Showing posts with label infant. Show all posts
Showing posts with label infant. Show all posts

Wednesday, December 3, 2014

Early Weight Loss Nomograms for Exclusively Breastfed Babies Have Arrived!

By: Lewis First, MD, MS; Editor-in-Chief 

newborn infant
Newborn infant. Photo by singingbeagle via Flickr.
For years, if not decades, we have simply told mothers of breastfed babies to expect their infants to lose about 10 percent of their weight during their first week of life as mom’s breast milk comes in. Yet how reliable and valid is that comment?

Flaherman et al. (doi: 10.1542/peds.2014-1532) attempted to look at the question of what is normal and abnormal early weight loss by gathering weights over time for over 161,000 infants who were over 36 weeks gestational age and exclusively breastfed.

The authors discovered differential weight loss by mode of delivery (vaginal versus caesarean) within hours of delivery and created nomograms to show birthweight loss over time and percentiles for those curves so as to identify neonates falling off curves, showing greater weight loss, and in turn signaling perhaps other morbidities preventing the good beginning infants need to get out of the starting gate.

These nomograms, as contained in this article and further discussed in an interesting accompanying commentary by Drs. James Taylor and Elizabeth Simpson (doi: 10.1542/peds.2014-3354), should be posted in your local nursery and used frequently in determining just how much you and the mother of your newest patients need to worry or  intervene to insure adequate breastfeeding and in turn weight gain occurs in the early days of a baby’s life.

Chart a course for this study and learn more about these new nomograms.

Related Reading:

Wednesday, November 5, 2014

Very Low Birth Weight Infants, Social Interventions: Two New Studies on Autism Spectrum Disorders

By: Lewis First, MD, MS; Editor-in-Chief 

Child with autism spectrum disorder.
Photo by KOMU News via Flickr
There is not a general pediatric peer-reviewed journal that has not published multiple studies on autism-spectrum disorders (ASDs) and ours is no exception. This month, we further our knowledge of ASDs by publishing two fascinating studies on this developmental abnormality.

The first by Pyhälä et al. (doi: 10.1542/peds. 2014-1097) compared slightly more than 1,000 adults born in Helsinki at very low birth weight (less than 1,500 grams) with term-born adults for ASD traits based on various developmental test batteries.

The results are well worth your attention and indicate that if children are born very low birth weight (VLBW) there is a higher risk of ASD traits as adults, especially in regard to social interactions. Although the authors note that faster growth in weight, height and head circumference from birth to term seemed to reduce this risk, suggesting that targeted interventions to aggressively grow a VLBW infant may play a role in improving an infant’s neurodevelopment as well. Just the fact that the authors have followed a cohort of VLBW infants into adulthood and tracked their developmental skills make this an interesting study to reflect upon.

A second study by Wetherby et al. (doi: 10.1542/peds.2014-0757) randomized toddlers with ASDs to receive either a parent-implemented social intervention at home or a group early social interaction program in a clinic, both designed in either case to help parents better communicate with their children in everyday activities. In this case, the results of this trial had a clear winner—the individual early social interaction program.

To find out what the program consisted of and whether it can be adapted by ASD families in your practice, review the findings in this study. Given that doing so will not require large amounts of professional time nor overwhelming amounts of parental time makes this a must-read if you care for children with ASDs.

Related Reading:

Monday, October 27, 2014

Why You Should be Thinking About Fetal Alcohol Spectrum Disorders in Your Practice

By: Lewis First, MD, MS; Editor-in-Chief 

Diagnosing someone with a fetal alcohol spectrum disorder (FASD) is easier said than done. The findings can be subtle and might be easily missed unless you uncover clues in the family history or are aware of the constellation of dysmorphology findings that can be associated with this disorder.

Sometimes there is a sense that a fetal alcohol spectrum disorder is a rarer entity than it actually is—and thus you need not worry about missing something unlikely to occur. Alternatively, you may figure it will eventually declare itself anyway if a child develops progressive development delay or another less subtle finding prompting a more careful diagnostic approach.

Yet the prevalence of fetal alcohol spectrum disorders appears to be more common than we might hope—at least according to a representative sample of children examined at ages 6 to 7 in the Midwest US as studied by May et al. (doi:10.1542/peds.2013-3319).

Figure showing final estimate of FASD prevalence in a Midwestern US city.
Copyright 2014 © American Academy of Pediatrics. Used with permission.

