November 18 is Prematurity Awareness Day.

I am one of those moms who had firsthand experience with prematurity. My twin boys were born 5 weeks early 6 years ago. Even though they’ve grown to be healthy boys, we had to struggle with low birth weight and health problems during the first year of their lives.

This is the reason why I tend to follow closely the latest new updates on prematurity. This is why I am sharing with you today some facts and figures on prematurity.

What is Preterm Birth?

Preterm birth is defined as delivery before 37 weeks of gestation is completed. In recent years, preemies have been loosely classified into 3 categories:

• Very preterm infants are those born before the 32^th week of gestation.
• Moderately preterm infants are those born between the 32nd and 34^th week of pregnancy
• Late preterm births are those which occur between the 34^th and the 36^th week of gestation.

Children born prematurely have a higher rate of health problems such as cerebral palsy, sensory deficits, and respiratory conditions, and learning disabilities compared to children born full term.

Statistics on Prematurity

Let’s look at some statistics on prematurity:

• Almost 13 million babies from all over the world are born prematurely each year.

• More than 1 million of these preemies die as a result of preterm delivery.

• More than 85% of preterm births occur in low- and middle-income countries of Africa and Asia

• One in 8 American babies is premature.

• The rate on preterm deliveries in the US has increased by 36% during the last 25 years, higher than most developed countries.

These figures are cited in the white paper of March of Dimes on Preterm Birth. The numbers are based on data collected by the World Health Organization (WHO).

Global distribution of preterm births

The white paper also reports the following preterm birth rates per region:

• Africa – 11.9%

• Asia – 9.1%

• Europe – 6.2%

• Latin America and the Caribbean – 8.1%

• North America – 10.6%

• Oceania – 6.4%

According to income or resources, the preterm birth rates are as follows:

• High income countries – 7.5%

• Middle income countries -8.8%

• Low income countries -12.5%

The figures clearly indicate that preterm birth rates are related to income or resources. What is surprising, even troubling is the fact the preterm birth rate in North America is quite high, higher that the rate in middle income regions.

Preterm birth rate in the US is high – and rising

Breaking down the North American rates among individual countries, the rate is 12.7% in the US according to U.S. National Center for Health Statistics and 8.2% in Canada according to a Canadian government report. The rate of preterm births seems to be increasing in some countries including the US, Denmark and Norway. There are several factors that contribute to the increasing rate of preterm births in the US and other countries, and include

• Increased births due to assisted reproduction which lead to multiple pregnancies that necessitate early delivery.

• Increased number of pregnancies in women older than 35

• Increased use of elective Cesarean sections close to term, thus increasing the number of late premature births.

In contrast, not much is known about the causes of premature births in low income countries but they are presumably related to poor health care system and economic problems.

Prematurity is a global problem and seems to be increasing due to many different reasons. But it all boils down to the fact that preterm births, unless medically necessary, do not benefit baby or mom.

Two research studies on the health of premature babies. One gives promising results, the other gives disappointing outcomes.

This research gives hope to parents of preemies. Researchers at the University of Adelaide, Australia found that a fatty acid in the brain is not well-developed when babies are born before the 33^rd week of pregnancy. The lipid has been identified as omega-3 fatty acid known as docosahexaenoic acid (DHA) and insufficiency of this compound in the preemie’s brain may lead to impaired mental development.

The researchers went on and studied the effect of a DHA-rich diet on preemies’ mental development. DHA supplementation was given through the mother’s milk or the infant formula. Breast milk was enriched with DHA by giving breastfeeding moms 1000 mg DHA per day in the form of tuna capsules.

The study looked at 657 preterm babies and the results showed that:

• Female preemies responded better to DHA enrichment than male preemies, and thus showed better mental development.
• Preemies weighing less than 1250 mg responded well to DHA supplementation.

It is not clear why baby boys did not respond well to DHA. The researchers hypothesized that this may be due to the fact that baby boys have faster metabolic rates than girls. At any rate, more research is necessary before this type of diet can be given to all promise. But it sure is promising.

Another research on preemies, however, did not show positive results. Preemies are highly susceptible to systemic infections because their immune system is not yet well-developed. If they survive the infection, they may suffer from neurological and developmental problems. British researchers investigated whether prophylactic administration of a blood cell growth factor to premature babies can reduce the risk of systemic infection and increase survival of preemies. Blood growth factors would raise white blood cell counts, the blood cells which primarily fight infection. The study results showed that although the white blood cell counts did rise, there was no improvement in infection and survival rates. More in depth studies on neonatal immune system is needed before similar procedures can be applied.

