to develop type 1 diabetes (roughly 1.2 times the rate) and type 2 diabetes (1.5 times). despite the neurosensory, mental and educational problems studied in school age and adolescent children born extremely preterm, the majority of preterm survivors born during the early years of neonatal intensive care are found to do well and to live fairly normal lives in young adulthood. young adults born preterm seem to acknowledge that they have more health problems than their peers, yet feel the same degree of satisfaction with their quality of life. beyond the neurodevelopmental consequences of prematurity, infants born preterm have a greater risk for many other health problems. for instance, children born prematurely have an increased risk for developing chronic kidney disease. epidemiology disability-adjusted life year for prematurity and low birth weight per 100,000 inhabitants in 2004. no data less than 120 120-240 240-360 360-480 480-600 600-720 720-840 840-960 960-1080 1080-1200 1200-1500 more than 1500 preterm birth complicates 5%–18% of births worldwide. in europe and many developed countries the preterm birth rate is generally 5–9%, and in the u.s. it has even risen to 12–13% in the last decades. as weight is easier to determine than gestational age, the world health organization tracks rates of low birth weight (< 2,500 grams), which occurred in 16.5% of births in less developed regions in 2000. it is estimated that one third of these low birth weight deliveries are due to preterm delivery. weight generally correlates to gestational age; however, infants may be underweight for other reasons than a preterm delivery. neonates of low birth weight (lbw) have a birth weight of less than 2,500 g (5 lb 8 oz) and are mostly but not exclusively preterm babies as they also include small for gestational age (sga) babies. weight-based classification further recognizes very low birth weight (vlbw) which is less than 1,500 g, and extremely low birth weight (elbw) which is less than 1,000 g. almost all neonates in these latter two groups are born preterm. about 75% of nearly a million deaths due to preterm deliver would survive if provided warmth, breastfeeding, treatments for infection, and breathing support. complications from preterm births resulted in 740,000 deaths in 2013, down from 1.57 million in 1990. society and culture economics preterm birth is a significant cost factor in healthcare, not even considering the expenses of long-term care for individuals with disabilities due to preterm birth. a 2003 study in the u.s. determined neonatal costs to be $224,400 for a newborn at 500–700 g versus $1,000 at over 3,000 g. the costs increase exponentially with decreasing gestational age and weight. the 2007 institute of medicine report preterm birth found that the 550,000 premature babies born each year in the u.s. run up about $26 billion in annual costs, mostly related to care in neonatal intensive care units, but the real tab may top $50 billion. notable cases james elgin gill (born on 20 may 1987 in ottawa, ontario, canada) was the earliest premature baby in the world, until that record was broken in 2004. he was 128 days premature, 21 weeks 5 days gestation, and weighed 624 g (1 lb 6 oz). he survived. in 2014, lyla stensrud, born in san antonio, texas, u.s., became the youngest premature baby in the world. she was born at 21 weeks 4 days and weighed 410 grams (less than a pound). kaashif ahmad resuscitated the baby after she was born. as of november 2018, lyla was attending preschool. she had a slight delay in speech, but no other known medical issues or disabilities. amillia taylor is also often cited as the most premature baby. she was born on 24 october 2006 in miami, florida, u.s., at 21 weeks and 6 days' gestation. this report has created some confusion as her gestation was measured from the date of conception (through in vitro fertilization) rather than the date of her mother's last menstrual period, making her appear 2 weeks younger than if gestation was calculated by the more common method. at birth, she was 23 cm (9 in) long and weighed 280 g (10 oz). she had digestive and respiratory problems, together with a brain hemorrhage. she was discharged from the baptist children's hospital on 20 february 2007. the record for the smallest premature baby to survive was held for a considerable amount of time by madeline mann, who was born in 1989 at 26 weeks, weighing 280.0 g (9.875 oz) and measuring 24 cm (9.5 in) long. this record was broken in september 2004 by rumaisa rahman, who was born in the same hospital, loyola university medical center in maywood, illinois. at 25 weeks' gestation. at birth, she was 20 cm (8 in) long and weighed 261 g (9.2 oz). her twin sister was also a small baby, weighing 563 g (1 lb 3.9 oz) at birth. during pregnancy their mother had pre-eclampsia, requiring birth by caesarean section. the larger twin left the hospital at the end of december, while the smaller remained there until 10 february 2005 by which time her weight had increased to 1.18 kg (2 lb 10 oz). generally healthy, the twins had to undergo