Research Paper on "Premature Babies and Developmental Delays"

Research Paper 14 pages (4060 words) Sources: 14

[EXCERPT] . . . .

Neurodevelopmental Disorders and Developmental Delays in Preterm Children

Brian O'Neal Ryan

201140 Fall 2011 COUN 502-D27 LUO

Preterm children are born at less than 37 weeks of gestation. As they mature, this group of children demonstrates a high rate neurodevelopmental disorders such as cerebral palsy and mental retardation. These children also display higher rates of developmental delays than do full term children. Later in life,

even preterm children without serious neurological difficulties or developmental delays as a group perform lower on measures of intelligence, academic achievement, and motor skills than do full-term children. These differences can be observed well into adolescence. For children born preterm the severity of any difficulties they might suffer is inversely related to the number of weeks of gestation they experienced. One of the reasons that this group demonstrates these physical and cognitive discrepancies may be due to a lack of thyroid hormones the child would normally receive from the mother in utero. These hormones have been demonstrated to be important in early neuronal differentiation and proliferation. Nonetheless, there is evidence that for preterm children without serious physical or neurological disorders environmental manipulations, parental education, and age-corrected expectations can attenuate these difficulties significantly

Neurodevelopmental Disorders and Developmental Delays in Preterm Children

The World Health Organization defines a preterm birth as a birth that occurs before 37 weeks or 259 days gestation (Beck, Wojdyla, Say, Betran et al., 2010). Worldwide, the majority of preterm births occur in Africa and Asia, but the highest percentages of preterm births (preterm births as a percentage of all births) occur in North America. Almost half of preterm births are idiopathic, 15-20% are due to medical decisions or are elective (probably adding to the higher percentage of preterm births in North America), and about 30% are due to the rupture of preterm membranes. Of all early neonatal death rate causes, preterm birth accounts for about 28% of deaths not due to some type of congenital malformation (Beck et al., 2010). Low birth weight, sensory and motor problems, and cognitive problems are associated with preterm births.

Although preterm and low birth weight babies are born in all socioeconomic levels, the rates are highest among impoverished mothers and especially among members of ethnic minority groups (Beck et al., 2010). The effects of preterm births are compounded by the difficulties these caregivers experience in helping their children attain normal levels of health and to develop at a normal rate. Often the caregivers of preterm children live in less protective environments and have limited access to the medical and social support services and intervention programs that are aimed at reducing the negative and long-term consequences of premature births (Beck et al., 2010; Sagial & Doyle, 2008).

Preterm births are exceptional among all of the different adverse outcomes that can occur during pregnancy because they are determined by a time span and are not tied to any particular etiology or specific pathophysiology. If an infant is born preterm the actual physical signs displayed are often in reverse proportion to the child's gestational age, which would be expected as preterm development occurs along a fairly predictable timeline. Thus, the research has indicated that there is little doubt concerning the notion that a child's gestational age is the most significant factor accounting for the utmost influence on later outcomes that are associated with preterm births. In the 1970's, prior to the prevalent use of hospital assisted ventilation for preterm infants, there were very few babies that survived if they were born before 28 weeks of gestation. However, with the earlier and increasing use of assisted ventilation, antenatal corticosteroids, and pulmonary surfactant as well as changing attitudes by both parents and physicians regarding the use of intensive care for preterm infants the survival rates for infants of very preterm births, particularly infants born before 28 weeks gestation, improved markedly during the mid-1990s (Saigal & Doyle, 2007). Even though preterm births at 32 -- 36 weeks of gestation are actually five times more frequent than births before 32 weeks of gestation, their public health effects are not well documented. Moreover, in the United States in 2003

12.3% of the births were preterm. This is concerning because since 1981 the records indicate that there has been a 31% rise in the United States preterm birth. Two-thirds of these births were late preterm births defined as occurring between 34 -- 36 weeks of gestation (Beck et al., 2010

