A Month for every Cause

It seems these days it's hard to find a month which isn't awareness month for something, usually they double, triple and quadruple up.

I remember a time when it was unusual to have an awareness month for anything and it really meant something.
Some conditions don't have big international organisations to co-ordinate World blah Day, week or month.
And so they get lost in the wash of Breast Cancer Awareness, things for prostate cancer, even arthritis or blindness. The competition for a ribbon colour has gone crazy as well - different shades of blue for different conditions for instance.

There is one awareness month which largely relies on word of mouth. It doesn't have an international organisation, it doesn't have a snazzy ribbon you can wear with pride, it doesn't sell specially coloured everyday objects in the supermarket to fund raise for research, support or awareness.
I don't know if we even mark it here or if it's much more of an American thing but, in the US at least, November is Prematurity Awareness Month. Unofficially purple has become the colour for prematurity. There isn't a ribbon as such but a number of people have a specially made pendant with a heart shape on it. It's the Preemie Purple Heart. It's not a New Zealand symbolism that we come to easily and is very militaristic. Of course, here in New Zealand we also don't award Purple Hearts as the American military do. They award it for bravery and injuries received.

While it's not our imagery here it's incredibly appropriate.

Prematurity leaves babies fighting for survival.
Prematurity leaves babies fighting way beyond their birth and infancy.
And Prematurity leaves scars, battle wounds if you will.

Sometimes those scars are visible surgical scars, other times it's minute brain damage, tiny changes which play havoc with their development, some times it's the re-wiring of the sensory system or damage to the child's lungs which they carry for ever. None of those can be seen by the naked eye but they are there nonetheless.

Prematurity is a common and wide-ranging issue. The best stats I could find say that globally between 10 -12% of all births are pre-term - that is before 37 completed weeks of pregnancy.
For New Zealand - we're doing better than the global average - we have between 6 - 8 % of all births each year are pre-term. We are also ahead of the pack generally in terms of survival rates as well.
But it has to be remembered that even at the 32 - 34 weeks gestational age the survival rate is around 95%.
Of course that's variable up or down depending on all sorts of things - complications in the pregnancy, size of the baby, complications in delivery and so on. But the fact remains that around 5% of babies born 6-8 weeks early won't come home with their parents.

And the gestational age where we've seeing the biggest rise in premature births is the 32 - 36 weeker bracket.

There's a lot of evidence and information out there about the battles, disabilities and difficulties micro and even a little later prem babies have. It's not been interesting enough until relatively recently to research the effects of prematurity on moderately and late pre-term babies.

We were all told to take them home and treat them like a full termer, catch up by 2 years old, no lasting effects and so on.

The evidence is mounting that no prematurity is really benign - some kids are simply lucky. Some of those 'lucky' kids actually have damage they simply managed to function round and no one would know it was there until tests were done for some completely different reason.

But here are some stats I've found on the 32 - 36 weeker cohort. Much of this has come from research done in the last few years at National Women's Hospital in Auckland so it's pretty up to date - and New Zealand relevant.

If you are new to the prem baby/child game then think first before you read this.
If you have a late pre-term baby/child think how you are placed first before reading this.
If all you know about prem babies is that they are cute miniatures of full term babies (as I did, once a blissful moon ago) then please do read on!
Prematurity is not an excuse - it's a reason.

32 to 36 weekers (and that's measured to 36 weeks and 6 days) are 3 times more likely than full termers to have CP diagnosed by aged of 5 1/2 years.

They are also 3 times more likely to have a developmental delay diagnosed by 5 1/2 years.

They are 1.6 times more likely to have an intellectual disability.

They are 5 times more likely to have ADHD.

Their maths and reading scores as assessed by teachers is worse than full termers at Year 2 level.

Their participation in Special Education supports is higher in early levels of school.

They are 1.5 times more likely to be blind, deaf or have a seizure disorder.

They have decreased IQ scores.

Schizophrenia, psychological developmental disorder, behavioural and emotional problems are more common - in fact 19 - 21% of 34 - 36 weekers had clinically significant behaviour problems diagnosed by 8 years old. This statistic is similar to both the 31 - 34 weeker cohort and the 25 - 30 weeker cohort.
It is double the statistic for full term children.

High blood pressure, high cholesterol and insulin resistance in late childhood/early teens is more likely in late pre-term children. This appears to be related to abnormal growth patterns in infancy.
The first two years of life are the prime catch up time for late pre-termers and yet they are two times more likely to be underweight, stunted in their growth or even suffer wasting.

What the researchers don't say is that particular stat is due to the huge numbers who have feeding problems - even beyond the typical prem baby issues with tiring, poor suck etc.
Reflux is endemic in the prem population which can lead to feeding problems, sensory issues can lead to gagging, texture issues, oral sensitivity and finally food aversion.
Again when the incidence of feeding problems in late pre-termers is looked at, if it persists beyond a few months old then it is often as severe, persistent, serious and needing as intensive treatment as it would for a micro-prem.

A large reason for these impacts is that their system is immature, unprepared for the sensory assaults of light, sound and being handled. But also a significant reason is that in those last 6 weeks of pregnancy critical brain development is taking place. Btween 34 and 40 weeks gestation the cortical volume of the brain increases by 50% and the cerebellar development increases by 25%. In late pre-term children there is evidence of the white matter of the brain being decreased in volume even without evidence of a brain injury so this important development is being disrupted by the premature birth.
That's why our kids are 'wired differently'.

Now all that sounds horribly depressing - and it is.
Our kids are never really out of the woods because with the high blood pressure etc they re at much higher risk of chronic health problems as adults. Some kids appear to skate through their pre-school and even early school years and then the organisational, the executive function demands increase and the skills just aren't there and things start to fall to pieces, leaving the parents wondering where they've gone wrong because they thought they'd escaped the evil clutches of prematurity.

But all is not lost.
Those who read this blog regularly know that despite it all my boys are doing fairly well in their schoolwork, they are happy, exploring and living life as best they can.
They have some huge challenges but with our support are rising to it.
The trick is - knowledge is power.
Knowing what the risk factors are and employing watchful waiting. Don't expect every part of the preemie alphabet soup to befall your child, but, if they start to show issues then jump for help sooner rather than later.
Know how to find support and make sure you get it.

It's a roller coaster ride with many twists and turns, raising a premature child - but remember, the highs are there right along with the lows and I find, knowing how deep the lows can be also makes the highs all the more sweeter.