MCHB/EPI Miami Conference — December 7 - 9, 2005

Preterm Delivery: Current Challenges — Transcript

BAO-PING ZHU: Morning. Good morning. I've been at this conference for a while. Since I think '97, so eight years and counting, so I'm very excited to see so many people showing up at the conference and our population is actually growing very rapidly and it's wonderful to see so many professionals here.

Everybody knows that preterm delivery is a major issue in this country as well in this world, so this session is going to be on preterm delivery challenges of the 21 st Century. I'm going to give a brief intro. I promise that I won't go over ten minutes, so look at your watch.

I looked through the internet and everything, you know, none is better than this picture that was depicted in the popular media in 2004. Just look at this little guy. He's fitting into two palms with so many tubes (inaudible) poor little guy. Just to give you an idea about the just terminology, the relationship between preterm delivery on the right, the yellow pie and the intrauterine growth retardation which is practically defined as less than ten percentile of birth weight given gestational age. And the other term that we talk about a lot is low birth weight, which is birth weight less than 2,500 grams. This is just a brief description of the relationship between the three, so these are not the same thing. Okay.

In the United States in 2003 about ten percent of the babies were born between 32 to 36 weeks of gestation and about two percent of the babies are born before 32 nd week of gestation. The total percentage of preterm delivery which is less than 37 weeks of gestation is about 12.3 percent. And this graph shows the trends in the nation of preterm delivery by race. You can see that overall the trend is going up. The line in the middle, the white line in the middle, however this trend is mostly dictated by the trends in the white population. In the African/American population the trend is going up a little bit and then going down a little bit and then in recent years it's pretty much very flat where as for white population the trend is going up continuously. It's almost linear relationship. If you look at the gestational age distribution trends in that you can see that the very preterm delivery, the yellow line at the bottom is almost very flat and the moderately preterm delivery is 32 to 36 weeks of gestation. The line is going up and the overall trend is going up which is pretty much dictated by the green line in the middle.

Preterm delivery is a major leading cause of infants deaths and neonatal deaths. This graph shows the percentage of neonatal deaths due to preterm delivery which is about 20 percent in 2002 and worldwide is about 27 percent. Preterm delivery is also a major determinant of many other diseases. This shows the relationship between gestational age and incidence of (inaudible). I'm not going to go through the three different lines but you can see general trend is that the relationship as gestation increases the risk decreases. And this is another major outcome which is cerebral palsy. You can also see a general trend there. This shows, I'm not going to go through all of the outcomes but just to show that blue bars show the normal birth weight outcomes whereas the red bars are a host of different neural behavior outcomes of school children with very low birth weight and gestational age less than 28 weeks and you can see that practically all of the outcomes preterm delivery babies do much worse than the normal birth weight babies. There are other outcomes that are not depicted in the previous slide which include depression, anxiety, social problems, attention deficit disorder and immature (inaudible) skills.

This graph shows basically the economic impact of preterm delivery. This is a mean total inpatient (inaudible) during the first ten years of life by gestation. You can see major differences there. If we compare with the term babies there, you know, there are enormous impact of the days during the first, you know, the first inpatient days during the first ten years of life and then this one shows the cost of inpatient admission during the first ten years of life by gestation. You can see that for every preterm baby this is, you know, in British pounds and I found this is one of the best studies that has ever been published. Every baby delivered preterm costs more than 16,000 British pounds. So why are the babies eager to come out?

We have two great speakers this morning to talk about the challenges and the reasons behind the trends and, you know, it's going to be very exciting session. The first speaker this morning is Claudia Holzman. Claudia is the associate professor of epidemiology at Michigan State . Did anybody notice last night Michigan State also won the basketball game? She has been involved with preterm delivery research for the past 14 years and she's one of the six (inaudible) grantees from the first March of Dimes grants on preterm delivery and she will present some of the data form that study as well. Claudia.