laser eye surgery to correct vision problems, a common occurrence among premature babies. in may 2019, sharp mary birch hospital for women & newborns in san diego announced that a baby nicknamed "saybie" had been discharged almost five months after being born at 23 weeks' gestation and weighing 244 g (8.6 oz). saybie was confirmed by dr. edward bell of the university of iowa, which keeps the tiniest babies registry, to be the new smallest surviving premature baby in that registry. born in february 2009, at children's hospitals and clinics of minnesota, jonathon whitehill was just 25 weeks' gestation with a weight of 310 g (11 oz). he was hospitalized in a neonatal intensive care unit for five months, and then discharged. richard hutchinson was born at children's hospitals and clinics of minnesota in minneapolis, minnesota, on june 5, 2020, at 21 weeks 2 days gestation. at birth he weighed 340 g (12 oz). he remained hospitalized until november 2020, when he was then discharged. on 5 july 2020 curtis means was born at the university of alabama at birmingham hospital at 21 weeks 1 day, and weighed 420 g (15 oz). he was discharged in april 2021. as of march 2023, he is the current world record holder. historical figures who were born prematurely include johannes kepler (born in 1571 at seven months' gestation), isaac newton (born in 1642, small enough to fit into a quart mug, according to his mother), winston churchill (born in 1874 at seven months' gestation), and anna pavlova (born in 1885 at seven months' gestation). effect of the coronavirus pandemic during the covid-19 pandemic, a drastic drop in the rate of premature births has been reported in many countries, ranging from a 20% reduction to a 90% drop in the starkest cases. studies in ireland and denmark first noticed the phenomenon, and it has been confirmed elsewhere. there is no universally accepted explanation for this drop as of august 2020. hypotheses include additional rest and support for expectant mothers staying at home, less air pollution due to shutdowns and reduced car fumes, and reduced likelihood of catching other diseases and viruses in general due to the lockdowns. research brain injury is common among preterms, ranging from white matter injury to intraventricular and cerebellar haemorrhages. the characteristic neuropathology of preterms has been described as the "encephalopathy of prematurity". the number of preterms that receive special education is doubled compared to the general population. school marks are lower and so are verbal learning, executive function, language skills, and memory performance scores, as well as iq scores. behaviourally, adolescents who were born very preterm and/or very low birth weight have similar self-reports of quality of life, health status and self-esteem as term controls. various structural magnetic resonance studies found consistent reductions in whole brain volume. the extensive list of particular regions with smaller volumes compared to controls includes many cortical areas (temporal, frontal, parietal, occipital and cingulate), the hippocampal regions, thalamus, basal ganglia, amygdala, brain stem, internal capsule, corpus callosum, and cerebellum. brain volume reduction seems to be present throughout the whole brain. in contrast, larger volumes were found in some of the same areas including medial/anterior frontal, parietal and temporal cortex, cerebellum, middle temporal gyrus, parahippocampal gyrus, and fusiform gyrus, as well as larger lateral ventricles on average. the cause of these inconsistencies are unknown. additionally, reductions in cortical surface area/cortical thickness were found in the temporal lobes bilaterally and in left frontal and parietal areas. thicker cortex was found bilaterally in the medial inferior and anterior parts of the frontal lobes and in the occipital lobes. gestational age was positively correlated with volumes of the temporal and fusiform gyri and sensorimotor cortex bilaterally, left inferior parietal lobule, brain stem, and various white matter tracts, as well as specific positive associations with the cerebellum and thalamus. several structural brain alterations have been linked back to cognitive and behavioural outcome measures. for example, total brain tissue volume explained between 20 and 40% of the iq and educational outcome differences between extremely preterm born adolescents and control adolescents. in another study, a 25% quartile decrease in white matter values in middle temporal gyrus was associated with a 60% increase in the risk of cognitive impairment. nosarti and colleagues previously hypothesised that maturational patterns in preterm brains were consistent with the age-related stages typically observed in younger subjects. their most recent study suggests, however, that their trajectory may not only be delayed but also fundamentally distinctive. since both smaller and larger regional volumes were found in very preterm individuals compared to controls. the evidence to support the use of osteopathic manipulations to provide benefit in neonatal care is weak.