intensely trivial



KC Birth Network conference: Late Preterm Birth

This is the third in a series of posts on what I learned at the KC Birth Network conference Apr. 23-24. “Late Preterm Birth: Increased Clinical Risk” was a talk given by Jodi Jackson, MD, a neonatologist at Children’s Mercy Hospital in Kansas City. Again, I’m not trying to polish this much, but I hope you can gather the importance of what Dr. Jackson said to the lecture hall full of midwives, doctors, nurses, and doulas about “late preterm” babies.
Late preterm infants (LPTI) are defined in pediatric literature as babies born before 38 wks. Obstetric literature calls 37-wks. babies “term.” Why this disconnect?
— In 2003, 12.3% of US births were preterm, representing a 16% increase since 1990 and a 31% increase since 1981. That is, 1 in 8 babies is born premature in US. Babies born between 34 and 36 completed weeks account for 71-74% of these preterm births (you would think it was earlier premature babies filling the NICUs, right?).
LPTI face a higher rate of morbidity and mortality than term babies, even though they may look normal, stable, etc. upon delivery.
It is nearly impossible to know for sure the baby’s gestational age.
— Preterm birth is one of the leading causes of death in the 1st month of life.
— “Cesarean delivery has increased risks for LPTI, term infants, and moms.”
— “Everything you do that you think is good has at least 4-5 bad side effects.”
Risks of elective c-section vs. vaginal birth for LPTI: increased risk of NICU stay of at least 7 days; if cephalic presentation, increase in mortality by 1.7-fold; increased risk of respiratory distress, need for oxygen; maternal morbidities (death, hysterectomy, blood transfusion, intensive care stay, antibiotic use)
Is the rise in labor induction rate related to an increase in LPTI? Yes, according to several studies. Rise in induction and cesarean rates is not explained by changing maternal demographics or risk factors.
— When disaggregated by maternal age, 11% of babies born to mothers > 40 y.o. are LPTI, less for women in younger age groups.
— When disaggregated by race/ethnicity, many more LPTIs are born to mothers who are black.
— Medical cost comparison: Preterm births cost $32,325 average in 2005; term births cost $3,325.
— Infant deaths by cause of death, per 100,000 live births: 134.6 die of birth defects; 113.5 of prematurity/low birth weight; 54 of SIDS; 42.7 of maternal pregnancy complications; 20.8 of respiratory distress syndrome. (Those numbers are higher than I expected. . . )
— Risk factors for LPT birth: prior preterm birth, race, maternal age, tobacco or drugs, infection, maternal chronic disease or pregnancy complications, multifetal pregnancies and assistive reproductive technology
— Morbidity risks for the LPTI: respiratory distress, hypothermia, hypoglycemia, feeding problems, hyperbilirubinemia, rehospitalization, SIDS, developmental outcomes
— This morbidity risk is MUCH higher in the LPTI than in the full-term infant
— LPTI newborns 4-7 times more likely to have at least 1 medical condition
“Early term” neonates — 37-38 wks. — have increased risk for respiratory distress syndrome, transitional tachypnea of the newborn (very common in babies born by cesarean), pulmonary hypertension, NICU admission or prolonged admission to the hospital
— 10% of LPTI experience temperature instability compared to 0% of term infants. (I wish Dr. Jackson had addressed the recent research on kangaroo care as a treatment for this.)
— Hyperbilirubinemia — LPTI have a much greater need for phototherapy to treat this.
— Neurodevelopment — lower birth-weight babies have higher rates of learning problems, ADD/ADHD, and emotional/behavioral problems.
Implicated factors for increased rate of late preterm births: increased surveillance, inaccurate gestational age, increased multifetal pregnancies, worsening maternal demographics, presumption of maturity at 34 wks., fear of fetal risks, maternal autonomy, physician practice patterns (convenience, delivery without indication, planned delivery, delivery mode).
Prevention of LPT birth: accurate gestational dating (prudent use of prenatal fetal testing, prudent use of labor induction and cesarean, targeting significant medical indications); assisted reproductive technology strategies to minimize multifetal gestations

Conclusions/my opinions:
1. Even though we in our culture don’t tend to be shocked by stories of babies born at 36 or 37 weeks, we need to realize there can be serious consequences for babies born at this gestational age. And if the babies suffer from being born at this point, their parents will struggle, too.
2. Our culture seems to consider labor induction normal these days. Instead of readily agreeing to induction, pregnant mamas should be asking their care providers questions about the reasons for induction and the likelihood of the proposed induction’s success. If you want some ideas about talking to your doctor about induction, ask me.
3. It was hard for me to listen to this talk, because Dr. Jackson was full of fear. Then again, she probably doesn’t spend much time around healthy, full-term babies. She sees parents terribly stressed out and babies with all sorts of disadvantages. We average folks sometimes talk about premature babies as being “miracles,” and we think they’re really cute — both true things. The reality in the NICU is much less warm and fuzzy. Check out this poignant comic strip about life for NICU parents.

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Comments

  1. * Mama&Ellie says:

    I was born by scheduled repeat C-section and was supposed to be full-term. But the doctor was wrong, and supposedly I was more like 37 weeks. My mom recalls that I couldn’t breathe properly on my own and couldn’t maintain my body heat. I was 6 days old before my parents got to hold me. I wore a breathing monitor for the first several months of my life.

    The picture stories like mine paint are sad and unnecessary. I think LPTI births are caused by the doctor’s disregard for the facts versus their routines, the parents’ ignorance about natural birth, and their unwavering trust in their care providers.

    Posted 7 years, 6 months ago
  2. * manhattandoula says:

    Mama&Ellie, I couldn’t agree with you more on the causes for LPTI births. I know there are a few cases that truly need medical intervention, but in general, “birth is safe; intervention is risky.”

    Posted 7 years, 6 months ago


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