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Mom's flu affects unborn babies

Thu, 23 Feb 2012 14:42:14 GMT

Flu shots during pregnancy protect babies from being born underweight, new research published in Canada's top medical journal suggests. Small-for-gestational-age babies have an increased risk of lifelong health consequences when they're older, including obesity, heart disease and diabetes.

The new study, appearing in this week's issue of the Canadian Medical Association Journal, suggests flu infection during pregnancy affects an unborn baby's fetal growth. The study was conducted by a team of U.S. and Bangladeshi researchers. In all, 340 healthy pregnant women in Bangladesh were put into two groups: one received an influenza vaccine, and the second received the pneumococcal vaccine as a "control."

Researchers compared the weight of babies born in two periods: during flu season and outside flu season. When the flu virus was dormant, there was no difference between the two groups of mothers in terms of the percentage of babies born to them which were small for their gestational age. But when flu was circulating, not only was there less flu-like disease among the mothers and babies who had received the flu shot, the babies born to the mothers vaccinated against flu weighed, on average, 200 grams more.

"That's a big difference in mean birth weight," said lead author Dr. Mark Steinhoff, a professor of pediatrics at Cincinnati Children's Hospital Medical Center.

Overall, the percentage of small-for-gestational-age babies was lower in the flu vaccine group than in the control group (25.9 per cent versus 44.8 per cent). In total, 336 babies were delivered; 327 were included in the analysis. "It's well known that, when there's a pandemic, pregnant women are highly vulnerable," said Steinhoff.

But even in non-pandemic years, Canadian research has shown that pregnant women are at an increased risk of being hospitalized with pneumonia or other flu-related complications. As women get closer to their due dates, their immune systems change, making them more vulnerable to serious illness due to influenza and other infections. That can put stress on the fetus.

Steinhoff 's team estimates vaccinating 10 pregnant women against the flu prevents one small-for-gestational-age baby. Other research has shown that the rate of premature births is lower among vaccinated mothers.

The Public Health Agency of Canada says expectant mothers, at any stage of pregnancy, should get a flu shot to protect themselves and their babies.

The agency says it's particularly important that women who will be in the later stages of their pregnancies, the second and third trimester, during flu season (which runs from November to April) are immunized because they face a greater risk of being hospitalized. The highest risk of hospitalization from flu is during the third trimester.

Mothers with migraines likely to have babies with colic

Wed, 22 Feb 2012 11:28:07 GMT

Baby colic is often characterized by incessant crying, which could also turn fatal for the infant’s life. A team of professionals from the University of California (UCSF) has affirmed that mothers suffering from migraines have about twice the chances of having a baby with colic.

As part of the study, about 154 mothers and their babies were examined. The mothers were enquired regarding the crying patterns of their babies and self experiences of migraines. Also, the scientists assured that the relentless crying of the baby was associated with the clinical definition of colic.

“If we can understand what is making the babies cry, we may be able to protect them from this very dangerous outcome,” commented Amy Gelfand, MD, a child neurologist with the Headache Center at UCSF.

The outcomes showed that mothers who suffered from migraines were 2 and a half folds likelier to have babies with colic. Cumulatively, 29% of infants who belonged to mothers with migraines suffered from colic. On the other hand, 11% of babies which belonged to mothers devoid of migraines, experienced colic. Generally, colic symptoms seen in babies are linked to gastrointestinal troubles. However, this correlation has not been affirmed by professionals.

The team believed that babies with colic may be more reactive to stimuli in their surroundings. This article titled, ‘Infant Colic is Associated with Maternal Migraine’ will be presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans.

Mom’s Migraines Linked to Baby’s Colic

Tue, 21 Feb 2012 12:50:02 GMT

NEW ORLEANS – New mothers may be more likely to face an inconsolable baby if they have a history of migraine, an observational study suggested.

A maternal history of migraine conferred a 2.6-fold higher likelihood of colic in otherwise healthy infants (P=0.02), Amy Gelfand, MD, of the Headache Center at the University of California San Francisco, and colleagues found.

