[Congressional Record Volume 151, Number 37 (Tuesday, April 5, 2005)]
[Senate]
[Pages S3212-S3214]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ALEXANDER (for himself and Mr. Dodd):
  S. 707. A bill to reduce preterm labor and delivery and the risk of 
pregnancy-related deaths and complications due to pregnancy, and to 
reduce infant mortality caused by prematurity; to the Committee on 
Health, Education, Labor and Pensions.
  Mr. ALEXANDER. Mr. President, today I am reintroducing the 
Prematurity Research Expansion and Education for Mothers who deliver 
Infants Early Act, or PREEMIE Act. This bipartisan bill expands 
research into the causes and prevention of prematurity, babies born 3 
weeks or more early, and increases education and support services 
related to prematurity. I am pleased that Senator Dodd is once again my 
partner on this legislation and we hope the Senate will pass the 
PREEMIE Act in this Congress.
  In June 2004, the Subcommittee on Children and Families, which I 
chaired, held a hearing to learn about the problem of premature birth. 
Unfortunately, Tennessee has the fourth highest rate of premature birth 
in the country. Fourteen percent of Tennessee babies are born 
prematurely. In an average week in Tennessee, 210 babies are born 
prematurely. Premature infants are 14 times more likely to die in the 
first year of life. It is the No. 1 cause of infant death in the first 
month of life. Premature babies who survive may suffer lifelong 
consequences including: cerebral palsy, mental retardation, chronic 
lung disease, and vision and hearing loss.
  In February 2004, the National Center for Health Statistics, NCHS, 
reported the first increase in the U.S. infant mortality rate since 
1958, from 6.8 infant deaths per 1,000 live births in 2001 to 7.0 in 
2000. This increase is extremely disturbing because the infant 
mortality rate is a measure of the health of society. NCHS subsequently 
reported that 61 percent of this increase in infant mortality was due 
to an increase in the birth of premature and low birthweight babies. 
Almost half the cases of premature birth have no known cause--any 
pregnant woman is at risk. We must address this issue.
  Finally, this is a costly problem. In 2002, the estimated charges for 
hospital stays for infants with a diagnosis of preterm birth or low 
birthweight, LBW, were $15.5 billion. The average hospital charge per 
infant stay with a principal diagnosis of prematurity/LBW was $79,000, 
with an average hospital stay of 24.2 days. Hospital charges for 
newborn stays without complications averaged $1,500 in 2002, with an 
average hospital stay of 2.0 days. Employers carry much of the burden. 
Almost half of that $15.5 billion was billed to employers or other 
private insurers, according to the March of Dimes. The other half is 
billed to Medicaid.
  As a nation, we must address this problem. The PREEMIE Act calls for 
expanding Federal research related to preterm labor and delivery and 
increasing public and provider education and support services. It is 
supported by the March of Dimes, the American Academy of Pediatrics, 
the American College of Obstetricians and Gynecologists, the 
Association of Women's Health, Obstetric and Neonatal Nurses, and many 
others.
  I hope my colleagues will join me in the fight to ensure a healthy 
start for all of American's children by cosponsoring and working with 
me for passage of the PREEMIE Act during this Congress.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 707

