World Prematurity Day

November 17, 2011 6:59 AM

A typical full term pregnancy is 40 weeks. Premature babies are those born before 37 weeks. Worldwide, 13 million babies are born premature. In the United States, 1 in 8 babies are born prematurely. Prematurity can lead to a host of lifelong cognitive, respiratory, vision, and digestive problems. November 17 is World Prematurity Day, devoted to raising awareness of the problems of as well as prevention of pre-term births.

On August 7, 1963, Patrick Bouvier Kennedy was born to President and Mrs. Kennedy about five and a half weeks early. The baby survived only 39 hours. Medical care for premature babies has advanced significantly since then. The youngest premature baby known to have survived is Amillia Taylor, born at 21 weeks and 6 days on October 25, 2006, weighing in at just 9 ounces.

Although healthcare for premature babies has improved, the number of premature births in the United States has risen by 36% over the last 25 years. Premature birth is also the #1 cause of death of newborns in the United States. In 2006, about 19,000 babies died in their first month.

Premature babies are often placed into Neonatal Intensive Care Units. NICUs have a wide array of specialized equipment for keeping preemies warm, for monitoring heart rates and respiratory rates, for helping preemies breathe, for managing intravenous lines into the baby, and for phototherapy to treat jaundice. Kangaroo care is also an increasingly popular way of helping preemies. Developed in response to the high death rate in preterm babies in Columbia as well as a lack of money for purchasing equipment, researchers found that babies held close to their mothers' bodies for periods of time not only survived, but thrived.

For parents, having a premature baby can be difficult emotionally. It is common for parents to feel guilty, depressed, distanced from the baby, and at odds with the NICU staff. Some parents are diagnosed with Post-Traumatic Stress Disorder because of the ordeal (previously on MeFi). Social support by others who have faced the challenges of a NICU has been found to help reduce anxiety and depression. The March of Dimes also runs an online support site called shareyourstory.org to help parents of premature babies.

Finally, there are a number of suggested steps for minimizing the chance of having premature births, including getting prenatal care, avoiding smoking and drinking of alcohol, and avoiding high levels of stress. Some new progesterone treatments may also help prevent pre-term births.

posted by jasonhong (33 comments total)

I was born five weeks early, underweight but of larger than average size, and looking a hell of a lot like E.T. Now reading this post I'm retroactively terrified for myself.
posted by villanelles at dawn at 7:14 AM on November 17, 2011 [1 favorite]

Thanks for the awareness/education. I was lucky in having a full term baby but I can vouch that anything traumatic that happens to your infant during labor/delivery (or even afterwards) defiantely causes PTSD. I thought mine was stillborn. Six weeks later RSV so severe, he was on oxygen. I can't even listen to those pertussus awareness campaigns without totally freezing up hearing that cough (similar to RSV).
posted by stormpooper at 7:18 AM on November 17, 2011

About half of all premature births are idiopathic in nature. It only became clear once I was pregnant with my second child (unplanned, as I would never have willingly put another child through what kid1 went through) that I have an incompetent cervix, a medical term that had to have been coined by a male obstetrician.
posted by headnsouth at 7:20 AM on November 17, 2011 [3 favorites]

I was eight weeks early, weighed 3.8 pounds. I did take time to catch up on a lot of things (tying shoes, riding a bike) but because I could always express myself just as well or better than other kids my age, I was often accused of being stubborn or lazy by my teachers. I've often wondered what the true effects of my prematurity really were.
posted by pinky at 7:35 AM on November 17, 2011 [2 favorites]

Huh, so even 3 weeks premature == serious problems, my mother's repeated comments to my wife that I was more like 8 weeks premature sounds more and more like bullshit. Coupled with that I look nothing like my father & brother, make my wife & I go HMMMM....
posted by Old'n'Busted at 7:38 AM on November 17, 2011 [4 favorites]

They should schedule it for November 17, but hold it on October 27.
posted by Evilspork at 7:45 AM on November 17, 2011 [20 favorites]

Nice, comprehensive post on the topic. Although premature babies are at risk for a variety of problems that be life-threatening and/or lifelong, it is truly amazing how well many of them do. We see a lot of NICU babies and NICU graduates at work, and it always amazes me to see a child that was in the OR at deaths door come back a few years later acting like a normal, healthy child. Some of the things they accomplish in the NICU are pretty impressive.
posted by TedW at 7:46 AM on November 17, 2011

My favorite preemie was 2 lbs 3 oz at birth. She arrived unexpectedly while her parents were on vacation, en route to Texas. She happened to come into the world just outside of St. Louis, which was a stroke of luck, as the hospital there was one of the best places for premature birth care at the time. There was no similar center near her parent's home town.

She started off in a tough situation but she was one of the lucky ones. Thirty-five years later, my favorite preemie - my wife - gave birth to a healthy, happy, 8 lb boy*.

