Each year in the United States approximately 440,000 babies are born premature. These infants are at greater risk of death, and are more likely to suffer lifelong medical complications than full-term infants. Clinicians and researchers have made vast improvements in treating preterm birth; however, little success has been attained in understanding and preventing preterm birth. Understanding the complexity of interactions underlying preterm birth will be needed if further gains in outcomes are expected. The Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine sponsored a workshop to understand the biological mechanism of normal labor and delivery, and how environmental influences, as broadly defined, can interact with the processes of normal pregnancy to result in preterm birth. This report is a summary of the main themes presented by the speakers and participants.

The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

Improved conditions of care for premature infants have led to markedly increased survival rates over the last few decades, particularly in very low and extremely low birth weight infants. Nutritional measures play a central role in the long-term outcome, health and quality of life of these premature infants. In this publication, leading experts from all 5 continents present the most recent evidence and critical analyses of nutrient requirements and the practice of nutritional care (with the focus on very low birth weight infants) to provide guidance for clinical application. After the introductory chapters, covering nutritional needs and research evidence in a more general manner, topics such as amino acids and proteins, lipids, microminerals and vitamins, parenteral and enteral nutrition as well as approaches to various disease conditions are addressed. Due to its focus on critical appraisals and recommendations, this book is of interest not only for the researcher who wants to keep up to date, but also for the clinician faced with premature infants in his practice.

This splendid volume presents numerous aspects of preterm labor and delivery, from its fundamental mechanism to clinically focused approaches. The incidence of preterm delivery is 6-7% in Japan, while globally up to 10% of pregnancies with preterm labor result in premature delivery. The rates of overall survival and intact survival of the premature infants are also excellent in Japan. Thus Japan’s approach to preterm labor and delivery has long attracted attention. In each chapter, experts describe specific issues unique to conditions in Japan, including diagnosis, tocolytic agents, definition of clinical chorioamnionitis, treatment of bacterial vaginosis, role of amniocentesis, management of preterm premature membrane rupture and also placental pathology, presenting definitive evidence of the reduced incidence of preterm delivery in Japan. This book benefits not only obstetricians, pediatricians and gynecologist, but also midwives, nurse practitioners, and medical and associated staffs in the field of obstetrics, pediatrics, as well as neonatal and perinatal medicine who are involved in delivery.

The improved survival of very preterm and very low birth weight infants in recent decades has been associated with an increase in the prevalence of physical and neurodevelopmental problems. Attention is increasingly being focused on the quality of life of survivors, who are at greater risk of brain damage and consequent neurological disorders, and neuropsychological and behavioural impairments. In this volume, leading experts present a comprehensive and up-to-date perspective on research in various aspects of the long-term consequences of very preterm birth. As well as extending existing knowledge of the neurodevelopmental sequelae following very preterm birth, a shared aim of this burgeoning body of research is to identify the mechanisms underlying variations in outcome, and thus recognise subgroups of children who are at increased risk of neurodevelopmental problems, for whom appropriate intervention strategies can be devised. Pediatricians, neurologists, psychiatrists and psychologists will all find this to be essential reading.