The prevalence of colic reached 28.6% for those babies compared with 11.1% among those without a migraineur mom, they reported in a study slated for presentation in April at the American Academy of Neurology meeting here.

"We really do not know what is happening when babies are having colic," Gelfand said in an interview with MedPage Today. "Traditionally it's thought to be abdominal pain, but we truly don't know."These preliminary results, while not warranting any firm causal conclusions, suggest a different explanation for at least some infants, Gelfand noted.

"A family history of migraine is the strongest risk factor for migraine," Gelfand explained. "Our hypothesis is that mothers who have migraine have migraine genetics, which they are then passing on to their infants, and that those infants are perhaps expressing those genetics very early in infancy as colic."

Their frequent bouts of crying and fussiness for hours on end might be a signal of headache. Or "babies with colic might be feeling sensitive to normal stimuli the same way that patients with migraine are often sensitive to normal stimuli during their attacks," Gelfand added.

If that is the case, pediatricians might consider counseling new mothers with a history of migraine to try cutting down on noise levels and other stimuli around their child during colic episodes, she suggested.

Some prior retrospective studies suggested that children with migraine were more likely to have had colic during infancy, but recall bias was a possibility. To investigate a possible migraine-colic link, Gelfand's group conducted a cross-sectional study at general pediatric clinics in San Francisco, asking 154 mothers about colic at well-child visits at age 2 months, when colic is most likely, to minimize that source of bias.

Surveys of the fathers -- available for 93 of the infants – showed a trend for 2.3-fold higher likelihood of colic with paternal migraine. The prevalence was 22.2% among infants whose fathers had migraine versus 9.5% in the others, though not a significant difference at P=0.24.

Colic was defined as unexplained crying or fussiness for three or more hours at least three days a week in otherwise healthy infants. Migraine history was considered positive if the parent either reported a physician diagnosis of migraine or screened positive with three questions on the ID Migraine tool.

One limitation was that the study didn't control for possible confounding factors. Another study released last week in Pediatrics pointed to smoking and nicotine replacement therapy use during pregnancy as risk factors for colic.

Reverse causation was also a possibility, though unlikely, because mothers with and without migraine were equally accurate in their perception of colic when asked in different ways in the questionnaire, according to Gelfand.

Further follow-up is needed to assess whether the babies with colic go on to develop migraine more often, she added. "It is important for us to understand what is causing colic because uncontrollable crying is one of the triggers for shaken baby syndrome -- for frustrating caregivers to the point where something like shaken baby syndrome can happen," Gelfand noted.

Babies can play pranks before they can talk

Mon, 20 Feb 2012 13:06:21 GMT

LONDON - Babies who are too young to speak can still forge friendships with each other and even make jokes, researchers have found. Tiny cameras strapped to a baby's head have revealed the world from an infant's point of view and offered scientists a unique view of life.

It was found that young babies, less than 18 months old, were able to communicate with each other through gestures, noises and shared play. The team at Charles Sturt University in Australia observed children aged from six months to 18 months in two childcare centres and nine family day care homes, reported the Daily Telegraph.

Researcher Jennifer Sumsion, professor of early childhood, said the footage showed the babies "were much more capable at a young age than we had anticipated", which "should reassure parents with children in childcare".

She said the babies interacted with each other through making eye contact, subtle gestures, reaching out, and even using humour. She said: "A child less than 12 months old handed a toy to another child then snatched it back at the last minute, and they repeated this several times in a playful manner before he handed the toy over."

She added that when a new child started at one of the centres, the other children came over and touched her but this frightened her so the children found a piece of material so she could hide and that comforted her.

Babies in Parliament OK, but Speaker prefers MPs plan ahead

Fri, 17 Feb 2012 10:20:26 GMT

Members of Parliament should plan ahead so they don't have to bring their babies in the House of Commons, Speaker Andrew Scheer said Thursday in a ruling on a controversy that erupted last week.

If plans fail, Scheer asked that he be given advance warning and said that as long as there are no disturbances related to a baby's presence, then he would have no cause to be concerned.

