RxPG News : Neonatology

Premature babies are less sensitive to temperature sensations later in life

Sun, 28 Dec 2008 14:51:50 PST

( from http://www.rxpgnews.com ) Premature infants who need intensive care or surgery are less sensitive to hot and cold sensations later in life, according to a study.

The research conducted by University College London - suggests that pain and injury related to major medical interventions in early development may alter how children respond to painful stimuli much later in life.

In the study, 43 11-year-old children born at less than 26 weeks of gestation - who are being followed up by the EPICure study group, were tested for their responses to different sensations - temperature and light touch - using quantitative sensory testing.

Compared to a group of children who had been born at full term, the premature children were less sensitive to temperature - but not to light touch, and this was most marked in those who had also undergone a surgical operation as a baby.

The researchers also found a more marked decrease in sensitivity to temperature and to touch close to scars relating to major chest surgery, again suggesting that the severity of injury in early life influences the degree of sensory change, said an UCL release.

A survey showed that the children's everyday pain experiences were similar, but there were some minor differences between the two groups in the way children coped with pain.

Suellen Walker of the UCL Institute of Child Health said: 'Our study shows that babies who are born premature and need intensive care or surgery develop long-term changes in their responses to hot and cold sensations.'

The study was published in the journal Pain.

Study into pre and pro-biotic use in primary prevention of necrotizing enterocolitis

Sat, 06 Sep 2008 10:15:44 PST

( from http://www.rxpgnews.com ) Scientists at UC Davis will launch a groundbreaking study to determine the best cocktail of pre- and probiotic supplements to give to premature infants to prevent a deadly intestinal disease.

Probiotics are live, beneficial microorganisms that confer health benefits, like the live bacteria in yogurt. Prebiotics are sugars that stimulate the growth of these bacteria.

The study is a novel approach to the primary prevention of necrotizing enterocolitis (NEC), the third-leading cause of death among preemies.

"It would be wonderful to be able to find a way to prevent this debilitating disease in infants and we believe that probiotics are a safe and effective way to do that," said study co-principal investigator Mark Underwood, an assistant clinical professor of neonatology at UC Davis Children's Hospital.

The study is unique because it will combine the expertise of neonatologists at UC Davis Children's Hospital with the expertise of researchers on the UC Davis campus in the departments of chemistry and viticulture and enology who specialize in research on the bacteria enriched by human milk.

The babies in the study will receive doses of both pre- and probiotic supplements identified by UC Davis milk researcher Carlito Lebrilla, a professor of chemistry, and David Mills, a microbiologist and professor of viticulture and enology.

Lebrilla, a chemist, identified the prebiotics in human milk, called oligosaccharides, and described their structure.

Microbiologist Mills has found that these sugars stimulate the growth of healthy bacteria, called bifidobacteria, in the intestine. Bifidobacteria normally flourish in gastrointestinal tract of healthy breast-fed infants.

"Certain bifidobacteria are amazingly adept at breaking down and consuming these complex oligosaccharides from milk," Mills said.

Lebrilla and a group of scientists at UC Davis have been examining the components of human milk that previously had no known nutritional value to the infant. It now appears that the purpose of these milk components is to nourish healthy bacteria in the intestine.

"That seems to one of their main functions," Lebrilla said. "If you feed the prebiotics, or oligosaccharides, to unhealthy bacteria they won't eat it."

Lebrilla said that the purpose of the healthy bacteria in the intestine is not known. But one idea is that they simply block the proliferation of unhealthy bacteria, he said.

"The beauty of this collaboration is that we can go from fundamental research to clinical trials quickly because we have all the expertise at UC Davis," Lebrilla said.

In the study, preemies in the UC Davis Children's Hospital Neonatal Intensive Care Unit will receive the oligosaccharides and two different types of bifidobacteria twice a day from birth until their discharge from the hospital. Researchers will examine saliva and other specimens to see what dose, type and combination of the pre- and probiotics work best to grow healthy bacteria.

"I don't think you could have put together a research group like this together anywhere else in the country," Underwood said. "This could only happen at UC Davis."

The cause of NEC is unknown. The disease doesn't occur often in healthy full-term infants and is seen less in premature babies who receive breast milk. However, 10 percent of preemies get NEC and of those, 40 percent die.

Scientists think NEC may be caused by exposure to disease-causing bacteria rather than healthy bacteria.

"Healthy babies are held, kissed, breast-fed and get good bacteria from their mothers and fathers. Preemies live in hospitals and can't be held because they're too fragile. They get colonized with unhealthy bacteria. We think that makes them sick," Underwood said.

Infants born at between 24 to 33 weeks gestation and weighing less than 1,500 grams — under three pounds — are considered premature and spend months in the hospital. About 13 percent of U.S. infants were born prematurely in 2006.

The NEC study is funded by a five-year, $3 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Allergy and Infectious Disease.

The grant will also fund research to identify the role that "defensins," protein-like molecules that act as natural antibiotics in the body, play in NEC. Defensins are found in every species of plant and animal and, in humans, on the skin, in white blood cells, and the linings of the surfaces of the eyes, ears, mouth, nose, intestines, lungs and urinary tract.

