Extremely preterm infants are surviving in greater numbers

Extremely preterm infants, those born before the 28th week of pregnancy, are surviving in greater numbers and escaping serious illness, according to a comprehensive review of births in a National Institutes of Health research network.

The study, published in the Journal of the American Medical Association, reviewed the birth records of more than 35,000 premature infants born from 1993 to 2012 in 26 U.S. centers participating in the Neonatal Research Network, a program funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The lead author was Barbara J. Stoll, M.D., chair of pediatrics at Emory University School of Medicine.

• Infants born at 23 and 24 weeks survived in greater numbers over the 20-year period. Of those born at 24 weeks, for example, only 52 percent survived in 1993 while 65 percent survived in 2012.
• A higher number of premature infants survived without major illnesses. For infants born at 27 weeks, for example, survival without major illness increased from 29 percent in 1993 to 47 percent in 2012.

Among the survivors, the researchers saw an increase in the rate of bronchopulmonary dysplasia a complication often resulting from respiratory therapy. Improvements in respiratory care appear to have saved many infants who otherwise may have died. Nonetheless, the infant's’ underdeveloped lungs often sustain damage.

“NICHD has funded newborn care research for many years,” said Rosemary Higgins, M.D., who oversees NICHD’s Neonatal Research Network. “We’re now seeing the results of that investment in improvements in survival and outcomes.”

More than 450,000 premature babies are born each year in the United States. Higgins attributed the boost in survival to advances in maternal and newborn care, such as the increased use of antenatal steroids - these drugs are given to women at risk for preterm birth to help stimulate lung development in the fetus. In 1993, physicians gave antenatal steroids to only 24 percent of women at risk for delivering too early, according to the study. A 1995 NIH consensus statement on antenatal steroids led to the widespread use of the treatment. By 2012, doctors were giving the steroids to nearly 87 percent of at-risk pregnant women.

The study authors noted that the increase in survival of extremely preterm infants parallels an increase in cesarean sections in this age group. It’s possible, Dr. Higgins explained, that “physicians are more likely to perform the surgery than they were in previous years.” The surgery may result in a less traumatic birth for the infant and therefore may contribute to survival.

The study authors also stressed the need for continued research on the care of extremely premature infants. Although survival has increased over the past two decades, including survival without major illnesses, preterm birth in the United States still poses a substantial burden to families and society at-large, they wrote.

Umbilical cord ‘milking’ improves blood flow in preterm infants

A technique to increase the flow of blood from the umbilical cord into the infant’s circulatory system improves blood pressure and red blood cell levels in preterm infants delivered by cesarean section, according to a study funded by the National Institutes of Health.

The study, published online in Pediatrics, was conducted by researchers at the Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns in San Diego, and Loma Linda University, Loma Linda, California. It was supported by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The technique, known as cord milking, consists of encircling the cord with thumb and forefingers, gently squeezing, and slowly pushing the blood through the cord to the infant’s abdomen. For infants delivered by cesarean, cord milking appears to offer benefits over the standard practice of waiting 45 to 60 seconds before clamping and then cutting the umbilical cord. These benefits, which include greater blood flow to and from the heart, higher red blood cell level, and higher blood pressure, were seen only in the infants delivered by cesarean. Among a smaller number of vaginal births, the researchers found no difference in blood volume between infants undergoing cord milking and those undergoing delayed cord clamping.

“The study results are very encouraging,” said Tonse Raju, M.D., chief of NICHD’s Pregnancy and Perinatology Branch. “The findings need to be confirmed in a larger number of births, but at this point, it appears that umbilical cord milking may prove to be of great benefit to preterm infants delivered via cesarean.”

Delaying umbilical cord clamping by 30 to 60 seconds is thought to allow sufficient time for blood from the umbilical cord to fill the blood vessels in the infant’s lungs, Dr. Raju explained in an earlier podcast. Among preterm infants, the delay is believed to protect from intraventricular hemorrhage, or bleeding in the ventricles — the cavities inside the infant’s brain. The hemorrhage is thought to result from low blood pressure, brought on by having too little blood in the circulatory system. Bleeding in the brain may result in developmental delays, cerebral palsy, and in severe cases, death.

