Pre-term births account for approximately 12 percent of all deliveries. They are associated with about 85 percent of neonatal deaths and morbidity and cost an estimated $18 billion annually in health care.

John Dagle, MD, PhD, director of neonatal transport for University of Iowa Stead Family Children’s Hospital, talks about these smallest of babies and their care:

What are some of the causes of premature birth?

Although we're still trying to understand what the trigger for normal labor is, a number of well-described causes of preterm delivery have been identified. There are factors related to maternal health, like high blood pressure; there are factors related to the infant's wellbeing, like placental function; and there are a number of environmental factors like smoking, infection, and stress that have been identified.

We're also finding that genetics plays a role in preterm deliveries, so we're currently trying to identify genetic risk factors in that area.

On average, how many premature babies are born at UI Stead Family Children’s Hospital each year?

Approximately 300 to 400 preterm infants are born at the UI Stead Family Children’s Hospitals every year.

What happens when a premature baby is born at another hospital in Iowa?

The primary care provider calls the UI Hospitals & Clinics Call Center and is connected to one of the physicians in the NICU. Information about the premature infant is collected and initial advice is given related to management of the infant's medical issues. Then the neonatal transport team is dispatched by either ground or by air to pick up the infant. The decision to go by ground or air depends on many factors including the infant's condition, the weather, and the distance from the University.

How many premature babies are transferred to UI Stead Family Children’s Hospital each year?

Approximately 100 preterm infants are transported each year from our referring hospitals.

Why is a neonatal transport team important?

A specialized neonatal transport team is extremely important—preterm infants are very fragile, they have very delicate lungs, they can also get very cold very fast in Iowa winters. Because of that, they require extensive stabilization and medical management prior to even placing the infant in the transport vehicle.

This initial stabilization may take a little time, but it's absolutely critical. Even something as simple as placing an IV catheter requires special skills when the baby weighs less than a pound. Careful management of seemingly small issues in these patients can make an enormous difference in their survival.

Who are the members of that team?

We're fortunate to have dedicated neonatal and adult transport nurses along with highly skilled respiratory therapists who form the core of the transport team. In some cases, in which the infant is very ill or requires advanced medical procedures, a staff or fellow physician may also go on the transport.

What happens when the baby first arrives at UI Stead Family Children’s Hospital?

Following arrival, there's a transfer of the infant from the transport equipment to the specialized NICU equipment. Because of the excellent communication within the team while the infant is on the way, we usually have most of the equipment ready to go before the child even arrives.

Equally important, there's a transfer of information from the neonatal transport nurse to the NICU health care team about additional details of the infant's birth and the transport. The baby is then examined and individualized care is initiated.

The neonatal intensive care unit at UI Stead Family Children’s Hospital is a Level 4 NICU. What does that mean?

A Level 4 NICU has a well-trained health care team that participates in the management of critically ill infants every single day. We have specialized facilities and equipment required for the optimal treatment of these infants, and we have a full complement of specialists required to manage any medical or surgical problem that a critically ill infant may encounter.

Do you track outcomes for premature babies cared for at UI Stead Family Children’s Hospital?

Yes we do. After discharge, we follow our preterm infants in two specialty clinics. Infants with significant medical issues are followed in a neonatology clinic. In addition, all preterm infants are eligible to be followed in our high risk clinic, which focuses on proper growth and tracking development of these children.

We also track the outcomes of our patients compared to those in other large Level 4 NICUs; and I'm proud to say we do very well in respect to both survival and medical outcomes compared to other large NICUs around the country.

Does a premature baby have an increased risk for other medical or developmental problems as they grow?

They can, although most of our preterm infants become very happy, healthy, normal children. A fraction of these infants can have significant medical and developmental issues. Extremely preterm infants have an increased risk of respiratory problems, as well as specific learning and behavioral difficulties as they get older. These are the infants we like to follow in our specialty clinic so we can optimize every aspect of their lives.

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