Showing posts with label infants. Show all posts
Showing posts with label infants. Show all posts

Thursday, November 13, 2014

NICU Evacuation During Hurricane Sandy

By: Editorial Board Member Joann Schulte, DO, MPH

Ambulances at the ready during Hurricane Sandy.
Photo by mlcastle via Flickr
One of the most stressful nights of my life was in a disaster shelter in Florida about 48 hours after Hurricane Charley came ashore near Port Charlotte on the west coast. As a public health physician, my job was to set up the surveillance for storm-related injuries and deaths and deal with whatever else needed medical attention.

I was relieved that the storm had taken a last-minute left hand turn into Charlotte County and spared St. Petersburg where I owned a home. But many other Florida residents had no such luck.  In the two days after Charley’s landfall on August 13, 2004, Florida opened 228 shelters housing 47,458 people. Another 59 special needs shelters housed 3,119 residents, mostly elderly, who required basic medical monitoring and administration of medications.

I found myself in the Sarasota Convention Center, dealing with new arrivals who seemed sleepy and announced that they’d been using a generator inside a garage. Diagnosing possible carbon monoxide didn't require a medical genius. After they were dispatched to a hyperbaric chamber, I wanted a rest.

But rest wasn't in the cards when I learned that a bus with 13 Alzheimer’s patients would be arriving because the nursing home’s generator had failed. “I’m sorry, but some of them are pretty combative,” was the message from the nursing director, who had performed a miracle in finding a bus to transport them to the convention center. Obviously the special needs shelters that dealt with diabetics or patients with COPD weren't ready or capable for the care of Alzheimer’s patients. I started half a dozen people on the phone making calls to find places that could take the 13 impaired men and women.

That’s why I found it easy to identify with the dilemma on the other end of life—evacuating a neonatal intensive care unit (NICU) that Dr. Michael Espiritu and his co-authors describe in the current issue of Pediatrics (doi: 10.1542/peds.2014-0936).

Portions of New York City, including the medical campus of New York University (NYU), can be flooded by the water surge driven by hurricane winds. The authors describe their experiences during 2012’s Hurricane Sandy, which arrived 15 months after Hurricane Irene.  With Irene, the neonatologists at NYU Langone Medical Center had successfully evacuated a population of 19 infants, including three who were mechanically ventilated and had done so in advance of the storm.  Sandy was another story.

The NYU hospital had an incident command structure and plans to deal with patient care. High-risk pregnant women were transferred out to minimize the odds of delivery room resuscitation or new NICU admissions; stable infants were discharged. On October 29, 2012, governmental decision makers had decreed that NYU and other hospitals would shelter in place, and the hospital had checked all the red power outlets that connect to emergency generators. The ventilators and other essential equipment had been plugged in and staffing was arranged. The NYU NICU had a census of 21 infants, including one on conventional ventilation and one on the high frequency oscillator (HFOV). Four other infants were on NCPAP. Then the power went out at 8:30 p.m.

Dr. Espiritu describes the measure taken for patient safety, and the ultimate transfer of infants to six other NYC hospitals. The infants left one by one. The NYU NICU is on the ninth floor and teams composed of nurses and respiratory therapist and a physician taking the infants down the unlighted stairs. One nurse carried an infant, sometimes holding the endotracheal tube in place. Others lugged IV pumps, oxygen tank and additional equipment. The physician ventilated each infant.

The authors report the evacuation took 10 minutes per infants, a passage lit by flashlights held by students at each landing. The infants departed between 945 p.m. and 1 a.m. The infants were all successfully transported to the receiving hospitals in ambulances contracted by FEMA.

The NYU NICU was closed for two and a half months after the Hurricane Sandy evacuation. Dr. Espiritu reports that the major problem was finding beds.  Who could accept a transfer patient was not a uniform decision – some hospitals permitted a fellow to do it. In others, it might be the chief of service. The authors suggested that future evacuations of NICUs or other hospital units might be more easily managed if the disaster response included a central bed management authority.