However, Dr. Anup C. Katheria, M.D., a neonatologist at the Neonatal Research Institute at the Sharp Mary Birch Hospital and the study’s first author, noted that some studies failed to find a reduction in intraventricular hemorrhage from delayed cord clamping among preterm infants delivered by cesarean. The scientists theorized that the use of an anesthetic in cesarean delivery reduces uterine contractions, and in so doing hinders the exodus of blood from the umbilical cord. Cord milking, they reasoned, might compensate for diminished blood flow through the umbilical cord and increase the amount of blood available to the infant.

The researchers enrolled 197 infants in their study. Mothers went into labor at or before the 32nd week of pregnancy. Of these, 154 were delivered by cesarean, with 75 assigned at random to the umbilical cord milking group and 79 assigned to the delayed clamping group. The 43 infants delivered vaginally also were assigned at random to either delayed clamping or umbilical cord milking.

Of the infants undergoing cesarean deliveries, those in the cord milking group had higher blood flow in the superior vena cava, the large vein carrying blood from the brain to the heart, and a higher output of blood from the right ventricle. The two measures, taken together, are an indication of blood circulation in the brain and body. Infants in the cord milking group also had higher blood pressure and higher levels of hemoglobin—a protein used as an indicator of the quantity of red blood cells.

Children's Health: Fewer repeat surgeries for children born with heart defect, ♦ dolescents uncertain about risks of marijuana, e-cigarettes,♦ Screening for vascular disorder among extremely preterm infants

Reinforced cylinder leads to fewer repeat surgeries for children born with heart defect Hypoplastic left heart syndrome is a congenital defect in which the left side of the heart does not develop properly, impairing normal circulation. A series of surgeries can help restore heart function. A new study has found use of a ring-reinforced cylinder instead of the usual non-reinforced conduit improved survival, reduced need for re-interventions, and induced physiological changes that may make patients better candidates for recovery after future surgeries.

Benefit of early screening for vascular disorder among extremely preterm infants Among extremely preterm infants, early screening for the vascular disorder patent ductus arteriosus before day three of life was associated with a lower risk of in-hospital death and pulmonary hemorrhage, but not with differences in other severe complications

Adolescents uncertain about risks of marijuana, e-cigarettes, study finds Teenagers are very familiar with the risks of smoking cigarettes, but are much less sure whether marijuana or e-cigarettes are harmful, according to a new study. The researchers compared teens' knowledge of cigarettes, e-cigarettes and marijuana because they heard from teachers, parents and youth that anti-smoking efforts needed to address more than just conventional cigarettes.

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Nearly 55 % of US infants sleep with potentially unsafe bedding

NIH, CDC study shows unsafe infant bedding use still common, despite warnings

Nearly 55 percent of U.S. infants are placed to sleep with bedding that increases the risk of sudden infant death syndrome, or SIDS, despite recommendations against the practice, report researchers at the National Institutes of Health, the Centers for Disease Control and Prevention, and other institutions.

Soft objects and loose bedding — such as thick blankets, quilts, and pillows — can obstruct an infant’s airway and pose a suffocation risk, according to the NIH’s Safe to Sleep campaign. Soft bedding has also been shown to increase the risk of SIDS Infants should be placed to sleep alone, on their backs, on a firm sleep surface, such as in a mattress in a safety-approved crib , covered by a fitted sheet. Soft objects, toys, crib bumpers, quilts, comforters and loose bedding should be kept out of the baby’s sleep area.

Based on responses from nearly 20,000 caregivers, the researchers reported that, although such potentially unsafe bedding use declined from 85.9 percent in 1993-1995, it still remained high, at 54.7 percent, in 2008-2010.

“Parents have good intentions but may not understand that blankets, quilts and pillows increase a baby’s risk of SIDS and accidental suffocation,” said the study’s first author, Carrie K. Shapiro-Mendoza, Ph.D., M.P.H.

The current study is an analysis of data from the National Infant Sleep Position Study (NISP), which collected information on the influence of infant sleep position and other safe sleep recommendations on infant care practices. The survey collected information by telephone from a random sample of more than 1,000 caregivers in U.S. households from 1992-2010.

“Parents receive a lot of mixed messages,” said study author Marian Willinger, Ph.D., special assistant for SIDS at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. “Relatives may give them quilts or fluffy blankets as presents for the new baby, and they feel obligated to use them. Or they see magazine photos of babies with potentially unsafe bedding items. But babies should be placed for sleep on a firm, safety approved mattress and fitted sheet, without any other bedding.”

