News

At-Home Cervical Ripening Safely Shortens Inpatient Labor

JAN 14 2022

Women who undergo balloon cervical ripening at home spend less time in the labor and delivery unit and have fewer cesarean deliveries than those who have the induction procedure in a hospital, researchers have found. The findings, from a meta-analysis of eight previously conducted randomized clinical trials involving 740 women, should spur hospitals to "create and adhere to evidence-based guidelines" for outpatient balloon use, according to the researchers. "Outpatient balloon cervical ripening is a safe alternative for low-risk patients and has the potential for significant benefits to patients, and labor and delivery units," the authors reported. The rate of labor induction in the United States rose to 29.4% in 2019, the year following publication of the ARRIVE trial of low-risk nulliparous pregnant women, which found that induction at 39 weeks resulted in fewer cesarean deliveries with no difference in neonatal outcomes compared with expectant management, defined as continuing pregnancy until at least 40 weeks 5 days unless induction was medically indicated. Most women require preparation with a balloon-tipped catheter that slowly inflates to stretch and thin out the cervix, a process that can take many hours. The devices have been shown to be safe, effective, and inexpensive, but the data on outpatient use are limited, according to the researchers. The new study is the "most comprehensive" examination of randomized clinical trials comparing outpatient and inpatient balloon cervical ripening, they say. The trials included singleton gestations of at least 37 weeks of primarily low-risk patients. Body mass index was slightly lower in the outpatient group, with no differences in maternal age, gestational age at induction, or parity. Six studies with 571 patients reported on the primary outcome, defined as time from labor unit admission to delivery. The outpatient group had a mean 16.3 hours compared with 23.8 hours for the inpatient group, a difference of 7.24 hours. However, data from three of the studies showed the inpatient group experienced 5.19 hours on average less between balloon expulsion and delivery, potentially due to more frequent adjustments and evaluation for expulsion. The researchers observed no differences in adverse maternal or neonatal outcomes, and no stillbirths were reported among 378 patients who had the outpatient procedure. Cesarean delivery occurred less often in the outpatient group (21%) vs the inpatient group (27%) (risk ratio, 0.76; 95% Cl, 0.59 – 0.98).

COVID-19 Vaccination During Pregnancy Not Linked to Complications at Birth: US Study

JAN 14 2022

COVID-19 vaccination during pregnancy was not associated with preterm delivery or underweight newborns, in a study published by the US Centers for Disease Control and Prevention (CDC). Rates of preterm birth were 4.9% among more than 10,000 women who received at least one dose of a COVID-19 vaccine, compared to 7.0% for roughly 36,000 unvaccinated women, researchers said. The difference was not deemed to be statistically significant. In addition, COVID-19 vaccination did not increase the risk of delivering a baby who weighed less than usual for the number of weeks of pregnancy, the researchers found. Results from the study support the CDC's recommendation on the safety of COVID-19 vaccination during pregnancy. "Evidence of the benefits of COVID-19 vaccination during pregnancy continues to accrue, including the detection of antibodies in cord blood," the researchers wrote, noting that pregnant women with COVID-19 have increased risks for intensive care unit admission, need for mechanical ventilation and death. The women in the study had become pregnant between May and October of 2020, before vaccines were available. Nearly all who were vaccinated got the shots in their second or third trimester of pregnancy. Some 96% of them had received at least one dose of an mRNA vaccine from either Pfizer Inc (PFE.N) and BioNTech (22UAy.DE), or Moderna Inc (MRNA.O). The remaining women received the single-shot vaccine from Johnson & Johnson (JNJ.N).

Mediterranean Diet, Mindfulness Each Reduce Small-for-Gestational Age Births

JAN 14 2022

Low birth weight affects up to 10% of pregnancies and stems from fetal growth restriction. Until today, no treatment that could improve this condition is available. A study published in JAMA led by researchers from BCNatal (Hospital Clínic-IDIBAPS and Hospital Sant Joan de Déu in Barcelona) with the support of the ”la Caixa” Foundation, has demonstrated for the first time that fetal growth can be improved by maternal lifestyle changes. The study specifically demonstrates a reduction of low birth weight babies up to 29% and 36% by intervening on the mother’s diet and lowering her stress level. The study was coordinated by Eduard Gratacós, director of BCNatal and the Fetal and prenatal medicine group at IDIBAPS and CIBERER, Francesca Crovetto (Hospital Sant Joan de Déu) and Fàtima Crispi (Hospital Clínic), from the Maternal-Fetal Medicine Services of BCNatal and researchers from the same groups. It was conducted in collaboration with the teams of Ramon Estruch, from the Internal Medicine Service at Hospital Clínic, head of the Cardiovascular risk, nutrition and aging group at IDIBAPS and researcher at CIBEROBN; Eduard Vieta, head of the Psychiatry and Psychology Service at Hospital Clínic, from the Bipolar and depressive disorders group at IDIBAPS and scientific director of CIBERSAM, as well as professionals from the esMindfulness Institute, directed by Andrés Martín-Asuero. The project also received the support of CEREBRA, CIBERER and AGAUR. Low birth weight is associated with birth complications and health problems. Low birth weight babies (birth weight below the 10th centile) account for 10% of all births. Low birth weight reflects growth restriction in fetal life, it is recognised by the WHO as one of the most important causes of perinatal mortality worldwide and it is linked to poorer neurodevelopment in childhood and higher risk of metabolic and cardiovascular health problems in adulthood. No treatment had existed until now that could prevent or improve this condition. The research team led by Dr Eduard Gratacós has been studying the possible causes and consequences of low birth weight for many years. “We saw that mothers of low birth weight newborns often had a suboptimal diet and high stress levels,” explains Dr Gratacós. This led to the idea of conducting a clinical trial to study whether structured interventions based on Mediterranean diet or stress-reduction could reduce fetal growth restriction and other pregnancy complications.

Neonatal Sepsis: WHO-Recommended Rx Needs a Major Rethink

JAN 14 2022

First-line treatment of neonatal sepsis in low- and middle-income countries (LMICs) with ampicillin-gentamicin — as recommended by the World Health Organization (WHO) — needs to be reassessed, a retrospective, observational cohort study suggests. Rates of resistance to this particular antibiotic combination are extremely high in LMICs, and this treatment is unlikely to save many neonatal patients, according to the study's results. "The WHO guidelines are over 10 years old, and they are actually based on high-income-country data, whereas data reported from low-income countries are reported by private labs, and they do not cater to the lower socioeconomic groups within these countries, which is important data to capture," Timothy Walsh, MD, University of Oxford, Oxford, United Kingdom, said. "The main take-home message from our data is that ampicillin-gentamicin doesn't work for most of the Gram-negative isolates we tested, and while there are alternatives, their use is confounded by [a lack of] financial support," he added. In this substudy of the Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) study, investigators focused on the effectiveness of antibiotic therapies after taking into account the high prevalence of pathogen resistance to ampicillin-gentamicin. Participating countries included Bangladesh, Ethiopia, India, Nigeria, Pakistan, Rwanda, and South Africa. "Blood samples were obtained from neonates presenting with clinical signs of sepsis," the authors note, "and WGS [whole-genome sequencing] and MICs [minimum inhibitory concentrations] for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis." Between November, 2015, and February, 2018, 36,285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had antibiotic data. A total of 2483 neonates had culture-confirmed sepsis, and WGS data were available for 457 isolates taken from 442 neonates. Slightly over three quarters of the 5749 neonates who had antibiotic data received first-line ampicillin-gentamicin. The other three most commonly prescribed antibiotic combinations were ceftazidime-amikacin, piperacillin-tazobactam-amikacin, and amoxicillin-clavulanate-amikacin. Neonates treated with ceftazidime-amikacin had a 68% lower reported mortality than those treated with ampicillin-gentamicin at an adjusted hazard ratio (HR) of 0.32 (95% CI, 0.14 – 0.72; P = .006), the investigators report. In contrast, no significant differences in mortality rates were reported for neonates treated with amoxicillin-clavulanate-amikacin or piperacillin-tazobactam-amikacin compared to those treated with ampicillin-gentamicin.

Surprising Data on Neurodevelopment of Babies Born During the Pandemic

JAN 14 2022

Columbia researchers found that babies born during the pandemic’s first year scored slightly lower on a developmental screening test of social and motor skills at 6 months—regardless of whether their mothers had COVID during pregnancy—compared to babies born just before the pandemic. The study which included 255 babies born at NewYork-Presbyterian’s Morgan Stanley Children’s Hospital and Allen Hospital between March and December 2020, was published in the journal JAMA Pediatrics. “Infants born to mothers who have viral infections during pregnancy have a higher risk of neurodevelopmental deficits, so we thought we would find some changes in the neurodevelopment of babies whose mothers had COVID during pregnancy,” says Dani Dumitriu, MD, PhD, assistant professor of pediatrics and psychiatry at Columbia University Vagelos College of Physicians and Surgeons and lead investigator of the study. “We were surprised to find absolutely no signal suggesting that exposure to COVID while in utero was linked to neurodevelopmental deficits. Rather, being in the womb of a mother experiencing the pandemic was associated with slightly lower scores in areas such as motor and social skills, though not in others, such as communication or problem-solving skills. The results suggest that the huge amount of stress felt by pregnant mothers during these unprecedented times may have played a role. “These were not large differences, meaning we did not see a higher rate of actual developmental delays in our sample of a few hundred babies, just small shifts in average scores between the groups,” Dumitriu says. “But these small shifts warrant careful attention because at the population level, they can have a significant public health impact. We know this from other pandemics and natural disasters.”

New York First to Add G6PD Deficiency to Routine Screenings

JAN 11 2022

New York State became the first state in the nation to add G6PD Deficiency to routine newborn screenings today, as New York State Governor Kathy Hochul signed the Brody James Bill into law. The bill, supported by The g6pd Deficiency Foundation, was named for two people whose lives were altered because G6PDd was not diagnosed until after it had caused severe health impacts. G6PDd (short for Glucose-6-Phosphate Dehydrogenase Deficiency) is the most common human enzyme disorder, affecting upwards of an estimated 400 million people worldwide and up to 6% of newborns in the US. G6PD Deficiency can have life-altering effects if it’s not caught early and proactively controlled. “We are so grateful to Governor Hochul, as well as Senator Rivera and Assemblyman Gotfried, for helping us make New York State a safer place for newborns and their families through the Brody James Bill,” said Keely Harris, Founder and President of The g6pd Deficiency Foundation. “I'm proud that this law will honor my grandson’s journey and help prevent G6PDd from causing life-changing injuries to other children like him. New York State has once again proven itself to be a leader on children's health issues, and we hope to see other states follow its example so that families around the country might have some protection from the life-threatening crises caused by G6PDd.” The bill, introduced by State Senator Gustavo Rivera and Assemblyman Richard Gotfried, is the first of its kind in the United States, although many countries around the world include this screening for newborns, as does the U.S. military as part of its routine medical assessment. It was inspired by the story of Keely’s now 8-year-old grandson Brody and another individual, James, who recently passed at 20 years old, due to complications from brain damage, caused by undiagnosed G6PDd as a newborn. In Brody’s case, after a harrowing experience with undiagnosed G6PD Deficiency that led to kernicterus, 1-week old Brody suffered brain damage that could have been avoided if he were screened at birth and diagnosed before he was discharged from the hospital. In response to the family’s ordeal, and in honor of her grandson’s ongoing battle, Keely founded The g6pd Deficiency Foundation which aims to raise awareness for the disease for both families and medical professionals and promotes newborn screenings as a life-saving tool. G6PD deficiency is an inherited genetic enzyme disorder that impacts the mechanism by which the body is able to process glucose. The majority of individuals who are G6PD deficient have no obvious clinical symptoms in the absence of “triggers” (such as primaquine or a reaction to fava beans) and are often unaware that they have this deficiency. G6PD deficiency has, however, the potential to cause attacks of acute hemolytic anemia, severe neonatal jaundice that can lead to kernicterus, and, more rarely, chronic anemia called Chronic Non-Spherocytic Hemolytic Anemia (CNSHA). A letter supporting the bill, written and signed by Dr. Richard O. Francis, Associate Professor, Department of Pathology & Cell Biology, Columbia University VP&S and Director of Special Hematology and Coagulation Laboratory at New York-Presbyterian Hospital-Columbia University Irving Medical Center stated, “Because testing for G6PD deficiency is not a part of New York State newborn screening, many times the infant who is not known to be G6PD-deficient is already at home while hyperbilirubinemia is developing and brain damage is occurring. Prior to the infant’s discharge from the hospital, if the clinician knew that the newborn was G6PD deficient, proper treatment and parental education could occur, thereby preventing the development of kernicterus. A lifetime of unexplained sickness and unnecessary hospitalizations could be avoided for the infant and his or her family members if screening for G6PD deficiency is performed at birth.” G6PD Deficiency is more common in families with Mediterranean, Asian or African ancestry and disproportionately impacts minority communities. However, in the 21st century, ancestry is not always known or clear. In absence of a screening or parental blood tests specifically for this genetic mutation, it is impossible to identify a G6PD deficient person. Adding universal screenings for G6PDd to the newborn screening list, along with Cystic Fibrosis and Sickle Cell Disease, would allow it to be diagnosed and treated early, saving lives, and sparing families unnecessary pain.

