import json

data = {
 "topic": "Preterm Birth",
 "slug": "preterm-birth",
 "category_id": 15175,
 "summary": "Preterm birth, defined as delivery before 37 completed weeks' gestation, is the leading cause of neonatal death and a major driver of long-term neurodevelopmental, growth, and cardiovascular risk, with risk rising as gestational age falls.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "Berkowitz's Pediatrics", "author": "Berkowitz, Carol D.;", "pages": [324, 331]},
  {"title": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan)", "author": None, "pages": [82]},
  {"title": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition", "author": "American Academy of Pediatrics", "pages": [213]},
  {"title": "Pediatric Clinical Practice Guidelines and Policies", "author": "American Academy of Pediatrics (AAP);", "pages": [263]},
  {"title": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition", "author": "Tricia Lacy Gomella, Fabien G. Eyal and Fayez Bany-Mohammed", "pages": [311, 1459]},
  {"title": "Update in Pediatrics", "author": None, "pages": [554]},
  {"title": "Textbook of Neonatal Resuscitation (8th ed)", "author": None, "pages": [216, 220]},
  {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [78]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Preterm birth is defined as delivery before 37 completed weeks of gestation; because of increased adverse outcomes even at 37-38 weeks, ACOG now defines 39 weeks as the target for optimal, nonmedically-indicated delivery\n"
   "- Preterm birth is the leading cause of newborn death and the second leading cause of death in children under 5 worldwide; more than 1 million children die annually from preterm birth-related complications\n"
   "- In the US, preterm infants comprise about 12.8% of all births, having risen over 30% in the past 30 years; late preterm births (34 0/7 to 36 6/7 weeks) account for over 70% of all preterm births and have driven most of the recent increase (up 25% since 1990, versus 10% for births under 34 weeks)\n"
   "- Contributing obstetric trends: labor induction rose from 9.5% (1990) to 22.5% (today); cesarean sections now exceed 30% of all births; rising maternal age, more elective cesareans, and increased use of assisted reproductive technology (raising multiple gestation rates) also contribute\n"
   "- US preterm birth rate is highest among Black women (14%) versus White women (9%); rates declined 2007-2014 (partly from fewer teen/young-mother births) but have risen again since 2016 for unclear reasons\n"
   "- About 70% of preterm births result from spontaneous preterm labor or premature rupture of membranes (associated with infection, pathologic uterine distension, HPA axis activation, decidual hemorrhage); the remaining 30% are medically indicated, from fetal causes (congenital anomalies, infection, growth restriction, fetal distress) or maternal causes (antepartum hemorrhage from placenta previa/accreta, preeclampsia, chronic maternal disease)\n"
   "- Multiple pregnancies carry higher preterm birth risk than singletons; complications of prematurity include respiratory disorders, sepsis, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity - risk and severity of each rises as gestational age falls\n"
   "- Neurodevelopmental risk (cerebral palsy, intellectual disability, sensory deficits) rises with decreasing gestational age, highest in survivors born at the limit of viability (at or before 25 weeks); even late preterm infants (33-36 weeks) have higher rates of cognitive impairment, cerebral palsy, and school problems than full-term children, and preterm children overall have higher rates of language disorders, visual-perceptual problems, minor neuromotor dysfunction, attention deficits, executive dysfunction, learning disabilities, and social/emotional difficulties\n"
   "- Other predictors of neurodevelopmental disability beyond gestational age: poor growth (especially head growth), asphyxia, sepsis (especially meningitis), chronic lung disease, necrotizing enterocolitis, and retinopathy of prematurity; VLBW malnutrition is linked to poorer head growth and higher rates of cerebral palsy and autism\n"
   "- Preterm birth (and especially low birth weight) has been linked to elevated blood pressure risk in childhood - one cohort found 7.3% prevalence of hypertension among 3-year-olds born preterm - and to abnormal circadian BP patterns, though data remain limited; enteral nutrition should be attempted as soon as possible in every preterm neonate despite gut immaturity, since nutrition strongly influences long-term growth and neurodevelopmental outcome"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Preterm birth is defined as delivery before 37 completed weeks of gestation. Recognizing that adverse neonatal outcomes are also increased at 37-38 weeks compared with later delivery, the American College of Obstetricians and Gynecologists has redefined optimal, nonmedically-indicated delivery as occurring at 39 weeks' gestation. Late preterm birth is specifically defined as delivery between 34 0/7 and 36 6/7 weeks' gestation."
  )},
  {"title": "Epidemiology", "content": (
   "Preterm birth is the leading cause of newborn death and the second leading cause of death in children under age 5 worldwide, with more than 1 million children dying annually from preterm birth-related complications; global incidence has risen over the past 20 years per WHO data. In the United States, preterm births comprise approximately 12.8% of all births, an increase of more than 30% over the past 30 years. Late preterm births now account for over 70% of all preterm births and have driven most of the recent increase - up 25% since 1990, compared with a 10% increase in births under 34 weeks over the same period. US preterm birth rates declined from 2007 to 2014, in part from fewer births to teenage and young mothers, but have risen again since 2016 for reasons that remain largely unclear. Preterm birth rates differ substantially by race, highest among Black women (14%) and lowest among White women (9%). Contributing obstetric practice trends include increased labor induction (from 9.5% in 1990 to 22.5% currently), cesarean sections now exceeding 30% of all births, increased use of assisted reproductive technology (raising rates of multiple gestation, which itself carries higher preterm birth risk than singleton pregnancy), increased maternal age, and rising rates of elective cesarean section, including \"at maternal request.\""
  )},
  {"title": "Etiology", "content": (
   "Approximately 70% of preterm births result from spontaneous onset of preterm labor or premature rupture of membranes; factors associated with spontaneous preterm labor include infection, pathologic uterine distension, activation of the hypothalamic-pituitary-adrenal axis, and decidual hemorrhage. The remaining approximately 30% of preterm births are medically indicated, driven by fetal or maternal conditions. Fetal indications for early delivery include congenital abnormalities, infection, growth restriction, and fetal distress. Maternal indications include antepartum hemorrhage (placenta previa, placenta accreta), hypertensive disorders of pregnancy (preeclampsia), and chronic maternal health conditions."
