Month: October 2011

– according to data from 1998 in the Western world the cost of hospital stay of a healthy term newborn is 900 euros while a premature with bigger problems costs 24.776 € and a premature end 90.975 €

-the tocolisis can facilitate the maturity of the organs and systems to extend the gestacidoes, by promoting the benefits of the use of glucocorticoids and allowing the transfer “ in utero ” to an intensive care unit neonatal decreasing early mortality and morbidity

Málaga, 2011-October prematurity is the leading cause of infant death in the first month of life. The birth of a premature child is a family crisis which accompanies frequently pictures of frustration, anxiety, obsessive-compulsive behavior, difficulty concentrating and take decisions, fear, ambivalence, and stress.

The mothers of the preterm children (those born between 37 of gestation and 24 weeks), experiencing more severe psychological disorders during the neonatal period that are more frequent the greater is the uncertainty before the presence and severity of possible complications of prematurity.

It’s an issue of paramount importance with health implications, social and economic why more than 200 experts in obstetrics from all Spain meet these days in Malaga to talk about prematurity in the V Symposium of obstetrics, Ferring-sponsored and backed by the Spanish society of gynaecology and obstetrics Association (SEGO).

The main socio-health consequence of prematurity is the high morbidity and mortality associated. 68% Of the fetal mortality, 70% of early neonatal mortality and altogether, 69 per cent of perinatal mortality is concentrated in this group of infants.

“ Despite these high rates of perinatal mortality, the survival of the PBS has improved substantially in recent years ”, says Dr. Luis Cabero, Professor and Chief of service of obstetrics and Gynaecology of the Vall d ’ Hebron of Barcelona and Director of the Education CommitteeTraining and training of the Federation of Gynecology and obstetrics (FIGO) and one of the speakers, “ thanks to better prenatal care, the increasingly widespread use of steroids conduct, attention to individualized during childbirth, postnatal resuscitation techniques improved and surfactant administration well as prophylaxis or treatment of hyaline membrane disease ”.

So it is important to rely on – inhibition of uterine contractions – tocolisis, because the delay of delivery can reduce the rate of long-term morbidity by facilitating the maturity of the organs and systems in the development process to extend the time to make effective benefits arising from the administration of glucocorticoids prior to delivery, and allow the transfer “ in utero ” to a neonatal intensive care unit. The secondary objective is to reduce perinatal mortality and morbidity associated with prematurity; given that any premature problems can occur, experts believe that any action to avoid it or to delay the birth must be used – unless specific contraindication – reduces morbidity and mortality early and long term of premature infants, including the late.

To Dr. Josep M. Lailla, President of the SEGO, Professor of obstetrics and Gynecology at the University of Barcelona and Chief of service of obstetrics and Gynaecology of the Hospital of Sant Joan de Déu, the situation in our country is encouraging because “ rates of maternal and fetal morbidity and mortality in Spain a place privileged after England and Germany ”.

The increase in late preterm births is one of the main causes of infant mortality. In addition, after discharge from the intensive care unit Neonatal, suffer major health problems requiring rehospitalizations: neurodevelopmental disorders, cerebral palsy, hearing and eye problems, respiratory acute processes and learning disorders, directly related to weight at birth, so a low birth weight can be a tremendous emotional and economic burden to the family

is difficult to find data on costs of premature birth, but according to a report by the U.S. Department of Health and Human Services. Monthly Vital Statistics Report. National Center for Health Statistics. Centers for Disease Control and Prevention, 46: 11, 1998, it is estimated that in the Western world the cost of hospital stay of a healthy term newborn is 900 euros while a premature with bigger problems costs 24.776 € and a premature end 90.975 €. In addition to the emotional cost, the economic cost associated with low weight continues throughout childhood due to the increased costs in health care and the needs of special education, more than 50 per cent of children between 6 and 15 preterm infants years remain of special education programs and their cost is more than 2.3 times the cost of a normal student of the same course.

It is important to control risk factors include the history of preterm delivery, surgery on uterine cervix, uterine abnormalities, multiple gestation, the presence of polyhydramnios, infections, the presence of short cervix between weeks 14 and 28 in gestation, the presence of a test of positive fibronectin between weeks 22 and 34 of gestation, the presence of uterine dynamics, or premature rupture of membranes that increases the likelihood of completion of gestation either spontaneous or induced by infection.

Dr. Carlos Larrañaga, specialist in area of the Hospital Virgen del Camino, Pamplona, and Rapporteur of the Symposium to a patient with threatened preterm delivery “ the essential thing is to make a proper diagnosis. Patients require fetal maturation with corticosteroids and relocation of the fetus “in utero” to the Center with the neonatal unit. To achieve these two objectives if you require may be given tocolytic, provided they are not contraindicated ”. Corticosteroids, tocolytic or antibiotics, in cases of premature rupture of membranes, are indicated treatments.

Complications in the future are under age at the birth, focusing on different aspects according to gestational age. The smaller more likelihood of more serious structural damage, including those of the CNS, with their resulting consequences that last a long time after birth. The greater birth, minor alterations and minor impact with shorter duration in the neonatal period and childhood. Thus the preterm neonate has a probability of 180 times higher death to the fetus to term.

Internationally defined arbitrarily different gestational ages correlated with prognosis of morbidity and mortality of the newborn. Thus, referred to as “ late preterm ” that happens completed 34 weeks of gestation and prior to the 37; “very preterm” from the 26 to 32 weeks and “extremely preterm” below the week 26 of gestation. Most international agencies still guided more by weight at birth than by gestational age, weight is a fact that objectively more easily. Thus refers to low birth weight newborn infants when it is less than 2500 g; very low weight when it is less than 1500g and extremely low weight when the limit is 1000g. Gestational age confirmed by ultrasound in the first quarter is the most reliable data for decision making.