Strollerderby : premature

They Say: Late Preemies At Risk for Developmental Delays

Kate Tuttle — Thu, 02 Apr 2009 15:00:00 GMT

They often look and seem like full-term babies, but new research suggests that babies born at 34 to 37 weeks are more likely than their 37-to-40-week peers to face developmental or behavioral delays or disabilities, require special education, and be held back in kindergarten.

Published in the journal Pediatrics, the study compared more than seven thousand late preemies with more than 150,000 full-term babies (all of them healthy singleton births). The late preemies faced developmetal delay or disability at rates 36% higher than their term peers, and their rate of suspension in kindergarten was 19% higher. In addition, researchers found a 10 to 13% increase in incidence of other problems, including being held back in kindergarten or needing special education.

Most babies, of course, are born at term (defined as anything from 37 to 42 weeks), but an increasing number are born prematurely, the largest bulk of these in the late premie category -- the numbers for all premature births in the United States have jumped from 9.4% in 1981 to 12.3% in 2003. Reasons for the rise aren't entirely clear, but some doctors are expressing concern that obstetricians and patients are unaware of the risks of even seemingly small amounts of prematurity.

From the New York Times article about the study:

“The biggest take-home point is that the late-preterm baby is not exactly the same as the term baby,” said Dr. Steven Benjamin Morse, an author of the study and an associate professor of pediatrics at University of Florida.

“They go home from the hospital in two to three days, and they look great, and they act like full-term babies,” he said. “But now we’ve found that they do have some increased risk of problems when they enter school. We were surprised.”

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Water Broke at 17 Weeks; Baby Survives

Miriam Axel-Lute — Fri, 13 Mar 2009 17:00:00 GMT

Sometimes the stars align. They certainly did for Matthew Janson, who was born Friday in Cleveland. See, his mother's amniotic fluid had started to leak back in November, when she was only 17 weeks pregnant.

Ususally that would spell doom. But they hung on. The premature rupture wasn't caused by infection or bleeding of the placenta or any of the "usual" caused.

The leak was slow, and infection was kept at bay. Although she'd been told to expect to miscarry within a few weeks, she made it to viability still pregnant. She entered the hospital at 23 weeks, but made it to 34 before delivering—Matthew was still premature, but not even wildly so, and quite healthy.

Although all the doctors involved want everyone to know just how unlikely this was (1 in 500,000 chance said one), it's still always nice to hear about a happy ending.

Photo (which is not of Matthew Janson) by Yager-Madden.

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They Say: Breastmilk Fights Respiratory Viruses Better in Girls

Miriam Axel-Lute — Thu, 12 Mar 2009 19:30:00 GMT

Science gets particularly exciting when it turns up things no one was expecting. Researcher Fernando Polack, working in Buenos Aires investigating how much protection breastmilk provides for very-low-birthweight babies against the wicked metapneumovirus (no vaccine yet developed), was surprised to find stark gender differences in his results:

Girls who were not breastfed had a much higher risk of rehospitalization for respiratory illness than boys, but breastfed girls were almost never rehospitalized. In boys, the difference between breastfed and not was insignificant. (The researchers hasten to point out that there are plenty of other benefits of breastfeeding that still hold true for boys.)

The fascinating part of this is that a gender difference may point to breastmilk's protective properties working differently than previously supposed. Maybe it's not just delivering mom's immunities until the kid gets its own—why would there be a gender difference in that? Could breastmilk prompt anti-viral protection in the absence of exposure to viruses somehow, interacting directly with the baby's developing immune system? (Of course, why would there be a gender difference in that either?) The report from Vanderbilt Medical Center speculates maybe, though they have no idea how.

Sounds to me for now like another thing to throw on the "we don't know what breastmilk is well enough to replicate it" evidence pile.

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Two Wombs, Two Babies: Mom Delivers Twins

JeanneSager — Tue, 03 Mar 2009 13:18:00 GMT

I'm a sucker for a happy ending.

Like finding out you have two uteruses (uteri actually) and getting pregnant with twins - one child per uterus. Oh, and best of all? Giving birth to two healthy little girls.

Michigan mom Sarah Reinfelder has uterus didelphys - a rare condition in which the two tubes in a female fetus don't join to create one larger, hollow organ. They remain two distinct parts of the body - uteri.