Fetal Gut May Have Insulin-Producing Cells That Shut Off at Birth

DEC 30 2021

In addition to pancreatic beta cells that secrete insulin, researchers have found that fetal cells in the gut secrete insulin proteins, but neonatal cells do not, suggesting that this ability is turned off at birth. The study findings are "plausible, because the pancreas and the small intestine originate from the same tissue in the growing fetus at about the fifth week of gestation," said senior study author Shalev Itzkovitz, PhD, principal investigator, Weizmann Institute of Science, in Rehovot, Israel, in a news story in The Jerusalem Post. The study by Adi Egozi, a PhD student at the Weizmann Institute of Science and colleagues in Israel and in the United States, was recently published in Nature Medicine. The researchers speculated that if they could get cells in adults to secrete insulin proteins, this might lead to a new way to treat diabetes, but this research is very preliminary. "We found insulin-producing cells in fetuses, yet not in neonates," Itzkovitz summarized in an email. "It would be exciting to uncover situations where the insulin-producing cells naturally re-appear, eg, in diabetes, gastric bypass, or other perturbations," and to "identify molecules that could awaken the beta-like state we discovered,” Itzkovitz added. The study findings "highlight a potential extra-pancreatic source of beta cells and expose its molecular blueprint," the researchers summarize. "The dream is to have a drug that could re-awaken the fetal insulin-expressing program," Itzkovitz said. "Even though the insulin-producing cells are a minority, the gut surface is huge, and their numbers add up," he noted. In addition, "gut cells are constantly replaced via divisions of stem cells." "This means that the impact of autoimmune attack in type 1 diabetes might be less pronounced on intestinal insulin-producing cells," according to Itzkovitz.

Delayed Umbilical Cord Clamping Improves Outcomes in Very Preterm Infants

DEC 30 2021

Delayed umbilical cord clamping for at least 60 seconds after birth significantly reduced death or disability in infants of less than 30 weeks’ gestation, according to data from nearly 1,500 infants. The burden of disability and mortality for babies born before 30 weeks’ gestation remains high, especially in low- and middle-income countries, wrote Kristy P. Robledo, PhD, of the University of Sydney, Australia, and colleagues. Delayed clamping of the umbilical cord is a simple procedure that may improve mortality in this population, but more research is needed; recommended times to delayed clamping range from 30 seconds to 3 minutes, they noted. In a study published in The Lancet Child & Adolescent Health, the researchers randomized 767 very preterm infants to delayed clamping at least 60 seconds after birth and 764 to immediate clamping. Of these, 384 were multiple births (who were individually randomized), 862 were male, and 505 were born before 27 weeks’ gestation. The primary outcome was death or disability at 2 years of age. Major disability was defined as cerebral palsy, severe visual loss, deafness requiring a hearing aid or cochlear implants, major language or speech problems, or cognitive delay at 2 years corrected age. The median time to clamping was 60 seconds in the delayed group and 5 seconds in the immediate group. Primary outcome data were available for 1,419 infants. Death or major disability occurred in 29% of infants assigned to delayed clamping compared to 34% of those assigned to immediate clamping (relative risk 0.83, P = .010). The infants were part of the APTS Childhood Follow-Up Study, an open-label superiority trial conducted in Australia and New Zealand. By age 2 years, 8% of infants in the delayed group and 11% of those in the immediate group had died; 23% and 26%, respectively, met criteria for major disability. The impact of delayed clamping translates to a 30% reduction in relative risk of mortality at 2 years of age, but no significant impact on major disability, the researchers wrote. The findings were limited by several factors including the unblinded study design, lack of data on heart rate or time to first breath, and the clamping prior to 60 seconds in 26% of infants in the delayed group based on clinical concerns for these specific infants, the researchers noted. However, the results were strengthened by the large size, low risk of bias, and specific primary outcome, they said. The data support findings from recent systematic reviews and highlight the need for further trials to evaluate delayed clamping at different time points, with larger populations, inclusion of time to first breath and heart rate, and improved measures of disability, the researchers added.

Spreading Holiday Cheer: NICU Babies 'Sleigh-ing It' in Ugly Sweaters

DEC 30 2021

Holiday merriment in a place often associated with trauma is part of the festivity of the winter season at Tallahassee Memorial HealthCare (TMH) in Tallahassee, Florida. As is their tradition, the nurses in the neonatal intensive care unit (NICU) at TMH dressed up their newborn patients in holiday attire. This year, they chose the "ugly sweater" look for the tiniest of hospital stayovers. About 20 baby photos grace the hospital's Facebook page, starting with a Grinch baby and ending with one dressed as a candy cane. The photos are "live and full of just as much cuteness as ever," marketing representative Morgan King said. The Facebook post, in keeping with custom, was full of puns to keep spirits high around an otherwise stressful environment. For starters: "There's snow way we would miss our favorite holiday tradition! This year, our NICU babies are sleigh-ing it in their ugly Christmas sweaters." An explanation beside the Grinch photo stated: "These NICU babies are so cute, they made our hearts grow three sizes." Another photo joked: "What's a snowman's favorite hot drink? Frost-tea." And aside a baby sporting a Christmas-tree costume: "We hope these babies really light up your day." The post continued, "Thank you to our incredible NICU team who always go above and beyond to make the holidays special for our NICU families. The sweaters were hand-made by our NICU team to help these little cuties and their families get in the holiday spirit." The parents of all babies pictured consented to their children being dressed up and photographed, the post further clarified. Earlier this year, NICU nurses took to Facebook with festive Halloween costumes for the babies under their care in a post that went viral, attracting national headlines. TMH has the only NICU and high-risk labor and delivery unit in the region, King said. "In addition to providing sick and premature babies the highest level of specialized care, our team works to make the NICU environment as comfortable as possible for our babies and families," she said. "Having a baby in the NICU can be unexpected and challenging for families, making the holidays feel less merry. Bringing the festive fun to these little ones and their parents through this annual tradition is just one of the many ways our team works to normalize the NICU environment and make an uncertain time special for families. Our crafty NICU night team created the sweaters and our day team helped bring their visions to life." Among the comments under the post, one visitor shared: "Praying for these special little ones and their families! They are rocking the sweaters!" The post ended with a disclaimer to use caution with fragile little ones. "Please remember, you should always place your little ones on their backs to sleep, with nothing else in the crib. These NICU babies have special circumstances and are monitored 24/7 by our skilled nursing team."

Program Assists Substance-Exposed Infants, Their Caregivers

DEC 30 2021

Pregnant with her second child, Clarissa Collins was at her methadone clinic when a woman walked in with a box of doughnuts and a baby doll. The woman, Tara Sundem, was partway through a five-year effort to open Hushabye Nursery and launch a novel family-focused program that would treat substance-exposed infants and offer care and support to their caregivers. Hushabye Nursery recently celebrated one year in its current care facility in Phoenix and Collins now works there as a peer support specialist, helping others in recovery, the Arizona Capitol Times reported. The center houses a 12-room inpatient nursery for infants suffering from neonatal abstinence syndrome – newborns experiencing withdrawal from opioids they were exposed to in the womb, such as heroin and prescription painkillers. But on that day in 2019, Collins begrudgingly attended Sundem’s support group for pregnant women with opioid use disorder. By the second group meeting, she decided to come back every week. “I looked forward to it. I wanted to see the other girls; I wanted to hear their stories. I wanted to meet the baby,” Collins said. “And we became this little family. We became very close friends.” As the opioid epidemic worsens nationwide, neonatal abstinence syndrome (NAS) cases are increasing, too. Nationally, the number of babies born with the condition increased 82% from 2010 to 2017, according to the Centers for Disease Control and Prevention. The national trend in NAS cases holds true in Arizona and has worsened since the Covid pandemic began. Arizona’s NAS rate in 2020 was 9.1 per 1,000 newborn hospitalizations, up from 5.67 per 1,000 in 2015, according to Arizona Department of Health Services vital statistics reports. In 2010, that figure was 2.65 per 1,000. Some of the increase can be attributed to better reporting and other factors, not the opioid epidemic itself, said Sara Rumann, with the department’s Bureau of Women’s and Children’s Health. “But we can say overall the general trend is that it has increased over the last 10 years,” Rumann said.

Fertility Treatments Not Linked to Psychiatric Disorders in Offspring

DEC 30 2021

Some reassuring findings for people pursuing assisted reproduction: babies born through the fertility procedures do not appear to be at increased risk of developing major psychiatric illnesses as they move through adolescence and into adulthood. The results, reported in JAMA Psychiatry, come from an analysis of more than 31,000 people conceived via assisted reproduction techniques (ART) in Sweden between 1994 and 2006. The researchers, from Sweden and the United States, found that in this group, rates of depression and suicidal behaviors were not elevated compared with the general population. "We welcome null findings in our study," said Chen Wang, MPH, a doctoral student at the Karolinska Institutet (KI) in Stockholm, and the lead author on the study. "Overall we found no greater concern for poorer psychiatric health in adolescents conceived with ART compared with the general population, except for an elevated risk of OCD [obsessive-compulsive disorder] that may be explained by differences in parental characteristics." "Couples and individuals undergoing or considering ART can indeed be reassured in the sense that our study found no indication that the treatment per se could make children vulnerable to poor mental health later in life," added Anna Sara Öberg, MD, PhD, the senior author of the paper, who holds appointments in epidemiology at the KI and the Harvard T.H. Chan School of Public Health, in Boston. ART has been linked to several potentially unwanted outcomes, including birth defects, preterm delivery, low birth weight, imprinting disorder, and possibly neurodevelopmental disorders. Previous research from Wang's team showed that children conceived with ART do not appear to be more likely to have attention-deficit/hyperactivity disorder or poor school performance than children conceived spontaneously. The new study expands on that earlier work, which was published this year in the journal Pediatrics. From a Swedish database of more than 1.2 million people born between 1994 and 2006, Wang's group identified 31,565 individuals born via ART ― defined as in vitro fertilization with or without intracytoplasmic sperm injection and transfer of fresh or frozen-thawed embryos ― during that period. At the time of final follow-up, in December 2018, participants in the study were between the ages of 12 and 25 years. To assess the risk of mental illness, the researchers looked for diagnoses in medical records from hospitals and outpatient clinics. They also included death certificates, to determine if suicide was the cause, and prescriptions of antidepressants to see if patients were being treated for depression.

Infant Milk Allergy Guidelines Promote Overdiagnosis, Study Says

DEC 15 2021

International guidelines developed to help doctors diagnose cow's milk allergy may lead to over-diagnosis, according to University of Bristol-led research published in the journal Clinical and Experimental Allergy. The study found that three-quarters of infants have two or more symptoms at some point in the first year of life which guidelines say may be caused by cow's milk allergy, yet the condition only affects one in 100. Cow's milk allergy can present with either acute or delayed symptoms. Delayed symptoms are more varied and include gut and skin symptoms, such as posseting (bringing up milk) and vomiting, colic, loose stools or constipation, and flaring of eczema. Many of these symptoms are already known to be common in infants, making delayed cow's milk allergy difficult to diagnose. Researchers found that one in four parents reported two or more possible "mild to moderate" symptoms every month. Symptoms were most numerous at three months of age, when all children were fully breastfed and not directly consuming cow's milk. At six months of age, there was no difference in the number of children with two or more symptoms between those consuming and not consuming cow's milk. Together, these findings suggest that the majority of symptoms listed in cow's milk allergy guidelines are common, normal and not caused by cow's milk allergy. Dr Rosie Vincent, Honorary Clinical Research Fellow at the Centre for Academic Primary Care, University of Bristol who led the research, said: "Guidelines, designed to help the non-specialist to diagnose cow's milk allergy in infants may unintentionally medicalise normal infant symptoms and promote over-diagnosis of cow's milk allergy." Senior co-researcher and children's allergy doctor, Dr Michael Perkin, from the Population Health Research Institute at St George's, University of London, added: "Our findings come against a background of rising prescription rates for specialist formula for children with cow's milk allergy, which is completely out of proportion to how common we know the condition is. Parents of young infants are often seen in clinics, worried about a medical cause for their infant's symptoms such as colic, bringing up milk or loose stools. However, our research confirms that these symptoms are extremely common. In an otherwise healthy infant, an underlying cause is unlikely. Incorrectly attributing these symptoms to cow's milk allergy is not only unhelpful, but it may also cause harm by discouraging breastfeeding." The researchers (from the University of Bristol, St George's, University of London, Imperial College London, King's College London, and St John's Institute of Dermatology), used data from the Enquiring About Tolerance study of 1,303 infants aged between three and twelve months, in which parents were asked to record any symptoms their child experienced on a monthly basis. They counted how many infants had cow's milk allergy symptoms each month, as defined in the international Milk Allergy in Primary Care (iMAP) guideline.