Scheer was asked to clarify the rules about having babies in the Commons last week after Quebec NDP MP Sania Hassainia told the media her three-month-old baby was kicked out. Her husband is usually on hand to help with their child, but Hassainia, who is breastfeeding, couldn't find him in time and had to bring the baby with her into the chamber because of a scheduled vote.

Fellow MPs began taking photos, which is not permitted in the Commons, and that prompted Scheer to dispatch a page to tell MPs to take their seats. Hassainia said she understood from the page that the baby was not allowed, but the Speaker's office said it was the taking of photos that was the problem, not the baby.

The incident prompted debate about whether Parliament does enough to accommodate mothers and whether there should be specific rules about whether babies are allowed or not. Scheer said in his ruling that MPs were "flouting the rules" when they started snapping photos and that's what drew his attention to the baby. He said it would be "of great assistance" if MPs told him privately that they had a problem and that would help avoid the kind of situation that unfolded last week.

He said votes are normally scheduled in advance and MPs can "plan accordingly," it would only be because of an unexpected vote that MPs might encounter a child care problem.

MPs should raise problems with Scheer, not media
Scheer, who mentioned he is the father of four young children, said he recognizes that plans sometimes fail.

"When that happens, members may find themselves in a difficult position. In such cases, provided there is no other type of disruption or disturbance, the Speaker's attention will likely not be drawn to the situation and the work of the House can proceed as usual," he said. He also said that if there is an incident MPs should talk to him directly instead of going to the media.

A parliamentary committee is going to review the rules of the Commons, and Scheer said he will welcome its input on what he called a "nebulous area."He has also asked for a review of the accessibility of changing tables in washrooms to ensure there is a sufficient number for MPs who bring their children to work.

Robotic surgery helps moms, babies

Thu, 16 Feb 2012 10:57:09 GMT

INDIANAPOLIS (WISH) - St. Vincent Hospital is using the DaVinci System to make a relatively simple procedure reinforces the mother's cervix to allow her a better chance to carry her baby to full term. The robotic system is also used in heart and prostate procedures, among others.

formula feeding

Wed, 15 Feb 2012 10:34:44 GMT

The term formula feeding means giving your baby formula milk in a bottle. Formula milk is based on cow’s milk that’s been processed to make it more easily digested by a new baby. It’s for babies who don’t get breast milk, or in addition to breast milk. No matter how persistent some women are with attempting to fully breastfeed their baby, they find for one reason or another, that it is better for themselves and their baby to change to bottle-feeding. This can be a difficult decision for some mothers to make, especially if they had their heart set on breastfeeding their new baby.

Seek some guidance from your local Health Nurse. If you are trying to establish breastfeeding, it has been suggested that the early use of bottles and dummies can interfere with the establishment. It can reduce both the infants sucking capacity and stimulation of the breasts. This may result in delayed and poor establishment of lactation.

What you need to know
Babies who aren’t breast-fed must only have formula milk – ordinary cow’s milk is not suitable.
It’s important to keep all feeding equipment clean by sterilising between uses. This is because formula fed babies don’t get the same protection from infection as breast-fed babies. Bottle-feeding with formula milk, or with expressed breast milk, gives mother’s flexibility when they go back to work.

However you feed your baby, you and your baby will love spending the time together. Hold your baby close when you’re bottle-feeding, and enjoy it.

A Guide to Bottle Feeding
You may bottle-feed from the start, or find you make the change from breast-feeding later on.

What you need
If you plan to fully bottle-feed you’ll need:

Sterilising equipment
At least six bottles and teats

Mixing jug
Bottle warmer (optional)
For an occasional bottle only, one or two bottles and teats will be fine. You may not need to buy all the sterilising equipment.

