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Ending Prematurity Is the Best Health Reform There Is

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Tanya could have fit into the palm of my hand. She was seven days old, but born two months too early. Glowing under her incubator's special lighting to prevent jaundice, Tanya was covered in bandages, weighed down by needles, and breathing with the help of a ventilator. Even if she survived her underdeveloped lungs and bacterial infection, she faced the probability of a lifetime of disabilities. The cost of her care as a newborn may exceed $1 million. Her lifetime cost of care could far exceed this amount. The saddest part of this story is that for many cases such as Tanya's, risks of prematurity could be reduced or even prevented.

Unfortunately, Tanya's story is not unique. Every year, more than 500,000 babies are born prematurely, defined as birth before 37 weeks gestation. Shockingly, North America has the second highest rate of preterm birth among the continents.

This week, two critical, but underreported events happened that could have a big impact on preterm birth and the broader health care landscape.

On Tuesday, the Centers for Disease Control and Prevention released a report citing that, for the first time in nearly three decades, the rate of premature birth in the U.S. declined two years in a row, down four percent between 2006 and 2008. Importantly, preterm births declined among ethnic and minority groups that have historically had high rates.

And on the heels of this report, the U.S. House Committee on Energy and Commerce Subcommittee on Health held a hearing to examine the causes and consequences of preterm birth and infant mortality. This was a welcome demonstration of the government's concern about decreasing preterm births, and its understanding of prematurity's broader implications.

While the causes of preterm birth vary, the outcomes are similar. Research shows that preterm birth is the leading cause of infant mortality, with premature babies comprising two-thirds of all infant deaths. It is associated with extremely high rates of lung disease, eye disease, hearing loss, neurological disabilities, developmental delay, and other chronic disease.

In addition to the tragedy of losing our youngest, most vulnerable babies, this problem costs the United States more than $26 billion annually in medical and educational costs and lost productivity. For example, the average cost of an infant admitted to Franklin County neonatal intensive care units is $66,000, but can occasionally exceed $2 million. Children born preterm are more vulnerable to infections, and are more likely to require lifelong medical care, special education services, and constant care. Moreover, mothers who conceive within six months of delivery have a 40 percent chance of delivering the second infant preterm; that rate doubles to 80 percent when the first infant is preterm.

Eighty percent of children who experience chronic illness become adults with life-long health problems, and chronic disease accounts for 75 percent of health care spending in America. Reducing preterm birth is therefore critical to containing overall health care costs.

In fact, prematurity is at the nexus of the systemic changes sought by health reform. Successful efforts to prevent preterm birth involve broader partnerships around overall community health, medical homes built around primary and preventative care, early interventions for at-risk pregnant women, school-based health care, and an increased emphasis on nutrition. And what we learn through these partnerships can dramatically improve the system as a whole.

For example, we brought together central Ohio's four hospital systems - Nationwide Children's Hospital, The Ohio State University Medical Center, OhioHealth and Mount Carmel Health System - along with the Columbus Public Health Department and local government and community organizations, to collaborate on the Ohio Better Birth Outcomes Project (OBBO) in Franklin County. Stretching from urban Columbus to rural Appalachia, our region of Ohio has some of the highest preterm rates in the state.

We developed a comprehensive, community-based strategy to address preterm birth. And our work placed us at the center of the community, leading to partnerships that allowed us to address secondary issues like asthma, childhood obesity, and education. For example, one of the OBBO initiatives pairs low-income, first-time mothers with registered nurses, who help prevent preterm birth and ensure a healthy delivery. But they stay with the family after birth all the way through the child's second birthday, helping the family through the challenges of early parenting. The program has been proven to reduce childhood injuries and improve school readiness.

OBBO has taught us that we can do more than just ensure that little Tanya survives; we can give her parents the tools they need to get her the best possible care, prevent future preterm births, and help their children lead healthier lives. And we can bend the long-term health care cost curve - because early intervention is the key to prevent a skyrocketing price tag.

For most pediatricians I know, improving the lives of children feels less like a job and more like a calling. Some of our most meaningful interventions come when caring for children like Tanya, who are often the most in need. But every single one of us would gladly trade the experience, if we could see far fewer children like Tanya come through our doors. That's not just the work of doctors--that's the work of all of us. Let's work together to build healthier communities that allow all our children to grow, and get the right start in life. In my book, that's the best kind of health reform there is.