Charles Bevins, a professor in the Department of Medical Microbiology and Immunology, has found that premature infants have low levels of defensins in the intestinal tract. Bevins will research whether premature infants with the lowest levels of defensins are at greatest risk of getting NEC.

Different approach needed to protect brains of premature infants

Wed, 11 Apr 2007 05:12:00 PST

( from http://www.rxpgnews.com ) A study of how the brain of a premature infant responds to injury has found vulnerabilities similar to those in the mature brain but also identified at least one significant difference, according to neuroscientists and neonatologists at Washington University School of Medicine in St. Louis.

In an animal model of brain injury, researchers showed for the first time that parts of the developing brain are vulnerable to damage from glutamate, a nervous system messenger compound. Glutamate is already well-known for its links to injury in the mature brain. But scientists also found damage in the developing brain that could not be linked to glutamate, suggesting that different treatments are needed to prevent brain injury in premature infants.

More than two percent of babies are born before the completion of their eighth month of gestation, and up to half of these infants suffer brain injury. Unlike adults, premature infants receive the most damage in the white matter, the portions of the brain that connect different brain regions.

"These injuries can lead to behavioral problems, developmental delay, cognitive impairment or cerebral palsy," says senior author Mark P. Goldberg, M.D., professor of neurology and of neurobiology. "In this study, we've identified a unique vulnerability in the developing brain's white matter that likely contributes to those disabilities. We will be looking for new drug treatments to prevent injury."

The research, reported in the April 11 issue of The Journal of Neuroscience, was conducted at the Hope Center for Neurological Disorders, a partnership between the University and Hope Happens, a St. Louis-based nonprofit organization dedicated to raising funds for neurological research. Goldberg is director of the center.

Goldberg and lead author William J. McCarran, M.D., a neonatology fellow in the Department of Pediatrics, worked with a "slice-based" model of injury's effects on the developing brain. Goldberg says the model strikes a compromise between the confounding factors present in whole animal models and the limitations of studying single brain cells in culture.

"In whole animals, it's difficult to separate out what makes the brain uniquely vulnerable, and in cell cultures the neurons aren't really in their proper environment," he says. "For our model, we use mouse brain slices that we can keep alive for 12 hours. That keeps all the connections, structures and cell types intact and in their proper relationship. Our ability to observe these connections at the microscopic level provides a new window for understanding perinatal brain injury.â

To probe how the brain's response to injury changes, researchers took slices from the brains of mice of different ages. At birth, the mouse brain's development lags somewhat behind the human brain. A 3-day-old mouse brain, for example, is roughly equivalent to the human brain during the sixth to seventh month of gestation. Scientists studied slices from 3-, 7-, 10- and 21-day-old mice.

To simulate injury, researchers deprived the slices of oxygen and glucose for one hour. At all ages, the resulting damage hit hardest on glial cells, support cells that surround, nourish and protect brain cells; and axons, the treelike branches that brain cells use to communicate with each other. Studies of the brains of premature babies have found a similar pattern of injury.

Researchers for many years have linked brain damage to the effects of glutamate. When Goldberg and McCarran used drugs to block a glutamate receptor prior to cutting off oxygen and glucose, it reduced injury with one noteworthy exception.

"In the three-day-old mouse brain slices, the blockers couldn't prevent damage to the axons," Goldberg says. "So something other than glutamate is killing the axons at that point in brain development."

In the early brain, axons lack a protective sheath called myelin. Glial cells supply this sheath, which is made mostly of lipids and makes about 50 percent of the human brain appear white, rather than gray. Goldberg and others have been developing a theory that much of the harm done by strokes and other brain injury begins in this white matter. They suspect that damage to connections between brain cells eventually leads to the cells' deaths.

Using the slice model, researchers plan follow-up studies of axons before they're coated in myelin and of potential protective compounds.

"This model turns out to be a powerful tool for seeking out and testing new drugs, so we want to test a number of new pharmaceuticals to see if any can protect axons early in brain development," Goldberg says.

Cot death could be linked to brain defect

Sat, 04 Nov 2006 19:23:37 PST

( from http://www.rxpgnews.com ) The Sudden Infant Death Syndrome (SIDS) or 'cot death' that kills about 300 babies a year in Britain may be linked to a defect in the brain, scientists have said.

Researchers led by Hannah Kinney at the Boston Children's Hospital in the US compared the brains of cot death victims with those of others who had died from recognised medical conditions.

They discovered a defect in the brain stem of the cot victims, reported the online edition of Daily Mail. Brain stem regulates breathing, blood pressure and body heat.

Researchers suspect that the defect might affect the ability of babies to wake up when threatened by external problems such as excessive heat or carbon dioxide when they are face down in bed.

'A normal baby will wake up, turn over and start breathing faster when carbon dioxide levels rise,' said Kinney, the lead author of a paper based on the study published in the Journal of the American Medical Association.

'These findings provide evidence that SIDS is not a mystery but a disorder that we can investigate with scientific methods, and some day may be able to identify and treat.'

So...how would you design your baby?

Tue, 05 Sep 2006 18:06:37 PST

( from http://www.rxpgnews.com ) The well-educated are significantly more open to the idea of "designing" babies than the poorly educated, according to a new study by psychologists at the University of East Anglia.

