Even later preemies face respiratory risks
July 27th, 2010
06:29 PM ET

Even later preemies face respiratory risks

Babies born weeks before their due date are at increased risk for serious breathing problems, according to a new nationwide study.

Preemies born before the 37th week of pregnancy are at increased risk for breathing and respiratory illness because their lungs aren’t fully developed. “The pulmonary system is the last to develop last in the fetus,” explains Dr. Judith Hibbard, one of the study authors.

Hibbard, a maternal fetal specialist at the University of Illinois in Chicago, says this study shows that "we need to deliver babies as close to 39 weeks as possible."

She says she was surprised to learn that “when babies were born at 34 weeks, the risk of respiratory distress syndrome increased 40 times.  Hibbard says even at 37 weeks the risk was still 3 times higher compared with a baby born at 39 or 40 weeks, which is considered to be full term.

Respiratory distress syndrome is a serious breathing problem more common in preemies, which often requires babies to be resuscitated in the delivery room.  According to the study published Tuesday in the Journal of the American Medical Association (JAMA), 9 percent of the late preterm babies had respiratory illness.  Hibbard says many of these babies had to be admitted to the neonatal intensive care unit, which brings along more problems including newborns being separated from the mothers; moms may not be able to breastfeed, leading to feeding difficulties for the baby; and preemies can have difficulty controlling their body temperatures.

According to the March of Dimes, premature babies also face other risks, including bleeding on the brain and vision problems, mental retardation and cerebral palsy.  The Centers for Disease Control and Prevention says prematurity is the leading cause of deaths among newborns.

Researchers studied electronic medical records from nearly 240,000 births at 12 medical institutions, which included a total of 19 hospitals, from across the United States.

Nearly 20,000 of those babies or 9.1 percent were late preterm births, which means babies were delivered between 34 weeks and 37 weeks of pregnancy.   This new research confirms data from the National Institutes of Health, which says 8 to 10 percent of all babies are born premature in the U.S.

The study  suggests that doctors are sometimes pressured to deliver babies early by inducing labor or Caesarean deliveries.  It cites a recent study that found 23 percent if late preterm births occur without a medical reason.  Hibbard says "it’s important for us obstetricians to start to decrease the trend for more and more preterm births."

Dr. William Barth, an OB-GYN in Boston, Massachusetts, and chairman of the Committee on Obstetric Practice for the American College of Obstetricians and Gynecologists says this new study is the largest to confirm what’s been known about the risks of preterm births.  But he believes the increase in late preterm births may be attributed to a reduction in stillbirths.

He says in 1990, the number of stillbirths was 4.5 in 1000 deliveries - since then the number has gone down to 3 in 1000 births.  “By far and way, the increase in late preterm births has been due to medically indicated births, not elective preterm births.  He says that’s an important tradeoff.

soundoff (32 Responses)
  1. mentat

    And this is news ... how? Seems like we've known for decades that premature birth leads to increased risk of lung disease. The revelation that "we need to deliver babies as close to 39 weeks as possible." is reported as new and exciting news ... What a dumb article.

    July 27, 2010 at 20:49 | Report abuse | Reply
    • aviekins

      this is news because the mentality throughout the American reproductive community has become "37 weeks is term", with many physicians believing that at that magic point, a baby is suddenly ready for life outside the uterus. similarly, expectant mothers who are miserably awaiting their babies (i've been there!) await that same point when their babies will be 'ready', and then often clamor for induction (or if nothing else, watch their bodies anxiously for any sign of impending labor since it 'could be any day now'). in reality, normal human pregnancy lasts an average of 37-42 completed weeks and should be allowed to last that long, without intervention unless medically necessary.

      the point of this article, if i'm not mistaking, is to highlight to large number of late-preterm babies that suffer from respiratory distress – babies that are often born due to induction or c/s that may be preventable. evidence that harm is truly being done to this population *may* be enough to effect a change... but i won't hold my breath.

      July 27, 2010 at 21:05 | Report abuse |
    • Rob

      This is news because some of us were premie babies. In fact I was very premature as were my brother and sister who both died young, sister at 10mo. and my brother at 28yrs. old, both of lung disease. Just because it isn't about you doesn't mean it's not news. Nobody is forcing you to read the article....

      July 28, 2010 at 11:11 | Report abuse |
  2. JAB

    I can attest, having delivered 31.5 week twins, that all those difficulties listed above are possible. We experienced those and many more. However, I am disappointed in the reference to breastfeeding. IT IS POSSIBLE. I pumped and when they could take it they did. It took tremendous effort and a supportive husband, but it is totally possible if that is what you want to do. Many nurses and docs just do not have the time or patience to help a new mother out and often there are more serious concerns from their perspective. But providing breast milk is one of the things a mother CAN do in an otherwise overwhelming situation of having a premature birth. I breast fed BOTH for a year. You don't have to, but you CAN do it if that is what you planned on. Don't let anyone tell you you can't. Keep asking for help and the right person will eventually come along.

