‘Late preterm’ babies are on doctors’ radar

Bill and Marcia Stlaske’s first pangs of fear coincided with her labor pains.

Stlaske, 31, had given birth to two healthy sons, both delivered somewhat early. But their third, Tyler, was on the way nearly a month before his January due date. Doctors tried to stave off delivery but found Stlaske’s amniotic fluid too low.

“They said they had to take him early,” said Marcia Stlaske, a second-grade teacher from Crystal Lake, Ill. “It was terrifying.”

Not long ago, Tyler’s birth on Dec. 30 at 36 weeks’ gestation would have been considered skirting the edge of prematurity, defined as being born before 37 weeks. Doctors would have treated him much like a full-term baby.

But after years of awareness education and clinical studies, medical professionals and parents increasingly consider “late preterm” babies as distinct cases requiring specialized treatment.

Hospitals have launched programs targeting late preterm infants, those born between 34 and 36 weeks’ gestation. And the efforts may be starting to yield improvements, experts say.

Though still statistically rare, health problems -- such as respiratory difficulties, which Tyler developed -- occur far more often in late preterm babies than they do in full-term infants.

In Illinois, the number of late preterm births increased about 18% from 1996 to 2006, to 9.3% of all live births, according to March of Dimes statistics.

But those numbers may be turning around. In 2007, the most recent year for which the March of Dimes has statistics, Illinois’ numbers for late preterm births came in at 9.1%, a slight reduction.

“Doctors have this on their radar, very much so,” said Dr. Faheem Uraizee, director of neonatology at Advocate Good Shepherd Hospital in Barrington, Ill., where Tyler was born. Late preterm birth “has been recognized as a very severe problem. Hopefully the spike that you have seen [in premature births] should stabilize.”

Those hopes are partly pinned to the extensive efforts to draw attention to the issue by organizations such as the March of Dimes. The group has tried for years to increase awareness about the health effects associated with late preterm births.

Dr. Diane Ashton, deputy medical director at the White Plains, N.Y.-based March of Dimes, said that in the last three years, researchers have begun to find more evidence that late preterm babies are at higher risks of breathing problems, jaundice and increases in blood-sugar levels. They’re also more likely to be admitted to intensive care units and to be readmitted, experts say.

At Central DuPage Hospital in Winfield, Ill., all babies born before 35 weeks are admitted to neonatal intensive care, said the unit’s medical director, Dr. Jeffrey Loughead.

That wasn’t the case until about 18 months ago. Before then, he said, the hospital made case-by-case calls on preemies and didn’t necessarily focus more on late preterm infants.

Changes in the last year and a half, Loughead said, were in response to studies indicating that even a full-term baby of 38 weeks’ gestation has double the mortality rate of a 40-week infant.

And when the choice on a delivery date is up to a mother and her doctor, experts now recommend waiting as long as possible. If an obstetrician counsels an antsy mom to hold off, Loughead said, “they’re not being mean or arbitrary.”

In a study in the New England Journal of Medicine in January 2009, researchers found increased likelihood of mortality, respiratory complications and admission to intensive care units in infants born before 39 weeks by elective C-section.

And in a December issue of the Pediatric Infectious Disease Journal, scientists said they’d found that late preterm infants had higher rates of a serious bacterial infection called sepsis.

Scientists aren’t certain what causes premature births, but the March of Dimes said multifetal pregnancies, previous premature deliveries and cervical and uterine abnormalities are known risk factors.

The age of the mother, chronic health problems such as high blood pressure and obesity, and cigarette, drug and alcohol use during pregnancy also might contribute, the organization said.

ggarvey@tribune.com

dtsimmons@tribune.com

Elizabeth Owens-Schiele, a freelance reporter, contributed to this report.