IMMUNE SYSTEM STAYS DEPLETED UP TO 3 YEARS AFTER MEASLES

IMPORTANCE OF MEASLES VACCINE TO PREVENT DAMAGING INFECTIONS

FRIDAY, May 8, 2015 (HealthDay News) -- Children who survive a measles infection remain vulnerable to other potentially deadly infections for as long as two or three years after the measles infection, according to research published in the May 8 issue of Science.

Michael Mina, Ph.D., of Princeton University in New Jersey, and colleagues analyzed public health data from before and after mass measles vaccinations began in Denmark, England, Wales, and the United States. They verified that the childhood mortality rate in those countries did indeed fall by about 50 percent following the introduction of the measles vaccine. Further, they found that children in those countries who contracted and survived the measles were more likely to subsequently die from another infectious disease.

Children's immune systems in England and Wales appeared to be weakened for as long as 28 months following a measles infection, during which time they were at increased risk for death from a viral or bacterial disease, the researchers reported. In the United States, the effect lasted about 31 months, and in Denmark, about 26 months.

"These results provide population evidence for a generalized prolonged (roughly two- to three-year) impact of measles infection on subsequent mortality from other infectious diseases," the authors write. The effect appears specific to measles. The research team conducted a similar analysis on pertussis, and found no association between a country's pertussis rate and subsequent childhood deaths due to other infectious diseases.

AUTISM AND PREECLAMPSIA LINK: NEW STUDY

Dec 9, 2014

Preeclampsia is a condition that appears during pregnancy and is characterized by high blood pressure and protein in the urine. Now, in a new study, researchers have found that children with autism spectrum disorder were more than twice as likely to be born to mothers with preeclampsia during pregnancy, suggesting a link between the two.

The researchers, from the University of California-Davis' MIND Institute, published their results in the journal JAMA Pediatrics. They also found that the likelihood of a diagnosis for autism spectrum disorder (ASD) increased further if the mother experienced more severe disease.

Preeclampsia typically occurs during middle to late pregnancy and up to 6 weeks after delivery, though it can sometimes appear earlier than 20 weeks. Symptoms for the condition include swelling, sudden weight gain, headaches and changes in vision.

In the US, preeclampsia affects 3-5% of pregnant women, but among women who have had it, around 20-40% of their daughters and 11-37% of their sisters will also get the disorder, according to the World Health Organization (WHO). 

Preeclampsia accounts for around 40-60% of maternal deaths in developing countries, and it can develop into eclampsia, a life-threatening condition often accompanied by seizures.

According to Cheryl Walker, senior author and researcher from the MIND Institute, preeclampsia can affect the developing brain in several ways. For example, limited nutrients and oxygen can cause oxidative stress, which encourages the release of proteins into the maternal bloodstream in an attempt to improve circulation.

The latest study involved over 1,000 children, between 2 and 3 years old, who were part of the Childhood Risks of Autism from Genetics and the Environment (CHARGE) Study in Northern California.
Though preeclampsia has previously been studied as an autism risk factor, the researchers say previous research has been inconsistent.
However, theirs is a population-based, case-controlled study that investigates not only links between autism and preeclampsia, but also whether autism risk is associated with preeclampsia severity.
In more than 500 male and female children who were diagnosed with autism, 200 were diagnosed with development delay and 350 were developing typically. All of the mothers of these children had confirmed preeclampsia.

Results showed that mothers of children who were diagnosed with autism were over twice as likely to have had preeclampsia during pregnancy.

Furthermore, mothers of autistic children or those with developmental delay were more likely to have had placental insufficiency, severe preeclampsia or both, compared with the mothers of children who developed typically.

Walker and her team also found that children with autism whose mothers had preeclampsia were more likely to have lower cognitive functioning. Additionally, they observed a correlation between preeclampsia and developmental delay without autism. "The level of detail obtained by the CHARGE Study on predictors, confounders and outcomes enabled a comprehensive exploration of this topic. While single studies cannot establish causality, the cumulative evidence supports efforts to reduce preeclampsia and diminish severity, to improve neonatal outcomes."

Slow Feeding Helps Prevent NEC in Smallest Preterm Infants

NEW YORK (Reuters Health) - 10-27-2014 Standardized slow enteral feeding (SSEF) is associated with a reduced risk of necrotizing enterocolitis (NEC) in infants born weighing less than 750 grams, compared with early enteral feeding, new findings show.

NEC remains a leading cause of mortality and morbidity in extremely preterm infants, although growing use of human breast milk to feed these babies and standardized feeding protocols have helped to reduce the disease's incidence, Dr. Sreekanth Viswanathan of Rainbow Babies and Children's Hospitals at Case Western Reserve University in Cleveland and colleagues note in their report.

Among infants born weighing less than 1,500 grams, the incidence of NEC is 7% to 9%, with a fatality rate of 15% to 30%, the team writes in the Journal of Parenteral and Enteral Nutrition, online October 14.

Some observational studies have shown an increased incidence of NEC in centers where babies are started earlier on enteral feeding and feeding volumes are advanced more rapidly, the researchers add. Dr. Viswanathan and his team hypothesized that introducing feeding more slowly to extremely low birthweight (ELBW) infants might reduce NEC risk.

To investigate, the researchers looked at 125 ELBW infants born at MetroHealth Medical Center in Cleveland who underwent the SSEF protocol, as well as 294 historic controls born at the same hospital who had received early enteral feeding. Babies were fed their mother's breast milk, when available, or formula, but donor breast milk was not used.