Preparation
Make up your baby’s feeds according to the instructions on the pack. The main points you need to remember are:

Ideally boil the water for 5 minutes and then allow to cool.
Always put the amount of boiled water in the mixing jug or bottle first, before the powder.
Always add the correct amount of scoops, making the feed either too weak or too concentrated can be potentially dangerous. DO NOT pack the scoop too firmly with formula powder. Level off the scoop with a knife. Follow the manufacturer’s instructions.
You can buy pre-measured sachets of dried milk which ensure you have the proportions right. Ready-to-feed formula is even easier, though it does cost more.
Keep made up formula refrigerated and only store this way for 24 hours.
Do not add anything else to your baby’s bottle such as cereal powder, honey sugar etc.
Important: Heating bottles of formula in a microwave oven is NOT recommended. The heat can be uneven, leading to scalding hot spots in the bottle.

When you bottle-feed:
Hold your baby close, and make sure the teat is always filled (this reduces the amount of air-swallowing).
Every so often, you’ll need to take the teat out of your baby’s mouth as the sides stick together and prevent a good flow.

Wriggling, crying and pushing the teat out with the tongue may mean your baby needs sitting up to get rid of wind.

Do not leave your baby unattended while they are drinking from a bottle.
If your baby’s fully or mostly bottle-fed, you may find it easier to make up all the infant formula you’ll need for the next 24 hours, and keep it in bottles in the fridge. Some babies take a bottle straight from the fridge, but most mothers feel it’s kinder to warm it by standing the bottle in a jug of hot water first, or using an electric bottle warmer.

Note: test the formula by shaking a drop or two onto your wrist or the back of your hand. It should feel more or less the same temperature as your skin.

If you need to switch to bottle feeding, do it gradually unless you’re changing over in the first few days. A sudden changeover can mean an uncomfortable build-up of milk in the breasts, which could lead to problems like mastitis. If you think you are developing mastitis contact your doctor immediately. Early treatment is essential.

How to get child care at vacation destinations

Mon, 13 Feb 2012 10:38:51 GMT

Sometimes mom and dad need a timeout, even on a family vacation. Maybe you want a date night, or a chance to play a round of golf together, actually ski side by side, or simply share an uninterrupted meal. Baby sitters abound wherever you go, but finding a responsible, trustworthy caretaker or day-care center can take some work before you leave home.

“Leaving your kid with a stranger can be one of the most nerve-racking experiences of parenthood,’’ says Sarah Christensen, who started Park City Sitters, in Park City, Utah, after relying on a similar child-care service during a trip to Idaho. “I realized how uncomfortable it is for parents to leave their own kids with people they don’t know.’’

Get creative when you start searching. Call ahead to your hotel for recommendations, contact local day-care centers, spread the word among your friends and hometown caretakers, and get online.

Waltham-based Care.com has a database with hundreds of thousands of providers across the country who offer child care and pet-minding services. If you are going to Miami, for instance, find someone there to watch your children so you can have a night out, and also hire someone at home to feed your beloved pet while you are away. You can even arrange for a caretaker to check on your elderly parents.

Search Care.com’s listings by region - you can refine your search by selecting age and price range, gender, and languages spoken, for instance - and then reach out to anyone whose profile and qualifications you like. Or post your own specific request and vet those who respond.

Katie Bugbee, managing editor at Care.com, recommends getting as detailed as possible: “You want to say, ‘Here’s when we’ll be in town and what we need. We are looking for a baby sitter who is at least 17 years old. You must be familiar with the challenges of watching an overexcited 4-year-old and be able to deal with a colicky newborn.’ ’’

Once you have narrowed it down to several people, adds Bugbee, do a phone interview, then Skype so you can “meet’’ face to face, run a background check, and get references.

“Don’t just call the people they give you,’’ says Bugbee. “Ask for the name of a high school coach, a university teacher, or their last boss, and get a sense of their maturity level and their ability to handle emergencies and challenging situations.’’

Not sure how much to pay your sitter? Care.com has a calculator that lets you find the average local rate at your destination.

Ethan Cross: Derriford 'extremely sorry' for baby death

Thu, 09 Feb 2012 10:35:33 GMT

Ethan Cross, who was born with some internal organs outside his body, died at Derriford Hospital in Plymouth. The Plymouth Coroner recorded a verdict of misadventure at the inquest into the baby's death.