She had some struggles in school, but she graduated from college. She worried that her lungs might not be as strong as they could be, but she has run several half marathons and is working towards a full one. She worried that it was something genetic (her brother was almost born earlier than she was, but medical intervention helped him reach full term), but her own pregnancy went without a hitch. I credit a whole lot of this to the care she had at birth and wish every premature child could be as lucky as she has been.

*8 lbs on the dot. She told him that he better not be over 8, and he listened. If you add his birth weight to her birth weight, the two of them together still weighed 5 oz less than I did. I was apparently the opposite of a premature birth.
posted by caution live frogs at 8:04 AM on November 17, 2011 [3 favorites]

I worked on a short video a couple of years ago that covered a lot about these issues of prematurity. It's called Reducing Infant Mortality. warning: self-link
posted by MythMaker at 9:00 AM on November 17, 2011

Why is the number of premature births increasing?
posted by miyabo at 9:48 AM on November 17, 2011

Does anyone know if the miscarriage/stillbirth rate has declined as the premature birth rate has increased? It could be that pregnancies that previously ended in miscarriage or stillbirth are now resulting in premature live birth, perhaps due to better medical care.
posted by ChrisHartley at 9:56 AM on November 17, 2011 [1 favorite]

I was a preemie at 996g (2.2 pounds). At two weeks old, one of the nurses of the NICU contracted salmonella from eating no-bake pastry with bad eggs, and infected almost the entire preemie ward. Apparently it was a miracle that all of us survived, although I didn't make it out of the hospital for three+ months (this was in Sweden in the 70:s).

After learning about hypoxia in school, my older brother used to tease me about having been in an incubator and not getting enough oxygen - in perfect sibling logic, that obviously damaged my brain and made me the stupid little sister, which I scoffed at, of course. It wasn't until I became an adult that I realized how truly and incredibly lucky I am to have no noticeable problems except nearsightedness and mild asthma (both of which run in the family anyway). It's also encouraging to see the advances made since then, and how people are getting better educated about the problem. Thanks for the post.
posted by gemmy at 9:57 AM on November 17, 2011

"avoiding smoking and drinking of alcohol, and avoiding high levels of stress"

It's really going to have to be one or the other.
posted by milk white peacock at 9:59 AM on November 17, 2011 [2 favorites]

A great place to look at resources regarding prematurity and educating both providers and patients on it is the March of Dimes Prematurity Campagin website, interestingly enough. When you dig around in the site, they have an amazing compilation of stats too, on infant mortality. ..I hope that I'm not repeating a link in the FPP.

I'm working as an RA (data entry RA ...) on a long-term prematurity prevention interventional study for women with a strong history of PTL/preterm birth -- I'll excited to see what all the data analysis is going to say, hopefully all the behavioral/medical interventions will show a decrease.

Another aspect of premature labor is the problem that we don't actually know what starts labor (oops), which is why we're pretty dang bad at stopping it. So I hope research continues to move forward in that regard.
posted by circle_b at 10:00 AM on November 17, 2011

Another point I think of with prematurity -- what depresses me most is that we have so many resources for preemies to survive, but resources for survivorship post-NICU are awful. With the increased rates of vision problems, cognitive problems, lung problems, neurological issues -- there's not enough support or money for families to cope with the caregiving that can follow, the procedures and treatments that their kid might need, etc. Families maxing out lifetime insurance caps, etc. or shit, even just a short stay in NICU is damn expensive.
posted by circle_b at 10:07 AM on November 17, 2011 [1 favorite]

Why is the number of premature births increasing?

I'm sure that's at least in part because neonatal care is improving so much, so many preemie births today would have fallen in the stillbirth column 25 years ago.
posted by torticat at 11:06 AM on November 17, 2011 [1 favorite]

Many "boutique" Ob-gyns induce early and perform quickie C-sections, especially during the holidays so neither they or Mommy-to-be has to be in the hospital at that time. It's a very risky practice. I've heard of scams where spurious diagnoses of maternal hypertension are made to fraudulently justify the induction and dupe the insurance company.
posted by Renoroc at 12:07 PM on November 17, 2011 [1 favorite]

I was born two months premature in 1964 and wasn't expected to survive. Back then, it wasn't unusual for mothers, like mine, to both drink and smoke during pregnancy.

I don't know if I have any problems as a result of the premature birth, or not. It's not something I worry about.
posted by Ivan Fyodorovich at 12:43 PM on November 17, 2011

The latest counsel is that birth even a few days before the 39th week is associated with worse health outcomes. A lot of hospitals are adopting policies prohibiting inducing before the 39th week of pregnancy.
posted by borges at 12:43 PM on November 17, 2011 [1 favorite]

I was born two months premature in 1964 and wasn't expected to survive. Back then, it wasn't unusual for mothers, like mine, to both drink and smoke during pregnancy.

I don't know if I have any problems as a result of the premature birth, or not. It's not something I worry about.

My brother was supposedly born 2 months premature in 1962, but back then they weren't able to accurately pinpoint the expected date of delivery the way they can now, and lots of "premature" births back then were in reality just miscalculated.
posted by headnsouth at 1:02 PM on November 17, 2011

Lovely post. Thanks very much for making it.

