The Scholtens: November 2011

Happy 1/2 Birthday to Peter!

Peter had his 6 month checkup yesterday and the doctor said (and I quote) . . . "he's just perfect" We, of course, agree . . . but, it is nice to get validation from a medical professional :) Peter now weighs 13 lbs, 6 oz and is 24 1/2" tall. He is still not quite on the growth charts for his actual age, except for head circumference (yay for the 2nd percentile!). What can I say? The kid has a big noggin! On the preemie growth chart (which he will be assessed on until he is 2) he is in the 55th percentile for weight, 95th percentile for length and 98th percentile for head circumference. Peter also had his follow-up appointment with Early On this past week. For the most part he is meeting milestones that a 7 month old should be attaining (except for rolling over - which he can do, he just won't . . . . we know this because we put him down for a nap on his back/tummy and return to find him on the opposite side . . . . he's just stubborn!) OK, that's enough rambling about our magnificent little man . . .

We woke up early this morning to make our first road trip with Peter . . . we drove to Watseka (Mommy's hometown). We'll be here for the Thanksgiving holiday . . . we surprised Grandma & Grandpa a day early . . . needless to say, they were pleased . . . more pictures from Peter's first adventure later this week!

Peter LOVES to stand up . . . he can stand while just holding our fingers . . . and, he is starting to figure out the motion of walking . . .

Fun Times!

Did you know that November is Prematurity Awareness Month? Me neither! However, in honor of our sweet little Peter, I thought I would share some interesting statistics related to prematurity

1) 1 in 8 babies in the US are born premature (before 37 weeks of completed gestation); that’s 543,000 babies per year.

2) At 25%, premature birth is the number one cause of neonatal mortality in the US.

3) The rate of premature birth increased by more than 20 percent between 1990 and 2006. This increase is directly related to increased use of invasive fertility treatments.

4) The average first-year medical costs, including both inpatient and outpatient care, are about 10 times greater for preterm infants than for full-term infants.

5) Although we have identified many risk factors associated with premature births, nearly 40 percent of these births have no known cause.

6) Risk factors for premature birth include maternal hormone imbalance, structural abnormality of the uterus, chronic illness, infection, and unhealthy lifestyle choices. Preterm delivery is also more likely when a woman is over age 35, under age 19, or is carrying multiple fetuses. In my case, Peter’s early arrival was due to pre-eclampsia and a blood clot on my barely functioning placenta.

7) Half of all neurological disabilities in children are related to premature birth.

8. Due to many recent advances, more than 90% of premature babies who weigh 800 grams or more (a little less than 2 pounds) survive. Those who weigh more than 500 grams (a little more than 1 pound) have a 40% to 50% chance of survival, although their chances of complications are greater. Peter weighed 1188 grams or 2 lbs, 9 oz.

9) The earliest preemie to ever survive was born at 21 weeks, 6 days gestation. The smallest preemie to ever survive was born weighing 9.1 oz.

10) Famous preemies include Albert Einstein, Mark Twain, Sir Winston Churchill, Victor Hugo, Napoleon Bonaparte, and Isaac Newton.

11) Patent ductus arteriosus (PDA): A heart problem that is common in premature babies. Untreated, it can lead to heart failure. Basically, there is an opening between valves that allows for nutrition to reach the baby. The valve needs to close shortly after birth and normally does. However, in some babies, the valve stays open. This was Peter's case. Luckily, he was treated with a drug that helped the valve to close. There are no long term effects of PDA.

12) Low blood pressure is a relatively common complication that may occur shortly after birth. It can be due to infection, blood loss, fluid loss, or medications given to the mother before delivery. Low blood pressure is treated by increasing fluid intake or prescribing medications. Peter received one blood transfusion when he was less than a week old to treat his low blood pressure.

13) Intraventricular hemmorhage (IVH): Bleeding into the brain’s ventricular system. This type of hemorrhage that is particularly common in premature and very low birth weight infants and can cause pressure in the brain and brain damage. We were so thankful the day we found out that Peter's head ultrasound came back clear, no bleeding in the brain.

14) Retinopathy of prematurity (ROP): Abnormal blood vessel development in the retina of the eye in a premature infant. In severe cases, such as that of Stevie Wonder, scarring and retina detachment cause vision loss. Peter had multiple eye exams while in the NICU, all resulting in a diagnosis of "Immature" . . . as he was not yet supposed to be in this world, immature was the diagnosis we were looking for. He has no eye issues.

15) A baby’s suck reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Therefore, infants born earlier than 34 weeks gestation usually require a feeding tube to meet their nutritional requirements. Peter was not introduced to breast or bottle until he was 5 weeks old.

