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This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.

Interviewer:  A new paper has been published by a group of scientists who reveal that preterm birth is the most frequent reason why infants die.  Dr. William Callaghan, with the Centers for Disease Control and Prevention’s Division of Reproductive Health, is one of the authors of the paper describing this finding.  Dr. Callaghan, welcome and thank you for being here today.   Please tell us about the paper and what’s important for us to know.

Dr. Callaghan:  We were interested in understanding the problem of infant mortality that is why approximately seven out of every one thousand infants die during the first year of life. To do this we conducted a study to determine what were the most important reasons that infants died in the United States.  This information is important for setting public health priorities – priorities for research, programs, resource allocation, public awareness, and public health policy aimed at reducing infant deaths.   We evaluated national birth certificates and death certificates to understand the major reasons why infants were dying in the first year of life and to try to understand how prematurity was contributing to these infant deaths. 

We found that about 1/3 of all infants died because they were born preterm, making preterm births the most frequent reason that infants die.   A normal term pregnancy lasts for 40 weeks.  Although prematurity refers to any births that occur before 37 weeks of gestation, the majority of infants who died from prematurity tended to be the smallest and most premature infants.  These infants most often died within the first week of life, and often within the first 24 hours.

Interviewer:  What did you find?

Dr. Callaghan:  In the United States, national statistics routinely track the leading causes of infant death.  However, with this system, there is not really a category per se for infant death caused by prematurity.  Deaths from prematurity fall into many different categories based on underlying cause, such as (the) mother’s pregnancy complications, or from the infants’ lungs being too immature.  We conducted this study to understand how much prematurity from all causes was contributing to the problem of infant mortality in the United States. 

Interviewer:  Dr. Callaghan why do preterm infants die more often than infants born at term?

Dr. Callaghan:  Well it takes a certain degree of physical maturity to survive outside of the womb.  Although advances in technology help preterm infants survive better than at any time in history, this intensive care cannot always be successful.  It is less successful for extremely small and extremely premature infants.

Interviewer: So what can be done to prevent infant mortality related to prematurity?

Dr. Callaghan:  Well even with the best of technology and specialized medical care, not all preterm babies can survive.  We found that about 2/3 of infants who died due to prematurity were born at or before 24 weeks of gestation, when infants’ vital organs such as the brain and lungs may be too immature to survive.  So ultimately, decreasing infant deaths in the United States depends not only on treatment, but on effectively preventing premature labor and delivery from occurring in the first place.

Interviewer: Can we prevent premature birth?

Dr. Callaghan:  Unfortunately, we are not yet able to accurately predict which women will have premature labor and prevent their premature delivery.  We know some of the factors putting healthy pregnancies at risk, such as infections in the womb or bladder.  But the majority of women who have a preterm infant do not have symptoms or an identifiable cause.  An expanded prevention research agenda is urgently needed to identify women at risk early in pregnancy and to identify early and effective strategies to prevent premature labor and delivery.

Interviewer:  So does this mean that we can’t do anything about prematurity?

Dr. Callaghan:  No, it doesn’t exactly mean that.  We believe that women should seek comprehensive prenatal care early in pregnancy, and that their infants should have access to care, so that mother and baby have the very best possible outcome.  This means promoting health of women before and throughout their reproductive years, especially before conception, and helping women begin prenatal care early in their pregnancy. 

Interviewer:  Dr. Callaghan is there anything that you can suggest for expectant parents or those contemplating parenthood?

Dr. Callaghan:  Certainly.  It’s important to keep up with news about pregnancy and prematurity.  My colleagues at CDC are continuing our research to learn more about the biological causes of prematurity and infant death.  And we are also deeply gratified that the March of Dimes joins us as a partner in research as well as taking a lead in helping the public understand and cope with prematurity.  March of Dimes affiliates are in almost every state and county in the country.  This means someone who is concerned about a first or subsequent premature birth will find an understanding person close to their home.

Interviewer:  Do you have any final comments?

Dr. Callaghan:  One day, we hope there will be breakthrough announcement on preventing prematurity.  Until then, we hope everyone will share our concern that prematurity and infant deaths are significant public health issues…issues that affect all too many of our own families and the lives of people living in our own neighborhoods.

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