The researchers selected their sample simply on the basis of their being below the 25th percentile for height, weight, and head circumference. This interesting study also includes a discussion of the risk factors that might point you towards diagnosing this disorder sooner.

If you need a refresher on ways to identify fetal alcohol syndrome so you can diagnose and implement early intervention services sooner rather than later, this is the study for you.

Related Reading: 

Tuesday, September 23, 2014

Location, Location, Location: Single Family Room Versus Open Bay NICUs

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Bob J. Galindo via Flickr

More and more NICUs are considering renovations or redesign to favor single family room intensive care versus open bay traditional units. While they certainly assure more privacy for a family, do they also improve medical and neurodevelopmental outcomes?

Lester et al. (doi:10.1542/ peds.2013-4252) report on a longitudinal, prospective quasi-experimental cohort study involving a conversion of one NICU from open bay to single family rooms comparing medical and neurodevelopmental outcomes of infants weighing fewer than 1,500 grams at discharge.

The results are quite impressive in showing the advantages of single family rooms in terms of the outcomes measured. Just why these results might be associated with single family versus open bay rooms awaits your own evaluation of the space we have given this article in our journal.

How important do you think a single family room is for your hospitalized infants or children? Do you agree with the findings in this study? Share with us your thoughts on space planning by leaving a comment below, sharing an eLetter, or posting on Facebook or Twitter.

Thursday, September 4, 2014

75 Years Later, What Does Birth Size Have to Do with Brain Function?

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Adrian Dressler via Flickr
If a baby is born with a smaller birth size, did you ever think it might influence brain tissue volume and function in that person’s later elderly life?

We certainly did not until we read the manuscript by Muller et al. (doi:10.1542/peds.2014-1108) being early released this week. The investigators studied an Icelandic birth cohort of more than 1,200 men and women born between 1907 and 1935 and then studied that cohort at an average age of 75 years via a brain MRI and cognitive assessment.

The results show an association with lower ponderal index (the ratio of body weight to length) at birth with late-life changes in brain tissue volume and function. Just how does this association play out and were there risk factors beyond birth weight that showed even stronger associations between birth size and elderly brain function?

If this blog doesn't intrigue you to read and learn more, you haven’t really read it. Open your mind to learning more from a cohort that has been studied for three-quarters of a century and offers many thought-provoking ideas as to the very long-term neurodevelopmental outcomes of being born smaller than average.

Related Reading:

Tuesday, August 26, 2014

Asthma, Eczema & Allergic Rhinitis from Pre-, Postnatal Second Hand Smoke Exposure?

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Javier Ignacio Acuna Ditzel

We certainly suspect an association exists between second-hand smoke exposure and allergic disease, but has it ever been confirmed in peer-reviewed scientific literature? Not as well as Thacher et al. (doi: 10.1542/peds.2014-0427) have done in an early release article we are sharing this week.

Their study involved more than 4,000 children followed for 16 years prospectively, while information was gathered on parental smoking habits, and symptoms of asthma, eczema and allergic rhinitis.

The results are fascinating and itching for your perusal. For example, second-hand smoke exposure in infancy seems to result in increased risk for asthma and allergic rhinitis, while exposure later in life seems to increase the risk of eczema.

These findings just scratch the surface of what awaits your own review of this study—so read on and learn more!

Related Reading:

Monday, July 14, 2014

Two Studies on the Benefits of Delayed Cord Clamping

By: Lewis First, MD, MS; Editor-in-Chief 

Early (less than 30 seconds) versus delayed (greater than 30-60 seconds) cord clamping has been the subject of a number of recent studies in our journal and others, and this week, we share two more that are worth your attention.

Photo by Mamma Loves via Flickr
The first by Diaz-Castro et al. (doi: 10.1542/ peds.2013-3798) looks at the influence of early versus late cord clamping relative to oxidative stress and inflammation signaling. The delay in clamping may reduce the amount of oxidative stress and inflammation and improve outcomes without other adverse complications—at least according to data shared by these authors.

To lend further support to delayed clamping, Ersdal et al. (doi: 10.1542/peds.2014-0467) looked at the timing of cord clamping relative to spontaneous respiration. The authors studied more than 15,500 infants born in Tanzania and looked at neonatal outcomes and found benefit in reducing risk of death when spontaneous respirations preceded cord clamping.

To better understand the pathophysiologic mechanisms that result in beneficial outcomes to newborns by delayed cord clamping, read both studies and you’re likely to be in accord if you aren't already in seeing even more benefit to this practice when a baby is born.

Related Reading: