Talk:Preterm birth

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A fact from Preterm birth appeared on Wikipedia's Main Page in the Did you know? column on 24 December 2004. The text of the entry was as follows: Did you know ...that Rumaisa Rahman, born prematurely in Chicago on September 19, 2004, was 8 inches (20 cm) long and weighed 8½ oz. (244 g) at birth?

Contents 1 Early Discussion 2 Tasks for cleanup 3 bacterial vaginosis and abortion 4 Regional definition? 5 mortality rates? 6 Prematurity and the parent 7 Lucky Preemies 8 Sense of odor 9 Prematurity and periodontal disease 10 Viability 11 37 vs 37-41 12 Factors Section 13 Records section 14 Babson and Benda chart and update to it 15 Magnesium sulfate 16 Preterm labour 17 MCOTW + current structure comments 17.1 Current structure 18 Disambig premature and preterm 19 Sources 20 Suggest to move article to "Preterm birth" 21 Post move clear-up 22 leveles of preterm - classification 23 Revision 12/15/08 24 Premature birth

[edit] Early Discussion

I'm still new at Wiki, so I hope my changes were good clean wikifications (-: I reduced the major list and rearranged the article, using the ecology article as a template (I was trained in that field so it seemed like a good place to start). JoeBoucher 22:26, Jan 14, 2004 (UTC)

I went ahead and did the merge with Prematurity.Nandesuka 15:21, 14 July 2005 (UTC)

[edit] Tasks for cleanup

This article has potential. The one thing I don't like is it's "laundry list" nature. It makes it hard to follow, and it's not very readable. I'd propose that the first thing we do is eliminate the laundry lists and replace them with well-written text. My overall goal is to make this article high-quality enough to merit being on the front page (it's clearly not there yet). Nandesuka 15:21, 14 July 2005 (UTC)

[edit] bacterial vaginosis and abortion

There was a recent row on Abortion#Physical_health over the status of evidence on a connection between abortion and premature birth. Also bacterial vaginosis was brought up as a factor, is that included under STD's? Just wondering if one or both should be added to the factors list. - RoyBoy ⁸⁰⁰ 05:43, 11 August 2005 (UTC)

[edit] Regional definition?

I believe "defined medically as birth occurring earlier than 37 completed weeks of gestation" is the definition proposed by the WHO but some countries have a different, equally strict, definition. PhS 20:44, 21 October 2005 (UTC)

[edit] mortality rates?

Do we have any reliable mortality rates for premature babies?DonaNobisPacem 07:08, 27 March 2006 (UTC)

[edit] Prematurity and the parent

The following needs to be edited: ""Additionally, parents often have difficulty becoming involved in their child's care because of the NICU setting. This affects the parents transition into parenthood because they are unable to fulfill their expected roles."

This seems very unscientific, and presupposes that that the premature birth is the first child for a couple ("transition into parenthood"). I recommend deleting or editing it.

65.31.132.187 08:49, 3 October 2006 (UTC)

[edit] Lucky Preemies

Is there such a thing as a 'lucky preemie'? I mean to say, a baby who was born at least two months before scheduled with low birthweight (but not under 2600 grams) and yet this has no effect on him in any way? —The preceding unsigned comment was added by Waux J.V. Trident (talk • contribs) 17:23, 6 December 2006 (UTC).

• Wasn't Winston Churchill a preemie?

[edit] Sense of odor

Seeing that prematuirty might demage the babies hearing or vision, can it also influence their sense of odour? !NOSIGN! —The preceding unsigned comment was added by 88.209.215.48 (talk) 10:25, 10 December 2006 (UTC).

