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1、INFECTIONANDPRETERMBIRTHSequelaeofPretermBirthPerinatalMortalityNeurologicHandicap(75%)(50%)(10%)IncidenceofPretermBirthinTheU.S.A. 1981-1994TimeTrendsinLowBirthWeight(<1,500g) byRace/Ethnicity-UnitedStates,1970-1990UABInfantswithBirthweights£1000GramsMeanBWSurvival1975900gms17%198
2、0860gms48%1985820gms56%1990804gms74%DistributionofNeonatalMortalityBWT(gms)Distribution<100060%1000-250020%>250020%**MajorityassociatedwithcongenitalanomaliesApproximatePrevalenceofCerebralPalsyper1,000BirthsbyBirthWeightandGestationalAgeLBW-PORT050010001500200025003000350040004500
3、5000BirthWeight(g)/GestationalAge(wks)01020304050PrevalenceofCerebralPalsyper1,000LiveBirthsTerm23024025023273236SurvivalRateforExtremelySmallInfants(<800g) inRelationtoMid-YearofBirth0204060801975198019851990Mid-YearofBirthSurvivorsperLivebirth,%Lorenz,1998PrevalenceofDisabilityAm
4、ongExtremelySmallSurvivors(<800g)inRelationtoMid-YearofBirthMid-YearofBirth0102030405060701975198019851990DisabledInfantsperSurvivor,%Lorenz,1998PercentageofExtremelySmall(<800g)LivebirthsSurvivingwithatLeastOneDisabilityin RelationtoMid-YearofBirth1990Mid-YearofBirth05101520197519
5、801985DisabledInfantsperLivebirth,%Lorenz,1998CerebralPalsyin<1000gminfantsSurvivorswithAnyDisability**(n)3212802560SurvivorswithCP*(n)166401280Survivors(n)2008,00016,000Survival(%)14080<1000gbirths(n)20,00020,00020,000Year196019851997*Assumingan8%incidenceinsurvivorsconsistentlyov
6、ertime.**Assuminga16%incidenceinsurvivorsconsistentlyovertime.EtiologyofPretermBirth50%30%20%SpontaneousPretermLaborPretermBirthforMaternalorFetalIndicationsPrematureRupture ofMembranesREVIEWOFINTERVENTIONSTOPREVENTPRETERMBIRTHPrenatalcareRiskscreeningNutritioncounselingCaloricsupp
7、lementationProteinsupplementationIronsupplementationMostlaborinhibitingagentsDrug,alcoholandtobaccocessationprogramsBedrestHydrationHomeuterineactivitymonitoringCommonlyusedinterventionswhichhavenotbeenshowntoreducepretermbirthinclude:INFECTIONANDPRETERMBIRTHSURGICALPATHOLOGYREPORT
8、ClinicalHistory34yearoldwh
