Premature Births: The Silent Crisis

By Kaaren Valenta

When Michael Joseph Cavanaugh was born on June 29, 2002, he weighed only one pound, two ounces and was 11½ inches long. His hand was about the size of his father’s fingernail.

The infant, son of former Newtown residents Ellen and David Cavanaugh, was born three months premature at Yale-New Haven Hospital.

Today Michael is a happy 18-month-old toddler who at 19 pounds and 30 inches is just a little small for his age.

“Michael is perfectly healthy and happy. Miracles do happen,” his mother said.

Michael is one of 1,500 premature infants cared for each year at the Yale-New Haven Hospital’s newborn special care unit. The unit, which regularly accepts transfers each year from other hospitals in Connecticut, New York, and Rhode Island, was the world’s first newborn special care unit when it opened in 1960.

Premature infants, known as preemies, come into the world earlier than full-term infants. Prematurity occurs when a pregnancy lasts fewer than 37 weeks; full-term infants are born 38 to 42 weeks after they are conceived. Michael Joseph Cavanaugh was born at 26 weeks.

“There were smaller babies than Michael in the nursery when he was born. They weighed less than a pound,” Ellen Cavanaugh said. “A couple of babies didn’t survive, but some did.”

Prematurity is a silent crisis in America. Every year more than 470,000 infants are born prematurely, and prematurity is on the rise. It now affects one out of every eight babies born in the United States.

Between 1981 and 2001, the rate of premature births rose from 9.4 percent to 11.9, an increase of more than 27 percent. Every year more than 470,000 infants are born prematurely, a number roughly comparable to the population of New Orleans or Cleveland. . Each year, 100,000 children develop health problems because of their early births. And prematurity is the leading cause of death in the first month.

 Preterm delivery can happen to any pregnant woman. It is happening more and more often. And in nearly half the cases, no one knows why.

That was the case with Ellen Cavanaugh, who had what seemed like a normal pregnancy for the first five months.

Ellen and David Cavanaugh grew up in Newtown, graduated from Newtown High School –– she in 1988 and he in 1984 –– and lived at the corner of South Main Street and Pecks Lane until they moved to Watertown three years ago. David’s parents are Rosemarie Cavanaugh and the late Joseph Cavanaugh, who was deputy fire marshal in Newtown for many years. Ellen’s mother, Shirley Gavel, retired from her job as a teacher at the Children’s Adventure Center in Sandy Hook to help care for her new grandson.

Ellen Cavanaugh has worked as an administrative assistant for the General Electric Company for 14 years. During her pregnancy, she was working at the GE headquarters in Fairfield.

“I was in a high-stress job,” she said. “That’s the only thing I can point to as a possible cause of the problem.”

According to a study published in the January 1, 2003, issue of the American Journal of Epidemiology, pregnant women who said they were experiencing high levels of stress from events such as marital separation, problems with in-laws, or issues at work were 80 percent more likely to have preterm delivery than those who reported low stress levels.

Ellen Cavanaugh was on her way to a yoga class –– to reduce her stress –– when she stopped at GE’s medical center to have her blood pressure taken. The nurse sent her straight to her doctor because her blood pressure was so high.

 “My doctor wasn’t very concerned but I asked for an ultrasound because I hadn’t felt the baby moving. That’s when we discovered that there was barely any amniotic fluid left and the baby had stopped growing at 23 weeks.”

Mrs Cavanaugh’s doctor sent her to Yale, where doctors hoped to be able to prevent an early delivery. “But when they did an ultrasound two days later, they found that Michael was not moving. So within ten minutes I was having a C section [Caesarian],” she said. “I was terrified. I was so scared.”

Michael was immediately intubated (placed on a respirator), and he had a little jaundice, or hyperbilirubinemia, but otherwise he was surprisingly healthy for a very premature infant. Common complications associated with extreme prematurity can include respiratory distress syndrome, apnea, anemia, bronchopulmonary dysplasia, intreventricular hemorrhage, patent ductus arteriosis, jaundice, and infections.

“He had no health issues,” Ellen Cavanaugh said. “Brain scans showed no bleeding [intreventricular hemorrhage]. He had a little jaundice so he was placed under lights for a very short time.”

Although mild jaundice, yellow discoloration of the skin and whites of the eyes, is fairly common in full-term babies, it is much more common in premature babies. It is caused by high levels of bilirubin, a compound that results from the natural breakdown of blood. Extremely high levels of bilirubin can cause brain damage, so premature infants are monitored for jaundice and treated quickly, before bilirubin reaches dangerous levels. Jaundiced infants are placed under lights that help the body eliminate bilirubin. In rare instances, blood transfusions are used to treat severe jaundice.

“Michael was a fighter,” Mrs Cavanaugh said. “For the first three days it didn’t look good. There were a lot of respiratory issues and at first he was losing weight because he was trying so hard. But that changed quickly. By the 14th day he pulled out the respirator. It was as if he was saying ‘I’m done with this.’”

On the 15th day, Ellen Cavanaugh was finally able to hold Michael. And exactly three months after he was born, Michael weighed almost five pounds and was discharged from the hospital.

Except for a week in January 2003, when he was admitted to the hospital treatment of a viral infection, Michael has been very healthy.

“For awhile someone from the state’s Birth to Three program came to the house to make sure he was making progress, but that stopped last May,” Mrs Cavanaugh said. “He is part of a study at Yale. We go every six months to track his progress.”

As a precaution, Michael will continue to use Albuterol puffs, a medication inhaled from a nebulizer, three times a day to keep his airways open. He also takes a new respiratory drug, Singular, but doctors expect to be able to discontinue all of the medication this spring.

“Michael started walking between 16 and 17 months, which is just about right because you have to subtract the three months that he was premature,” Ellen Cavanaugh said, smiling as her son grabbed her cell phone, held it to his ear and shouted, “Hello.”

“Now he’s perpetual motion,” she said. “He’s our little miracle boy.”

In January 2003, the March of Dimes launched a five-year, $75 million campaign to find out what is causing the growing incidence of premature births and how it can be stopped. The campaign is also advocating for a five-year funding increase of $50 million to support prematurity-related research being conducted under the aegis of the National Institutes of Health. For more information on premature birth, visit the March of Dimes website at www.marchofdimes.com.