Negative Confirmatory Trial Did Little to Drive Down Use of Questionable Preterm Drug

DEC 15 2021

Use of hydroxyprogesterone caproate injection (Makena) for recurrent preterm birth remained high in the U.S. after a "confirmatory" clinical trial failed to show a benefit of the drug, a new analysis indicates.

"Despite the negative trial results and FDA (Food and Drug Administration) efforts to remove the drug from the market, use and spending continue, demonstrating a level of support for the drug among physicians, likely owing to conflicting evidence supporting the drug's use," researchers report in JAMA Internal Medicine. "The FDA has faced difficulties removing accelerated approval drugs from the market even when they fail to show a clinical benefit in their required confirmatory trials," first author Rachel E. Sachs, a professor of law at Washington University School of Law in St. Louis, said. "We wanted to look at whether the publication of negative trial results and statements by the agency or its advisory committees would be sufficient to drive down a drug's use and therefore its spending," she said. "We found that while use and spending did decline after these events, use has remained high, meaning that states may be spending their limited financial resources on products with weak or no clinical benefits," Sachs said. "In other words, issuing statements about the drug's clinical efficacy does not on its own significantly drive down use and spending - the agency does need to take steps to remove the drug from the market in order to have that effect," she added. Makena received accelerated approval in February 2011 based on a clinical trial demonstrating that it reduced the risk of preterm birth in women with previous spontaneous preterm birth. In March 2019, however, results of the FDA-required confirmatory trial failed to replicate the initial trial's reduction in recurrence preterm births. In October 2019, an FDA advisory committee narrowly voted to withdraw approval and a year later the FDA Center for Drug Evaluation and Research (CDER) proposed taking the drug off the market. But Makena's manufacturer requested a hearing, which FDA granted in August 2021. The proceedings remain ongoing. Sachs and colleagues used national Medicaid drug utilization and spending data to examine changes in hydroxyprogesterone caproate fills from 2010 to 2020. They found that use of the drug increased from less than 11,000 fills per quarter between 2010 and 2014 to more than 30,000 fills per quarter in the first quarter of 2019. In the second quarter 2019, after the failed the post-approval trial, there was no decline in use. Between the third and fourth quarters of 2019, use of the drug declined more than 8,000 fills per quarter, coinciding with formal publication of the negative trial and the FDA advisory committee recommendation to withdraw it from the market. A subsequent decline in use was noted in quarter three of 2020, but use remained high at 19,554 fills per quarter (54.9% of the maximum volume reached in the second quarter of 2017). Since the second quarter of 2019, brand name Makena has maintained more than half of market share, despite availability of generic versions of the drug since 2018. Sachs and colleagues say low uptake of the generics may be driven by the newer branded autoinjector formulation of Makena that the FDA approved in February 2018. "The autoinjector has resulted in continued high spending on hydroxyprogesterone caproate, despite generic availability," they note. In the third quarter of 2020 alone, "state Medicaid programs reimbursed (before rebates) $41,872,080 for all forms of hydroxyprogesterone caproate, 73.2% of which was for the Makena autoinjector," they report in their article.

Human Milk Introduced to Japanese Market

DEC 9 2021

Prolacta Bioscience, the world's leading hospital provider of 100% human milk-based nutritional products for premature and critically ill infants, announced the enrollment of the first baby into a Japan-based clinical trial evaluating growth and safety associated with an Exclusive Human Milk Diet including Prolacta's 100% human milk-based fortifiers (Prolacta's EHMD). The Japan-based study — "JASMINE: A Randomized, Controlled Study to Assess Growth and Safety of the Exclusive Human Milk Diet (EHMD) in Very Low Birth Weight (VLBW) Infants" — began in October 2021. In Japan, Prolacta's human milk-based products will be registered as a drug. "Initiation of this study in Japan is another industry first, being led by Prolacta," said Scott Elster, CEO of Prolacta. "Japan's regulatory authorities have very strict requirements for conducting drug trials. Our industry-leading quality and safety standards meet Pharmaceuticals and Medical Devices Agency. (PMDA) regulations, allowing us the opportunity to conduct this study and introduce an exceptional level of nutritional care for preterm babies in Japan." "We know that Prolacta's EHMD is the gold standard diet for premature infants," said principal investigator, senior professor of pediatrics Dr Katsumi Mizuno, MD, PhD, of the Showa University School of Medicine in Tokyo. "This study is necessary to bring a higher level of nutritional care to our very low birth weight babies in Japan." Mizuno-sensei, in association with a clinical research organization, will oversee the 10-site study taking place at Showa University Hospital, Showa University Koto Toyosu Hospital, Showa University Northern Yokohama Hospital, Nara Medical University Hospital, Saitama City Hospital, Fujita Health University, Tokyo Metropolitan Bokutoh Hospital, Nagano Children's Hospital, Takatsuki General Hospital, and Gifu Prefectural General Medical Center. The study will evaluate three of Prolacta's 100% human milk-based products.

UK Data Show Good Safety of COVID-19 Vaccines in Pregnancy

NOV 30 2021

COVID-19 vaccination is safe for pregnant women and not associated with higher rates of complications, data released by the UK Health Security Agency showed on Thursday, as officials urged pregnant women to take up the offer of shots. The real-world data from the rollout of COVID-19 vaccines in Britain support other studies around the world that the vaccines are safe to give at any stage of pregnancy, the UKHSA said. It found that there were not substantial differences in rates of stillbirths, rates of births of babies with low birthweight and the proportion of premature births between vaccinated women and unvaccinated women. Officials said the data were especially reassuring given that the first pregnant women to be offered the vaccine were those with underlying health conditions who would be expected to be at a higher risk of complications. "Every pregnant woman who has not yet been vaccinated should feel confident to go and get the jab, and that this will help to prevent the serious consequences of catching COVID-19 in pregnancy," said Dr Mary Ramsay, Head of Immunisation at UKHSA. The UKHSA data found that vaccinated women had a stillbirth rate of 3.35 per 1,000, slightly lower than the rate of 3.60 per 1,000 in unvaccinated women. The proportion of women giving birth prematurely was 6.51% for vaccinated people, slightly higher than 5.99% for unvaccinated women. The government is urging pregnant women who have not yet been vaccinated to get their shots. The health ministry said catching COVID-19 came with much bigger risks than having the vaccine, adding that only 22% of women who gave birth in August were vaccinated. It said that 98% of pregnant women in hospital with symptomatic COVID-19 were unvaccinated, and vaccine take-up was lower in deprived areas and some minority groups.

Neonate Rewarming Tied to Increased Electrographic Seizure Risk, Poor 2-Year Outcomes

NOV 30 2021

Neonates with hypoxic ischemic encephalopathy who are treated with hypothermia have an increased risk of seizures during rewarming, and those seizures are associated with greater death and disability at 2 years, a new study suggests. Researchers examined data on 120 newborns at a mean gestational age of 39 weeks who were randomized to receive either 72 hours (n=66) or 120 hours (n=54) of cooling as an intervention for hypoxic ischemic encephalopathy. The primary endpoint was electrographic evidence of seizures during the 12 hours prior to rewarming compared with the first 12 hours of rewarming. Compared with the 12 hours prior to rewarming, infants had significantly greater seizure risk during the first 12 hours of treatment for both 72-hour rewarming (odds ratio 2.7) and 120-hour rewarming (OR 3.2). At ages 18-22 months, the infants who experienced seizures during rewarming had a significantly higher risk of mortality or severe disability (OR 1.7) in adjusted analysis that accounted for baseline clinical encephalopathy and seizures as well as treatment center. "The presence of higher odds of seizures during rewarming that are associated with death and disability at two years is a new and important finding," said lead study author Dr Lina Chalak, a professor of pediatrics and psychiatry and director of the Neonatal Neurological Intensive Care and Fetal and Neonatal Neurology Fellowship Program at the University of Texas Southwestern Medical Center in Dallas. "The underlying mechanisms are likely related to impaired auto-regulation with hemodynamic mismatch between oxygen delivery and metabolic demands during rewarming which precipitates seizures," Dr Chalak said by email. These results suggest that there's a significantly elevated risk of seizures during the rewarming period, most of which typically go unnoticed if not monitored with EEG or amplitude compressed EEG, Dr. Chalak added. For infants randomized to a 72-hour rewarming period, 27% experienced seizures during the first 12 hours of rewarming, compared with 14% in the 12 hours prior to initiation of rewarming. For infants randomized to a 120-hour rewarming period, 21% experienced seizures during the first 12 hours of rewarming, compared with 10% in the 12 hours prior to treatment initiation.

Enriched Infant Formula Offers No Academic Benefit Later: Study

NOV 30 2021

Infants who are given nutrient- or supplement-enriched formula milk do not later have higher academic scores as adolescents than those fed with standard formula, a study published online in the BMJ suggests. One goal of modifying infant formula has been to make long-term cognitive outcomes similar to those for breast-fed infants, the authors noted. Rates for breastfeeding beyond 6 weeks are low in many parts of the world and more than 60% of babies worldwide under the age of 6 months are given formula to replace or supplement breast milk, the paper states. So far, research has been inconclusive on benefits, though enhancements continue to be added and claims have been made as to their benefits on cognition in advertising. Long-term trials are difficult as researchers move on and participants are lost to follow-up. In a new study, however, researchers led by Maximiliane L. Verfürden, MsC, with the University College of London’s Great Ormond Street Institute of Child Health, linked data from seven dormant, randomized, controlled infant formula trials to participants’ performance later as adolescents in the United Kingdom on mandatory national school math and English exams at ages 11 and 16 and found no difference in scores. They followed 1,763 adolescents who had been participants in the formula trials, which were conducted between 1993 and 2001, and were able to link 91.2% (1,607) to academic records. They found “no benefit of the infant formula modifications on cognitive outcomes.” In this study, the researchers discuss three widely available types of modified infant formulas that have been promoted as benefiting cognitive development: formula enriched with nutrients; formula supplemented with long-chain polyunsaturated fatty acids (LCPUFAs); and follow-on formula fortified with iron.

Neonate Rewarming Tied to Increased Electrographic Seizure Risk, Poor 2-Year Outcomes

NOV 15 2021

Hypothermia has been shown to improve long-term outcomes in neonatal hypoxic ischemic encephalopathy compared to normothermia. Despite this, there is room for optimization of care, as 29% of infants continue to have abnormal outcomes at age 18 to 22 months, where data on the risk of seizures during the rewarming phase is limited. This nested cohort study (SMART) assessed the likelihood of electrographic seizures during rewarming at 72 or 120 hours and their association with neurodevelopmental outcomes at 2 years, where it was hypothesized that seizures during rewarming were associated with higher odds of abnormal neurodevelopmental outcomes. The main endpoint was the occurrence of electrographic seizures during rewarming initiated at 72 or 120 hours compared with the preceding 12-hour epoch. Secondary endpoints included death or moderate or severe disability at age 18 to 22 months. Among 120 newborns, higher occurrence of electrographic seizure during the rewarming phase after hypothermia was associated with elevated relative risk of death or disability at 2-year follow-up. This association between seizure occurrence during rewarming and poor neurodevelopmental outcomes supported the American Clinical Neurophysiology Society’s Guidelines of continuous electroencephalography monitoring in neonates with suspected perinatal asphyxia at high risk. In addition to the standard 72-hour duration of hypothermia, it is recommended that monitoring be continued throughout rewarming until normothermia and seizure control has been achieved. A limitation of this study was the lack of hemodynamic evaluation to confirm the underlying mechanisms of electrographic seizures and rule out confounding causes of seizure in neonates.

