Abstract
As noted, a major public health issue is that of preterm birth, which occurs in 10–12% of pregnancies in the USA, an incidence which appears to resist improvement despite advances in the practice of maternal-fetal medicine. Importantly, this complication of pregnancy accounts for about 75% of perinatal mortality and often is associated with several serious long-term developmental and health issues for the infant who survives. As noted earlier, preterm birth is defined as that <37 weeks gestation, while very preterm birth is that <33 weeks gestation and extremely <28 weeks gestation (Reece and Hobbins 2007). Appropriate for gestational age, preterm infants must be distinguished from small for gestational age infants, defined as ≤10 percentile (Zhang et al. 2010), although it is recognized that small infants are not necessarily growth restricted, and those with growth restriction are not necessarily small (Bhide 2011; Zhang et al. 2010). In part, a consequence of maternal and/or fetal infection (Abramowicz and Kass 1966; Romero et al. 1988), preterm birth has many causes, and a more clear understanding of the mechanisms of this scourge is essential to its amelioration. Also as noted earlier, several aspects of the basis for antenatal steroid therapy for pulmonary development have been established (Ballard and Ballard 1995; Ballard et al. 1980). Nonetheless, a considerable body of evidence supports the value of this modality in lessening infant morbidity and mortality (Bonnano and Wapner 2009), and a number of considerations remain to be resolved such as the ideal drug, dosage regimen, indications for retreatment, and so forth.
The woman about to become a mother, or with her newborn infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs … God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should hazard it negligently, unadvisedly, or selfishly.
(Oliver Wendell Holmes 1842/1843, p. 503)
Notes
- 1.
“Ulysses” a Poem by Alfred Tennyson (1809–1892; 1st Baron Tennyson)
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Longo, L.D. (2018). Additional Clinical Aspects of Developmental Physiology and Clinical Care. In: The Rise of Fetal and Neonatal Physiology . Perspectives in Physiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7483-2_20
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