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'Near-term' unease grows

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They're not quite full term, but they're not that premature. They're "near-term" babies, born roughly four or five weeks before their estimated due date.

They typically have normal Apgar scores, used to evaluate newborns' physical condition. Their birth weight is in the normal range. They usually go home with Mom. Most people think they must be healthy.

And generally they are. But research suggests that appearances might be deceiving in some cases. Though near-term babies on average are healthier than preemies, they may not be quite as healthy as full-term babies.

Pediatrician Marvin Wang says he became interested in studying near-term babies a few years ago after an obstetrician colleague asked about the merits of scheduling cesarean sections before the 37th week of gestation, when babies are considered full-term.

It's rumored that some celebrity moms have asked to deliver their babies via C-section a month before their due dates to get a head start on slimming down, says Wang, co-director of the newborn nursery at Massachusetts General Hospital.

He says celebrities aren't the only mothers asking for C-sections before 37 weeks. Indeed, research suggests that "patient-choice" C-sections are on the rise. Wang says comments he has heard suggest that some might be scheduled too early so Mom can fit maternity leave into her work schedule. When he lectures about near-term infants' health problems, Wang says, "The nurses will say, 'Man, can you tell our OBs this?'"

Medical problems abound

In a study published last year in the journal Pediatrics, Wang and his co-authors found that near-term infants, representing roughly 7% of babies born at their hospital, had significantly more medical problems and higher hospital costs than their full-term peers.

The study compared 90 near-term infants with 95 full-term infants. Near-term babies were more likely to be evaluated for infections and have low blood sugar, unstable temperatures, breathing problems and jaundice.

As a result, 27% of the near-term babies required treatment with intravenous fluids, while only 5% of the full-term babies did. And 50 of the near-term infants didn't get to leave the hospital with their mothers, compared with only seven of the full-term babies.

With his study, Wang says, "one of the things I was hoping to relay: You know what? Unless there is a benefit to the child and the mother, it's not a great idea to be delivering before 37 weeks if you can avoid it."

Robin Yannetti of Swampscott, Mass., couldn't avoid delivering son Aaron at 36 weeks and two days' gestation. A sonogram showed that Aaron's umbilical cord was wrapped around his neck several times, so his mother underwent an emergency C-section at Massachusetts General on Sept. 14.

Unlike many near-term infants, Aaron was a great breastfeeder from the start, Yang says. But he did have other problems typical of near-term babies, such as breathing difficulties and an inability to maintain his temperature, a possible sign of infection, Yang says.

In the end, though, says dad David Yannetti, Aaron was able to leave the hospital five days after his birth, just a day after his mother went home. "We were thrilled," Yannetti says.

Gestation-wise, Ethan Carr, of Lake Zurich, Ill., was a week older than Aaron when he was born. Based on his mother's due date, Ethan technically was full-term, born two days past 37 weeks.

But, Yang says, due dates can be off by a few days, and a baby born right on the cusp might look more near-term than full-term.

That was Ethan's experience, says mom Stasia Carr, whose water broke early. Although he had jaundice, Ethan left the hospital with his mother two days after his June 6 birth. But he had to be placed on a special light-emitting blanket for a few days to treat his jaundice.

Like many near-term babies, Ethan just wasn't getting the hang of breastfeeding and was so sleepy his mother had to wake him to feed him. "By the time we got to the second month, everything seemed to even out, and I constantly thought of him as being three weeks early," Carr says.

Getting the word out

The Association of Women's Health, Obstetric and Neonatal Nurses recently launched a campaign to raise awareness of the needs of near-term infants.

"We're very cavalier about this group," says Barbara Medoff-Cooper, University of Pennsylvania nursing professor and co-chair of the nursing group's near-term initiative. One reason for that attitude, says Medoff-Cooper: Near-term babies look positively robust next to extremely premature babies, those born as early as 24 or 25 weeks' gestation.

"I think we have to be very conscious of the fact that if we place a 35-week or 36-week baby into the nursery, we can't expect them to be feeding like a full-term baby," Medoff-Cooper says. "We also have to do a really good job of teaching families what to look for about feeding issues, about jaundice, about any signs of infection."

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© Copyright 2004 USA TODAY, a division of Gannett Co. Inc.

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