Under the SSEF protocol, infants born weighing less than 750 grams had 14 NPO days, followed by seven trophic feeding days; infants weighing 750 to 1,000 grams at birth had seven NPO days followed by seven trophic feeding days. While feeding advancement was 15 to 20 milliliter per kilogram per day in the historic controls, infants in the SSEF group received an additional 0.5 ml per feed every other day (less than 750 g) or every day (750-1,000 g).

Days to full feeds ranged from 16 to 22 for the historic controls, and 44 to 52 days for the babies weighing less than 750 g in the SSEF group and 32 to 36 days for the larger babies.

NEC occurred in 5.6% of the SSEF group and 11.2% of the controls (p=0.10), while 1.6% of SSEF babies and 4.8% of the controls required surgery to treat NEC (p=0.17).

When the researchers looked at babies born weighing less than 750 g, however, differences were significant. The risk of NEC was 2.1% in the smallest SSEF babies, compared to 16.2% for the smallest control infants (p<0.01). The risk of combined NEC and death was 12.8% for the SSEF group weighing less than 750 g, and 29.5% for the controls (p=0.03).

The babies in the study on the SSEF protocol who did develop NEC got sick at 60 days of age, on average, compared to 30 days for the control infants, according to Dr. Viswanathan.

Among the surviving babies, adjusted analysis showed no difference between the SSEF and control groups in discharge weight or length.

Nearly 50 babies weighing less than 750 g have been born at the study hospital over the past five years, Dr. Viswanathan noted in a telephone interview with Reuters Health, and all were treated with the SSEF protocol.

"We had only one case of NEC and that baby survived. No one died and no one required surgery for NEC," he said. "That is the group that I think benefits the most from the slow feeding protocol."

Feeding of VLBW infants varies from hospital to hospital, Dr. Viswanathan said. "There is no consensus on how to feed small babies," he added. "That's why the study is important, because in most of the centers the idea is to start early."

But any protocol is better than none, Dr. Viswanathan said. "One of the most important things if you want to reduce the NEC rate is having a standardized feeding protocol," he said. "If everyone in the unit follows the same protocol that actually itself reduces your NEC rate, but it won't eliminate NEC."

The new findings may not be generalizable to centers that use donor breast milk instead of formula, Dr. Viswanathan said. "What we believe is especially in small babies, when you switch to formula, you need to slow down so they can get adapted, and they tolerate it much better," he added.

CAUSE OF MOST PRETERM BIRTHS FOUND

British scientists may have found the cause of pre-term premature rupture of fetal membranes (PPROM), which accounts for 40 per cent of pre-term births worldwide, and often leads to the infant's death. The study, which was carried out by researchers from Queen Mary University of London (QMUL) and University College London (UCL), was presented in "Placenta".

The researchers discovered that stretching the amniotic membrane leads to the overproduction of prostaglandin E2 (PGE2), which is damaging to both the cells and the mechanical structure of the tissue. In turn, the protein connexin 43 (Cx43) reacts to this overextension, which reduces the mechanical properties of the membrane even more. According to the researchers, this probably leads to premature rupture and pre-term birth.

Hence, the researchers believe to have found an approach to prevent many pre-term births. "Our findings have provided a new understanding of why pregnant women who have pre-term contractions go on to rupture their membranes early", said co-author Anna David.

COMMON CHILDHOOD VACCINE CUTS CHANCE FOR "SUPERBUG" - STUDY SAYS

FRIDAY, Oct. 10, 2014 (HealthDay News) -- The childhood pneumococcal vaccine helps children avoid the suffering and danger of ear infections, meningitis and pneumonia. And a new study suggests it may provide an added bonus: cutting down on infections from antibiotic-resistant "superbugs."

First used in children in 2010, the pneumococcal vaccine was linked to a 62 percent reduction between 2009 and 2013 of drug-resistant infections of bacterial pneumonia, meningitis and bloodstream infections for children under 5.

"The vaccine is an important tool against antibiotic resistance," said lead researcher Sara Tomczyk, an epidemic intelligence service officer in the Respiratory Diseases Branch of the U.S. Centers for Disease Control and Prevention.

"Along with appropriate antibiotic use, it is part of the solution to protecting ourselves against the growing threat of antibiotic resistance," she added.

The pneumococcal vaccine is currently recommended for all children age 5 and younger. Pneumococcal bacteria can cause ear infections, pneumonia and meningitis. It is the most common vaccine-preventable bacterial cause of death, the researchers noted.

Antibiotic-resistant strains are especially worrisome because standard drugs do not seem to help fight these bacteria. 

But the advent of the pneumococcal vaccine may have lessened the danger. According to Tomczyk, more than 4,400 cases of antibiotic-resistant, invasive pneumococcal disease were prevented between 2010 to 2013.

"Not only does this vaccine prevent pneumococcal infection, which means fewer antibiotics are prescribed, but it also prevents antibiotic-resistant infections," she added.

Tomczyk said the vaccine has been so effective that the U.S. government's Healthy People 2020 goal of reducing bacteria-resistant pneumococcal disease from 9.3 to 6 cases per 100,000 children was achieved nine years early and has since dropped to 3.5 cases per 100,000.

The vaccine is required in three-quarters of states before a child can be admitted to day care, Tomczyk noted, and 85 percent of U.S. children have by now received the recommended four doses.

Pneumococcal conjugate vaccine is given in four doses, at 2, 4 and 6 months of age and at 12 through 15 months.

The results of the study were scheduled to be presented in Philadelphia on Oct. 8 at IDWeek, the annual meeting of a number of groups focused on infectious disease. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Dr. Adriana Cadilla, a pediatrician at Miami Children's Hospital, said, "It's wonderful news that we have proof that the vaccine works as well as it does."

It has clearly reduced antibiotic-resistant pneumococcal disease, she added. "It seems to be doing a great job. It is something parents should make sure their children have."

The vaccine is not just for kids, Tomczyk stressed. One dose is recommended for all adults 65 and older, followed by a dose of the pneumococcal polysaccharide vaccine six to 12 months later. 

There are more than 90 types of pneumococcal bacteria, she noted. The pneumococcal conjugate vaccine protects against 13 of the most common severe pneumococcal infections among children, while the pneumococcal polysaccharide vaccine protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease, which is why both are recommended for older adults.

Additionally, one dose of the pneumococcal vaccine is recommended for adults 19 and older who have certain cancers, HIV or kidney failure, followed by doses of polysaccharide vaccine, Tomczyk said.

CMV and Breastfeeding Link

Breast Milk a Risk for Spreading Common Virus to Preemies, Study Finds

CMV dangerous for low birth weight infants, but mom can be tested before delivery to see if she carries virus

TUESDAY, Sept. 23, 2014 (HealthDay News) -- For babies born at very low birth weights, breast milk is more likely than a blood transfusion to lead to a potentially dangerous infection known as cytomegalovirus (CMV), a new study finds.

The researchers evaluated more than 500 very low birth weight infants -- all of whom weighed 3.3 pounds or less and many who were born to mothers with a history of CMV infection, to see whether breast milk or transfusions carried the bigger risk. Infants born at very low birth weights are especially vulnerable to this viral infection, the study authors noted.

Of 29 babies who developed CMV, none were linked to blood transfusions. But, 27 were linked to breast milk, the study found.

"We didn't know we were going to find so much CMV in breast milk," said study corresponding author Dr. Cassandra Josephson, a professor of pathology and pediatrics at Emory University School of Medicine in Atlanta.

Of the 29 babies who got CMV infections, five developed serious illness and three died. By testing blood, urine and breast milk, the researchers learned that one of the 29 babies developed the infection through the placenta. In another infected baby, the source of infection could not be determined. Infections in the other 27 babies were linked to CMV-positive breast milk.

The study was published Sept. 22 in the journal JAMA Pediatrics.

Just over 300 of the babies in the study needed one or more blood transfusions. A total of more than 2,000 transfusions were given.

Preventive measures were taken before the babies were given blood. The blood was screened for CMV before being given to the infants, and the white blood cells were removed to further reduce the risk of CMV transmission, Josephson explained.

Among all of the mothers in the study, about three-quarters were CMV-positive. CMV is a type of herpes virus. It often has no symptoms, but can lead to infection and serious illness in people with compromised immune systems. CMV can be spread through sexual contact, organ transplants, saliva, urine and respiratory droplets, according to the National Library of Medicine (NLM).

Most people recover in a month or so without medicine, according to the NLM. But, very low birth weight babies can develop serious illness and even die, the researchers noted.

Mothers who know in advance that they may deliver a low birth weight baby can talk to their doctor about preventive measures, Josephson said.

"If they know they are going to deliver early, I would suggest finding out if they are CMV-positive," she said. CMV can be detected through a blood test, according to the NLM.

The study shows that the current standard of care to screen blood is working, said Dr. Deborah Campbell, professor of clinical pediatrics and chief of neonatology at Children's Hospital at Montefiore in New York City.

"It would be helpful for moms to know their CMV status," she said. "Even though CMV can be transmitted to the baby in breast milk, it is still very important for the low birth weight baby if at all possible to receive mother's milk or donor milk."

"Given the benefits of breast-feeding, new strategies to prevent [CMV] are needed, because freezing and thawing breast milk did not completely prevent transmission in the present study," the study authors wrote.

They also noted that the Austrian Society of Pediatrics recommends that premature infants should be fed pasteurized breast milk until they reach 34 weeks of gestational age.

NEONATAL CAFFEINE USE FOR APNEA DOESN'T AFFECT LONG TERM SLEEP

Check Up: Study finds premature birth a risk factor for sleep troubles

September 8, 2014

The very idea of caffeinating fragile preemies may sound misguided. But eight years ago, an international study that compared the stimulant to a placebo found it had benefits, including relieving sleep apnea.

Still, there were lingering concerns. Caffeine works in the brain, blocking a molecule that promotes sleep. Animal studies suggest that such early biochemical tinkering can lead to permanent sleep and breathing abnormalities.

"I think we all know from daily life the effect that caffeine has on us," said lead author Carole L. Marcus, a pediatric pulmonologist and director of the sleep center at Children's Hospital. "We give the equivalent of six cups of coffee a day for a week or more - and these are little babies whose brains are still developing."

The new study, published Friday in the American Journal of Respiratory and Critical Care Medicine, tracked down 201 of the original 2006 premature babies, now ages 5 to 12. Half had gotten caffeine therapy, the other half a placebo.

For two weeks, the children wore a noninvasive sensor at night to monitor their sleep. The parents also filled out questionnaires.

There were no differences in the children's sleep patterns, including how long they took to fall asleep and how soundly they slept.

But both caffeine and placebo groups had high rates of sleep disorders. Overall, about 10 percent had periodic limb movement disorder (episodes of involuntary movement, usually of the legs), and 14 percent had obstructive sleep apnea. In general, less than 4 percent of school-age children have apnea, and 5 percent to 8 percent have the limb movement disorder.

