With more tiny babies surviving, Shelby County tries to cut number of preterm births
By Tom Charlier, The Commercial Appeal, Memphis, Tenn. | |
McClatchy-Tribune Information Services |
Feeding tubes shoot lipids, or pure fat, straight into her veins to promote weight gain and brain development. Goggles shield her sensitive eyes, and vital-sign monitors tether the incubator cradling her in the neo-intensive care unit of
That Airiyanna is even alive on this day -- nearly a week after her birth -- is a feat that only a few decades ago would have been rare, considering she was delivered 10 weeks premature weighing a little more than 2 pounds.
"She's in great shape for her age," said
That much is certain. Premature, low-birth-weight babies like Airiyanna, on average, spend six times longer in the hospital and rack up a bill 25 times greater than the typical newborn delivered at full term. They face at least a 15 percent chance of such neurological impairments as cerebral palsy, a 40 percent risk of developmental problems and a 60 percent chance of health complications.
Across
It's a major reason
The drop in the infant mortality rate -- from a three-year average of 12.9 per 1,000 live births in 2006-08 to 10.2 per 1,000 births in 2010-12 -- represents significant progress against a problem that has been a county priority since the late Dr.
But with fewer babies dying, there's a whole new challenge: Dealing with an increase in the number of kids needing costly extra medical care, physical therapy and help at school.
"We've been so focused on infant mortality that we've overlooked the fact that so many very fragile children are being born," said
For Joyce and others, the emphasis has shifted from fighting infant mortality to reducing the number of babies born prematurely and, usually as a consequence, at dangerously low birth weights. In a reflection of its socioeconomic and demographic makeup,
In 2012, the most recent year for which data is available, nearly 12 percent of the 13,898 babies born in the county weighed less than the 5.5-pound threshold. The rate nationally is a little more than 8 percent. Nearly 13 percent of babies in the county were born before 37 weeks, compared to a national prematurity rate of 11.6 percent.
"Some of them do very well," Dr.
The widespread poverty of
The area's large African-American population is another factor. For reasons that aren't fully understood, black women -- even those who are relatively affluent, healthy and have good access to doctors -- are more likely than their white counterparts to deliver prematurely. This is true even though African-American women are less likely than white women to smoke.
"It's plausible, based on the ... research, to suggest that African-Americans in general have higher stress in their daily lived experiences than non-Hispanic whites," Joyce said.
Taylor and other department officials have focused on initiatives intended to help women get prenatal care early in their pregnancies through improved access to health care services and through visits to the home. There are a number of related programs anchoring the department's efforts.
One is Healthy Start, a federally funded initiative that follows mothers through pregnancy until the child is 2 years old and helps them adhere to healthy habits before and after birth. Another is HUGS, or Helping Us Grow Successfully, a state-funded program that monitors moms and kids through the child's fifth birthday.
Other department programs and policies ensure that pregnant women are eligible for health insurance and that babies are protected from hepatitis B even if the mother tests positive.
The efforts appear to be paying off. During a two-year period covering 2010-11, the number of babies in the county who were born at 28 weeks or earlier was 22 percent lower than the figure for the period of 2006-07. At the same time, there was a 24 percent decline in the number of babies born weighing less than 1,000 grams, or about 2 pounds, 3 ounces.
"Those are the babies we usually worry about the most," Taylor said.
Another factor in the reduced number of low-birth-weight babies is a recent decline in teenage pregnancies, she said.
Aside from the health implications, there are huge fiscal costs associated with premature, low-birth-weight deliveries. Nationwide, hospital bills for low-birth-weight babies account for nearly half of all infant hospitalization costs, according to some estimates.
Making the problem even more difficult to attack is the fact that it's usually difficult to predict which mothers will deliver prematurely -- and determine why it happened.
Some local mothers have their own theories.
Kiyatajuan Harris, a 33-year-old
Harris said her job, which involves pushing heavy computer-laden carts for a manufacturing services company, might have been a factor in her premature delivery.
"I have a very physical job ...," she said. "I think all that bending up and down had something to do with it."
She's convinced an amniocentesis test, in which a needle is inserted to draw amniotic fluid, caused her premature delivery. Preterm labor and early delivery are potential risks from the test, according to medical experts, but those cases are extremely rare.
Until the amniocentesis, Cunningham hadn't experienced any complications, but afterward, it felt as though the baby "was pressing on my bladder," she said.
"Before I got pregnant with Malik I was in good shape. I went to the gym every day, had a personal trainer," Cunningham said.
She too, however, worked hard, holding down two jobs, one being an
Like many extremely low-birth-weight babies, Malik experienced a variety of life-threatening challenges immediately after he was born in
The hospital bill topped
Not due to deliver until October, she experienced cramps and cervical dilation in June. Doctors performed a cerclage, an operation in which the cervix is sewn closed to prevent delivery, and put Ervin on complete bed rest.
But the cerclage failed, making an extremely premature birth inevitable. Ervin said doctors suggested she get a partial-birth abortion because the baby likely would be born blind, deaf, mentally disabled and suffer from cerebral palsy.
Ervin weighed that option seriously. "I didn't want to bring a child into the world with those kind of challenges," she said.
But she decided against an abortion, saying, "I just had to hold onto my faith and let God handle the rest."
Still, the outlook for the baby was so grim that Ervin had her mother and sister go to
Arrianna survived and had none of the major disabilities doctors had feared. But she spent 111 days in the ICU, underwent 21 blood transfusions and had a shunt for brain bleeding. And, like Malik, she was sent home with a breathing machine, and underwent physical and speech therapy. She rang up a hospital bill of about
In addition to the physical problems, the consequences of prematurity are potentially dire in terms of brain development. During the final weeks of pregnancy, synapses, the junctions where impulses pass from one nerve cell to another, are being formed at rates of up to 40,000 per second, according to researched cited by the
"In children that are born prematurely ... they've experienced a traumatic event," said Joyce, of the institute. "They've confronted more adverse situations already."
Low-birth-weight babies are more likely to have below-average IQs and experience learning difficulties. As a result, they tend to suffer in terms of social development and scholastic achievement, the effects of which extend all the way to adulthood. Research published in the
Joyce takes that premise one step further: Low-birth-weight babies, because they tend to do poorly in school, could be at greater risk of dropping out and getting involved in criminal activity.
"We know that the biggest predictor or being involved with the criminal justice system has to do with their school record," she said.
Both Malik and Arrianna have avoided those pitfalls, staying active and interested in school.
Malik, 14, is an eighth-grader at
But Malik also is something of a musical prodigy, spending much of his free time playing on a keyboard in his family's
"If he hears a song at church ... he'll come home and play it," said Cunningham, who is trying to get her son into
Arrianna, meantime, is a sixth-grader at
Arrianna said she dreams of being a fighter pilot in the
Ervin said her daughter's early struggles inspired her to become a physical therapist assistant. Recalling the shock she felt when she first saw her underdeveloped baby, Ervin expresses wonder at progress her daughter has made.
"We've been very blessed ...," she said. "I just want families and mothers to know there is hope.
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