Enriched Infant Formula Offers No Academic Benefit Later: Study

NOV 15 2021

Infants who are given nutrient- or supplement-enriched formula milk do not later have higher academic scores as adolescents than those fed with standard formula, a study published online in the BMJ suggests. One goal of modifying infant formula has been to make long-term cognitive outcomes similar to those for breast-fed infants, the authors noted. Rates for breastfeeding beyond 6 weeks are low in many parts of the world and more than 60% of babies worldwide under the age of 6 months are given formula to replace or supplement breast milk, the paper states. So far, research has been inconclusive on benefits, though enhancements continue to be added and claims have been made as to their benefits on cognition in advertising. Long-term trials are difficult as researchers move on and participants are lost to follow-up. In a new study, however, researchers led by Maximiliane L. Verfürden, MsC, with the University College of London’s Great Ormond Street Institute of Child Health, linked data from seven dormant, randomized, controlled infant formula trials to participants’ performance later as adolescents in the United Kingdom on mandatory national school math and English exams at ages 11 and 16 and found no difference in scores. They followed 1,763 adolescents who had been participants in the formula trials, which were conducted between 1993 and 2001, and were able to link 91.2% (1,607) to academic records. They found “no benefit of the infant formula modifications on cognitive outcomes.” In this study, the researchers discuss three widely available types of modified infant formulas that have been promoted as benefiting cognitive development: formula enriched with nutrients; formula supplemented with long-chain polyunsaturated fatty acids (LCPUFAs); and follow-on formula fortified with iron. In one supplement group the academic results were worse than for those given standard formula. At age 11, children who had been given the LCPUFA-enhanced formula scored lower in both English and math. “Given the potential associations between the source of LCPUFAs and adverse cognitive outcomes, long-term follow-up of trials testing infant formulas from other sources of LCPUFAs is recommended,” the authors wrote.

Drug Used to Prolong Gestation Linked to Increased Cancer Risk in Offspring

NOV 15 2021

Children exposed in utero to 17 alpha-hydroxyprogesterone caproate (17-OHPC) may be at increased risk for cancer, a new study suggests. In an analysis of data from more than 18,000 mother-child pairs, researchers found that, overall, offspring of women who were injected with the synthetic progesterone during pregnancy had nearly double the risk of any cancer compared with those not exposed to the hormone. Exposure during the first trimester carried some of the highest risks for cancers later in life, including for pediatric brain cancer (adjusted hazard ratio 34.72), prostate cancer (aHR 5.10), and colorectal cancer (aHR 5.51), according to the report published in the American Journal of Obstetrics & Gynecology. “Exposure in the womb to a drug used to prevent miscarriage in the 1950s and 60s increases the offspring’s risk of cancer many decades later, especially for prostate, colorectal, and pediatric brain cancer,” said the study’s first author, Caitlin Murphy, an associate professor at the School of Public Health at the University of Texas Health Sciences Center in Houston. “This drug is still available in the United States for pregnant women to prevent preterm birth,” Murphy noted. “We were surprised by the strength of our findings,” Murphy said in an email. “This is newsworthy because rates of several cancers are increasing across generations, starting with persons born in the 1960s or Generation X. Increasing rates of cancer across generations implicate exposures in very early periods of life as risk factors. This is consistent with our finding that earlier and more frequent injections of 17-OHPC in pregnancy was associated with higher risk of cancer in offspring. We need to know if risk of these cancers begins before birth, so that we can better weigh the pros and cons of medications in pregnancy.” While it isn’t known exactly how the drug may raise cancer risk, Murphy says it may be because the drug isn’t an exact duplicate of progesterone. “Synthetic hormones, or drugs made to act like natural hormones, disrupt the way natural hormones work, especially during the vulnerable time of fetal development,” she said. “The potential for synthetic hormones to disrupt development and increase risk of cancer is well-established by studies of diethylstilbestrol, a synthetic estrogen that was commonly prescribed to pregnant women to prevent miscarriage in the 1950s and 60s. 17-OHPC is a synthetic progestogen and may similarly contribute to risk of cancer.” To look at possible impacts of the medication on fetuses, Murphy and her colleagues turned to data from Child Health and Development Studies (CHDS), a population-based cohort of more than 18,000 mother-child dyads receiving prenatal care in the Kaiser Foundation Health Plan (Oakland, CA) between 1959 and 1966, and followed for 60 years. CHDS monitors participants by annual linkage to the California Department of Motor Vehicles, the California Department of Vital Statistics and the California Cancer Registry.

Stillborn Birth Linked to Maternal SARS-CoV-2 Infection

NOV 15 2021

Clinicians in Ireland are warning about a spate of stillbirths in the first few months of 2021 that they have linked to SARS-CoV-2 infections. There were six women in the country who suffered stillbirths and one who experienced a miscarriage, each a few weeks after she had COVID-19. Five of the cases so far involved the variant B.1.1.7, which has now come to dominate cases in Ireland, the UK, much of Europe, and the US. In all instances, the placenta was extensively damaged. “The placentas look completely burnt out, just incredibly necrotic and damaged,” says Keelin O’Donoghue, an obstetrician at Cork University Maternal Hospital in Ireland who is part of team preparing a manuscript on the cases. “They all have suffered acute injury, which is why you have an acute effect in terms of fetal compromise or death.” In addition to the stillbirths and miscarriage, there have also been three instances so far this year in Ireland in which expectant mothers diagnosed with COVID-19 had emergency deliveries and severely degraded placentas. The babies survived. “There’s a very abnormal appearance” to the surface of the placenta when it is cut for examination, says Brendan Fitzgerald, a pathologist at Cork University Hospital who has examined five of the affected placentas, “with white streaks and nodules occupying large portions of the placental disk. It is a very uncommon finding that we would rarely see in routine practice.”

Masimo Launches Dual SET Pulse Oximetry

NOV 1 2021

Masimo announced Dual SET Pulse Oximetry for Root, a highly versatile patient monitoring and connectivity hub. The first application of Dual SET Oximetry is a significant advancement to Masimo SET-guided critical congenital heart disease (CCHD) screening, with the CE marking and European launch of the Masimo SET MOC-9 module and the addition of the Eve CCHD Newborn Screening Application for Root. Together, this combined solution enhances the automation of newborn screenings using Dual SET Oximetry: two simultaneous measurements of oxygen saturation (SpO2) at pre- and post-ductal sites by the intuitive Eve application, customized to align with a hospital’s CCHD screening protocol. CCHD affects approximately 2.5 to 3 newborns per 1000 live births and requires intervention soon after birth to prevent significant morbidity or mortality; later detection in infants also increases the risk of brain damage. Traditionally, newborns were observed for evidence of CCHD by physical assessment and monitoring for common symptoms, but studies have shown that physical assessment of newborns alone can be unreliable and may fail to detect some infants with CCHD before discharge. Adding screening with pulse oximetry can help clinicians identify CCHD before an infant becomes symptomatic. Clinically proven Masimo SET Measure-through Motion and Low Perfusion pulse oximetry has been shown in more than 10 CCHD screening studies – representing over 300,000 babies – to increase the effectiveness of screening newborns for CCHD. For example, in a study of almost 40,000 infants, CCHD screening sensitivity increased from 63% with physical exam alone to 83% with physical exam and SET. In another study of more than 120,000 infants – the largest CCHD screening study to date – combined use of clinical assessment and SET increased screening sensitivity from 77% to 93%. Evidence from CCHD studies using SET has even been used to help establish CCHD screening guidelines used around the world. Powered by Masimo SET pulse oximetry, the Eve CCHD Newborn Screening Application is designed to simplify the CCHD screening process by providing step-by-step visual instructions, animations, and a detailed, easy-to-interpret display of screening results – standardizing and enhancing clinical workflows, improving consistency in screening practices among clinicians, and reducing the possibility of calculation errors. Eve also allows clinicians to incorporate perfusion index into screening, which has been shown to increase sensitivity to the detection of CCHD. Already available for Radical-7 and Rad-97 Pulse CO-Oximeters, Eve is particularly well suited for display on Root’s large, high-resolution screen. With its built-in barcode scanner, Root can automatically associate patients with their screening results, and with its integration into the Masimo Hospital Automation platform, Root automates the transfer of those results to electronic medical records (EMRs) – eliminating the need for manual charting. Now, with the addition of the new Masimo SET MOC-9 module for Root – made possible by another key differentiator of the hub, its advanced, flexible connectivity capabilities – CCHD screening guided by Eve is even more streamlined and efficient: one pulse oximetry sensor can be connected to Root via Radical-7, and a second via the MOC-9 module, allowing for the pre- and post-ductal SpO2 readings needed for screening to be taken simultaneously rather than sequentially, with results conveniently displayed on one screen. This Dual SET Oximetry technique streamlines the CCHD screening process, improving clinical workflows. Gerard R. Martin, MD, C.R. Beyda Professor of Cardiology at Children’s National Hospital, said, “As an advocate for congenital heart disease efforts nationally and internationally, I believe Masimo SET pulse oximetry is an excellent tool for pulse oximetry CCHD screening. Having access to accurate simultaneous pre-ductal and post-ductal measurements helps simplify the process of screening and allows for rapid recognition of discrepancies, ultimately improving newborn care.” Root is a powerful, expandable hub that integrates an array of technologies, devices, and systems to provide centralized, multimodal monitoring and connectivity solutions. Root’s plug-and-play expansion capabilities allow clinicians to simultaneously monitor with numerous measurements in addition to dual oximetry Masimo SET, such as advanced rainbow Pulse CO-Oximetry measurements, O3 regional oximetry, and SedLine brain function monitoring, for expanded visibility of patient status. Using Root in combination with the Hospital Automation platform, monitoring data from all connected devices can be automatically charted in EMRs. Augusto Sola, MD, Vice President of Medical Affairs at Masimo, commented, “As a neonatologist who has worked nationally and internationally in the early diagnosis and treatment of hypoxemic and hyperoxemic conditions that affect neonates in order to improve neonatal survival and quality of life for these fragile infants, I know that Masimo SET measure-through motion technology’s accuracy and reliability have not only enabled CCHD screening with pulse oximetry, but have helped dramatically reduce retinopathy of prematurity (ROP). SET provides reliable, high-quality monitoring to prevent serious long-term morbidities and is now the standard of care for CCHD newborn screenings and ROP. With the availability of the SET MOC-9 Module, clinicians can now obtain simultaneous, dual oximetry pre- and post- ductal measurements, using one display, and increase efficiency of CCHD newborn screenings with Root. Furthermore, the Eve application on Root is automated and therefore simplifies and systematizes the screening process. Millions of newborn babies and their families throughout the world will be greatly benefited by this unique solution.”

Advanced Hearing Protection for Neonatal Transport & MRI

OCT 21 2021

NEATCap Medical has developed innovative passive noise protection systems for premature infants in the NICU, Transport and MRI. Sound levels experienced by ill newborns during air and ground hospital transport can average over 80 dBA, with peak levels as high as 85-95 dBA, and sound levels within MRI are similarly high. Because such loud noise can elicit physiological instability in heart rate in neonates during ambulance transport and MRI examinations, it is important to reduce patient noise exposure in these environments. NEATCAP DREAMIES T-M offer a unique solution to this problem. DREAMIES T-M materials and design provide sound attenuation across the audible frequency range, including low-frequency sounds associated with the air and ground transport sound environments, and sounds within the magnetic resonance imaging (MRI) sound environment. Reduced exposure to noise increases the probability that the MR examination can be completed without sedation and with fewer motion artifacts. Features include transparent, low-profile, contoured, soft foam sealing ear cups; adjustable, soft, stabilizing headband to secure ear cups; easy-to-fit and remove with Velcro closure; no skin-contacting adhesives to irritate skin allows patient positioning within transport incubator and MRI head coil; compatible with transport and MR imaging protocols; single Patient Use; and range of sizes to fit the full range of neonatal patients from small premies to full-term infants.

