by Tiffany Capuano

Early labor for pregnant women can be frightening and overwhelming, but for the babies who enter this world prematurely, it’s even riskier.

According to the March of Dimes, more than 17,500 births are premature in Georgia each year, and those numbers are rising. In an average week, 340 Georgia babies are born preterm (or premature) – prior to 37 weeks gestation.

The stakes are high for premature babies.

“We have a population of survivors,” says Gonzalo Mantilla, a neonatologist at Northside Hospital. “We are now able to [preserve] life [at] less than 24 weeks. With high-technology respirators and drugs like Surfactin, it can be possible.”

When born prematurely, babies often struggle with breathing and feeding issues, circulatory problems and heart defects. In addition, there are risks for blindness, hearing loss and brain damage caused by hemorrhage.

“Even babies who are born near term – between 34 and 36 weeks – are discharged early and they tend to come back because of poor nutrition or dehydration,” Mantilla says. But the bigger problem is that these can all lead to learning disabilities and development delays. “These problems are because of prematurity.”

Despite improved technology, new medications and better prenatal care, there remains an increase in premature births. Between 1994 and 2004, the rate of infants born preterm in Georgia increased more than 8 percent, according to the March of Dimes. Infant mortality has also increased slightly, according to the National Center for Health Statistics.

Among the contributing factors to the rise in premature births is assisted reproduction, often resulting in multiples, which are at a higher risk for being born prematurely. At Northside, it’s not unusual to see three to four sets of triplets born in the same day. Mantilla adds that about 50 percent of twins are born prematurely.

The Root Cause

The specific causes of preterm labor and delivery are largely unknown among the medical profession. About 75 percent of all preterm births happen spontaneously, while the remaining preterm births result from medical intervention to deliver the baby early due to fetal or maternal complications, according to March of Dimes statistics.

Doctors are slow to blame one root cause for preterm labor; it’s often a combination of factors.
In fact, higher rates of preterm labor occur in women older than 40 and in African-American women. Medical experts believe there are factors that increase the risk of having a spontaneous preterm birth, such as demographic and genetic characteristics, behavioral and environmental factors, and medical conditions.

Pregnant women should be aware of their increased risk of preterm labor if they have: a history of preterm labor, a pregnancy of multiples, uterine/cervical abnormalities, infection, diabetes, hypertension, late or no prenatal care, smoking, and alcohol or illicit drug use.

Advice from the Frontlines

“Most of the research, techniques and therapies used at the hospitals are possible because of money raised by the March of Dimes,” says Bert Weiss, host of Q100’s morning radio show and the father of a premature son. Weiss will chair this year’s March of Dimes’ Dining Out fundraiser June 8. “I felt I owed them,” he adds.

Parents of premature babies or those dealing with the possibility of a premature birth are encouraged to find support from other parents who have been there. A parent support group, typically found through a hospital, will help parents of preemie babies understand what to expect now and in the future.

Northside Hospital’s Parents Partnered for Preemies program, which started in 2002, offers parents a way to connect with other parents dealing with premature births. Every year, the hospital hosts a birthday celebration for all of its preemie babies, connecting alumni and new parents.

Parents also suggest learning as much as you can by being involved in the baby’s care and reading as much information as possible.

Parents who endured lengthy hospital stays with their preemie, sometimes away from family and friends, say they did many little things to help them survive the uncertainty and help their baby along, including: kangaroo care, where a parent holds the baby against the chest with skin-to-skin contact; taping their voices, singing or reading a book, which is played at their baby’s bedside; and a daily journal documenting what was happening to their baby.

Many parents of preemies may hesitate to have another child, but Debbi Scarborough of Atlanta is among those who felt the risk was worth it. “Our best present to our son – and a one-in-a-million chance – was giving him a sibling,” she says.

The Fisher Family

Darren, Jennifer and Kate Reese, age 16 months, of Marietta

 Gestational age at birth: 31 weeks, 6 days

 Size at birth: 3 lbs., 5 oz.

 Hospital stay: seven weekss

 Cause of preterm labor: Preeclampsia

 Complications at birth for baby: Kate had respiratory failure, severe jaundice, transient hypoglycemia, apnea, anemia, heart arrhythmia, circulatory problems in the lungs and heart, as well as gastroesophageal reflux and feeding problems. Kate’s twin was lost in utero at 10 weeks. At 14 weeks, doctors suggested the Fishers terminate the pregnancy because of a condition called cystic hygroma, a lymphatic system disorder where a cyst in the fetus’ skin swells with fluid. By week 17, all symptoms of the condition had disappeared. The Fishers call Kate their “miracle baby.”

 Effects of prematurity: Constant monitoring for six months at home and caffeine medication for apnea and slowed heart rate; severe reflux meant medication for nine months and thickened breast milk/formula to avoid choking; vitamins for one year to prevent anemia; and Synagis injections monthly (during winter months) to guard against respiratory syncytial virus, or RSV. Besides Kate’s small size, long-term effects have yet to be determined.