Infant mortalities in the US is on the decline (or at least it used to). In 1900, infant mortality rate was 100 deaths per 1000 live births. A hundred years after, in 2000, the rate was 6.86 per 1000 live births. However, this decline seems to have leveled off and the rate in 2005 is 6.89. This is according to a 2007 report by the Centers for Disease Control and Prevention (CDC). Based on these figures, the US was 29^th in infant mortality world ranking.

The CDC further reports that the reason why infant mortality rates did not improve during the last years is the increase in premature births, estimated at 9%. Although medical developments have enabled more and more preemies to survive – even as early as the 22^nd week of gestation – the rate of deaths among preemies is still higher compared to babies born full term. Infants born even just a few weeks early can have three times mortality rates than those for full-term infants

Premature births are related to the rise in multiple pregnancies that usually end up in pre-term delivery and low birth weights. However, maternal factors such as advanced age, obesity, diabetes and hypertension also contribute to the rise in premature births.

This ranking of the US is seemingly low compared to other developed countries, according a report in the LA Times.

The Scandinavian countries Sweden, Norway, Finland, as well as Asian countries Japan, Hong Kong and Singapore are ranked top, with mortality rates below 3.2 per 1000 live births. The reason for these low mortality rates according to experts, are the homogeneous populations in this country and the type of health care system. According to a researcher at the Center for Studying Health System Change, the US health care system is great in treating ill people with high-tech interventions. However, it is lacking in preventive care.

Is there no end to the disadvantages of being a preemie? I am a scientist and I believe in science. But the scientific findings that point towards future problems for babies born premature are just so overwhelming that they can break a mother’s heart.

First, there are the health problems – from respiratory distress to autism to short life expectancy – that can affect their physical and cognitive development. And now it’s their social skills.

A USA today article reviews several studies that investigated how being born pre-term can affect a person’s personality. And here – brace yourself – are the bad news:

• The more premature is an individual as a baby, the less likely he/she is to marry, become a parent or earn a high salary
• Ex-preemies are less likely to leave home, live together with a partner, or have an active sexual life
• Ex-preemies are more likely to be inhibited, less adventurous, and would tend to follow social conventions.

According to one of the researchers, these studies suggest that people born prematurely can have “a spectrum of social and emotional difficulties that range in severity from quite mild to severe.”

I have two little boys who were born 5 weeks early. And these studies tell me that my boys are most likely to grow up as sexually-repressed social misfits. Is it any consolation that they are also most unlikely to get divorced, be unemployed or get arrested?

Should I simply believe these scientific findings, give up and just leave my boys’ life to destiny? Or should I and their Dad believe in them and give them all the chances of proving these predictions wrong?

I think every parent’s heart knows the answer.

This one really breaks my heart – newborn babies in intensive care units are in pain and medical care is not doing enough to ease it.

The study published in the July 2 issue of the Journal of the American Medical Association analyzed 42,413 painful procedures performed on 430 newborns. And the results are equally painful to a parent’s heart , as follows:

• only 2% of the newborns received medications to lessen pain
• only 18.2% were given non-pharmacological pain therapy.
• about four out of five babies received no interventions to relieve pain

The procedures and interventions conducted are many and ranges from a simple heel stick to draw blood to the complicated task of inserting a chest tube. The majority of babies who go to intensive care are preemies. Most of the procedures are necessary for monitoring as well as keeping the infant healthy. However, little babies aged 1 to 4 weeks old are very sensitive to pain. Repeated or prolonged exposure of babies to lots of pain can affect the way their brains process pain and may also have an effect on their long-term development and behaviour.

However, doctors are hesitant about using pain relieving-medications on these babies because of the risks. There are no medications especially designed for premature babies. The effects as well as side effects of commercially available pain relievers on very young infants are unpredictable.

The researchers recommend that pharmacological and non-pharmacological pain relief should be combined to get the desired effect. Giving babies sucrose or glucose solution, for example, has been shown to ease injection pains. The kangaroo care position has also shown to be helpful. Topical anesthetics may be used for mild procedures.

I remember the two weeks my premature twin boys spent at the neonatal clinic. There was one instance when the paediatrician had to search every square cm of his forehead and prick several times before she could hit a vein. I could understand that finding minute blood vessels on a tiny baby is an extremely difficult but necessary task. But this is no comfort for a mom, any mom, any parent.

Switzerland, a country which has one of the best health care systems in the world, has a big problem. More and more babies are born premature and Swiss hospitals have no place to put them, according to the daily “20 Minuten.” These hospitals are overwhelmed with the increase in premature births in recent years. With serious consequences for the premature babies.