Drs. Shapiro-Mendoza and Willinger conducted the analysis with colleagues at CDC, the Yale School of Medicine in New Haven, Connecticut, the Boston University School of Public Health and the Boston University School of Medicine. The study was published online in Pediatrics.

SIDS is the unexplained death of a child within the first year of life. In 1992, the AAP issued its recommendation that infants be put to sleep on their backs. Two years later, the NICHD and its partners launched the Back to Sleep campaign, later renamed Safe to Sleep. The rate of SIDS in the United States has fallen 50 percent since 1992. However, since 2000, the SIDS rate has declined slowly, and researchers have reported an increase in other unexpected infant deaths, resulting from such causes as accidental suffocation, entrapment in bedding material or other causes. These accidental suffocation deaths have increased from 7.0 per every 100,000 live births in 2000 to 15.9 in 2010.

As part of the survey, caregivers were asked whether infants were placed to sleep on such items as blankets, bean bag chairs, rugs, sheepskin, cushions, or pillows. Caregivers were also asked about whether the infant was covered with such bedding materials as a blanket, quilt or comforter, sheepskin, or a pillow. The Safe to Sleep campaign advises against blankets or other coverings, and recommends sleep clothing, such as a one-piece sleeper, and keeping the room at a comfortable temperature.

“Bedding use for infant sleep remains common despite recommendations against this practice,” the study authors wrote.

By 2007-2010, most respondents reported following these Safe to Sleep recommendations: placing the infant to sleep in a crib or bassinet, placing the infant on his or her back, and not sharing a sleep surface with the infant. However, use of bedding was consistently 50 percent or higher for each of these years.

From 1993-1995 to 2008-2010, covering with thick blankets declined from 56 percent to 27.4 percent and covering with quilts or comforters declined from 39.2 percent to 7.9 percent. However, the authors did not see significant declines such bedding materials placed under infants, with 25.5 percent-31.9 percent reporting placing blankets under infants and 3.1 percent-4.6 percent placing cushions under infants.

“Interestingly, we also observed a greater decline in bedding use over the infants (quilts/comforters and thick blankets) compared with bedding (blankets) under infants,” the study authors wrote. “This finding raises a concern that parents may incorrectly perceive the recommendations as only pertaining to items covering or around the infant, and not include items under the infant.”

The researchers speculate that among the reasons mothers used bedding were to provide warmth and comfort or to prevent falls from an adult bed or sofa by using pillows as a barricade. They noted that a study of images from popular magazines targeting women of childbearing age found that more than two thirds of these images showed infants sleeping with potentially hazardous bedding such as blankets and pillows.

“Seeing images such as these may reinforce beliefs and perceptions that having these items in the infant sleep area is not only a favorable practice, but also the norm,” the researchers wrote.

The authors also found that caregivers of Hispanic and African-American infants were more likely to use potentially hazardous bedding compared to caregivers of white infants. In addition, younger mothers were more likely to use this bedding than were older mothers, as were non-college educated mothers compared to college-educated mothers.

11/5/14 Health News: Fecal testing in colorectal cancer screening ♦ Fruit, vegetables,whole grains and nuts lower stroke risk ♦ BPA exposure by infants ♦ Craving in alcoholics

Support for fecal testing in familial colorectal cancer screening

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BPA exposure by infants may increase later risk of food intolerance

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Sharing Bed With Infant is Dangerous

Roughly 14 percent of infants share bed with adult or child. NIH-funded study shows physician advice can reduce potentially life-threatening practice

The percentage of nighttime caregivers who reported that an infant usually shares a bed with a parent, another adult, or a child more than doubled between 1993 and 2010, according to researchers at the National Institutes of Health and other institutions.

Over the 17 years of the study, researchers recorded increases in bed-sharing among all racial and ethnic groups; however, the increases were most notable among African American and Hispanic families. Bed-sharing can increase the risk of unexpected infant death, including SIDS, which is also more common among African American infants, the researchers said.

The researchers also found that advice from physicians could significantly reduce the potentially life threatening practice. Caregivers who perceived physicians’ attitude as against sharing a bed were about 34 percent less likely to report that the infant usually shared a bed than were caregivers who received no advice.

Based on responses from nearly 20,000 caregivers, the researchers reported that the proportion of infants sharing a bed with another person rose from 6.5 percent to 13.5 percent over the 17-year period of the study. The majority of bed sharing, 85 percent, was with parents.

