Monday, December 2nd, 2013
A growing number of the smallest premature babies are surviving and, in many cases, thriving–but medical issues commonly persist long after birth. More from NBC News:
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Alexis [Clarke] was born after she’d been in the womb just over 25 weeks; a typical pregnancy lasts 40 weeks. Babies born before 37 weeks are considered premature, but with medical and technological advances, it’s no longer unusual for very preterm babies to survive. The key, in general, is a steroid for mothers and a drug for their babies.
Alexis’ journey has been marked by ups and downs. Just as her parents thought she was ready to be discharged in time for Thanksgiving, one of her doctors told them she needed emergency eye surgery. Then a small cough raised concerns that she’d contracted whooping cough, prompting her to be put into isolation (tests came back clear). But an MRI of her brain delivered the good news that her development seems to be proceeding normally.
Baby Alexis is hardly the tiniest preemie born, but her journey from neonatal intensive care to home is typical of other extremely premature babies. In 2011, less than 1 percent of live births in the U.S. were considered “extremely preterm,” delivered before 28 weeks. That represents more than 28,000 babies. Meanwhile, the total number of premature births in the U.S declined last year to 450,000, or 11.5 percent, the lowest preterm birth rate in 15 years.
“In the past six years we’ve had babies survive that we didn’t think could survive,” Dr. Krishelle Marc-Aurele, one of Alexis’ doctors, told NBC San Diego.
Some hospitals are divided on treating babies born in the “gray zone,” between 23 and 25 weeks. In the U.S, up to 90 percent of neonatal units resuscitate babies born as soon as 23 weeks. Younger than that and most doctors believe a baby is not viable. “The lower level of viability is inching down,” said Dr. John Muraskas, who resuscitated the smallest surviving baby on record, Rumaisa Rahman, born in 2004 weighing 9.2 ounces.
Muraskas, a professor of pediatrics and neonatal/perinatal medicine at Loyola University Medical Center, said the key treatments began in the 1990s and have made all the difference.
Now doctors routinely give moms on the brink of delivering too soon two doses of steroids to help the baby or babies’ lungs mature quicker and strengthen the blood vessels in the brain. That reduces the risk of a premature infant developing a brain bleed.
Once born, preemies receive surfactant, a drug administered through a breathing tube into their lungs that makes them stronger and less stiff, and able to breathe independently sooner.
Thursday, October 24th, 2013
The definition of a “full term” baby is being honed by the American College of Obstetricians and Gynecologists, who are adjusting the definition in order to better equip parents and hospitals with the knowledge they need to care for babies born between 37 and 42 weeks gestational age. More from Reuters:
“We have increasingly recognized that newborn outcomes are not uniform between 37 and 42 weeks,” Dr. Jeffrey Ecker said.
Babies delivered between 37 weeks and 39 weeks of pregnancy will now be considered “early term,” according to the American College of Obstetricians and Gynecologists.
“Full term” infants will be those born between 39 and 41 weeks.
Babies born between 41 and 42 weeks of pregnancy will be thought of as “late term.” Finally, those born at 42 weeks or later will still be considered “postterm.”
Ecker is the chair of The College’s Committee on Obstetric Practice. He is also a high-risk obstetrician at Massachusetts General Hospital in Boston.
“Language is important in communicating that it’s not just one period of time and to recognize that outcomes do differ,” he told Reuters Health.
A growing body of research has found babies born before 39 weeks are not as developed as those born later.
Babies born after 39 weeks have fewer poor outcomes such as breathing, hearing and learning problems, The College says in its joint statement with the Society for Maternal-Fetal Medicine. The statement was published Tuesday in Obstetrics and Gynecology.
The brain grows by about a third between week 35 and week 39 of pregnancy, according to The College. And a layer of fat to help keep the body warm is added during the last weeks of pregnancy.
Pregnant? Calculate your due date, or find your due-date club.
Image: Pregnant woman’s belly, via Shutterstock
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Wednesday, August 28th, 2013
A review of research on preterm babies reveals that super-early preemies (those born between the 22 and 25 weeks gestation) face significant health risks years later. Compared with full-term babies, these preemies had increased risk of neurological problems at 4 to 8 years of age. Care of premature infants continues to improve, but this review points to the importance of trying to keep babies in the womb as long as possible, TIME.com reports.
More from TIME.com:
It’s not the first hint that preemies are at higher risk of health issues for being born before their development was completed. Some recent studies showed, for example, that babies who were born earlier had poorer test scores in reading and math compared with those born full term. A study published in 2011 that analyzed the long-term effects of premature birth on cognitive abilities such as memory and attention span in early adulthood revealed that people who were born extremely premature performed worse on executive function tests and took longer to complete higher-order intellectual tasks. As adults, these individuals also scored an average of 8.4 points lower on IQ assessments compared with people who were born at full term.
