November is Prematurity Awareness Month. According to March of Dimes, 1-in-10 babies is born preterm each year in the United States. But what does that mean and why do we need to consider gestation period post-birth? Villanova public relations sat down with Michelle M. Kelly, PhD, CRNP, CNE, FAANP, associate professor of Nursing at the M. Louise Fitzpatrick College of Nursing, Villanova University, to discuss and explain the importance of preterm education for lifelong health.
Q. Firstly, what qualifies as preterm birth?
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?
Kelly. 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?
Kelly. 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?
Kelly. 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?
Kelly. 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% 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 life-long risks, identifying and communicating one’s status with health practitioners early and often allows for effective treatment and positive outcomes.
About Michelle M. Kelly, PhD, CRNP, CNE, FAANP: Dr. Kelly is an educator, a neonatal nurse practitioner, and a pediatric nurse practitioner. Her research has focused on long-term outcomes of preterm birth survivors, leading to multiple publications, with recent work coalescing literature and research that supports that preterm birth is a lifelong effect that can be modified with intervention. In "The Influence of preterm birth beyond infancy" published in the Journal of the American Association of Nurse Practitioners in August 2020, she and her co-author call for curriculum and practice standards to advance and include this new body of literature, noting that healthcare providers must recognize the lifelong risk conferred by preterm birth.
About Villanova University: Since 1842, Villanova University’s Augustinian Catholic intellectual tradition has been the cornerstone of an academic community in which students learn to think critically, act compassionately and succeed while serving others. There are more than 10,000 undergraduate, graduate and law students in the University's six colleges—the College of Liberal Arts and Sciences, the Villanova School of Business, the College of Engineering, the M. Louise Fitzpatrick College of Nursing, the College of Professional Studies and the Villanova University Charles Widger School of Law. Ranked among the nation’s top universities, Villanova supports its students’ intellectual growth and prepares them to become ethical leaders who create positive change everywhere life takes them. For more, visit www.villanova.edu
Michelle Kelly, PhD Associate Professor | M. Louise Fitzpatrick College of Nursing
Michelle Kelly, PhD, CRNP, is an expert in children's health, neonatal intensive care, and long-term health effects of premature birth.