New Ceiling Supply Units Add Flexibility in Hospitals

Sep 30 2021

Dräger’s new Ambia and Ponta ceiling supply systems offer hospitals substantial flexibility in creating customized workstations that supports specific clinical needs in the operating room (OR), intensive care unit (ICU) and neonatal intensive care unit (NICU). The ceiling supply systems provide the ability to mount medical equipment and accessories on all four sides of the frame rail. This optimizes space, and allows equipment and accessories to be placed exactly where they are needed. Free positioning of a mix of electrical and gas outlets on all panels make it possible to place more outlets on a media column or head. The result, Ambia helps streamline workflow with the goal of increasing the satisfaction and safety of staff and patients – now and in the future. And with coordinated frame color selections and drawer decor variants, Ambia and Ponta can be easily integrated into any room concept, creating a patient-friendly environment. In addition, lighting options featuring warm, glare-free light, along with the ability to select from a range of RGB colors, helping to contribute to a calming and soothing atmosphere. Ambia and Ponta feature intuitive user interfaces that support quick and easy operation. The arm brake handles feature touch-sensitive sensors that automatically release the brakes, allowing rapid positioning of the media heads or columns. The brake handle locations on the units can also be adapted to suit individual staff or workflow requirements for ideal ergonomics. The handles communicate using wireless technology, allowing them to be located almost anywhere on the system. For infection protection, rounded profiles and smooth materials that are compatible with a wide range of disinfection products help make the Ambia and Ponta easy and fast to clean and disinfect. A range of cable management options help eliminate cord clutter and assist with reducing exposed surface area and the accumulation of dirt. A touchless user control for operating ceiling and floor lights further supports infection prevention efforts. Dräger has more than 60 years of consulting experience in the design of medical workplaces, including the analysis of work processes and space requirements, consulting for optimized workflows and digitally supported room concept creation, and on-site equipment implementation.

COVID-19 Vaccines in Pregnancy May Protect Baby, Too

Sep 30 2021

Women who receive COVID-19 vaccines during pregnancy pass antibodies to their babies, which could protect newborns from the disease, research has shown. In a new study that examines umbilical cord blood from 36 deliveries, researchers provide additional evidence that vaccines – and not COVID-19 infections – elicited the antibodies detected in this cohort. Researchers with New York University Langone Health conducted a study that included pregnant women who had received at least one dose of an mRNA COVID-19 vaccine (Pfizer/BioNTech or Moderna). All neonates had antibodies to the spike protein at high titers, the researchers found. Unlike similar prior studies, the researchers also looked for antibodies to the nucleocapsid protein, which would have indicated the presence of antibodies from natural COVID-19 infection. They did not detect antibodies to the nucleocapsid protein, and the lack of these antibodies suggests that the antibodies to the spike protein resulted from vaccination and not from prior infection, the researchers said. The participants had a median time from completion of the vaccine series to delivery of 13 weeks. The study was published online in the American Journal of Obstetrics & Gynecology MFM. “The presence of these anti-spike antibodies in the cord blood should, at least in theory, offer these newborns some degree of protection,” said study investigator Ashley S. Roman, MD, director of the division of maternal-fetal medicine at NYU Langone Health. “While the primary rationale for vaccination during pregnancy is to keep moms healthy and keep moms out of the hospital, the outstanding question to us was whether there is any fetal or neonatal benefit conferred by receiving the vaccine during pregnancy.” Questions remain about the degree and durability of protection for newborns from these antibodies. An ongoing study, MOMI-VAX, aims to systematically measure antibody levels in mothers who receive COVID-19 vaccines during pregnancy and in their babies over time.

HPV Infection During Pregnancy Ups Risk for Premature Birth

Sep 30 2021

Persistent human papillomavirus (HPV) 16 and HPV 18 during a pregnancy may be associated with an increased risk of premature birth. Findings published online in JAMA Network Open found that 15.9% of individuals who had a persistent HPV 16 or 18 infection during the first and third trimesters of their pregnancy gave birth prematurely, compared with 5.6% of those who did not have an HPV infection at all. The findings prompted the question of “the pathophysiology of HPV in pregnancy and how the virus is affecting the placenta,” said Lisette Davidson Tanner, MD, MPH, FACOG, who was not involved in the study. Researchers said the findings are the first to show the association between preterm birth and HPV, which is an incurable virus that most sexually active individuals will get at some point in their lives, according to the Centers for Disease Control and Prevention. “The results of this study are very important in helping us understand the burden caused by HPV in pregnancy,” study author Helen Trottier, MSc, PhD, researcher at the Centre Hospitalier Universitaire Sainte-Justine, said in an interview. “We may have just pinpointed an important cause of preterm birth that has so far been unexplained.” Dr Trottier and colleagues examined data from 1,052 pregnant women from three university-affiliated health care centers in Montreal between Nov. 8, 2010, and Oct. 16, 2016. Only 5.6% of those who did not have an HPV infection had a premature birth, compared with 6.9% of those who tested positive for any HPV infection in the first trimester. When looking at the first trimester, researchers found 12% of those diagnosed with HPV 16 and 18 had a preterm birth, compared to 4.9% of those who had a high-risk HPV infection other than HPV 16/18. When looking at the third trimester, researchers found that 15.9% of those with HPV 16/18 had an increased risk of giving birth prematurely, compared to those who had other high-risk HPV infections. When researchers looked at the persistence of these HPV infections, they found that most HPV infections detected in the first trimester persist to the third trimester. The findings also revealed that persistent vaginal HPV 16/18 detection was significantly associated with all preterm births and spontaneous preterm births. This association was also found among those who had HPV infections detected in their placentas. Meanwhile, 5.8% of those who had an HPV infection only during the first trimester experienced a preterm birth.

Congenital Syphilis Still Diagnosed Beyond Neonatal Period in US

Sep 30 2021

The annual number of congenital syphilis cases reported to the U.S. Centers for Disease Control and Prevention surged 183% from 462 cases in 2014 to 1,306 cases in 2018, and too many of these cases are being missed at or before birth, researchers say. During the entire study period, a total of 3,834 infants were delivered with congenital syphilis, the study team reports in Pediatrics. Of these deliveries, 55.5% were liveborn and asymptomatic when syphilis was diagnosed, while 38.1% were liveborn and symptomatic, and 6.4% were stillborn. Over the study period, the proportion of infants diagnosed with congenital syphilis beyond the neonatal period declined from 5.9% to 2.9%. However, there were 67 cases of symptomatic infants diagnosed beyond the neonatal period. “This finding was concerning as infants who are diagnosed and treated later in life may develop long-term problems from congenital syphilis, which include intellectual disabilities, physical deformities, and deafness,” said lead study author Dr Anne Kimball of the Division of Sexually Transmitted Diseases Prevention at the CDC in Atlanta. “Congenital syphilis can be prevented by diagnosing and adequately treating maternal infection during pregnancy or prior to pregnancy,” Dr Kimball said by email. For this reason, the CDC recommends universal screening for syphilis early in pregnancy, with repeat screening at 28 weeks’ gestation and at delivery for pregnant people at increased risk for syphilis acquisition on the basis of individual risk factors or high community prevalence, Dr Kimball said. Maternal serological status should also be confirmed before mothers and infants are discharged from the hospital after labor and delivery, including confirmation that the mother received at least one syphilis test during pregnancy and again at delivery for mothers at increased risk, Dr Kimball said. Among the cases of congenital syphilis found after the neonatal period, the majority had physical examination findings (67%) or abnormal long-bone radiographs (69%) indicating congenital syphilis. Many of these infants (36%) also had reactive syphilis testing in the cerebrospinal fluid; cases had a median serum nontreponemal titer of 1:256. Cases diagnosed after the neonatal stage had a median age of 67 days, although the ages ranged from 29 to 249 days.

New Study Evaluates the Feasibility of Using Masimo EMMA Capnography on Mechanically Ventilated Neonates

Sep 27 2021

Masimo announced the findings of a study published in the European Journal of Pediatrics in which Dr. Masashi Hotta and colleagues at the Osaka Women’s and Children’s Hospital in Japan found that the Masimo EMMA Portable Capnograph “may be considered an effective monitoring device” for mechanically ventilated preterm infants (neonates). Noting the importance of maintaining an appropriate range of partial pressure of arterial carbon dioxide (PaCO2) in preterm infants, especially while undergoing mechanical ventilation in the neonatal intensive care unit (NICU), the researchers sought to evaluate whether noninvasively monitoring end-tidal carbon dioxide (EtCO2) with EMMA could help clinicians maintain neonatal PaCO2 in the delivery room. They chose EMMA not only because of its portability but because it offers a solution with a small dead space (1 mL). The researchers enrolled 40 neonates (gestational age of 26+0 to 31+6 weeks) who required intubation in the delivery room (the EMMA monitoring group) and compared their PaCO2 value, either at admission to the NICU or 2 hours after birth, with that of 43 infants who did not undergo EMMA monitoring (the historical control group). They defined “appropriate” PaCO2 as 35 – 60 mmHg, as measured using a blood gas analyzer. The researchers found that the proportion of infants with appropriate PaCO2 was greater in the EMMA group than in the control group (80% vs. 42%, p = 0.001). Stratified according to birth weight (< 1000 g vs. > 1000 g), they found that in smaller neonates, there was no significant difference in the proportion of infants with appropriate PaCO2 between groups, but in the larger cohort, the rate of appropriate PaCO2 was significantly higher in the EMMA group: 93% vs. 44%, p < 0.001. The study authors concluded that EMMA “facilitated the maintenance of an appropriate PaCO2 for mechanically ventilated pre-term infants, especially infants with birth weight ≥ 1000 g, in the delivery room.” They noted that the main strength of their study was that they “collected intervention data prospectively and showed the feasibility of using a portable capnometer during resuscitation of intubated preterm infants” – the first study of its kind. EMMA provides seamless mainstream capnography for patients of all ages in a compact, easily portable device. The instrument requires no routine calibration and minimal warm-up time, with accurate EtCO2 and respiration rate measurements and continuous EtCO2 waveforms displayed within 15 seconds.

Masimo CEO Joe Kiani Appointed to President’s Council of Advisors on Science and Technology

Sep 22 2021

Masimo announced that Founder, Chairman, and CEO Joe Kiani has been appointed by President Joe Biden to the President’s Council of Advisors on Science and Technology (PCAST). Since 1933, with the creation by President Franklin D. Roosevelt of a Science Advisory Board, each President has established an advisory committee of scientists, engineers, and health professionals. Created by Executive Order, President Biden’s PCAST will advise him on matters involving science, technology, education, and innovation policy. The Council also provides the President with scientific and technical information needed to inform public policy relating to the American economy, the American worker, national and homeland security, and more. In particular, President Biden has asked PCAST to consider such pressing topics as how the pandemic can inform public health needs and how scientific and technological breakthroughs can help address climate change. The 30 members of the Council, the most diverse in history, include distinguished individuals from sectors outside the Federal Government with diverse perspectives and expertise in science, technology, education, and innovation, including 20 elected members of the National Academies of Sciences, Engineering and Medicine, five MacArthur “Genius” Fellows, two former Cabinet secretaries, and two Nobel laureates. Joe Kiani commented, “Thank you, President Biden, for this appointment. I am excited to work with this incredible PCAST group and others to explore ways that science and technology, and policies that can shape them, can improve healthcare, the environment, innovation, and equity in our country and the world.”

