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Survival, at a cost

Prematurity exacts a staggering medical and financial toll. With the number of early births at an all-time high, scientists are struggling to find solutions.

November 21, 2005|Shari Roan | Times Staff Writer

IT'S early morning on the neonatal intensive care unit and Haezxler Galeas -- all 2.2 pounds of her -- is making a fuss.

A noiseless fuss, that is. With a ventilator running into her mouth to help her breathe, crying is a feat still above and beyond the capabilities of a baby born four months too soon.

Instead Haezxler (pronounced Hasler) squirms, frowns, makes a fist -- and her heart rate and blood pressure tick upward. Her ever-present nurse, Bella So, changes her diaper and suctions mucus from around the baby's dime-sized mouth. She repositions the blankets and swaddling, designed to make the infant feel as if she's back in the womb, and increases the baby's anxiety medication. Finally, Haezxler sleeps.

Such intense, round-the-clock care is just the beginning -- not only for Haezxler, but for thousands like her.

Never before has this nation -- despite having one of the world's most advanced medical systems -- cared for so many babies born prematurely. More than 12% of all births occur at or before 37 weeks gestation, or at least three weeks before full gestational age, almost all of them requiring extra, often intensive, medical care.

According to preliminary government statistics released last week, the number of American babies born prematurely last year topped a historic half-million mark. Hospital costs alone for preemies totaled $18.1 billion in 2003, according to the March of Dimes. Added to that are the costs of parents' lost work time and healthcare services for children after the initial hospitalization.

With the long-term effects of prematurity becoming ever clearer, doctors, policy experts and researchers are struggling anew to prevent the problem. But first they must better understand its causes.

"The results of prevention efforts for prematurity in the past haven't been spectacular," says Dr. Gabriel Escobar, an expert on premature birth and a research scientist at the Kaiser Permanente Division of Research in Oakland. "But we are seeing more -- and better-conducted -- research to try to figure out what we can do. There is a sense of urgency."

Infant-health doctors are all too aware of the irony of the problem. Although they have dramatically reduced death rates among preemies -- babies like Haezxler survive 70% of the time in top neonatal centers, up from around a 30% survival rate three decades ago -- no one can quite figure out how to stem the tide of premature infants. Since 1983, the rate of premature birth in the United States has risen nearly 30%, according to the March of Dimes.

"We've been pacified by our own successes," says Dr. Nancy S. Green, medical director of the March of Dimes. "But a lot of these survivors have these chronic conditions, chronic lung disease that develops into asthma; neurological and behavior problems."

In one of the longest-running studies following children born at extremely low birth weight, published in July in the Journal of the American Medical Assn., researchers found significantly more chronic health conditions and educational limitations when comparing them with normal-birth-weight children at age 8.

Another study, published in 2000, found that even among babies who don't have physical defects, developmental delays are common by school age. In the study, from Syracuse University researchers, 61% of preterm children experienced low achievement or had special needs in school compared with 23% of full-term children.

Meanwhile, health experts are growing more uneasy over the numbers of "near-term" babies, born just a week or two early, who were long considered small but healthy. Recent studies suggest that a sizable number of these children ring up higher medical costs as infants and are at higher risk for learning disabilities. While births of babies with less than 32 weeks gestation have remained stable, more babies than ever before are being born at 32 to 36 weeks.

"Most people wouldn't think a 36-week baby is premature. But the reality is that these babies have a substantially harder time than the term baby," says Escobar, who has conducted studies on near-term births.

An unprecedented amount of private and government money is being funneled into studies on preterm birth. The new attention, he and other experts hope, will produce prevention strategies in the near future.

Growing demand

Solutions can't come soon enough at places like Childrens Hospital Los Angeles, where there is always a waiting list for one of about 40 beds in the neonatal intensive care unit.

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