Prematurity and prevention: Is it feasible?

Preterm birth, especially at gestational ages less than 33 weeks is the major cause of neonatal mortality and late morbidity as well. In the last two decades major improvements have been achieved in the field of management both on the obstetrical and neonatological side. Consequently the mortality rate has been strongly reduced but unfortunately the same success has not been always obseived as afr as handicaps rate in survivors is concerned.Moreover it has been pointed out that the positive trend obseived in the first half of the last decade has stopped and no major progresses have been noticed after 1995. Therefore it is crucial to prevent the premature birth.Unfortunately the rate of babies born at veiy early gestational ages seems lo be increasing mainly due to the increasing number of multiple pregnancies fro IVF programs and a belter detection of fetal compromise inducing iatrogenic premature birth. Prevention's programs can be applied with success when dealing with one particular possible cause but, due the multiplicity of aetiological factors,preventive programs directed toward a general population have offered unsatisfactory results. Among the many factors responsible of premature births socioe economic conditions play a principal role and any effort should be directed toward removing the unfavourable situations. From the neonatological point of view the availability of technical resources adequate for assisting ihe.se fragile babies is necessary to improve at least the mortality rate.The clinical and ethical implications must be evaluated.