[edit] Prematurity and periodontal disease

The evidence for a connection between prematurity and periodontal disease is not definitive. See this paper prepared by the March of Dimes http://www.marchofdimes.com/files/MP_PeriodontalDiseaseAndPretermBirth031004.pdf I plan to edit the article, but would appreciate feedback from other editors before proceeding. Thank you, marchbabies, February 2, 2007

I agree. The orginal sentence "Periodontal disease increases the risk of preterm birth more than 4 times. As a matter of fact this is one of the most serious risk factors, that is completely preventable." This seemed to me to be an editorial comment. I deleted everything except the Periodontal diease link. Some studies have suggested this but they vary considerably. Jeffjacks7 14:25, 17 March 2007 (UTC)

[edit] Viability

While there is now a single well-documented case in the U.S. of an infant surviving at 21 weeks (see the article cited by RingTailedFox), viability is still generally thought to be at 23-24 weeks. The survival at 23 weeks in the best U.S. hospitals is around 15-20%. The survival at 22 weeks is still essentially 0%. As the article states, "if doctors had known Amillia's real gestational age, they might not have intervened. He said he thought she was at least 23 weeks, and doctors were shocked when the Taylors' fertility specialist pinpointed the exact date of fertilization. Fassbach cautioned against rushing to redefine the medical standards for fetus viability." Would change the sentence to "...betamethasone or dexamethasone, which are often given when the fetus approaches viability at 22-24 weeks."Hallbrianh 03:01, 22 February 2007 (UTC)

[edit] 37 vs 37-41

It seems as if some people prefer to say that prematurity is defined as birth "earlier than 37-41 completed weeks of gestation" rather than simply "37 completed weeks". The problem I see with "37-41" is that it's ambiguous - 40 weeks is "earlier than 41", which is in the range 37-41 so someone could argue that 40 weeks is premature. Furthermore, why 41 as the upper range? why not 42, 50, 99 or 4826? All major sources say "< 37", they don't give a range. Ciotog 13:36, 16 March 2007 (UTC)

[edit] Factors Section

I re-did the factors section, to try to eliminate the repeated sentences that were awkward or went into far too much detail on the cited references. However, am not happy with the results. It might be better to get away from the lists, but needs to have more text than simply stating essentially 'factor X increases the risk of preterm delivery'. Also, the references contain hyperlinks that are not accessible by those who do not have special access to the web resource. This still needs significant revision.Hallbrianh 21:48, 28 May 2007 (UTC)

I really don't like the laundry list at all; whenever possible we should be moving away from adding those, not adding more of them. Rather than just revert it, I figured I'd bring it up here. Would you like to take a crack at rewriting that section again so that the laundry list is a textual paragraph (or two?) Nandesuka 01:35, 29 May 2007 (UTC)

[edit] Records section

I've removed the names of minors from the records section. All statements are sourced and the sources give the names, should anyone need them. The general principle here is to avoid this article appearing in search results on the minor's name in his or her future (hopefully very successful) life. --Tony Sidaway 23:36, 3 June 2007 (UTC)

[edit] Babson and Benda chart and update to it

Would a suitable addition to this article be a description of the role of the Babson and Benda growth graph for preterm infants and the recent revisions to this graph from increased sample sizes? I came in contact with this information while examining the top-cited papers at BioMed Central. The second most cited manuscript across the history of this resource as of 2007-12-21 (>101,000 accesses) is:

Fenton, Tanis R (2003-12-16). "A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format". BMC Pediatrics (BioMed Central) 3 (13). doi:10.1186/1471-2431-3-13. PMID 14678563. http://www.biomedcentral.com/1471-2431/3/13/abstract. Retrieved 2007-12-21. "The Babson and Benda 1976 "fetal-infant growth graph" for preterm infants is commonly used in neonatal intensive care. ... The purpose of this study was to develop an updated growth chart beginning at 22 weeks based on a meta-analysis of published reference studies.". 

Thanks for considering this. I am not a physician myself, so I would prefer to leave the integration of this information to someone with experience in the area. --User:Ceyockey (talk to me) 20:22, 21 December 2007 (UTC)

[edit] Magnesium sulfate

I added an intriguing news report (from a recent conference) that simple administration of magnesium sulfate can cut cerebral palsy in half - in case I forget, the media report should be supplemented with the proper scientific citation once it becomes available. Also, I've omitted mention of geophagy because any link with it needs proof, but it will be something interesting to watch for. Wnt (talk) 17:45, 1 February 2008 (UTC)

[edit] Preterm labour

I was asked to expand preterm labour, which is actually about pretty much the same thing. Presently I have turned it into a redirect here. I was however wondering if it is reasonable to deal with the subject in two dedicated articles: one on prematurity from the mother's perspective (symptoms, signs, diagnosis, interventions), and another from the child's perspective (complications, treatment for those complications).