 How did baby’s prematurity affect your family? Jennifer spent nearly eight hours a day, every day, at the hospital during Kate’s hospital stay. She says it was tough keeping up with life and relationships when their lives revolved around the NICU. “It was difficult on our marriage, and we had to have a strong relationship,” says Jennifer. “We had to talk about things we didn’t want to have to talk about.”

 How has your child’s health/development changed since birth? Kate’s growth and development are on target for her adjusted age, says Jennifer. Although she still has feeding issues, she is growing and stands at the 75th percentile on the preemie scale.

The Scarborough Family

Matt, Debbi, Steven, age 12, and Sam, age 9, of Atlanta

 Gestational age at birth: 25 weeks, 4 days

 Size at birth: 2 lbs., 1 oz.

 Hospital stay: four months

 Cause of preterm labor: Placental abruption

 Complications at birth for baby: Steven had a “brain bleed,” caused by hydrocephalus, resulting in insertion of a ventricular shunt to drain spinal fluid; undeveloped lungs; double hernia; mitral stenosis (a heart condition); and vision problems.

 Effects of prematurity: Steven developed severe asthma and contracted RSV as a young child. He has been diagnosed with Asperger’s syndrome, a high-functioning form of autism that may have been the result of the brain bleed. At age 8, Steven’s tubes that drain spinal fluid became blocked. He had surgery to increase and lengthen the shunts, and he may continue to need tubing replacements throughout his lifetime. He was expected to have heart surgery by age 5 to repair the mitral valve, but has not yet needed it.

 How did baby’s prematurity affect your family? “When Steven was born, the hospital didn’t like mothers to talk to other mothers. You could only find support from your immediate family,” says Debbi. “They didn’t encourage it because many babies didn’t make it. I wanted to talk and learn from other people.” The Scarboroughs didn’t name their son for two weeks.

 How has your child’s health/development changed since birth? “Doctors told us that Steven may not have a chance at walking or seeing, and that he would be unable to care for himself,” says Debbi. “We just went on our faith.” Steven now stands at 5 ft., 4 inches and 118 lbs. “When his journey began he wasn’t even on the height/weight charts, but now he’s at the 100th percentile,” boasts Debbi. “People would have no idea he was a preemie. He’s the biggest in his fifth-grade class and stronger than ever.”

 Other children in the family: Younger brother Sam, 9, was born full-term.

The De La Cerda Family

Carlos, Amanda and Veronica, age 4, of Kennesaw

 Gestational age at birth: 30 weeks, 2 days

 Size at birth: 2 lbs., 15 oz.

 Hospital stay: six weeks

 Cause of preterm labor: Amanda developed HELP Syndrome, characterized by severe preeclampsia with dangerously high blood pressure, liver and kidney failure and was losing the ability to clot blood. Her mother also delivered prematurely.

 Complications at birth for baby: Veronica had jaundice; needed a ventilator to breathe; had to be tube-fed until she learned to swallow, suck and breathe when eating and had digestive issues.

 Effects of prematurity: Veronica saw a pediatric ophthalmologist because of ventilator use, but has no vision problems. No other known effects to date.

 How did baby’s prematurity affect your family? ”We were aware of the possibility of her coming in contact with germs that could potentially be fatal,” says Amanda. “My husband worked part-time after my maternity leave so he could be her primary caregiver.” Veronica started daycare one day a week at 8 months, 3 days a week at 10 months, and full-time after her first birthday.

 How has your child’s health/development changed since birth? Veronica met her developmental milestone by 18 months. Once at the lowest percentile growth, Veronica is now in the 99th percentile for growth.

 Other children in the family: “We had to take a hard look if a second child would be right for us,” says Amanda. “I know it is a good possibility that when pregnant again I could be put on bed rest and deliver early again.”

The Weiss Family

Bert, Stacey and Hayden, age 4, of Atlanta

 Gestational age at birth: 34 weeks

 Size at birth: 3 lbs., 8 oz.

 Hospital stay: four weeks

 Cause of preterm labor: Not known; premature rupture led to early delivery.

 Complications at birth for baby: Hayden had severe gastroesphogeal reflux and had to learn how to suck. He also couldn’t regulate his own body temperature. He also had jaundice, but fortunately he didn’t need a ventilator.

 Effects of prematurity: Hayden continued to have severe reflux for the first year of his life and continues to have feeding issues as a preschooler.

 How did baby’s prematurity affect your family? “I’ve never felt such pain than when we left the hospital without him,” says Stacey. Bert adds, “Those memories come flooding back. It was a tough feeling to leave the hospital without our baby. We had many friends who had babies, and they were in and out of the hospital in 24 hours.”

 How has your child’s health/development changed since birth? “Hayden is still small for his age, coming in under the 25th percentile for his age. He never caught up in size,” says Stacey. Hayden is also delayed in his small motor skills, but excels in his verbal abilities.

 Other children in the family: The Weiss family is expecting their second child this summer and preparing for the possibility of an early delivery. “We are doing some preventative measures,” Stacey adds.