Iron Deficiency in Pregnancy Is Common, yet Many Aren't Being Screened for It

Sep 15 2021

Many pregnant patients are not being screened for iron deficiency despite it being a common cause of anemia in pregnancy that could increase the risk of maternal and infant death. Researchers analyzed data from 44,552 pregnant patients in Ontario, Canada, collected between 2013 and 2018 to determine the prevalence of ferritin testing, the standard test for iron deficiency, over the course of 5 years. Their study, published in Blood Advances, revealed that only 59.4% of pregnant persons received a ferritin test, the standard test for iron deficiency. Of those pregnant persons, 25.2% were iron insufficient and 52.8% were iron deficient at least once during pregnancy. They also found that 71% of these iron tests were ordered during the first trimester, when the risk of iron deficiency is lowest. “We are not only missing a very large proportion of women who are iron deficient going into pregnancy, but we’re missing those that become iron deficient later on in their pregnancies,” study author Dr Jennifer Teichman, hematology resident at the University of Toronto, said in an interview. Researchers said iron deficiency during pregnancy is associated with maternal fatigue, cognitive dysfunction, depression, low birth weight, and poor brain development of the child. Teichman explained that if iron deficiency during pregnancy is identified early enough, doctors would have enough time to treat the condition with iron supplements before the patient goes into delivery. She also explained prenatal vitamins, which contain some iron, do not contain enough of the mineral to fix iron deficiency. “One really important point is that the amount of iron contained in a prenatal vitamin is really low,” Teichman explained. “It’s enough to make up the difference of the additional iron that she needs to sustain her pregnancy, but it’s not enough to treat a woman who’s already got low iron going into pregnancy. So there’s a difference between a prenatal vitamin and true iron supplementation.” Researchers also found that those who came from a household with a low annual income were even less likely to receive a ferritin test, which was a troubling finding since women of lower socioeconomic status are more likely to be iron deficient in pregnancy. “[This] says something about how we as health care providers are contributing to this gap in care,” Teichman said. “Women of lower socioeconomic status sort of have a triple whammy: They’re more likely to be iron deficient, they’re less likely to have it diagnosed, and they’re less likely to have it corrected.” Teichman and her colleagues took a unique approach by looking at isolated ferritin levels as opposed to complete blood counts, which is the typical screening for anemia in pregnancy, said Lissette Tanner, MD, MPH, FACOG, who was not involved with the study. “Those who meet the criteria for anemia should be evaluated for the cause with initial suspicion for iron deficiency anemia, as that is the most common etiology,” said Dr. Tanner, assistant professor of gynecology and obstetrics at Emory University, Atlanta. The Centers for Disease Control and Prevention recommends screening for iron deficiency anemia in pregnant persons, in addition to universal iron supplementation to meet the iron requirements of pregnancy. Additionally, the American College of Obstetricians and Gynecologists recommends that all pregnant persons be screened for anemia with a complete blood count in the first trimester and again between 24 and 28 weeks of pregnancy. However, iron deficiency is completely missed by ACOG’s recommendations, said Michael Auerbach, MD, of the department of medicine, Georgetown University, Washington. “They recommend a [complete blood count] on all presenting pregnant women, but they do not recommend iron parameters, including a ferritin test, unless the mother is anemic,” said Auerbach, who was not involved in the study. “I think those guidelines are in need of revision.” Teichman hopes her team’s findings will motivate change in obstetric and hematologic guidelines that recommend routine prenatal testing. “I think ferritin should be a part of routine prenatal testing,” Teichman said. “And I also think that patients need to be empowered to ask what their iron levels are in pregnancy and providers need to know what a normal iron level is.”

Infants Breathe Better When Pregnant Moms Exercise

Sep 15 2021

Lung function in early infancy may be influenced by the mother's level of physical activity during pregnancy, results of a study from Sweden suggest. Low-lung function at 3 months of age, as measured by the ratio of time to peak tidal expiratory flow to expiratory time (tPTEF / tE), was more frequent among children whose mothers were physically inactive during the first half of pregnancy compared with those who exercised either moderately or strenuously, reported Hrefna Katrin Gudmundsdottir, MD, a pediatrician and PhD candidate at the University of Oslo, Norway. The results were based on a prospective observational study of 841 mother-child pairs. "The potential link between maternal inactivity and low lung function in infancy adds to the importance of advising pregnant women and women of childbearing age on physical activity," she said in an oral abstract presented during the virtual European Respiratory Society (ERS) International Congress. Jonathan Grigg, MD, professor of pediatric respiratory and environmental medicine at Queen Mary University of London, United Kingdom, who was not involved in the study, commented that it "offers a fascinating hint that increased physical activity of mothers is associated with better lung function in their babies and, therefore, possibly their health in later life. More research is needed to confirm this link, but it is important that women feel supported by their healthcare providers to be active in a way that is comfortable and accessible to them." Impaired lung function in infancy is associated with wheezing and asthma in childhood, and lower lung function later in life, Gudmundsdottir said. She also noted that impaired lung function begins in utero and is related to fetal and infant size, family history of asthma, and/or maternal smoking. Physical activity during pregnancy has been demonstrated to reduce the risk of preterm birth and cesarean birth, and to children being born either abnormally small or abnormally large for their gestational age, she explained. To see where physical inactivity in the first half of pregnancy is associated with lower lung function in otherwise healthy 3-month old infants, Gudmundsdottir and colleagues looked at data on a mother-child cohort from the prospective population-based PreventADALL study, which was designed to study prevention of atopic dermatitis and allergies in children in Norway and Sweden. A total of 814 infants (49% female) had available measures of tidal flow volume in the awake state at 3 months, as well as mother-reported data on physical activity at 18 weeks of pregnancy.

COVID-19 Disease May Actually Cause Preeclampsia, Suggests Study

Sep 15 2021

New evidence strongly suggests that COVID-19 disease causes an increased risk of preeclampsia and preterm birth in those who have an infection while pregnant, according to a retrospective observational study published in the American Journal of Obstetrics and Gynecology. Though the study was observational, its primary finding was a dose-response relationship between the severity of COVID-19 disease and the likelihood of preeclampsia or preterm birth, fulfilling a key criterion for establishing causality in an association. “The fact that 43% (13/30) of the cases of preeclampsia diagnosed after SARS-Cov-2 infection were preterm preeclampsia (< 37 weeks) suggests that COVID-19 may be a cause for medically indicated preterm birth that contributes to the excess preterm birth delivery rate previously reported,” wrote Jonathan Lai, MD, of the Fetal Medicine Research Institute of King’s College Hospital, London, and colleagues. The study also found an increased likelihood of COVID-19 disease in those who had preeclampsia before their infection. “Whether preeclampsia can predispose COVID-19 some cases, or that the two conditions may co-occur because they share similar risk factors requires further investigation,” the authors wrote. It’s also unclear whether the increased risk of pre-eclampsia is contributing to the higher preterm birth risk, according to Linda Eckert, MD, a professor of Ob.Gyn. at The University of Washington who specializes in maternal immunization. “COVID is linked to preeclampsia in this study, and COVID is linked to preterm birth,” Dr. Eckert said in an interview. “The question of whether preeclampsia leading to preterm birth is also linked to infection is not possible to tease out in this study as all the factors are likely interrelated. There is a relationship between COVID and preterm birth absent preeclampsia.” The researchers retrospectively examined data from 1,223 pregnant women who tested positive for SARS-CoV-2 between February 2020 and March 2021 at any of 14 National Health Service maternity hospitals in the United Kingdom. The researchers compared the severity of disease among the women with their risk of preeclampsia as a primary outcome, followed by the outcomes of preterm birth and gestational age at delivery. COVID-19 infections were classified as asymptomatic, mild illness (lacking shortness of breath, dyspnea, or abnormal chest imaging), moderate illness (evidence of lower respiratory disease but an oxygen saturation of at least 94%), and severe illness (requiring “high dependency or intensive care secondary to respiratory impairment/failure or multiorgan dysfunction”). The researchers adjusted their analysis of preeclampsia to account for prior risk of preeclampsia based on maternal characteristics and medical history. Analysis of preterm birth risk included adjustment for maternal age, weight, height, race, method of conception, chronic hypertension, smoking, and diabetes. Preeclampsia occurred in 4.2% of the women, and 17.6% of the women had a preterm birth. In addition, 1.3% of the cohort had a miscarriage, and there were 10 (0.81%) fetal deaths. Since 21 cases of preeclampsia occurred before the women tested positive, the researchers removed those cases from the analysis. Among the remaining 30 cases, 13 women had preterm preeclampsia and 17 had term preeclampsia. When the researchers compared the study population’s risk of preeclampsia with that of a separate population with similar risk factors, they found a dose-response increased risk in those with COVID-19 infections. While 1.9% of asymptomatic patients had preeclampsia, incidence was 2.2% in patients with mild disease, 5.7% in those with moderate disease, and 11.1% in those with severe disease. Women with severe COVID-19 tended to be older and to have a higher body mass index. After adjustments, women were nearly five times more likely to develop preeclampsia if they had severe COVID-19 compared to women with asymptomatic infection (adjusted relative risk [aRR] = 4.9). Those with moderate or severe disease had triple the risk of preeclampsia compared to those with mild or asymptomatic infection (aRR = 3.3).

Company Introduces Disposable Ear Coupler for Infants

Sep 1 2021

Sanibel Supply has introduced a new disposable ear coupler for auditory brainstem response (ABR) testing in infants: the EARturtle. Resembling a turtle shell in shape and form, the EARturtle is placed over the baby’s ear for non-intrusive ABR testing. The EARturtle is distributed by Hearing Screening Associates (HSA) in the US. The main benefit of the EARturtle is its flexibility, as it can be used with the RadioEar IP30 and Sanibel Supply EARturtle adapter and similar transducer couplers. Thus, it can be used with various equipment for ABR testing. Jakob Skovgaard, Business Unit Manager, Sanibel Supply, comments: “Our goal is to make it easy for users of diagnostic hearing equipment to acquire quality consumables. With the EARturtle, we offer a consumable that can help to make ABR newborn hearing screening a more widely adopted discipline, which is very important in our eyes.” Other benefits worth of note: 1) Safe to apply on sensitive skin. The EARturtle complies with ISO 10993-1:2018, ensuring it is safe to apply on the sensitive skin of babies. 2) Equivalent RETSPLs to other disposable ear couplers. The EARturtle RETSPL values are equivalent to the EarCup and other known disposable ear couplers. 3) Equivalent performance to other disposable ear couplers. The EARturtle has a relatively flat frequency response in the range from 350 Hz to 5.5 kHz, which is equivalent to the EarCup and other known disposable ear couplers.

Jury Out on PIGF Testing for Suspected Pre-eclampsia

Aug 30 2021

The addition of placental growth factor (PlGF) measurement to usual care of women with suspected preeclampsia does not improve maternal or neonatal outcomes, according to results of PARROT Ireland, the largest multicenter randomized controlled trial of PlGF-based testing for women with suspected preeclampsia to date. “Given the lack of maternal or neonatal clinical benefit demonstrated in our trial, we cannot endorse the use of PlGF testing as a diagnostic adjunct to clinical care in women with suspected preeclampsia at present and recommend further research be conducted,” researchers write in the BMJ. Cohort studies have suggested high sensitivity and high negative predictive value of PlGF testing in gauging the need for early delivery in women with suspected preeclampsia. However, there is concern that integrating PlGF testing into routine clinical care may lead to an earlier intervention, lowering gestational age at delivery and increasing problems in newborns. The PARROT Ireland study, conducted at seven maternity hospitals, enrolled women with a singleton pregnancy between 20 and 36 weeks’ gestation and with signs or symptoms suggestive of evolving preeclampsia. The primary analysis - based on 1,202 women randomly allocated to usual care alone and 1,017 to usual care plus point-of-care PlGF testing - showed no significant difference in maternal or neonatal morbidity with the integration of point-of-care PlGF testing. “The PARROT Ireland trial shows that integrating a PlGF test into routine investigations for women presenting <37 weeks with a singleton pregnancy and signs/symptoms of evolving preeclampsia did not improve or worsen outcomes for women or their babies,” lead author Dr Deirdre Hayes-Ryan of INFANT Research Centre UCC, Cork University Maternity Hospital, told Reuters Health by email. “The results add to the information available currently on the impact of PlGF as an interventional test and do not support the use of PlGF testing as a diagnostic adjunct in women with suspected preeclampsia,” Dr Hayes-Ryan said. “Given the imminent assessment of PlGF testing by the National Institute for Health and Care Excellence (NICE), we recommend urgent reappraisal of the evidence and postponement of updating of guidelines on PlGF testing until an individual participant data (IPD) meta-analysis is performed,” the researchers advise in their paper. “An IPD meta-analysis of participants from both the UK and Irish PARROT trials is feasible, given both trials employed the same online electronic clinical report form templates and collected the same data points,” they add. Dr Hayes-Ryan said NICE has contacted them in relation to the trial results, and it is her understanding that they are currently performing an appraisal of all available research.

