The March of Dimes is leading a national effort to bring attention to the issue of premature births this week on Wednesday with the observation of Prematurity Awareness Day. Jonathan Klein, MD, director of the state's most advanced Neonatal Intensive Care Unit, located at University of Iowa Children's Hospital within University of Iowa Hospitals and Clinics, offers these comments:

What special action is University of Iowa Children's Hospital taking to help observe Prematurity Awareness Day?

On Tuesday, November 14, in honor of Prematurity Awareness Day, the UI is going to use pink and blue floodlights to illuminate the gothic tower at University of Iowa Hospitals and Clinics. This is to bring awareness to the silent crisis of more than 500,000 premature babies born every year in the United States. Just to get a concept of how many babies that is, if we took the population of Des Moines, Cedar Rapids, Davenport, and Waterloo and put them together, that would equal how many premature babies are born each year in the United States.

How does that rate compare to other nations?

There certainly are other nations, especially in Western Europe, where they have better access to global medical care, so their incidence of prematurity is much lower than the United States. At the same time, there are other countries that the United States is ahead of in terms of reducing the rate of prematurity. But overall the problem has risen. Twenty years ago the rate of prematurity was about 9 percent of all deliveries and now it's about 12 percent of all deliveries.

What are the factors that lead to premature deliveries?

There are numerous factors responsible for a woman going into premature labor and delivering before 37 weeks gestation. This includes having twins and triplets, which can be related to fertility drugs and in vitro fertilization.

A large cause is due to lack of prenatal care. The problems may include:

• The mother develops pregnancy-induced hypertension
• Cigarette smoking
• Mothers pick up infections
• The membrane ruptures early, allowing infection to occur
• Problems related just to age, with teenagers, on one end and of the spectrum, and women over the age of 40 on the other

You've received research funding from the March of Dimes. What research are you conducting in this area?

The University has embarked on a very large research project primarily headed by. Jeff Murray, MD, and John Dagle, MD, who's working with him. They're looking at genetic factors associated with pre-term labor and trying to figure out why some women, when they're exposed to various factors, undergo pre-term labor and deliver prematurely, and other women sail through pregnancy and never go into premature labor.  

What needs to be done to reduce the rate of premature births?

• Get prenatal care, even before a woman gets pregnant
• Prepare by seeking an obstetrician ahead of time
• Practicing proper nutrition and health, including taking adequate levels of folate
• Avoid cigarette smoking during the pregnancy, and ideally at all times  
• Continue better research to identify what could keep these 500,000 women, out of the four million pregnant women a year, at risk of delivering prematurely

If a baby does arrive early, what should be done to ensure he receives the specialized care needed?

It's important to find a neonatal intensive care unit that has collected all the specialized expertise necessary to care for these very tiny and very fragile babies. Look not only for doctors that specialize in neonatology, but you also want to find the specialized nurses, respiratory therapists, dietitians, pediatric surgeons, pediatric cardiologists, and so forth.

In order to have that you have to have that kind of regionalized and put all the expertise in localized areas, rather than having them spread throughout the state of nation.  

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