Obstructive sleep apnea is different from the apnea of prematurity. In the obstructive form, the throat airway collapses or becomes blocked. In preemies, breathing stops because their immature nervous systems cannot yet enable continuous respiration.

Obstructive apnea can lead to daytime sleepiness, learning problems, high blood pressure, and heart disease. Limb movement disorder is less understood but has been linked to attention deficit hyperactivity disorder and a serious sleep problem called restless leg syndrome.

If caffeine isn't a culprit, why are sleep disorders common in former premature babies?

One possibility, the researchers noted, is enlarged tonsils. About a quarter of the children had already undergone tonsillectomies, the primary treatment for childhood obstructive sleep apnea.

"We're thinking the rate of apnea would have been even higher if not for the tonsillectomies," Marcus said.

The limb movement may be related, at least partly, to iron deficiency. Low blood iron levels were found in the children with the movement disorder who underwent testing.

All the children with apnea or limb movement disorder were referred for more testing and treatment, but most former preemies are not even checked for such problems. The study suggests that should change.

"We should be screening these children," Marcus said. "Then we could prevent problems, or treat them earlier."

EPO (SYNTHETIC ERYTHROPOIETIN) APPEARS TO PREVENT BRAIN DAMAGE IN PREEMIES

TUESDAY, Aug. 26, 2014 (HealthDay News) -- A hormone used to reduce the need for blood transfusions might also protect the brains of premature babies, a new study suggests.

Synthetic erythropoietin (EPO), which stimulates red blood cell production, appears to prevent brain damage when used shortly after preterm birth, said lead researcher Dr. Petra Huppi, a professor of pediatrics and newborn medicine at the University of Geneva, in Switzerland.

"The real test of whether EPO protects the brains of these children will be when they are evaluated when they are older," she said.

Infants born before the 32nd week of pregnancy face dire health risks, including brain damage and incomplete development of the brain, especially the part of the brain called white matter.

Many are left with long-term developmental disabilities, including motor and thinking problems, and attention and learning difficulties, the researchers noted.

Huppi noted that EPO, commonly used to treat anemia, is safe and has no side effects. It's been used to treat premature infants for decades, she said. Its use as a performance enhancer in sports has been banned.

In the first step of the study, published in the Aug. 27 issue of the Journal of the American Medical Association, researchers reviewed MRI brain scans of 165 infants. Close to half had received three doses of EPO within two days of delivery.

MRI scans done when the infants were the equivalent age of a full-term birth found that the brains of babies who received EPO showed less damage than the brains of infants who hadn't been given the hormone.

According to Huppi, this is the first study that has shown a benefit of EPO on the brains of preterm babies.

However, Dr. David Mendez, a neonatologist at Miami Children's Hospital, remains skeptical.

"The role EPO has in protecting brain tissue is still theoretical and not proven," he said. "This study raises more questions than it answers."

Over the years, many different drugs have been tried to preserve the brain tissue of preemies, Mendez said. "The most recent incarnation of this is the use of EPO," he said. But still more work is needed, Mendez said.

In this study, too few children were given EPO to say the findings weren't purely by chance, he said. The association reported in the study does not prove a cause-and-effect relationship.

Mendez also said that although EPO has been used for years to reduce the need for blood transfusions in preemies, its use is falling out of favor.

"There has been some concern that EPO reduces white blood cell counts and there is some concern that EPO may predispose the baby to have an eye condition called 'retinopathy of prematurity' that can lead to blindness," he said. "A lot of neonatologists don't even use EPO anymore."

As for the brain scans, Mendez said it's easy to tell a completely normal brain from a completely damaged one, but it's not as easy to evaluate the area between the two, which is where most preemies fall, he said.

Huppi said the next stage of the study is to test the children when they are 2 and 5 years old. This assessment will confirm whether or not EPO really protects the brains of premature babies, she said.

"If this does turn out to be the case, this will be an important step in preventing brain damage and its consequences in premature babies," Huppi said.

STUDY: Maternal Singing Calms Preemies

Thu, Aug 14 2014

By Krystnell Storr

NEW YORK (Reuters Health) - For preemies, the combination of hearing mother’s voice softly singing while being held against her skin can have a number of health benefits - and it helps moms, too, a new study suggests.

When mothers in a neonatal intensive care unit sang while holding their preterm infants in a skin-to-skin “kangaroo care” position, the babies’ heart rate improved compared to when they were held without singing. Mothers’ anxiety levels dropped as well.

“We noticed that many mothers want to speak or sing during kangaroo care as a natural feeling of love and care for their child,” said lead author Shmuel Arnon, a physician at the Meir Medical Center in Kfar Saba, Israel.

“I thought that singing in public will cause mothers who are not very musically talented to be embarrassed, but on the contrary they felt much more united with their child,” Arnon told Reuters Health.

“Holding a premature baby for the first time can cause a mother anxiety for a variety of reasons. The baby has tubes and lines that a mother might worry about messing up, and the baby is fragile, sometimes weighing less than a pound,” said Larry Gray, a pediatrician at Comer Children's Hospital at the University of Chicago who was not involved in the new study.

Nevertheless, Gray said, skin-to-skin contact can be life-saving. The baby and mother become “in sync,” and in some cases the baby no longer has to work as hard to keep warm.

Every year, nearly 500,000 babies in the U. S are born prematurely, according to the Centers for Disease Control and Prevention. Beyond their tiny size, preemies are vulnerable to a number of health problems because their organs and nervous systems are not fully developed.

Past research has found that preemies’ breathing, heart function and feeding all improve when they hear mother’s voice, which is familiar from their time in the womb, Arnon and his coauthors write in Acta Paediatrica.