The findings will be presented by Dr. Simon Hampton at the BA Festival of Science on Setpember 5.

Dr. Hampton and his team at UEA's School of Social Work and Psychosocial Studies examined what different groups of people in the UK would "design into" their children given the opportunity.

The evidence suggests that there are gender, age and socio-economic class differences in what is deemed desirable and that many prospective parents would be prepared to manipulate their babies in ways that are at odds with moral orthodoxy.

"People assume that the very notion of designer babies stems from the desire of prospective parents for their children to be healthy," said Dr. Hampton.

"However, the picture is complicated by the shifting meaning of 'healthy' and confusion about when the manipulation of children's physical, psychological or social characteristics is legitimate, natural or ethical."

We are often presented with information and speculation about what reproductive technologies might achieve in the future and with various ethical dilemmas. This new research is among the first to investigate the thoughts and feelings of ordinary prospective parents.

The results of a series of surveys of 100-200 participants included:

-The better educated prospective parents are, the further they are prepared to go to improve their children's IQ.

-Women interpret certain interventions in child rearing as "design acts" more readily than men.

-People over 50 interpret certain interventions as "design acts" more readily than people under 25.

-Because of "parental uncertainty" - the idea than women know for certain if a child is their's whereas men do not ?men show a significantly greater preference than female parents for their children to inherit their own characteristics.

-Parents see different physical, social and intellectual characteristics as desirable depending on the sex of the child.

-Older women and childless women are significantly more willing to "improve" the physical, social and intellectual characteristics of prospective children? (This can be explained by women seeking to increase their genetic heredity, particularly when their time to reproduce begins to decrease.)

-Both men and women see genetic engineering as acceptable primarily for medical applications.

Reproductive technologies and designer babies will be held in ARTS 01.02 at UEA on Tuesday September 5 from 4-6pm.

Longer needles best for infant immunization

Fri, 04 Aug 2006 19:25:37 PST

( from http://www.rxpgnews.com ) Infants vaccinated with a long needle experience fewer reactions but get the same protection (immunogenicity) as a shorter needle, finds a study published on bmj.com today.

In the UK, primary care practitioners administer infant immunisations at 2, 3 and 4 months of age. Despite recommendations for use of a wide-long (23G, 25mm) needle, many UK practitioners immunise infants using a narrow-short (25G, 16mm) needle and uncertainty has arisen because of insufficient data to define best practice.

In a previous study, researchers from Oxford found that the wider-longer needle significantly reduced local reactions at 4 months of age. However, they did not know whether this was due to difference in needle length or gauge, or whether needle size affected vaccine immunogenicity.

To answer these questions, they carried out another trial comparing three needle sizes varying in length and diameter.

696 infants were randomly immunised with either a wide-long (23G, 25mm); a narrow-short (25G, 16mm); or a narrow-long (25G, 25mm) needle at 2, 3 and 4 months. Parents recorded local and general reactions for 3 days following each dose and antibody concentrations were measured 28-42 days after the third dose.

Local reactions decreased significantly with wider-longer over narrower-shorter needles.

Significantly fewer infants vaccinated with the longer needle experienced severe local reactions. Immunogenicity following injection with the longer needle was, however, comparable to that achieved with the shorter needle.

Comparisons between the same length, different gauge needles showed little difference in local reaction or immune response suggesting that needle length, rather than gauge, is responsible.

The results show a clear benefit of using the longer needle at each dose whilst achieving comparable immunogenicity, say the authors. They suggest that vaccine manufacturers and national policymakers use this evidence in recommendations for infant immunisation.

With increasing parental attention focused on the safety rather than the efficacy of vaccines, simple interventions, such as the use of a longer needle, that reduce local reactions should be welcomed, they conclude.

Meconium may provide clues to fetal alcohol exposure

Tue, 27 Jun 2006 02:20:37 PST

( from http://www.rxpgnews.com ) Fetal alcohol exposure is usually determined through self-reported maternal consumption. Self-reported drinking, however, is often an unreliable measure. Researchers have found that the presence of certain fatty acid ethyl esters (FAEEs) in meconium may provide a dependable biomarker of fetal alcohol exposure.

"There are only a few biomarkers that indicate if an infant has been exposed to alcohol during pregnancy, and most of them are not strictly associated with alcohol use," said Enrique M. Ostrea, Jr., professor of pediatrics at Wayne State University. "In this study, we have found a direct association between the presence of certain FAEEs and alcohol use." Ostrea, Jr. is also the corresponding author for the study.

When people drink alcohol, it combines with certain fats in the body known as fatty acids, and FAEEs are formed. These "markers" are either deposited in tissues or, in the case of a growing fetus, in fetal urine or meconium.

"People characteristically underreport the amount of alcohol they drink," said Michael Laposata, director of clinical laboratories at the Massachusetts General Hospital and professor of pathology at Harvard Medical School. "One can measure blood alcohol but it disappears from the blood relatively quickly after drinking stops, so only very recent intake can be documented. FAEEs are 'long-term markers' of alcohol intake because they stay much longer in blood than alcohol itself and, in this case, accumulate in meconium."

