Health NW: Preventing premature births

<center>Kathryn B. Brown, FNP</center>

For new parents, watching their newborn baby sleep peacefully is one of the sweetest sights on Earth. The smooth skin, chubby cheeks and angelic expressions of infants are captivating. It's amazing to watch a healthy newborn grow and begin to interact with the world in the first months of life.

But when a baby is born prematurely, life is not so peaceful. These babies often must spend the first weeks or months of life in a neonatal intensive care unit (NICU). Because their lungs and brain aren't as developed as they should be, they aren't able to breathe, suck and swallow like newborns born full-term. They may need oxygen and a respirator to help them breathe and are fed intravenously or via a tube that goes down into the stomach.

A NICU is a busy place, full of impossibly tiny babies, worried parents and lots of technology. Premature babies (known as "preemies") are connected to monitors that constantly check their heart rates, respiratory rates and the oxygen content of their blood. The monitors beep warning signals to notify nurses and physicians when there might be a problem.

Premature infants face many possible medical problems. Most problems, such as apnea and respiratory distress syndrome, are because of the immaturity of the baby's lungs. Preemies are at risk for bleeding within the brain, heart problems and an eye disorder called retinopathy. Their immature immune systems make them vulnerable to infection.

Technological advances have made it possible to save babies who are born as early as 23 weeks of pregnancy (37-42 weeks is normal). Preemies who weigh as little as 1 pound can survive, though the smaller they are at birth, the greater the chance of long-term medical problems.

A pregnant woman can reduce her risk of preterm delivery by seeing her health care provider for a pre-pregnancy check up, and then going for regularly scheduled prenatal care appointments. Alcohol use, smoking and illegal drug use all increase the risk of preterm delivery. Women who don't gain enough weight during pregnancy tend to deliver underweight, premature babies. (Women who are at a normal weight before pregnancy should gain 25-35 pounds.)

Other risk factors for preterm births are high blood pressure, fibroids or other abnormalities of the uterus or cervix, a history of three or more abortions or miscarriages, age less than 17 or more than 35, diabetes and untreated urinary or genital tract infections. African Americans and Native Americans have a higher rate of preterm deliveries as compared to Caucasian, Asian and Hispanic women. Women under a lot of stress, especially those who are physically, emotionally or sexually abused, are at high risk.

However, 50 percent of pregnant women who deliver preterm have no known risk factors.

The rate of premature births in this country has increased 27 percent since 1981. In 2001, 9.4 percent of babies born in Oregon were premature. The risk is even higher in the eastern half of the state, according to Michelle Sitz, Eastern Oregon Division director for the March of Dimes. Ten percent of all births, and 12.4 percent of births to Native Americans in Eastern Oregon are preterm.

The March of Dimes' annual WalkAmerica fund-raiser will be held April 26 or May 3, depending on your location. This is the March of Dimes' biggest fund-raiser, and money from this nationwide event goes to research into the causes of prematurity, prevention of preterm births and genetic birth defects.

If you are pregnant or know someone who is, the March of Dimes website at www.marchofdimes.com has excellent information about how to have a healthy pregnancy. There is also a Pregnancy and Newborn Health Education Center which you can call toll-free: (888) MODIMES.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to kbbrown@eastoregonian.com.

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