October 5, 2007

Study seeks to reduce premature birth risks

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Patricia Temple, M.D.

Study seeks to reduce premature birth risks

Melanie Lutenbacher, Ph.D.

Melanie Lutenbacher, Ph.D.

Babies born very early, like those struggling in the Neonatal Intensive Care Unit, can start out life with severe disadvantages, including serious medical problems and difficulty learning, seeing and hearing.

A Vanderbilt University Medical Center research project, Tennessee connections to Better Birth Outcomes (BBO), is one of many initiatives that incorporates prenatal care — and in this case the extension of the care of children to even before conception — into the mission of the Monroe Carell Jr. Children's Hospital at Vanderbilt.

Patricia Temple, M.D., professor of Pediatrics, and Melanie Lutenbacher, Ph.D., APRN, associate professor of Nursing and Pediatrics, are currently supervising the enrollment of 300 women in the four-year BBO project, funded by a $2.48 million grant from BlueCross BlueShield of Tennessee Health Foundation.

Women are randomized into two groups — half into the System of Care (SOC) group and half who don't receive SOC, but are given routine prenatal care and interviewed 13 times over 20-24 months.

The SOC is based on the best evidence available, combining medical and biobehavioral interventions expected to reduce premature births and delay subsequent pregnancies in women with a history of preterm births.

Women in the SOC group will benefit from usual prenatal care in the clinic alternating with home visits from a nurse-midwife, Lynn Wilkening, C.N.M. The women in this group also benefit from the postpartum component of the project. The Tennessee Nurses for Newborns organization, a home nurse-visiting agency, will follow the mother and her infant for the first 18 months of life. Temple is the medical director of Nurses for Newborns.

Mothers who can enroll in this project have had at least one premature baby, the group at highest risk for a recurrence.

Premature babies are those born prior to 37 weeks. Nationally, Tennessee ranks 48th in infant mortality and 47th in preterm births. In 2003 there were 8,900 births in Davidson County. Of those, 1,000 were premature.

The 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.

“I see babies in the Peds clinic for a visit — they've been in the NICU for three months, they're coming in with an oxygen tank, barely functioning at a 1-month-old level, and they're starting out life with so many disadvantages…we feel like we have an evidence-based strategy that can prevent this,” Temple said.

Lutenbacher said the goal is to help women enrolled in the SOC group to have both a healthier delivery and a better outcome after the pregnancy.

“It's a two-pronged approach: dealing with the current pregnancy, but also trying to help the woman in a larger global way, helping her with her plan for the future.”

Temple said one of the contributors of a premature birth is the mother's health before she gets pregnant. “Anemia, diabetes, hypertension, infections — these all underlie why moms have premature births.”

Lutenbacher said the home visits are beneficial for another reason — giving the provider a birds-eye view of the expectant mother's home situation. “When you see a patient at the clinic, she is putting her best face forward, and you don't always know what their home environment is like.”

Temple said she and Lutenbacher believe the project should help relieve some of the financial strain on the health care system since prenatal home visits can mean fewer preterm infants, fewer prenatal hospitalizations and fewer infant hospitalizations.

When the study is complete, the SOC group will be compared with the group who received no intervention.

“Our expectation is that we'll see a difference in the groups, and that those in the SOC group will have better outcomes,” Lutenbacher said. “At that point, we would have a prototype for a program that can be replicated.”