The condition isn't dangerous, and many women go on to have children, but twins from uterus didelphys are rare, which makes Reinfelder's daughters extra special. So far, only three cases have been reported in the entire world.

The larger twin developed in Reinfelder's larger uterus, weighing in at four pounds, fifteen ounces. Her sister was a full pound smaller. The girls were delivered via a C-section, approximately seven weeks prematurely. The babies are expected to be released from the hospital in three to four weeks. Reinfelder and husband Shane have an elder child - 10-month-old William at home. They were shocked to find out she was pregnant with the twins - especially because she was on the birth control pill at the time.

"I was like okay, and then they did the ultrasound and said, 'Guess what? You're pregnant twice!' and that's when I almost wet my pants," Sarah told her local TV news station.

Can you really blame her?

Image: Upper Michigan Source

Via Jezebel

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"Angels in Waiting" Apparently Still Waiting

Kate Tuttle — Wed, 25 Feb 2009 16:30:00 GMT

For all the ink spilled in the whole Octomom saga, not much has been written yet about the group that has offered to take over the care of the octuplets (free of charge!). Angels in Waiting, which was introduced to the drama via a Fox News interview also starring Gloria Allred, says it's willing to take the eight babies, keep them in "a home" (presumably not Suleman's), and provide the care they need as medically fragile premature newborns.

All of which sounds fairly generous -- a point repeatedly made by various bloggers who are dying for Suleman to turn over them babies! -- until you read more about them. Angels in Waiting is not devoted to helping stressed-out, possibly mentally ill mothers of multiples take care of their kids -- their goal is to prepare babies born to meth addicts to be adopted out. From their website:

Angels in Waiting is dedicated to moving these special little angels into loving homes with Registered Nurses as their foster parents and then on to adoptive homes in which they could recover or stabilize, grow and now flourish; their troubled pasts overshadowed by their hopeful futures.

Founded by a registered nurse whose own life was changed through the care and ultimate adoption of a micro-premie born to a meth-addicted mother, Angels in Waiting is clear about its mission: putting babies into homes, not with their birth parents, preferably with a foster mother who is also a nurse. And who works for Angels in Waiting!

It's a little unclear to me how this model fits into the Nadya Suleman situation. Despite the seemingly endless questions about her ability to care for these babies, she has expressed a steadfast determination to parent all her children. If she proves to be unfit, as many have predicted, I have no doubt child protective services will step in. But CPS's goal is twofold: help the children, and help support the parent so that the family can be re-united. This is not the goal of Angels in Waiting, whose website is filled with gauzily religious testimonials about "tiny ones" and "injured ones" -- and which has a "donate" button on each page. One thing not made clear on the Angels website is how many babies they have actually helped, how big their operation is, or where donated money actually goes (though they do make a big deal about the need for scrapbookers to help create memory books for the angels).

As nutty and publicity hungry as Suleman has appeared so far to be, she has some stiff competition here.

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Mom Resuscitates Baby Four Times On Phone With Emergency Control

JeanneSager — Wed, 28 Jan 2009 18:33:00 GMT

Four times Cordelia Nolan's newborn son stopped breathing, and four times she brought him back while she waited for emergency workers to show up on her doorstep.

Nolan's cousin, Kieran Byrne, acted as a go-between between a 999 (this was Britain) operator and Cordelia while she repeated CPR again and again on her little boy, just ten weeks old and born two months premature.

Wow. Not the pithiest of statements, but this one stopped me cold.

I saw myself going through the motions in my head and bursting into tears. I know adrenaline kicks in when you're faced with adversity, and a mother's love for her child will always prevail, but I don't know if I'd have had the wherewithal to keep up the fight if my child continued to falter. What's remarkable about the 999 conversation (available in full thanks to the Daily Telegraph) is just how calm Nolan sounds, even as Byrne gets increasingly frustrated with the operator as she tries to collect information and dispatch emergency workers (give him credit, he was stressed and he was still respectful!).

Notably, Nolan had been offered training in CPR before her son Emrys was released from the hospital. Because he was born prematurely, it was a precautionary measure offered by the hospital - and one that proved not just necessary but life-saving. I've heard from moms of premies who have gone through a whole ration of training; one told me the hospital even contacted her local ambulance corps to offer THEM training on how to deal with her son's specialized needs in case of emergency.