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Prematurity Research 
     Expansion and Education for Mothers who deliver Infants Early 
     Act'' or the ``PREEMIE Act''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress makes the following findings:
       (1) Premature birth is a serious and growing problem. The 
     rate of preterm birth increased 27 percent between 1982 and 
     2002 (from 9.4 percent to 11.9 percent). In 2001, more than 
     480,000 babies were born prematurely in the United States.
       (2) Preterm birth accounts for 24 percent of deaths in the 
     first month of life.
       (3) Premature infants are 14 times more likely to die in 
     the first year of life.
       (4) Premature babies who survive may suffer lifelong 
     consequences, including cerebral palsy, mental retardation, 
     chronic lung disease, and vision and hearing loss.
       (5) Preterm and low birthweight birth is a significant 
     financial burden in health care. The estimated charges for 
     hospital stays for infants with any diagnosis of prematurity/
     low birthweight were $15,500,000,000 in 2002. The average 
     lifetime medical costs of a premature baby are conservatively 
     estimated at $500,000.
       (6) The proportion of preterm infants born to African-
     American mothers (17.3 percent) was significantly higher 
     compared to the rate of infants born to white mothers (10.6 
     percent). Prematurity or low birthweight is the leading cause 
     of death for African-American infants.
       (7) The cause of approximately half of all premature births 
     is unknown.
       (8) Women who smoke during pregnancy are twice as likely as 
     nonsmokers to give birth to a low birthweight baby. Babies 
     born to smokers weigh, on average, 200 grams less than 
     nonsmokers' babies.
       (9) To reduce the rates of preterm labor and delivery more 
     research is needed on the underlying causes of preterm 
     delivery, the development of treatments for prevention of 
     preterm birth, and treatments improving outcomes for infants 
     born preterm.
       (b) Purposes.--It the purpose of this Act to--
       (1) reduce rates of preterm labor and delivery;
       (2) work toward an evidence-based standard of care for 
     pregnant women at risk of preterm labor or other serious 
     complications, and for infants born preterm and at a low 
     birthweight; and
       (3) reduce infant mortality and disabilities caused by 
     prematurity.

     SEC. 3. RESEARCH RELATING TO PRETERM LABOR AND DELIVERY AND 
                   THE CARE, TREATMENT, AND OUTCOMES OF PRETERM 
                   AND LOW BIRTHWEIGHT INFANTS.

       (a) General Expansion of NIH Research.--Part B of title IV 
     of the Public Health Service Act (42 U.S.C. 284 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 409J. EXPANSION AND COORDINATION OF RESEARCH RELATING 
                   TO PRETERM LABOR AND DELIVERY AND INFANT 
                   MORTALITY.

       ``(a) In General.--The Director of NIH shall expand, 
     intensify, and coordinate the activities of the National 
     Institutes of Health with respect to research on the causes 
     of preterm labor and delivery, infant mortality, and 
     improving the care and treatment of preterm and low 
     birthweight infants.
       ``(b) Authorization of Research Networks.--There shall be 
     established within the National Institutes of Health a 
     Maternal-Fetal Medicine Units Network and a Neonatal Research 
     Units Network. In complying with this subsection, the 
     Director of NIH shall utilize existing networks.
       ``(c) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, such 
     sums as may be necessary for each of fiscal years 2005 
     through 2009.''.
       (b) General Expansion of CDC Research.--Section 301 of the 
     Public Health Service Act (42 U.S.C. 241 et seq.) is amended 
     by adding at the end the following:
       ``(e) The Director of the Centers for Disease Control and 
     Prevention shall expand, intensify, and coordinate the 
     activities of the Centers for Disease Control and Prevention 
     with respect to preterm labor and delivery and infant 
     mortality.''.
       (c) Study on Assisted Reproduction Technologies.--Section 
     1004(c) of the Children's Health Act of 2000 (Public Law 106-
     310) is amended--
       (1) in paragraph (2), by striking ``and'' at the end;
       (2) in paragraph (3), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(4) consider the impact of assisted reproduction 
     technologies on the mother's and children's health and 
     development.''.
       (d) Study on Relationship Between Prematurity and Birth 
     Defects.--
       (1) In general.--The Director of the Centers for Disease 
     Control and Prevention shall conduct a study on the 
     relationship between prematurity, birth defects, and 
     developmental disabilities.
       (2) Report.--Not later than 2 year after the date of 
     enactment of this Act, the Director of the Centers for 
     Disease Control and Prevention shall submit to the 
     appropriate committees of Congress a report concerning the 
     results of the study conducted under paragraph (1).

