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Too Many Babies Born Premature

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By JENNIFER PORTMAN

Tallahassee Democrat

Published: November 28, 2008

TALLAHASSEE - There is no shouting here.

In the neonatal intensive care unit at Tallahassee Memorial hospital, nurses' voices are restrained even as they rush in with new patients and gently push needles into thread-thin veins. Too much stimulation can overwhelm their tiny charges. With underdeveloped lungs, babies cannot cry out.

As the Tillman family of Tallahassee discovered, no parent ever wants to be in these spotless rooms with miniature medical instruments. But hundreds of area parents each year find themselves in this crowded ward of dread and miracles.

"Every time they walk in the door they wonder, 'Is my baby going to die?'" said Linda Frimmel, director of the NICU. It treats 600 to 650 infants a year, about three-fourths of them premature. "They are totally unprepared, and they are scared."

For some reason, often unknown, their baby has come too soon. Not in the 38 to 41 weeks that he should have, but weeks or even months early, before his body and vital organs have fully developed, too soon to have soaked up infection-fighting antibodies, long before he can suck, swallow and breathe all at the same time. Parents are told right away: Your baby's chance of dying is 80-to-20.

By now, state and national public health officials had hoped the number of premature births would be on the decline. It's not.

Between 1995 and 2005, Florida saw a 17 percent increase in babies born early, putting them at greater risk of dying before their first birthday or suffering lifelong health problems.

The March of Dimes ranked Florida the 10th-worst state on its national prematurity report card. Nationally, rates have gone up 30 percent since 1981.

"We are not doing well," state epidemiologist Bill Sappenfield said. "We are not improving."

As midwife Miriam Gurniak said: "It's a mess."

The March of Dimes and other advocates for maternal and infant health are trying to reverse the troubling trend with a campaign to make reducing prematurity a top national priority.

"More than 80 percent of the time we don't even understand why people go into labor early," said David Dixon with North Florida Women's Care, the largest obstetrics practice in Tallahassee. "There are still so many who deliver early that we have no explanation for."

Doctors and researchers know that factors such as smoking, drinking or other drug use during pregnancy increase the risk of premature birth. The oldest and youngest moms are also at higher risk, as are those carrying multiple babies, those who've had infertility treatments or previous premature births, or those who are under stress or in poor health. Black moms also have a greater chance of preterm delivery.

But no one knows exactly why one woman who has all the warning signs can have a healthy, full-term baby, while someone with no obvious problems will spend months hunched over a plastic box in the intensive care unit.

"They can take really, really good care of themselves and still end up here," said Shelly Frazier, a NICU nurse and family education coordinator.

"I think there is a lack of knowledge that it can happen to anyone," said former Tallahassee state Rep. Loranne Ausley, whose son Will was premature. "Never in a million years did I think I would have spent four months of my life in that unit. You just don't think it can happen to you."

An increase in Caesarean sections is partly to blame. Sappenfield, who's working on a study of the issue, said C-sections account for about 30 percent of Florida's increased prematurity rate.

Frazier said: "People in our community have gotten really comfortable with premature births."

But while one baby born early might do fine, another might not.

Ausley said she and her husband were not given one "iota of hope" that her son would survive. But against all odds he did, and now he's in kindergarten.

But, she warned: "Not all of these stories have these kinds of happy endings."

Preterm birth is the leading cause of death for babies in their first month. Those who survive are at risk for cerebral palsy, respiratory and vision problems and other ailments that can linger their whole lives.

"The cost of prematurity is staggering," Sappenfield said.

The March of Dimes estimates the first-year health care costs for babies born prematurely are more than 10 times those of babies born full term.

The emotional price for families is also high. Marriages often fall apart, experts say, and mothers sometimes experience intense guilt.

While much about preterm birth remains a mystery, health experts say making sure women are healthy is essential.

"You want to be in the best possible condition before you are pregnant," Frazier said.

That's easier said than done, some say.

"The health care system is imploding," Gurniak said. "As a country we are less healthy than we were a generation ago."

Tackling the problem of prematurity is going to take a holistic approach.

"We aren't going to be able to give a pill or a shot," said Jennifer Bitner, executive director of the March of Dimes North Florida division. "It is such a complicated problem because every pregnancy is different."

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