That was a lesson I learned from Charley with the elderly patients at the other extreme of life. It took us eight hours to find the nursing homes that could take the Alzheimer’s patients. The NYU authors describe a situation that many hospitals may have to face and suggest some concrete steps hospitals should take. Maybe your hospital isn't on the coast, but the weather isn't always sunny, and you never know what the wind might bring your way. What kind of planning and drilling have you done?

Wednesday, November 12, 2014

Infant Neurodevelopment After Congenital HHV-6 Infection

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

HHV-6 Inclusion bodies. Photo via the US National Cancer Institute
While we usually think of human herpesvirus 6 (HHV-6) as being the virus responsible for roseola, there is much more to this virus than a simple viral exanthem. About 1 percent of infants are born with vertical transmission of HHV-6 and when this happens, the results are far more worrisome than just being at risk for a viral exanthem.

Dr. Mary Caserta and her colleagues in Rochester (doi: 10.1542/peds. 2014-0886) have been actively studying congenital HHV-6 and this month release their findings on early developmental outcomes of children who have received the virus through vertical transmission from mother to baby. The authors performed developmental testing in a prospective double-blind controlled study at four points between 4 months and 30 months of age.

The results suggest that by 1 year old, some detrimental effects on neurodevelopment can be seen in those infants infected congenitally with HHV-6 compared to controls.

Have you thought about HHV-6 as a cause for developmental delay in your patients? After reading this study, you will want to learn more about what this virus can potentially do if it is present at the time of birth. We suspect more studies will be forthcoming at a faster rate given what we are learning about this virus—and if you haven’t read much about it, this is a great study to start with. Check out the study and learn more!

Related Reading:

Friday, November 7, 2014

Talking Early and Often to Babies: Closing the Word Gap Between Mothers and Fathers

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

Photo by Chris O'Brian via Flickr
A key takeaway of the recent AAP National Conference and Exhibition (NCE) meeting was the emphasis on early childhood literacy and the need to increase talking time with your infants and toddlers as much as possible to promote early brain and child development. Yet how are we doing in making this happen?

Johnson et al. (doi: 10.1542/peds. 2013-4289) report on a prospective cohort study of late preterm and term infant whose vocalizations were recorded, along with parent conversation, during their birth hospitalization and again at 44 weeks post-menstrual age and at 7 months (corrected age). The results show that mothers respond more to their baby’s vocalizations than fathers, and when parents do vocalize with their babies, there is a remarkable gender preference.

So are we happy with these findings, or can we as health care professionals do even more? How often do you talk to parents about conversing with their baby? Do you make sure the quieter parent upgrades their game, rather than let the other partner do the honors, so baby gets a balanced perspective and even more brain stimulation than just from the more vocal parent?

This article sounds off with a number of thought-provoking findings that we hope you share with new parents as they start talking with their babies. There’s a lot to talk out loud about in this study—and I hope you do (perhaps even with your infant).

Related Reading: 

Friday, October 24, 2014

Sociodemographic Differences and Infant Dietary Patterns

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our November issue. To learn more about Dr. Schulte, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH

Jarred baby food. Photo by Parenting Patch via Wikimedia Commons
You are what you eat, and the diet for infants is supposed to be exclusively breast milk for the first six months of life. But what about the transition to solid foods in the second half of the first year? What dietary patterns are associated with adequate growth and not obesity? This infant feeding topic is an important one in a country where obesity and diabetes are common and emerge early.

New research published this month in Pediatrics (doi: 10.1542/peds.2014-1045) explores infants’ second six months of life and finds the transition to a different diet is important with regards to an infant’s growth, weight gain and obesity. Dr. Xiaozphong Wen and his colleagues at the State University of New York Buffalo did a secondary data analysis of the US Center for Disease Control and Prevention and the US Food and Drug Administration’s jointly funded and administered Infant Feeding Practices Study data to examine dietary patterns of infants as their parents started their transition to solid foods.

