Preterm Births in Germany: Statistics, Causes and Future Outlook
Every 12th child is born before the 37th week of pregnancy. In recent decades, the survival and developmental chances of these premature babies have significantly improved. A birth before the 37th week of pregnancy is considered a preterm birth. In Western Europe, premature babies generally survive from the 23rd to 24th week of pregnancy. There are additional classifications based on birth weight: <2500 g (low birth weight, LBW), <1500 g (very low birth weight, VLBW), and <1000 g (extremely low birth weight, ELBW). In 2017, the proportion of preterm births in Germany was 8.6% of all newborns; about 20% of these were multiple births. Thus, every twelfth child is born prematurely. Slightly more than 1% of all births involve babies with a birth weight under 1500 g, who require longer, specialized care.
The causes of preterm births are often unknown, although many risk factors are known. Risk factors from a previous pregnancy primarily include a prior preterm birth and previous interventions such as dilation and curettage after miscarriage or abortion. In the current pregnancy, factors such as a short interval to the previous pregnancy (less than six months), lack of prenatal care, artificial fertilization methods (e.g., in vitro fertilization), multiple pregnancies (twins, triplets), extreme weight before pregnancy (underweight or obesity), malnutrition, gestational diabetes, and infections (e.g., urinary tract infections, sexually transmitted infections, or uterine infections) can increase the risk.
The health of the mother and her personal history also play a role. Risk factors include the mother's age (younger than 16 or older than 35 years), ethnicity (non-Hispanic Black women or Native American/Alaska Native women in the U.S.), stress or lack of social support, domestic violence and smoking.
The survival chances and developmental prospects of preterm babies have greatly improved, but certain issues such as developmental delays, cerebral palsy, vision and hearing problems, ADHD, and learning difficulties still occur more frequently in premature babies than in those born at term. The key factors influencing development are birth weight, gestational age, whether the mother received corticosteroids prematurely, and post-birth complications. The baby's gender also plays a role, with girls tending to have better outcomes than boys of the same gestational age. Babies born before the 23rd week of pregnancy rarely survive. For babies born between 23 and 24 weeks, there is a chance of survival, but most have neurological problems. Most babies born after the 27th week survive without neurological damage.
Premature babies, due to their immature organs, are prone to numerous complications that increase with the degree of immaturity and are exacerbated by factors such as infections, diabetes, high blood pressure, or preeclampsia in the mother. The brain of a premature baby can cause irregular breathing (premature apnea), difficulties in sucking and swallowing, and an increased risk of brain hemorrhages and developmental delays. Problems in the gastrointestinal tract and liver often lead to frequent spitting up, slow digestion, bowel damage (necrotizing enterocolitis), and jaundice (hyperbilirubinemia). Impaired kidney function makes it difficult to regulate electrolytes and water balance, which can result in growth deficits and metabolic acidosis. Respiratory problems and respiratory distress syndrome (RDS) are common due to a lack of surfactant, and bronchopulmonary dysplasia (BPD) may develop. Abnormal growth of the retinal blood vessels can lead to retinopathy of prematurity and possibly blindness, while myopia and strabismus can also occur.
Premature babies have difficulty regulating their blood sugar and mineral levels, which can lead to hypo- or hyperglycemia, as well as metabolic bone disease and hypothyroidism. A persistent ductus arteriosus (PDA) strains the heart and may require medication or surgery. Lastly, premature babies cannot regulate their body temperature well, leading to hypothermia. They are therefore often kept warm in incubators or under heat lamps.
Regular prenatal care, early detection and treatment of risk factors, as well as the avoidance of tobacco, alcohol, and drug use can help reduce the risk of preterm birth. Although not all risk factors can be avoided, good prenatal care is crucial. Pregnant women who notice signs of preterm labor or a rupture of membranes should immediately consult their doctor to discuss possible measures.
The treatment of premature babies focuses on addressing complications individually, such as respiratory issues, infections, anemia, and eye diseases. Parents should visit frequently and engage in skin-to-skin contact. Fluffy materials should be removed from the crib to reduce the risk of sudden infant death syndrome. Babies are initially fed intravenously until they can tolerate food in their stomach, first via a feeding tube and then orally. Breast milk is the best food for premature babies, as it reduces the risk of necrotizing enterocolitis and infections. However, for babies with very low birth weight, breast milk may be low in some nutrients such as calcium, and it may need to be fortified with a nutrient solution. Very premature babies may spend weeks or months in the neonatal intensive care unit. They may require ventilation or special medications. Discharge from the hospital occurs when the baby can eat without special support, gain weight, regulate body temperature, and no longer has apnea. Preterm babies are carefully monitored at home and may receive therapy if needed.
Additionally, research is being conducted on numerous studies aimed at improving the well-being of premature babies. These include newly developed therapeutic strategies to improve eating abilities, food tolerance, and independent drinking. Another study focuses on parent-child interaction, which is particularly important for the socio-emotional and behavioral development of the infant. This interaction is intended to take place through skin-to-skin contact.
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