About the series

Why a series about premature births? Perhaps more than anything, it was that $76.8-million building. The backhoes started chewing up the earth next to Women & Infants Hospital in Providence in 2007, and one major purpose was to make room for all the preemies, who today crowd into a space too small by half.

Clearly there's no end in sight to the stream of babies born too early. Journal medical writer Felice J. Freyer wanted to better understand why this is happening, and what premature births mean for families and society. Freyer won a 2007 Media Fellowship from the Kaiser Family Foundation to explore the question. Over the ensuing months she talked with doctors, nurses, researchers, mothers, fathers and children to develop this portrait of an American epidemic. Meanwhile, Women & Infants’ new building has risen five stories high and is scheduled to open Sept. 14, 2009.

Felice J. Freyer has been The Providence Journal's medical writer since 1989. She first wrote about premature babies in 1990, in a story that won the Will Solimene Award for Excellence in Medical Communication from the America Medical Writers Association. She has also won honors for stories about a woman’s struggle with depression, a terminally ill man who sought the right to kill himself with a doctor’s help, and a woman who gave her kidney to a stranger. Her 2003 account of a fire survivor's recovery was among the stories in The Journal’s Station nightclub package, which was a finalist for the Pulitzer Prize. In 2007, Freyer won the second place award for Excellence in Health Care Reporting from the Association of Health Care Journalists, for her story about the first American to undergo brain surgery to treat obsessive-compulsive disorder. Recently the New England Society of Newspaper Editors named her the 2008 "Master Reporter." E-mail Felice Freyer

Kathy Borchers has been a Journal photographer since 1985. A native of Dayton, Ohio, she was a photographer at The Louisville (Kentucky) Courier-Journal and The Topeka (Kansas) Capital-Journal before coming to Providence. She recently worked on the series about four eighth-grade students making the transition to high school, and photographed Taylor Marcello, a Scituate girl who is a primordial dwarf. She has been a winner in the Robert F. Kennedy Journalism Awards, has won an Award of Excellence in the National Press Photographers Pictures of the Year competition, and has won several awards in the Boston Press Photographers Association. E-mail Kathy Borchers

Production

The Price of Miracles is a collaboration among The Providence Journal's print and online teams, including projo.com chief designer Mike Foran, designer Beth Heaney, graphic artist Tom Murphy, assistant city editor Tony Laroche, photo editor / page designer Cecilia Préstamo, visuals managing editor Michael Delaney and news producer maria caporizzo. It was edited by managing editor Susan Areson.

© 2009, Published by The Providence Journal Co., 75 Fountain St., Providence, RI 02902

Sources

Thanks to Dr. James F. Padbury, pediatrician-in-chief at Women & Infants Hospital, for providing background information for the “Every Day Matters” graphic and checking its accuracy.

The “Are You at Risk?” graphic drew from a multitude of sources, including some diligent data-crunching by Samara Viner-Brown and Rachel Cain of the Rhode Island Department of Health, who gathered information from the state’s Maternal and Child Health Database. The Web pages for the March of Dimes Prematurity Campaign and its data source, Peristats, were also invaluable resources.

Information on the cost of premature birth came from the U.S. Agency for Healthcare Research and Quality (thanks to Anne Elixhauser and Bob Isquith), Blue Cross & Blue Shield of Rhode Island, and United Healthcare.

The following publications were also among our sources.

Preterm Birth: Causes, Consequences and Prevention, The Institute of Medicine, National Academies Press, 2007 (Order pdf or book, cost $54-$82).

Three-part report in The Lancet (volume 371) (subscription required for full text, no charge for abstracts):  “Epidemiology and Causes of Preterm Birth,” Robert L. Goldenberg et al, Jan. 5, 2008; “Primary, secondary and tertiary interventions to reduce the morbidity and mortality of preterm birth,” Jay D. Iams, et al, Jan. 12, 2008; “An overview of the mortality and sequelae of preterm birth from infancy to adulthood,”  Saroj Saigal and Lex W. Doyle,  Jan. 19, 2008.

Born Too Soon: Premature Births in the U.S. Black Population, March of Dimes, August 2007.

“Committee Opinion: Late Preterm Births.” American College of Obstetricians and Gynecologists. (registration required for committee opinion).

“Cost of Hospitalization for Preterm and Low Birth Weight Infants in the United States,” Rebecca B. Russell et al, Pediatrics, July 2007.

Dane County Birth Outcomes Investigation, Dr. Thomas Schlenker and Dr. Mamadou Ndiaye, Feb. 19, 2008 (PowerPoint presentation).

 “Effect of Late-Preterm Birth and Maternal Medical Conditions on Newborn Morbidity Risk,” Carrie K. Shapiro et al, Pediatrics, vol. 121, Feb. 2,  2008.

"Extreme Prematurity ––The Continuing Dilemma" By Betty R. Vohr and Marilee Allen, New England Journal of Medicine, Jan. 6, 2005.

Group Prenatal Care and Perinatal Outcomes: A Randomized Controlled Trial. Jeannette R. Ickovics et al, Obstretics and Gynecology, August 2007 (abstract only).

“Management and Outcomes of Very Low Birth Weight,” Eric C. Eichenwald and Ann R. Stark, New England Journal of Medicine, April 17, 2008. (subscription required).

“Neurologic and Developmental Disability at Six Years of Age after Extremely Preterm Birth,” Neil Marlow et al, The New England Journal of Medicine, Jan. 6, 2005.

"Perinatal Care at the Threshold of Viability," Clinical Report, American Academy of Pediatrics.

Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality, Fleda Mask Jackson, Joint Center for Political and Economic Studies Health Policy Institute, Washington, D.C. 2007.

 “Recent Trends in Infant Mortality in the United States,” National Center for Health Statistic, Brief, October 2008.

“The Relationship Between Cesarean Delivery and Gestational Age Among US Singleton Births," Vani R. Bettegowda, et al, Clinics in Perinatology, 2008, (abstract only).

Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination. James W. Collins Jr. et al. American Journal of Public Health, December 2004.