CHICAGO — Bill and
Marcia Stlaske's first pangs of fear coincided with her labor
pains.
Stlaske, 31, had given birth to two
early-but-healthy sons, but their third, Tyler, was on the way
nearly a month before his January due date. Doctors tried to
stave off delivery but found Stlaske's amniotic fluid too low.
"They said they had to take him
early," said Stlaske, a second-grade teacher from Crystal
Lake, Ill. "It was terrifying."
Not long ago, Tyler's birth on Dec. 30 at 36
weeks' gestation would have been considered skirting the edge
of prematurity, defined as being born before 37 weeks in the
womb. Doctors would have treated him similarly to a full-term
baby.
But after years of awareness education and
clinical studies, medical professionals and parents
increasingly consider so-called "late preterm"
babies as distinct cases requiring specialized treatment.
Hospitals have launched programs specifically targeting late
preterm infants, those born between 34 and 36 weeks'
gestation. And the efforts may be starting to yield
improvements, experts say.
Though still statistically rare, health
problems — such as respiratory difficulties, which Tyler
developed — occur far more often in late preterm babies than
they do in full-term infants.
In Illinois, the number of late preterm
births increased about 18 percent between 1996 and 2006, to
9.3 percent of all live births, according to March of Dimes
statistics.
But those numbers may be turning around. In
2007, the most recent year for which the March of Dimes has
statistics, Illinois' numbers for late preterm births came in
at 9.1 percent, a slight reduction.
"Doctors have this on their radar, very
much so," said Dr. Faheem Uraizee, director of
neonatology at Advocate Good Shepherd Hospital in Barrington,
Ill., where Tyler was born. Late preterm birth "has been
recognized as a very severe problem. Hopefully the spike that
you have seen (in premature births) should stabilize."
Those hopes are partially pinned to the
extensive efforts to draw attention to the issue by
organizations such as the March of Dimes. The group has tried
for years to increase awareness about the health effects
associated with late preterm births, which can make up as much
as 70 percent of all premature babies.
Dr. Diane Ashton, deputy medical director at
the White Plains, N.Y.-based March of Dimes, said in the last
three years researchers have begun to find more evidence that
late preterm babies such as Tyler suffer higher risks of
breathing problems, jaundice and increases in blood sugar
levels. They're also more likely to be admitted to intensive
care units and to be readmitted, according to experts.
At Central DuPage Hospital in Winfield,
Ill., all infants at 35 weeks' or less gestation are admitted
to neonatal intensive care, said the unit's medical director,
Dr. Jeffrey Loughead. That wasn't the case until about 18
months ago. Before that, he said, the hospital made
case-by-case calls on preemies and didn't necessarily focus
more on late preterm infants.
Previously, he said, "if you were in
your last several weeks ... people were pretty laissez
faire."
Changes initiated over the last year and a
half there, Loughead said, were in response to studies
indicating that even a full-term baby of 38 weeks' gestation
has double the mortality rate of a 40-week infant.
The hospital's new policies, which include
more frequent monitoring of glucose levels and the
temperatures of late preterm babies, have resulted in fewer
readmissions, Loughead said.
"We don't have a long period of time to
compare it to," he said, but "the preliminary data
looks encouraging."
And when the choice on a delivery date is up
to a mother and her doctor, experts now recommend waiting as
long as possible. If an obstetrician counsels an antsy mom to
hold off, said Loughead, "they're not being mean or
arbitrary."
Dr. William MacKendrick, head of neonatology
at Evanston Hospital, said plateaus in the numbers of late
preterm births nationally are encouraging, but it will take
time to see if the turnaround is permanent.
"It's probably a little early to
tell," MacKendrick said, adding that he has seen
increased awareness among medical professionals of the special
problems late preterm babies can face.
Evanston Hospital sends all babies who spend
fewer than 36 weeks in the womb to its infant special care
unit, and anecdotal evidence shows the more frequent checks
help, he said.
Part of the intensive monitoring comes from
the fact that preemies' development can be unpredictable.
Proof positive of that is tiny Avery Luaces,
swaddled in pink flannel in her parents' Grayslake, Ill.,
home.
David and Kathy Luaces expected a
Valentine's Day baby. But in December, Kathy showed signs of
preeclampsia, a condition marked by high blood pressure and
high protein levels in urine after 20 weeks of pregnancy. If
untreated, it can lead to serious complications including
kidney and liver problems or even seizures. It can affect the
birthing process.
Avery emerged via cesarean section at
Advocate Good Shepherd on Jan. 1, weighing 4 pounds, 6 ounces,
but was unusually healthy for being born so premature. Doctors
pored over records of her respiratory development, a crucial
milestone.
"She zipped right through that,"
said David Luaces, who also remembered requirements for
temperature regulation and feeding. Her physicians told the
couple Avery's hospital stay could stretch up to three weeks,
but she was home in nine days.
While babies like Avery prove not all
preemies suffer health problems, evidence exists that longer
gestational periods lower the risk for some complications. In
a study released in the New England Journal of Medicine in
January 2009, researchers found increased likelihood of
mortality, respiratory complications and admission to
intensive care units in infants born by elective C-section at
less than 39 weeks' gestation.
And in a December 2009 issue of the
Pediatric Infectious Disease Journal, scientists said they'd
found in late preterm infants higher rates of a serious
bacterial infection called sepsis.
Scientists still aren't certain what causes
premature births, but the March of Dimes said multifetal
pregnancies, previous premature deliveries and cervical and
uterine abnormalities are known risk factors.
The age of the mother, chronic health
problems such as high blood pressure and obesity, and
cigarette, drug and alcohol use during pregnancy also might
contribute, the organization said.
The March of Dimes gave Illinois a D on its
2009 report card for preventing premature births, a grade that
officials said was about average for the nation.
No state got better than a B on the rating,
which is based on the percent of childbearing-age women who
smoke (20 percent in Illinois), the percent who are uninsured
(16.7 percent in 2009) and the rate of premature live births
(about 13 percent in Illinois).
Dr. Dennis Crouse, a neonatologist and a
professor of pediatrics at Southern Illinois University, said
a woman's risk of delivering prematurely climbs after age 29,
with statistics reaching 1 in 5 by the time she's 40.
"Women are delivering later in
life," Crouse said, also noting that increasing numbers
of fertility treatments contribute to the rise. But with
national legislation on the horizon to limit the number of
embryos that can legally be implanted in a woman, he said,
some of those numbers may fall as well.
In Illinois, the state human services
department funds community health centers' programs to educate
parents on the importance of healthy pregnancies, efforts that
officials hope will reduce premature births and infant
mortality.