September 22, 2006

Efforts to reduce preterm birth rate bolstered by grant

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Efforts to reduce preterm birth rate bolstered by grant

Patricia Temple, M.D., center, and Melanie Lutenbacher, Ph.D., right, visit with Kristy Gott and her son, Will, in the NICU.
Photo by Susan Urmy

Patricia Temple, M.D., center, and Melanie Lutenbacher, Ph.D., right, visit with Kristy Gott and her son, Will, in the NICU.
Photo by Susan Urmy

Vanderbilt University Medical Center has received the largest grant ever awarded from the BlueCross BlueShield of Tennessee Health Foundation to study premature births.

The $2.48 million grant will fund the Tennessee Connections to Better Birth Outcomes research project led by Patricia Temple, M.D., professor of Pediatrics, and Melanie Lutenbacher, Ph.D., associate professor of Nursing and Pediatrics.

The four-year project is designed to determine whether the use of prenatal progesterone combined with medical and biobehavioral interventions can prevent premature births and delay subsequent pregnancies in women with a history of preterm births.

Nationally, Tennessee ranks 48th in infant mortality and 47th in preterm births. “We have a critical problem in Tennessee and locally,” said Temple. “Too many infants are dying in the first year of life. It's a tragedy and it is linked to prematurity.

“There are multiple factors that cause prematurity, but our project focuses on reducing the stresses and infections while helping moms with the social issues that are associated with preterm birth.”

Premature babies are those born prior to 37 weeks. In 2003 there were 8,900 births in Davidson County. Of those, 1,000 were premature.

The health challenges and costs of caring for a premature baby can be overwhelming. On average, premature infants stay in Vanderbilt's Neonatal Intensive Care Unit (NICU) 20 days, incurring charges of $94,000 per infant. Stays can range from a few days for closer-to-term infants to several months for more preterm infants.

Tennessee Connections for Better Birth Outcomes plans to enroll 300 mothers over a two-year period with an 18-month follow up. The study will use conventional prenatal medical therapies, alternating regularly scheduled prenatal care between clinic and home nurse visitors, called a System of Care (SOC), and the prenatal administration of progesterone to prevent premature births and reduce health care costs while improving maternal and child health outcomes.

The postpartum component of the SOC model will use the Nurses for Newborns service, a home nurse visiting agency that follows an infant during the first 18 months of life.

Temple is the medical director of the Tennessee Nurses for Newborns organization.

“Our long-term goal is to reduce premature births and create a model of care that could be replicated,” said Lutenbacher.

“With this project we have the opportunity to evaluate the system of care that we have developed. We based our model upon multiple interventions that show promise in preventing prematurity, decreasing health disparities and improving maternal and child health outcomes.

“This is very much a translational research project where we are testing how well scientific findings work in the real world.”

Not only will the project directly assist mothers and infants, projected calculations show it should also relieve some of the financial strain on the health care system.

Temple points out that most of the savings will come from prevention.

“Prenatal obstetrical nurse home visits can mean fewer preterm infants, fewer prenatal hospitalizations and fewer infant re-hospitalizations. In a study from the University of Pennsylvania, this added up to a savings of more than 750 hospital days and a total savings of $2.8 million for 85 mothers.

“For every dollar invested in this program, there is $13 returned. If we can prevent a $250,000 hospital admission for a 24-week old baby and it only costs $5,000 to prevent it, why aren't we doing it? It's not just the hospital costs, but the cost to the education system and the family. There are incredibly longterm, lifelong costs associated with infants born very prematurely.”

Women who agree to enroll in the study will receive either one progesterone shot weekly or a nightly dose vaginally starting after 16 weeks gestation through 36 weeks.

A 2003 National Institutes of Health (NIH) trial showed that the use of progesterone is effective in preventing preterm births.

“We feel that moms who have had previous preterm births need to be aware that progesterone is an effective treatment to reduce their risk,” said Temple. “Mothers who have had premature babies are more motivated to have a healthier baby.”

Temple hopes to begin enrolling patients in January 2007.

“The high incidence of premature births in our state presents both an emotional and financial burden for our community and our health systems,” said Calvin Anderson, vice president of federal and community relations for BlueCross BlueShield of Tennessee. “We trust this grant will make a huge difference.”

The BlueCross BlueShield of Tennessee Health Foundation Inc. (THF) was established in 2003 to promote the philanthropic mission of BlueCross BlueShield of Tennessee. THF awards grants focused on high-impact initiatives across the state which promote healthy lifestyle choices and help control health care costs for Tennesseans.