At any rate: I have identified the following recent sources on the subject:

• Lancet series 2008 (PMID 18177753 - introduction)
  • PMID 18177778 - Lancet review 2008 on epidemiology and causes
  • PMID 18191687 - Lancet review 2008 on primary, secondary and tertiary interventions
  • PMID 18207020 - Lancet review 2008 on sequelae for the child
• PMID 17671256 - NEJM review 2007 - "prevention of preterm delivery"

I am really not up-to-date with this, but I will nominate the article for MCOTW and would be happy to contribute up to GA level for this absolutely essential topic. JFW | T@lk 19:52, 27 July 2008 (UTC)

I know this is an old question, but I would keep the two articles separate. And from preterm labour I would omit all discussion of sequelae for the child, just refer to this article. In a high risk pregnancy that is being closely monitored, preterm delivery by C-section may (and increasingly does) occur without prior labor. --Una Smith (talk) 05:39, 7 December 2008 (UTC)

[edit] MCOTW + current structure comments

This page has been nominated as the new medical collaboration of the week. I've set up a topic heading here to discuss changes to the article within the period of it being the MCOTW. Perhaps, for order, we could use subheadings to discuss different issues and leave it under this one header. —Cyclonenim (talk · contribs · email) 16:19, 30 November 2008 (UTC)

[edit] Current structure

I'm not convinced the structure of the article as it stands now is the best way to do it. Perhaps I'm a sucker for conventions but I feel we should tidy it up in some way. Perhaps have topic headings as:

• Overview and/or classification
• Signs and symptoms
• Causes
• Prevention
• Treatment

• Separated into maternal and fetal treatments?

• Prognosis

• Separated into mother and fetal prognosises?

• Epidemiology
• Records
• See also
• References
• External links

That way we can keep it as close to WP:MEDMOS as possible. Opinions, anyone? —Cyclonenim (talk · contribs · email) 16:19, 30 November 2008 (UTC)

Y Except prognosis remains as complications —Cyclonenim (talk · contribs · email) 21:31, 1 December 2008 (UTC)

If it is possible to provide all the relevant content in this framework, probably good. JFW | T@lk 00:41, 2 December 2008 (UTC)

[edit] Disambig premature and preterm

The terms premature and preterm, as used in the lead, need disambiguation. Preterm is before 37 weeks; premature is not mature enough to do without supportive medical care. Most but not all babies born at or after 37 weeks gestation are mature. Some term babies are premature. Some preterm babies are mature. --Una Smith (talk) 17:05, 30 November 2008 (UTC)

Intro has been modified accordingly.Ekem (talk) 02:44, 1 December 2008 (UTC)

Right now, the intro half-implies they're the same thing, and half-implies they're different. Also, preterm birth redirects here. I assume it might be because they're used interchangeably among non-medical types, and have a more precise meaning among medical types. We should (a) reword the intro (easy, I'll give it a stab and you can fix or revert as needed) and (b) consider an article of its own for preterm birth (way over my head, but I enjoy adding things to other people's to do lists). --Floquenbeam (talk) 21:58, 4 December 2008 (UTC)

I tweaked it, but now I think I just re-invented the wheel, I didn't look at previous versions first. Mine is close to but different than Una's. I'll leave it at mine for now, because I think it scans a little better, but if my version lacks too much of the precision of the old version just revert back. --Floquenbeam (talk) 22:20, 4 December 2008 (UTC)

"Preterm birth" is the medically preferred term not at least because it has a more precise and workable definition than "premature". The article talks about preterm birth and prematurity is a consequence of being preterm. While used as synonyms, preterm and premature are different as pointed out above. It would make sense to move the article to "Preterm birth", redirect "Premature birth" to this article and, within the article, discuss the difference.Ekem (talk) 22:53, 4 December 2008 (UTC)

Are full-term babies that aren't fully developed classified as premature? While we're at it where does miscarriage overlap - since as I read it at the moment 'wouldn't survive without medical intervention' sounds like the definition of miscarriage? LeeVJ (talk) 23:03, 4 December 2008 (UTC)

