Ahead Of Their Time

(2 of 2)

One of the reasons Kentucky was singled out for special attention is that its rate of preterm births--1 in 7--is one of the highest in the nation. The Chandler Medical Center's is even higher, a stunning 27%. But that's in large part because so many high-risk patients are transported to its state-of-the-art NICU facility, designed to accommodate the most vulnerable newborns. Like many other teaching hospitals, the medical center could be viewed as a victim of its success. But Dr. James Ferguson, chair of the University of Kentucky's department of obstetrics and gynecology and a seasoned professor who flashes a smile when he says things you should pay attention to, sees an opportunity in his hospital's large number of preemies. As part of the March of Dimes project, Chandler has set a goal of reducing late preterm singleton births 15%.

Taking a cue from earlier interventions that singled out one factor or another and failed to make a dent in the problem, the March of Dimes is trying what medical director Dr. Nancy Green calls a "kitchen-sink approach." Much of its focus is on the nuts and bolts of a healthy pregnancy: screening for bacterial infections, watching for signs of domestic violence, discouraging alcohol consumption, encouraging smoking cessation (1 in 4 pregnant women in Kentucky smokes), monitoring weight gain and nutritional intake and, when necessary, giving drugs to prevent preterm labor. Weekly injections of a progesterone-based drug after week 16, for example, can reduce the recurrence of premature births by one-third.

A major emphasis of the new project is on educating the public about the dangers of preterm labor--and reminding physicians that a vacation, for instance, isn't a good-enough reason to schedule an early delivery. The assumption: if mothers knew the real risks of prematurity, they would be less likely to request induced labor or a C-section and would stick out the pregnancy to term.

The project is also focused on the final three weeks of pregnancy, a time when most mothers-to-be assume they are out of the woods. But as Dr. Henrietta Bada, chief of neonatology at the University of Kentucky, explains, those last few weeks in the womb are critical for a newborn's development. The health risks for a baby born at week 35, she says, are more like those of a baby born at week 30 than one born at week 37. "The perception is that a big baby--even if he's premature--is going to act like a term baby. He's not."

Nobody understands those risks better than Zach's parents, Sean and Terri Noble. Terri, 34, suffered from pregnancy-induced high blood pressure, a condition that can often be treated if caught early enough but that in Terri's case led to severe preeclampsia and the emergency C-section that saved her life--and that of her tiny son. His life, she says, "is a miracle." The true miracle, however, might be to keep babies like Zach from being born too soon.