Predicting, preventing preterm births

Each year, 15 million babies worldwide are born prematurely, arriving at least three weeks before their due dates. Globally, prematurity is the largest cause of death before age 5, and even with excellent medical care, children who survive can have lasting physical, developmental and cognitive challenges.

Doctors don’t know what prompts most premature births. That’s why, over the last decade, Stanford’s top obstetricians, neonatologists, geneticists, microbiologists, immunologists, epidemiologists, health policy experts and bioengineers have been investigating the basic science of preterm birth. They’re explaining how it is triggered and what factors put a pregnancy at risk for ending early. At the same time, our clinicians continue to hone their ability to care for the highest-risk newborns, especially those whose premature arrival comes with complications such as rare genetic or congenital diagnoses. Ultimately, our experts aim to predict and prevent many preterm births, helping more babies arrive safely.

Premature baby in the hospital incubator.
(Image credit: Getty Images)

Finding treatments

Because their lungs aren’t fully developed, breathing is premature babies’ first big challenge. Preemies can also suffer neurological and gastrointestinal complications of their early arrival, as well as vision and hearing loss.

Stanford researchers are studying treatment solutions such as the artificial lung surfactant being developed in Annelise Barron’s lab and the innovative methods for preventing and treating neurological injury that are deployed in the Neuro NICU at Lucile Packard Children’s Hospital Stanford. Because premature births happen everywhere, our researchers are also exploring how to improve neonatal care in low-resource settings around the world.

Scientist develops protein mimic to help injured lungs breathe

The material could be used to synthesize a film that coats the inner surface of lungs, possibly leading to better, cheaper treatments for acute lung injury in humans.

Prenatal steroids reduce risk of brain bleeding in preemies

Steroid treatments intended to mature premature infants’ lungs before birth also protect them against brain hemorrhages after they are born, according to a California-wide study.

Unit focuses on neurology care for babies at risk of brain injury

Lucile Packard Children’s Hospital Stanford is home to a Neuro NICU that specializes in helping premature or ill newborns who are at risk for brain injuries.

Study shows benefits of cochlear implants in deaf babies with developmental delays

Cochlear implants, or “bionic ears,” might improve intellectual development in deaf babies who have developmental delays, according to a Stanford study that challenges popular belief among doctors.

The pioneer of preemie care

Phillip Sunshine, MD, has been helping preemies since he arrived at Stanford in 1957, when the discipline of neonatology was still in its infancy.

Researchers design more accurate method of determining premature infants’ risk of illness

Stanford researchers have developed PhysiScore, a non-invasive way of electronically scoring and assessing a baby’s well-being and predicting whether future medical treatment might be needed.

New work on preemies’ neurological problems

Packard Children’s neonatologist Anna Penn examines the role of the placenta in brain development.

Antibiotic use in California neonatal intensive care units varies widely, study finds

A study of hospitals in California found that how often doctors use antibiotics to treat infants differs from hospital to hospital and that using more antibiotics isn’t always better for patients.

Countdown to Childx: Global health expert Gary Darmstadt on improving newborn survival

Gary Darmstadt, MD, is working to improve infant care for babies in developing countries. Simple practices like better hygiene and breastfeeding could make the difference between life and death for millions of babies worldwide.

New focus for university’s global health efforts

A new inter-disciplinary course – in which students collaborate on projects to address global needs – epitomizes Stanford’s approach to global health research.

A new guide for how to feed the smallest preemies

The new toolkit gives guidance for medical caregivers on nutrition for very-low-birth-weight babies and reflects advances published since the last version came out in 2008.

Nurse talking to concerned father while looking at the medical chart on clipboard of patient who is in an incubator at neonatal intensive care unit
(Image credit: Getty Images)

Helping parents

Becoming the parent of a baby who arrives early can be quite overwhelming.

Stanford physicians and nurses have undertaken several projects to improve collaboration with preemies’ moms and dads, including documenting the benefits of parents’ hands-on care, such as cuddling their baby or providing breast milk. Our teams also offer recognition and support for the trauma parents may experience when their child is ill.

Packard/Stanford child psychologist discusses how parents of preemies sometimes develop PTSD

Watching preemies fight for life in the NICU takes an emotional toll on their parents. Richard Shaw, MD, a child psychiatrist at Stanford, has studied how these experiences affect parents whose babies are born prematurely.

Strategies helped California hospitals improve breast milk feeding rates for preemies, researcher says

Stanford researchers and their collaborators worked to implement practices that would benefit premature babies at 11 hospitals in California. They found that improving breast milk feeding decreased a serious illness associated with prematurity.

Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges

A lot is uncertain about prognoses for babies born prematurely, rendering it difficult for doctors to communicate possible risks or outcomes to parents. A team at Stanford is attempting to make the counseling process easier for preemies’ parents.

