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Preterm Birth: Risks and How Children’s Hospital Can Help

10/31/2011 

Born at 23 weeks, 1 pound 3 ½ ounces, with eyes fused shut and appearing lifeless, baby Lucy already had the odds stacked against her. Unresponsive and with undeveloped lungs, most infants this premature Dr. Fuentes conducts ultrasounddon’t survive, and those who do often experience major problems for life.

Pregnant women and those trying to conceive need to know about preterm labor and delivery, what they can do to help prevent it, and the type of prenatal and neonatal care that’s available if necessary. This will help ensure the expectant mom’s own well-being while giving her baby the best chance possible for a healthy life.

“Preterm infants – or those born before the 37th week of pregnancy – are at greater risk for short-term and long-term complications, including disabilities and impediments in growth and mental development, and even death,” said Dr. Jeffrey Pietz, chief of newborn medicine, Children’s Hospital Central California. “The earlier the birth, the greater the risk.”

Preterm Births

Over the past 40 years, significantly improved neonatal intensive care, treatment and surgery have greatly enhanced premature infants’ health. Unfortunately, they have not reduced the prevalence of preterm birth, which is the major cause of neonatal mortality in developed countries.

In the United States, preterm births occur in about 12 percent of all pregnancies. A normal pregnancy should last about 40 weeks to give the baby optimum time to develop. A pregnancy that ends between 20 and 37 weeks is considered preterm, and all preterm babies – like baby Lucy – are at considerable risk for health problems.

During an average week in California, for example, 10,611 babies are born, according to the March of Dimes. Of these babies:

  • 1,111 are born preterm
  • 723 are born low birthweight, and
  • 55 die before their first birthday

Generally, medical caregivers do not resuscitate infants born less than 23 weeks. Some major hospitals choose not to resuscitate newborns under 25 weeks, primarily because the preemies’ health is often seriously impaired.

In Lucy’s case, caregivers resuscitated her and she survived fortunately with no major developmental issues. She received expert neonatal care at Children’s Hospital’s Neonatal Intensive Care Unit (NICU), an 88-bed regional tertiary Level IIIc NICU with 21 private and semi-private rooms and an additional 18 beds in satellite units throughout the Central Valley. The only one of its kind in the Valley, Children’s NICU provides 24-hour coverage by board certified neonatologists with consultations from medical and surgical subspecialists. It’s the highest level of care a baby like Lucy and others can receive.

Risks Premature Babies Face

Some babies born early do very well – but they are the exception. Babies born very preterm are at high risk for problems with their brain, breathing and digestion in the first few days of life. They are also at risk for complications later in the form of delayed development and learning problems in school. Effects of premature birth can have damaging consequences throughout their lives. 

Specifically, medical complications premature infants are at serious risk for include:

  • Neurological – Apnea of prematurity (breathing stops for more than 15 seconds); retinopathy of prematurity (ROP); developmental disability; cerebral palsy; and intraventricular hemorrhage
  • Cardiovascular – Failure of the ductus arteriosus to close after birth
  • Respiratory – Chronic lung disease; respiratory distress syndrome
  • Gastrointestinal and metabolic – Feeding difficulties; necrotizing enterocolitis (NEC); rickets of prematurity
  • Hematological – Anemia of prematurity; thrombocytopenia; jaundice
  • Infection – Sepsis; pneumonia; urinary tract infection

Prevention

Exact causes of preterm labor and delivery remain unknown. Healthcare providers emphasize the importance of prevention to decrease the incidence of preterm birth. While you should consult your family practitioner or obstetrician regarding your specific healthcare needs, researchers have identified the following risk factors that put certain women at greater risk than others for the condition.

Groups of women

  • Women who have had a previous preterm birth
  • Women who are pregnant with twins, triplets or more
  • Women with certain uterine or cervical abnormalities
  • African-American women
  • Women younger than 17 and older than 35
  • Women who have a low income

Lifestyle and environmental risks

  • Late or no prenatal care
  • Smoking
  • Drinking alcohol
  • Using illegal drugs
  • Domestic violence, including physical, sexual or emotional abuse
  • Lack of social support
  • Stress
  • Exposure to certain environmental pollutants

Medical risks

  • Urinary tract, vaginal, and sexually transmitted infections
  • Diabetes
  • High blood pressure and preeclampsia
  • Clotting disorders
  • Bleeding from the vagina
  • Certain birth defects in the baby
  • Being pregnant with a single fetus that is the result of in vitro fertilization
  • Being underweight before pregnancy
  • Obesity
  • Short duration between pregnancies (less than six to nine months between birth and the beginning of the next pregnancy)

Medical care before and during pregnancy is vital to protecting the health of the mom-to-be and that of her baby. Preconception counseling and testing provide the opportunity for a woman to be prescreened for health and risk potentials before attempting to become pregnant. Preconception care has been shown to reduce neonatal morbidity and mortality especially in women who are at risk.

Sometimes genetic testing or counseling is recommended before pregnancy to identify patients at risk. This information helps the woman make informed decisions about her own health and that of her baby before birth. It also allows her to institute appropriate interventions, when possible, before conception to improve the pregnancy outcome.

In addition to its NICU, Children’s Hospital partnered with Saint Agnes Medical Center in Fresno to form a Maternal Fetal Center that expands access to perinatologists – physicians specially trained to care for expectant mothers and their unborn children while experiencing high-risk pregnancies.

“We can then work with the mom’s family practitioner or obstetrician and monitor the mom and her baby throughout her pregnancy,” said Dr. Armando Fuentes, medical director of perinatology at the Maternal Fetal Center. “If problems do come up, a number of tests and interventions are available to ensure that mother and baby receive the best care possible.”

Baby Lucy was one of the lucky ones – she beat the odds. In fact, a neonate with Lucy’s characteristics stood only a 7 percent chance of survival without severe impairment, according to national preterm birth outcome data. The cause of preterm birth isn’t always clear and can’t always be avoided. However, becoming aware of risk factors that may make you more susceptible to the condition and seeking medical care early in the process, can significantly increase the probability of having a healthy pregnancy and baby.

Why take a chance.