[[Page S3213]]

       (e) Review of Pregnancy Risk Assessment Monitoring 
     Survey.--The Director of the Centers for Disease Control and 
     Prevention shall conduct a review of the Pregnancy Risk 
     Assessment Monitoring Survey to ensure that the Survey 
     includes information relative to medical care and 
     intervention received, in order to track pregnancy outcomes 
     and reduce instances of preterm birth.
       (f) Study on the Health and Economic Consequences of 
     Preterm Birth.--
       (1) In general.--The Director of the National Institutes of 
     Health in conjunction with the Director of the Centers for 
     Disease Control and Prevention shall enter into a contract 
     with the Institute of Medicine of the National Academy of 
     Sciences for the conduct of a study to define and address the 
     health and economic consequences of preterm birth. In 
     conducting the study, the Institute of Medicine shall--
       (A) review and assess the epidemiology of premature birth 
     and low birthweight, and the associated maternal and child 
     health effects in the United States, with attention paid to 
     categories of gestational age, plurality, maternal age, and 
     racial or ethnic disparities;
       (B) review and describe the spectrum of short and long-term 
     disability and health-related quality of life associated with 
     premature births and the impact on maternal health, health 
     care and quality of life, family employment, caregiver 
     issues, and other social and financial burdens;
       (C) assess the direct and indirect costs associated with 
     premature birth, including morbidity, disability, and 
     mortality;
       (D) identify gaps and provide recommendations for feasible 
     systems of monitoring and assessing associated economic and 
     quality of life burdens associated with prematurity;
       (E) explore the implications of the burden of premature 
     births for national health policy;
       (F) identify community outreach models that are effective 
     in decreasing prematurity rates in communities;
       (G) consider options for addressing, as appropriate, the 
     allocation of public funds to biomedical and behavioral 
     research, the costs and benefits of preventive interventions, 
     public health, and access to health care; and
       (H) provide recommendations on best practices and 
     interventions to prevent premature birth, as well as the most 
     promising areas of research to further prevention efforts.
       (2) Report.--Not later than 1 year after the date on which 
     the contract is entered into under paragraph (1), the 
     Institute of Medicine shall submit to the Director of the 
     National Institutes of Health, the Director of the Centers 
     for Disease Control and Prevention, and the appropriate 
     committees of Congress a report concerning the results of the 
     study conducted under such paragraph.
       (g) Evaluation of National Core Performance Measures.--
       (1) In general.--The Administrator of the Health Resources 
     and Services Administration shall conduct an assessment of 
     the current national core performance measures and national 
     core outcome measures utilized under the Maternal and Child 
     Health Block Grant under title V of the Social Security Act 
     (42 U.S.C. 701 et seq.) for purposes of expanding such 
     measures to include some of the known risk factors of low 
     birthweight and prematurity, including the percentage of 
     infants born to pregnant women who smoked during pregnancy.
       (2) Report.--Not later than 1 year after the date of 
     enactment of this Act, the Administrator of the Health 
     Resources and Services Administration shall submit to the 
     appropriate committees of Congress a report concerning the 
     results of the evaluation conducted under paragraph (1).

     SEC. 4. PUBLIC AND HEALTH CARE PROVIDER EDUCATION AND SUPPORT 
                   SERVICES.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.) is amended by adding at the end the 
     following:

     ``SEC. 399O. PUBLIC AND HEALTH CARE PROVIDER EDUCATION AND 
                   SUPPORT SERVICES.

