Monthly Medicine: Children’s Health

medical practice

By Susan Denson,
M.D., and Amir
Khan, M.D., Children’s
Memorial Hermann
Hospital and The
University of Texas
Health Science Center
at Houston

Prematurity and infant mortality are major public health concerns in the United States today. Although significant advancements in medical care for premature infants have been achieved, prematurity remains the leading cause of infant mortality. In neonatal intensive care units all over the nation, babies born too soon are fighting for their lives.

In 2007, there were more than 4.3 million births in the United States, according to the Centers for Disease Control’s most recent published numbers. Of those babies, 12.7 percent were born premature. Despite widespread efforts to reduce the incidence of prematurity, the rate of pre-term births continues to rise.

Texas is no exception to this troubling trend. From 2000 to 2006, there was a 10 percent increase in premature births, according to the CDC. In Texas in 2006, 8.4 percent of all infants were born premature. In 2007, both the percentage of Texas infants born premature and the infant mortality rate rose, according to Texas Kids Count. Prematurity rates rose 14 percent, and infant mortality rose 9 percent during the same period. Since 10 percent of all babies in the U.S. are born in Texas, this represents a significant portion of the overall population.

Texas received a grade of “F” from the 2009 March of Dimes Annual Report card, which compares the preterm birth rate of all fifty states. Texas’ low grade is impacted by the high teen birth rate, child poverty rate, high school drop-out rate, and rate of children whose parents do not have full-time employment.

Factors contributing to the upward trend of prematurity in the U.S. include: lack of proper prenatal care; increased number of teenage mothers; greater use of assisted reproductive techniques, which increase the rates of multiple births; an increase in the proportion of births to women over 35 years old; and changes in clinical practice, such as the early induction of labor or performance of Cesarean sections close to but not at full term, according to the March of Dimes.

A preterm birth is a delivery before 37 weeks of gestation. A late preterm is delivery between 32 to 36 weeks, and very preterm is delivery before 32 full weeks of gestation.

Births before 32 weeks of gestation (2 percent of all births) account for most neonatal deaths and disorders.

The typical pregnancy is now only 39 weeks, a week shorter than a full term pregnancy. These late preterm babies have a greater likelihood of breathing problems, feeding difficulties, body temperature instability, jaundice and reduced brain development than full-term babies.

Most premature births can be prevented with proper prenatal care. Women who see a health care provider regularly during pregnancy have healthier babies, are less likely to deliver prematurely and are less likely to have other serious problems related to pregnancy. A typical prenatal care schedule for a low-risk woman with a normally progressing pregnancy is:
A) Weeks 4 to 28: One visit per month (every 4 weeks)
B) Weeks 28 to 36: Two visits per month (every 2 to 3 weeks)
C) Weeks 36 to birth: One visit per week.

A woman with a chronic medical condition or a “high-risk” pregnancy may need to see her health care provider more often. Expectant mothers should keep all prenatal care appointments, even if they are feeling well.

What has been accomplished in the prevention of prematurity and infant mortality? Improvements have been made in infant mortality in the last 15 years and have been impacted by several major developments, including surfactant therapy that helps develop premature lungs and techniques to prevent Sudden Infant Death Syndrome (SIDS). March of Dimes research success includes the development of surfactant therapy in the early 1980s.

While there is still much work to be done to prevent premature birth, Children’s Memorial Hermann Hospital is leading the way with education and prevention programs for expectant parents.

In the Children’s Memorial Hermann Women’s Center, the Antepartum Support Program, offered in cooperation with the March of Dimes, offers crucial support services to high-risk, expectant mothers. The program provides socialization and education about premature birth, as well as relief for bed-bound, expectant mothers from the stress and boredom caused by being in the hospital and away from family.

March of Dimes volunteers visit Children’s Memorial Hermann three times per week to spend time with each high-risk pregnancy patient. The volunteers provide personal care items to make the hospital stay more comfortable, as well as educational materials about pregnancy, premature birth and parenting. The program also offers books, movies, crafts, and group social events though Antepartum Support Group Meetings.

High-risk, expectant mothers also receive tours of the Children’s Memorial Hermann Neonatal Intensive Care Unit, where they can see what a premature newborn may look like after he or she is born. A glimpse of the medical care required for a premature baby also helps mothers see what a difference it makes if a pregnancy can be sustained for days or even weeks longer, giving their baby a better chance of survival and quality of life.

The disturbing trend of premature birth and the dynamics underlying it highlight the critical importance and timeliness of the annual March of Dimes March for Babies on April 25 at The University of Houston’s Robertson Stadium. Memorial Hermann Healthcare System is the presenting sponsor for the event, which raises awareness and critical funds to support cutting-edge research to continue to address the crisis of premature birth.