Monday, February 3, 2003

March of Dimes targeting early births

By Tim Bonfield
The Cincinnati Enquirer

The March of Dimes, with a mission in preventing birth defects, has launched a new national campaign to reduce premature births.

The five-year, $75 million awareness campaign was launched because premature births have risen 27 percent since 1981, resulting in tremendous cost to families, the medical system and society.

"Many of these babies come into the world with serious health problems. Those who survive may suffer lifelong consequences, from cerebral palsy and mental retardation to blindness," said Dr. Jennifer House, president of the March of Dimes.

A kickoff for the Greater Cincinnati portion of the awareness campaign is Wednesday.

The effort is especially timely for Hamilton County, because premature births are closely linked to infant mortality rates here - rates that have exceeded national averages for years.

Independent of the March of Dimes effort, several local health agencies have formed a steering committee to look for new ways to reduce infant mortality rates. That committee is expected to make recommendations on how to spend $100,000 set aside late last year in the Hamilton County budget.

"It is vital for the future well-being of babies in our community that we take action about the problem of premature birth now," said Dr. Claudia Harsh, a Cincinnati gynecologist who has been working with the March of Dimes effort.

A child born before 37 weeks of gestation is defined as premature. Normal gestation is 40 weeks. Thanks to technology, some premature babies survive being born at less than 24 weeks and weighing as little as one pound.

But such success comes at immense cost. The smallest premature babies spend several weeks in intensive care, often depending on machines to breathe; a variety of expensive medications; and round-the-clock monitoring by machines and highly trained nurses.

Nationwide, nearly 12 percent of all live births in 2001 were premature - a figure that translates into 476,000 babies. In Ohio, more than 18,000 premature babies are born per year.

The average hospital charge for a preemie is $58,000, compared to $4,300 for a normal newborn.

The costs add up to billions of dollars nationwide. But that cannot compare to the emotional devastation of parents spending weeks in the hospital only to watch their baby die, which often occurs when babies are born at less than two pounds.

Such cost figures also do not reflect the long-term emotional and financial burdens of raising children with lifelong medical problems, such as mental retardation, cerebral palsy, heart damage, digestive disorders and blindness.

In many ways, the costs of premature birth reflect the success of medical technology.

"Children born at three to four pounds are surviving and going home, some with moderate learning disabilities and other problems. Those children used to die," said Dr. Edward Donovan director of the Child Policy Research Center at Cincinnati Children's Hospital Medical Center. "But the smaller the children get, the more problems that occur if they survive."

The causes of premature birth are still not fully understood, which is why the rates have been so difficult to reduce, Dr. Donovan said.

Contributing factors include a woman's previous history of going into early labor, alcohol and drug abuse, smoking during pregnancy, lack of prenatal care to detect fetal problems, even the increasing use of fertility drugs that result in multiple births.

However, as many as half of premature births cannot be traced to a specific risk factor.

"That is why the March of Dimes is promoting more research in this area," Dr. Harsh said.

Premature birth and infant mortality run higher than national average in Hamilton County.

Nationally, 11.6 percent of live births are premature. In Hamilton County, the figure is 12.3 percent.

Nationally, 6.9 babies per 1,000 born in 2001 died within their first year. In Hamilton County, the infant mortality rate was 9.9 deaths per 1,000 live births.

Premature birth is one of two leading factors in infant mortality, nearly equal to birth defects, according to the Centers for Disease Control and Prevention.

Other lesser causes of infant mortality include SIDS, accidental injuries, diseases and infections, and abuse.

Reducing premature births will reduce infant mortality, so the Infant Mortality Steering Committee will likely work closely with the March of Dimes campaign, Donovan said.

The committee includes representatives from Children's Hospital, University Hospital, Cincinnati Health Department, Greater Cincinnati Health Council, the Ohio Medicaid program, and Every Child Succeeds.

The committee plans a daylong conference about the issue, draft a strategy for reducing infant mortality, gather data to track progress, and produce reports.

Many agencies are involved in the issue. The goal is to build more coordination among them, Dr. Donovan said.


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