The Problem With Prematurity
For reasons no one can fully explain, preterm birth – defined as delivery before the 38th week of pregnancy – is on the rise. More than 12 percent of babies born in the United States are preterm, up from 10 percent a decade ago. In Hamilton County, the situation is even more grave. A recent study by Cincinnati Children's found nearly 19 percent of the county's babies are born prematurely.
To combat the trend, physicians at Cincinnati Children's are working hard to understand the causes of prematurity, says James Greenberg, MD, director of the Division of Neonatology. The hope is that knowledge gained from such research can translate into practical ways to help families deliver healthy, full-term babies.
Advanced Care Aids Survival
In recent years, physicians have made enormous strides in caring for preterm babies. Babies born at just 25 weeks gestation now stand about a 50 percent chance of survival thanks to better ventilators, improved drugs and more effective, less invasive treatments. In hopes of making even more progress, researchers at Cincinnati Children's are studying how inflammation compromises lung development and how blood vessel development in the lungs relates to pulmonary hypertension.
But focusing on better treatments only addresses part of the problem, says Dr. Greenberg. After all, while preterm babies may survive their early months, many face a lifetime of health problems including blindness, chronic respiratory problems and learning disorders.
Full-Term Goal
To reduce infant mortality and prevent the myriad health problems associated with prematurity, physicians need to increase gestational age. To do that, they must first understand what causes preterm delivery.
At Cincinnati Children's, the Division of Neonatology is working with the Cincinnati Health Department and the medical center's Child Policy Research Center to recruit faculty, invest in research and set up studies to look at the various types of prematurity.
Cincinnati Children's is in a unique position to study the problem, says Dr. Greenberg, because unlike most academic medical centers, it works closely with the community hospitals where most of the babies are born. The division provides compre¬hensive neonatology services for Level III Newborn Intensive Care Units at Cincinnati Children's, University Hospital and Good Samaritan Hospital and for seven area Level II Special Care Nurseries.
"We care for preterm babies at almost every hospital in the region," he says, "so we get a population-based view of prematurity." That's essential because prematurity is a multifaceted problem.
Preventing Premature Birth
Many people think of prematurity as a socioeconomic problem of low-income women who get inadequate prenatal care. While poverty is an important contributing factor, and one that the medical center is addressing through its Every Child Succeeds outreach program, it is not the only cause.
Babies are born prematurely for many reasons, including cervical dysfunction, infection, high blood pressure, diabetes, inflammation of the membrane around the baby, drug abuse by the mother, fertility treatments, or miscalculation of gestational age, which can lead a physician to schedule a delivery too early.
"While we've made a lot of progress caring for preterm babies," Dr. Greenberg says, "the big opportunity to make a difference is understanding and preventing prematurity in the first place. Prevention strategies have to consider multiple causes to be effective. That's where we're focusing our efforts."