It's a happy story all around, especially for baby Emrys, who is doing just fine. How do you think you would have handled this one?

Image: Daily Telegraph

They Say: See Your Dentist to Avoid Pre-Term Labor

Miriam Axel-Lute — Wed, 14 Jan 2009 15:00:00 GMT

A new study from the Journal of Clinical Microbiology is estimating that up to 80 percent of pre-term labors could be caused by mouth bacteria—the kind that are usually in your mouth and don't cause much trouble there, but can apparently cause an immune reaction and labor if they get into the bloodstream, say through a cut in the gum or cheek.

Assuming further research bears this out (which it may or may not), it's one of those findings that I have very mixed feelings about.

On the one hand, given all the various problems that we know prematurity, even late prematurity, causes, identifying a reason for it is huge and exciting.

On the other hand, I can just see every woman with a preemie being told it's her fault for not brushing her teeth enough. Do we need another thing for pregnant women to freak out about? Especially since this is normal mouth bacteria, and it's probably going to get into the bloodstream from time to time no matter what you do. In fact, I'll bet that obsessive attempts at oral hygeine would probably backfire (think about those bleeding gums if you haven't flossed in a while).

Of course the other approach the article mentions—prophylactic antibiotics—sounds like a prescription for resistant bugs and nasty yeast infections unless you could target high-risk people pretty carefully.

The one fairly concrete takeaway from the article is the suggestion to see a dentist before pregnancy to make sure you don't have peridontal disease, and clearing it up if you do. That could be a useful thing to add to general pre-conception recommendations. Anything else, I think I'd want a separate study showing it really worked before anyone began adding another item to the pregnancy "thou shalts."

Photo by martinhoward.

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Baby Born Two Days After Mom's Death

JeanneSager — Tue, 13 Jan 2009 20:40:00 GMT

There's no avoiding the horrors of this story. A woman has died. A mom will never get to see her baby girl.

And yet, there's something beautiful about the story of little Aya Jayne Soliman (OK, beautiful and total sob, melt-down inducing).

Her mother was forty-one, a former skating champion, who always wanted to be a mother. When she collapsed from a brain hemmorhage at twenty-five weeks pregnant, she could have lost that chance. But doctors decided to keep her alive for two more days, to give her baby girl a chance at life.

They administered two shots of steroids to boost the baby's lungs, and forty-eight hours after declaring Jayne Soliman braindead, doctors performed a C-section to bring into the world little Aya Jayne (thus named by her father because "Aya" is Arabic for "miracle). The baby is just over two pounds, but she's alive and faring well in the hospital. And her father, Mahmoud Soliman, is struggling to contain the grief at losing his wife with the happiness that her "one true wish" was fulfilled.

"She would have been a great mum. In the space of forty-eight hours I have experienced joy at the birth of my child and endured torment over losing my wonderful wife," Soliman said.

There's still a long road ahead of them (imagine, two pounds!), but often the birth of a child can help rouse a family from its grief - if for no other reason than the demands that an infant makes on their time. There's no second to think sad thoughts when the baby's screaming for a diaper change or the next feeding.

And, hopefully, one day, Aya Jayne will grown up and learn that even in death, her mother was fighting for her. (Yes, you can start weeping now - I am).

Image: BBC News (Jayne Soliman with friends)

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Pre-Term Elective C-Sections Are Dangerous: So Why Insure Them?

Miriam Axel-Lute — Fri, 19 Dec 2008 15:00:00 GMT

Michael McGuire is CEO of UnitedHealth, a health-insurance provider in New Jersey. In an op-ed in the Trenton Times recently he talked intelligently about the health dangers of elective pre-term c-sections.

The evidence keeps mounting—prematurity, even by a few weeks, means higher rates of breathing problems, cerebral palsy, NICU stays, etc. When the baby's not ready to come out, it's not ready, folks.

McGuire makes the impressive assertion that when he explained this carefully to a "pilot group" of physicians and hospitals and they stopped scheduling c-sections before 39 weeks, there was a 46 percent drop in NICU stays. Those are results to write home about. As he writes, "That's almost half the number of newborns with potential health problems, almost half the number of distraught parents, al most half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous."

