When Baby Arrives Too Soon
A premature birth involves serious risks for an infant, and it can happen to any expectant mother.
Northwestern Lake Forest Hospital (NLFH) welcomed new board-certified neonatologists to its staff this year—physicians who specialize in treating premature or ill infants. Hamida Khan, MD, the neonatology site leader, helps answer questions about their role and what you can do to ensure a healthy pregnancy.
Q: What is the neonatologist’s role at the hospital?
A: A neonatologist is a pediatrician trained to care for ill or premature infants. The specialization requires a three-year fellowship and a three-year residency—so that’s six additional years of training after medical school.
We attend high-risk deliveries and care for sick or premature infants in the hospital, whether it’s a breathing problem, an infection, low birth weight, a congenital defect or other complications keeping the baby from going home. We are hospital-based, meaning that we don’t see patients in private practice; the infants in NLFH’s Special Care Nursery are under our care until they are discharged.
Q: What is a typical day for a neonatologist, and how do you work with the hospitalists from Ann & Robert H. Lurie Children's Hospital of Chicago on staff?
A: We spend the morning doing rounds, caring for the infants in the neonatal intensive care unit (known as the Special Care Nursery at NLFH). We update the pediatrician and parents on the infant’s condition, and then we’re on call 24/7 for high-risk deliveries. We attend the delivery and may admit the infant to the Special Care Nursery.
The physician hospitalists on staff here from Lurie Children's are excellent. They are on call 24/7, and if there is an emergency they can attend a high-risk delivery, along with the nursery’s specially trained nurses, while the neonatologist is called in.
Q: What are the biggest challenges of treating premature or sick infants?
A: It really depends on how premature the infant is. At NLFH, the Level II+ Special Care Nursery allows us to treat babies born as early as 30 weeks (normal gestation is 40 weeks) without transferring to another hospital. These babies are on better footing than infants who are born even earlier. For parents, the challenge is managing the unexpected. There are ups and downs with premature or sick infants. Parents may be excited one day, then discouraged the next. When they go home, some of the infants require specialized care as well as follow-up to monitor any long-term developmental effects.
Q: In the U.S., premature births have increased dramatically since 1980 and costs have topped $27 billion. What are the causes?
A: High rates of premature births are the main reason the U.S. has higher infant mortality than other wealthy nations. But according to the Centers for Disease Control, the rate has declined in the last two years for mothers in most demographic groups—and that’s good news.
Social-economic factors aside, no one knows for certain what causes pre-term labor. It may be an abnormality in the uterus or cervix, a previous pre-term birth or a medical condition like diabetes or preeclampsia. A woman in her 40s who has had infertility treatments may have a higher chance of conceiving multiples, which may end up as pre-term deliveries.
However, age itself is not automatically a risk factor. Infection in the reproductive system is one of the most common causes, and unfortunately most women don’t know when they have an infection.
Q: What can pregnant women do to prevent preterm labor?
A: Take good care of yourself, and stay in contact with your obstetrician. Every woman who is pregnant should get good pre-natal care. Stop any drinking, smoking or drug use. If at any time a patient feels something out of the ordinary, she should contact the obstetrician right away. In some cases, depending on the gestational age of the fetus, mothers may be given medication to slow the process as we try to wait longer. But this kind of intervention has to be done quickly. A woman who waits a few days until she calls or comes in may not have this opportunity.