluate the efficacies of postnatal interventions that improve outcomes.


Recommendation IV-2: Investigate the economic consequences of preterm birth. Researchers should investigate the gaps in understanding of the economic consequences of preterm birth to establish the foundation for accurate economic evaluation of the relative value of policies directed at prevention and guidelines for treatment.


This research should


  • assess the long-term educational, social, productivity, and medical costs associated with preterm birth, as well as the distributions of such costs;

  • undertake multivariate modeling to refine the understanding of what drives the large variance of the economic burden, even by gestational age at birth;

  • be ongoing to provide the basis for ongoing assessments; and

  • establish the basis for refined economic assessment of policies and interventions that would reduce the economic burden.

Suggested Citation:"Section IV Recommendations ." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
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Suggested Citation:"Section IV Recommendations ." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×
Page 430
Suggested Citation:"Section IV Recommendations ." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×
Page 431
Suggested Citation:"Section IV Recommendations ." Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. doi: 10.17226/11622.
×
Page 432
Next: SECTION V Research and Policy: 13 Barriers to Clinical Research on Preterm Birth and Outcomes of Preterm Infants »
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The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups.

While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems.

Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

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