Other studies have found that kangaroo care can aid brain development, provide pain relief and help a preemie stay warm. The researchers write that both interventions are easy to implement and, at no extra cost, can be combined as a helpful distraction for anxious mothers.

To see whether adding singing to kangaroo care benefited babies or mothers, the study team recruited 86 pairs of mothers and infants between October 2011 and March 2012.

All the babies were born between four and eight weeks early, but were stable enough to participate and able to hear.

Over the course of two days, mother-infant pairs had kangaroo-care sessions with and without singing. Each therapy session started 30 minutes after the babies were fed. Mothers sat in chairs reclined at a 40-degree angle, holding their baby, who was clad only in a diaper, against their skin. A blanket was placed over the baby’s back and then the mother’s hospital gown was wrapped around the infant.

The sessions took place in a quiet room, and the babies’ heart rate, breathing and temperature were monitored.

On the day mothers were asked to sing, they were instructed to stick with a simple and repetitive lullaby in their native language, ideally one they had sung to the baby during pregnancy.

For the first and last ten minutes of each session, every baby received kangaroo care alone, but for 20 minutes in between, mothers assigned to the singing group were told to sing softly. The mothers could see a sound analyzer while they sang and were told to keep the volume of their singing between 60 and 70 decibels.

“We provided each mother a place for her to feel comfortable. Many mothers felt that it was easier to sing than to sit in KC (kangaroo care) position and do nothing,” Arnon said.

Before and after each session, mothers answered a standard questionnaire to measure their anxiety on a scale from 20 to 80, with 80 being the worst. Mothers were compared to themselves on days when they sang or didn’t sing, and the researchers found singing made a significant difference in their anxiety levels.

On average, mothers who didn’t sing during kangaroo care dropped from about a 56 on the anxiety scale before the session to a 43 afterward. Mothers who sang dropped from a score of about 51 beforehand to a 26 after.

For the babies, researchers were interested in changes to the infant’s heart rate variability, a measure of nervous system strength and health that’s based on the number of heart beats during breathing in and out.

They found the infants’ heart rate measurements were significantly better during kangaroo care with singing compared to kangaroo care alone, and they were also much better during and after the singing sessions compared to the period before the mother started singing.

“Even preterm infants recognize their mother’s voice from the womb. By using kangaroo care to deliver music, the baby enjoys other stimuli such as vibrations, smell, tactile, auditory and warmth,” Arnon said.

Gray called the study “fabulous” and said it shows that skin-to skin contact can help both the mother and the baby. It also “shows that babies do best when mothers are allowed to be mothers,” he noted.

“We live in a wonderful world where we have high powered technology that saves lives. Babies need their mothers just as much as they need this medical technology and this study shows that they can get both,” Gray said.

HISPANIC MOMS AT HIGH RISK FOR SERIOUS BIRTH DEFECTS, REPORT SAYS

FRIDAY, June 20, 2014 (HealthDay News) -- Hispanic mothers are at especially high risk of having newborns with serious birth defects of the brain and spine called neural tube defects, according to a new report.

Also, more babies are born prematurely to Hispanics than women of other ethnicities, the March of Dimes report states.

This report, updating a similar 2008 paper by the nonprofit foundation, also highlights the fact that a greater proportion of Hispanic women have babies each year than any other population in the United States, making it the fastest-growing ethnic group in the country.

"One of the things that caught our eye was, while Hispanics represent 17 percent of the population, 24 percent of premature babies are Hispanic," said Dr. Edward McCabe, senior vice president and chief medical officer of the March of Dimes, an organization aimed at improving the health of mothers and babies.

Hispanic women may be more prone to giving birth prematurely -- defined as before the 37th week of pregnancy -- because of risk factors such as being three times as likely as white mothers to be younger than 17 years old. They are also less likely to have graduated from high school and more likely to lack health insurance. The rate of preterm births among Hispanics was about 12 percent higher than that of white mothers in 2012, the report said.

Neural tube defects, which include conditions such as spina bifida and anencephaly, are malformations of the brain and spinal cord that can cause death or disability.

Experts suggested that Hispanic mothers are significantly more likely to give birth to babies with these birth defects than white or black women because corn masa flour is a staple of the diet of a majority of Hispanics. Corn masa flour, used to make tortillas and other foods, is not fortified with folic acid, a B vitamin that can help prevent neural tube defects. Wheat flour manufacturers are required by the U.S. Food and Drug Administration to fortify that type of flour with folic acid, also called folate.

Also, Hispanic women are less likely to report taking a multivitamin containing folic acid prior to becoming pregnant, according to the report.

"This is why the March of Dimes is striving to have masa cornmeal fortified with folate," said Dr. Diana Ramos, an associate clinical professor of obstetrics and gynecology at the University of Southern California Keck School of Medicine in Los Angeles.

"Corn masa flour is not part of the standard American diet, so, since 2012, we've been working on this, making progress slowly," added Ramos, co-chair of the newly established March of Dimes Hispanic Advisory Council.

McCabe said the March of Dimes has launched a Spanish-language site, Nacersano.org, that offers information about the specific health needs of Hispanics. He said a variety of outreach efforts, including the website and new advisory council, are needed to help raise awareness in the Hispanic community about the need for folic acid consumption and prenatal health.

Other health literacy efforts aimed at Hispanics should focus on tackling smoking, obesity and type 2 diabetes, he said.

"By 2050, it's projected that 30 percent of the population of women of childbearing age will be Hispanic," he said. "Clearly, it's a growing population."