Preterm and Early Term Birth Linked to Increased Autism Rise

Aug 30 2021

Preterm and early term birth were associated with a significantly increased risk for autism spectrum disorder in both boys and girls in a study that included more than 4 million children born over a 40-year period in Sweden. According to the study, which was published in Pediatrics, the prevalence of ASD was 2.1% for all preterm births, 1.6% for early term births and in 1.4% for term births. In a related editorial, Elisabeth C. McGowan, MD, and Stephen J. Sheinkopf, PhD, both associate professors of pediatrics at Brown University, said the findings were consistent with previous research “suggesting a dose response-type relationship between degree of prematurity and ASD risk.” They called the new study “in many ways a definitive accounting of the elevated rates of ASD in preterm infants.” “And although the impact of prematurity on brain development may be part of the causal chain resulting in ASD (or other neurodevelopmental outcomes), these factors are operating in a complex biological landscape, with pathways to ASD outcomes that can be expected to be heterogeneous,” they wrote. For the study, Casey Crump, MD, PhD, vice chair for research in the department of family medicine and community health at the Icahn School of Medicine at Mount Sinai in New York, and colleagues included 4,061,795 singleton infants born in Sweden from 1973 through 2013 who survived to the age of 1 year, were followed up for ASD and were diagnosed by 2015. They categorized participants by gestational age at birth: extremely preterm (22 to 27 weeks), very to moderate preterm (28 to 33 weeks), late preterm (34 to 36 weeks), early term (37 to 38 weeks), term (39 to 41 weeks) and post term (at or more than 42 weeks). The first three groups were combined for summary estimates of preterm births (at or less than 37 weeks). The prevalence ratios, when adjusted for covariates, were significantly elevated among extremely preterm (3.87; 95% CI, 3.48-4.31), all preterm (1.40; 95% CI, 1.36-1.45) and early term births (1.12; 95% CI, 1.10-1.14), Crump and colleagues reported. According to the authors, an estimated 83.7% of ASD cases among participants born extremely preterm, 37.7% of cases among those born any preterm and 18.9% of cases among those born early term were attributed to gestational age at birth. “In this large population-based cohort, preterm and early term birth were associated with significantly increased risks of ASD in boys and girls,” Crum and colleagues wrote. “These findings were largely independent of measured covariates and unmeasured shared familial factors, consistent with a potential causal relationship.” McGowan and Sheinkopf said other investigations have shown “higher incidences of early cognitive, language motor and impairment, and school problems, social-emotional problems, and psychiatric disorders, some of which may extend to adulthood,” among late preterm infants. They said, “careful attention should be paid to biological vulnerabilities at later gestational ages.” “For example, between 34 and 40 weeks, brain weight increases nearly one-third, cortical volume increases nearly 50%, and absolute myelinated white matter volume increases fivefold,” they wrote.

AHA Targets Rising Prevalence of Obstructive Sleep Apnea in Children

Aug 30 2021

Obstructive sleep apnea is becoming more common in children and adolescents as the prevalence of obesity increases, but it may also be a preventable risk factor for cardiovascular disease, according to a new scientific statement from the American Heart Association. The statement focuses on the links between OSA and CVD risk factors in children and adolescents, and reviews diagnostic strategies and treatments. The writing committee reported that 1%-6% of children and adolescents have OSA, as do up to 60% of adolescents considered obese. The statement was created by the AHA’s Atherosclerosis, Hypertension, and Obesity in the Young subcommittee of the Council on Cardiovascular Disease in the Young and was published online in the Journal of the American Heart Association. Carissa M. Baker-Smith, MD, chair of the writing group chair and director of pediatric preventive cardiology at Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Del., explained the rationale for issuing the statement at this time, noting that the relationship between OSA and CVD in adults is well documented. “There has been less focus on the importance of recognizing and treating sleep apnea in youth,” she said in an interview. “Thus, we felt that it was vitally important to get the word out to parents and to providers that paying attention to the quality and duration of your child’s sleep is vitally important to a child’s long-term heart health. Risk factors for heart disease, when present in childhood, can persist into adulthood.” For making the diagnosis of OSA in children, the statement provides clarity on the use of polysomnography and the role of the apnea-hypopnea index, which is lower in children with OSA than in adults. “One controversy, or at least as I saw it, was whether or not polysomnography testing is always required to make the diagnosis of OSA and before proceeding with tonsil and adenoid removal among children for whom enlarged tonsils and adenoids are present,” Dr Baker-Smith said. “Polysomnography testing is not always needed before an ear, nose, and throat surgeon may recommend surgery.” The statement also noted that history and physical examination may not yield enough reliable information to distinguish OSA from snoring. In areas where sleep laboratories that work with children aren’t available, alternative tests such as daytime nap polysomnography, nocturnal oximetry, and nocturnal video recording may be used – with a caveat. “These alternative tests have weaker positive and negative predictive values when compared with polysomnography,” the writing committee noted. Home sleep apnea tests aren’t recommended in children. Questionnaires “are useful as screening, but not as diagnostic tools.” Pediatric patients being evaluated for OSA should also be screened for hypertension and metabolic syndrome, as well as central nervous system and behavioral disorders. Diagnosing OSA in children and adolescents requires “a high index of suspicion,” the committee wrote. Pediatricians and pediatric cardiologists should exercise that high index of suspicion when receiving referrals for cardiac evaluations for attention deficit hyperactivity disorder medication, Dr. Baker-Smith said. “Take the time to ask about a child’s sleep – snoring, apnea, etc. – especially if the child has obesity, difficulty focusing during the day, and if there is evidence of systemic hypertension or other signs of metabolic syndrome,” she said.

Product to Secure Endotracheal Tubes Now on Sale

Aug 25 2021

B&B Medical Technologies announced that Baby Tape Plus is available for immediate sale. The product is used to secure endotracheal tubes for neonatal patients, is an FDA listed Class I device and carries the CE mark. B&B Medical has come to be known as a manufacturer that provides unique solutions for the NICU since the introduction of their infant water seal CPAP valve, the B&B Bubbler, in 2014. “Being one of the pre-eminent manufacturers of endotracheal tube security products and bubble CPAP components gave us special insight into a need that the market was requesting”, said Allyn Wilkes, Acute Care Account Representative at B&B Medical. “The clinician/patient field testing we conducted assisted us in designing a cost-effective product with the performance and reliability that our customers expect from B&B Medical’s endotracheal tube security products”. Baby Tape Plus is a pre-cut endotracheal tube holder made from a non-irritating, latex free hydrocolloid adhesive that is skin friendly for infants. Like all B&B Medical endotracheal tube holders, Baby Tape Plus is designed to be quick and simple to use in a wide variety of situations. The circular tube wrap makes for a cleaner, easier application and the larger wing tabs cover a bigger surface area for greater security, they can also be trimmed to fit a wide range of infants. In addition, the securing neonatal ET Tubes the middle tape strips can also be used to secure nasogastric/orogastric tubes and cannulas. “We’ve had numerous requests from all over the globe to add a solution for babies to our line of endotracheal tube security products” said Stu Novitz, VP of Sales and Marketing at B&B Medical. “We believe the addition of Baby Tape Plus will further establish B&B Medical as a leader in the neonatal and endotracheal tube security markets.” B&B Medical Technologies’ goal is to develop innovative products that deliver positive outcomes, provide good patient care while addressing the need to control healthcare costs. We pride ourselves on developing products that support the patient and clinician’s need throughout the continuum of care.

World’s Smallest Baby at Birth Released from Hospital

Aug 10 2021

A baby thought to be the world's smallest at birth—weighing around the same as a large apple when she was delivered—was discharged from hospital after more than a year of treatment. Kwek Yu Xuan was born on June 9, 2020, at Singapore's National University Hospital (NUH,) just under 25 weeks into the pregnancy term. Pregnancy usually lasts for around 40 weeks. At birth, Yu Xuan weighed just 212 grams (7.47 ounces) and measured 24 centimeters (9.4 inches) long, according to the hospital. Delivered via emergency caesarean section, Yu Xuan is likely to be the lightest baby to survive a premature birth. According to the Tiniest Babies Registry managed by the University of Iowa, the previous smallest survivor was a baby girl born in the U.S. in May, 2019, who weighed 245 grams at birth. The NUH announced that the baby had been "discharged home well" in a Facebook post. "We are happy for the little fighter and her family, and proud of the care provided by our team," the post said. "Our best wishes to Little Yu Xuan as she continues to grow, thrive and beat the odds every day." The hospital said in a statement that Yu Xuan had grown to around 6.3 kilograms (13.8 pounds) and is progressing well. The 14-month-old infant has chronic lung disease and pulmonary hypertension—two conditions that are often associated with extreme prematurity—and has to be on a ventilator at home, although the hospital said she is expected to get better with time. Born in the midst of the global pandemic, the hospital said she had a "limited chance of survival" due to her extremely premature birth. "Against the odds, with health complications present at birth, she has inspired people around her with her perseverance and growth, which makes her an extraordinary 'COVID-19' baby—a ray of hope amid turmoil," the NUH said in the statement. Yu Xuan's mother was forced to undergo an emergency caesarean section at 24 weeks and six days of gestation due to preeclampsia—dangerously high blood pressure during pregnancy that in rare cases can be fatal.

Women's Heart Health Tied to Multiple Pregnancy Complications

Jul 27 2021

Women with prepregnancy cardiovascular disease (CVD) risk factors have increasingly worse pregnancy outcomes, including a higher rate of maternal intensive care unit (ICU) admissions and fetal deaths, a new study suggests. "With every additive cardiovascular risk factor — and it didn't matter which risk factor — there was a graded and consistently higher risk for each of the pregnancy complications," senior author Sadiya Khan, MD, Northwestern University Feinberg School of Medicine in Chicago, said in an interview. Previous studies have shown that the presence of individual risk factors such as obesity and hypertension before pregnancy are associated with worse maternal and neonatal outcomes. Identifying the association with the total burden of prepregnancy CVD risk factors, however, may help guide comprehensive prevention strategies that look beyond targeting any one risk factor, the authors note. The results were published online July 20 in the European Journal of Preventive Cardiology. The researchers analyzed 18,646,512 pregnancies using maternal and fetal data drawn from the US National Center for Health Statistics and pooled individual-level data from births to women aged 15-44 years (mean, 28.6 years) from 2014 to 2018. Women were categorized on the basis of having 0 to 4 prepregnancy CVD risk factors: hypertension, diabetes, self-reported smoking, and a BMI less than 18.5 kg/m2 or greater than 24.9 kg/m2. All analyses were adjusted for maternal age at delivery, race/ethnicity, education, receipt of prenatal care, parity, and birth plurality. Over 60% of the women had one or more CVD risk factors, with 52.5% having one, 7.3% two, 0.3% three, and 0.02% four.

Hematologic Cancer Increases Risk for Delivery Complications

Jul 27 2021

The risk of in-hospital complications and poor birth outcomes were greater in pregnant women with current or historical cancer diagnoses, new research suggests. The study, published in Mayo Clinic Proceedings, found that women with current and historical cancer diagnoses had an increased risk of death, kidney injury, and stroke during delivery hospitalizations, compared with those with no cancer. When it came to delivery outcomes, this group also had a higher risk for preterm birth and postpartum hemorrhage. Those with a current cancer diagnoses had a 1.7-fold increase in odds for a preterm birth, compared with women without cancer. “Our study found that metastases increased the odds of mortality, cesarean delivery, preterm birth, and stillbirth,” the researchers noted. “Coupled with previous research reporting that pregnant women are more likely to be diagnosed with advanced disease, this implies that pregnant women with newly diagnosed cancer have poor prognoses.” However, although women with prior cancer had increased odds of mortality, the researchers said it was not statistically significant. “The study really did not show an increase of mortality [for women with prior cancer diagnosis],” said Justin Chura, MD, a specialist in gynecologic oncology who was not involved in the study. “And the reason might be because there is not or the reason might be because it’s such a rare event. You would need 100 million births to assess that. So I would actually use caution in that interpretation.” Researchers analyzed more than 43 million delivery hospitalizations of women with or without current or historical cancer diagnoses between January 2004 and December 2014. They found that the most common cancer diagnoses were hematologic, thyroid, cervical, skin, and breast. Of the five most common cancers, the prevalence of all maternal complications and negative delivery outcomes was the highest among women with hematologic cancers. They were more likely to experience peripartum cardiomyopathy, acute kidney injury, and arrhythmia, compared with other cancers. Postpartum hemorrhage, maternal mortality, and placental abruption was also more likely to occur in those with this type of cancer. “I was surprised that it was the hematologic cancers that were worse when they did it by cancer type,” said Dr Chura, who is the chief of surgery and the director of gynecologic oncology and robotic surgery at the Cancer Treatment Centers of America’s Eastern Regional Medical Center in Philadelphia. “I think this is a useful bit of information for counseling our patients and also to identify the cohort with the highest risk.” The findings also suggested that those with skin cancer had the highest odds for stroke, while women with cervical and breast cancers were more likely to experience acute kidney injury and preterm birth. Dr Chura said cancer treatments can have an impact on a woman’s health when she’s giving birth. For example, if a woman is diagnosed with cervical cancer, doctors may perform a cone biopsy on her where they remove a large portion of the cervix and still leave them with the ability to conceive and become pregnant. However, those patients are left with a higher risk of a preterm delivery. For women with a hematologic cancer like non-Hodgkin’s lymphoma, chest radiation may cause some subsequent damage to their heart muscles “and now the stress of pregnancy puts more demand on the heart that can lead to cardiac complications for that patient,” Dr Chura said. “There are potential long-term effects from radiation and chemotherapy,” Dr Chura said. Previous studies have shown that chemotherapy may affect pregnancy and delivery. A 2019 study published in the Journal of Cancer also found that 59 pregnant women with cancer had increased mortality compared with those without the long-term illness. Meanwhile, another 2018 study published in Cancer found that women who conceived less than a year after starting chemotherapy had higher risks of preterm birth in comparison with those who conceived more than a year after starting chemotherapy. The study also found that cancer survivors who conceived more than a year after finishing chemotherapy with or without radiation had no higher risk of a preterm birth than those without cancer. Dr Chura said the new study could force doctors to think about the long-term effects of their cancer therapies and make them more apt to think about how to make cancer therapy less toxic with less long-term health consequences, while still curing patients. “Most oncologists, when dealing with younger patients, are very focused on curing the cancer at hand, but not necessarily thinking 5 or 10 years down the road,” Dr Chura said. “[This study] could help inform or at least make us aware of the long-term consequences of our cancer therapies.”

