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Preterm birth is a heterogeneous syndrome, and its description includes three factors: spontaneous abortion or medical induction, whether there is premature rupture of membranes and the mode of delivery.
Some people have also proposed a phenotypic classification system, including features related to the etiology of the mother, fetus, and placenta, as well as the signs of delivery and the route of delivery.
Twelve preterm phenotypes (i.
e.
, independent biological entities with specific risk factors, neonatal anthropometric measurements, neonatal morbidity and mortality risks) have been identified.
The INTERGROWTH-21 newborn study is the second phase of the 21st Century International Federation of Fetal and Newborn Growth Project.
The project is a population-based research project carried out from 2008 to 2015, involving nearly 70,000 mothers and babies worldwide .
In this study, the researchers investigated whether the preterm birth phenotype is related to differences in the clinical, epidemiology, growth, and neurodevelopment of preterm infants and full-term infants under 2 years of age.
The results of the study were recently published on JAMA Pediatrics.
The INTERBIO-21 study included a cohort of premature and full-term newborns registered from maternity hospitals in 6 countries from March 2012 to June 2018, and followed up from birth to 2 years of age.
Ultrasonography was performed for all pregnancies.
The data analysis time is from November 2019 to October 2020.
A total of 6,529 babies (3312 boys [50.
7%]) were included in the analysis.
Among them, 1381 cases were premature delivery (average [SD] gestational age at birth, 34.
4[0.
1] weeks; 5148 cases were full-term delivery (average [SD] gestational age at birth, 39.
4[0] weeks). In 1381 preterm infants, 8 phenotypes were found: undetected maternal, fetal or placental conditions (485 cases, 35.
1%); infection (289 cases, 20.
9%); preeclampsia (162 cases, 11.
7%); fetal distress (131 cases, 9.
5%); intrauterine growth restriction (110 cases, 8.
0%); severe maternal disease (85 cases, 6.
2%); bleeding (71 infants [5.
1% ]); Congenital abnormalities (48 infants [3.
5%]).
For all phenotypes, preterm birth is a risk factor for recurrence.
Each phenotype differs in neonatal morbidity and infant outcome.
For example, infants with no major disease phenotype have a lower neonatal morbidity at the age of 1, but an increase in morbidity and hospitalization (odds ratio [OR], 2.
2; 95% CI, 1.
8-2.
7).
Compared with full-term neonates, neonates with fetal distress (OR, 10.
6; 95% CI, 5.
1-22.
2) phenotypes have the highest risk of 10 percentiles below the INTER-NDA standard value in the field of fine motor development .
Neonatal Severe Morbidity Index by Preterm Birth Phenotype According to the preterm birth phenotype, the risk of scoring less than 10 percentiles in the INTERGROWTH-21st developmental assessment at 2 years of age.
The results of this study indicate that the maternal risk factors, less than There are different patterns in neonatal morbidity of gestational age, growth and development of newborns and children, severe morbidity, and neurodevelopment of preterm birth phenotypes.
These different patterns may be related to specific pathological factors, which affect the growth of the fetus.
Impact, as previously reported for early neonatal outcomes.
For example, neonates with an intrauterine growth restriction phenotype have a lower incidence in the neonatal period, but more growth restriction and neurodevelopmental retardation in childhood.
Neonates without major disease phenotypes and gestational age have a low neonatal incidence, but the incidence increases at 2 years of age.
People with an infected phenotype have a lower gestational age at birth and a lower risk of being younger than gestational age, but a higher risk of morbidity and growth restriction after birth.
In summary, in this study, preterm birth syndrome is composed of well-defined phenotypes with different neonatal morbidity, early childhood morbidity, growth, and neurodevelopment under 2 years of age.
Therefore, the concept of treating preterm birth as a purely time-based entity may no longer be appropriate.
The phenotypic classification of preterm infants helps to better understand the causes and mechanisms associated with preterm birth.
Although the results of the study indicate that about 35% of the phenotypes are not related to different clinical conditions, newborns with preterm phenotypes still have a higher risk of growth and development.
References: Villar J, Restrepo-Méndez MC, McGready R, et al.
Association Between Preterm-Birth Phenotypes and Differential Morbidity, Growth, and Neurodevelopment at Age 2 Years: Results From the INTERBIO-21st Newborn Study.
JAMA Pediatr.
Published online March 01, 2021.
doi:10.
1001/jamapediatrics.