Therefore, depending on their age preterm infants are at risk for many different types of medical problems that can affect different organ systems. Preterm children have been shown to have significantly higher proportions of sensory deficits, cerebral palsy, learning disabilities, and other illnesses compared to children who are born at full term. The morbidity that is associated with preterm births will often extend well into the child's later life. This can lead to massive physical and psychological effects on the child and family and enormous economic costs for both the family and society (Saigal & Doyle, 2008). In 2005 estimates that the total costs to the United States of the complications of preterm births with respect to medical, educational, and estimated loss of productivity were more than 26.2 billion dollars (Beck, et al., 2010).

Medical

Issues Associated with Preterm Births

When a baby is born before term most of its organs are immature; however, the brain and the lungs appear to be especially susceptible to the consequences of a birth before term. This inevitably results in high rates of long-term health and neurological issues for these children. Because there are increasing costs to provide for neonatal intensive care as well as increasing social and economic burdens of the disabilities associated with preterm births there is an ongoing debate concerning the notion if the use of intensive care is actually justifiable for preterm infants that have borderline viability. As survival rates increase clinicians will find themselves increasingly exposed to the survivors of preterm births. As a result physicians and other health care workers should be aware of the ever-changing outcomes of preterm births as well as the long-term effects of the disabilities associated with preterm births and the numerous health problems that are incurred on the survivors, their families, and on society Saigal & Doyle, 2008).

Neurological Problems

Neurological problems associated with preterm birth are numerous and include developmental disability, developmental delays, apnea of prematurity, retinopathy of prematurity, cerebral palsy, hypoxic-ischemic encephalopathy, and intraventricular hemorrhage. This last complication, bleeds within the ventricles of the brain, has been known to affect as many as 25% of preterm babies and is especially a problem if the baby is born before the 32nd week of pregnancy (Saigal & Doyle, 2008). Babies can be resilient and milder brain bleeds may not result in severe or lasting complications; however, more severe bleeds can result in severe irreparable brain damage or even death.

With respect to neurological issues in preterm infants, the thyroid gland, pituitary gland, and the hypothalamus all begin their development early in gestation. Berbel, Navarro, Auso, Varea, et al. (2010) investigated the role of the thyroid gland in brain development. At about 10-12 weeks thyroid hormone synthesis begins and serum thyroid hormone levels progressively riseor the remainder of gestation. The hypo-thalamic-pituitary-thyroid axis that deals with stress, hormone regulation, and other functions, becomes functional in the infant during the latter half of gestation, but its development continues until nearly two months after birth in normal human infants. As a result, the developing infant requires thyroid hormones from the mother during its development in utero. Thyroid hormones are extremely important regulators of the infant's brain development during the both the fetal and neonatal periods. During these periods these hormones control both neuronal and glial proliferation in specific brain regions and are important in regulating neural migration and neural differentiation. Neural differentiation also includes the development of neuronal connections and myelination which are crucial to normal development. This differentiation takes place in very discrete developmental periods or windows. Thus, the role of these thyroid hormones in coordinating the timing of specific developmental signals and events is critical and even transient disruptions in thyroid hormone availability can lead to very profound effects on the brain development of the infant.

Some research has been able to link the neurodevelopmental problems associated with preterm birth to lack of maternal thyroid hormones, as the immature infant's thyroid gland cannot meet their own requirements.

Magnetic Resonance Imaging (MR) can be useful to identify the structural abnormalities of the preterm infant's brain. However, in many developmentally delayed children MRI cannot determine any structural difficulties and other more sensitive methods must be used. For example, Filippi, Ulug, Deck, Zimmerman, and Heier (2002) in a seminal study, reported results of using Proton MR Spectroscopy to detect differences in brain myelination of normal children to developmentally delayed children over the age of two years that had normal MR scans. Children under age two with delays did not yet demonstrate this difference. Consequently, preterm children may have subtle differences in their brains… READ MORE

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