Preterm birth: crisis and opportunity.

摘要

The health of much of the developed world has improved in recent years, thanks to social and medical advances, including improved diagnostics and therapeutics. But in the USA, at least one important public-health problem, preterm birth, has worsened in the past decade.The US Institute of Medicine (IOM), in a report released on July 18, said that 94% of births occurred before 37 weeks of gestation in 1981. But since then, the rate has risen by more than 30%, and now preterm births account for 12-5% of all births. This proportion, which is unacceptably high, looks even worse when broken down by race, ethnic group, and socioeconomic status. The highest rates of preterm birth occur among racial and ethnic minorities, especially African-Americans (17-8% vs 11-5% for white women). Preterm birth rates are also higher for Hispanic women (11-9%), and American I ndians and native Alaskans (13-5%), than for white women.Advances in perinatal and neonatal care have reduced the mortality due to preterm birth, but morbidity remains a serious problem. Infants born early are at high risk for developmental problems, birth defects, cerebral palsy, mental retardation, visual impairment, hearing loss, and other, sometimes less obvious, central nervous system disorders, including language and learning disabilities, attention-deficit hyperactivity disorder, and behavioural problems. The cost to society of these complications was more than USdollar26- billion in 2005, or dollar51600 for each infant bom early, with the cost of medical care accounting for two-thirds of this amount. The rest of the price tag is mainly an estimate because little is known about the actual costs of preterm birth beyond inpatient care and first hospitalisation. A good deal of money is thought to be spent on early intervention programmes, special education, and lost productivity by parents and other caregivers. And, of course, the cost of preterm birth is not merely economic. Preterm birth also exacts an enormous physical, emotional, and psychological toll on families.