Miscarriage is prior to 20 w gestation, then a baby born is either preterm and later term if alive or stillborn. Premature is a functional assessment (generally with the assumption of the baby being preterm).Ekem (talk) 23:41, 4 December 2008 (UTC)

Yes, "term" babies (meaning born at 37+ weeks gestation) that aren't fully developed are regarded as premature. "Classified" isn't quite the right word, because prematurity is a transient condition. The dividing line between miscarriage and stillbirth/perinatal death is a legal one. In the US, most states define the line at 20w. Before about 24w, it is not a question of medical intervention; survival is unlikely regardless. --Una Smith (talk) 05:33, 7 December 2008 (UTC)

I revised the lead some more. I think it is important to specify that the gestational age is for humans only. And to at least acknowledge that premature birth is a concern also in animal husbandry. From the following section I deleted the tangents into calculation of gestational age, and gathered the US-specific data. The transition from US to world data is weak, but I left it at that because the world data section itself is largely a tangent into LBW and SGA. --Una Smith (talk) 06:38, 7 December 2008 (UTC)

[edit] Sources

The article has a lot of sources of borderline quality. Some are from websites, and some run through IP addresses. All very messy. I'm also uncertain whether the list of ORs for certain risk factors is meaningful for any reader. Personally, I'd prefer to have all items of that list sourced to a single review. JFW | T@lk 00:41, 2 December 2008 (UTC)

[edit] Suggest to move article to "Preterm birth"

[edit] Post move clear-up

Ok now the page is moved, I adjusted the lead a little to reflect this, but before going further, do we leave premature birth as a straight redirect, explaining the difference in this article, or as an article in it's own right leaving this one with more focus? following is the line I cut fromintro which might the basis of premature birth miniarticle ; 'Premature birth whose organs are insufficiently developed, requiring medical support for survival. It is closely related to preterm birth' LeeVJ (talk) 16:16, 14 December 2008 (UTC)

I think Premature birth should redirect to Preterm birth, where there should be a mention of premature birth in the lead and a paragraph comparing and contrasting the two. --Una Smith (talk) 16:25, 14 December 2008 (UTC)

On further reflection, agree this is the way to go, a smaller article on premature birth would inevitably lead to a merge request into this article! LeeVJ (talk) 18:21, 14 December 2008 (UTC)

I reworked the lead and section on prematurity, inverting a lot of the paragraph structure, to better relate preterm and premature, and transition to the rest of the article. --Una Smith (talk) 00:13, 16 December 2008 (UTC)

[edit] leveles of preterm - classification

Routing around for refs found this one:[Moutquin JM (April 2003). "Classification and heterogeneity of preterm birth". BJOG 110 Suppl 20: 30–3. PMID 12763108. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1470-0328&date=2003&volume=110&issue=&spage=30. ] I don't have full text but abstract gives several severities, and causes which seem more concise than current causes: LeeVJ (talk) 18:38, 14 December 2008 (UTC)

Preterm birth is stratified into mild preterm (32-36 weeks), very preterm (28-31 weeks) and extremely preterm (<28 weeks) with increasing neonatal mortality and morbidity. Recent studies suggested that infection was mostly responsible for extreme preterm birth, while stress and lifestyle accounted for mild preterm birth, and a mixture of both conditions contributed to very preterm birth

[edit] Revision 12/15/08

I revised the article in an attempt to bring it up to speed incorporating information of recent review articles, notably from Lancet in early 2008 that provided the framework of I, II, and III intervention. I also attempted to preserve the work that had been done as much as I could. The work is not complete (not that I expect it ever to be), and the references have not yet been all checked. Ekem (talk) 03:21, 15 December 2008 (UTC)

Did I blink? Nice job! LeeVJ (talk) 15:11, 15 December 2008 (UTC)

[edit] Premature birth

Every instance of "premature birth" in Wikipedia probably should be changed, disambiguated, either to preterm birth or to "premature (baby)". Some sections of this article are not about preterm birth but about premature babies. Also, in some cases very early delivery is required; such deliveries are not preterm births in the sense of this article, but the babies nonetheless are premature. So perhaps we do need a separate article about premature babies. --Una Smith (talk) 16:55, 17 December 2008 (UTC)