New breast pumping approach helps preemies’ moms to improve milk supply, says Packard/Stanford study

Producing breast milk can be difficult for mothers of premature babies. A new approach – using both breast pumps and hand-expression techniques shortly after giving birth – developed by Stanford researchers is helping mothers breast feed their preemies.

Low-tech yet essential: Why parents are vital members of care teams for premature babies

Premature births can be emotionally difficult for parents, but the skin-to-skin contact that occurs when parents hold their babies “kangaroo-style” is essential for preemies to grow and heal.

NICU trauma intervention shown to benefit mothers of preemies

Parents of preemies often develop symptoms of anxiety, depression or PTSD from the stress of having a premature baby. Stanford researchers used an intervention technique that helped parents cope with the emotional difficulties associated with prematurity.

NICU family support program launched at children’s hospital

The program helps parents better understand the often complex issues their babies face and the treatments they will receive.

Newborn news, delivered each morning at Packard Children’s

At Packard Children’s Hospital, staff provide a “Your Baby’s Daily Update” filled with important information for parents of newborns.

The benefits of touch for babies, parents

Doctors at Packard Children’s Hospital recommend that new mothers incorporate physical touch with their babies into their routines because many studies have shown that skin-to-skin contact provides health benefits for both babies and mothers.

Pregnant woman and her female doctor in a consultation. Woman lying down while her doctor doing ultrasound examination.
(Image credit: Getty Images)

Understanding risk factors

For most of the 380,000 premature births that occur across the country each year, physicians can’t pinpoint a reason the baby comes early. Stanford scientists are working to identify factors that increase the risk of premature births across the population. And they’ve developed a blood test for pregnant women that can measure gene activity signals in the mother, fetus and placenta to predict which pregnancies will end in premature birth.

Genetic variation in progesterone receptor tied to prematurity risk

A key hormone receptor evolved quickly as early humans migrated from Africa, producing localized gene changes that may affect modern women’s risk of preterm birth, according to a Stanford-led study.

For pregnant soldiers, recent deployment linked to higher risk of premature delivery

Giving birth soon after military deployment is linked to greater risk of premature delivery, a Stanford study of U.S. servicewomen found, but deployment history itself does not raise prematurity risk.

Ahead of time: Predicting who will deliver a baby prematurely

Prematurity is the leading cause of death in infants around the world, but doctors still don’t understand why some babies are born prematurely. Researchers at Stanford are searching for risk factors to predict preterm births.

Pregnant women with PTSD more likely to give birth prematurely, study finds

Pregnant women with a recent diagnosis of post-traumatic stress disorder were 35 percent more likely to deliver a premature baby than were other pregnant women, a study of more than 16,000 births found.

Obesity before pregnancy linked to earliest preterm births, Stanford/Packard study finds

Women who are obese before they become pregnant face an increased risk of delivering their babies before 28 weeks of pregnancy, a new study of nearly 1 million California births has found.

New database expected to strengthen prematurity research

A new online tool will make it easier for researchers to share many types of data from scientific studies of premature birth.

Infections linked to premature births more common than thought, Stanford study finds

Fungal or bacterial infection in amniotic fluid, which may be linked to prematurity, is more common than doctors thought.

Bacterial community in pregnant women linked to preterm birth, study finds

A specific pattern of high bacterial diversity in the vagina during pregnancy increases a woman’s risk of giving birth prematurely, a new study finds.

Blood test for pregnant women can predict premature birth

Measuring RNA fragments in a pregnant woman’s blood gives a reliable estimate of the baby’s due date and can predict if the baby will arrive prematurely, a Stanford-led team has shown.

Doctor doing an ultrasound to a female asian patient at the hospital
(Image credit: Getty Images)

Biology of pregnancy

Although the basic trajectory of pregnancy – nine months from conception to birth – has been recognized for centuries, many aspects of its biology remain mysterious. Stanford scientists are uncovering previously unappreciated details such as how the placenta functions, how the mother’s immune system helps her body keep time during pregnancy and how certain maternal illnesses affect fetal development.

Immune system changes during pregnancy are precisely timed

A woman’s immune system changes throughout a normal pregnancy in a highly orchestrated manner, Stanford researchers have found. The findings lay the groundwork for tests to predict preterm birth.

Gone too soon: What’s behind the high U.S. infant mortality rate

Infant mortality is higher in the U.S. than in many other developed countries, largely due to premature births.

Zika infection causes developing cranial cells to secrete neurotoxic levels of immune molecules

New research shows that cranial neural crest cells can be infected by the Zika virus, causing them to secrete high levels of cytokines that can affect neurons in the developing brain.

