Premature babies are everywhere: tabloids brim with "miracle tots" who have survived against the odds, while broadsheets mull over reports such as last week's on the long-term effects on youngsters who, a few years ago, wouldn't have had a chance. Eighty per cent of them, according to this new study, are left with a mental or physical problem, a cost far worse than was previously thought.
But these babies are the tiniest infants who can possibly survive early birth, those born before 23 weeks' gestation. A premature baby, though, is defined as any who emerges before the 37th week of pregnancy (ie, three weeks before the official "term" date). Of the approximately 40,000 babies who are born prematurely every year in the UK, only a small proportion falls into this "youngest" category. The vast majority - about 37,000 - are born at 28 weeks or more. They are almost always old enough to survive; but are they old enough to escape unscathed, or is there a legacy for them, too?
Like most mothers of premature babies, I have always suspected that there is a legacy. Nearly 13 years ago, my daughter Rosie was born at 29 weeks weighing 2lbs 15oz: she spent two weeks on a ventilator and two months in an incubator. I always realised her early life had been very different from what nature intended: but it wasn't until I could compare it with the "normal" arrivals of her three younger sisters that I began to understand quite how different it had been.
Whereas my younger children emerged plump and alert from the safety of a womb that had nudged them out when it had done its job, Rosie was plucked skinny and sleepy from a uterus that intended - had pre-eclampsia and the surgeon's knife not intervened - to hold on to her for a good while yet. Whereas my later babies spent their early weeks attached to a breast, cuddled in my arms or lying within earshot, Rosie spent her first few weeks in a plastic box with little in the way of physical contact from anyone. Her breast milk was delivered (once she was well enough to take it at all) via a hard plastic tube, and she was surrounded by voices that were mostly alien, punctuated by the strange bings and bongs of special-care technology.
At nine weeks, I could interpret every nuance of my younger babies' cries, every murmur of their babbles, every syllable of their body language. When Rosie was nine weeks old I was just taking her home, and she was, comparatively speaking, a virtual stranger. It took a lot of toil and tears to claw back those two months; sometimes I feel I am clawing them back still. There is a time in life, short but crucial, when a baby belongs only to its mother and a mother belongs only to her baby: prematurity robs you of it, and while it's hard to quantify exactly what has gone, it's hard to believe it was nothing.
Richard Cooke, professor of neonatal medicine at Liverpool Women's Hospital and an adviser to the premature baby charity Bliss, agrees that there is almost bound to be a knock-on effect. He stresses that studies look at populations and not at individual children, but much of the data he quotes makes sobering listening for a mother like me. When they are older, premature babies of the sort of gestation and weight Rosie was, apparently, tend on average to have a lower IQ, take fewer GCSEs and do less well in those that they do take, socialise less effectively with their peer group and find it harder to concentrate. They also tend to be shorter, and have a higher tendency to asthma and eye problems.
It is, says Cooke, not surprising that the cards seem stacked against premature babies. "What you have to realise is that 40 weeks' gestation is the peak time, in the whole of human life, for brain growth," he says. "If you are born eight or 12 weeks early, you come to that crucial period of peak brain growth when you are still struggling to feed yourself, when you are not at your optimum weight and when your body is still dealing with other problems. The later effects may be subtle, but the overall effect will be felt if any organism is restricted in its time of peak growth."
According to Peter Pharoah, emeritus professor of public health at the University of Liverpool, it is unclear to doctors how far the effects of prematurity on brain development are due to the situation inside the womb before the birth, or to the effects on the baby once he or she is in the outside world. "A baby born prematurely may already have suffered from growth retardation inside the womb, which may be connected with the early delivery," he says. "And as well as this, there are going to be implications of being forced to breathe and regulate body temperature and survive outside the womb environment at a time when the body is designed for life inside."
In other words, a premature baby like Rosie - who had possibly suffered the effects of growth retardation associated with pre-eclampsia - could be doubly disadvantaged, firstly by being starved inside the womb, and then by having to cope with the external environment long before she was ready.
But there is good news, too, for parents like me. Firstly, doctors believe that while prematurity can never be the best start in life, it is not the final word. Evidence suggests that the effects of being born too soon can be mitigated by a supportive early environment. What's more, existing studies are inevitably outdated when it comes to an individual child's future: technology is improving all the time, so a child like Rosie cannot be compared with a group of older premature babies who will have been treated with now-outdated techniques.
And it's not just complicated technical stuff that makes a difference. It's sensitivity in special-care units, too. In our day at the special-care unit at St Thomas's Hospital in London, the lights glared out round the clock, the hubbub was constant and, if a baby needed a prompt to breathe, a sharp knock was delivered on the incubator side by a nurse. No longer, says Grenville Fox, a consultant neonatologist there. "These days we have quiet times during the day, and we turn down the lights at night. We'd never knock on the incubator wall to jolt a baby into breathing - we're aware of the shock that could cause," says Fox. "We're better at positioning the babies, too; we keep them in a foetal position as much as possible, and we lie them on fluid-filled mats to make their environment womb-like. In the past, there was a definite 'look' associated with prematurity - you'd see a child of eight or nine who still walked with their arms and legs splayed because they'd spent their early weeks in an unnatural position in an incubator. But you won't see that in the future."
Rosie knows the story of her early life, of course. But while we will never forget the difficulties and traumas of those weeks and months, she will never know them - not in her conscious mind, anyway. But I believe they have left their imprint.
A few weeks ago, I took her back to St Thomas's, and we stood together staring at the impossibly tiny figure of a baby who looked just as she once did. We both had tears in our eyes: me because I was seeing how far my daughter had come, she, I believe, because of a heightened sense of empathy that comes from having once been such a vulnerable person herself. When we left the unit, she turned and gave me a hug, and I realised that, while nothing can ever erase those awful early months, we will always go on making up for those cuddles we both needed but couldn't have.