The Buffalo researchers analyzed a subsample of 1,555 infants followed from 2005 to 2007 and looked at four dietary patterns and growth, identified based on 18 foods typically eaten by US infants. The 18 foods included formula, breast milk, juices, cereal, fruits, vegetables, meats, seafood, peanuts/nut products and sweet foods.

At six months of age, the four patterns were “high sugar/fat/protein”, “infants guideline solids”, “formula”, and “high dairy/ regular cereal.” At 12 months, the four patterns were “high sugar/fat/protein”, “infant guideline solids”, “formula/baby cereal” and “high dairy”.

Mothers supplied the dietary histories, reporting what their infants were fed in the prior week. Nine surveys were done, spanning the transitions in feeding patterns from three months to 12 months.The researchers calculated sex- and age-specific length-for-age Z scores and BMI Z scores to examine infants’ growth and a correlation with each diet.

At six months of age, “high sugar/fat/protein” and “high dairy/regular cereal” were associated with infants being shorter and fatter. The authors concluded that the “infant guideline solids” with breastfeeding was a promising, healthy diet for infants.

The study is an important one because it provides information that can guide physicians and parents in selecting a diet that will help children grow without being coming obese. The right diets can shape children’s health as adults and offer a way to control diabetes and other conditions related to obesity.

Related Reading:

Wednesday, October 15, 2014

Sofas and SIDS: A Dangerous Combination

Photo by stevepb via Pixabay
By: Lewis First, MD, MS; Editor-in-Chief 

Recently we received a manuscript from Dr. Rechtman et al. we found so worrisome that we are early-releasing the results of their study this week prior to official publication next month (doi:10.1542/peds.2014-1543).

The study uses data from a national database to look at infant deaths that occurred on sofas in 24 states from 2004 through 2012. The authors then compared demographic and environmental data from sofa deaths to other sleep-related infant deaths in other locations. The fact that sofas account for almost 13 percent of sleep-related infant deaths is concerning, and it’s worth knowing, and sharing with your infant patients’ parents, that these deaths are more apt to be labeled as suffocation or strangulation.

This blog post cannot do justice to the myriad of risk factors associated with infant deaths, so rather than try, check out the study and learn more. After reading this study, I hope you will agree that the sofa is off limits when it comes to safe sleep environments for babies!

Related Reading:

Monday, September 29, 2014

If You See One Emergency Department Approach to Febrile Infants, You See Only One of Many Approaches

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Joseph Nicola via Flickr

Nothing provokes more discussion in a clinical conference than asking, “What is the best way to diagnose and manage febrile infants when you don’t want to miss a serious bacterial infection?” Do all infants under 3-months-old need a full sepsis evaluation, some, none over a month, or is the approach solely dependent on immunization status of the child, family or community?

While algorithms and guidelines exist as to best practice based on evidence to date, what really happens in emergency departments when these children are evaluated?

Aronson et al. (doi: 10.1542/peds.2014-1382) share with us the results of a retrospective cohort of more than 17,000 infants seen in 37 different emergency departments (EDs) to look at patient and hospital level variation in diagnostic testing, treatment and disposition. The variations across EDs and patients is stark and worth your attention. If there was ever a need for a well-circulated, evidence-based common approach to these young infants and their fevers, this study certainly calls for one.

So what do you do with your febrile babies under 3 months of age? Do you follow a care pathway or guideline? If so, which one? Share with us your thoughts on your approach to febrile infants seen in emergency departments or your office by sending us your comments to this blog, via an eLetter, or on Facebook or Twitter.

Related Reading:

Wednesday, August 27, 2014

Effect of a Pertussis Epidemic on Vaccination Status: Coughing Up Some Interesting Findings

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by  Sandy Chase via Flickr

From late 2011 throughout 2012, a pertussis epidemic occurred in Washington State. One would think that an epidemic would result in an uptick in infants being up-to-date on their pertussis vaccinations, but think again—at least after you read the study by Wolf et al. (doi: 10.1542/peds.2013-3637) we are early releasing this week.