For this study, researchers examined 124 mother/infant pairs. Based on self reports, 93 of the mothers had consumed alcohol during pregnancy, and 31 had not. FAEEs were analyzed in the infants' meconium by a highly sensitive and specific method called positive chemical ionization gas chromatography/mass spectrometry. Results were correlated to maternal alcohol use during pregnancy.

The presence of FAEE ethyl linoleate in meconium is highly indicative of fetal exposure to alcohol during pregnancy, said Ostrea, Jr.

"The incidence of ethyl linoleate in meconium was found to be significantly higher in the alcohol-exposed group when compared to the control group," he said. "There was also a significant association between alcohol exposure and group concentrations of ethyl linoleate. Furthermore, the highest ethyl-linoleate concentration was only found in the alcohol-exposed infants."

Ostrea, Jr. said that results also suggest that FAEEs ethyl arachidonate and docosahexanoate may have potential as biomarkers of alcohol effects on the developing fetal brain.

"Polyunsaturated long chain fatty acids, such as arachidonic and docosahexanoic acids, are important for the body," he explained. "Arachidonic acid is used in the formation of important compounds called eicosanoids, while docosahexanoic acid is used for retinal and brain development in the fetus and infant. We propose that when the fetus is exposed to alcohol arachidonic and docosahexanoic acids may become unavailable to the fetus for its developmental needs, particularly brain development. This could result in mental retardation."

"This is an important report," said Laposata. "The measurements of the FAEEs are exceedingly well done. However, the test is only able to identify about one quarter of the mothers who ingest alcohol during pregnancy." He suggested that testing expectant mothers for alcohol intake prior to delivery would have more merit than testing meconium after birth because an objective identification of alcohol intake during pregnancy could lead to intervention, possible cessation of drinking, and a better outcome for the fetus. "We have an obvious need to check mothers during pregnancy before damage to the fetus is done," he said.

Until that transpires, said Ostrea, Jr., "our manuscript is supportive of the validity of using FAEEs as biomarkers of prenatal alcohol exposure. This would allow early identification and treatment for children born with fetal alcohol effects who might otherwise not be recognized, particularly if the mother does not admit to drinking."

Delayed Umbilical Cord Clamping Boosts Iron in Infants

Sat, 17 Jun 2006 20:17:37 PST

( from http://www.rxpgnews.com ) Just a two-minute delay in clamping a baby's umbilical cord can boost the child's iron reserves and prevent anemia for months, report nutritionists at the University of California, Davis.

Iron deficiency is a concern for both wealthy and poor nations. It is a problem particularly in developing countries, where half of all children become anemic during their first year, putting them at risk of serious developmental problems that may not be reversible, even with iron treatments.

"By simply delaying cord clamping for this brief time, we can provide the infant with the extra blood, and the iron it contains, from the placenta," said Dewey, an expert in maternal and infant nutrition. "This is an efficient, low-cost way to intervene at birth without harm to the infant or the mother."

She noted that although iron deficiency is a greater problem in developing countries, it is also a serious issue in industrialized nations like the United States, particularly for low-income and minority families and in lower birth-weight infants or babies born to iron-deficient mothers.

The umbilical-cord clamping procedure halts blood flow from the placenta to the infant in preparation for cutting the umbilical cord. During the past century, it became common practice to clamp the cord about 10 seconds after the baby's shoulders are delivered. However, there has been little scientific research to justify such rapid clamping.

The previous studies conducted on delaying clamping have indicated no risk and some significant benefits to later clamping.

In the UC Davis study, the researchers set out to specifically evaluate whether delayed clamping improves iron status of full-term, normal-birth-weight infants during their first six months. The researchers also examined whether delayed clamping has greater impact among children who are already at increased risk of developing iron deficiency due to low birth weight or an iron-deficient mother.

The 16-month-long study was conducted at Hospital de Gineco Obstetrica in Mexico City, in collaboration with Mexico's National Institute of Public Health. A total of 476 normal-weight, full-term infants and their mothers were involved in the study. Each mother-child pair was randomly assigned to have the umbilical cord clamped at either 10 seconds or two minutes after the baby's shoulders were delivered.

Data on the infants' diet, growth and illnesses were collected when the children were 2, 4 and 6 months old. Iron status of the babies also was measured at birth and at the end of the study.

Of the original group, 358 mother-child pairs completed the study.

The study revealed that a two-minute delay in cord clamping at birth significantly increased the child's iron status at 6 months of age, and it documented for the first time that the beneficial effects of delayed cord clamping last beyond the age of 3 months.

This also was the first study to show that the impact of delayed clamping is enhanced in infants that have low birth weights, are born to iron-deficient mothers, or do not receive baby formula or iron-fortified milk.

"The data show that the two-minute delay in cord clamping increased the child's iron reserve by 27-47 mg of iron, which is equivalent to one to two months of infant iron requirements," Dewey said. "This could help to prevent iron deficiency from developing before 6 months of age, when iron-fortified foods could be introduced."

Researchers identify agents that may make vaccines effective at birth

Tue, 25 Apr 2006 21:10:37 PST

( from http://www.rxpgnews.com ) Newborn babies have immature immune systems, making them highly vulnerable to severe infections and unable to mount an effective immune response to most vaccines, thereby frustrating efforts to protect them. Researchers at Children's Hospital Boston now believe they have found a way to enhance the immune system at birth and boost newborns' vaccine responses.

