RICHARD WALKER / RWALKER@STARBULLETIN.COM
Madison Charles, who just turned 4, was born prematurely. She and her parents, Yavette and Glenn Charles, recently attended the March of Dimes Hawaii Chapter's Prematurity Summit at Kapiolani Medical Center.
Summit warns of critical
rise in pre-term birthsMarch of Dimes aims to raise
awareness of the national problem
Yavette and Glenn Charles lost their jobs and apartment, often sleeping in their car, as their baby, who was born premature and weighed only 1.69 pounds, fought for survival for six months in the hospital.
The Laie couple described the emotional and economic turmoil they endured during the March of Dimes of Hawaii Chapter's First Annual Prematurity Summit on Tuesday night at Kapiolani Medical Center. Their story brought home the national crisis of an increase in pre-term babies.
Madison Charles was born on Feb. 21, 2000.
Her fourth birthday was celebrated with a big cake during a break at the summit.
"I am sharing this miracle with Kapiolani and the doctors and nurses," Yavette Charles said, noting many were in the summit audience.
"If it wasn't for them, I wouldn't have my miracle with me today."
Dr. Scott Berns, National March of Dimes vice president of chapter programs, said pre-term birth is the nation's No. 1 obstetric challenge. "It's a common problem for everyone."
The March of Dimes began a $75 million, five-year National Prematurity Campaign last year to make the public aware of premature-birth problems and cut the pre-term birth rate by at least 15 percent.
It is the leading cause of neonatal mortality in the first 27 days of life and the second-leading cause of infant deaths in the country, Berns said.
One of many factors in pre-term birth could be the ability with medical advances to save babies that once would not have lived, he said.
Other contributing factors:
>> More births to women 35 and older.
>> More multiple births, substance abuse, infections, increased stress and early deliveries for medical reasons.
Periodontal diseases are another risk factor, said Dr. Mike Rethman, American Academy of Periodontology president, advising pregnant women to get a dental exam and practice good oral hygiene.
Use of drugs and tobacco, physical abuse and amount of household income were among questions asked of Hawaii women in a national Pregnancy Risk Assessment Monitoring System, said Cheryl Prince, U.S. Centers for Disease Control and Prevention epidemiologist at the state Health Department.
The study concluded that risk factors for pre-term delivery are no different here from on the mainland, she said.
Berns noted that lifetime medical expenses for a pre-term baby are about $500,000; the national hospital bill for prematurelow birth weight babies was estimated at $13.6 billion in 2001; and the average charge for a pre-term baby is $75,000 per stay compared with $1,300 for an uncomplicated newborn stay.
"These data just shocked me," he said.
In 2001 in Hawaii, 2,163 babies were born too early (before 37 weeks gestation), representing 12.8 percent of all live births in the state, according to the March of Dimes. The number of pre-term births far outstripped other public health problems, including breast cancer, which averaged 805 cases annually from 1995 to 2000, statistics show.
Hawaii's pre-term birth rate jumped more than 24 percent between 1991 and 2001, to one in eight births from one in 10. Hawaiians, part-Hawaiians and Filipinos have the highest pre-term birth rates, above the state average of 9.5 percent.
Madison Charles was removed by Caesarean section to save her life and that of her mother, who was suffering a life-threatening complication of pre-eclampsia during pregnancy, a condition indicating the placenta may be detaching from the uterus.
The baby was in the neonatal and pediatric intensive care units for almost six months, including 3 1/2 months on a ventilator with a chronic lung disease. Yavette was hospitalized for a week while her blood pressure was stabilized.
Madison has had pneumonia twice, catches colds fairly easily and has some sinus problems but otherwise is as feisty as she was when she was a baby, her mother said. Her speech and writing skills are improving with therapy and a special-needs preschool class.
She has a new sister, Cassie, born Dec. 31, 2002, weighing 6 pounds, 3 ounces. Yavette said precautions were taken to prevent pre-eclampsia, and she had no problems giving birth. Cassie now weighs 25 pounds -- almost as much as her 26-pound, 4-year-old sister.
Madison's biggest developmental delay was in eating, her mother said. She was on a feeding tube for 18 months and just began chewing and eating food about seven months ago, she said. "She would gag and throw up constantly."
Dr. Greigh Hirata, Kapiolani perinatologist who had two sons born prematurely, said risk factors are well known in pre-term cases, but causes are not known for most women.
He described tremendous stress on families with pre-term births, especially for neighbor-island parents separated from families. "It's a social nightmare."
Dr. Sherry Loo, Kapiolani neonatologist, said a "major evolution" has occurred in medical and nursing care for mothers and pre-term babies, but "we're not really curing anything." She said research is the only way to prevent complications.
Dr. Kenneth Ward, chairman of the Department of ObstetricsGynecology, University of Hawaii School of Medicine, said powerful technology being used to tackle other health problems could be applied to the puzzle of pre-term births.
But there is little funding for pregnancy research compared with $2 billion for AIDS research this year, he pointed out. "It's a huge problem and will require huge resources."
Ward has a National Institutes of Health grant for a four-year study of genetic factors and believes pre-term labor genes will be discovered within five years.
"We have a greater opportunity of solving pre-term labor of any medical center in the world, and our population will be the first to get helped," he said.