My kids were born 4 weeks early. My son was 5lbs 7oz and my daughter was 4lbs 12oz. Big for twin preemies.

My son has had some lung issues since he was born, but thankfully his sister hasn't experienced them. I'm hopeful that over time, he'll grow out of them.

jasonhong: "Some new progesterone treatments may also help prevent pre-term births."

One of the little facts that I discovered while making that post was that a few small trials had actually determined the efficacy of progesterone treatments in helping to prevent premature births 30 years ago, but the doctors ran out of money and were unable to create a larger followup study. Their results were published and the idea abandoned until relatively recently.

Imagine how many premature births might have been prevented (or decreased in severity) had this knowledge been followed up on in the 1980's.
posted by zarq at 1:16 PM on November 17, 2011 [1 favorite]

My little bro was 3 months early. He fit in the palm of my father's hand. My mother was airlifted to UCSF (a 6 hour drive away). He is now a 6'5 college student, very smart and somewhat surly.
posted by mollymayhem at 2:40 PM on November 17, 2011 [1 favorite]

When my mom went into pretem labor with me, her doctors injected her with alcohol in an effort to halt the process, as it were. As she puts it - "I got an instant hangover and you came out anyway." Ladies and gentlemen, my mom.
posted by pinky at 2:52 PM on November 17, 2011

Crumbs! That would be preTERM.
posted by pinky at 2:53 PM on November 17, 2011

Where did this come from?

>Premature babies are those born before 37 weeks.

Physicians consider birth at or after 36 weeks to be term.
posted by megatherium at 2:58 PM on November 17, 2011

Spent the evening hanging out with my best little buddy while her parents went to a theme-evening on the subject. She was 1lb 4oz, and it was months before I got to meet her. We have caught up pretty good tho and drew zombies most of the evening, and threw stuff at eachother for the rest of it. She's still tiny for her ages, and her school debut been pretty typical for micrpreemies, but she's got a lot of stuff going for her and a lot of people on her side.
posted by Iteki at 4:10 PM on November 17, 2011

>Premature babies are those born before 37 weeks.

Physicians consider birth at or after 36 weeks to be term.

Not this physician, among others. The distinction is important in my line of work because premature infants less than 60 weeks post-conceptual age are at increased risk for breathing problems after anesthesia and are commonly admitted for overnight monitoring following procedures that would normally be done as outpatient surgery. Outpatient vs. inpatient makes a difference on a number of levels, so we pay very close attention to those numbers.
posted by TedW at 6:17 PM on November 17, 2011 [1 favorite]

Megatherium, I saw the 37 weeks number across a number of sites, this seems to be a more definitive source from the US National Institutes of Health. Here's another link from March of Dimes.
posted by jasonhong at 6:19 PM on November 17, 2011

My granddaughter was born 14 weeks premature and weighed 2.5 pounds. She had to have some physical and speech therapy when younger and was much smaller than other kids her age for a long time. She looks like a little doll in her first photos (I'm a step-gmom and didn't meet her until she was five). But now she's taller than I am, very smart and quite sporty.

The advances in preemie care have been wonderful.
posted by deborah at 7:05 PM on November 17, 2011

"My brother was supposedly born 2 months premature in 1962, but back then they weren't able to accurately pinpoint the expected date of delivery the way they can now, and lots of 'premature' births back then were in reality just miscalculated."

The date of my conception was pretty unambiguous to my mom, as I understand it.
posted by Ivan Fyodorovich at 7:13 PM on November 17, 2011

I went into premature labor and they tried a couple different drugs before IV alcohol. In my case I was instantly drunk, and they told me to drink daily. My daughter was still early, but of a normal size and weight. It was hard to accurately calculate my due dates. Both kids turned out fine and were earlier than their due dates.
posted by Katjusa Roquette at 11:29 PM on November 17, 2011

Some ten years ago, I found out that I was apparently born 35 weeks into the term (says so in the medical records). When I asked my mother about this, she said: "Yeah, when your brother was born, I was really worried, but he turned out to be fine. When you were born 5 weeks early, it was unexpected, but I wasn't worried this time, because I knew it'd be ok. And when I was expecting your sister a few years later, I already knew what to expect." Is it possible that we all really were 5 weeks early, or can it simply be chalked down to miscalculation?
posted by daniel_charms at 11:32 PM on November 17, 2011

I was born 8 weeks premature at 4lb back in 1982 in the UK and have fortunately experienced no significant related health problems. My mother had a terrible pregnancy and because she could not keep anything down at all the doctors prescribed some heavy anti nausea medication. She was uncomfortable taking it but the doctors said if you dont you will lose the baby so she did and I somehow made it through.

As the story goes they were not expecting me to last very long and they required a name for the death certificate. My mum was hoping for a girl and my parents hadn't decided on a boys name so the nurse ended up naming me.
posted by numberstation at 3:06 AM on November 18, 2011