He notes carefully, as do I, that sometimes a pre-term c-section is medically necessary for health of mother and/or baby. Obviously, that is not what I'm talking about. But I would include c-sections that are planned for medical reasons,* but where there is no medical reason not to carry the baby to term. I think those are far, far more common than the over-hyped "too posh to push" phenomenon.

So here's what I want to know: If it's documented to be such a health risk, why don't McGuire and his colleagues just stop paying for c-sections that are unnecessarily scheduled at an unsafe time?

Insurers already go out of their way to not cover things they claim are optional (including some that are emphatically not), not to mention dangerous. Usually I question their judgment, but the evidence is pretty compelling on this one.

I'm all for educating docs, but it seems to me the insurers could stop this practice cold with their purse strings.

Photo by César Rincón.

*(Of course, many of those "medical reasons," like a previous c-sections or breech presentations, don't actually require a c-section, but that's a separate post.)

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They Say: Even Late Preemies at Higher Risk

Kate Tuttle — Mon, 15 Dec 2008 18:02:00 GMT

While it's long been known that premature babies face a much higher incidence of cerebral palsy and other medical problems, most of the infants thought to be at risk were those born before 34 weeks -- the tiny babies, notably premature, whose entire bodies can fit into the palm of their father's hands. But new research suggests that even bigger, healthier-seeming babies, when born before term, are much more likely to fall victim to the health problems of prematurity. And at a time when more and more women are giving birth early due to inductions or scheduled C-sections, that risk needs to be better communicated, according to the doctors who authored the study.

The study, which examined the circumstances of more than 140,000 babies born at 30 weeks or later, concluded that babies born from 34 to 36 weeks' gestation, although often appearing as big and healthy as full-term newborns, were three times more likely to have cerebral palsy than babies born at 37 weeks, and up to 25% more likely to face mental retardation and other developmental delays. Because the babies in the study have not yet entered elementary school, the authors point out, it's too early to know whether other learning-based problems will be detected.

While overall rates of prematurity are fairly steady, the number of babies born from 34-36 weeks is growing, and currently represents one in 11 births in the US. The study did not look into the reasons for the late preterm births, and some surely were medically indicated (pre-eclampsia, for instance, pretty much demands that a baby be born early, to save both lives).According to the study's authors, however, some of those "late preterm" births were due to early inductions or C-sections that were not medically necessary (remember that the next time a Hollywood starlet says she's due "sometime in the fall" and has a six-pounder).

Pre-term Elective C-Sections Are Dangerous: So Why Insure Them?

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Does Where You Live Put You At Risk For A Preterm Baby?

SunnyChanel — Wed, 12 Nov 2008 22:45:00 GMT

I’m really not sure if pure geography has anything to do with it, but the recent study by the March of Dimes on preterm births shows evidence that where you live may affect the odds of having a preemie. Who had the highest and lowest preterm births? Vermont had the lowest amount whereas Mississippi had the highest.

The March of Dimes, as part of a “federal goal of lowering preterm births” , did the study and graded the nation with a big fat “D”. That ain’t too good. According to the AP, more than 500,000 babies in the United Sates are prematurely born every year, with a rise steadily over the last twenty years.

The goal for the government is to have “no-more than 7.6 percent of babies born” before 37th weeks of pregnancy by 2010. In Vermont, the lowest on the scale, 9% of the babies born there were premature. And in Mississippi the rate was a whopping 18.8%.

They found that there were three factors that lead to a premature birth:

Lack of insurance – not enough or early enough pre-natal care.

Smoking – they suggest that a shocking 17% of women smoke during pregnancy!

Late Preemies – Babies born between 34 and 37 weeks sometimes babies are delivered via C-section early “either deliberately or because of confusion about the fetus's exact age.”

So if you're going to have a baby, get some insurance, stop smoking, reschedule that C-section and move to Vermont.

Via: Salon/AP

Neonatal Nurse Puts Preemie in Her Pocket and Takes Pictures

JeanneSager — Wed, 12 Nov 2008 17:57:00 GMT

A nurse on the neonatal unit of an Israeli hospital is facing disciplinary action after photos of her holding a premature infant girl in her pocket landed in the hands of hospital adminstration. The hospital's director general has her back, saying the photos were taken as part of a presentation to be shown to parents of preemies.