PESTICIDE EXPOSURE DURING PREGNANCY AND AUTISM RISK

June 26, 2014 APA

During pregnancy, the exposure to pesticides significantly increases the risk of having a child with an autism disorder. According to a US study that was published in "Environmental Health Perspectives", this leads to a two-thirds increased risk.

Scientists from the University of California, Davis, compared the domiciles of 1,000 mothers of two to five year-olds with autism, developmental delays or normal development with local data on pesticide application.

During their pregnancy, one third of the participants lived close to sites where pesticides were applied - within a distance of 1.25 to 1.75 kilometres. "What we saw were several classes of pesticides more commonly applied near residences of mothers whose children developed autism or had delayed cognitive or other skills", said study leader Irva Hertz-Picciotto. ́

The developing foetal brain may respond to the toxins much more sensitively than that of adults, said the physicians. It was assumed that pesticides distort the structural development and neuronal signalling pathways. Whether or not certain groups of women are more vulnerable to these toxins still needs to be researched. But it was already clear that pregnant women should avoid contact with these chemicals, the researchers emphasised.

US News Ranks Best Pediatric Hospitals in 2014

Megan Brooks

June 10, 2014

Boston Children's Hospital and Children's Hospital of Philadelphia tied for first place in the latest US News & World Report's annual rankings of the best US pediatric hospitals released today.

The 2 hospitals have consistently topped the honor roll of US pediatric hospitals. Children's Hospital of Philadelphia was number 1 and Boston Children's was number 2 in the 2013–2014 rankings. A year earlier, the 2 hospitals were tied in the rankings.

The 2014–2015 honor roll highlights pediatric centers that provide high-quality care in 3 or more specialties. Both Boston and Philadelphia posted outstanding scores in all 10 specialties.

Making the honor roll this year:

1. Boston Children's Hospital

1. Children's Hospital of Philadelphia

3. Cincinnati Children's Hospital Medical Center

4. Texas Children's Hospital, Houston

5. Children's Hospital Los Angeles

6. Children's Hospital Colorado, Aurora

7. Nationwide Children's Hospital, Columbus, Ohio

8. Ann and Robert H. Lurie Children's Hospital of Chicago

8. Children's Hospital of Pittsburgh of UPMC

10. Johns Hopkins Children's Center, Baltimore

"Finding care for a child with a life-threatening or rare condition is one of the most overwhelming experiences parents face," Ben Harder, managing editor of health care analysis at US News & World Report, said in a statement. "We hope the rankings and information in Best Children's Hospitals help make a family's search for the best care possible for their child a little easier."

US News & World Report has ranked pediatric hospitals each year since 2007. They say the methods behind the new rankings underwent various changes this year, and they highlight 2 such changes in a statement: The scoring weight assigned to infection prevention and to use of "best practices" was increased, and the weight of hospital reputation was decreased. Survival rates, adequacy of nurse volume, and procedure volume are also among the considerations.

"Each year, we strive to hone the methodology and improve the rankings' usefulness to families," said Avery Comarow, US News & World Report's health rankings editor. "With the input of working groups of pediatric medical experts, we've made these changes to better measure care in each specialty."

According to US News, 83.3% of each hospital's score relied on patient outcomes and the care-related resources each hospital makes available. The remaining 16.7% were derived from 3 years of responses to an annual survey of 150 pediatric specialists and subspecialists in each specialty.

To gather clinical data, U.S. News sent a clinical questionnaire to 183 pediatric hospitals. The physicians were asked where they would send the sickest children in their specialty, setting aside location and expense.

Hospitals were ranked in the following 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology.

Here are the top 3 hospitals by specialty:

Cancer

1. Dana-Farber/Boston Children's Cancer and Blood Disorders Center

2. Children's Hospital of Philadelphia

3. Cincinnati Children's Hospital Medical Center

Cardiology and Heart Surgery

1. Boston Children's Hospital

2. Texas Children's Hospital

3. Children's Hospital of Philadelphia

Diabetes and Endocrinology

1. Boston Children's Hospital

2. Children's Hospital of Philadelphia

3. Yale-New Haven Children's Hospital

Gastroenterology and Gastrointestinal Surgery

1. Boston Children's Hospital

2. Ann and Robert H. Lurie Children's Hospital of Chicago

3. Cincinnati Children's Hospital Medical Center

Neonatology

1. Children's Hospital of Philadelphia

2. Texas Children's Hospital

3. Cincinnati Children's Hospital Medical Center

Nephrology

1. Boston Children's Hospital

2. Cincinnati Children's Hospital Medical Center

3. Children's Hospital of Philadelphia

Neurology and Neurosurgery

1. Boston Children's Hospital

2. Children's Hospital of Philadelphia

3. Johns Hopkins Children's Center

Orthopedics

1. Boston Children's Hospital

2. Children's Hospital of Los Angeles

3. Rady Children's Hospital

Pulmonology

1. Children's Hospital of Philadelphia

2. Cincinnati Children's Hospital Medical Center

3. Boston Children's Hospital

Urology

1. Boston Children's Hospital

2. Riley Hospital for Children at IU Health

3. Children's Hospital of Philadelphia

   
   

SAFER TO GIVE MMR AND CHICKEN POX VACCINES SEPARATE FOR FIRST DOSE, RESEARCHERS SAY

MONDAY, June 9, 2014 (HealthDay News) -- Toddlers who get a newer vaccine that fights four infections in one jab have a slightly increased risk of fever-induced seizure, a large new study confirms.