If an epidemic doesn't prompt parents to insure their infants are vaccinated, just what will? Drs. Jessica Atwell and Daniel Salmon (doi: 10.1542/peds.2014-1883) reflect on the implications of this study in a topical commentary that accompanies this study.

We welcome your thoughts on this study and commentary and on what you are doing to improve your own vaccination rates in your practice, since an epidemic does not appear to be a significant change agent. Share your comments with us via a response to this blog, an eLetter or on Facebook or Twitter.

Related Reading: 

Tuesday, August 19, 2014

Refusal of Vitamin K: A Potential Harbinger of Subsequent Immunization Refusal

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

Photo by  Alexander Torrenegra via Flickr
Recently we have become more and more aware of parents refusing Vitamin K prophylaxis. This is
especially prevalent in settings of home births due to parents not wanting any added pain or injection of artificial substances into their newborns’ bodies despite the minimal (if any) risk of receiving this potentially life-saving medication. So is this a problem, beyond the important risk of bleeding?

Well, if refusal to accept vitamin K means subsequent refusal to also accept other injections, including immunizations into their children, this is a serious issue that requires study to determine if such an association does exist.

Sahni et al. (doi: 10.1542/peds.2014-1092) looked at the question of neonatal vitamin K and immunization refusal in a retrospective cohort study of all infants born in Alberta, Canada between 2006 and 2012. Sadly, a highly significant association is identified and the discussion by the authors addresses the “why” and what we might do about this problem.

Do your patients’ parents refuse vitamin K? Do they also refuse vaccines? Have you been able to change their minds, and if so how? We welcome your ideas and comments by responding to this blog, sending an eLetter or sharing your comments on Facebook or Twitter.

Related Reading:

Thursday, August 14, 2014

Do Older Febrile Infants Also Require Empiric Acyclovir?

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

Photo by US Dept. of Agriculture via Flickr
More and more often, we are seeing acyclovir added to the antibiotic regimen for a febrile infant in their first two weeks—and even into their first month—of life for empiric treatment of herpes simplex virus (HSV).

But what happens after those first four weeks? Should febrile infants older than a month also get empiric acyclovir and PCR testing for HSV, or are there clinical indicators (e.g. encephalitic signs) that would suggest a non-empiric approach reserved for febrile infants with observable neurologic concerns?

Gaensbauer et al. (doi: 10.1542/peds.2014-0294) looks into the use of empiric acyclovir for older infants and children using cases identified at 15 children’s hospitals via the Pediatric Health Information System (PHIS) database to identify factors associated with unnecessary testing and treatment for HSV. The results suggest we might do with less empiric acyclovir, and in turn, less cost to patients without compromising quality or missing a case of HSV that would not be as subtle as in early infancy.

Read the study and decide if you can reduce your own empiric use of acyclovir or not.

Related Reading:

Tuesday, July 22, 2014

Jaundice in Breastfed Infants: How Long Can It Last?

Photo by Cheryl via Flickr
By: Lewis First, MD, MS; Editor-in-Chief 

We certainly see babies coming into offices at 3 and even 4 weeks of age still looking somewhat
yellow, prompting us to check a bilirubin level and finding an unconjugated level still over 5 mg/dL. Is this prolonged level normal? Should we worry and keep checking levels or reassure parents that all is well?

Maisels et al. (doi: 10.1542/peds.2013-4299) looked into this issue of the natural history of hyperbilirubinemia and jaundice in newborns by measuring transcutaneous bilirubin levels in predominantly breastfed infants over 35 weeks gestation.

The results suggest that almost a third of breastfed infants will stay jaundiced for their first month of life. As to whether a particular level of bilirubin correlates with the color or location of the jaundice, the authors looked into this as well. Their findings were interesting confirming the lack of accuracy of predicting bilirubin by distribution of visible jaundice, but reassuring in that the wide range of levels obtained by severity of color do not appear to be high enough to be worrisome.

The brief summary in this post just begins to skin the surface on a nice study well worth reading in its entirety to have a better understanding of when to worry and not to worry about persistent unconjugated jaundice in breastfed infants.