Most troubling here, no one seems to know whether the baby girl's parents were aware their daughter was out of her incubator and slipped kangaroo-style into a nurse's scrub pocket or whether they agreed to have their delicate baby used in the photo the hospital said was supposed to provide a bit of humor in the presentation. What's funny about a teeny weeny baby struggling to survive catching the creeping crud from a nurse's dirty pocket?

The nurse is said not to have initiated the photos - she was simply doing what she was told. A veteran of more than a dozen years on the neonatal unit, you'd hope she'd have more sensitivity and just plain sense.

Do you think she should be disciplined or should the punishment be levied on the boss who passed down the order?

Source/Image: YNetNews

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Sad Update: Baby Never Really 'Came Back to Life'

Hannah Tennant-Moore — Tue, 19 Aug 2008 17:30:00 GMT

A premature baby who was pronounced stillborn, put in the morgue, and then discovered moving and breathing five hours later died on Tuesday and was buried the same day.

Since the baby's death, a leading Jerusalem neonatologist has shed new light on the situation, completely contradicting the hospital director's claims that this was a "medical miracle." According to Arthur Eidelman, the baby, named Bana Hiba, did not die and come back to life, as doctors at the Western Galilee Hospital asserted. Rather, babies who are that premature--Bana Hiba was in the 23rd week of gestation--have very irregular heartbeats, sometimes going for as long as five minutes without exhibiting any sign of respiration.

Given this, Eidelman said that premature babies who appear to be stillborn should be left in the delivery room for 20 minutes and closely monitored for signs of life. If there is no heartbeat after 20 minutes, the baby is pronounced dead. Putting live fetuses in the cooler, he said, slows down their metabolism so that they are in a state of "suspended animation." Doctors even do this intentionally sometimes to try to save premies.

So even if gynecologists were too quick to pronounce Bana Hiba dead, their actions were certainly not to blame for the baby's death. However, they may be to blame for putting her parents on a heartbreaking emotional roller coaster.

Both the Health Ministry and the hospital are conducting investigations into the sad case.

Photo: Channel 2

Stillborn Baby Comes Back to Life

Hannah Tennant-Moore — Mon, 18 Aug 2008 22:50:00 GMT

I know what you’re thinking, and the answer is no: I did not learn about this story from The National Enquirer. Sensational though this headline sounds, it is factually accurate, according to numerous Israeli news sources.

In Israel, a 26-year-old pregnant woman began hemorrhaging and experiencing intense pain. Tests showed that her fetus, in its 23^rd week of gestation, was already dead. After an emergency operation to remove the fetus, doctors pronounced the 610-gram baby girl dead. She was sent to the morgue to be prepared for burial.

Five hours later, the baby’s mother asked to see her daughter’s body one last time. Picking up the tiny bundle, she immediately started screaming. Her baby was moving. The child was rushed to the intensive care unit, where she is still struggling to survive.

The baby’s father has criticized the Western Galilee Hospital for negligence, accusing them of too quickly pronouncing his premature daughter dead. But the hospital director maintains that senior doctors made no mistakes; the only way to explain how the baby spontaneously started breathing again is that it was a “medical miracle.”

He noted that this miracle may have been related to the cool temperature of the morgue, which vastly lowered the baby's oxygen consumption. There have been extremely rare cases of people who "came back to life" after it appeared that they had frozen to death. The Health Ministry will likely set up an investigating committee to look into the matter.

Photo: Channel 2

UPDATE:

Baby Never Really "Came Back to Life"

Low Birth Weight Babies, Especially Girls, Likely to Develop Autism

Cole Gamble — Thu, 05 Jun 2008 17:05:00 GMT

The possible causes for autism grew by one today as new research finds babies born before term, underweight and especially female are twice as likely to develop autism… This is according to a report by the U.S. Centers for Disease Control and Prevention. Although it is not understood what this link means, experts say it is further prompting for pregnant women to seek prenatal care. Currently one in every 150 children in the US is autistic and 1 in every 8 children is born premature.

Strollerderby : premature

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