At issue is a vaccine that targets measles, mumps, rubella and varicella (chickenpox) in one shot, instead of giving the traditional MMR and varicella vaccines separately.

In theory, one shot sounds better than two. But in the new study, 1-year-olds who received Priorix-Tetra -- the MMRV vaccine used in Canada -- were twice as likely to develop a fever-related seizure as children who got separate MMR and chickenpox shots.

The findings are in line with a 2010 study of the MMRV vaccine used in the United States, known as ProQuad.

In the United States, parents now have to explicitly ask for the MMRV if they want their toddler to have it, said Dr. Nicola Klein, who led the ProQuad study.

But even with the increased risk posed by the MMRV vaccine, the odds of a brief, fever-related seizure are extremely low.

And the seizures aren't dangerous, "though they are scary for parents," said Klein, co-director of the Kaiser Permanente Vaccine Study Center in Oakland, Calif.

She said children are actually much more likely to suffer a high fever and seizure if they were to catch the measles.

"Get your child vaccinated," she stressed. "We're in the middle of a 20-year high in measles cases."

Fevers are part of the immune system response, whether to infection or vaccination.

It's not clear why the MMRV is more likely to cause a fever-related seizure than the separate shots, said Shannon MacDonald, a post-doctoral fellow at the University of Calgary in Alberta, Canada, who led the new study. But one theory maintains the combined vaccine triggers a stronger immune response and a higher fever in some children, which makes a seizure more likely.

MacDonald's findings, published online June 9 in CMAJ (Canadian Medical Association Journal), are based on records for almost 278,000 Alberta children between the ages of 12 and 23 months. The children received either the MMRV or separate MMR and chickenpox shots on the same day.

Overall, the study found, children's seizure rate peaked seven to 10 days after they were vaccinated. At that point, there were almost six seizures for every 10,000 doses of the MMRV, versus two seizures for every 10,000 doses of the separate vaccines.

"You see the same increase in risk with these different formulations," said MacDonald, referring to the Priorix-Tetra and ProQuad vaccines.

The traditional approach -- separate MMR and chickenpox vaccines -- seems safer.

"There's no question children should be vaccinated," MacDonald said.

As of May 30, the U.S. Centers for Disease Control and Prevention had received reports of 334 measles cases in 18 states. Nearly all have involved unvaccinated U.S. residents who traveled to countries where measles is common, then brought the virus home with them.

Besides causing misery -- fever, cough, and a body-wide rash -- measles infection can lead to serious complications. Up to 5 percent of infected children develop pneumonia, the CDC says, while one in 1,000 suffers brain inflammation. And for every 1,000 children who develop measles, one or two will die.

But parents should be aware that the MMRV carries a higher seizure risk and discuss that with their pediatrician, MacDonald said. Some parents may still want the combined shot, to spare their child from two needle jabs, she added.

Based on the ProQuad study, the U.S. Advisory Committee on Immunization Practices changed its stance on the MMRV. Now it says that unless parents ask about the combined vaccine, doctors should default to separate shots for young children getting their first dose of the MMR and chickenpox vaccines.

The story is different, though, with the second dose, typically given between the ages of 4 and 6 years. In general, fever-related seizure is uncommon at those ages, and the advisory committee says the MMRV is the better option.

POOR DIET BEFORE PREGNANCY RELATED TO PRETERM DELIVERY

Increased risk of preterm birth risk through poor diet before pregnancy

Statistically, one in ten pregnancies across the globe ends in a preterm birth. The risk for this is influenced by several factors. Australian researchers have now discovered that the mother's diet prior to conception is one of the factors. The study was published in "The Journal of Nutrition".

Scientists from the University of Adelaide analysed the eating patterns among 300 women in Southern Australia before they became pregnant and compared them with outcomes at birth. It showed that those who consistently ate a healthy diet including lean meat, fish, fruit, vegetables and whole grains, had a lower risk of preterm birth.

"On the other hand, women who consumed mainly discretionary foods, such as takeaway, potato chips, cakes, biscuits, and other foods high in saturated fat and sugar were more likely to have babies born preterm", said lead author Jessica Grieger. In fact, the likelihood was 50 per cent higher.

"Preterm birth is a leading cause of infant disease and death", said Grieger. The better one understands the reasons, the more one can do to positively influence the survival and long-term health outcomes for children. Nutrition is considered an important factor in this, which can be relatively easily modified.

Measles Vaccine Refusal Helps Make 2014 a Record Year

Robert Lowes

May 29, 2014

The number of measles cases in 2014 through May 23, the highest year-to-date total since 1994, has the Centers for Disease Control and Prevention (CDC) worried that the virus may become endemic again on US soil as it spreads from overseas travelers to pockets of vaccine refusers.

The CDC has received reports of 288 confirmed cases of measles — none fatal — from January 1 through May 23, with 280 associated with importation from at least 18 countries, according to an article published online May 29 in the Morbidity and Mortality Weekly Report. Most of the 45 individuals who actually imported the virus were US travelers returning from abroad.

In 69% of the 288 cases, the person was unvaccinated. In another 20%, vaccination status was unknown. For 195 US residents who had measles and were unvaccinated, 165, or 85%, declined a shot for religious, philosophical, or personal reasons.

The United States had 764 measles cases in 1994 through May 23, and 963 by year's end, according to data released at a press conference today.

The CDC declared in 2000 that the United States had eliminated measles as an indigenous disease, meaning there was no longer any year-round endemic transmission of the virus. Although this country's status has not changed, other countries such as the Philippines are rife with the disease.

Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, warned at the press conference that the findings are a "wake-up call."

"Measles anywhere in the world can reach our country, and unvaccinated Americans are at risk," said Dr. Schuchat. "Measles can really get out of control quite quickly. You can get indigenous spread if you can't break the chain of transmission."

As of now, 15 scattered US outbreaks that account for 79% of all cases are "being contained," said Dr. Schuchat. The largest outbreak, involving 138 cases, has hit unvaccinated Amish communities in Ohio that had dispatched aid workers to the Philippines, which is recovering from last year's Typhoon Haiyan.

Vaccinate Before Takeoff

One key to lowering the measles case count, said Dr. Schuchat, is for Americans with international travel plans to get 2 doses of the measles, mumps, and rubella (MMR) vaccine if they haven't been vaccinated or don't know their immunization status. The 2-dose regimen also applies to healthcare workers and childcare attendants who are catching up on measles protection. As always, pregnant women and individuals with suppressed immune systems should not receive the vaccine.

Dr. Schuchat noted that individuals born before 1957 probably had measles at some point, which relieves them from getting the shot. The vaccine debuted in 1963. She described it as "very safe and effective."

Routine vaccination for children consists of a first dose at 12 to 15 months of age and a second dose at 4 to 6 years of age. If someone is traveling internationally with a child aged under 12 months, however, the CDC recommends a single dose before departure. Such a child should receive a second dose at 12 to 15 months and a third at least 28 days later. Children aged 12 months or older should have 2 doses separated by at least 28 days.

More information on the CDC's recommendations for measles vaccination is available on the agency's Web site.

Morb Mortal Wkly Rep. Published online May 29, 2014. Full text

New Dialysis Treats Tiniest of Newborns

New Dialysis Machine Treats Tiniest of Newborns

Last Updated: May 22, 2014.

	Device needed because adult dialysis machines overpower babies' blood vessels, experts say More Sharing ServicesShare|Share on facebookShare on myspaceShare on googleShare on twitter Comments: (0) Tell-a-Friend
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Device needed because adult dialysis machines overpower babies' blood vessels, experts say.

By Steven Reinberg
HealthDay Reporter

THURSDAY, May 22, 2014 (HealthDay News) -- Italian researchers have successfully used a small kidney dialysis machine they invented to treat newborns with kidney failure.

"We have developed a machine for neonates [newborns] who were not treatable before," said lead researcher Dr. Claudio Ronco, director of the department of nephrology at San Bortolo Hospital in Vicenza.

"The neonate is so small that it requires dedicated technology," he said. "To try to treat the patient with an adult machine is like trying to fix a watch with a tool that you use for a large car."

Adult-size dialysis machines can be modified for use with children. But, the machines are difficult to use in infants because they can overpower an infant's tiny blood vessels, the researchers said. And, the machines generally can't be used on babies under 6.6 pounds or so, according to Dr. Ana Paredes, a pediatric nephrologist at Miami Children's Hospital.

The new machine, called CARPEDIEM (Cardio-Renal Pediatric Dialysis Emergency Machine), is a miniaturized device that supports kidney function in newborns and small children weighing between 4.4 pounds and 22 pounds.

The advantage of the new machine is that it can handle very low blood flow and filtration, and it uses tiny catheters that protect the infant's blood vessels. In contrast, adult machines are designed to handle much higher blood flow and use much larger catheters.

The report was published in the May 24 issue of The Lancet. Funding for the study was provided by the Association of Friends of the Kidney Vicenza.

Kidney dialysis is a procedure that uses a machine to help do some of the kidneys' work when the kidneys aren't functioning anymore (or aren't functioning well). Dialysis helps to filter some of the waste products out of the blood, according to the National Kidney Foundation.

Ronco's team tried the miniaturized dialysis machine for the first time in August 2013. The first patient was an infant weighing only 6.3 pounds. This infant had multiple organ failure after a complicated delivery.

"This baby was dead -- it was considered dead," Ronco said. Without this machine, it was doubtful that this baby could have been treated, he added.

After more than 20 days of dialysis with the new device, the infant was taken off the machine when kidney function had been restored. The baby left the hospital after 50 days, the researchers said.

"To stay at the bedside of this baby with the machine we developed was to rediscover why I do medicine. It was satisfaction for 40 years of effort," said Ronco.

Since this first use of CARPEDIEM, 10 more infants have been treated successfully with the device in Europe, Ronco said.

Ronco hopes to present the new technology to the U.S. Food and Drug Administration for approval. "There is definitely an interest in the United States for this machine," he said.

Dr. Benjamin Laskin, a pediatric nephrologist at the Children's Hospital of Philadelphia and author of an accompanying journal editorial, said when adult dialysis machines are used, they have to be "jerry-rigged to make them work."

"Having a machine designed for infants is certainly an advantage," he said.

Laskin and his co-author wrote that more study is needed on the CARPEDIEM machine to ensure that it's an effective option for infants who need dialysis.

Paredes, who is also director of the Dialysis Unit Program at Miami Children's Hospital, is excited about the potential of this new device.

"This is a tremendous development," she said. "I look forward to using this machine in the U.S."

More information

For more information on dialysis, visit the U.S. National Library of Medicine.

SOURCES: Claudio Ronco, M.D., director, department of nephrology, San Bortolo Hospital, Vicenza, Italy; Benjamin Laskin, M.D., pediatric nephrologist, Children's Hospital of Philadelphia; Ana Paredes, M.D., pediatric nephrologist, and director, dialysis unit program, Miami Children's Hospital; May 24, 2014, The Lancet