What is Prematurity?

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. This is your Weekly Dose of Wellness. I'm Deborah Howell and today's guest is Dr. Tony Soliman, medical director of the neonatal intensive care unit at Miller Children's and Women's Hospital, Long Beach. Welcome, Dr. Soliman.

Antoine Soliman, MD: Thank you, Deborah. Nice to be here.

Deborah Howell (Host): Such a pleasure to have you. Now with the advancement of medicine and prenatal care, prematurity is declining in the US and that is good. In 2006 the pre-term birth rate was 12.8% and in 2013 it dropped down to 11.4%. But even with these advancements, of course, one in nine babies are born prematurely in the US each year and that's just one too many. So let's shed some light on this topic. First off, what is prematurity?

Antoine Soliman, MD: Well, it's an important topic and one of the things that we want to realize right off the bat, prematurity is the number one cause of death for children under the age of five worldwide. When we describe or define prematurity, it is birth before 37 weeks gestation. And that's the definition that most professionals are using.

Deborah Howell (Host): The number one cause.

Antoine Soliman, MD: Yeah, you know, we look at prematurity in a variety of ways and it affects children in different societies. Obviously, more advanced countries have a problem with babies that are extremely premature and developing nations still suffer from problems with babies that are even more mature because there's a variety of ways to describe prematurity.

Deborah Howell (Host): Okay, so let's get into that. Are there different levels of prematurity?

Antoine Soliman, MD: Yeah, we look at babies that are born before 37 weeks in about three categories. One are the late pre-term babies, those are babies that are born 32 to up to 37 weeks. There are very premature babies that are born 28 to 32 weeks, and then there's a very small number of babies that we define as extremely premature, and those are the babies born before 28 weeks gestation.

Deborah Howell (Host): Okay. Before 28 weeks. Wow. How tiny are these children?

Antoine Soliman, MD: Some of them can be, you know, somewhere between 1 and 2 pounds. So they're very, very small, very fragile newborns. We don't see a lot of them, but the percent that we do see have significant problems both early on in the course as well as for the survivors some more chronic problems.

Deborah Howell (Host): Okay, so what are some of the common health concerns for premature infants?

Antoine Soliman, MD: Well, depending obviously on the gestational age at birth and the birth weight, that will, you know, put the baby at higher risk for certain diseases. We know that the earlier the baby is born the more severe health problems. The most severe being death of course. And so survival at say 23 weeks is much less than survival at even 26 weeks and higher. So death is the most severe. We know that of those babies that survive to discharge, there's intellectual disabilities, some of them have problems moving their muscles or motor problems like cerebral palsy. Staying longer within the NICU can certainly be a challenge for many patients. Other long-term health problems could be, you know, breathing problems, chronic lung disease. Many of them have reactive airways or asthma.

Deborah Howell (Host): Wow, that's a lot of stuff to handle. I was curious when you said having problems staying in the NICU for a long period of time, what kind of problems?

Antoine Soliman, MD: Well, we know that babies that are born extremely premature can stay up to four months in the NICU or even longer just because they are born that early. So, whenever a patient is in the ICU for a long time, the cost of keeping them alive in terms of, you know, putting them on a ventilator and giving certain medications, those can add morbidities to the patient. It's very different than if the baby was inside the mother.

Deborah Howell (Host): Are there risk factors for prematurity itself?

Antoine Soliman, MD: Yeah, you know, prematurity is something that a lot of groups and organizations are looking into because it is such a common and severe problem. Some of the things that we've found are that, you know, having a prior premature birth will increase the risk of having a subsequent baby that's born premature. If a mother is carrying more than one fetus, so multiples, twins, triplets, higher order. We know that certain health conditions that a mother has like high blood pressure or diabetes or certain clotting diseases, problems with the mom's uterus. These are all things that can contribute to delivering a baby early.

Deborah Howell (Host): Is that why some women are put on bed rest?

Antoine Soliman, MD: Yeah, sometimes a woman would be asked by her physician to stay on bed rest because her risk of delivering early is higher. And then even when a mom does everything right and her pregnancy is going very well, there's certain things that come up like an infection during the pregnancy that can cause an early delivery.

