Preterm Birth and Lifelong Health

November is Prematurity Awareness Month—a month that places a spotlight on the current state of maternal and infant health in the United States and globally.

According to the nonprofit March of Dimes, one in 10 babies is born preterm each year in the U.S. But what does that mean, and why do we need to consider gestation period post-birth?

We sat down with Michelle Kelly, PhD, CRNP, CNE, FAANP, associate professor of nursing at Villanova University's M. Louise Fitzpatrick College of Nursing, to discuss and explain the importance of preterm education for lifelong health.

Q: To begin, what qualifies as preterm birth?

Dr. Kelly: A full-term pregnancy lasts 40 weeks. Infants born before the completion of 37 weeks of gestation are preterm. And there are levels of prematurity:

• Extremely preterm: Infants born before the completion of 25 weeks of gestation.

• Very preterm: Infants born before the completion of 32 weeks of gestation.

• Moderately preterm: Infants born between 32-34 weeks of gestation.

• Late preterm: Infants born between 34-36 weeks of gestation.

Q: Why do health practitioners need to be aware of gestation history?

DK: Understanding the potential long-term physical and mental health implications is essential to mitigating the risks. Clinicians cannot change the reality that someone was born early. However, clinicians can utilize that information in treatment decisions. Instituting treatment or therapies early can help minimize the expression of that risk and improve future health.

Q: What are the health risks for children born prematurely?

DK: The earlier an infant is born, the greater the risk to their overall health and development. And while it is much better to be born at 35 weeks instead of 25 weeks, it does not mean that those born closer to term escape all risks.

During infancy and childhood, a preterm birth can cause difficulty with breathing, feeding, gaining weight appropriately and achieving important developmental milestones. Research suggests that children and adolescents born at any level of prematurity are at risk for challenges in school, conditions that require physical or behavioral therapy as well as conditions typically associated with immature body systems, such as respiratory issues like asthma. Additionally, long-term follow-up studies indicate that risk continues into adolescence and adulthood.

Q: What are some long-term issues that stem from being born preterm?

DK: Adolescents and adults born preterm continue to be at risk for reduced lung function, wheezing and asthma. Research findings suggest that there are also cardiovascular risks, particularly an increased incidence of hypertension (high blood pressure). Additionally, an increased incidence of mental health conditions, specifically anxiety and depression, are associated with preterm birth. All these increased risks are modifiable with early recognition and treatment.

Q: What recent research has been conducted and what strides have been made to improve the lives of those born preterm? Is the prognosis for those born preterm positive?

DK: Today's NICU environment is vastly different from the NICU of the past. Premature babies born in the last 20 years have survival rates that exceed 95 percent for all but the earliest of gestational ages. Increased attention to developmentally supportive care, breastfeeding, kangaroo care and the recognized importance of family presence in the NICU is now the standard of care.

Research and advocacy aimed at supporting families touched by prematurity and raising awareness of healthcare providers and K-12 educators are gaining international attention. While being born preterm presents lifelong risks, identifying and communicating one's status with health practitioners early and often allows for effective treatment and positive outcomes.