As Babies Are Born Earlier, They Risk Problems Later

"...late-preterm babies are about five times as likely to die in the first
week of life and about three times as likely to die in the first year
than full-term babies, studies show."

"Some studies have found evidence that these babies are more likely to
have subtle problems with speech development and coordination and
behavioral and learning difficulties."

"...researchers suspect they may also be at increased risk for behavioral
problems such as hyperactivity and possibly cerebral palsy and
mental retardation."
________________

Good to see that the Post ran this story on the front page.

But Teresa is right to point out the glaring absence of any concern
for the possibility -- make that likelihood -- that toxic chemicals
or pseudo-hormones are a contributing factor in the increasing rate
of prematurity. (Now why does this seem familiar?) It seems to me
that it would be quite feasible for the EPA and/or the NIH to create
a monitoring program to look for a correlation by comparing body
burdens of suspect chemicals in premature births with full-term births.
(Preferably by using maternal blood and hair samples, along with
cord-blood, placental tissue and hair from the babies -- but NOT
by subjecting newborns to the taking of blood samples. They DO
feel pain!) If the Federal agencies won't look into it, then some of the
states (California, New York, New Jersey, etc.) should take this on.

It will probably take a goodly number of years to identify all of the
specific chemicals that may be involved (although we already know
of dozens that can cause developmental problems for fetuses). But
I would think that we would have at least a general indication of such
a correlation even with the preliminary data (provided the sample size
was large enough.)

Ironically, the three factors that *are* pointed to in this article are
ALL linked to higher socio-economic class -- very much the opposite
of what you would otherwise expect. Maybe "prosperity" isn't all it's
cracked up to be.

By the way -- the article is rather misleading when it refers to babies
"being born just shy of" full-term or "slightly early". That sounds like
a week or two shy of 40 weeks -- not 4 to 6 weeks early, as explained
half-way down. That's major.

Craig Gingold
(near) Midpines CA

To: ef <EarthFirstAlert [at] yahoogroups.com>
From: Teresa Binstock <binstock [at] peakpeak.com>
Date sent: Sat, 20 May 2006 06:56:54 -0600
Subject: [EF!] As Babies Are Born Earlier, They Risk Problems Later - preemies increasingly

common
Send reply to: earthfirstalert [at] yahoogroups.com

Shall we pretend that increasing levels of intra-body toxins are not
contributing to the increased rate of premature births? Shall we insist
- as does the EPA - that toxin reporting ought be severely limited?

Teresa

* * * **

As Babies Are Born Earlier, They Risk Problems Later*

By Rob Stein
Washington Post Staff Writer
Saturday, May 20, 2006; A01
http://www.washingtonpost.com/wp-dyn/content/article/2006/05/19/AR2006051901702.html


[foto] Becky Veduccio of Bloomfield, N.J., said daughter Sophie spent
several days in intensive care after being delivered 3-1/2 weeks early.
(By Russ Veduccio)


More and more babies each year are being born just shy of spending a
full pregnancy in their mothers' wombs, putting more infants at risk of
health and possibly developmental problems because they enter the world
before they are ready.

The percentage of babies born slightly early has been increasing
steadily for more than a decade and is now at an all-time high. So many
babies are being born a few weeks early -- more than 350,000 annually --
that the average U.S. pregnancy has shortened from 40 weeks to 39.

The increase is driven by a combination of social and medical trends,
including the older age of many mothers, the rising use of fertility
treatments and the decision by more women to choose when they will
deliver. At the same time, medical advances are enabling doctors to
detect problem pregnancies earlier and to improve care for premature
babies, prompting them to deliver more babies early when something
threatens their lives or those of their mothers.

Many obstetricians argue that the trend is positive overall because they
are preventing thousands of stillbirths and avoiding potentially serious
risks for mothers. But other experts worry because these babies are
prone to a long list of serious, potentially life-threatening complications,
which often require intensive, costly treatment. Moreover, growing evidence
suggests that their long-term development may be more problematic.

"We should be concerned about these babies," said Tonse N.K. Raju of the
National Institute of Child Health and Human Development. "They have
more short-term problems, and there is evolving evidence that they have
long-term risks as well."

Although most of these babies fare well and face far less risk than very
premature infants, researchers have begun to realize that they are
nevertheless more prone to short-term complications, such as problems
breathing and feeding, and jaundice. And because so many are being born
each year, even a small increased risk translates into thousands of sick
babies. Studies are also starting to suggest that these children may
tend to not develop as well as full-term babies, leading to behavioral,
learning and other difficulties.

"There's no question these babies tend to have more [immediate] problems
compared to full-term babies," said Richard E. Behrman of the Federation
of Pediatric Organizations, who chairs a panel assembled by the National
Academy of Sciences that will issue recommendations on the rising
late-preterm birth rate next month. "The concern is about whether there
is some adverse impact on their long-term development."

For years, most of the attention focused on the earliest, smallest
"preemies" -- those born before 32 weeks -- because they face the
greatest risks of dying or having permanent disabilities, such as
cerebral palsy, deafness and blindness. But the proportion of babies
born that early has leveled off, while the rate of "near-term" or
"late-preterm" births -- between 34 and 36 weeks -- continues to rise.
They now account for about two-thirds of all preterm births.

"These kids have been below the radar screen," said Marie C. McCormick
of the Harvard School of Public Health. "They're just starting to get
our attention."

