September is NICU Awareness month
Many babies born too early require care in the NICU (neonatal intensive care unit.)
Preterm birth is more common than you may realize.
Currently, 10.4% of births in the U.S. are preterm (prior to 37 weeks gestation). Full term pregnancy is 40 weeks. Nearly 400,000 babies were born prematurely in the U.S. last year. Preterm birth rates vary by race and ethnicity, with the highest rates seen among African American mothers (14.6%).
Obesity does not directly increase preterm birth, but its related conditions of hypertension and diabetes contribute to preterm birth. When the cause for prematurity is known, premature birth most frequently results from a premature rupture of the fetal membranes (PROM) which initiates labor. Placental abruption, chorioamnionitis, and incompetent cervix are other possible causes of premature birth.
Risk factors for preterm birth:
There are multiple risk factors for premature birth including having a previous premature birth, pregnancy with multiple babies (twins, triplets, etc.), gestational diabetes, infections, drug or alcohol use, smoking, and advanced maternal age. Sometimes preterm birth occurs without any identifiable cause.
Hypertensive disorders of pregnancy (PIH) complicate up to 10% of pregnancies globally and account for at least 8 to 10% of all preterm births. The overall incidence of preterm birth is 5.5% among women with preeclampsia, and the risk of prematurity is higher when preeclampsia develops prior to 28 weeks gestation.
NICU care is usually successful: a typical case.
I want to share an illustrative, happy story about a set of twins who needed NICU care. Their mother was hospitalized for pregnancy-induced-hypertension. Her twins were delivered at 3:00 a.m. by emergency C-section for worsening preeclampsia. I was the doctor on call and attended their birth. The girls were born at 32 weeks gestation with little Ellie weighing two-and-a-half pounds, and larger Emma, weighing in at four pounds. We admitted these babies to the NICU for routine care.
When their father came into the NICU to see his girls I thought I recognized him, but was not sure. When I accompanied him to update the twins’ mother, I realized that we three attended the same church. (I always liked to give extra special attention and care to the babies of people that I knew personally.)
Each baby girl responded well to routine NICU care. They came off of mechincal ventilation and positive pressure support in short order. Their mom pumped breast milk throughout their NICU stay to provide the best protection and nutrition for her daughters. Both were tube fed for some time and later bottle fed. Emma was bigger and strong enough to go home at 3 weeks of age, but Ellie stayed a bit longer in the NICU, about 6 weeks, for growth and feeding issues.
After their discharge home, I was fortunate to see these girls on most Sunday mornings and watch these girls grow up in our church. As part of a strong family, they remained healthy and thrived for the next twenty years.
The picture below is their senior high school photo from 2020. One is now a RN practicing in the ICU and the other is a teaching assistant (with a social work degree) at a preschool. Aren’t they beautiful?
Other survival and outcome figures:
Not all NICU stories have such a happy ending. Some babies are born extremely premature at 24 to 26 weeks gestation due to severe maternal preeclampsia. Babies born at 22 to 24 weeks gestation always have a challenging course in the NICU, and very little chance for an ultimate normal outcome.
These tiny babies typically develop respiratory distress in the early phase and later chronic lung disease. Most suffer with neurological complications, some develop gastrointestinal injury, vision and hearing deficits, and later they show signs of long term language and learning disorders. They have a much higher rate of cerebral palsy 100/1,000, compared to 1-2/1,000 among full term babies. The prevalence of autism spectrum disorder is increased (~6%, compared to 1.4% in full-term babies) in micropreemies born below 26 weeks gestation.
There is good news for babies born at 28 weeks gestation and above.
Between 80 and 90 percent of premature babies who reach 28 weeks gestation will survive their NICU stay. And only 1 in 10 preemies born at 28 weeks have long-lasting health problems. When I discuss possible outcomes with parents of a “28 weeker” (as we call them), I tell them that I see their baby as a perfectly normal child!
An easy-to-remember guide for survival rates in premature infants:
40% for babies born at 24 weeks gestation,
50% for those born at 25 weeks,
60% for those born at 26 weeks,
70% for those born at 27 weeks,
80% for those born at 28 weeks
What questions do you have about premature babies and NICU care?
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I work next door to a NICU. I always say - over there they are saving lives every day. Three cheers to all neonatologists for the incredible work you do.