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Born too small … Born too soon

September 3, 2010

by Ahimsa Porter Sumchai, M.D.

“We are only now beginning to understand the lifelong impact that being born too small and too early has on the individuals and their families.” – William Callaghan, M.D., MPH, Acting Chief, Maternal and Infant Health, Centers for Disease Control

Describing this photo of her family, Dr. Sumchai says: “I was 5 years old. We were living in Potrero Hill housing projects at 27 Dakota St.: George Donald Porter, Mildred Porter, Terry Porter and Roger Porter is the baby.”
I was a 5-pound baby with a perfectly round, perfectly bald head at birth, according to my cousin Ellen Shipp. Like many small for gestational age (SGA) and premature infants, my tiny head was not deformed when I passed through the birth canal of my mother, Mildred Porter. I was lucky. I was a healthy baby – but always ended up being one of the smallest pupils in a given classroom … all the way through medical school!

Many babies born too small and too soon are at higher risk for sepsis, pneumonia, hypoglycemia, temperature instability, feeding difficulties, brain damage, seizures and apnea compared to babies born full term.

According to Dr. William Callaghan, the senior scientist of the Centers for Disease Control’s Maternal and Infant Health Branch, in testimony before the congressional subcommittee on health, “The question of why African American mothers are more likely to have a preterm birth, even when socioeconomic and other factors are controlled for, is one of the ‘Holy Grails’ of perinatal medicine.” Many scientists are looking at the role caesarian sections and early induction of labor is having on the rising incidence of preterm births in our countries.

Some of you have heard horror stories about women whose labor was induced because it was in some way convenient for family or health care providers for her to give birth more quickly. The health of the mother and the health of the baby are the only driving considerations in the decision to induce an early labor and delivery.

By now most of you know that African American women have the highest infant mortality rates in Bayview Hunters Point, a statistic that is also borne out in national studies. Recent evidence suggests that infant mortality in Black women is linked to a low incidence of breast feeding. The American Academy of Pediatrics recommends breastfeeding as the best nutritional option for all babies.

The preterm birth rate in the U.S. jumped 20 percent between 1990 and 2006. A July 2010 article in Contemporary Pediatrics reports the 2006 Federal Preemies Act authorized an expansion of federal work to prevent preterm birth. It is up for reauthorization next year. Preemies and SGA infants cost about $26 billion to care for in 2005.

Catherine Spong, M.D., of the National Institute of Child Health and Human Development testified before a recent congressional hearing before the House Committee on Energy and Commerce to promote legislation on preterm birth and infant death. An analysis by the National Center for Health Statistics found that in 2005, 37 percent of all infant deaths can be attributed to preterm risk factors. Preterm infants are at higher risk for Sudden Infant Death Syndrome and have higher rates of neurological and developmental disabilities in childhood.

The rising tide of the AIDS epidemic among African American women has changed the face of child health in the U.S. Twenty years ago pediatric doctors were skilled in caring for children with bacterial infections that are now preventable in the developing world by vaccines. Today, antiretroviral therapy given to HIV infected women during pregnancy and to their infected newborns can help to eliminate mother to child transmission of an infection that in the 1980’s killed most congenitally infected babies by the time they reached age 5. An infection that continues to kill HIV infected children in the developing nations of the world.

The most significant health care disparity we face in the United States and locally in San Francisco’s southeast sector remains the unforgivable rates of infant death seen in the African American community. Under the American Recovery and Reinvestment Act of 2009, health care providers who reduce racial and ethnic health disparities in patients can receive incentive payments for demonstrating meaningful interventions that reduce those disparities.

Under the American Recovery and Reinvestment Act of 2009, health care providers who reduce racial and ethnic health disparities, such as the high rates of infant death in Bayview Hunters Point, can receive incentive payments for demonstrating meaningful interventions that reduce those disparities.

The first step involves the collection of data on race, ethnicity and language using an electronic health record system. Using the electronic health record to evaluate and monitor specific disparities can lead to eliminating differences in health care access and outcomes according to the Health Information Technology Policy Committee.

Bay View Health and Environmental Science Editor Dr. Ahimsa Porter Sumchai can be reached at (415) 835-4763 or asumchai@sfbayview.com.

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