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Chat with Dr. Adam Wolfberg

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April 28, 2008

Dr__Adam_Wolfberg: Hi, this is Dr. Adam Wolfberg, at Tufts Medical Center. I'll be chatting for the next hour about prematurity and the article that ran in the Globe magazine yesterday.

Em__Guest_: My girlfriend had a baby boy a year ago at 24 weeks and although he has had a rough year, he is doing great now, and no developmental delays

Dr__Adam_Wolfberg: That's wonderful news. I'm really pleased to hear that. It's always encouraging to hear about the great outcomes at 24 weeks. It's just important to keep in mind that not all babies are as fortunate as your girlfriend's baby.

soxfan__Guest_: how long does it usually take for any developmental delays to show up? is there any sort of benchmark?

Dr__Adam_Wolfberg: It's a great question, and one that is probably best directed toward your pediatrician. Usually, but not always, significant developmental delay is noticeable by two years of age.

Dr__Adam_Wolfberg: However, if anything concerns you (and this applies to all kids, not only those born prematurely) it is definitely worth having a conversation with your pediatrician.

O_Kee__Guest_: Is it true that Premmie Girls do better than Boys? Why?

Dr__Adam_Wolfberg: It is true that at any gestational age, and at any birth weight, girls do better than boys. No one is really sure why this is.

Dr__Adam_Wolfberg: Just to clarify, I meant my previous comment to relate to premature newborns. At term, boys and girls do equally well (and are equally delightful).

me__Guest_: what is the most common issue with preemies? Lungs?

Dr__Adam_Wolfberg: Yes, the lungs are probably the organ that has the most trouble adapting to life outside the womb prematurely.

Dr__Adam_Wolfberg: Were any readers following this chat born prematurely themselves? I'd love to hear from you...

sharon__Guest_: i had a preemie 5 yrs ago -- what are my chances of it happening again ?

Dr__Adam_Wolfberg: Hi Sharon, your risk of having another preterm delivery is definitely increased compared to other women who have had only full-term babies.

Dr__Adam_Wolfberg: It's a bit hard to say what your specific risk is, because it probably depends on why you delivered early. There is a medication (progesterone) that can reduce the risk of having another preterm delivery, so I would definitely have a discussion with your obstetrician either before you get pregnant, or immediately after you get pregnant.

SD__Guest_: What are some of the causes of preterm delivery? Should women who've had cervical biopsies or LEEP be concerned?

Dr__Adam_Wolfberg: There are many causes of preterm delivery -- from infection to cervical insufficiency to maternal illness nthat requires premature delivery.

Dr__Adam_Wolfberg: There is no evidence that cervical biopsies or LEEP procedures cause preterm delivery (the concern would be that these procedures would injure the cervix and lead to cervical insufficiency -- when the cervix dilates prematurely)

Dr__Adam_Wolfberg: That said, if a woman has had multiple LEEP procedures, or has had the more invasive surgical cold knife cone procedure, it is definitely worth discussing this with an obstetrician, who could perform cervical-length ultrasounds if she/he thought it were necessary.

jorge_julio__Guest_: hi, my brother and his wife had a preterm baby at 23 weeks and there were some complications and he didnt make it...would you say that each preemie has to be evaluated on a case by case basis and that a general number of how many weeks of when a baby is viable isnt really a good barometer

Dr__Adam_Wolfberg: I'm so sorry for your brother's and your sister-in-law's loss. I think that the number of weeks can give obstetricians and neonatologists a good idea about what to expect when a baby is born and may help them counsel patients about what is possible and what is impossible.

Dr__Adam_Wolfberg: However, each baby does need to be evaluated at birth, because there certainly is variation from one baby to another. Again, I'm very sorry about your family's loss.

joyce__Guest_: sorry - i am now 31 weeks in to a very high risk pregnancy due to history of stillbirth; if his next growth u/s doesn't go well on may 9 (his growth has been dropping off - he was in the 70% now at 20%) we have to deliver - will he have a good chance of survival without complications?

Dr__Adam_Wolfberg: Joyce, It's difficult for me to give you meaningful advice since I know so little about you and your pregnancy. However, babies born at 31 weeks, in general, do really well. I would strongly recommend that you ask your obstetrician to set up a consultation for you with a neonatologist, who can walk you through exactly what you can expect.

dinkydude__Guest_: This may not be a relevant discussion, as our first child was born technically pre-term but not extremely so (34 weeks); he had no complications except for a bit of extended jaundice. He's a very healthy 13 year old now, but is there anything we should be on the lookout for in his development?

Dr__Adam_Wolfberg: I think if your child is 13 and nothing has come up related to his prematurity, it is highly unlikely that anything will appear now. Best of luck -- parenting a 13-year old is quite a challenge.

Dr__Adam_Wolfberg: Thanks to all for your questions and comments. I'm going to sign off and go back to clinic now.

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