Study shows no benefit from drug widely used to prevent premature labor

Stanford researchers found that repeated doses of nifedipine, which is given to women after episodes of preterm labor, doesn’t prevent premature labor.

Elevated blood-sugar levels in pregnancy tied to baby’s heart-defect risk

Congenital heart defects are correlated with moderate elevation of the mother’s blood sugar during pregnancy, even if she’s not diabetic, according to a new study.

A most mysterious organ: Looking for answers about the fetus’s lifeline

It’s the black sheep of human organs – the one we can’t wait to get rid of. Most often, it’s tossed in a bucket for early disposal. But Lucile Packard Children’s Hospital Neonatologist Anna Penn, MD, PhD, and Stanford neuroscientists Theo Palmer, PhD, and their colleagues are keen to get their hands on as many as possible.

A pregnant woman has an ultrasound scan with a doctor
(Image credit: Getty Images)

Safer pregnancies and births

Across most regions of the United States, maternal mortality rates are on the rise. The exception is California, where maternal deaths have dropped substantially in the last 10 years.

Two research groups housed at Stanford, the California Maternal Quality Care Collaborative and the California Perinatal Quality Care Collaborative, have made the difference. They are coordinating a statewide effort to spread evidence-based practices that safeguard the health of pregnant women and infants before, during and after birth. Detailed toolkits for how to handle obstetric emergencies such as hemorrhage, blood clots and preeclampsia give medical teams across the state a road map for saving lives when every minute counts.

When eclampsia makes a rare appearance, Packard Children’s team is ready

Doctors at Packard Children’s were prepared to help when they noticed Veronica De La Cruz’s symptoms of eclampsia, a rare condition in which high blood pressure can cause potentially deadly seizures in pregnant women.

How California reversed the national trend of rising maternal mortality

Compared to other developed countries, three times as many women die during or shortly after birth in the United States. California is an exception to this trend, in part because of researchers studying what causes these maternal deaths.

New obstetric hemorrhage toolkit

Stanford researchers have developed a toolkit for maternal hemorrhaging to help doctors recognize and respond to this rare but dangerous event.

New toolkit aims to prevent dangerous blood clots in pregnancy

A new toolkit developed by Stanford researchers helps doctors identify and treat venous thromboembolism, which can cause fatal blood clots in pregnant women.

New preeclampsia toolkit will help prevent maternal deaths

High blood pressure toward the end of pregnancy can escalate into a condition called preeclampsia. Stanford researchers have developed a new toolkit to prevent maternal deaths from this rare but potentially fatal condition.

Unneeded cesareans are risky and expensive

Many cesarean sections in California are unnecessary, putting mothers at risk from complications and increasing health care costs.

New targets for lowering maternal mortality

The Stanford-based California Maternal Quality Care Collaborative has taken a multi-pronged approach to reducing preventable maternal deaths among California women.

father touching head of a premature baby in a incubator at the Neonatal Intensive Care Unit in hospital
(Image credit: Getty Images)

Preemies we’ve helped

Every day, experts at the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital Stanford assist pregnant women and premature infants navigating high-risk diagnoses. Meet some of our Neonatal Intensive Care Unit graduates and their parents.

Side by side by side: Saving the Luevanos triplets

The three identical boys shared one placenta, and blood vessels connected the triplets. After doctors at Texas Children’s Hospital surgically sealed off the blood vessels using lasers, a team at Packard Children’s successfully delivered the three healthy boys.

Twins who shared amniotic sac, a potentially deadly condition, now home with mom and dad

Kate and Annie, twin girls who shared the same amniotic sac, made it home for Christmas after Stanford doctors performed an emergency cesarean.

Boy undergoes complex liver, kidney transplants – all before age 3

Dane Conrads was “desperately ill” when he received his liver transplant in 2014. More recently, he also benefited from one of the most complicated kidney transplants ever performed at Packard Children’s Hospital.

Newborn with heart defect saved after 13-hour operation

The baby’s condition, tetralogy of Fallot, was complicated by the fact that he was also missing his pulmonary valve and one of his pulmonary arteries was detached. But a doctor gave the distraught parents a glimmer of hope.

Innovative oxygen therapy helps to save unborn baby with deadly heart defect

Prenatal oxygen treatment plus fast and aggressive action after birth helped a San Jose baby born at Lucile Packard Children’s Hospital survive until he could undergo surgical repair of his heart at 11 days old.

Packard Children’s has smallest child yet to get pacemaker

Jaya Maharaj, who weighed just 3.5 pounds after birth, is the smallest baby to receive a pacemaker.

One-in-a-million: Naturally conceived quads leave Packard Children’s

The odds of quadruplets being conceived without fertility treatments is about 1 in 729,000. Samantha Weng had four baby girls delivered by emergency cesarean at Packard Children’s.

Produced by Sofie Bates