    July 27, 2010 at 21:29 | Report abuse | Reply
    • Krystle

      Good for you for making it so far with breastfeeding – especially with the NICU. How inspirational, it's great to hear success stories and you deserve A LOT of praise for making it!

      July 28, 2010 at 09:20 | Report abuse |
    • jp

      My wife gave birth to our twin girls at 35 wks...she had an otherwise uneventful pregnancy...however, he Dr. thank goodness had the forethought and knowledge to give her the 2 steroid shots necessary to speed up lung development. Our girls were born at 35 wks and were in the nicu for 2 days only for a bit of jaundice and to regulate temperature. they are now 2.5 years old and have no health problems....these steroid shots are necessary, i would imagine in multiple pregrnancies for the fact that getting to 39-40 wks is probably very very rare.

      July 28, 2010 at 12:23 | Report abuse |
    • Sandra

      I also had twins early (34 wks & 1 day) and they received pumped breastmilk for 1 year. Mine never nursed because of their stay in the NICU. I ended up later (3 months) having to supplement formula because I wasn't making enough breatmilk. I figured some was better than none. The nurses and doctors attributed their reasonably short stay (10 days for my son & 11 days for my daughter) partially due to, they felt, receiving breastmilk. The surgical & NICU teams at my hospital are second to none providing the highest quality of care. My son was born not breathing and had to be resucitated and my daughter started having breathing difficultlies and had to be put on a CPAP. We are truly blessed to have 2 healthy babies that are now 17 months old.

      July 28, 2010 at 13:34 | Report abuse |
    • Cheryl

      I also delivered a premature baby. He was born at 28 weeks. I also breastfed. I had to pump for the first 64 days while he was in the hospital. I did it and was able to to continue breastfeeding until he was 10 months. I only stopped then because I was back and work and not able to produce enough milk. I had wonderful staff at the hospital we were at with lots of support for breastfeeding.

      October 12, 2010 at 15:03 | Report abuse |
  3. WildMontana

    Mentat, unless you've delivered a premature baby, shut the F* up! I had a baby at 32 weeks. However, I was lucky that the chances of her being born before term were known to me at 24 weeks. Intensive steroid therapy (shots daily until the end) help to hasten the maturity of her respiratory system. We were able to save her. The baby I had prior to her was born at 24 weeks and wasn't so lucky.

    I also pumped breast milk religiously. I had enough to feed not only my baby, but enough to donate to the human milk bank in North Carolina.

    July 27, 2010 at 22:33 | Report abuse | Reply
  4. Helene

    I was surprised that, in this article about respiratory problems preemies can have, the use of steroid shots to mature the lungs was not even mentioned. These shots are crucial to speed up development of the lungs if early delivery appears to be imminent. I delivered at 28.5 weeks, and THANKFULLY our baby was on the vent for less than 24 hours and has absolutely no issues with breathing problems or illness (or any other issues- we were extremely blessed). My doctor gave me 2 doses of the steroid shots when I was admitted to the hospital and I really believe this may have saved her life! Medicine has come a long way to help these preemies- too bad it is still lacking in ways to prevent the many things that can cause premature labor.

    July 27, 2010 at 23:59 | Report abuse | Reply
    • Denise

      ok so I dont know how much this will help anyone, but here goes. I was born 24-25 weeks early. I wieghed 1 pound and 10 ounces. I was 11 1/2inches long. My eyes were fused closed, and my ears were fused to my head. I had to have heart surgery because one of the vavles on my heart had not fully developed. I have a long scar on my left shoulder blade. My skin was so frail and thin that the doctors had to tape it closed. My chance of survival was 30%. To this day I am grateful to not have any major health problems. I have bad vision, but thats about it. I stay in an incubater for 96days, when I left the hospital I wasnt even 5lbs. My parents had to dress me in cabbage patch clothes because at that time there wasnt very many prematures born. I hope that with today's technology that many more premature babies are able to survive.

      July 28, 2010 at 02:30 | Report abuse |
  5. Liz

    I hope this doesn't make doctors try to stop a woman's labor if she goes into labor at what they think is 36 weeks. Often, docs miscalculate the due date. I am pregnant and I don't want to be pregnant forever. My original due date was Nov 6 according to my cycle, but now docs are pushing it back to Nov 22! Let nature take its course unless the woman is over five weeks early!

    July 28, 2010 at 06:23 | Report abuse | Reply
    • Liz

      I can't tell you how many of my friends were measuring small and then went on to have normal-sized babies on their original due date!

