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11/15/2013

Why all babies are not born equal

Premature

A premature baby boy is examined at Toronto East General Hospital in 2004. Tannis Toohey/Toronto Star

Do all babies have the same shot at enjoying a long and healthy life? Not only is the answer "no," the reality is that a baby's health is largely determined by two uncontrollable factors: geography and gender.

On Friday, Pediatric Research published a series of papers that provide the "first systemic estimates of impairment after neonatal morbidity," according to an accompanying editorial (co-authored by Sick Kids' Zulfiqar Bhutta).

In other words, the researchers crunched a boatload of data to better understand newborn conditions and how they impact a baby's health. One of their findings was that boys are 14 per cent more likely to be born early than girls -- and even if a boy and girl are born at the same degree of prematurity, the boy still has a higher risk of death and disability.

Why? Because girls mature faster than boys, even in utero.

"Even in the womb, girls mature more rapidly than boys, which provides an advantage, because the lungs and other organs are more developed," professor Joy Lawn, one of the studies' primary researchers, explained to BBC News.

But irrespective of gender, premature birth is a major public health issue (one important enough to earn its very own day: this Sunday is World Prematurity Day). Every year, roughly 15 million babies are born too soon, with the majority of them in India and China. Of those, one million die.

And if a premature baby does manage to survive, he or she is at a greater risk of developing a disability; under 3 per cent will end up with "moderate or severe impariments" and another 4.4 per cent will have a mild impairment. (Preemies, for example, are more vulnerable to eye problems like retinopathy -- it's estimated that 185,000 newborns are affected by retinopathy, with some 20,000 suffering from severe disabilities, including blindness).

And just as geography influences a baby's chances at health and survival, it also amplifies the consequences of preterm birth. A preemie born in a low-income country is 10 times more likely to die than a baby born prematurely in a wealthy country. In middle-income countries, the risk of disability is twice as high compared to the wealthiest nations.

In global health, huge amounts of philanthropic dollars have recently gone towards improving maternal and child health -- roughly $25 billion in the last three years. But only 1 per cent, barely even a sliver of the pie, has been earmarked for improving newborn health.

Considering the years of life lost due to "neonatal conditions" -- three times that of HIV and more than for all cancers -- things clearly are not adding up.

"Neonatal conditions result in social and economic loss to families and nations," wrote the authors of the editorial accompanying the new studies. "Investing in care of every woman and every newborn will reduce both deaths and disabilities."

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

 

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