St. Louis hospital to study birth defect

Date: 3/31/2009

BETSY TAYLOR
Associated Press Writer

ST. LOUIS (AP) — A top children's hospital wants to improve the survival rate of infants born with a birth defect that many families have never heard of until their child is diagnosed.

Dr. Brad Warner, surgeon-in-chief of St. Louis Children's Hospital, said Tuesday that he and others plan research to better understand the condition, known as CDH, or Congenital Diaphragmatic Hernia. One in 2,000 babies is diagnosed with the disease, doctors say. Half of those don't live to their first birthday.

The condition occurs when the diaphragm, which separates the chest cavity from the abdomen, does not completely form in the womb. The contents of the belly migrate to the chest, which keeps the lungs from developing properly.

Eight babies at the St. Louis hospital died last year from the condition.

Doctors at St. Louis Children's Hospital say they're part of a national database registry to collect and track information on children with the condition. They plan to recruit faculty candidates that are able to explore fetal surgery intervention and are working to collect DNA for analysis.

Treatment for the birth defect varies.

Many are stillborn. Babies who die from the birth defect usually have insufficient lung tissue to survive, or develop hypertension in the blood vessels of the lungs. Medications to lower blood pressure in the lungs lower the baby's overall blood pressure, which can be problematic.

Of those who live, some are in distress from the moment the umbilical cord is clamped; others are OK for their initial hours of life, then get worse. A third group, which is the most uncommon, initially looks good, but later exhibits signs, such as bowel sounds in the chest, that reveal the condition.

In some cases, doctors have performed surgery on pregnant women and their fetuses to try to address problems before a baby is born, but those procedures have risks. Children with CDH can grow up to be healthy adults.

Doctors say they hope to better understand predictors of good and bad outcomes for babies with the condition, as well as how to address the many complications that can arise.

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On the Net:

Breath of Hope: http://www.breathofhopeinc.com/

Copyright 2009 The Associated Press.

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.

Vaccine slashes diarrheal illness in kids

Date: 10/25/2008 2:05 PM

By MARILYNN MARCHIONE
AP Medical Writer


WASHINGTON (AP) _ A vaccine against rotavirus, the leading cause of diarrhea in infants, has led to a dramatic drop in hospitalization and emergency room visits since it came on the market two years ago, doctors reported Saturday.

A bonus: the vaccine seems to be preventing illness even in unvaccinated children by cutting the number of infections in the community that kids can pick up and spread.

"We're a little surprised by the degree of impact given the coverage we've achieved," said Jane Seward of the federal Centers for Disease Control and Prevention. Only about half of young children had received the vaccine and very few had received all three doses when the studies were done.

Results were reported Saturday at an infectious diseases conference in Washington.

Before the vaccine, more than 200,000 U.S. children were taken to emergency rooms and more than 55,000 were hospitalized each year with rotavirus, which causes vomiting and diarrhea, mostly from January through May. Worldwide, the virus kills 1,600 young children each day.

Since Merck & Co.'s Rotateq came out in 2006, hospital visits and stays due to the virus have dropped 80 percent to 100 percent, studies by the CDC and several other groups show.

Last winter, rotavirus cases started and peaked two to three months later and were much less extensive than in previous years, CDC scientists report. Hospitals in a network that tracks these cases for the CDC saw more than an 80 percent drop in admissions from them, one study showed.

Another study, by Merck, found a 100 percent drop in hospitalizations and ER visits during the 2007 and 2008 rotavirus seasons compared to previous ones. The study was based on a review of health insurance claims for about 61,000 infants and diagnoses by doctors in routine clinical practice.

Rotateq is an oral vaccine given at two, four and six months of age. In June, a second rotavirus vaccine came on the market — GlaxoSmithKline's Rotarix. It requires only two doses, completed by four months of age.

Also at the conference, scientists reported that a new version of Wyeth's Prevnar vaccine seems to better protect kids against germs that cause pneumonia, meningitis and ear infections, but whether it makes it onto the market before dangerous strains become a big problem remains to be seen.

Scientists have been retooling Prevnar, which came on the market in 2000 and is advised for children under age 2. It protects against the seven strains of Strep bacteria that were causing the most serious infections at the time. Since then, new strains have become more of a threat and increasingly are resistant to common antibiotics.

