Premature birth, when a mother gives birth before the 37th week of pregnancy, is a leading cause of infant mortality and can have significant, long-term health consequences for the newborn infant.

Between the years 2007 and 2014, the rate of premature or “preterm” birth in the United States steadily declined. However, according to recent statistics, the United States’ premature birth rate increased to 9.93 percent of all births in 2017, marking the third year in a row the national premature birth rate has risen. According to research from the Centers for Disease Control and Prevention, premature birth disproportionately affects the children of mothers who are racial or ethnic minorities, with the preterm birth rate among African-American mothers being about 50 percent greater than the rate among white mothers in 2017.

With these rising rates in mind, we asked College of Public health faculty who research preterm birth or treat prematurely born infants to share their perspectives on the phenomenon.

'Progress has stalled, and disparities remain'

Brandie DePaoli Taylor, associate professor in the Department of Epidemiology and Biostatistics

Preterm birth can be triggered by a variety of factors, such as chronic health conditions, stress, or genital infections. But because of inconsistencies in birth records, it is difficult for researchers such as myself to monitor national trends and determine what causes preterm birth in the specific or the aggregate. My own research has found that biological pathways, such as infectious and non-infectious inflammation in maternal blood, as well as locally in the amniotic fluid or placental tissues, are not associated with all preterm births. This emphasizes that many causes can lead to an infant being born too early.

While the causes of preterm birth are still being examined, researchers do know that in developed countries with comparable and reliable data, rates of preterm birth have increased over the past 20 years. The US has had some of the highest rates in the developed world, reaching 12.8 percent in 2006 before decreasing from 2007-2014. Recent data from 2014-2016 shows that progress has stalled and disparities remain, with preterm birth being much more frequent among mothers who are racial or ethnic minorities. Additionally, increasing maternal age, use of fertility treatments, and chronic health conditions may influence trends of preterm birth in developed nations. Interestingly, it is preterm births later in pregnancy, around 36 weeks, that contribute to recent increasing trends.

Better data would enable researchers to identify the causes behind preterm birth, which in turn would improve prevention, development of treatments and clinical management. Further research into the factors at play in the rising preterm birth rate would have a significant impact in ending this troubling trend.

'Early sensory and motor intervention shows promise'

Carole Tucker, associate professor and chair of the Department of Physical Therapy

An estimated one in 10 babies are born early, sometimes months before their expected birth date. For these newborns, preterm birth can mean an increased risk of long-term complications including visual, hearing, and sensory impairments, as well as learning disabilities and motor or movement problems. These impairments may limit the infant's ability to move and interact with the physical and social environments critical for the development of social, cognitive and communication skills.

While the first weeks of life for these tiny ones focus on life-saving care, as their medical condition stabilizes, pediatric physical therapists like myself begin looking towards ensuring prematurely born infants’ future health and development. I work with a gifted team of physical and occupational therapists and the medical care team in the Infant Intensive Care Nursery at Temple Health. Research shows that early identification and treatment may improve long-term outcomes for preterm infants. Therefore, we evaluate those at high risk for movement complications and provide early movement, touch and sensory interventions to "preemies" to promote their tolerance to the sounds, sights and movement experiences as a newborn. This early sensory and motor intervention shows promise to reduce the impact of being born too early on later movement abilities.

'Premature birth is an abrupt separation from the parent'

Amy Lynch, associate professor of instruction in the Department of Rehabilitation Sciences

Adverse Childhood Experiences (ACEs), an incident or series of incidents in which a child suffers trauma, abuse or neglect, have long-term physical and mental health ramifications that last well into adulthood. While premature delivery is not a conventional early ACE, the infant and parents who experience premature delivery experience a significant early trauma together. 

Premature birth is an abrupt separation from the parent. The preterm infant’s vulnerable, immature central nervous system has to navigate the bombardment of adverse sensory experiences, pain, and discomfort while receiving care from numerous providers in the medical environment sustaining their life. Meanwhile, parents experience sudden loss of a pregnancy and full care of their infant, atop emotional and financial stress associated with their newborn in a NICU nursery. Child and parent lose the opportunity to share every single “typical” parent-child interaction that comes with early life: feedings, changing diapers, bathing, “this little piggy”-type infant games, and rocking to sleep. Sharing these occupations is crucial to infant development of trust and relationship through the calm, consistent presence of their parents. Premature birth disrupts this process.

I believe that it is imperative that practitioners consider using a trauma lens when supporting the evolving preemie family system. The lasting impacts of collective trauma do not go away when the child is discharged from the hospital. Outcomes of prematurity can include decreased attention, regulation, and coping skills, which are also common after ACEs. Recognizing this may allow practitioners to approach such behaviors earlier and as opportunities to promote post-traumatic resiliency for both parent and child.