The stork assigned to Lancaster County makes about 5,500 deliveries a year.


More than 600 of those deliveries are made too early, not a good thing for the baby, the mother or the community as a whole, say local health care officials perplexed over the high number of early arrivals.


Is the stork directionally impaired? Is he lousy at time management? Are those 600 babies delivered by the stork’s evil twin?


Fable aside, Lancaster physicians and nurses say they don’t know why so many babies here are born prematurely or before 37 weeks gestation. “For two-thirds of preterm births there is no known cause,” said Dr. Philip Bayliss medical director of maternal-fetal medicine at Lancaster General’s Women & Babies Hospital. “The other third are because of medical complications.


“Clearly, for the past two decades, the rate of preterm births has risen,” said Bayliss, a perinatologist who opened the only maternal-fetal medicine practice in the county two years ago.


Dr. Kevin Lorah, a neonatologist and director of Women & Babies’ neonatal intensive care unit, said the hospital has experienced a 15 to 20 percent increase in all deliveries since it opened its doors in 2000. About 11 percent of all its births are preterm. “Something’s not right,” he said.


In response to the demand for more specialized care, Women & Babies plans to add eight more beds to its NICU this year, bringing the number of licensed beds to 29, said Lorah.


It is soon to be augmented by Ephrata Community Hospital’s plan to build a neonatal intensive care unit at its main campus. The hospital plans to open a five-bed NICU in January, said Dr. Vincent D. Glielmi, vice president for medical affairs.




Not just here




The rising rate of preterm births is not a problem exclusive to Lancaster County.


March of Dimes says the rate of preterm births in the U.S. hit a record high in 2002, the year for which information was last available.


Babies born prematurely, or before 37 weeks gestation, numbered more than 480,000, or 12 percent of all births that year. It was a 27 percent increase since 1982, reports the March of Dimes.


Statewide the rate is 8.2 percent. Locally, it’s 11 percent, say health care officials.


A high premature birth rate is a problem not only because of the risk to the baby, but also because of the trend’s detriment to society and the economy, said Kathy Siembieda, associate director of program services for March of Dimes of Central Pennsylvania.


“Many of these babies face lifelong medical challenges,” said Delores Smith, director of program services for March of Dimes. “It takes a tremendous physical toll on the child, and it also affects the family in terms of cost and lost time at work.”


March of Dimes reported that employers lose an average of $2,700 in lost productivity for the first year of a preemie’s life. They also face an average of $41,600 in direct health-care costs vs. $2,800 for a healthy, full-term delivery.


Socially, premature babies are at greater risk for birth defects, chronic health problems, physical disabilities and learning disabilities. The strength of a family is weakened by the stress of a preterm birth.


March of Dimes reported that the average charge for an uncomplicated newborn stay is $1,500. For a preemie, it averages $79,000 per stay.


Statewide, hospitals charged $600 million for premature-baby care in 2002, reported the Pennsylvania Health Care Cost Containment Council. That is 50 percent of the $1.2 billion charged for all newborn care.




Adding NICU space




Ephrata Community expects to deliver 600 babies this year, said Glielmi, at least 50 of those will be preterm. Currently, Ephrata sends its problem cases to other hospitals with NICUs, including Women & Babies, Hershey Medical Center and Polyclinic Hospital in Harrisburg. Sometimes those hospitals’ NICUs are full, and Ephrata has to look as far away as Philadelphia.


Cathy Smith, a registered nurse and clinical leader at Ephrata Community, said keeping the baby and mother together is paramount for their recovery. “It’s important, too, that the family unit stay intact” at such a stressful time, she said.


Audrey McCarty, a registered nurse and medical coordinator at Ephrata Community, said the NICU plans were formulated about two years ago after the hospital surveyed new parents throughout the county and asked what they would want in a post-natal care unit.


“Many said they choose a hospital because of the availability of special services,” she said. Although the expectant parents might not need special care, it makes them feel safer to know that it’s available.


Ramping up for NICU services is a huge undertaking. Besides providing state-of-the-art equipment and specially trained staff, the hospital’s other departments must gear up for the task, including respiratory, imaging, laboratory, cardiology, pharmacy and social services.


The hospital employs trained neonatal nurses, and it has a contract with Onsite Neonatal Partners Inc. of Voorhees, N.J., to provide three regularly assigned neonatologists to the hospital. “We will have a neonatologist on staff 24 hours a day,” said McCarty.


Heart of Lancaster Regional Medical Center in Lititz, a for-profit hospital owned by Health Care Associates of Florida, opened an obstetric unit last fall. It is on track to deliver more than 100 babies this year, said Deborah Willwerth, chief nursing officer. But the medical center has no plans to add a NICU and instead will continue to divert serious cases to other hospitals with Level II and III nurseries.


Women & Babies has Level I and II nurseries as will Ephrata Community. Very serious cases that require Level III NICU care will continue to be sent outside Lancaster County to places such as Hershey Medical.




Tracking trends




Bayliss, of Women & Babies, said some known reasons for premature births include more older mothers and the growing number of multiple births aided by fertility drugs.


In just one week last month, Women & Babies cared for six sets of twins and one set of triplets, said Lorah. Ephrata and Heart of Lancaster each had one set of twins two weeks ago.


Most multiple births are delivered preterm and almost all of the babies spend time in NICU because of low birth weight and breathing problems.


Another trend Lorah sees is more babies in general being sent to NICU. He said once the service is available, pediatricians caring for newborns will use it.


“We’re seeing more near-term or full-term babies with low birth weights, infections or other medical issues such as low blood sugar,” said Lorah, who heads a team of five neonatologists.


While having a NICU available to a community is a blessing, it also has its downside, said health care officials.


Siembieda, of March of Dimes, said she has seen people adopt a laissez faire attitude about premature births, believing that all will work out because doctors can do amazing things these days to help the baby survive. “Almost every family knows of a small baby who survived,” she said. “A lot of babies are saved in NICUs, so the attitude of many is: Premature? So what?”


Siembieda pointed out the fine line: While the survival rate of a baby born at 35 weeks is typically very high, the risk of that baby dying is doubled versus a baby born at 37 weeks.


The longer the mother can carry the baby, the better the chance for survival.


Willwerth of Heart of Lancaster said prenatal physicians first try to stop early labor with drugs and bed rest to buy the baby more time.


Bayliss said it is a common practice that extends the gestation period for high-risk babies. But, he stressed, the most important thing the community can do to reduce the rate of preterm births is to support public awareness and education about “the true risk.”


“Go into a school and see the number of special education students; the impact of preterm births stretches across families, schools and the whole community,” he said. “My first and primary role is education,” he said, noting he works alongside local obstetricians and other health care providers to educate them to identify high-risk pregnancies and to encourage them to teach expectant mothers about the importance of getting early and regular prenatal care.