The experimental new vaccine adds six of these to the original seven. Scientists from Wyeth and from Johannes Gutenberg University in Mainz, Germany, compared immune responses to the new vaccine, given to 293 babies, versus those of an equal number of babies given the old one.

The new vaccine did about as well as the old one on the original strains and well on five of the six new ones.

The company has said it plans to seek federal approval for it in early 2009, and review can take a year or more. British-based GlaxoSmithKline has a similar vaccine in final-phase testing that targets 10 strains common in Europe and other regions.

In the meantime, parents should continue to have their toddlers get the existing Prevnar, and to use antibiotics only when needed because they don't work against the common cold and overuse worsens the bacteria resistance problem, said Dr. Cynthia Whitney, a pneumonia expert at the CDC.

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On the Net:

Infectious disease meeting: http://www.icaacidsa2008.org/

CDC: http://www.cdc.gov/vaccines/.

Copyright 2008 The Associated Press.

Pediatricians double vitamin D recommendations

Date: 10/13/2008 12:07 AM

By LINDSEY TANNER
AP Medical Writer


CHICAGO (AP) _ The nation's leading pediatricians group says children from newborns to teens should get double the usually recommended amount of vitamin D because of evidence that it may help prevent serious diseases.

To meet the new recommendation of 400 units daily, millions of children will need to take daily vitamin D supplements, the American Academy of Pediatrics said. That includes breast-fed infants — even those who get some formula, too, and many teens who drink little or no milk.

Baby formula contains vitamin D, so infants on formula only generally don't need supplements. However, the academy recommends breast-feeding for at least the first year of life and breast milk is sometimes deficient.

Most commercially available milk is fortified with vitamin D, but most children and teens don't drink enough of it — four cups daily would be needed — to meet the new requirement, said Dr. Frank Greer, the report's co-author.

The new advice is based on mounting research about potential benefits from vitamin D besides keeping bones strong, including suggestions that it might reduce risks for cancer, diabetes and heart disease. But the evidence isn't conclusive and there's no consensus on how much of the vitamin would be needed for disease prevention.

The new advice replaces a 2003 academy recommendation for 200 units daily.

That's the amount the government recommends for children and adults up to age 50; 400 units is recommended for adults aged 51 to 70 and 600 units for those aged 71 and up. Vitamin D is sold in drops for young children, capsules and tablets.

The Institute of Medicine, a government advisory group that sets dietary standards, is discussing with federal agencies whether those recommendations should be changed based on emerging research, said spokeswoman Christine Stencel.

The recommendations were prepared for release Monday at an academy conference in Boston. They are to be published in the November issue of the academy's journal, Pediatrics.

Besides milk and some other fortified foods like cereal, vitamin D is found in oily fish including tuna, mackerel and sardines.

But it's hard to get enough through diet; the best source is sunlight because the body makes vitamin D when sunshine hits the skin.

While it is believed that 10 to 15 minutes in the sun without sunscreen a few times weekly is sufficient for many, people with dark skin and those in northern, less sunny climates need more. Because of sunlight's link with skin cancer, "vitamin D supplements during infancy, childhood and adolescence are necessary," the academy's report says.

Recent studies have shown that many children don't get enough vitamin D, and cases of rickets, a bone disorder often associated with malnourishment in the 1800s, continue to occur.

Greer, a University of Wisconsin pediatrician, acknowledged that most studies suggesting vitamin D may play a much broader role in disease prevention have been observational, not the most rigorous kind of medical evidence.

Nonetheless, many doctors consider the research compelling and many have begun to offer patients routine vitamin D testing.

Adrian Gombart, a vitamin D researcher at Oregon State University, said the new recommendations are safe and conservative but that 400 units "is probably not enough."

Gombart's lab work in human tissue has shown that vitamin D helps increase levels of a protein that kills bacteria. He said many experts believe that between 800 and 1,000 units daily would be more effective at helping fight disease.

Several members of an academy committee that helped write the guidelines have current or former ties to makers of infant formula or vitamin supplements.

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On the Net:

Academy: http://www.aap.org

Institute of Medicine: http://www.iom.edu

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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On the Net:

Archives: http://www.archpediatrics.com

Copyright 2008 The Associated Press.