       ``(a) In General.--The Secretary, directly or through the 
     awarding of grants to public or private nonprofit entities, 
     shall conduct a demonstration project to improve the 
     provision of information on prematurity to health 
     professionals and other health care providers and the public.
       ``(b) Activities.--Activities to be carried out under the 
     demonstration project under subsection (a) shall include the 
     establishment of programs--
       ``(1) to provide information and education to health 
     professionals, other health care providers, and the public 
     concerning--
       ``(A) the signs of preterm labor, updated as new research 
     results become available;
       ``(B) the screening for and the treating of infections;
       ``(C) counseling on optimal weight and good nutrition, 
     including folic acid;
       ``(D) smoking cessation education and counseling; and
       ``(E) stress management; and
       ``(2) to improve the treatment and outcomes for babies born 
     premature, including the use of evidence-based standards of 
     care by health care professionals for pregnant women at risk 
     of preterm labor or other serious complications and for 
     infants born preterm and at a low birthweight.
       ``(c) Requirement.--Any program or activity funded under 
     this section shall be evidence-based.
       ``(d) NICU Family Support Programs.--The Secretary shall 
     conduct, through the awarding of grants to public and 
     nonprofit private entities, projects to respond to the 
     emotional and informational needs of families during the stay 
     of an infant in a neonatal intensive care unit, during the 
     transition of the infant to the home, and in the event of a 
     newborn death. Activities under such projects may include 
     providing books and videos to families that provide 
     information about the neonatal intensive care unit 
     experience, and providing direct services that provide 
     emotional support within the neonatal intensive care unit 
     setting.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, such 
     sums as may be necessary for each of fiscal years 2005 
     through 2009.''.

     SEC. 5. INTERAGENCY COORDINATING COUNCIL ON PREMATURITY AND 
                   LOW BIRTHWEIGHT.

       (a) Purpose.--It is the purpose of this section to 
     stimulate multidisciplinary research, scientific exchange, 
     and collaboration among the agencies of the Department of 
     Health and Human Services and to assist the Department in 
     targeting efforts to achieve the greatest advances toward the 
     goal of reducing prematurity and low birthweight.
       (b) Establishment.--The Secretary of Health and Human 
     Services shall establish an Interagency Coordinating Council 
     on Prematurity and Low Birthweight (referred to in this 
     section as the Council) to carry out the purpose of this 
     section.
       (c) Composition.--The Council shall be composed of members 
     to be appointed by the Secretary, including representatives 
     of--
       (1) the agencies of the Department of Health and Human 
     Services; and
       (2) voluntary health care organizations, including 
     grassroots advocacy organizations, providers of specialty 
     obstetrical and pediatric care, and researcher organizations.
       (d) Activities.--The Council shall--
       (1) annually report to the Secretary of Health and Human 
     Services on current Departmental activities relating to 
     prematurity and low birthweight;
       (2) plan and hold a conference on prematurity and low 
     birthweight under the sponsorship of the Surgeon General;
       (3) establish a consensus research plan for the Department 
     of Health and Human Services on prematurity and low 
     birthweight;
       (4) report to the Secretary of Health and Human Services 
     and the appropriate committees of Congress on recommendations 
     derived from the conference held under paragraph (2) and on 
     the status of Departmental research activities concerning 
     prematurity and low birthweight;
       (5) carry out other activities determined appropriate by 
     the Secretary of Health and Human Services; and
       (6) oversee the coordination of the implementation of this 
     Act.

     SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

       There are authorized to be appropriated to carry out this 
     Act, such sums as may be necessary for each of fiscal years 
     2005 through 2009.

  Mr. DODD. Mr. President, I rise today to join Senator Alexander in 
reintroducing the Prematurity Research Expansion and Education for 
Mothers Who Deliver Infants Early (PREEMIE) Act--legislation intended 
to address the growing crisis of premature birth in our nation.
  I think when many of us hear about a baby being born early, we don't 
give much thought to what it means. After all, it is not all that 
uncommon--I'm sure that almost all of my colleagues knows someone born 
prematurely. Thanks to modem medicine it is also not uncommon for a 
baby born early to end up healthy and happy.
  But this feeling that prematurity is somehow ``normal'' or to be 
expected masks a growing health crisis. Prematurity has real 
consequences in health and economic terms. We need to bring to light 
this issue that affects some of the most vulnerable members of our 
society: newborn babies.
  As a member of the Health, Education, Labor, and Pensions (HELP) 
Committee I, along with my colleagues, have devoted much time and 
effort to improving the health of our nation's children and infants. 
And yet despite our efforts, the problem of prematurity continues to 
persist and even grow. What is so striking about prematurity is how 
many parents face these enormous emotional and financial burdens. 
Nearly 1 out of every 8 babies in the United States is born 
prematurely--that's 1,300 babies each day, and over 470,000 each year 
(including more than 4,000 in my home state of Connecticut).
  Despite all of the health care advances of the last decades, the 
problem of prematurity is not in any way abating. According to recent 
data released by the National Center for Health Statistics, in 2002 the 
infant mortality rate actually increased for the first time since 1958. 
Much of this increase is attributable to infant death in the

