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Q: It's really amazing that anyone could give birth to eight children. But I can imagine the problems of having all those children growing up in the same household.

I'm a 35-year-old male with a twin brother. We were much less premature than the octuplets but almost died of breathing problems. Also I'm much smaller than my brother. Please explain.

-- T.N., Chicago
A: Medical science for the care of premature infants has advanced tremendously since you were born -- that's a good thing because the number of very premature infants has also increased.

Many social factors, such as drug use, are responsible for this increase. The use of infertility drugs resulting in multiple births is also a cause. The greater the number of children simultaneously carried to term, the greater the amount of prematurity.

It takes nine months (39 weeks) for a human baby to mature to best be able to live outside the uterus. But being born three weeks early is rarely a problem.

One of the most common problems with premature birth -- and often a quite serious one -- is respiratory distress syndrome. Quite simply, the infant has trouble moving air in and out of the lungs or moving gases across the lining of the lungs.

Hyaline membrane disease is the most common cause of respiratory distress syndrome. If a child is born between 35 and 36 weeks, it has a 5 percent chance of developing the disease. This percentage increases to 50 percent in infants born between 26 and 28 weeks.

This condition is caused by a deficiency in surfactant, a chemical that lowers the surface tension of fluids in the lungs. Without this lowering, the lung tissue sticks together making it difficult to breathe.

Fortunately, over the years, several artificial surfactants have been developed that can be infused into the lungs. The latest -- calfactant (brand name Infasurf) -- was just introduced this year.

Normally, same-sex twins are identical or very close in size to each other, but this is not always the case. If you and your brother each had your own placenta (the tissue where you implant onto the side of the uterus), your placenta may have been in a less optimum place. Even if you both used the same placenta, your blood supply may have been weaker.

Whether or not a multiple birth is involved, preventing or decreasing prematurity is one of the most important things that can be done for a healthy pregnancy outcome. Although a few things can be done near the end of a pregnancy to slow down birth, the best approach is for the woman to practice healthy behaviors during her pregnancy and even before conception.

A pregnant woman should not smoke, drink alcohol or use other drugs, and she should exercise and eat a healthy diet with supplements as directed by a health professional. We all have "good" excuses for not leading a healthy life for ourselves, but there are no good excuses when it comes to a healthy pregnancy.

Update on cancer screening: As you all know, screening for cancer is by far the best way to deal with these dreaded diseases.

Screening for colon cancer is no exception. It starts with regularly checking your stools for the presence of blood. Usually, this is blood you cannot see but which can be detected using chemical tests.

It's recommended that you screen for colon cancer by having at least one sigmoidoscopy after the age of 50, and more often if you have a higher family risk, blood in the stools or other signs or symptoms.

Recent research indicates that sigmoidoscopy may not be enough. Research presented at a meeting of the American College of Gastroenterology indicates that most cancer of the colon is found in a part of the colon that cannot be seen using a sigmoidoscope, but requires a longer colonoscope.

So if you are considering having a sigmoidoscopy to check for cancer of the colon, talk with your doctor about the risks, benefits and costs of having a colonoscopy instead.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

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