      July 28, 2010 at 06:24 | Report abuse |
    • BWM

      Liz –

      My water broke unexpectedly when I was 37 weeks pregnant – which was a shock because my pregnancy had been smooth with no signs of preterm labor – and my son experienced significant respiratory distress. He spent 10 days in the NICU and had to have chest tubes and be on a ventilator. The doctors believe he was technically 36 weeks based on his lung development and other factors. Please know that the risks for respiratory distress are still significant even at 36 weeks. My doctor even warned me of this risk before my son was delivered (and when they still thought he was 37 weeks!).

      As a side note, my son will be a year old in two weeks and I am still breastfeeding. It's definitely possible to breastfeed even with a preemie in the NICU!

      July 28, 2010 at 08:58 | Report abuse |
    • Krystle

      Liz, lets hope this is your last pregnancy since it's such a burden for you to deliver on time.

      If your due date was pushed back then you're baby was probably measuring smaller and could benefit from the extra time in utero. Dr's should try to delay labor when it medically benefits the baby, not when Mom is mentally "done" with pregnancy.

      July 28, 2010 at 09:24 | Report abuse |
    • Elaine

      Was your due date changed after your ultrasound? A woman's due date is first calculated according to cycle dates. During the early ultrasound, measurements are made to more accurately estimate the age of the fetus. If your due date changed (as they often do) it is probably because your baby was measuring as younger than indicated by your dates. Cycle dates are notoriously incaccurate. No OB will "change your due date" just because the feel like it! And believe me, you would truly feel terrible if you electively delivered early and your baby ended up in the NICU with IVs and feeding tubes and respiratory assistance. Suck it up and incubate your baby the natural way!

      July 28, 2010 at 12:50 | Report abuse |
  6. Waterfalls

    I agree, let nature take its course unless there is a valid (safety) reason not to...

    July 28, 2010 at 08:08 | Report abuse | Reply
  7. Marg

    I have to agree with Liz and Waterfalls about letting nature take its course. My duedate for my son was also pushed back a week. Then I went into labor naturally at what was now 36.5 weeks with my new due date. It would have been 37.5 weeks with my original due date. Either way, I delivered a perfectly healthy 8 lb boy that needed no intervention. They even did all of the 'premiee tests' because he was before 37 weeks, and he passed with flying colors. I would have been rather mad to have a dr try to stop my labor because I needed to reach some magic 39 week mark!

    I can see intervening if the baby will be born more than 35 weeks early, but between 35 and 42 weeks the baby may really know best if the delivery is a natural start.

    July 28, 2010 at 08:58 | Report abuse | Reply
    • Veggie1970

      Babies come when they are ready. I've run the gamut from delivery within days on either side of my due date, to delivery 17 days late, to delivering 10 weeks early. Agreed what this article presents is not really news to anyone; my preemie spent time in NICU with babies significantly older gestationally than her 30 weeks and in far worse shape. We can, however, hope that some medical professionals and mothers to be will think twice before insisting on induction on the due date (or, as the trend seems to be going, a week or two before). Not only is it best for baby to come when the time is right (in most cases, obviously there are exceptions), but spontaneous labor is typically quicker and easier because an unripened cervix does not have to be forced open.

      July 28, 2010 at 09:30 | Report abuse |
    • Veggie1970

      Marg, I would disagree that no intervention should be taken with a 35 weeker. There are significant risks. 37 weeks is considered full term; anything before that calls for measures to be considered and taken depending upon the circumstances. To deliver a healthy 8 lb. baby before 37 weeks is an exception. I've seen a nearly 10 pound 36 weeker spend weeks on a ventilator.

      July 28, 2010 at 09:33 | Report abuse |
    • Marg

      Veggie–I'm not sure I believe that three is anything magic about 37 weeks. Babies come when they are ready. Not only that, but doctors are only estimating those due dates in some cases. Mine was one date based on my cycle, then another based on my ultrasound. I am generally skeptical about any date regardless. I also think that you need to take the individual family history into account. After I had my son my grandmother commented that I should have expected to deliver around 37-38 weeks since all 5 of her healthy babies were born around then.

      July 28, 2010 at 09:55 | Report abuse |
    • Elaine

      Technically any baby born BEFORE 38 weeks is preterm. 38-42 weeks is the medical definition of a term infant. Even a baby born at 37 weeks and 6 days is still considered preterm.

      July 28, 2010 at 12:54 | Report abuse |
    • Kirstyloo

      There are tests that they can do to assess lung maturity. This would be appropriate in this age group. If the lungs are not mature, it would be very appropriate to try to stop it. That being said, I don't think that this is the point of the article. It is about changing the mind set that 36, 37 or even 38 weeks is really "term" or equivalent to 39 or 40 weeks. Because people think that 37 weeks is term (which it techinically is), it encourages people to intentially deliver then.

