A normal pregnancy lasts between 38 to 40 weeks. A premature baby or preemie as it is called is now that is delivered before 37 weeks of gestation. Premature babies are underweight because they have not had the chance to develop fully inside the mother's womb. They are fragile besides being small and in the initial days or months require special care that is provided in neonatal intensive care units.

However not all hospitals are equipped with modern facilities required to deliver neonatal care to premature babies. In such conditions, chances of a baby's survival are minimal. An article published in the July 20, 2005 issue of the Journal of American Medical Association says premature babies encounter the following problems in early life:
* Anemia
* Feeding problems
* Breathing problems
* Jaundice
* Issues with regulation of body temperature.

Small hospitals with basic facilities are not well versed in handling these problems. The issues are acute because at least 12.5 percent of babies born in the United States are premature by virtue of being delivered before 37 weeks of gestation. Babies born just a few weeks before this timeline may not require special care, but some 1 percent that are born before 32 weeks need constant care.

The present study by researchers at the Stanford University School of Medicine examined how premature babies fared in California between 1991 and 2000. Around 48,237 babies were followed during the study. Premature babies were defined as weighing 500 grams and 1,500 grams at birth, which is roughly the period equating to 32 weeks of gestation.

Researchers said premature babies were able to survive if they were born at hospitals that had specialized neonatal care units. Large medical centers that delivered at least 100 "ultra-low-weight" premature babies fell under this segment. Such hospitals were also able to provide a variety of advanced medical services because they had experienced teams to handle any complications.

Fetal and infant mortality was the lowest in hospitals that had tertiary neonatal intensive care units. But researchers reported in the May 24 issue of the New England Journal of Medicine that just 35 percent of babies were born at large, well-equipped centers in 1991, while 21.6 percent babies were born in such centers in 2000.

The study authors said at least 21 percent of premature baby deaths were preventable in 2000 only if smaller hospitals had shifted these babies to centers with tertiary neonatal units. The study had some limitations in that it only assesses infant mortality, while conditions like intraventricular hemorrhage and chronic lung disease were ignored. These conditions are important because they impact the future life of the baby.

Furthermore better obstetrical care was available at large hospitals, which meant women were able to receive rapid emergency cesarean section when required, thus preventing potential death of the baby.

The authors concluded by saying that regional centers need to pool resources in order to prevent complications arising as a result of premature birth. Premature babies can be very ill and therefore need special care and attention in the early months of their life.

If women feel they have a chance of delivering prematurely, it is better to shift to large centers where round the clock monitoring of the baby as well as the mother is possible.

Main Study
"Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants."
Phibbs, Ciaran S, Baker, Laurence C, Caughey, Aaron B, Danielsen, Beate, Schmitt, Susan K, Phibbs, and Roderic H.
N Engl J Med 2007 356: 2165-2175.
Volume 356:2165-2175, May 24, 2007, Number 21