16) The transfer of maternal IgG antibodies to the fetus predominantly occurs after the 30th week of pregnancy. Premature birth interrupts this transfer, leading to lower levels of maternally-transmitted antibody at birth. Peter was born in the 30th week of pregnancy and is therefore much more susceptible to infections than full-term newborns. He had a yeast infection while in the hospital.

17) Infant respiratory distress syndrome (RDS): Caused by developmental insufficiency of surfactant production and structural immaturity in the lungs, RDS is the most common single cause of death in the first month of life of the developed world. I was given glucocorticoids 48 hours before Peter’s birth to help speed his production of surfactant. Peter was given an exogenous surfactant through a breathing tube into his lungs shortly after birth and again 3 days later to mitigate his RDS.

18) Bronchopulmonary dysplasia (BPD) or Chronic Lung Disease (CLD): Characterized by inflammation and scarring in the lungs, BPD is a chronic lung disorder that is most common among children who were born prematurely with low birth weights and who received prolonged mechanical ventilation to treat RDS. Peter developed BPD as he required oxygen assistance well past his due date. This puts him at a significantly increased risk of respiratory challenges. A common cold for a term, health baby his age could put him in the hospital and back on breathing support.

19) Necrotizing enterocolitis (NEC): The death of intestinal tissue. NEC primarily affects premature infants or sick newborns and has a 20-30% mortality rate. Babies born at Peter’s gestation have roughly a 5-10% chance of developing NEC. Peter did not develop NEC.

20) Neonatal hyperbilirubinemia: Newborn jaundice is a condition marked by high levels of bilirubin in the blood. The increased bilirubin cause the infant’s skin and whites of the eyes (sclera) to look yellow. Severe cases can result in brain damage. Peter required a week of phototherapy to treat his jaundice.

21) Because of their large skin surface area relative to their weight, premature babies usually must weigh at least 4 pounds in order to efficiently maintain their body temperature. Peter spent 45 days in an incubator before he was big enough to sleep in a bassinet.

22) Apnea of prematurity: Cessation of breathing by a premature infant that lasts for more than 15 seconds and/or is accompanied by hypoxia (oxygen deprivation) or bradycardia (a heart rate of less than 100 bpm). It occurs in at least 85 percent of infants who are born at less than 34 weeks of gestation. Peter had one apnea episode on his first day of life. He never had a bradycardia episode. This is highly unusual for a baby that required oxygen support as long as he did.

23) Umbilical and inguinal hernias occur more often in premature infants. Inguinal hernias require hernia repair surgery. Umbilical hernias are usually self-resolving.

24) Cerebral palsy (CP): A broad term used to describe a group of chronic “palsies” — disorders that impair control of movement — due to damage to the developing brain. Premature babies are 8 times more likely to develop CP than full-term babies because their immature lungs may be unable to provide sufficient oxygen to the brain.

25) 25-27 weekers spend on average 71 days in the hospital prior to discharge. 28-30 weekers on average spend 39 days. 31-34 weekers, 12 days. 35-38 weekers, 4 days. 39-42 weekers, 3 days. Peter spent 52 days in the NICU, costing our insurance roughly $470,000.

26) More than 70% of premature babies are born between 34 and 36 weeks of gestation. Twelve percent are born between 32-33 weeks, 10% are born between 28-31 weeks, and 6% are born at less than 28 weeks.

27) The average birth weight of singletons is 7 lbs. 5 oz., of twins is 5 lbs. 3 oz., and of triplets is 3 lbs. 11 oz. Peter weighed 2 lbs, 9 oz.

28) Preeclampsia is a pregnancy condition in which hypertension arises in association with protein in the urine. The only known cure is delivery of the placenta. Preeclampsia affects 5-8% of women and 0.42% of all pregnant women need to deliver before 34 weeks because of severe preeclampsia – that’s about 16,800 babies each year in the U.S. Peter was delivered at 30 weeks due, in part to me developing pre-eclampsia.

29) Premature labor can be managed with hydration, bedrest, medications to stop labor (e.g., magnesium sulfate, nifedipine, terbutaline), and medications to help prevent infection (especially in instances of premature preterm rupture of membranes).

30) The body of a mother who delivers early will automatically produce milk that’s specially designed to nourish her premature baby, with extra minerals, fat, and protein. The leukocytes and antibodies in breast milk protect babies from infection.

So, there you are . . . more information than you really wanted? It is for me, too . . . Stay Tuned for an exciting monologue on RSV, its prevention and what that means for our household (I know, your just full of anticipation!