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Social Economical Issues

Low Birth Weight in the United States

The authors in this review provide extensive coverage of the socio-economical problem of low birth weight infants. According to the World Health Organization, a low birth weight infant is one born weighing less than 2,500 kg. Low birth weight is an important cause of perinatal mortality, infant morbidity, and childhood poor outcomes. They emphasize that low birth weight children being a heterogeneous cohort, the etiological factors contributing to the disorder are either preterm birth or fetal growth restriction. Clear descriptions of associated definitions are also given.

Neonatal outcomes associated with low weight at birth are considered in this paper. For example, low birth weight places the infant at a more considerable risk of late adult chronic medical conditions. Race and ethnicity are possible contributing factors. Survival having of small infants in the US has improved, the outcomes and strategies to reduce low birth weight are under close attention in this study.

The long-term ophthalmic outcome of low birth weight children with and without retinopathy of prematurity

This is a prospective trial, which enrolled more than 500 infants and traced down 50% of them, and ophthalmic long-term outcome of low birth weight infants studied in the UK. Preterm-born children are at risk of developing long-term neurological, developmental, and ophthalmic morbidity. The former is cerebral palsy, deafness, and hydrocephaly. The latter include deficits of visual acuity, contrast sensitivity and color vision, retarded ocular growth, and refractive errors, strabismus, and severe visual impairments. Visual impairments of children at the age of 10-12, compared with a control group of children born at full term are under investigation in this paper. Correlations between neonatal ophthalmic findings and their later outcome were revealed.

The study describes in detail that low birth weight children are at increased risk of visual impairments compared to those who are full-term born. Statistical analysis of the raw data allows authors to claim that low birth per se is a prognostic factor of visual disturbances.

Long term effects of low-birth-weight

The contributor from EmoryUniversitySchool emphasizes that low birth weight infants experience the risk of developing many complications, and only a few of them are permanent. Once, there is a common belief that low birth weight children have a greater chance of repeating a grade in school, and are prone to more difficulties graduating from high school in a timely, low birth weight becomes a major social issue.

Low birth weight is the major cause of infant mortality nowadays. These infants often experience developmental consequences, which include hyperactivity disorders, and are related to school achievement. One-third of low birth weight is likely to graduate from high school at the appropriate age. This is an example of how biological grounds determine social development, which, in turn, may influence economical status. Many of the causative factors of low birth weight are behavioral parental patterns. Appropriate perinatal care and prenatal family approach (aimed at behavior changes) may lower the risk of having a low birth weight infant.

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Perinatal outcomes associated with low birth weight in a historical cohort

In the Brazil study, low birth weight shows a close relationship with unfavorable perinatal outcomes. Low birth weight is an important issue in developing countries' public health. In this survey, a database of around 44,000 infants, more than 6,000 of them with low weight is under the scope. Low birth weight infants show usual markers of adverse perinatal outcome more frequently.

According to this search, small infants are at great risk of cesarean delivery or labor induction. They tend to experience more frequent signs of perinatal compromises, such as deviations of amniotic volumes, disturbing patterns of fetal heart rate, malformations, and unsatisfactory Apgar scores. Thus, prenatal assistance as a whole, with particular attention to neonatal care and especially to those born with low weight, may change the long-time outcomes for such babies in developing countries. The survey confirms a strong association between low birth weight and unfavorable perinatal outcomes. Nevertheless, the study has evident weak points, for example, according to the authors, low weight infants are delivered 4.7 times more frequently vaginally than term, which is controversial.

Behavioral symptoms of attention-deficit/ hyperactivity disorder in preterm and term children born small and appropriate for gestational age: A longitudinal study

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This study comprises more than 1,500 infants from Finland and more than 800 of them actually participated, to reveal associations between birth status and attention disorder symptoms rated by parent(s) in the child. The symptoms were rated at the 56-month follow-up. The investigators in this survey claim that preterm birth does not correlate significantly with high parent-rated behavioral symptoms scores of attention-deficit/hyperactivity disorder at the age of 56 months. Nevertheless, being born small for gestational age (less than 2 Standard Deviations) may be associated with high symptoms scores.

Heinonen et al. evaluated attention-deficit/hyperactivity disorder risk for low birth weight and preterm infants in a longitudinal regional birth cohort study. Either small body size at birth and prematurity is reported to be associated with increased risk for symptoms of attention-deficit/hyperactivity disorder. Thus, mothers with low birth weight children face challenges and may experience negative recollections of birth that affect their behavior with their child.

The health consequences of low birth weight: literature review and critique

In this extensive literature search, numerous contributions of birth weight and socio-demographic factors to health outcomes at the population level were considered. The article notes that several methodological problems hamper studies of low birth weight, such as lack of control points in neonatal intensive care units, or an unwarranted reliance on health provider data. Nevertheless, it is possible to establish a negative relation between low birth weight and child health outcomes.  Should the social environment for particular parents improve, low birth weight may be anticipated substantially?