Plymouth Hospitals NHS Trust said: "This was a very sad case and we are extremely sorry that there were failings in the care given to Ethan."A statement from the trust said: "We will, of course, consider the coroner's full findings and look to see whether any further changes are needed."

'Sub-standard care'
There were 109 Sudden Unexpected Incidents (SUIs) at Derriford Hospital between January 2009 and October 2010, including three unexpected child deaths and 29 unexpected adult deaths. Ethan died on 14 November 2009. His family, from the North Prospect area of Plymouth, declined to comment after the inquest.

However, speaking through solicitor Rob Antrobus, the family said it was "reassuring" that the hospital trust had identified steps to take and improvements to be made. "Sadly the coroner, delivering a verdict of misadventure, has found evidence of sub-standard care which has played a significant part in baby Ethan's death," Mr Antrobus told BBC News. "The family sincerely hopes that the lessons learned in this tragic case result in other families not having to go through what they did."

Diabetes 'increases birth defect risk'

Wed, 08 Feb 2012 11:46:48 GMT

“Diabetic mothers-to-be have high risk of giving birth to children with congenital abnormality,” The Guardian said today.

The news is based on UK research that compared the rates of birth defects in women with and without diabetes. It found that about 7% of pregnancies in women with diabetes were affected by birth defects that were not caused by problems with the number or structure of the chromosomes. This was 3.8 times higher than the rate in women without diabetes. The study also found that women who have worse control over their blood sugar around the time of conception were at greater risk.

It has been known for some time that diabetes in pregnancy is associated with a higher risk of various complications, and this large study provides further evidence on the link between diabetes and birth defects. UK medical guidance already addresses this risk, and recommends that from adolescence onwards, women with diabetes should be routinely given information on the importance of planning any future pregnancies and on getting specialist care and advice when they decide to have a baby. Women with very poor control of their diabetes are also advised not to become pregnant until their blood sugar control has improved.

Women with diabetes are likely to already be aware of these risks. However, this study provides another reminder that diabetic women who are thinking about becoming pregnant should discuss their options with their doctor first.

Where did the story come from?
The study was carried out by researchers from Newcastle University, the Regional Maternity Survey Office in Newcastle, and the South Tees NHS Trust. It was funded by Diabetes UK, the Department of Health, the Healthcare Quality Improvement Partnership, and the four primary care trusts in northeast England. The study was published in the peer-reviewed medical journal Diabetologica.

The Guardian provided good coverage of this story, and put it into context of what is already known about how a woman’s diabetes can affect her pregnancy. The shorter news article in The Independent covered the basics of the story, but could be taken to suggest that the study was the first to discover the risk. In fact, this risk has been known for some time.

What kind of research was this?
Pregnancies in women with diabetes are already known to be at increased risk of various complications, including stillbirth and birth abnormalities. This cohort study aimed to clarify the extent to which diabetes increases the risk of major birth defects, and how this risk is affected by other factors such as maternal age, smoking and socioeconomic status.

A cohort study is the best way to assess this type of question, which could not be answered by a randomised controlled trial. Clearly, women with diabetes differ from women without diabetes in terms of their medical condition, but the two groups may also vary in other ways. It is important that researchers take such differences into account during their analyses.

What did the research involve?
The researchers used data collected on approximately 401,000 pregnancies that occurred between 1996 and 2008. They looked at whether mothers had diabetes, and if their babies had birth defects. The researchers then looked at whether birth defects were more common in babies born to mothers with diabetes.

The researchers obtained their data from the north of England, collected by the Northern Diabetes in Pregnancy Survey (NorDIP) and the Northern Congenital Abnormality Survey (NorCAS). NorDIP contains data on pregnancies in women diagnosed with diabetes at least six months before conception. It does not include women with gestational diabetes (diabetes that only occurs in pregnancy).

The study excluded multiple pregnancies (twins or triplets) and included pregnancies where the baby died at or before 20 weeks of pregnancy, or where the pregnancy was terminated due to a foetal abnormality. It included all eligible births in the study region in the study period. Abnormalities were classified according to standard definitions, and could be recorded up to the age of 12 years. Some birth abnormalities are caused by problems with the number or structure of chromosomes (the structures in the cell that contain our DNA). These abnormalities were looked at separately.