In a study published in the online edition of the journal Blood on April 25, Ofer Levy, MD, PhD and colleagues in Children's Division of Infectious Diseases show that the newborn immune system functions differently than that of adults, but that one portion of the immune response is fully functional and can be harnessed to boost immunity in these tiny infants, possibly making infections like respiratory syncytial virus, pneumococcus, pertussis, HIV and rotavirus much less of a threat.

For about a decade it's been known that people's first line of defense against infection is a group of receptors known as Toll-like receptors (TLRs) on the surface of certain white blood cells. Functioning like an early radar system, TLRs detect the presence of invading bacteria and viruses and trigger production of "danger signals" proteins known as cytokines that trigger other immune cells to mount a defense against the infection. People have 10 different kinds of TLRs, and Levy's team decided to examine how well they function in newborns by studying white blood cells from their cord blood.

"We found that when most Toll-like receptors are stimulated, newborns' immune responses are very impaired," Levy says. "But there was one important exception."

Levy's team, including Harvard graduate Eugenie Suter and senior author Michael Wessels, MD, showed that one TLR, known as TLR8, triggered a robust immune response in a group of white blood cells (called antigen-presenting cells) that is crucial for vaccine responses. When TLR8 was stimulated by various agents that mimic viral antigens, the cells produced normal, adult levels of two key cytokines TNF-alpha and IL-12 and another immune-system stimulant, CD40.

"These findings suggest that agents that stimulate TLR8 could be used to enhance immune responses in newborns, perhaps as adjuvants given along with vaccines," Levy says. "We plan to test this approach in animals, and eventually in human babies."

Levy notes that the ability to vaccinate newborns rather than wait until they reach 2 months of age would provide important global health benefits. "Birth is a point of contact with healthcare systems," he says. "Families may not see a health care provider after that. From a global health perspective, if you can give a vaccine at birth, a much higher percentage of the population can be covered."

Conceivably, TLR8 stimulators could also be given alone in special circumstances to help a baby fight off an infection in progress, or as a preventive measure in the event of a disease outbreak or bio-terrorist threat, Levy adds.

Levy's team is uncovering other differences between the newborn and adult immune systems that could lead to additional targets for drugs or vaccines. A related paper, to be published soon in the journal Pediatric Research, finds that when newborns' TLRs are stimulated during the first week of life, their white cells' production of the cytokine IL-6, which inhibits parts of the immune response, is greater than that in adults.

A third study, to be published in the Journal of Immunology, finds that newborns' cord blood also has high levels of adenosine, providing an explanation for newborns' altered immune response: adenosine alters the physiology of white cells to suppress production of TNF-alpha (but not of IL-6) when TLRs are stimulated. When Levy's team used antagonists to inhibit adenosine's activity, newborns' white blood cells produced normal, adult levels of TNF-alpha in response to bacterial and viral triggers. "In the future, we could try to block adenosine in newborn animals to see if this helps protect against infection," Levy says.

Levy believes the differences his team has uncovered in newborns' immune response patterns may serve an evolutionary purpose. Nature may suppress babies' production of inflammatory cytokines like TNF-alpha and IL-12 before birth because they can trigger preterm labor, while increasing production of adenosine and IL-6, which may have a protective effect on the pregnancy.

In 1999, Levy discovered that newborns are deficient in a natural antibiotic called bactericidal/permeability-increasing protein (BPI), produced by white blood cells known as neutrophils. Based on this discovery, clinical trials are now underway at the University of Texas Southwestern Medical Center in Dallas to replace the missing BPI in high-risk newborns with heart conditions who are undergoing cardiac bypass operations.

"As we better understand the molecular pathways that account for newborns' susceptibility to infections, we can leverage them to enhance their immune defenses," Levy says.

First FDA Clearance of Sterile Field Cord Blood Collection Bag

Tue, 25 Apr 2006 21:04:37 PST

( from http://www.rxpgnews.com ) ViaCell, Inc. (NASDAQ: VIAC) and Pall Corporation (NYSE: PLL) announced today the first U.S. Food and Drug Administration clearance of a cord blood collection bag suitable for use in a sterile field. Pall and ViaCell collaborated on the development and design of the new collection bag. ViaCell has exclusive rights to the new collection bag for family cord blood banking and expects to introduce it as part of its ViaCord® collection kit. The new sterile field bag will give families and their health care providers the ability to more safely and easily collect umbilical cord blood from newborns, even when born by cesarean section.

Umbilical cord blood is a valuable source of stem cells used to treat more than 40 life threatening diseases including a wide range of cancers, immune deficiencies and genetic disorders. Collection of cord blood is a critical first step in the process of preserving a baby's umbilical cord blood to meet these and other future medical needs. It is important that the collection kit simply and aseptically collect as much blood as possible since larger units for cord blood generally produce more viable stem cells.

