November 20, 2009

The Fight Against Prematurity

Iowa, Illinois receive "D" grade

Madison Cooper was born 15 weeks early. Her limbs were so thin she reminded her grandpa of a Tinker Toy.

Her eyes hadn't yet opened; her ears were nubs that hadn't fully formed. She weighed 1 lb., 7 ounces, and was 12 inches long - a little longer than the 10-dollar bill she was placed next to for an early photo.

She was born 25 weeks gestation at the Genesis BirthCenter in Davenport and transported to University of Iowa Hospitals, where she lived the first three months of her life in the neonatal intensive care unit. She remained on oxygen for nearly a year.

She's one of the lucky ones.

Despite her premature birth and a heart valve repair at two weeks, Madison has not suffered any permanent damage. Today at 17 months, she remains small for her age - in the 3rd percentile - but has overcome the life-threatening circumstances of her birth. She's growing and catching up quickly.

Madison represents the advances made in treating premature newborns.

This week, however, the March of Dimes sounded the alarm that more needs to be done to prevent prematurity. For the second consecutive year, its annual report card gave Iowa a dismal "D" grade, with a state pre-term birth rate of 11.6 percent. Illinois also earned a "D" with a pre-term birth rate of 13.1 percent. The nation as a whole also received a "D."

"Recently, the Commonwealth Fund ranked Iowa second best in the nation for children's health care. Yet we received a D grade for our prematurity rate," said Stephen Hunter, M.D., March of Dimes Iowa Chapter State Prematurity Chair. He spoke at a news conference Wednesday at the Genesis BirthCenter in recognition of Prematurity Awareness Month.

"So where is the disconnect? How can we be right at the top of the best in children's health care, yet be failing so many babies right from the beginning at birth? This report card is an opportunity to rally public and legislative support for programs that will help reduce the preterm birth rate in Iowa and in our country. We want everyone to focus on solutions for women and babies because preterm birth can happen to any pregnant woman."

Overcoming the odds
Madison is the daughter of Mitch and Katie Cooper of Bettendorf. Her mother is among the many pregnant women who do everything right but still deliver babies too soon.

"Madison's mom, Katie, is very health-conscious and did everything by the book during her pregnancy," says Madison's paternal grandmother, Sue Cooper of Davenport. "She eats well and doesn't smoke or drink. She received excellent prenatal care. Her first child, Chase, was born full-term."

While the research continues, the March of Dimes wants expectant parents, health care providers, hospitals and health insurance companies to collaborate on what can be changed.

A few interventions include:

• Smoking cessation;
• Health care before and during pregnancy;
• Providing progesterone supplementation to women who have a history of preterm birth; and,
• Eliminating any elective delivery prior to at least 39 weeks of gestation.

"Although we know that many babies may need to be delivered early because of health complications with the mother or baby, we also know there is a growing number of women who are electing to deliver their baby before reaching their critical due date," said Dr. Hunter, who is also a maternal/fetal medicine specialist at University of Iowa and the Associate Director of Iowa's Statewide Perinatal Care program.

A little over 70 percent of all pre-term births are late pre-term - those between 34-36 weeks gestation. Research shows a large majority of these babies are born by Cesarean section.

"Mothers, we urge you to understand your choices," Dr. Hunter said. "Nine months of a healthy pregnancy is the best gift you can give your future baby. The last few weeks and days count. Don't ask your doctor to induce you for purely elective reasons, especially much before your due date."

Currently, labor is induced in more than 1 in 5 births, double the rate in 1990.

Leading the way
Genesis BirthCenters are leading the way as hospitals across the nation adopt standards of care that restrict elective labor inductions and C-sections before 39 weeks gestation.

Kenneth Naylor, M.D., of Obstetrics and Gynecology Specialists, P.C., Davenport, has played a key role in perinatal safety initiatives at Genesis and is a representative of the Iowa Section of the American College of Obstetricians and Gynecologists (ACOG). He read an ACOG statement supporting the March of Dimes' call to action.

"ACOG has long advocated waiting until at least 39 weeks gestation before performing scheduled Cesarean deliveries," he said. "With the rising rate of elective labor inductions, ACOG also advises waiting until after 39 weeks gestation in this clinical situation."

Educating patients and practitioners about the risks of elective deliveries before 39 weeks gestation is helping, he said. Most women who ask to deliver before their due date are understanding once they are informed that mounting scientific evidence shows it's safer for the baby to wait.

Meanwhile, Zahi Zeidan, M.D., Medical Director of the Genesis Neonatal Intensive Care Unit, deals with the aftermath of preterm births, which nationally rose 36 percent between the early 1980s and 2006. Genesis has the most advanced NICU in the region, thanks to a partnership between Genesis and the University of Iowa that brings world-class care to premature and sick babies.

"Although science and technology has advanced, there are significant complications that premature babies face," Dr. Zeidan said. "There can be chronic problems that last a lifetime. These can be very stressful on the babies and the parents."

Premature babies have an increased risk of lasting disabilities, such as cerebral palsy, mental retardation, learning and behavioral problems, lung problems and vision and hearing loss. They can experience feeding problems and challenges gaining weight.

Dr. Zeidan turned the spotlight on Madison, who toddled around happily while the TV cameras focused on her.

"Madison, a 25-weeker, was one of the lucky babies to survive without complications," he concluded.