The researchers looked at the effect of various diabetes-related factors including how well the woman’s blood sugar was controlled at around the time of conception, whether she had type 1 or type 2 diabetes, and diabetes complications diagnosed before pregnancy (such as kidney or eye problems). They also looked at the effect of maternal age at the time of delivery, gestational age at time of delivery, folic acid intake before conception, foetal gender, number of previous babies, pre-pregnancy care, and smoking during pregnancy. Any significant factors were taken into account in the analyses to determine the effect of the individual factors.

What were the basic results?
Among the 401,149 pregnancies, 1,677 were in women with pre-existing diabetes. Most of these women (78.4%) had type 1 diabetes. Overall, 9,488 pregnancies were affected by at least one major birth defect, and 129 of these were in women with diabetes.

In women with diabetes, 71.6 per 1,000 pregnancies were affected by non-chromosomal major birth defects. This was 3.8 times higher than the rate in women without diabetes. Women with diabetes did not have an increased risk of having a baby with birth defects caused by chromosomal abnormalities.

When looking at specific factors linked to the risk of birth defects, the researchers found that women who had worse blood sugar control at around the time of conception were at increased risk of having babies with birth defects. Blood sugar control is often calculated using a measure called HbA1c level. This represents the levels of haemoglobin in the blood with a sugar molecule attached.

Doctors generally try to keep HbA1c levels below 7%. In this study, each increase of 1% in HbA1c over 6.3% was associated with a 30% increase in the odds of birth defects (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.2 to 1.4). Women who already had kidney problems as a result of their diabetes also had an increased risk of having babies with birth defects (OR 2.5, 95% CI 1.1 to 5.3).

Some other factors were associated with an increased risk of birth abnormalities when looked at in isolation, such as low intake of folic acid and lower socioeconomic status. However, once all other factors were taken into account, these were no longer statistically significant.

How did the researchers interpret the results?
The researchers concluded that the main modifiable factor associated with birth defects in women with diabetes is their blood sugar control at around the time of conception. They say that the association with diabetes-related kidney problems needs to be studied further.

Conclusion
This study supports the existence of an association between maternal diabetes and increased risk of birth abnormalities, and helps quantify the size of the association. The study’s strengths include its large size and ability to include the entire population in the study area. However, there are a number of points to note:

The researchers took into account various factors that could influence the results. However, as with all studies of this type, it is possible that unknown or unmeasured factors, other than maternal diabetes, could have affected the risk of birth defects. From this study we cannot say what effect diabetes arising in pregnancy (gestational diabetes) might have on risk of birth defects, as these women were not included in this analysis. The study relied on registry-recorded data, and there may be some omissions or inaccuracies in this data. That said, the registries used standard systems for recording data that should increase the reliability of their records.

The link between maternal diabetes and an increased risk of birth defects is already established. Better blood sugar control can help reduce this risk, although it cannot eliminate the risk completely. The National Institute for Health and Clinical Excellence (NICE) recommends that women with diabetes who are trying to conceive should aim for an HbA1c of less than 6.1%, if this can be achieved safely. It also suggests that women with an HbA1c of over 10% should avoid becoming pregnant.

NICE also recommends that:
Women with diabetes who are planning to become pregnant should be informed of the need to establish good blood sugar control before conception, and that maintaining it throughout pregnancy will reduce the risk of miscarriage, birth defects, stillbirth and neonatal death. They also say that it is important for healthcare providers to explain that these risks can be reduced, but not eliminated entirely.

The importance of avoiding unplanned pregnancy should be an essential component of diabetes education from adolescence onwards for women with diabetes. Women with diabetes who are planning to become pregnant should be offered pre-conception care and advice before they stop using contraception. This study supports the need for specialist information and planning for pregnancy in women with diabetes. Women with diabetes who are thinking about becoming pregnant should discuss this with their doctor if they have not already done so.