I believe the new ViaCord collection bag provides a significant benefit to the obstetrician, said Yoni Branhard, M.D., Vice Chairman of the OB-GYN Department, Lenox Hill Hospital, New York City. This is an innovative initiative in cord blood banking. The sterile bag gives my colleagues and me the comfort that, no matter how we deliver a child vaginally or by cesarean - we are collecting the cord blood in a high quality manner.

Collecting blood from the umbilical cord of babies born by cesarean section, unlike vaginal births, must be done in a sterile surgical field. There are about 1.2 million cesarean sections performed in the U.S. each year, representing about 30 percent of all births. Since not all cesarean births are planned, ViaCell intends to include the new sterile field bag in its ViaCord collection kit provided to all expectant families who decide to preserve their baby's umbilical cord blood. Expectant parents and medical professionals will then have the optimal tools to collect their infant's cord blood, no matter the type of birthing situation.

Karen A. Foster, Vice President, ViaCord Processing Laboratory, said, "We are excited by our collaboration with Pall in developing this innovative bag that allows us to continue offering families the highest quality product. This is a significant development in cord blood collection and further demonstrates our commitment and ability to lead technological advancements in cord blood banking.

"Our agreement with ViaCell is another milestone in Pall's development and customization of tools to help make cell therapy routine, safe and simple," says Judy Angelbeck, PhD, Senior Vice President, Pall New Technologies. "We are proud to work with ViaCell as they are committed to the highest standards of cord blood collection, processing and storage for family cord blood banking."

Restricting vitamin D intake during pregnancy lowers infant birth weight

Tue, 25 Apr 2006 20:47:37 PST

( from http://www.rxpgnews.com ) Pregnant women who drink a certain quantity of milk every day could have a healthy baby, says a study.

Milk is an important source of vitamin D, calcium, riboflavin, protein and energy during pregnancy, but some women are advised to cut down their consumption for various reasons including the prevention of allergies in their children.

Dr Kristine Koski and other researchers at McGill University in Canada found that babies of mothers who drank at least half a pint of milk a day during pregnancy weighed more at birth than those born to women who drank less, reported the online edition of Telegraph.

Restricting milk or vitamin D intake during pregnancy lowered infant birth weight in otherwise healthy, non-smoking, well-educated mothers, the study published in the latest issue of the Canadian Medical Association Journal said.

"This is an important finding because increasing numbers of women are restricting milk consumption during pregnancy believing that it will lower fat intake, minimise weight gain, treat self-diagnosed lactose intolerance or prevent their children from developing allergies," Koski said.

"Although most nutrients in milk may be replaced from other foods or with supplements, vitamin D is found in few commonly consumed foods except for milk.

"Mothers and health professionals need to understand that this dietary practice may restrict essential nutrients and negatively affect foetal development," the researchers said.

Extremely low birth-weight babies transition successfully to adulthood - Study

Wed, 08 Feb 2006 11:23:37 PST

( from http://www.rxpgnews.com ) As young adults, the majority of extremely low birth-weight infants are attaining similar levels of education, employment and independence as normal birth-weight infants, according to a study by researchers at the Michael G. DeGroote School of Medicine at McMaster University in the February 8 issue of the Journal of the American Medical Association (JAMA).

This is good news for the infants and their parents, as more than a quarter of low birth weight children have development difficulties such as cerebral palsy, blindness and delayed development, compared to two per cent of normal birth-weight infants.

Dr. Saroj Saigal, professor of pediatrics, conducted a study over two years to determine the outcomes at young adulthood of extremely low birth-weight infants, in comparison to a group of normal birth-weight children.

The measures of successful transition to adulthood included educational attainment, student and/or working roles, independent living, getting married, and parenthood.

The study included 166 extremely low birth-weight people who weighed 1.1 to 2.2 lbs. at birth and were born between 1977 and 1982 as well as 145 socio-demographically comparable normal birth-weight participants.

The low birth-weight infants have been followed from birth, the normal birth-weight children were recruited at age eight years. Both the low birth-weight and normal birth-weight children were assessed at ages eight, as teens and at young adulthood of 22 to 25 years old.

The proportion of participants who graduated from high school was similar (82 percent of low birth weight infants compared to 87 percent of those with normal birth weight). Overall, no statistically significant differences were observed in the education achieved to date. A substantial proportion of both groups were still pursuing postsecondary education (32 percent versus 33 percent).

No significant differences were observed in employment or school status, as 48 percent of low birth-weight and 57 percent of normal birth-weight young adults were permanently employed.

No significant differences were found in the proportion living independently, married/cohabiting, or who were parents.

The age of attainment of the above markers was similar for both groups. These findings hold even though participants included the 27 per cent of low birth-weight and two per cent of normal birth-weight people with disabilities.

"Against our expectations and many odds, a significant majority of young adults who were low birth weight infants have overcome earlier difficulties to become functional members of society," said Dr. Saigal, a neonatologist with the McMaster Children's Hospital in Hamilton.

"It isn't clear what factors contributed to the positive outcome beyond adolescence, as all through childhood the low birth weight cohort was significantly compromised in comparison with their peers. Our study should provide hope to parents for an equivalent, if not a better, future for their premature children in the longer term."

Saigal says more studies from research centres with established databases from the recent era are needed.