  )},
  {"title": "Complications", "content": (
   "Complications of preterm birth include respiratory disorders, sepsis, patent ductus arteriosus, varying degrees of intraventricular hemorrhage and its sequelae, necrotizing enterocolitis, and retinopathy of prematurity; the degree of prematurity is the key variable driving these outcomes, with earlier birth associated with higher rates of each complication (outcomes for multiples are otherwise similar to singletons at comparable gestational age). Neurodevelopmental risk - cerebral palsy, intellectual disability, and sensory deficits - increases with decreasing gestational age and increasing severity of brain injury, with risk of disability, especially cognitive impairment, highest in survivors born at the limit of viability (at or before 25 weeks' gestation). Beyond gestational age itself, other predictors of neurodevelopmental disability include poor growth (especially poor head growth), asphyxia, sepsis (particularly meningitis), chronic lung disease, necrotizing enterocolitis, and retinopathy of prematurity. Children born preterm - including those born late preterm (33-36 weeks), who have higher rates of cognitive impairment, cerebral palsy, and school problems than full-term children - show higher rates than full-term controls of language disorders, visual-perceptual problems, minor neuromotor dysfunction, attention deficits, executive dysfunction, learning disabilities, social-communicative problems, and emotional difficulties. Malnutrition in preterm newborns, especially very low birthweight (VLBW) infants, is associated with poorer head growth, persistently smaller head size with resulting poor psychomotor/mental skills, and higher rates of cerebral palsy and autism. Preterm birth and low birth weight have also been identified as risk factors for hypertension and cardiovascular disease later in life; one retrospective cohort found a 7.3% prevalence of hypertension among 3-year-olds born preterm, and preterm birth has also been linked to abnormal circadian blood pressure patterns in childhood, though these data remain limited and require further study."
  )},
  {"title": "Treatment", "content": (
   "Immediate management at birth focuses on a systematic, gestational-age-informed approach to neonatal transition and resuscitation, since preterm newborns are more likely to require assistance and are also more vulnerable to injury from resuscitation procedures - the goal is initiating support without delay while avoiding unnecessarily invasive interventions. Enteral nutrition should be attempted in every preterm neonate as soon as possible, despite the immaturity of the preterm (especially VLBW) gastrointestinal tract, given nutrition's central role in long-term growth and neurodevelopmental outcome. Ongoing management requires coordination of medical, developmental, and social services given the multiple chronic conditions preterm infants may face, and correction for degree of prematurity should be applied when assessing growth and development. Primary care physicians providing ongoing care for former preterm infants should plan for longer well-child visits to adequately evaluate nutritional and developmental progress and assess family adjustment to caring for the infant at home."
  )},
  {"title": "Prevention", "content": (
   "Because 70% of preterm births arise from spontaneous preterm labor or membrane rupture linked to infection, uterine overdistension, HPA axis activation, or decidual hemorrhage, and the remaining 30% are medically indicated for fetal or maternal reasons, prevention efforts address both pathways: reducing nonmedically-indicated early delivery (reflected in the shift to a 39-week target for elective delivery) and managing modifiable contributors to spontaneous preterm labor and medically indicated preterm delivery where possible. The rising rate of late preterm birth driven partly by obstetric practice patterns (increased induction, increased cesarean rates, assisted reproduction, elective delivery) represents an area where practice changes could meaningfully affect population-level preterm birth rates."
  )}
 ],
 "clinical": [
  {"title": "Ongoing care of the former preterm infant", "content": (
   "For any preterm infant, gestational age at birth (and, closely related, birthweight) is the single most useful piece of information for anticipating risk - the earlier the birth, the higher the risk of respiratory disease, IVH, NEC, retinopathy of prematurity, and long-term neurodevelopmental impairment, with the highest risk concentrated in infants born at or before 25 weeks. Start enteral feeding as early as feasible even in very preterm infants, since nutrition is closely tied to long-term head growth and neurodevelopmental outcome, and malnutrition (particularly in VLBW infants) is specifically linked to smaller head size, poorer psychomotor/mental outcomes, and higher rates of cerebral palsy and autism.\n\nIn primary care follow-up, always correct chronologic age for degree of prematurity when assessing growth and developmental milestones, and plan for longer well-child visits to properly evaluate nutritional status, developmental trajectory, and family coping. Screen proactively - not just reactively - for the recognized long-term risks of prematurity: language delay, visual-perceptual problems, minor neuromotor dysfunction, attention and executive function difficulties, learning disabilities, and social/emotional problems, since these can be subtle and are common even in children who look well at early exams, including those born late preterm (33-36 weeks) who are often mistakenly treated as low-risk. Track growth parameters, especially head circumference, as an early marker of nutritional adequacy and neurodevelopmental risk. Given the described association between preterm/low birth weight and later hypertension, consider incorporating blood pressure monitoring into longer-term follow-up for children with a preterm birth history, while recognizing the evidence here is still preliminary."
  )}
 ]
}

with open("/tmp/preterm-birth.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")