1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

Article Content

One of the most popular AJN covers in recent years bears a photograph of a premature infant on his father's outstretched hand (November 2002). Michael "Misha" Alexander Scott, weighing 2 lbs., 11 oz. at 26.5 weeks of age, opened his eye at the exact moment his mother snapped the picture. There is something quite moving about the images of premature infants, some weighing even less than Misha, who live and sometimes die surrounded by tubes, wires, pumps. And there's also something quite powerful in images of nurses who care for preemies and their families. This month's cover photograph, a judges' choice in our recent photojournalism contest and exhibition (see page 29), portrays the neonatal intensive care unit (NICU) nurses who work so hard to save these tiny lives.


There's much that nurses must do to prevent premature births. This month, AJN publishes a study of the costs of prematurity by Katherine D. Cuevas, Debra R. Silver, Dorothy Brooten, JoAnne M. Youngblut, and Charles M. Bobo (see page 56). These researchers have contributed to a growing body of evidence showing that the costs of the initial hospitalization increase as birth weight or gestational age decrease. The difference in cost between normal-birth-weight infants and the lowest-birth-weight infants is stunning: an average of $5,816 for the former group, compared with $250,596 for the latter.


Cuevas and colleagues point out that infertility treatments are contributing to prematurity and poor neonatal outcomes. The December 2004 issue of Fertility and Sterility features a metaanalysis conducted by McGovern and colleagues of studies examining premature, singleton births after in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT). Although prematurity might be expected with multiple implantations (imagine quadruplets pushing to find room in the womb), the authors concluded that the risk of having a premature birth in singleton pregnancies after IVF or GIFT was twice as high as with natural conception. And in the January-February 2005 issue of Human Reproductive Update, Ombelet and colleagues commented on the fact that the "multifetal pregnancies" arising from IVF are associated with an increase in the "incidence of maternal, perinatal, and childhood morbidity and mortality"; they call for collecting more data on IVF techniques, sharing the data with policymakers, and linking reimbursement policies with best practices.


Nurse researchers show the high costs of prematurity.

FIGURE. No caption a... - Click to enlarge in new windowFIGURE. No caption available.

There must be greater investment in preventive measures. Nancy Sharts-Hopko and Margaret Comerford Freda have written commentaries in this issue on prematurity, its risk factors, and why it's relevant to all nurses (see pages 60 and 61). Indeed, most nurses see pregnant women in their personal, if not professional, lives. All of us have opportunities to engage in the primary prevention of prematurity-to urge women to get prenatal care and adequate nutrition and to ask careful questions about IVF and GIFT.


The March of Dimes urges that the limits on income for eligibility for Medicaid (currently at 133% of the poverty level, or $20,841 for a family of three) not be lowered, so that women's access to prenatal care will not be compromised. According to the Robert Wood Johnson Foundation, 83% of the uninsured are in families with a working head of household. Even when employers provide health insurance options, rising employee-paid premiums, deductibles, and copayments can cause some families to bypass insurance coverage, further restricting women's access to prenatal care. The March of Dimes also promotes the Prevent Prematurity and Improve Child Health Act of 2005, reintroduced in Congress with bipartisan support. This act would, among other things, provide more federal resources for prenatal care.


I applaud the NICU nurses who save and rebuild lives in their everyday work, but I wish we didn't need so many of them. The NICU nurses I've talked with would like nothing better than to see healthy babies born into healthy families.