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Early arrivalsIn an ongoing landmark study, Monash researchers are gathering information that is helping improve the long-term outcomes for very premature babies. TIM PEGLER reports We are all familiar with images of premature babies in intensive care – tiny infants attached to ventilators and countless other wires and tubes serving as surrogate umbilical cords, connecting them to machines that keep them alive. They are babies who weren’t ready for the world, babies who, for reasons often only nature can understand, could not remain in the safety of the womb and who until recently had very little chance of survival.
In 1976, Professor Yu established Monash Medical Centre’s Growth and Development Clinic. A year later, the clinic began its first collaborative study of very premature babies, working with the Royal Women’s Hospital. The study was the first of its kind in Australia and produced evidence that vulnerable early arrivals could survive with intensive medical care. Links were then forged with the Royal Children’s and Mercy hospitals, and the Victorian Infant Collaborative Study (VICS) group was formed. The team began its first long-term study, focusing on very premature babies born in 1979–80. Very premature babies (born at 27 weeks or earlier) have a fight on their hands from birth. Generally, their brains are still developing, respiratory systems are not ready for breathing air, and their digestive tracts are not prepared for nourishment that does not come via the umbilical pipeline from the placenta. Survival is no certainty for such early arrivals, but if they do win this first battle, they may be confronted with disabilities such as blindness, deafness, extremely low IQ and cerebral palsy, which occur at about four times the rate they do in full-term babies. The VICS project charted the progress of the 1979–80 premature babies – and a control group of full-term infants – at ages two, five, eight and 14, useful milestones for measuring social adaptation and overall development. At age two, children should be walking and talking. At four to five, any support needs for their schooling should be clear, and parents can proactively seek the best educational option. At eight to nine, children should be established at primary school, and at 14 at secondary school. VICS measures included IQ, growth, behavioural tests and school functioning, and the first group produced some surprises. Growth and Development Clinic pediatrician and honorary lecturer in medicine Dr Elizabeth Carse says that compared to full-term newborns, premature children at term age (37 weeks or more) were considerably smaller and had “a lot of catching up to do”. At age two, the premature children remained small but a growth spurt arrived during middle childhood. And by age 14, the children were taller and seemed more comfortable at school than expected. “We’d always thought that if you hadn’t caught up by the time you were about two, you weren’t going to,” Dr Carse says. “But at 14 they were not as small as originally predicted.” When it came to social interaction, the premature babies had a higher incidence of hyperactivity during their early years, but this also changed with maturity. Academically, there were fewer high achievers and more low achievers among the study group. But while some of the children needed help during their early school years, they needed less support at secondary school, she says. The clinic hopes to revisit the original 80 subjects of the 1979–80 group, now in their early 20s, to check on their educational and employment status. The task of locating them can be slow and expensive however, so additional research funding is required. Meanwhile, the clinic is monitoring three subsequent groups of very premature babies: those born in 1985–87, 1991–92 and 1997. Advances in neonatal care mean greater numbers of increasingly premature babies survive today, some from as early as 23 weeks gestation. As one of the few population-based studies in the world – gathering data on every premature baby born in Victoria and comparing them against a control group of full-term babies matched for date of birth, gender and, where possible, postcode – the findings have international significance. The pool of information on premature infants improves quality of life for all pre-term babies born today. Not only does the research assist in continually adapting and improving hospital care for newborns, but also better understanding of problems that potentially confront these children and their parents means help or treatment can be arranged earlier. Dr Carse says the research also provides useful information for prospective parents of premature babies as well as the counsellors who advise them. “It makes a huge difference to a couple to know how babies born at 23 or 24 weeks are faring today if they have a baby on the borderline of survival and are trying to decide whether to have a caesarean section to save that baby – at potential cost to subsequent reproductive chances,” she says. For the most part, the VICS work offers good news to anxious parents. Dr Carse says more than 50 per cent of the most premature babies (23 or 24 weeks) rate as completely normal on every available test. Seventy-five per cent of those born between 23 and 27 weeks are “within the range of normal or very mild impairment, which means they go to normal schools and cope well in the general school population”. “When you see them as strapping eight-year-olds, it can be hard to believe they were once frail little babies,” Dr Carse says. “The majority are thriving and healthy, with no long-term problems.” The Child
Fortunately, the grade three student is doing well. Every few years the family visits the Growth and Development Clinic at Monash Medical Centre for a series of tests to monitor her progress and compare it to that of a full-term child born at the same time. Dr Elizabeth Carse tests Breanna’s balance, coordination and motor skills as well as her lung capacity and psychological development. “She spent 10 weeks in hospital when she was born,” Mrs Haney says. “It’s great to see her like this now.” ACTION: The Victorian Infant Collaborative Study is a joint project of several Melbourne teaching hospitals and Monash’s Faculty of Medicine, Nursing and Health Sciences. For information on the project and the work of the Growth and Development Clinic, visit www.monashinstitute.org/health/premature.htm |
So
what does the future hold for these frail pre-term infants? Does
fighting spirit and advanced medical care deliver long-term quality of
life, or are they disadvantaged from day one? Thanks to a landmark study
pioneered by Monash University professor of neonatal medicine Victor Yu,
such questions could soon be answered.
Nine-year-old
Breanna Haney can walk a straight line with the best of them. But when
she was bornpremature at just 28 weeks, her parents, Heather and Len,
had no idea what lay ahead.