The Belgium author in his review pointed to the increasing incidence of low birth weight in European countries. The author focused sighting on the role of social factors. It must be noted that, according to his search, data concerning school age and adulthood outcomes still lack, because most attention is paid to early childhood yet. As for his Appendix, it is worthily to remember social factors of low birth weight: smoking, alcohol, stress, coffee, as well as health-related factors: abortion, fertility treatment, hypertension, socio-demographic risk factors: age, education, marital status, social class.

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Measuring socio-economic differentials in low birth weight: looking beyond parental employment and educational attainment

As this literature search emphasizes, as long as prematurity is the leading cause of neonatal mortality, and a major cause of pediatric morbidity and disability, low birth weight is the most important epidemiology indicator. Once it refers both to mothers' and children's health, birth weight is a sensitive health care indicator. At the same time, socioeconomic status is not an easily observed measure. Very often income, education, and occupation are taken as its variables as if they were interchangeable. However, for people of reproductive ages education and income are not interchangeable. This is why estimating proper correlations is sometimes problematic.

Fernández et al. conclude, socioeconomic status of the mother, and her associated lifestyle plays a major role in the probability to deliver a low birth weight infant. It should be noted women’s style of life, work, and reproductive patterns set several particularities that differ from men’s. The author in a well-researched paper aims to improve the understanding of social inequalities in low birth existing behind the socioeconomic status concept.

Toronto Public Health

Low birth weight infants represent a major health problem worldwide. Low birth weight rates are higher in the US compared to other developed nations. Thus, the associated costs being enormous, they are related not only to the initial mother’s and infant’s hospital costs but to the long-term payments associated with neurological disorders, developmental impairments, and learning disabilities.

In their excellent literature watch, researchers from Canada conclude that low weight births are a major health problem both to the individual infant and to the entire family and the society. The negative impact of maternal stress and workload on birth weight is reported. Chronic stress might be an etiological factor that affects fetal growth. Maternal depression could play a key role in the etiology of low birth weight. Even though there are a lot of studies dedicated to low birth weight infants, evidence-based recommendations are still under development.

The Costs of Low Birth Weight. National Bureau of Economic Research

Describes an attempt of the National bureau of economic research to calculate the costs of low birth weight. It is stated that even among babies weighing up to 2 kilograms (those who have a relatively low mortality rate), each additional 454 grams of weight are associated with a $10,000 difference in hospital inpatient services charges. The contributors give a comparison of the health at birth, hospital costs, and infant mortality rates between heavy and light newborns from twin pairs of the United States, and search for the effects of maternal smoking during pregnancy. Surprisingly, analysis suggests that low birth weight implies smaller effects than previously thought. For example, the authors conclude, estimates of excess costs due to low birth weight are more than three-time upwardly biased. The latter implies that the $263 million estimates overstate true costs of maternal smoking by two-thirds.

Cost of hospitalization for preterm and low birth weight infants in the United States

Discusses United States community hospitals from participating states, and grades the paying into four categories: Medicaid, private insurance, self-pay, and other.  Furthermore, the direct costs of low birth weight infants hospitalization in the US were calculated. The low birth weight associated admissions impact hospital costs for infants considerably. According to the manuscript, low birth weight infants in hospital costs average a little more than $15,000, with a mean length of stay of almost 13 days to compare with $600 and a little less than 2 days for healthy newborns. It is also important to mention that costs for 4.6 million infant hospitalizations are estimated at $12.4 billion. Eight percent of all infant stays included a diagnosis low birth weight account for almost a half of total infant costs.

Thus, suggested low birth weight infants account for 50% of infant hospitalization costs and 25% of total pediatric costs. It is calculated among low birth weight infant stays, almost a half of costs provided by had Medicaid, a half by private insurances, and minor contributors are self-pay, and Medicare.

Low birth weight outcomes and disparities in Connecticut: a strategic plan for the Family Health Section. Department of Public Health

Provides data concerning the quality of life of surviving low birth weight infants, with special attention to ongoing newborn morbidity. This leads to an increase in survivors and a greater frequency of diseases. A team from Connecticut has worked out a plan for the Family Health Section concerning low birth weight. It is considered there were more than 2,700 hospitalizations for low birth weight newborns in 2006, with charging $195 million totally. This kind of hospitalization tends to be longer (8 times more) and more costly (20 times more) compared to usual weight infants. Low birth weight infants are more frequently transferred to other health care facilities and require long-term home health services following hospital discharge. Thus, further healthcare costs are added.

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A variety of public health interventions planned, which include assuring quality to care before, during, and after pregnancy, tobacco cessation program, individual case management and home attendance for first-time mothers, assessment public awareness of biobanks for biomedical research, etc. 

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