Breastfeeding protects babies from respiratory illness

Tue, 07 Feb 2006 15:19:37 PST

( from http://www.rxpgnews.com ) Breastfeeding could protect babies from respiratory illness, says a study adding to mounting evidence that the longer a mother breastfeeds her infant the greater the health benefits.

Researchers led by Caroline Chantry at the University of California, University of Rochester and the American Academy of Paediatrics conducted an analysis of a survey of 2,277 children aged between 6 and 24 months.

They identified five groups -- formula-fed only, full breastfeeding for less than one month, full breastfeeding from one to four months, full breastfeeding from four to less than six months and full breastfeeding for six months or more. Full breastfeeding allows for the use of formula on less than a daily basis.

They then looked at the percentage of children in each group who experienced pneumonia, wheezing and recurrent (three or more) colds or ear infections. The results showed the protective effects of breastfeeding.

"We found that babies who received an additional two months of full breastfeeding were over four times less likely to contract pneumonia and half as likely to suffer recurrent ear infections," Chantry said.

Chantry and her colleagues found that the health benefits of the additional two months of full breastfeeding continued to protect babies from respiratory illnesses through their second birthdays.

Previous research by others has shown that exclusive breastfeeding for six months also provides greater protection against gastrointestinal infections, she added.

Risk of death by SIDS increases in the winter months

Wed, 18 Jan 2006 23:41:37 PST

( from http://www.rxpgnews.com ) The number of infants who die from Sudden Infant Death Syndrome, or SIDS, increases in the cold winter months, according to the National Institute of Child Health and Human Development (NICHD), one of the National Institutes of Health. During these colder months, parents often place extra blankets or clothes on infants, hoping to provide them with more warmth. In fact, the extra material may actually increase infants risk for SIDS.

Parents and caregivers should be careful not to put too many layers of sleep clothing or blankets on infants or to keep room temperatures too warm because overheating increases the risk of SIDS, said Duane Alexander, M.D., Director of the NICHD. Of course, parents and caregivers should always place infants to sleep on their backs for naps and at night.

For more than a decade, the NICHD has led the Back to Sleep campaign, which recommends a number of ways to reduce the risk of SIDS. Unless theres a medical reason not to, infants should be placed on their backs to sleep, on a firm mattress with no blankets or fluffy bedding under or over them. If a blanket is used, it should be placed no higher than the babys chest and be tucked in under the crib mattress. The babys crib and sleep area should be free of pillows and stuffed toys, and the temperature should be kept at a level that feels comfortable for an adult. Since the NICHD campaign began, the overall SIDS rate in the United States has declined by more than 50 percent.

Despite the campaigns progress, SIDS is the leading cause of death in infants between 1 month and 1 year of age and claims the lives of approximately 2,500 infants each year. SIDS is the sudden unexplained death of an infant in the first year of life. Most SIDS deaths happen when babies are between two and four months of age. The causes of SIDS are still unclear, but it is possible to reduce factors that increase SIDS risk.

The American Academy of Pediatrics (AAP) recently issued updated recommendations for reducing the risk of SIDS:

-Always place your baby on his or her back to sleep, for naps and at night

-Place your baby on a firm sleep surface, such as on a safety-approved crib mattress, covered by a fitted sheet

-Keep soft objects, toys, and loose bedding out of your babys sleep area

-Do not allow smoking around your baby

-Keep your babys sleep area close to, but separate from, where you and others sleep

-Consider offering a clean, dry pacifier when placing your baby on his or her back to sleep

-Do not let your baby overheat during sleep

-Avoid products that claim to reduce the risk of SIDS

-Do not use home monitors to reduce the risk of SIDS

-Reduce the chance that flat spots will develop on your babys head by providing Tummy Time when your baby is awake and someone is watching; changing the direction that your baby lies in the crib; and avoiding too much time in car seats, carriers, and bouncers

Although the rate of SIDS among African American infants has declined by almost 50 percent since the Back to Sleep campaign began, it is still higher than that of white infants. In fact, African American infants are twice as likely to die of SIDS as are white infants. To help eliminate the racial disparity in SIDS rates, the NICHD has forged partnerships with several African American organizations. In 2003, Alpha Kappa Alpha Sorority, Inc., the National Coalition of 100 Black Women, Women in the NAACP, and the NICHD held three SIDS Summits, which brought together thousands of participants from across the country to learn more about SIDS. Since the Summits, these partners have continued their work in communities across the country. They met recently to discuss the updated AAP recommendations and future campaign direction.

While we have made great progress in reducing the rate of SIDS for African American infants by almost 50 percent, there is much work ahead, said Yvonne Maddox, Ph.D., Deputy Director of the NICHD. The winter SIDS alert is one way to remind parents and caregivers that we can reduce the risk of SIDS by placing babies on their backs to sleep for naps and at night.

The NICHD is also working within the American Indian community to help reduce the racial disparity in SIDS rates. American Indian babies are nearly three times as likely to die of SIDS as white babies. Research has found that among the Northern Plains American Indian community, overheating is one of the biggest risk factor for SIDS. The NICHD is establishing partnerships with American Indian organizations to help create and disseminate culturally appropriate SIDS risk reduction materials.

