Improving the treatment of premature babies

For many years the March of Dimes has funded research aimed at improving the treatment of premature infants. Grantees have contributed to the medical advances that have greatly improved the chances of survival for even the smallest babies. However, premature birth remains a leading cause of infant death all over the world. Some survivors face lifelong health problems, including learning disabilities, cerebral palsy, blindness, hearing loss and other chronic conditions. Today's grantees continue to improve upon successful treatments and develop new ones to save even more premature babies and give them a healthier future.

Premature babies are at risk of many serious medical complications. One of the most common of these is respiratory distress syndrome (RDS). Babies with RDS struggle to breathe because their immature lungs do not produce enough surfactant, a protein that keeps small air sacs in the lungs from collapsing. March of Dimes grantees helped develop surfactant therapy, which was introduced in 1990. Since then, deaths from RDS have been reduced by two-thirds.

Although surfactant treatment was a major breakthrough, March of Dimes grantees continue to improve it. About 20 percent of babies with RDS do not respond to surfactant treatment. Natural surfactant contains four known proteins, called SP-A, SP-B, SP-C and SP-D, but surfactant treatments contain only SP-B and SP-C. Grantee Ka Yee Christina Lee, PhD, of the University of Chicago is studying the structure and function of SP-B in order to design an improved synthetic surfactant that can mimic the activity of the natural protein and be effective when the one currently available fails. Along with surfactant, many babies with RDS receive additional oxygen and mechanical breathing assistance. These treatments, though lifesaving, can contribute to lung injury and a chronic breathing problem called bronchopulmonary dysplasia (BPD). Up to 50 percent of the smallest survivors (under about 2 pounds) develop BPD. Machiko Ikegami, MD, PhD, of the University of Cincinnati, is investigating whether adding SP-D to commercial surfactant treatments will help prevent BPD. This surfactant protein appears to help the immune system fight off lung infections and may help prevent the inflammation that contributes to lung injuries.

Lifesaving oxygen treatment unfortunately contributes to retinopathy of prematurity (ROP), a leading cause of blindness in premature babies. It results from abnormal growth of blood vessels in the retina. March of Dimes grantees are seeking to find out how too much oxygen triggers this response. The retina is the delicate light-sensing tissue that lines the back of the eye and sends messages to the brain. In severe ROP, the retina may detach from the back of the eye, resulting in loss of vision. As many as 16,000 premature babies in the United States develop some degree of ROP each year. The smallest babies, those born at less than 32 weeks gestation, are at the highest risk.

Laser and other treatments can sometimes help preserve vision in babies with severe ROP. Grantee Guo-Hua Fong, PhD, at the University of Connecticut Health Center in Farmington, is seeking to find out whether a specific gene becomes overly active when there are high levels of oxygen, possibly triggering the abnormal growth of blood vessels in the eye. If so, it may be possible to develop preventive treatment by inactivating this gene. The outlook for premature babies has improved greatly. However, many of these babies face serious complications and lasting disabilities. Many March of Dimes grantees seek new ways to improve the care of these tiny babies, and others strive to prevent premature delivery.

Most common questions

Is premature birth a serious health problem?

Yes. Premature babies are at increased risk of newborn health complications, including breathing and intestinal problems and bleeding in the brain. They also are at increased risk of death and lasting disabilities, including intellectual disabilities, behavioral problems, cerebral palsy and vision and hearing loss.

What is late-preterm birth?

Late-preterm birth refers to babies born between 34 and 36 weeks of pregnancy. More than 70 percent of premature babies are born at this time. While these babies are usually healthier than babies born earlier, they are 3 times more likely to die in the first year of life than full-term infants. They also are at increased risk of newborn health problems, including breathing and feeding problems. Some late-preterm births result from early induction of labor or cesarean delivery due to pregnancy complications. However, in some cases, early delivery may occur without good medical justification. Unless there are medical problems, women should wait until at least 39 weeks to schedule an induced labor or c-section to prevent possible prematurity-related problems in their babies.

Which women are at greatest risk for premature birth?

Three groups of women are at greatest risk. These include women who have had a previous premature birth, women who are pregnant with twins or more, and women with certain abnormalities of the uterus and cervix. Treatment during pregnancy with the hormone progesterone can help reduce the risk of another premature birth in some women who have had a previous premature birth. These women should discuss with their health care provider whether this treatment is right for them.

©2013 March of Dimes Foundation. The March of Dimes is a non-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).