Deborah Howell (Host): Okay. So I'm wondering, can prematurity be prevented?

Antoine Soliman, MD: You know, like I said, a lot of people are looking into this, and the more we investigate we realize that there are certain easy answers or easier answers to help reduce. So, things like partnering with a health care provider before a woman gets pregnant, that's critical. You know, having a plan of, okay, we want to be able to have a baby, making sure that her health is in good standing, reducing some, you know, things that can cause problems like smoking or drug use. Eating healthy and even stress in a woman's life has been associated with pre-term birth. So we know a lot of women are stressed out in general, but trying to find ways to reduce stress is helpful in that. And then of course looking at the healthcare delivery model that we have, are we offering early inductions or cesarean births for non-medical reasons, trying to reduce those will reduce prematurity.

Deborah Howell (Host): I see. Okay, so now the baby's born. What type of care does a premature infant need?

Antoine Soliman, MD: Well, the type of care really depends on where the baby's born. To optimize that I think that we are looking now at much more of a comprehensive care where you have a large team of experts. Before the baby is delivered a mother comes into a hospital setting, she is cared for by experts that know how to monitor a baby, know that there are certain medications that the mother can receive to help reduce the problems. Antenatal steroids, sometimes antibiotics would help with that. Having a team at the delivery itself, this is critical, you know, this is a very important time for a baby, that the second a baby comes out having a team that's expert and knows what to do to help the baby breathe and so on, that's very important to long-term outcomes. And then in the NICU, we realize that there's a process that has to happen that involves multiple specialists, as well as partnering with the family. So we try to look at a delivery of care model now that's much more comprehensive that involves focusing on the patient as well as the family, realizing that there's innovations in medicine that can help the baby have a better outcome.

Deborah Howell (Host): Yes, we're continually learning, aren't we? So what advancements have been made in neonatal care in the past five years, say?

Antoine Soliman, MD: Well certainly we've identified that there are contributions from innovations in medical devices. Say something as simple to us as an isolette is a very intricate piece of machinery that can monitor a patient and can contribute to the patient's, you know, fluid and electrolyte management and all sorts of things. Having devices that monitor less invasively, those are all advances that we are very excited to have at most of the major neonatal ICUs. There's nutritional support that has become much more comprehensive now involving like I said experts that focus much more on human milk and the importance of a mother's milk and how to help her with that supply. And then looking at the delivery of care like I mentioned earlier, just taking a step back and saying, a team of experts that does this every day for a large number of patients always has better outcomes. When we look at data from centers that only care for a handful of premature babies every year, their outcomes are not nearly as good as a regional center that really cares for a large number.

Deborah Howell (Host): Exactly. And what makes Miller Children's NICU stand apart from other regional NICUs?

Antoine Soliman, MD: Well, being one of the regional NICUs here in the state of California, we realize that we do get patients transferred to us from other neonatal ICUs for what we call a higher level of care because we have experts here that can handle the whole spectrum. But I think what really makes us stand out is that we have all the experts in one place. We don't need to separate the mother from the baby. And that's very important because being a children's and women's hospital, the mother can feel very reassured that if everything is going great, she and her baby will have a great outcome. But in the rare event that things don't go as well, the baby never has to leave the same building.

Deborah Howell (Host): That truly is awesome. It really is. Where can listeners go to get more information?

Antoine Soliman, MD: I think that there's a variety of resources that are available right now. I think prematurity has become a lot more of a topic that has shown that with public awareness things can improve. Certain organizations like the World Health Organization certainly has lots of information, websites. Organizations like the March of Dimes, they have a whole wealth of information for both professionals as well as just families that are interested or have gone through or possibly even going to go through this experience. And of course our hospital website certainly has a lot of information about that.

Deborah Howell (Host): That's right. To learn more or to listen to a podcast of this show, you can also visit memorialcare.org. Thank you so much, Dr. Soliman, for coming on the show today. It's been just wonderful having you.

Antoine Soliman, MD: Thank you, Deborah.

Deborah Howell (Host): I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. Have yourself a wonderful day.