November is Prematurity Awareness Month. Unfortunately, that does not mean that NFL players will be trading their pink game apparel for purple counterparts. There are, however, other ways to raise awareness about a cause. I have compiled a list of 30 facts to post on Facebook for each day in November. Since blog-readers can usually handle more than 140 characters at a time, you get all 30 facts on November 1st. Lucky you!
1) 1 in 8 babies in the US are born premature (before 37 weeks of completed gestation); that’s 543,000 babies per year.
2) At 25%, premature birth is the number one cause of neonatal mortality in the US.
3) The rate of premature birth increased by more than 20 percent between 1990 and 2006.
4) The average first-year medical costs, including both inpatient and outpatient care, are about 10 times greater for preterm infants than for full-term infants.
5) Although we have identified many risk factors associated with premature births, nearly 40 percent of these births have no known cause.
6) Risk factors for premature birth include maternal hormone imbalance, structural abnormality of the uterus, chronic illness, infection, and unhealthy lifestyle choices. Preterm delivery is also more likely when a woman is over age 35, under age 19, or is carrying multiple fetuses. In my case, Peter’s early arrival can be best explained by my bicornuate (heart-shaped) uterus.
7) Half of all neurological disabilities in children are related to premature birth.
8. Due to many recent advances, more than 90% of premature babies who weigh 800 grams or more (a little less than 2 pounds) survive. Those who weigh more than 500 grams (a little more than 1 pound) have a 40% to 50% chance of survival, although their chances of complications are greater.
9) The earliest preemie to ever survive was born at 21 weeks, 6 days gestation. The smallest preemie to ever survive was born weighing 9.1 oz.
10) Famous preemies include Albert Einstein, Mark Twain, Sir Winston Churchill, Victor Hugo, Napoleon Bonaparte, and Isaac Newton.
11) Patent ductus arteriosus (PDA): A heart problem that is common in premature babies. Untreated, it can lead to heart failure. The respiratory and digestive setbacks Peter struggled with during his first week of life were due to PDA. Happily, ibuprofen closed this opening between Peter’s pulmonary artery and aortic arch; otherwise, he would have needed heart surgery.
12) Low blood pressure is a relatively common complication that may occur shortly after birth. It can be due to infection, blood loss, fluid loss, or medications given to the mother before delivery. Low blood pressure is treated by increasing fluid intake or prescribing medications. Peter received one blood transfusion when he was less than a week old to treat his low blood pressure.
13) Intraventricular hemmorhage (IVH): Bleeding into the brain’s ventricular system. This type of hemorrhage that is particularly common in premature and very low birth weight infants and can cause pressure in the brain and brain damage. Peter suffered a grade 1 (mild) IVH.
14) Retinopathy of prematurity (ROP): Abnormal blood vessel development in the retina of the eye in a premature infant. In severe cases, such as that of Stevie Wonder, scarring and retina detachment cause vision loss. Mild cases, such as that of Peter, are self-resolving.
15) A baby’s suck reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Therefore, infants born earlier than 34 weeks gestation usually require a feeding tube to meet their nutritional requirements. Peter was not introduced to breast or bottle until he was 6 weeks old.
16) The transfer of maternal IgG antibodies to the fetus predominantly occurs after the 28th week of pregnancy. Premature birth interrupts this transfer, leading to lower levels of maternally-transmitted antibody at birth. Peter was born before the 28th week of pregnancy and is therefore much more susceptible to infections than full-term newborns. He had conjunctivitis and a yeast infection while in the NICU; thankfully, no respiratory infections or sepsis.
17) Infant respiratory distress syndrome (RDS): Caused by developmental insufficiency of surfactant production and structural immaturity in the lungs, RDS is the most common single cause of death in the first month of life of the developed world. I was given glucocorticoids 24 hours before Peter’s birth to help speed his production of surfactant. Peter was given an exogenous surfactant through a breathing tube into his lungs shortly after birth to mitigate his RDS.
18) Bronchopulmonary dysplasia (BPD): Characterized by inflammation and scarring in the lungs, BPD is a chronic lung disorder that is most common among children who were born prematurely with low birth weights and who received prolonged mechanical ventilation to treat RDS. Peter did not develop BPD; he only required respiratory assistance until he was a month old.
19) Necrotizing enterocolitis (NEC): The death of intestinal tissue. NEC primarily affects premature infants or sick newborns and has a 20-30% mortality rate. Babies born at Peter’s gestation have roughly a 5-10% chance of developing NEC.
20) Neonatal hyperbilirubinemia: Newborn jaundice is a condition marked by high levels of bilirubin in the blood. The increased bilirubin cause the infant’s skin and whites of the eyes (sclera) to look yellow. Severe cases can result in brain damage. Peter required a week of phototherapy to treat his jaundice.
21) Because of their large skin surface area relative to their weight, premature babies usually must weigh at least 4 pounds in order to efficiently maintain their body temperature. Peter spent 37 days in an incubator before he was big enough to sleep in a bassinet.
22) Apnea of prematurity: Cessation of breathing by a premature infant that lasts for more than 15 seconds and/or is accompanied by hypoxia (oxygen deprivation) or bradycardia (a heart rate of less than 100 bpm). It occurs in at least 85 percent of infants who are born at less than 34 weeks of gestation. Peter’s apnea and bradycardia episodes persisted until he was nearly 10 weeks old.
23) Umbilical and inguinal hernias occur more often in premature infants. Inguinal hernias require hernia repair surgery. Umbilical hernias are usually self-resolving. Peter has a big umbilical hernia.
24) Cerebral palsy (CP): A broad term used to describe a group of chronic “palsies” — disorders that impair control of movement — due to damage to the developing brain. Premature babies are 8 times more likely to develop CP than full-term babies because their immature lungs may be unable to provide sufficient oxygen to the brain. My sister, Kelly, was born 7 weeks premature and has CP.
25) 25-27 weekers spend on average 71 days in the hospital prior to discharge. 28-30 weekers on average spend 39 days. 31-34 weekers, 12 days. 35-38 weekers, 4 days. 39-42 weekers, 3 days. Peter spent 73 days in the NICU, costing our insurance $538,193.95.
26) More than 70% of premature babies are born between 34 and 36 weeks of gestation. Twelve percent are born between 32-33 weeks, 10% are born between 28-31 weeks, and 6% are born at less than 28 weeks. Peter had roughly a 1/150 chance of being born as early as he was, given his parents’ ethnicity.
27) The average birth weight of singletons is 7 lbs. 5 oz., of twins is 5 lbs. 3 oz., and of triplets is 3 lbs. 11 oz.
28) Preeclampsia is a pregnancy condition in which hypertension arises in association with protein in the urine. The only known cure is delivery of the placenta. Preeclampsia affects 5-8% of women and 0.42% of all pregnant women need to deliver before 34 weeks because of severe preeclampsia – that’s about 16,800 babies each year in the U.S.
29) Premature labor can be managed with hydration, bedrest, medications to stop labor (e.g., magnesium sulfate, nifedipine, terbutaline), and medications to help prevent infection (especially in instances of premature preterm rupture of membranes). Unfortunately, nifedipine and bedrest only held off Peter’s delivery for 24 hours after I went into preterm labor.
30) The body of a mother who delivers early will automatically produce milk that’s specially designed to nourish her premature baby, with extra minerals, fat, and protein. The leukocytes and antibodies in breast milk protect babies from infection; for this reason, neonatologists refer to it as “liquid gold”.