After an extensive body of research showed that placing infants to sleep on their backs reduces their risk of SIDS, the NICHD led a coalition of organizations to launch the Back to Sleep campaign in 1994. Along with the NICHD, the coalition consists of the AAP, the Health Resources and Services Administration, the Association of SIDS and Infant Mortality Programs, and First Candle/SIDS Alliance.

Pacifiers Reduce Sudden Infant Deaths (SIDS)

Fri, 09 Dec 2005 21:26:38 PST

( from http://www.rxpgnews.com ) Use of a dummy seems to reduce the risk of sudden infant death syndrome (SIDS), finds a study published online by the BMJ today.

Researchers in California interviewed mothers or carers of 185 infants who died and 312 randomly selected controls matched for race/ethnicity and age.

They obtained information on dummy use during the index sleep (defined as the last sleep or the sleep during the night before the interview), on other environmental factors related to sleep, and on risk factors for SIDS.

After adjusting for known risk factors, use of a dummy during sleep was associated with a 90% reduced risk of SIDS compared with infants who did not use a dummy.

The reduced risk was consistent across a wide range of social and economic characteristics and risk factors examined.

The reduced risk also seemed to be stronger when an infant was in an adverse sleep environment (such as sleeping prone or on the side, sleeping with a mother who smoked, or sleeping on soft bedding), although these differences did not reach significance.

"Use of a dummy is associated with a substantial reduction in the risk of SIDS," say the authors. "Our results also provide some evidence that use of a dummy may reduce the impact of other risk factors for SIDS, especially those related to adverse sleep conditions."

They suggest that the use of dummies may be an effective strategy for public health intervention.

Neonatal intensive care unit designs are critical to infant health

Fri, 17 Jun 2005 03:31:38 PST

( from http://www.rxpgnews.com ) Effective neonatal intensive care units (NICUs) provide more than just services - they're designed in a way that contributes to the health of the infants being treated, says a Texas A&M University authority on health care facility design and environmental psychology.

Mardelle Shepley, a professor of architecture at Texas A&M, says properly designed NICUs can potentially result in a number of health-related benefits for the infants in them, but the design of NICUs should be handled appropriately because these infants are exceedingly vulnerable. Some of the benefits, she says, include infants conserving energy, improved ability by infants to manage their environment, growth, decreased respiratory support, decreased lung disease and decreased length of stay.

"Conscientious architects are becoming increasingly aware of the impact of design decisions on the sensory environment of the neonatal intensive care unit," Shepley says. "Since the first symposium on health care design in 1988, the notion of creating healing environments has evolved from a tangential, subjective design consideration to an intervention based on science."

In other words, designers of NICUs are taking into account things such as lighting, noise, and the physical layout of the facility, not only for the infants, but for the staff and families as well, Shepley explains.

Modifications to NICU environments can reduce stress among staff members by allowing them to better care for infants and their families, she notes. For example, an improved environment can enable nurses to spend more time engaging in patient and family support activities instead of walking around searching for supplies - an activity that previous research by Shepley identified as occupying a significant portion of nurses' time.

What's more, research shows that routine activities, management roles and lack of knowledge are often perceived as the most stressful by NICU nurses. Variation in the form of window views and differing lighting levels can energize routine activities, and technology that supports supervision can better support management activities, Shepley says.

As it pertains to the infant, the intensive care unit should be designed in a way that fosters sleep opportunities because research suggests that sleep is critical to brain development, she notes. Visual and auditory stimulation should be controlled because these senses are less developed in infants than are other senses and are more susceptible to disruption.

Lighting in these units, Shepley says, should be adjusted to reinforce natural daily light variations, and the lighting level should be controlled in a way that allows for gradual changes in the level. Light levels should be no brighter than needed to complete a task, and individualized lighting should be available at each baby station, Shepley recommends. Individualized lighting, she explains, is the best compromise to meet the needs of the infant and the staff because lighting needed by infants may not be comfortable to staff. Reduced lighting also has been shown to significantly reduce conversation levels among staff, the primary contributor to noise in an intensive care unit.

Numerous studies identify noise as a primary stressor for infants, patients and staff of health care facilities, with infants particularly disoriented by noise because their hearing is still immature, Shepley says. Noise can prevent an infant from reaping the developmental benefits of sleep, but noise can be reduced through acoustic and configuration modifications to the facility and modifications in staff behavior through educational programs. However, some forms of noise, such as music, have been shown to be effective in reducing stress in infants by reducing cortisone levels in the brain that are associated with stress, she notes.

Visual and spatial elements of NICUs are rarely addressed because it is assumed that infants in intensive care have limited visual ability and lack consciousness to be affected by visual and spatial cues, but Shepley says these areas merit attention and could have an impact on staff and family perception and behavior. Color selection relative to infants is largely inconsequential, she says because of their lack of visual perception, but with regard to adults, studies have indicated persons in high anxiety situations prefer pastels rather than saturated colors. Common sense, she says, dictates that color schemes should be subdued so they don't interfere with accurate reading of the infants' skin color.

"The future of evidenced-base design for infants and staff in NICUs is hopeful," Shepley notes. "The stage has been set to enable the design disciplines, the medical establishment and the academicians to work together to significantly improve the quality of life for infants, families and staff in neonatal intensive care units."