Related Reading:

Thursday, July 17, 2014

Sleep-Related Deaths: Do Risk Factors Differ by Age?

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Flickr user Liz

We certainly recognize the importance of counseling families against bed-sharing and to avoid putting objects in the crib in hope of reducing the risk of sudden unexpected infant death (SUID). Yet do some risk factors in sleep environment appear to play a more prevalent role at some ages in infants relative to others when it comes to a SUID occurring?

Colvin et al. (doi: 10.1542/peds.2014-0401) performed a cross-sectional study of sleep-related infant deaths using data obtained from death reports in 24 states during 2004 through 2012. The authors discovered that at different times during infancy, different risk factors play a role in increasing the chance of unexpected death.

For example, bed-sharing is more likely to play a role in a death of an infant in the first three months of life, whereas having an object in the crib or moving from a back to a prone sleep position worsens SUID chances for an older infant (4 months to 1 year).

When it comes to anticipatory guidance on sleep environment for infants, this study will help you further refine instructions to parents to insure that more emphasis is paid to certain risks based on the age of the infant.

Read this study and see if it doesn't help you better educate your families on proper sleep environment for babies.

Related Reading:

Thursday, July 10, 2014

The Microbiome and Vaccine Responsiveness

By: Editor-in-Chief Lewis First, MD, MS
Bifidobacterium adolescentis by YTambe via Wikimedia Commons

It seems that almost every recent issue of our journal has had an article on the microbiome and the role of probiotics in cultivating the composition of this environment to reduce the incidence and prevalence of common childhood illnesses like upper respiratory and gastrointestinal infections.

This month, we share a study by Huda et al. (doi: 10.1542/ peds.2013-3937) noting how the composition of the stool microbiome might indicate a better or worse response to oral and parenteral infant vaccines. For example, when the stool microbiota composition is rich in Bifidobacterium, thymic development and response to vaccines is enhanced. Other microbiome organism predominance appears to do just the opposite—again suggesting that what organisms predominate in the microbiome of the intestines can influence a child’s health and well-being.

Are you using probiotics in your patients? Are they getting fewer infections as a result? Share your opinion on this topic via a response to our blog, an eLetter, or by way of Facebook or Twitter.

Related Reading: 

Tuesday, June 10, 2014

Classifying Sudden Unexplained Infant Deaths in a Multistate Registry: A New Tool for Prevention Strategies

By: Lewis First, MD, MS

Photo by Janine via Flckr
Given the complexity of classifying a sudden unexpected infant death (SUID), such as one being due to sudden infant death syndrome or accidental sleep-related suffocation, a method of doing such classification in a clear and consistent manner could be quite beneficial—at least those are the thoughts of Shapiro-Mendoza et al. (doi: 10.1542/peds.2014-0180) who have established a system of classifying these death subtypes into groups and further help to identify with their system the highest risk groups that we might be able to intervene and potentially prevent a SUID event.

Just how useful this new system might be is further explained in a commentary associated with this special article by Moon and Byard (doi: 10.1542/peds.2014-0602), who provide historical and international context as well as analysis about the practicality and potential benefits and challenges of Shapiro-Mendoza et al.’s classifications.

If you need an update on just what the various subtypes of SUID are and what we might be able to do about them, then this article and commentary are just what the pediatrician ordered. Read them both and as you do, think about the useful applications of this classification system when it comes to prevention strategies for SUID.

Related Reading:

Friday, May 30, 2014

Filtered Sunlight for Hyperbilirubinemia: Safe & Cost-Effective

Pediatrics Associate Editor William V. Raszka, MD, shares his expert perspective on a new article from our June issue. To learn more about Dr. Raszka and his work in pediatrics and pediatric infectious diseases, check out our Contributors page.