Nearly 9 percent of all babies delivered in the United States were born
late-preterm in 2003, according to the most recent federal data. That is
up from 7.6 percent a decade earlier and the highest since the
government started tracking such births -- and translates into about
50,000 more of these babies each year.

"It's a huge increase," said Mary E. D'Alton of Columbia University.
"The question is: Are we doing too many of these deliveries?"

While the precise cause of the increase is unclear, one reason is that
more women are delaying childbearing until their thirties, when they are
prone to complications, including premature labor. Older women are also
more likely to need fertility treatments, which increase the chances of
having twins and triplets -- which tend to be born early. The obesity
epidemic may also play a role -- obese women have more complications,
such as high blood pressure and diabetes, that can make it necessary to
end a pregnancy early.

Medical advances are making it easier to spot babies who are in distress
or developing poorly, prompting doctors to deliver them early -- either
by Caesarean section or by inducing labor with drugs -- to prevent
stillbirths. Techniques for caring for premature babies have also
improved, giving physicians more confidence that a baby will survive
if delivered early. That makes them more likely to suggest an early
delivery at any hint of a problem that might endanger the mother or baby
-- or risk a lawsuit.

"In the past they wouldn't have dared -- they would have tried to wait it
out," McCormick said. "Now they know what the neonatal intensive-care
unit can do. That's been a very powerful, powerful change."

So powerful, obstetricians say, that the rate of stillbirths has dropped
and the chances that a premature baby will survive have risen sharply.

"We shouldn't be worried," said Charles J. Lockwood of the Yale
University School of Medicine. "We're doing a good job of avoiding
stillbirths and subsequent infant mortality. When you have a fetus with
no growth or insufficient food, the better place for that fetus is outside
the womb."

But some specialists question whether the increase in Caesareans and
inductions is the reason for the drop in stillbirths. And they worry that
too much of the increase may be due to women hastening delivery for
nonmedical reasons -- they want to make sure their mother will be in
town, their husband has a business trip pending, or they are just fed up
with being pregnant.

"It's a common request," said Mark Lollar, an obstetrician in San Ramon,
Calif., who routinely honors such requests for the wives of professional
athletes so their husbands can be present. "I have no problem arranging
that for them."

Lollar and other obstetricians insist that they make sure that the fetus
is at least 38 weeks old. "We never compromise the mother or the baby's
safety," Lollar said.

Other experts, however, say it can be difficult to calculate the precise
gestational age of a fetus.

"If a woman comes in late in the pregnancy and only has one ultrasound,
you can have an error of up to two weeks, which can be significant,"
Tonse said.

After losing her first baby three days before her due date, Becky
Veduccio and her doctor decided to induce labor in March just before her
37th week. Her daughter, Sophie, spent several days in intensive care
getting breathing help, antibiotics and intravenous fluids. Less than a
week later she was readmitted to the hospital for jaundice, and she has
had digestive problems ever since.

"I thought 36 1/2 weeks would be okay," said Veduccio of Bloomfield,
N.J. "But it's been just torturous. Every time we thought we could
relax, something else would happen."

The lungs, brains and other organs of babies born even a week or two
early are often underdeveloped, making the infants much more likely to
have problems breathing, maintaining their body temperature and feeding.
They are also vulnerable to infections and jaundice, which can be
life-threatening or cause brain damage.

Such complications often require them to be sustained in the hospital
for a week or two until they are fit to go home, adding thousands of
dollars to the cost of their care. Often, they end up being readmitted
once doctors realize they are not quite fully formed.

"These babies often masquerade as term babies," said Elizabeth A. Catlin
of Massachusetts General Hospital in Boston. "They look like full-term
babies -- they are chubby, they have a head of hair. But they just don't
have the maturity and development of full-term babies."

In addition to the added cost and anxiety the complications cause,
late-preterm babies are about five times as likely to die in the first
week of life and about three times as likely to die in the first year
than full-term babies, studies show.

"Doctors ought to be aware that there's no free lunch," said Michael
Kramer of McGill University in Montreal. "There are a lot more babies
out there who are getting sick and dying."

Although very little research has been done on these babies' long-term
well-being, researchers suspect they may also be at increased risk for
behavioral problems such as hyperactivity and possibly cerebral palsy
and mental retardation.

"Could this group of babies be contributing significantly to the total
burden of mental retardation in the United States and the world?" asked
Gabriel J. Escobar of Kaiser Permanente Medical Care Program in Oakland,
Calif. "I would say yes. We don't know how much, but it's not trivial."

Some studies have found evidence that these babies are more likely to
have subtle problems with speech development and coordination and
behavioral and learning difficulties.

"The thinking had been that these babies were basically the same as
term babies," said Steven B. Morse of the University of Florida. "Now it
looks like they really are different."

Morse presented a study at a conference in San Francisco this month
that found late-preterm babies were significantly more likely to fall behind
in reaching language, coordination and developmental benchmarks at
age 3, were less likely to be ready to start preschool at age 4, and were
more likely to need special-education classes, have behavioral problems
and be held back in kindergarten.

"A lot of brain maturation occurs in those last few weeks," he said.
"How the brain develops when the baby is still inside the mother may be
different than how it develops when it is outside. If these kinds of
development problems persist for these children, that is a concern from
a societal standpoint."