BEFORE THEIR TIME PREMATURE BIRTHS PRESENT COMPLEX HEALTH PROBLEMS AND INCUR GREAT EXPENSE - AND THEIR NUMBERS ARE RISING.

Byline: Mariko Thompson Staff Writer

For the first time since her week-old twin boys' birth, Brande Voss was told she could change their diapers. Amid the wires, tubes and blipping monitors that distinguish the neonatal intensive care unit from the nursery, she was gripped by fear.

Tyler and Trevor, born seven weeks premature on March 17, weighed 3 pounds, 3 ounces and 2 pounds, 10 ounces, respectively. With their reddish translucent skin and legs no thicker than candlesticks, her babies seemed like fragile ghosts. She didn't see how she could change them without hurting them.

``My husband jumped in and did it,'' recalls Voss, a Simi Valley resident. ``I was nervous. These babies are still supposed to be inside of you.''

A growing number of American babies are spending their first weeks of life in the confines of the NICU. In 2001, more than 476,000 babies, or about 12 percent, were born premature in the United States. Since 1981, preterm births have jumped 27 percent. Unable to breathe, eat or keep warm on their own, premature babies need machines and incubators to stay alive. Once they pass that test, they face the risk of lifelong health and developmental problems.

Full-term babies are delivered between 38 and 42 weeks. A premature baby spends fewer than 37 weeks in the uterus. The earliest a baby is considered viable is at 23 weeks.

A mother's risk factors for preterm delivery include being under the age of 17 or over the age of 35; carrying twins or multiple births; suffering from hypertension; or having uterine, cervical or placental abnormalities. But in half of all cases, the cause can't be determined, according to the March of Dimes.

That organization has launched an awareness campaign and pledged $7.7 million a year toward research on premature births. The problem transcends the individual family. Hospital care for premature infants has a major financial consequence. The average hospital charge for a preterm baby runs $58,000, compared to $4,300 for the typical newborn.

The earlier the baby is born, the greater the risk for learning and developmental disabilities that may require special education, says Dr. Douglas Cunningham, campaign chairman for the March of Dimes Southern California chapter. That, too, comes at a cost to society. The Los Angeles Unified School District spends about $13,000 per pupil for special education services for one year, compared to about $7,000 for general-education students.

``If you look at it from a public health standpoint, the cost is considerable,'' Cunningham says. ``Insurance companies list premature birth and treatment in the top five of the most difficult and financially troublesome diagnoses. Adults and children with severe body burns and those requiring organ transplant are in the same category.''

A miracle twice over

That Tyler and Trevor were born at all is a testament to reproductive technology and advances in treating high-risk pregnancies. Brande, 28, and her husband, Jeff, 31, conceived identical twins on their third and final attempt at in vitro fertilization. They were ecstatic. Because they were having twins, the couple were referred to a perinatalogist, a specialist in high-risk pregnancies. At their first visit, 15 weeks into the pregnancy, the couple received terrible news.

One twin, Tyler, was receiving most of the blood from the shared placenta, a condition called twin-to-twin transfusion. The disparity affects amniotic fluid levels and left Trevor trapped at the top of Brande's uterus without any of the cushioning fluid. Twin-to-twin transfusion also can lead to heart failure, which their doctor believed was happening to the boys. Brande and Jeff were told to think about terminating the pregnancy.

About 10 days later, the situation reversed. Trevor floated in amniotic fluid. The twins did not appear to have heart problems. But the twin-to- twin transfusion remained a problem for Trevor, who grew at a much slower rate. Once the weight gap between Tyler and Trevor became too extreme, doctors would have to deliver the twins. Brande and Jeff toured the NICU and prepared for a Caesarean section delivery.

At 31 weeks, Brande gave birth at the Tarzana campus of Encino-Tarzana Regional Medical Center.

At the Tarzana NICU, the sickest babies sleep in transparent incubators in a dark corner farthest from the door, away from all of the foot traffic. The babies who are almost healthy enough to go home are in cribs closest to the door.