Babies are considered premature when they are born before the 37^th week of pregnancy. In recent years, the incidence of preterm births in Switzerland has risen drastically and is currently estimated as 9% of all births. The reasons of the rise in incidence include the tendency of women to put off pregnancy later in life and the increase in the rate of multiple births, again as a consequence of late pregnancies and the use of assisted reproductive technology.

Unfortunately, Swiss hospitals seem to have limited number of intensive bed spaces in their neonatal units and cannot cope with the increasing number of preemies. In many cases, the premature, low birth weight babies have to airlifted, transported by helicopters to other hospitals. In Zurich alone, it is estimated that about 3 preemies per week have to be transferred to other neonatal clinics.

This relocation can have some serious consequences for some babies. For one thing, those with very low birth weights may not survive the trip. These preemies are highly susceptible to stress and infection. In addition, with the transfer, these babies are separated from their moms who themselves are probably in need of medical care and cannot travel with the babies. This is a time when the babies need their mothers the most.

When I had my twins in Frankfurt, Germany 5 years ago, I opted for the hospital with the largest neonatal unit in the city because my babies were expected to be delivered preterm. Although they had to stay at the neonatal unit for 2 weeks, I was in the same hospital and could go and breastfed them 3 times a day.

Honestly, I wouldn’t have known what to do had I been separated from my babies then. For all those moms and babies affected by this problem, I feel for you.

The Swiss are trying to resolve this problem as fast as they can. I really hope the resolution will come soon.

It’s long been known that touch is an integral part of baby’s development. For premature babies, it’s even more important as it helps them to recover better from pain. Premature babies are poked, prodded, stuck with needles and generally go through a lot of medical interventions. In a study done by a team in McGill University School of Nursing in Montreal that focused on preemies, those who were cuddled tightly against their mother’s bare skin, known as kangaroo mother care position, seemed to be more comfortable faster than those just swaddled in blankets.

The team studied 61 preterm babies born between 28 and 31 weeks. Half were assigned the kangaroo mother care position, and half to the usual treatment of being swaddled in an incubator. Before a heel lance procedure, where the heel is poked with a needle, the kangaroo mother care babies were held tightly for 15 minutes. After lancing, the babies’ grimaces, maximum heart rate, and blood oxygen saturation levels were studied, counted and measured. The experimental group had lower numbers in all the measurements. The team concluded that the experimental preemies recovered from the pain in 1.5 mins. versus the incubated/swaddled babies who took as long as 3 minutes, some taking even longer.

This is a welcome conclusion for parents, especially mothers, of preemies who are sometimes left to watch their babies in the sidelines, allowed only to grasp their babies through an incubator. For otherwise healthy babies with no serious complication, parents can be allowed to take an active participation in helping their babies heal and recover faster.

Researchers in the USA have revealed that many factors come together to determine the survival rate of babies born prematurely, especially those who have extremely low birth weight. Babies who fall into this category are normally those born between 22 and 25 weeks of gestation. These factors according to the report are:

1. Gestational age
   This refers to how old the baby was in gestation before being born. Generally aggressive treatment is given for infants born during the 25^th week of a pregnancy. Dr. Rosemary Higgins of the NICHD and co-author of the study said that it is not always easy to determine the gestational age of a premature baby as some babies may be as much as two or more weeks older or younger than presumed.
2. Birth weight
   The study found that the lighter the preemie, the greater the risk of developing disabilities and not surviving. Birth weight is normally around 2.2 pounds or less than 1000 grams.
3. Singletons
   Premature babies that were not twins or other multiple births tended have a better chance of survival.
   Babies whose mothers received antenatal steroids to aid in lung development. Antenatal steroids or corticosteroids are normally given to women who go into labor prematurely or are known to have given birth early.
4. Girl babies

It was also found that girl babies had a more favorable rate of survival than boys when born between 22 and 25 weeks of gestation.

It was found that these factors also helped minimize the chances of neurological problems. Some of these problems include cerebral palsy, blindness, hearing loss and impaired cognitive functions.

The findings from the study will be used as a guide to help doctors and parents decide whether premature babies should get more aggressive treatment to give them a better chance of survival. The alternative, where these factors are absent and so the chance of survival very low, the premature babies will more likely be given what is known as ?comfort care?.

The findings are designed to help doctors and patients decide the type of care and treatment to give to low birth weight infants. Comfort care refers to care that forgoes painful medical treatment given to preemies that have a slim chance of survival.

The study was published in the April 17^th issue of the New England Journal of Medicine.