Preterm birth is defined as delivery prior to 37 weeks of completed gestation based on the last menstrual period. Preterm birth is the number one cause of neonatal intensive care unit admissions and the number one cause of newborn death in the otherwise normal baby in the United States.
The costs of preterm birth were estimated to be $26 billion per year in 2006. The causes of preterm birth are numerous, including increased numbers of twins, triplets and higher multiples from in-vitro fertilization and other reproductive techniques, an older population having babies and, thus, more medical complications requiring preterm delivery, and diseases like pre-eclampsia. Unfortunately, the majority of babies are born early from idiopathic preterm labor, a condition caused by contractions without an identifiable cause that lead to delivery.
In spite of all of our 21st century medicine and advanced technology, very little has impacted or reduced the incidence of preterm birth. Today, approximately one in eight babies is born prematurely, a number that has actually increased since the 1960’s. Preterm birth has traditionally been managed, yet there is no real, reliable prevention.
Is there any help for these preterm babies?
In the last century, there are very few interventions that have made a difference in preventing prematurity from an obstetrical side. We have made great advances in imaging and neonatal care, but have done virtually nothing to keep babies from delivering early.
The only benefit to babies that obstetricians have traditionally offered is exposure to a glucocorticoid-type of steroid. By administering either betamethisone or deximethisone to the mother at risk for preterm delivery, babies will functionally mature their brain, lungs, intestines and forty other tissues in their bodies by two weeks within 48 hours. The babies do not grow two weeks bigger in two days. The steroid effect simply gets them ready to be born early by accelerating cellular maturation.
Medications that are frequently used in acute preterm labor include magnesium sulfate, terbutaline, nifedipine and indomethacin. Each has its own risk and potential short-term benefit, and each will frequently stop labor long enough to allow for the mother to receive her two days of steroid injections.