The fact that the effects of premature birth last into adulthood is concerning, since they are not only at a disadvantage in some cognitive functions, they even have a reportedly higher risk of death in early adulthood as well. Advancements in care of premature babies have undoubtedly improved, but lessening their health risks is still a task at hand. In 2012, a team of researchers from the University College London Institute for Women’s Health reported that death rates and health problems among extremely preterm babies has remained unchanged for decades.
While the parents of preemies may find this news less-than-reassuring, this research can help children by giving “parents and clinicians a heads-up for what to look out for during development,” TIME.com says.
Image: Premature baby’s foot, via Shutterstock
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Friday, August 16th, 2013
Babies who are born before the 37th week of pregnancy have been shown in a new study to carry an elevated risk of developing heart disease as an adult, specifically affecting the heart’s right ventricle, which controls the heart’s ability to pump blood. More from CBS News:
The researchers behind the new study, published Aug. 12 in Circulation, point out that that up to 10 percent of young adults today are born premature.
“We wanted to understand why this occurs so that we can identify the small group of patients born premature who may need advice from their health care provider about this cardiovascular risk,” said study author Paul Leeson, a professor of cardiology at the University of Oxford’s Cardiovascular Clinical Research Facility in the U.K., in a press release. “The changes we have found in the right ventricle are quite distinct and intriguing.”
The study was funded by the British Heart Foundation.
The human heart contains four chambers: the right and left atria — which receive and collect blood — and right and left ventricles, which pump blood from the heart into the circulatory system and rest of the body.
The ventricle on the right side of the heart, specifically, pumps blood from the heart to the lungs, according to the National Heart Lung and Blood Institute.
When breathing air in, a cycle kicks off in which oxygen is passed from the lungs through blood vessels and into the blood. Then, carbon dioxide (waste) is passed from the blood through the lungs where it’s removed when you breathe out. The left atrium is what receives this oxygen-rich blood from the lungs, which is then pumped out by the left ventricle into the main artery of the body, the aorta. Then it is delivered to the rest of the body.
The researchers followed a group of premature babies born in the 1980s until they were about 25. They were given standard heart tests checking for blood pressure and cholesterol, in addition to MRI machines to measure patients’ blood vessels and heart structures. They then created a computer model to determine how much blood is being pumped in their hearts.
“Their hearts appear to be slightly smaller, they had slightly thicker walls and had a slight reduction of the blood they are pumping,” Leeson told CBS News’ Alphonso Van Marsh of those born prematurely, when compared to those born at full term.
People with these types of changes in the right ventricle’s structure are more likely to have mild to moderate cases of high blood pressure (hypertension), and are at an increased risk for heart failure or cardiovascular-related death, according the researchers.
Image: Heart monitor, via Shutterstock
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Monday, June 3rd, 2013
Faced with a shortage of injection drugs used to provide nutrition to critically ill premature babies and cancer patients who can’t eat any other way, the US Food and Drug Administration said it will begin importing the medication from Norway. NBC News has more:
The agency said Wednesday it immediately will begin importing trace elements, potassium phosphate and sodium phosphate — drugs used in total parenteral nutrition or TPN — from a Norwegian plant affiliated with Fresenius Kabi USA LLC, based in Lake Zurich, Ill.
“Hospitals can start ordering the drugs today,” said Valerie Jensen, associate director for the FDA’s drug shortage program.
That should start reversing a two-year shortage that has forced hospitals to ration the drugs that provide essential nutrients for patients who can’t eat or drink by mouth, said Jay Mirtallo, past president of the American Society for Parenteral or Enteral Nutrition, or ASPEN.
“I think it’s huge. It’s a great win for us,” said Mirtallo. “For too long, we’ve been limping along trying to feed our patients.”
Without adequate TPN drugs, tiny babies and other patients can develop severe side effects, including horrifying skin lesions and deficiencies that can demineralize their bones, leading to fractures, experts say. Some may have lasting developmental delays caused by missing nutrients.
The FDA is exercising regulatory discretion in allowing the drugs to be imported. When the agency turns to a foreign source, as it has for 14 other drugs in the past two years, officials evaluate the foreign drugs to make sure quality is adequate and does not pose undue risk to U.S. patients, officials said.
The move comes after 14 U.S. senators demanded earlier this month that the FDA act to end the shortage of infant drugs.
Image: Premature baby in a NICU, via Shutterstock
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