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PROFILE: KDMC study focuses attention on prematurity

ASHLAND, Ky. — Kentucky is facing a growing problem — unborn babies aren’t growing enough. In fact, one in every seven babies born in the Bluegrass is pre-term.

Not surprisingly, the March of Dimes gave the Commonwealth an “F” on its 2008 national report card for its burgeoning rates of premature birth and low birth weight babies — as it topped the scales, with 46th and 39th national rankings respectively.

The stats speak

Preterm birth is the top cause of newborn death, leading to lifelong problems like heart disease, diabetes and hypertension. Kentucky youth advocates say low birth weight and preterm babies are 28 percent more likely to die and 34 percent more likely to dropout of high school.

It costs the nation a whopping $26 billion annually.

But, unbelievably, 62 percent of expectant Kentucky moms surveyed said they didn’t believe late preterm birth was a serious problem.

Baby steps

In 2007, Ashland’s King’s Daughters Medical Center stepped up for babies, entering into a three-year cooperative focus study with two other Kentucky hospitals, with high hopes of making a difference for babies, ending prematurity.

Hand-in-hand with March of Dimes, the Kentucky Division of Maternal and Child Health and Johnson & Johnson Co., health care providers like doctors, nurses, hospital administrators, patients and the community joined forces to educate and make folks understand prematurity, explained Julie Terry, in KDMC’s marketing/PR department.

Amanda Preston understood the timeliness of the program. As a KDMC neonatal intensive care nurse, she saw infants born right around 34 to 38 gestational weeks. Dubbed as “late preterm”births, the babies were quickly filling the unit.

“I think those were the sickest kids I saw daily,” added the KDMC director of women’s health. “Their lungs just weren’t ready. When a lot of people think of prematurity, they imagine the tiniest babies being born around 23 to 24 weeks. But, really, the sheer volume is born just a little too early. It puts a real financial strain on health care.”

Women she witnessed delivering late preterm babies “run the gamut,” spanning all financial and educational backgrounds from young moms, to women with high blood pressure, to moms who abused drugs and alcohol.

“For every week below 38 weeks, the risk of the baby having problems doubles,” Preston said. “It’s a very serious problem for a baby to be born even a few weeks early.”

The “Healthy Babies are Worth the Wait” program enabled Preston to reach out to women early-on in their pregnancies.

By intervening right after their initial obstetrician checkup around 12 weeks, moms have an educator beside them through the pregnancy answering questions, serving as a sounding board.

When expectant mothers arrive at KDMC for pre-admission testing for the pregnancy in the early days, the HBWW team is already geared up, ready to speak to the women about expectations, Preston elaborated.

Talking points include baby’s brain development — a premature baby’s brain doesn’t develop adequately, inhibiting skills through life; the potential impact of smoking and abusing drugs during pregnancy; the importance of going to every doctor’s appointment, and seeing the dentist throughout the nine-months, because any inflammation, including a mild case of gum disease or a hangnail, just might send a mom into preterm labor.

“We are making people understand just how pregnancy should be done,” Preston touted. “Being only one in three hospitals participating in the entire setting, we’re pacesetting — setting an example for federal quality guidelines on how to do it right.”

A first-time mommy, Preston practices all she preaches. As a NICU nurse, she has seen many happy baby birthdays. KDMC welcomes an average of 1,600 infants yearly — around 130 to 150 monthly.

But, when her baby Grace arrived 3 1/2-years-ago, it was equally important to Preston to carry her bundle of joy to the gestational finish line. Predicted to be a large baby, her physician scheduled her C-section right at 39 1/2 weeks, considered a full-term pregnancy.

But, little Grace made a surprise appearance, three-days earlier than the planned C-section, when Preston’s water broke in a local restaurant.

“Still, she was born term — right at 39 1/2 weeks,” Preston laughed. “She knew it had to be that way.”

Infant upturns

Since the “Healthy Babies” initiative kick-off, KDMC greeted national and state prematurity experts from as far as California and North Carolina who spoke to case workers, doctors, health department leaders, community agency representatives, and anyone in the medical center who wanted to learn more.

It’s all about putting everyone on the same page, Preston said.

“We are always working to get the word out, keeping our stamina while shifting the practice in the community, and changing the way it was done in the past.”

From a happy birth experience, individualized nurse care, visits from internationally-certified lactation consultants who help with breast feeding, taking home baby in a brand-new and free infant car seat, to follow-up visits with a pediatrician, KDMC is going the distance for moms, dads and babies, Preston pointed out.

It’s working. As the monetary grant ended Dec. 31, numbers are already being tallied with official findings to be released later this year. Initially, over the past three years, KDMC reported a four percent decline in late preterm births — between 34 to 38 weeks gestation.

Lower numbers of babies were admitted to NICU and babies were generally healthier, Preston totted up.

Preston credits the improvement to cooperation from parents, physicians and nursing staff as they educate about the risks of “late preterm” deliveries.

“Even though the program has ended, it’s my personal goal to continue to keep monitoring,” Preston finalized.

Doctor involvement

Dr. Richard Ford was one of the first local obstetricians to join the prevention team as a primary investigator of the prematurity dilemma, with five physicians involved currently, Preston said.

Concerned, Ford was happy to do it, talking to his colleagues, urging the importance of carrying babies to term. Those conversations were the first milestone in the program’s success, getting everyone on the same page.

“Once everyone had an appreciation of why we want to get folks to 39 weeks then we were able to do an effective job counseling patients of the importance.”

Of course, delivering hundreds of babies annually, Ford understands just how uncomfortable a mom is around her 36th week of pregnancy, when it’s hard to sleep, walk, or even breathe. That’s when she begs to be induced.

“All of us appreciate her discomfort, but we’re trying hard to convince moms that enduring the misery is worth it for the health of her baby. Those few extra weeks will make a difference. … We tell them they don’t want to see their babies in intensive care getting IVs, very sick, right after delivery,” Ford said.

Ultimately, to breakdown this statewide cycle of prematurity, we must become healthier as a community, Ford said.

Obesity, smoking during pregnancy and prescription drug abuse tops the list of local hurdles.

“It leads to early delivery,” he warned. “We have to fix these everyday problems and be there for them after pregnancy, getting moms to stop smoking, into rehab, becoming healthier for their kids.”

Bringing it to light

Highlighting the HBWW successes, Kentucky Educational Television (KET), produced an original documentary, “A KET Special Report: Born Too Soon in Kentucky,” which aired in early-February.

The documentary examines the high costs of preterm births and community efforts to prevent the issue. Funded in part by the Foundation for a Healthy Kentucky, it was filmed and developed in collaboration with the Kentucky Dept. for Public Health and the March of Dimes, Terry said.

KDMC physicians, caregivers and patients are prominently featured in the production, filmed for several days in August and December last year.

It may be viewed online at www.ket.org.