Sharing a bed, with an adult or another child, increases an infant’s risk of death from sudden infant death syndrome, or SIDS or other sleep-related causes. To reduce infants’ risk of sleep-related deaths, the American Academy of Pediatrics (AAP) recommends  that infants sleep in the same room, but not in the same bed, as caregivers. Cribs, portable cribs bassinets, or playpens that meet safety standards can be placed next to the caregiver’s bed. Infants should not be placed to sleep on an adult bed at any time.

Caregivers were much less likely to report that the infant shared a bed if they perceived that their physicians were against the practice. The researchers also found that if physicians gave advice that caregivers perceived as neutral regarding bed sharing, their infants were more likely to bed-share than were infants of caregivers whose physicians didn’t give them any advice at all.

“It’s important for doctors to discuss sleeptime habits with new parents in order to convey the risks of bed sharing clearly,” said Marian Willinger, Ph.D., study co-author and special assistant for SIDS at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

SIDS is the unexplained death of a child within the first year of life. In 1992, the AAP issued its recommendation that infants be put to sleep on their backs. Two years later, the NICHD and its partners launched the Back to Sleep campaign. The rate of SIDS in the United States has fallen 50 percent since. However, in that time, researchers have reported an increase in other unexpected infant deaths, resulting, for example, from accidental suffocation, entrapment in bedding material or other causes.

Based on new recommendations from the AAP, in 2011 the NICHD and its partners expanded the Back to Sleep campaign to include information that parents and caregivers can use to reduce the risk of other unexpected sleep-related causes of infant death, in addition to SIDS. These include entrapment and suffocation. The expanded campaign is known as Safe to Sleep.

Each year from 1993 to 2010, researchers with the National Infant Sleep Position Study surveyed more than 1,000 caregivers about their infant sleep practices. About 85 percent of respondents were the infant’s mother.

The researchers found that over the course of the17-year study, bed-sharing became more common among all ethnic and racial groups. Using a three-year moving average calculation, they found that among white infants, the proportion of those usually bed-sharing increased from 4.9 percent in 1993 to 9.1 percent in 2010. For Hispanic infants, the percent usually bed-sharing rose from 12.5 percent in 1993 to 20.5 percent in 2010. With African-American infants, the percentage of those usually bed-sharing increased from 21.2 percent to 38.7 percent during the same time period.

“The disparity in nighttime habits has increased in recent years,” said Dr. Colson. “Because African-American infants are already at increased risk for SIDS, this trend is a cause for concern.”

More than half of the caregivers surveyed since 2006 reported that they had not received advice from their doctor about bed sharing.

Concentrated MOTRIN® Infants’ Drops Original Berry Flavor Recalled

You may have noticed that Concentrated MOTRIN® Infants’ Drops Original Berry Flavor 1/2 fl oz bottles are not readily available where you shop. This is because the makers of the product, McNeil Consumer Healthcare Division of McNEIL-PPC, Inc. (McNeil), has voluntarily recalled three lots of Concentrated MOTRIN® Infants’ Drops Original Berry Flavor 1/2 fl oz bottles from wholesalers and retail stores in the United States. McNeil is asking consumers to stop using and dispose of any product they may have that is included in this recall.

Product	Lot #	UPC Code
Concentrated MOTRIN® Infants’ Drops Original Berry Flavor 1/2 fl oz bottles NDC 50580-100-18	DCB3T01 DDB4R01 DDB4S01	300450524157

After releasing these three lots of Concentrated MOTRIN® Infants’ Drops Original Berry Flavor 1/2 fl oz into the market, tiny plastic particles (approximately 1 mm in size or about the size of a poppy seed) were identified in a different product lot during manufacturing. This lot was not released to the market. It was determined that the particles originated in a shipment from a third party supplier of ibuprofen, the active ingredient in Concentrated MOTRIN® Infants’ Drops Original Berry Flavor 1/2 fl oz.

Out of an abundance of caution, McNeil is voluntarily recalling the three lots released to the market made with the same batch of active ingredient. McNeil has worked with the third party to ensure that corrective measures are currently in place and are effective. The potential for adverse medical events related to the reason for this recall is not likely. Concentrated Infants’ MOTRIN® Drops Dye-Free Berry Flavor 1 fl oz is not included in this recall. Children’s and Adult MOTRIN® products also are not included in the recall.

The health and well-being of consumers is our company’s #1 priority. If you have any questions or concerns, or would like to inquire about a refund, please call our Consumer Care Center at 1-877-414-7709 or click here for more information.