2020.
6087 For more information, please click to read the original text to download Metz Medical APP~
Some people have also proposed a phenotypic classification system, including features related to the etiology of the mother, fetus, and placenta, as well as the signs of delivery and the route of delivery.
Twelve preterm phenotypes (i.
e.
, independent biological entities with specific risk factors, neonatal anthropometric measurements, neonatal morbidity and mortality risks) have been identified.
The INTERGROWTH-21 newborn study is the second phase of the 21st Century International Federation of Fetal and Newborn Growth Project.
The project is a population-based research project carried out from 2008 to 2015, involving nearly 70,000 mothers and babies worldwide .
In this study, the researchers investigated whether the preterm birth phenotype is related to differences in the clinical, epidemiology, growth, and neurodevelopment of preterm infants and full-term infants under 2 years of age.
The results of the study were recently published on JAMA Pediatrics.
The INTERBIO-21 study included a cohort of premature and full-term newborns registered from maternity hospitals in 6 countries from March 2012 to June 2018, and followed up from birth to 2 years of age.
Ultrasonography was performed for all pregnancies.
The data analysis time is from November 2019 to October 2020.
A total of 6,529 babies (3312 boys [50.
7%]) were included in the analysis.
Among them, 1381 cases were premature delivery (average [SD] gestational age at birth, 34.
4[0.
1] weeks; 5148 cases were full-term delivery (average [SD] gestational age at birth, 39.
4[0] weeks). In 1381 preterm infants, 8 phenotypes were found: undetected maternal, fetal or placental conditions (485 cases, 35.
1%); infection (289 cases, 20.
9%); preeclampsia (162 cases, 11.
7%); fetal distress (131 cases, 9.
5%); intrauterine growth restriction (110 cases, 8.
0%); severe maternal disease (85 cases, 6.
2%); bleeding (71 infants [5.
1% ]); Congenital abnormalities (48 infants [3.
5%]).
For all phenotypes, preterm birth is a risk factor for recurrence.
Each phenotype differs in neonatal morbidity and infant outcome.
For example, infants with no major disease phenotype have a lower neonatal morbidity at the age of 1, but an increase in morbidity and hospitalization (odds ratio [OR], 2.
2; 95% CI, 1.
8-2.
7).
Compared with full-term neonates, neonates with fetal distress (OR, 10.
6; 95% CI, 5.
1-22.
2) phenotypes have the highest risk of 10 percentiles below the INTER-NDA standard value in the field of fine motor development .
Neonatal Severe Morbidity Index by Preterm Birth Phenotype According to the preterm birth phenotype, the risk of scoring less than 10 percentiles in the INTERGROWTH-21st developmental assessment at 2 years of age.
The results of this study indicate that the maternal risk factors, less than There are different patterns in neonatal morbidity of gestational age, growth and development of newborns and children, severe morbidity, and neurodevelopment of preterm birth phenotypes.
These different patterns may be related to specific pathological factors, which affect the growth of the fetus.
Impact, as previously reported for early neonatal outcomes.
For example, neonates with an intrauterine growth restriction phenotype have a lower incidence in the neonatal period, but more growth restriction and neurodevelopmental retardation in childhood.
Neonates without major disease phenotypes and gestational age have a low neonatal incidence, but the incidence increases at 2 years of age.
People with an infected phenotype have a lower gestational age at birth and a lower risk of being younger than gestational age, but a higher risk of morbidity and growth restriction after birth.
In summary, in this study, preterm birth syndrome is composed of well-defined phenotypes with different neonatal morbidity, early childhood morbidity, growth, and neurodevelopment under 2 years of age.
Therefore, the concept of treating preterm birth as a purely time-based entity may no longer be appropriate.
The phenotypic classification of preterm infants helps to better understand the causes and mechanisms associated with preterm birth.
Although the results of the study indicate that about 35% of the phenotypes are not related to different clinical conditions, newborns with preterm phenotypes still have a higher risk of growth and development.
References: Villar J, Restrepo-Méndez MC, McGready R, et al.
Association Between Preterm-Birth Phenotypes and Differential Morbidity, Growth, and Neurodevelopment at Age 2 Years: Results From the INTERBIO-21st Newborn Study.
JAMA Pediatr.
Published online March 01, 2021.
doi:10.
1001/jamapediatrics.
2020.
6087 For more information, please click to read the original text to download Metz Medical APP~