On Day 35, Tyler and Trevor graduate from the incubator to what nurse Jamie Englert calls the ``big boy crib.'' The metal crib decorated with Easter bunnies is second from the door. Quilted blankets drape across the top, creating a tentlike effect.

Brande, with a willowy figure and dark, curly hair, arrives every day around lunchtime and sits in the rocking chair by the crib. The boys sleep about 22 hours a day.

With nurse Gila Hanks' guidance, Brande has learned to feed them, change them and bathe them. She goes home for dinner, then returns around 7:30 p.m. with Jeff to give the boys their bath.

``Being with them is better than sitting at home wondering what's going on,'' she says.

Anxious days

The first few weeks in the NICU were unsettling for Brande. Alarms constantly blared from heart-rate and breathing monitors. Babies who seemed stable one day looked gray the next. At 6 days old, Tyler contracted a staph infection and went on antibiotics for two weeks.

Pauses in breathing, called apneas, and a slowing heartbeat, known as bradycardia, are routine problems faced in the NICU. Because their immune systems aren't fully developed, premature babies also are susceptible to infections. More serious medical problems include respiratory distress syndrome and brain hemorrhage.

Generally, the longer the baby spends in the womb, the greater the odds of survival. Delivered at 25 weeks, the chances are 50-50. After 27 weeks, about 85 percent survive, says Dr. James Banks, medical director of the NICU at the Tarzana campus.

``For parents, it's like flying in the back of an airplane in turbulence,'' he says. ``You have no control and it's scary.''

Moving to the crib is one of several milestones for Tyler and Trevor. Tyler weighs 4 pounds, 10 ounces. Trevor has reached 3 pounds, 13 ounces. The feeding tubes and catheters are gone. They have started to anticipate their feedings by making fussy noises.

The boys are expected to remain in the NICU for a few more weeks, closer to what would have been their normal due date. Once they go home, Brande will have to keep them away from other children for at least three months.

Hanks helps to arrange the boys in Brande's arms, making sure their heads are supported.

``This is the first time I've held them both while I was standing up,'' Brande says, with a startled smile.

When they start to fuss, she returns the boys to their crib. Hanks layers them with blankets. The babies curl toward each other so that they're face to face. Trevor sucks Tyler's thumb.

``Oh my gosh,'' Brande says. ``That is so cool.''

She rushes for her camera and snaps away, joyous as only a mother can be.

The facts on preterm births

What we know about premature births:

--Everyday, 1,305 American babies - or 1 in 8 - are born too soon.

--Prematurity has increased 27 percent in 20 years.

--Risk factors for premature birth include: multiples births; complications such as bleeding or high blood pressure; having uterine, cervical or placental abnormalities; being under the age of 17 or over the age of 35; drinking alcohol, smoking cigarettes, or taking street drugs; having an untreated genital or urinary infection; insufficient weight gain during pregnancy; extreme stress.

--In nearly half of all cases, there is no known cause.

--Prematurity is the leading cause of death in the first month of a baby's life.

Five warning signs of preterm labor (prior to the 37th week of pregnancy):

--Contractions every 10 minutes or more often. They don't have to be painful.

--Clear, pink or brownish fluid leaking from the vagina.

--Feeling that the baby is pushing down.

--Low, dull backache.

--Cramps similar to those experienced during menstruation. May be accompanied by diarrhea.

For more information on the March of Dimes Prematurity Campaign, visit www.marchofdimes.com or call [phone].

- M.T.

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) ON THE COVER: Brande Voss holds Trevor and Tyler, who arrived prematurely due to a condition in the womb known as twin-to-twin transfusion.

(2 -- 3) Trevor and Tyler Voss, who were born March 17, seven weeks premature, doze in the neonatal intensive care unit of Encino-Tarzana Regional Medical Center. The boys sleep an average of 22 hours each day. Below, Tyler Voss grabs his mother's finger.

Andy Holzman/Staff Photographer

Box:

The facts on preterm births (see text)