      I had a breech baby last year, and I knew that I was going to need a C-section. My OB scheduled it for 39 weeks not one day earlier because of this information. Other mothers that I spoke to during that time were often scheduled for their C-section at 38 weeks or sometimes 37 weeks because they were "term." The mothers thought that this was great because they didn't know about this data and the small but real risk to their babies.

      July 28, 2010 at 12:58 | Report abuse |
  8. Amanda

    I was born at 27 weeks, (in 1980, mind you,) and deal with a degree of bronchitis, however it doesn't affect my day-to-day living. I also have HORRIBLE vision, but for the most part, I'm relatively normal! Just want to let you all know that humans can be very strong, mothers and babies included.

    July 28, 2010 at 09:58 | Report abuse | Reply
  9. Rose

    All the more reason to be in best possible shape before you get pregnant. Then, maintaining a very healthy lifestyle while
    pregnant. Thankfully, I did this because my son was delivered at 29 weeks and was/is (30 years old now) very healthy.
    He weighed 4lbs. 16 inches tall, spent 29 days in Neonatal but otherwise fine. While it was a bit difficult, I breastfed,
    using pump for first few weeks. After he got out of hospital, I continued to breastfeed for first year. Several years later,
    delivered another premie – 31 weeks, for a completely different reason than the first. She weighed in at 5lbs. and left hospital w/me after 7 days because she had no health issues. Again, I pumped breast milk for first few days then continued when she was able to nurse on her own. We were truly blessed and I thank God every day, but I feel strongly
    that maintaining healthy lifestyle before pregnancy, during pregnancy and nursing played important roles in both their ultimate good health.

    July 28, 2010 at 10:34 | Report abuse | Reply
  10. Miss Me

    My grandchild was born at 28 weeks in St. Mary's Hospital in St. Louis, Missouri (a hospital which takes its Mission Statement seriously – and may the grace of God be bountiful to each and every person on staff in the NICU and ICU/L&D). My granddaughter weighed 2 lbs. 2 oz. Thanks to the pre-delivery care, Surfactant, and the most dedicated group of healthcare professionals I have ever met in my life, my granddaughter never had to be intubated during the 6 weeks she lived in the NICU. Today she is 14 months old, just started walking, trying to talk and – on rare occasions – wheezing in this oppressive heat and humidity.

    To all expectant mothers – I encourage you to educate yourself on the delicacy and training required for a newborn requiring intubation. Know your doctor's qualifications; know whether the hospital you plan to deliver in has Surfactant ready and whether they have a qualified intubation specialist on staff around the clock. If we hadn't known the right questions to ask, the well-meaning people of the little country E.R. we started in, might not have called Air-Evac (God bless those wonderful people also) and its very likely that we would be facing a much different situation today.

    There are no stupid questions when it comes to the health and care of your child – or your grandchild 🙂

    July 28, 2010 at 11:31 | Report abuse | Reply
  11. SAM

    Cant blame that on SMOKIERS...........

    July 28, 2010 at 11:41 | Report abuse | Reply
  12. S Criner

    Just to reiterate what others have said – my son was born at 36 weeks and 1 day. He weighed 6 lbs 11 oz and was 19 in long and STILL had under-developed lungs. He spent a week in the NICU – and it is extremely emotionally trying on all involved. The bonding doesn't take place as quickly, and there is clear "seperation anxiety" when you leave your baby for hours at a time. Lucky for us, now at 3 he is in the 90th percentile in height, the 50th or so for weight, and has never had real problems with his health.

    July 28, 2010 at 12:33 | Report abuse | Reply
  13. Amiee

    I find it strange that there was no mention of steroid shots or in the great advancements over time in the care of preemies. Much has improved since the 80's when I was born at 6 months. Also the difference in development between boys and girls as far as lungs go. I am fine and healthy while my twin didn't live past two days. It is important for parents to know the risks and to try to carry their child as full term as possible, however, I would like to see an article detailing the challenges and how parents and preemies overcame them.

    July 28, 2010 at 12:39 | Report abuse | Reply
  14. Kathleen

    I had a 36 week baby who spent a week in the NICU. While he did not need a breathing machine, his breathing was very rapid and it took a few days for him to breath normally. His main problem was eating. He would fall asleep at breast or bottle without eating anywhere near what he needed. They had to gavage him in order to get him nutrients. He's now a healthy 4 month old in the 50th percentile for weight but it really drove home for me that a 36 week baby is a preemie and not ready to be in the world. I had developed preeclampsia at 34 weeks and when my symptoms got worse during 2 weeks of strict bedrest they decided he had to be born or we would both die. He was 5 lbs 2 oz at birth.

    July 30, 2010 at 16:10 | Report abuse | Reply
  15. pagingdrgupta.blogs.cnn.com

    Even later preemies face respiratory risks.. Great! 🙂

    April 17, 2011 at 13:36 | Report abuse | Reply
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