AAP: Late pre-term births: what can be done?

October 13, 2008

When is a one-week-old newborn not one week old? When she’s a late preterm baby, delivered before 37 weeks-gestation. Late preterm children often have slower biological development, are at greater risk for cerebral palsy, and suffer cognitive deficits, said Marliee C. Allen, MD, of Johns Hopkins School of Medicine.

When is a one-week-old newborn not one week old? When she’s a late pretermbaby, delivered before 37 weeks' gestation. Late preterm children often have slowerbiological development, are at greater risk for cerebral palsy, and suffer cognitivedeficits, said Marliee C. Allen, MD, of Johns Hopkins School of Medicine.

And, most crucially, there are a whole lot more late preterm babies than everbefore. The rate of children born before week 37 is now 11.2% (from 1995 to 2000).Multiple birth rate doubled in the last decade, and the triplet rate went up 400%.White Americans and older women (age 35 to 39) both have doubled their pregnancyrate.

And, don’t forget that medicine allows premature babies to live today whomight not have survived 20 years ago. Infant mortality rates have dropped for50 years, finally leveling in 2002. The new viability limit is 23 to 24 weeksgestation, which is not even through the second trimester.

“Late preterm infants are the bulk of the population,” Allen said,referring to those born between 34 and 36 weeks’ gestation. The societalcost of each of these children is $51,000 per year, above and beyond the standardchildrearing costs.

It would obviously be better of obstetricians could somehow keep the childrengestating until 37 weeks. But the causes of preterm birth are varied and interrelated.How many membrane ruptures are caused by infection? What about induced labor andC-section appointments due to the child’s or the mother’s help? Therearen’t easy answers, other than “We don’t know yet.”

But as a society, we need to know. The varied causes, massive costs, and healthyissues make late preterm development as important an issue as the myriad causesof heart disease, Allen said. It should be funded as such, she said, to applause.