Preemies Grow Up

Next month Danny Schuster will celebrate his 10th birthday. His parents, Carol and Jim, will celebrate his resiliency, his spirit--his life. Born more than three months early, at 1 pound, 15 ounces, Danny entered a world of needles, tubes and sensors. Just after birth, delicate blood vessels leaked in his brain, causing a stroke on his right side and mild cerebral palsy. His undeveloped lungs, still sticky and stiff, worked, but only with the help of medication and a breathing machine. Carol cried when she saw him, so small and fragile in his incubator. He didn't walk until 17 months, then wore a leg brace to stretch his calf muscles. His doctors warned the Schusters that Danny could face chronic problems and would probably never play sports. But with extra help and lots of love, he has triumphed. Today, Danny is a good student, an avid soccer and baseball player, and a happy kid. "He was a miracle baby," says Carol.

Babies are never meant to be born so early. But for a host of reasons, including a rise in infertility treatments and multiple births, they are--and increasingly so. In 1981, preterm babies accounted for 9.4 percent of all births in this country; by 2001, the rate had jumped to 11.9, a 27 percent increase. For decades, the priority was to keep these tiny babies alive outside the womb. Now, thanks to new drugs and better care in the neonatal intensive-care unit, doctors are able to focus on their futures. Research has shown that preemies can face a lifetime of health problems, including blindness, chronic lung disease, cerebral palsy and mental retardation--conditions so vast and costly that the March of Dimes kicked off a $75 million campaign in January to raise awareness about preterm delivery and fund research into how to prevent it. But new studies are also offering some hope. Scientists recently reported that hormone treatments can dramatically reduce premature births in women at risk. And in one of the first long-term aptitude studies, researchers found that preemies aren't necessarily destined for a lifetime of learning problems. "I used to be very pessimistic about the future for these children," says Dr. Maureen Hack, a neonatologist at Rainbow Babies and Children's Hospital in Cleveland and a prominent preemies researcher. "Now I'm a realist. Yes, they have more problems as a group, but a lot of these kids do pretty well."

The new study on learning, published in The Journal of the American Medical Association last month, found that many preemies (born at less than 37 weeks, compared with 40 weeks for full-term babies) defy expectations, dramatically improving their mental capacity as they grow. Researchers followed almost 300 of the smallest babies, including Ryan and Tyler Fitzgerald, half of a team of quads who weighed 11 pounds total. On average, their scores on a picture vocabulary test jumped 11 points between the ages of 3 and 8, compared with a typical 4.5 jump in non-preemies. Even some of their IQ scores, thought to remain constant over a person's lifetime, went up. Many of those considered borderline mentally retarded (an IQ between 70 and 80) at 3 had normal scores --five years later. The improvement points to the brain's ability to recover from injuries connected with premature birth, says lead author Dr. Laura Ment of Yale's School of Medicine. "We were thrilled," she says.

There's no formula for success, but research repeatedly shows that preemies benefit from their environments. In the JAMA study, two-parent families and mothers with more schooling improved the odds for their kids. And where moms were less educated, early intervention services, like speech therapy, helped. Extra attention may even make preemies more resilient. In another study, Hack tracked a group of preemies until they were 20 and found they were less likely than full-term babies to take up risky behaviors such as drinking, drugs and sex. That could reflect doting moms and dads, who watched their newborns struggle to survive. "These children are very special to their parents," says Hack.

The positive findings are a welcome dose of optimism, but they must be weighed against other data and the very real hurdles that persist. Research shows that key parts of preemies' brains are smaller, even eight years after birth. Preemies are more likely to be enrolled in special ed and often have lower IQ scores. In the JAMA study, IQ scores actually dropped in a group of babies who had severe brain bleeds after birth. Some researchers worry that the study may paint too rosy a picture of long-term development. And no matter what the studies show, preemies cost families a lot of money: hospital bills alone can mount to hundreds of thousands of dollars.

The best outcome of all would be to stop the early births altogether. Half have no identifiable cause, and even when the reason is known--multiple babies, drug use, infections--there has been no good antidote. But for a subset of women who have a history of delivering early, there may finally be an answer. In a study sponsored by the National Institute of Child Health and Human Development, weekly injections of a progesterone-type hormone prevented more than one third of preterm births, an exciting early finding for researchers who want to put an end to the anguish.

Taken together, the good news may be starting to turn the tide for preemies. Babies like Paige Martina Lamson, who should still be curled up in the warmth of her mother's womb, are leading the charge. Born three months early, her head the size of an orange, her feet as small as ballpark peanuts, she lies in an incubator at Rainbow, serenaded by the "peekaboo" trills of her parents, Mike and Jill. "She's my mini-baby," says Jill. If all goes as planned, tiny Paige will be big enough to go home in May. The Lamsons say they're ready for the joys and the struggles to come. "We'll be there for her no matter what," says Jill. A future every one of our little ones deserves.

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