Leah Shannon shouldn't even be here yet. Her due date is November 8, but she's a veteran of the neonatal intensive care unit - a resident for 100-plus days.
Leah's one of the hundreds of thousands of American babies who come too soon. Born at 37 weeks gestation or earlier, they struggle against a range of health problems from heart defects to brain damage - problems that follow many of them throughout their lives.
"She was born at 24 weeks and she was born a pound and 6 ounces," said Leah's mother, Terretha Shannon of Cleveland. "And today she's 5 pounds and 12 ounces."
A new report from the March of Dimes finds the number of premature births is going up in the U.S. for the second year in a row after holding steady for the past three years.
The report finds that 9.8 percent of babies born in the U.S. are born prematurely -- 380,000 a year.
That's down from 10.4 percent in 2007, but it's ticked back up from 9.6 percent in 2015.
"We are very alarmed by this," said Stacey Stewart, president of the March of Dimes.
"Our concern is that we could be heading in the wrong direction with respect to women's health and moms' health and babies' health."
"They may face cognitive difficulties and delays, other developmental delays."
The March of Dimes - a charity founded to help prevent birth defects and premature births, surveyed rates of early births in all the states and U.S. territories.
They graded states and cities based on preterm birth rates. Overall, the U.S. gets a "C". Cities like Baton Rouge and Birmingham get "F"s, with preterm birth rates of 12 percent or more.
The states with the highest rates of preterm births include Mississippi, with 13.6 percent of babies born too soon; Louisiana with 12.6 percent and Alabama at 12 percent.
Oregon and New Hampshire have the lowest rates but even Oregon sees 8 percent of babies born too soon, and New Hampshire 7.8 percent. Portland, Oregon gets an "A" with a rate of 7 percent
Race is clearly a factor: 8.9 percent of white babies are born prematurely, but 13.3 percent of African-American babies and 10.5 percent of American Indian babies are.
According to Save the Children, the United States has the highest rate of babies who die the day they are born in the industrialized world. It says 130 countries have lower preterm birth rates than the U.S.
In Britain, for instance, 7.7 percent of babies are born prematurely.
Why are so many babies born prematurely? Smoking is a major cause. Teenage women are also more likely to have premature babies, as are women who don't receive good prenatal care. And black women have far higher rates than white women.
There are genetic factors, too.
But the main causes are not completely understood, said Dr. Jonathan Fanaroff of the University Hospitals Rainbow Babies and Children's Hospital in Cleveland.
"Part of the issue is that we don't fully know all of the causes of prematurity," Fanaroff said.
"We certainly know a number of factors, some of those are modifiable, such as smoking. And others are much more complex, such as racial disparities and poverty."
Nearly half of U.S. pregnancies are unplanned, which means mothers may not get good prenatal care.
"One of the things that we are also trying to study and understand more, is what are the other stresses and risks that may go on in a mom's life that may increase the risk of babies born too soon," said Stewart.
"How does poverty or the effects of racism for example, or how do environmental toxins, for example, how do those impact the health of the mom and potentially put the babies health at risk as well."
Prematurity costs the U.S. healthcare system billions of dollars.
"A lot of people assume, well a baby is born too soon, they will stay in the hospital, they'll stay in the neonatal intensive care unit for a few days, maybe a few weeks and everything will be fine," Stewart said.
"But what we know is that many babies, even though they may get terrific care in a hospital setting, often face lifelong challenges. They may face cognitive difficulties and delays, other developmental delays. They may face other challenges like cerebral palsy or other kinds of birth defects."
"She just came early, I guess."
Leah has a heart defect called patent ductus arteriosus or PDA. It's an unclosed hole in the aorta - the main heart artery.
"They put a clamp on her heart. It'll stay there forever," said Terretha.
It's not clear why her baby was born prematurely. "They were like, 'did you do any drugs?'" Terretha said. "I said nothing but what you guys gave me. They said it was nothing I did wrong. She just came early, I guess."
Caring for a baby in the NICU can be exhausting. "I've been here every single day she's been here," Terretha said.
"I haven't missed one day, and I work nights 7 pm to 7 am, so I worked last night, took a shower, took my daughter to school, back here with Leah. When I leave here, got to pick my daughter up, go cook, go back to work."
And she pumps breast milk for Leah, who probably won't go home until sometime next year.
"Every day I have to pump every two hours," Terretha said.
"I'm so ready to go home."