Thesis Sounding Board

Black and native americans have high rates of prematurity, I was thinking maybe Susy could learn something which could help make more effective preventative nursing interventions.

Originally posted by llg

Good question ... but how do we know what the appropriate minority is in this population? Perhaps, white women are the minority in this case ... or women over 35 ... or tall women ... whatever.

If the question has never been studied before and Suzy decides to do qualitative study, what rationale would there be to pick one race (and I assume you mean racial minority) over another? She might want to pick one type of pregnant woman (e.g. adolescents ... or women with other children in the home), but there are lots of different sub-categories to consider in this case. There is no reason to believe at this point that race is a more significant factor to this topic than are some of the other factors I have named. In fact, I would bet that whether or not the woman has other small children in the home is more important than race to this topic.

llg

>>>Friday, January 31, 2003

Premature birth rates rising in state, U.S.

Health officials can't pin down the reason for the increase

By CAROL SMITH

SEATTLE POST-INTELLIGENCER REPORTER

Premature births are on the rise in Washington, making them the biggest and most costly obstetrical problem facing the state, doctors said yesterday.

Prematurity is also the leading cause of death among newborns, accounting for 23 percent of deaths in the first month of life.

In this state, preemie births increased 19 percent between 1990 and 2001, but no one is sure why. Nationally, the rates have risen 27 percent since 1981._

The growing number of multiple births caused by fertility treatments and advancing maternal age both play a role, but can't explain the whole increase, said Dr. Gregory Sorensen, director of pediatrics at Swedish Medical Center.

In this state, about 10 percent of all births, or about 7,500 babies a year, are born before 37 weeks gestation, giving Washington the seventh-lowest rate in the nation. Nationwide, 12 percent of births -- about 476,250 babies -- come early.

The state's large Caucasian and Asian American populations contribute to the lower rates, since both groups on average have fewer preterm births, said Rachel Hien, state program director for March of Dimes in Washington. African American and Native American women have the highest rates of premature deliveries. Despite the state's relatively good ranking, however, the number of premature births is on the rise.

"We're still going in the wrong direction," she said.

Many children born prematurely have lifelong medical problems or disabilities, ranging from lung disorders and brain damage to cerebral palsy and blindness, as a result of their early arrival.

"For every miracle baby, there are 100 more (born prematurely) who have a different story," said Joseph Zavaglia, state chairman of the March of Dimes, and father of three babies born prematurely, one of whom died.

Medical care for a preemie can exceed $500,000 over the child's lifetime, said Zavaglia. The average hospital costs before a preemie goes home run around $58,000, more than 10 times that of a normal birth.

That adds up to a staggering $4.7 billion a year, he said.

In Washington, medical care for premature babies exceeds $500 million a year, said Dr. Arthur Maslow, of Pacific Northwest Maternal-Fetal Medicine Clinic in Tacoma. "That's a lot of health care dollars this state can't afford."

The March of Dimes is hoping to reverse that trend by investing in a 5-year, $75 million campaign to increase research into the causes of prematurity, as well as education to prevent it. The organization is drawing attention to the problem in the hopes more women will recognize the signs of premature labor and get help in time to stop it, or at least delay it long enough to buy the baby time.

Babies born at 24 weeks have only a 10 percent shot at survival. By 28 weeks, survival rates increase to 95 percent. About one in four preemies have disabilities.

Petite, blonde and blue-eyed Morgan was born just a day over 25 weeks at 1 pound 9 ounces. Her ears were just flaps of skin, and her eyes were still fused shut, but she fought to survive, enduring surgery to correct a heart valve problem, and brain bleeding. Now 21 months old, she is barely bigger than a six-month old, but she's walking and her parents couldn't be happier.

"In the midst of all the confused emotion, we always had to find something positive," said her mother, Rhonda Thomas, of all the weeks they spent in the hospital watching their daughter develop outside the womb.

"These babies are the most resilient," she said. "They have to be."

Rhonda and her husband, John, count themselves among the lucky ones -- those for whom the outcome appears positive.

The reasons for the increase in preemie birth rates continue to confound doctors.

"They've gone up a half to 1 percent a year, every year for the last two decades," Maslow said.

Half of all premature births have no known cause. Risk factors for premature birth include diabetes, high blood pressure or other chronic disease, smoking, and infections during pregnancy. Very young, or much older moms are also at risk.

Susy I wish you luck no matter what you decide to study, my suggestion was based on my perception of your interests [from reading your health care posts] and my belief nurses can help with the documented higher prematurity and lower birth weights of black and native american women.

hey susy, I know you are joking! we all know the correlation is not strange! With your love of children, experience with at-risk groups and strong belief in preventative care I'm still thinking you could maybe find some effective nsg. interventions or teaching strategies.

I think a lit review would be helpful first. Do any of the topics sound more interesting than the others?

renerian

REading your posts again I am glad I am done with my graduate program......PHEW

renerian