Report urges states to tackle preterm birth crisis

Date: 11/12/2008

By LAURAN NEERGAARD
AP Medical Writer

WASHINGTON (AP) _ The odds of having a premature baby are lowest in Vermont and highest in Mississippi.

The March of Dimes mapped the stark state-by-state disparities in what it called a "report card" on prematurity Wednesday — to track progress toward meeting a federal goal of lowering preterm births.

There's not much chance of meeting that goal by the original 2010 deadline, if the "D'' grade the charity bestowed on the nation is any indication. Ohio also earned a "D."

More than half a million U.S. babies — one in every eight — are born premature each year, a toll that's risen steadily for two decades. The government's goal: No more than 7.6 percent of babies born before completion of the 37th week of pregnancy.

Preterm birth can affect any mother-to-be, stressed a recent U.S. Surgeon General's meeting on the problem. Scientists don't understand all the complex causes.

But Wednesday's report highlights big geographic differences that March of Dimes president Dr. Jennifer Howse called "a dash of cold water."

In Vermont, 9 percent of babies were preemies in 2005, the latest available data. In Oregon and Connecticut, just under 10.5 percent of babies were premature.

Travel south, and prematurity steadily worsens: In West Virginia, 14.4 percent of babies were preemies; more than 15 percent in Kentucky and South Carolina; more than 16 percent in Alabama and Louisiana; and a high of 18.8 percent in Mississippi.

Ohio's had 13 percent of babies born premature.

The report urges states to address three factors that play a role:

—Lack of insurance, which translates into missed or late prenatal care. In states with the highest prematurity rates, at least one in five women of childbearing age are uninsured. Early prenatal care can identify risks for preterm labor and sometimes lower them.

—Smoking increases the risks of prematurity, low birthweight and birth defects. Government figures suggest 17 percent of women smoke during pregnancy. The new report urged targeting smoking by all women of childbearing age. About a third of those women smoke in Louisiana and West Virginia, the report says, compared with 9.3 percent and 11 percent in Utah and California, respectively.

—Then there's the trickier issue of so-called late preemies, babies born between 34 and 37 weeks. They're fueling the nation's prematurity rise. While not as devastating as a baby born months early, being even a few weeks early can cause learning or behavioral delays and other problems. And recent research suggests at least some near-term babies are due to Caesarean sections scheduled before full-term, either deliberately or because of confusion about the fetus's exact age.

Howse urged hospitals to double-check that women given an early C-section truly need one for a medical problem, as current health guidelines recommend.


Copyright 2008 The Associated Press.

Fan use linked to lower risk of sudden baby death

Date: 10/6/2008 4:01 PM

By CARLA K. JOHNSON
Associated Press Writer

CHICAGO (AP) _ Using a fan to circulate air seemed to lower the risk of sudden infant death syndrome in a study of nearly 500 babies, researchers reported Monday.

Placing babies on their backs to sleep is the best advice for preventing SIDS, a still mysterious cause of death. Experts also recommend a firm mattress, removing toys and pillows from cribs, and keeping infants from getting too warm.

Such practices helped slash U.S. SIDS deaths by more than half over a decade to about 2,100 in 2003. But SIDS remains the leading cause of death in infants ages 1 month to 1 year.

"The baby's sleeping environment really matters," said study senior author Dr. De-Kun Li of the Kaiser Permanente Division of Research in Oakland, Calif. "This seems to suggest that by improving room ventilation we can further reduce risk."

SIDS is the sudden death of an otherwise healthy infant that can't be attributed to any other cause. These babies may have brain abnormalities that prevent them from gasping and waking when they don't get enough oxygen.

The new study, published in October's Archives of Pediatrics & Adolescent Medicine, offers another way to make sure babies get enough air.

More research is needed, said Dr. Fern Hauck of the University of Virginia in Charlottesville, but she said that because fan use is in line with theories, it may be worth considering.

"This is the first study that we know of that has looked at this issue," said Hauck, a member of the American Academy of Pediatrics SIDS task force.

Researchers interviewed mothers of 185 infants who died from SIDS and mothers of 312 infants of similar race and age. Moms answered dozens of questions about their baby's sleeping environment.

Researchers took into account other risk factors and found that fan use was associated with a 72 percent lower risk of SIDS. Only 3 percent of the babies who died had a fan on in the room during their last sleep, the mothers reported. That compared to 12 percent of the babies who lived.

Using a fan reduced risk most for babies in poor sleeping environments.

The study involved infants in 11 California counties. It was supported by grants from the National Institutes of Health.

___

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Copyright 2008 The Associated Press.

ABC's 'Private Practice' explores bioethics

Date: 9/30/2008 10:26 AM

By SANDY COHEN
AP Entertainment Writer

LOS ANGELES (AP) _ On a massive sound stage at Hollywood's Raleigh Studios, a woman is dying of ovarian cancer. One doctor wants to treat her traditionally, by removing her uterus and ovaries. Another wants the patient to participate in a clinical trail that might preserve her ability to have children, but could have serious side effects.

On a different day, an obstetrician is conflicted about whether to deliver a premature baby she believes was conceived solely because the umbilical-cord blood could save the family's older, dying child. Another doctor struggles to do what's right when his teenage patient — who has HIV but doesn't know it — confides that he plans to have sex for the first time.