By: William V. Raszka, MD

Photo by Julia Falkner via Pixabay
Severe neonatal jaundice with progression to acute bilirubin encephalopathy and kernicterus is a worldwide problem. Here in the US, health care providers can select from a wide range of effective phototherapy options to treat infants with elevated bilirubin levels. In resource-poor settings, that is not often the case. The expense of the equipment, unreliable electrical power supply, inadequate maintenance programs, and limited number of testing and treatment choices all contribute to a lack of effective phototherapy options.

Slusher and colleagues in the June issue of Pediatrics (doi: 10.1542/peds.2013-3500) report a novel and cost effective way to treat neonatal hyperbilirubinemia. Infants in Lagos, Nigeria with elevated bilirubin levels were exposed to filtered sunlight five to six hours a day under an outdoor canopy. The canopy roof was made of one of two commercially available window-tinting films. The films prevent the transmission of most ultraviolet and infrared light while allowing the transmission of effective levels of therapeutic blue light. Up to six infants and their mothers could stay under each canopy. Investigators showed that during the midday hours, infants were exposed to the correct amount of irradiance and that treatment was effective on more than 92 percent of all treatment days. No infants required exchange transfusion. Some had transient elevated core body temperatures while a smaller number had decreased body temperature. No infants had to be dropped from the study because of adverse effects.

We talk about back-to-basics all the time, but this study demonstrates adherence to such a principle really can provide benefit. The observation that direct sunlight decreases serum bilirubin levels in neonates was originally published in 1958, and since that time we have focused our attention on developing equipment that artificially creates the optimal wavelengths necessary to photoisomerize bilirubin.

However, in many resource-poor areas appropriate equipment is either not available or functional. Exposing infants to direct sunlight increases the risk of sunburn, hyperthermia and other complications. Using a simple readily available film as a filter solves both problems. The film can be stretched over locally available materials at a cost of approximately $50 per canopy. Each canopy lasts approximately six months and this could be extended if they could be protected during storms. While $50 is still a sizable investment, the morbidity prevented is staggering. Though the canopy is most useful in sunny and warm environments, variations (e.g. tinting applied over plastic) might make the intervention useful in cooler climates. This novel, practical and effective method to treat hyperbilirubinemia is welcome news indeed.

Tuesday, April 29, 2014

How Good Is a Dipstick Vs. Urine Microscopy to Screen for UTI?

Have you ever been told that a urine dipstick alone may not be a good enough marker for predicting a UTI in a febrile infant—and that urine microscopy was needed as well to support the diagnosis pending culture?

Public Domain via the National Cancer Institute
Glissmeyer et al. (doi: 10.1542/peds. 2013-3291) used the large Intermountain Healthcare database involving more than 13,000 febrile infants to determine the ability of urine dipstick testing by itself when compared with microscopy or a combination of the two to screen for possible UTI. The results will surprise you and may even change the way you practice.

Take a peek at this study and let us know your thoughts. Would you use the dipstick findings alone or still rely on microscopy to convince you to treat for a presumptive UTI? Let us know by responding to this blog, sharing your thoughts via an eLetter, or on Facebook or Twitter.

Related Reading:

Wednesday, April 2, 2014

Quality Report: Reducing Hypothermia in Preterm Infants

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our April issue:

Photo by bradleyolin via Flickr
Even very slight hypothermia can have a profound negative effect on preterm infants, including respiratory distress syndrome, metabolic derangements and intraventricular hemorrhage and other challenges that can lead to increased mortality and morbidity.

Today, we are releasing a Quality Report by Dr. Russo and colleagues on the implementation of strategies in the delivery room to minimize rates of hypothermia (doi: 10.1542/peds.2013-2544). Of course, aggressive strategies to avoid hypothermia could lead to hyperthermia, which is also dangerous.

Dr. Russo and colleagues implemented a multidisciplinary practice to safely warm up moderately hypothermic infants less than 35 weeks old by using an occlusive wrap (without drying the infant first), a warming mattress and cap for all infants, as well as keeping the operating room temperatures up between 21-23°C.

So, how did they do? Take a look and see how cool their work is and how you can be red hot in your NICU by adopting their strategies. Let us know how it goes. Comment below or on our Facebook page, find us on Twitter, or share your comments as an eLetter on our journal site.

