A Word from our Neonatologist

Wyoming’s first neonatologist urges awareness for a birth risk affecting 1 in 10 U.S. families

Written by Dr. Shelley Springer, neonatologist and pediatrician with Casper Children’s Center

The arrival of a newborn baby should be a joyous occasion, but for 1 in 8 families in the United States and 1 in 10 families worldwide, their babies deliver more than three weeks before the due date. This is prematurity.

An intubated female premature infant born prematurely 26 weeks 6 days gestation, 990 grams. Photo taken at approximately 24 hours after birth. (Photo by By ceejayoz (http://www.flickr.com/photos/ceejayoz/3579010939/) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons)

Across the country, prematurity is responsible for 35 percent of all infant deaths, is a leading cause of long-term neurological disabilities in children, and costs the U.S. healthcare system more than $26 billion per year. A full-term pregnancy lasts 40 weeks, but many babies are electively delivered earlier.  Even babies born at 35 to 37 weeks’ gestation – so called late-preterm babies – are premature and can suffer life-long consequences from this early delivery. In the U.S. in 2012, roughly 456,000 babies were born prematurely, 1,000 of those in Wyoming.

Premature babies require specialized care at birth, including specially trained pediatricians called neonatologists, hospital teams equipped and trained to care for babies weighing less than 5 pounds and a neonatal intensive care unit, or NICU.  Because every part of a premature baby is incompletely developed, caregivers must be prepared to replace or assist the functioning of every organ, including breathing, circulation, the warmth and quiet darkness of the womb, and the special protections and nourishment that would be uniquely provided by the mother through her placenta should the pregnancy have continued.  And, yes, even late preterm infants can experience life-threatening problems after birth that require NICU care.

How long the infant will stay in the hospital is difficult to predict at birth, but can range from a week or two to months and even years. Data from 2009 states that, on average, hospitalizations for low birthweight newborns were longer (16 days versus 2.5 days) and more costly ($70,000 versus $2,800) compared to “normal” weight infants.  And, especially in Wyoming, low birth weight newborns are usually transferred to other health care facilities or required home health services following hospital discharge, further adding to the associated healthcare costs.

Babies born prematurely may have lifelong consequences such as:

  • Neurodevelopmental Delay (also called “cerebral palsy) – this is a disorder of movement, muscle tone or posture resulting from injury to the developing brain either during pregnancy or while the baby’s brain is still immature.
  • Impaired cognitive skills —   It’s not unusual for developmental milestones to be more delayed in premature babies than their prematurity would suggest.  After school age, the appearance of learning disabilities are not uncommon.
  • Vision problems —  Babies born earlier than 30 to 32 weeks may develop premature eye disease, called retinopathy of prematurity (ROP).  Although neonatologists and pediatric ophthalmologists try to minimize the likelihood, this condition can impair vision and cause blindness.
  • Hearing problems —  Premature babies are at increased risk for hearing loss. All babies have their hearing checked before going home, but hearing problems can develop during infancy.  Language acquisition is a good indicator of hearing ability.
  • Dental problems — Preterm infants are at increased risk of problems, such as delayed tooth eruption, tooth discoloration and improperly aligned teeth.
  • Behavioral and psychological problems —  Children born prematurely are more likely than full-term infants to have issues such as attention deficit hyperactivity disorder (ADHD), depression or generalized anxiety, and difficulties interacting with others their own age.
  • Chronic health issues – Infants and children born prematurely, even if mildly premature, are more likely to have chronic health issues  that can impact their health and well-being for life. Infections, asthma and feeding problems are more likely to develop or persist. Preterm infants are also at increased risk of sudden infant death syndrome (SIDS).  Many experts believe that common chronic health problems of today’s adults, such as cardiovascular disease, atherosclerosis, high blood pressure, obesity, Type 2 diabetes, and reproductive issues in women, are the result of the fetal environment that resulted in premature birth.

In some cases, the reason for the premature birth is apparent.  For example, when the pregnancy is jeopardizing the mother’s health, or when the mother’s health is jeopardizing the health of the fetus and the risk of prematurity is less than the risk of continuing the pregnancy, doctors will recommend preterm delivery.  Many babies are electively delivered at 36 to 37 weeks for social convenience, although this practice is resoundingly discouraged and is becoming less common. However, for most mothers, the reason for premature labor and delivery is unknown. The causes of low birth weight are complex, and include pre-conception maternal health and lifestyle factors, pregnancy considerations (such as multiples), social environment, and family history.

Because many of these risk factors can be modified,  awareness and education of the issues surrounding premature birth is a major public health initiative around the world. Nov. 17 was designated World Prematurity Day in 2008 and was celebrated in over 60 countries in 2013.  In 2014, Wyoming has the unique opportunity to add their support to improving outcomes for premature babies and their families with the addition of Wyoming’s first neonatologist/pediatrician to the medical staff at Wyoming Medical Center in Casper.  In a combined commitment with Casper’s hospital and medical community, many of Wyoming’s premature infants, as well as mothers with high-risk pregnancies, soon may be able to stay in Casper for their hospital and subsequent pediatric care.  This will be a great step forward for the benefit of Wyoming’s children and families everywhere.

For more information or to schedule an appointment with the neonatologist, please go to www.casperchildrenscenter.com . For families with babies in the NICU, it is a very stressful experience. Go to www.nicu-pedia.com for information that will inform and empower you to help you get through it.