Bioethical questions like these come up weekly on ABC's "Private Practice," the "Grey's Anatomy" spin-off that begins its second season Wednesday.

"We're telling stories ... that will provide a lot of moral debate among our doctors and maybe debate at home when you watch," said series creator Shonda Rhimes.

The issues they face cause plenty of drama for the doctors at the Oceanside Wellness Group, where Kate Walsh's character, Addison Montgomery, came to work after leaving "Grey's" Seattle Grace Hospital.

"They're all viable conflicts ... grounded in these medical stories," Walsh said. "It's topical but not so procedural that it's not a Shonda Rhimes show. You still have all the great dialogue and characters and stories and romance."

Like "Grey's Anatomy," ''Private Practice" features an ensemble cast of doctors whose personal lives are often far messier than their professional ones. They have affairs with one another and struggle with love as they overcome tough medical challenges and the financial realities of keeping their medical co-op alive.

The bioethical issues raised are based on real medical cases and community concerns, said researcher and writer Elizabeth Klaviter.

"We look at the things that have ourselves and our family members and friends buzzing — the issues that people are talking about in terms of right or wrong and the laws, ethics and social morays that are put on us in terms of how we conduct ourselves," said Klaviter, who also researches cases for "Grey's Anatomy."

"Doctors disagree," she said. "We're looking for cases where there are different courses of action or treatment."

This season, the doctors at Oceanside Wellness will have to decide what rights prostitutes have to medical care and whether to treat a sex offender at their child-friendly practice. They also engage in an abortion debate that surprised actor Tim Daly, who plays Dr. Pete Wilder.

"I never thought we'd be doing something like that on Disney," which owns ABC, he said. "It was just these characters discussing their opinions and they didn't agree and they were passionate about it, just like in the real world."

Daly and his castmates credit Rhimes and the show's writers for using the forum of a prime-time drama to inspire viewers to consider current bioethical issues.

"If you can make anybody think in this day and age, and entertain them at the same time, that's a dream come true," said KaDee Strickland, who plays Dr. Charlotte King, a physician at a rival hospital.

Making bioethics a theme of the show is "seductive," Walsh said, because it deepens the characters while raising important issues for viewers to ponder. Though she said it was a risk for her to leave "Grey's," she feels she landed in a good place.

"It was a risk but it wasn't like sex-without-a-condom risk. It was an offer I couldn't refuse," she said. "I'm hugely grateful that it did really well last fall... It's really a testament to Shonda and her gift for being able to tap into the culture and the big collective consciousness of what people really relate to."

History proves that viewers respond to medical shows: "We may never end up in a courtroom or never end up arrested, but sooner or later everybody's going to come through the doors of a doctor's office," Rhimes said. Exploring bioethics adds a new dimension to the already-beloved genre.

"It's something more and more doctors are facing these days," Rhimes said. "It's just a very different way of looking at medicine that I don't think we normally think about — the ethics of what you're doing."

ABC is owned by The Walt Disney Co.

Copyright 2008 The Associated Press.

Doctors: infection led to Turkish newborn deaths

Date: 9/22/2008 2:18 PM

By SUZAN FRASER
Associated Press Writer

ANKARA, Turkey (AP) _ An infection spread by IV treatment led to the weekend deaths of 13 premature newborns at a hospital in western Turkey, a doctor investigating the deaths told the private Dogan news agency Monday.

The deaths drove the number of babies killed by infections in Turkey to at least 40 in three months.

In July, more than 27 newborns died of an infection at a hospital for high-risk births in the capital, Ankara. Government-appointed doctors investigating the deaths said a staff shortage had increased the risk of infection.

Recep Ozturk, a doctor at Istanbul's Cerrahpasa University Hospital, said preliminary results indicated that IV-spread infection caused the latest deaths at Izmir's Tepecik hospital Saturday and early Sunday, Dogan reported. Ozturk, who spoke on behalf of the group of doctors investigating the case, said the infection appeared to be spread by intravenous solution, Dogan reported.

A local prosecutor was investigating whether neglect may have been a factor.

Izmir health department head Mehmet Ozkan said the hospital believed the babies were not neglected. Tepecik hospital was caring for 41 newborns overnight Saturday. After the 13 deaths, the unit was placed under quarantine and no new babies have been admitted. The hospital has 30 incubators and can accommodate 45 infants.

The bodies of three babies buried over the weekend were being exhumed to help with the investigation, the state-run Anatolia news agency reported.

Hospitals in small towns in Turkey generally lack specialized premature birth units, and high-risk or premature babies are often taken to larger hospitals in cities such Istanbul, Ankara or Izmir.

Health workers unions say, however, that the larger hospitals are often understaffed or ill-equipped to care for large numbers of newborns.

"These unfortunate deaths are very saddening," Prime Minister Recep Tayyip Erdogan said. "There may have been neglect, this will become clear after the investigation."

"Premature births constitute a high risk, and this may have played a part, too," he said.

Turkey's infant mortality rate is relatively high, at 23.66 in 1,000 in 2005, compared with that of its EU-member neighbor Greece, where 3.8 newborns out of 1,000 died the same year, according to the Organization for Economic Co-operation and Development.

Copyright 2008 The Associated Press.