[[Page S3214]]

first month of life--of which prematurity is the leading cause. Since 
1981, the premature birth rate has increased by 27 percent. This stands 
in stark contrast to some of the breathtaking medical discoveries of 
the past two decades. We can now treat and even cure many types of 
cancer, but we can't prevent babies from being born too soon.
  Mr. President, the consequences of prematurity are devastating. As I 
mentioned earlier, it is the leading cause of neonatal death--a tragedy 
that no family should have to face. For those infants that survive, a 
lifetime of severe health problems is not uncommon. Prematurity has 
been linked to such long-term health problems as cerebral palsy, mental 
retardation, chronic lung disease, and vision and hearing loss. 
Premature babies have the deck stacked against them from the moment 
they are born. And even in the fortunate cases where there are no life-
long health consequences, the experience of a premature birth takes an 
enormous emotional toll on a family.
  Prematurity also carries a significant economic cost. According to a 
recent study conducted by the March of Dimes, hospitalizations due to 
prematurity cost a total of $15.5 billion during the year 2002--
accounting for nearly half of all hospital charges for infants in this 
country. And this number does not even include the cost of care for 
problems later in life resulting from a premature birth. Much of this 
cost falls on employers who are already bearing the weight of 
skyrocketing health care costs.
  Given the emotional and economic toll that prematurity takes on this 
country, we know remarkably little about why it happens, and how it can 
be prevented. Some of the risk factors associated with preterm birth 
are known, including advanced age of the mother, smoking, and certain 
chronic diseases. But nearly 50 percent of all premature births have no 
known cause. And because we know so little about the causes of 
prematurity, we also do not know how to prevent it.
  For such a large (and growing) problem, it is astounding how little 
we know. It is critical that we make a national commitment to solving 
this puzzle. We must do everything we can to expand research--both 
public and private--into the root causes of prematurity.
  Senator Alexander and I are introducing the PREEMIE Act for precisely 
this reason. Our bill would coordinate and expand research related to 
prematurity at the Federal level. It would also educate health care 
providers and the general public about the risks of prematurity, and 
measures that can be taken before and during pregnancy to prevent it. 
Pregnant mothers need to know the warning signs and symptoms of 
premature labor--and they need to know what to do if they begin to 
notice those signs.
  Finally, because we will never eliminate prematurity completely, our 
legislation would provide support services to families impacted by a 
premature birth. As we're investigating the causes of prematurity and 
increasing awareness in expectant parents, we need to reach out to the 
mothers and fathers across our country whose children are born too 
soon. We need to give them emotional support during the difficult days, 
weeks, and months that often follow a premature birth. We need to make 
sure that the doctors, nurses, and other hospital staff who care for 
premature babies are sensitive to the needs of their parents, their 
brothers, and their sisters. And we need to make sure that when the 
time finally comes to bring a premature baby home, parents have all the 
information they need to make that transition.
  It is my hope that this legislation will complement and support some 
of the efforts going on in the private sector--such as the March of 
Dimes ambitious campaign to increase public awareness and reduce the 
rate of preterm birth. I urge all of my colleagues to join us in 
support of this important legislation.
                                 ______