When it comes to womb time, even a week matters to child's future education

Extreme prematurity can lead to a lifetime of special education needs. But being born a few weeks early -- even a week early -- can matter too, researchers have learned.

Scottish researchers analyzed data on more than 400,000 schoolchildren, paying attention to gestational age at delivery and the children's use of special education services. In a study published this week in PLoS Medicine, they write quite bluntly:

"... deliveries should ideally wait until 40 weeks of gestation because even a baby born at 39 weeks — the normal timing for elective deliveries these days — has an increased risk of [special educational need] compared with a baby born a week later."

Read the full gestatation-and-special-education study here.

It includes a link to a March of Dimes explanation of why the last weeks of pregnancy count -- something to consider when scheduling that C-section.

-- Tami Dennis

Photo credit: Los Angeles Times

 

'Kangaroo care' boosts preemie survival

The concept of "kangaroo care" for infants is appealing. Kangaroo care was described more than 40 years ago as providing newborns -- especially premature babies -- with skin-to-skin contact. Other aspects of kangaroo care include breastfeeding and early response to medical problems. Many neonatal units worldwide adopted kangaroo care, but the practice fell out of favor somewhat after a 2003 review by the Cochrane Library showed the practice had no effect on infant death rates.

However, a new study, an analysis of 15 studies of kangaroo care in low- and middle-income countries, found big benefits to the practice. Dr. Joy Lawn, who is affiliated with the group Save the Children, found a 51% reduction in infant death rates in babies weighing less than 4.4 pounds. The paper, published Monday in the International Journal of Epidemiology, suggests that several newer studies that were not included in the Cochrane analysis provide a more accurate picture of the benefits of kangaroo care.

"We are more confident than ever that kangaroo mother care works," said Lawn in a news release. "No matter if babies are born in Lilongwe, London or Los Angeles, preterm babies need extra care to survive. Kangaroo mother care is low-cost and feasible, and we now have proof it is one of the most highly effective ways to give more babies the chance to survive and thrive."

-- Shari Roan

Photo credit: Mark Boster  /  Los Angeles Times

Premature births down but C-sections continue rise

Statistics on childbirth released today show progress on some fronts and discouraging news on others. The most promising data was in rates of premature birth and low birth-weight babies. Both showed the first decline in rates since the early 1980s. The statistics were among a report released today by the National Center for Health Statistics.

The preterm birth rate, defined as infants delivered at less than 37 weeks of pregnancy, fell 1% in 2007. The rate is now 12.7% of all births. According to the March of Dimes, the improvement is largely due to a reduction in deliveries taking place a week or two early. But March of Dimes President Jennifer Howse said in a news release, "We're encouraged by this drop in the preterm birth rate, and hope that the emphasis we've put on the problem of late preterm birth is beginning to make a difference."

The rates of preterm births were uneven across the country. Alaska, Idaho and New Hampshire experienced significant declines -- 7%, 9% and 10%, respectively -- while other states showed increases. The rate in California increased from 10.7% in 2006 to 10.9% in 2007. Data on state performance can be found on the March of Dimes website.

Rates of low birth-weight babies also declined slightly, from 8.3% in 2006 to 8.2% in 2007. However, any drop is important since the rates of both preterm and low birth-weight births had been steadily climbing for more than 20 years.

On a less optimistic note, births to teenage women increased for the second straight year, now accounting for 42.5 of every 1,000 U.S. births. And the rate of C-section delivery, long criticized as needlessly high, continues to soar. C-section deliveries now make up 31.8% of all births. It's the 11th straight year the C-section rate has increased.

The data also showed that births to unmarried women continue to rise to historic levels, now accounting for almost 40% of all births. The U.S. fertility rate is also up 1%, to 69.5 births per 1,000 women ages 15 to 44.

The report, "Birth: Preliminary Data for 2007," can be accessed on the Centers for Disease Control and Prevention website.

-- Shari Roan

Photo credit: Loyola University Medical Center via Getty Images

Octuplet births remind him: Miracles happen

The birth of octuplets Monday at Kaiser Permanente Medical Center has triggered warnings from doctors that the medical outcome for multiple-birth babies so small and premature is often poor. While the unidentified octuplets are reported to be doing well, all low-birth weight babies are at higher risk for health problems, as was detailed in today's Los Angeles Times.

I received an e-mail from a reader this morning, however, reminding me that no one can see the future. Wallace Danielson, of San Diego, was born Aug. 5, 1924, in his parents' home outside Missoula, Mont., he said. He was three months premature and weighed 1 pound, 5 ounces. The town's doctor made a house call to check on the newborn. "That kid will never make it," he said, and left the house. Danielson doesn't know how his parents and older sister responded to that prediction, but they rallied around him. The neighbor ladies came over and helped the family and offered advice, he was told. He was fed goat's milk with an eye dropper and was placed close to a wood-burning stove -- what his parents described as his "incubation." The kid lived.

Danielson is 84 now, he told me in a telephone interview. He was a puny child but eventually reached normal height and has been healthy for most of his life. He served in World War II and the Korean War and earned two college degrees, in physics and chemistry and in foreign trade. He spent his career as a technical writer and editor. Being a man of science, Danielson asked me what the odds of survival are for a 1.5-pound newborn. Studies show infants born today weighing between 1.2 pounds and 1.10 pounds have a 50% chance of survival. Survival rates have improved greatly over the last two decades due to a number of advances in neonatal medicine. In 1970, the odds of a 1.12-pound baby surviving were about 20%.

I have no idea what the odds of survival were in 1924 for a 1.5-pound baby born and cared for at home. I can't imagine how his parents even handled him. "You were about the size of a box of butter," I told Danielson. "And I'm pretty slippery," he said, laughing. "I survived."

-- Shari Roan

Photo: Ken Hively / Los Angeles Times

Nation gets a low grade in preventing premature birth

The rate of premature birth in the United States is shockingly high for a developed country that possesses sophisticated healthcare technology. The nationwide rate is 12.7% even though federal health officials say it should be no more than 7.6%. Prematurity rates have worsened in recent years, increasing by more than 15% between 1995 and 2005.

Those statistics have earned the country a D in the March of Dimes first annual Premature Birth Report Card issued today. States were also given grades. Vermont had the lowest rate, at 9%, which earned it a B. California's rate is 10.7%, earning it a C. Eighteen states plus Puerto Rico and the District of Columbia received grades of F.

Premature birth exacts an enormous cost on babies and on society, according to the March of Dimes. It is the leading cause of newborn death and a major cause of lifelong disability. Such births cost the nation $26 billion a year.

Earlier this year, the March of Dimes established a petition seeking more federal attention to the problem and more money for research on prevention.

— Shari Roan

Photo credit: Ken Hively/Los Angeles Times