Related Reading:

Tuesday, April 1, 2014

Case Report: Buccal Cell Chimerism in a Monochorionic Dizygotic Twin

Our Case Report Editor, Dr. Jeffery Malatack shares a case report we early released this month from our upcoming April issue:

Public Domain Photo
A case report has the capacity to bring to attention an observation that challenges the existing understanding of nature even when the implications of this paradigm alteration aren’t known.

Such is the case with the report by Fumoto and colleagues at the Kyorin University School of
Medicine’s HLA laboratory in Kyoto, Japan (doi: 10.1542/peds.2013-1938). Not until recently has the existence of monochorionic dizygotic twins (MCDZT) been known.

Prior to work by Souter et al. in 2003, monochorionic twins were believed to all be monozygous. Subsequent to Souter’s publication, MCDZT were recognized to be not extremely rare particularly in pregnancies by in vitro fertilization. Once such twins were recognized blood chimerism between such twins was noted to occur fairly often. Blood derived from one zygote was found in the blood stream of the twin derived from the other zygote and vice versa.

This finding, it is assumed, occurs when placental vessels cross during in-utero development mixing one twins blood elements with the others. Until Fumoto’s report, only blood elements were known to be chimeric in MCDZT and only on occasion. Fumoto upsets that notion by finding chimeric buccal cells in each of a twin set. The authors speculate on the mechanism of this finding and possible implications of its occurrence in the report.

It appears that the more deeply we look into biology, the more we find exceptions that no doubt are new harbingers of deeper understanding of nature’s overall plan.

Tuesday, March 4, 2014

Sounding Off on Infant Sleep Machines

Have parents told you that they have installed infant “sleep machines” in their baby’s room, devices that essentially provide ambient noise to mask other room sounds that can disturb a baby’s sleep? Have you ever wondered if there were any risks to using these devices?

Photo by Geralt via Pixabay
Hugh et al. (doi: 10.1542/peds.2013-3617) did wonder, and decided to measure the sound levels of these machines when played at maximum volume placed 30,100 and 200 centimeters from the baby’s crib. The results will make some noise when you read them in regard to potential damage to an infant’s ears that can occur when the device is close to the crib at maximum volume.

Currently there are no rules or recommendations of how loud is too loud for these machines—but after reading this study, perhaps you will want to offer some suggestions to families who insist that these sleep devices are the only thing that allows their baby to sleep through the night. The cost of a sound sleep at the expense of hearing loss may not be worth the risk. Hear more about this study and these machines by checking out this interesting article being early released this week.

Related Reading:

Wednesday, February 26, 2014

Fever During Pregnancy and Health Effects on Offspring

Photo by operalynn via Flickr
When a pregnant mother experiences fever, does it make a difference on the health outcome of the infant once born?

Dreier et al. (doi: 10.1542/peds.2013-3205) did a meta-analysis of cohort and case-control studies looking at prenatal fevers and infant health outcomes. The results do suggest an increased adverse effect on offspring—but just what effects and whether or not the risk can be modified with antipyretics await your read of this interesting article.

Maternal fever is always a hot topic for pediatricians as well as obstetricians—and this study will certainly contribute to the discussion.

Tuesday, February 18, 2014

In the NICU, It’s Not What You Say to Babies—It’s How Much You Say to Them

Photo by Public Domain Pictures
via Pixabay
While the neonatal intensive care unit is a relatively quiet environment to reduce stress levels on babies, families and staff, this does not mean that parents should not be talking to their babies.

Thanks to Caskey et al. (doi: 10.1542/peds.2013-0104), we see that the more parents talk to their young infants in the NICU, the better the developmental outcomes, in terms of language and cognitive scores as assessed by Bayley developmental testing measures.

This is a fascinating study that will perhaps increase the amount of parent-baby conversation in your nurseries—but read the study and see what you think.

Better yet, why not converse about this study (quietly) with parents in the NICU?