Premature & Past Due

Though doctors still argue about just what constitutes a premature or postmature birth, both kinds are hazardous for the infants involved, specialists told the American Academy of General Practice in San Francisco last week. Half of all infant deaths are among "preemies," but not enough research is being done to cut down the death rate, said Dr. James L. Dennis of Oakland, Calif. And while some authorities deny that there is such a thing as postmaturity, Chicago's Dr. Mitchell J. Nechtow said that 12% of births are delayed two weeks beyond the due date, and 4% are three weeks late.

Not enough doctors and nurses are trained in the special handling of incubator cases, said Dr. Dennis, especially in regulating the oxygen supply, now that it is known that an excess of oxygen can cause blindness (TIME, Sept. 28, 1953). Even with the best of care, many preemies begin to suffocate because a membrane blocks the lungs' air sacs: nobody knows why half of such cases get better and show no ill effects, while the other half die. Bile pigment, which the immature liver cannot handle, may pile up in the blood and cause brain damage. Best way to treat it, Dr. Dennis said, is to replace 80% to 90% of the baby's blood in an exchange transfusion. A note of caution: sulfa drugs seem to increase the risk of cerebral palsy from bile pigment, should not be given to preemies.

When babies stay in the womb too long, said Dr. Nechtow, the death rate is three times that of normal-term babies. One reason: the placenta may shrink, so the fetus is forced to live off his own tissues and loses weight. At the same time, the difficulty of delivery increases, with more frequent breech presentations, use of mid-forceps and Caesarean section. While Dr. Nechtow warned the G.P.s against resorting lightly to drastic measures, he urged them not to hesitate to induce labor or do a Caesarean section if the examination convinces them that the time is overripe.

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