Systemic and Structural Racism Present in U.S. Neonatal Intensive-care Units

Jul 27 2021

Quality of care across and within neonatal intensive-care units (NICUs) in the United States varies by race and ethnicity, according to a new study that points to systemic and structural racism starting at birth. This study highlights "many important quality gaps that raise unanswered questions about the relationships between race and ethnicity and processes and outcomes of care," the study team says in their paper. "Ultimately, until neonatal and pediatric clinicians and providers accept that they must practice social as well as technical medicine and follow through to address social determinants of health and act against racism, we will not achieve comparable high-quality care for all infants," they add. For their study, Dr Erika Edwards of the Vermont Oxford Network and the University of Vermont, in Burlington, and colleagues used Baby-MONITOR, a summary quality measure for NICUs. This tool includes nine elements including five process measures (any human milk at discharge, no admission hypothermia, antenatal steroid exposure, no healthcare-associated infection, and timely retinal examination) and four outcome measures (survival to hospital discharge, no chronic lung disease, no pneumothorax, and greater than median growth velocity). A higher Baby-MONITOR score indicates a higher quality of care. The prospective cohort study included 169,400 infants born between 25 to 29 weeks' gestation or with a birth weight of 401 to 1,500 grams at 737 US hospitals. When compared with non-Hispanic white infants, African American and American Indian infants had significantly lower (worse) process scores on discharge on human milk, no admission hypothermia, and antenatal steroid exposure. And African American, Hispanic, Asian American and American Indian infants had higher (better) outcome scores on survival to hospital discharge, no chronic lung disease, and no pneumothorax, the authors report. "An increased risk for preterm birth, receipt of lower quality care, and socioeconomic disadvantages over of the life course are all markers of the structural and systemic racism found in the United States," they point out. "Even within the same hospitals, African American infants received lower average scores on important markers of quality of care, such as the receipt of antenatal steroids and having no hypothermia on admission. We also found that the geographical location of hospitals continues to play a role in determining the quality of care by race and ethnicity," they note. To their knowledge, this is the first study to use Baby-MONITOR to evaluate the quality of care for American Indians and these infants had lower average process score and higher average outcome score, compared with that of white infants. "American Indian mothers have the second highest rates of preterm birth behind non-Hispanic African American mothers. Addressing the quality of care that Native Americans receive deserves further attention with consideration of the context of the specific perinatal risk factors that American Indian women face," Dr Edwards and colleagues suggest in their paper.

Texas Hospital Delivers 107 Babies in 91 Hours

Jul 15 2021

A Texas hospital set a record at the end of June when staff delivered more than 100 babies in 91 hours, according to a local report. The deliveries occurred across two 48-hour stretches at Andrew Women’s Hospital at Baylor Scott & White All Saints Medical Center in Fort Worth, according to WFAA 8, an ABC affiliate in Dallas. On June 24, staff delivered 25 girls and 27 boys in 47 hours. On June 28, staff delivered 55 babies, including a set of twin girls, in 44 hours. “It’s been all fireworks as our Labor and Delivery teams … have been busy delivering an adorable group of Fourth of July babies —107 of them in just 91 hours to be exact!” the hospital said in a Facebook post. The stretch of deliveries broke the hospital’s record from June 2018, WFAA 8 reported. The hospital averages about 16 deliveries per day and last year delivered 6,000 babies, including 100 sets of twins and two sets of triplets. Six of the baby girls were named Gianna, the news outlet reported. Other popular names included Reign for girls and Atlas and Daniel for boys. The staff expected to see an uptick in births this year as people recover from the pandemic, but the June influx was rare and exceptional, according to NBC 5. “We thought it was going to be higher the last few months because of the pandemic, but didn’t see the baby boom until now, so people must’ve gotten more reassured,” Jay Herd, MD, an obstetrician at the hospital, told the news outlet. The hospital’s labor and delivery teams create photo galleries of babies who are born around the holidays. The Tiniest Texans series features portraits of the newborns, often dressed in holiday-themed clothes.

Fewer Preterm Infants in US Getting Mechanical Ventilation

Jul 15 2021

The duration of respiratory support for preterm infants in the US has increased in recent years as the reliance on mechanical ventilation has declined and use of noninvasive ventilation has become more common, a new study suggests. Researchers examined data on preterm infants from a clinical cohort of 259,311 infants in the Pediatrix Clincal Data Warehouse as well as a national cohort of 1.17 million infants in the National Inpatient Sample. All the preterm infants were born before 35 weeks gestation and received care on neonatal intensive care units between 2008 and 2018. From 2008 to 2018, the proportion of neonates in the clinical cohort receiving mechanical ventilation declined from 29.4% to 18.5% and the proportion receiving noninvasive ventilation climbed from 57.9% to 67.4%. Over this same period, the mean number of days on respiratory support increased from 13.8 to 14.4, driven in large part by more widespread use of continuous positive airway pressure and nasal intermittent positive pressure ventilation, the study team reports in JAMA Pediatrics. "While our study couldn't provide the exact reason why mechanical ventilation was decreasing, the decline in mechanical ventilation use seemed to begin at about the same time one of the largest clinical trials evaluating continuous positive airway pressure (CPAP) as the primary respiratory support in preterm infants was released," said Dr Dupree Hatch, an assistant professor of pediatrics and medical director of the NICU at Vanderbilt University Medical Center in Nashville, Tennessee, who led the current study.

"This study, the SUPPORT trial, along with several other studies released about the same time caused many of us in neonatal medicine to reconsider our approach to respiratory support in preterm infants," Dr Hatch said by email. Over the study period, the mean duration of mechanical ventilation declined from 10.3 days to 9.7 days among infants who received this type of respiratory support. During the same period, the mean duration of noninvasive ventilation increased by 3.2 days among infants receiving this type of support. In the national cohort analysis, researchers also found evidence of reduced use of mechanical ventilation. The proportion of preterm infants receiving this form of respiratory support declined from 22.0% to 18.5% during the study period. One limitation of the analysis is that researchers were unable to link the two data sets, making it possible that the populations in the two cohorts might not be entirely comparable, the authors note. Changes in transfer patterns during the study period also could have influenced the outcomes. Even so, the results underscore the importance of clinicians keeping up to date on the literature around respiratory support and carefully considering how trial outcomes might be relevant in the treatment of individual patients, said Dr Sara DeMauro, associate director of neonatal clinical and epidemiological research at the Children's Hospital of Philadelphia, who coauthored an editorial accompanying the study. "Mechanical ventilation usage is declining because neonatologists are concerned that exposure to mechanical ventilation is injurious, particularly to the preterm/immature lung," Dr DeMauro said by email.

Out-of-Pocket Costs for Childbirth More Than $3000

Jul 15 2021

Families with private health insurance pay around $3,000 for newborn delivery and hospitalization, while adding neonatal intensive care can push the bill closer to $5,000, based on a retrospective look at almost 400,000 episodes. The findings suggest that privately insured families need prenatal financial counseling, as well as screening for financial hardship after delivery, reported lead author Kao-Ping Chua, MD, PhD, assistant professor and health policy researcher in the department of pediatrics and the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan, Ann Arbor, and colleagues. “Concern is growing regarding the high and rising financial burden of childbirth for privately insured families,” the investigators wrote in Pediatrics. “Previous studies assessing this burden have focused on out-of-pocket spending for maternal care, including hospitalizations for delivery. However, there are no recent national data on out-of-pocket spending across the childbirth episode, including both deliveries and newborn hospitalizations.” To address this knowledge gap, Dr Chua and colleagues turned to Optum’s deidentified Clinformatics Data Mart, comprising 12 million privately insured individuals across the United States. The investigators identified 398,410 childbirth episodes occurring between 2016 and 2019. Each episode was defined as one delivery and at least one newborn hospitalization under the same family plan. Out-of-pocket cost included copayment plus coinsurance and deductibles. Primary outcomes included mean total out-of-pocket spending and proportion of episodes exceeding $5,000 or $10,000. Subgroup analyses compared differences in spending between episodes involving neonatal intensive care or cesarean birth. The mean out-of-pocket spending was $2,281 for delivery and $788 for newborn hospitalization, giving a total of $3,068 per childbirth episode. Coinsurance and deductibles accounted for much of that cost, at 55.8% and 42.1%, respectively, whereas copayments accounted for a relatively minor portion (2.2%). Almost all episodes (95%) cost more than zero dollars, while 17.1% cost more than $5,000 and 1.0% cost more than $10,000. Total mean out-of-pocket spending was higher for episodes involving cesarean birth ($3,389) or neonatal intensive care ($4,969), the latter of which cost more than $10,000 in 8.8% of episodes. “Because details on plan benefit design were unavailable, the generalizability of findings to all privately insured Americans is unclear,” the investigators noted. “However, the proportion of childbirth episodes covered by high-deductible health plans in this study is consistent with the prevalence of such plans among Americans with employer-sponsored insurance.” The findings suggest that financial reform is needed, Dr Chua and colleagues concluded. “To avoid imposing undue financial burden on families, private insurers should improve childbirth coverage,” they wrote. “An incremental step would be providing first-dollar coverage of deliveries and newborn hospitalizations before deductibles are met. Ideally, however, insurers would waive most or all cost-sharing for these hospitalizations, consistent with the approach taken by Medicaid programs and many developed countries.”

Probiotic Supplementation Regulates Newborn Immune System

Jul 15 2021

Supplementing breastfed infants with bifidobacteria promotes development of a well-regulated immune system, theoretically reducing risk of immune-mediated conditions like allergies and asthma, according to investigators. These findings support the importance of early gut colonization with beneficial microbes, an event that may affect the immune system throughout life, reported lead author Bethany M. Henrick, PhD, director of immunology and diagnostics at Evolve Biosystems, Davis, Calif., and adjunct assistant professor at the University of Nebraska, Lincoln, and colleagues. “Dysbiosis of the infant gut microbiome is common in modern societies and a likely contributing factor to the increased incidences of immune-mediated disorders,” the investigators wrote in Cell. “Therefore, there is great interest in identifying microbial factors that can support healthier immune system imprinting and hopefully prevent cases of allergy, autoimmunity, and possibly other conditions involving the immune system.” Prevailing theory suggests that the rising incidence of neonatal intestinal dysbiosis – which is typical in developed countries – may be caused by a variety of factors, including cesarean sections; modern hygiene practices; antibiotics, antiseptics, and other medications; diets high in fat and sugar; and infant formula. According to Dr Henrick and colleagues, a healthy gut microbiome plays the greatest role in immunological development during the first 3 months post-partum; specifically, a lack of bifidobacteria during this time has been linked with increased risks of autoimmunity and enteric inflammation, although underlying immune mechanisms remain unclear. Bifidobacteria also exemplify the symbiotic relationship between mothers, babies, and beneficial microbes. The investigators pointed out that breast milk contains human milk oligosaccharides (HMOs), which humans cannot digest, but are an excellent source of energy for bifidobacteria and other beneficial microbes, giving them a “selective nutritional advantage.” Bifidobacteria should therefore be common residents within the infant gut, but this is often not now the case, leading Dr Henrick and colleagues to zero in on the microbe, in hopes of determining the exactly how beneficial bacteria shape immune development. It is only recently that the necessary knowledge and techniques to perform studies like this one have become available, the investigators wrote, noting a better understanding of cell-regulatory relationships, advances in immune profiling at the systems level, and new technology that allows for profiling small-volume samples from infants. The present study involved a series of observational experiments and a small interventional trial. First, the investigators conducted a wide array of blood- and fecal-based longitudinal analyses from 208 infants in Sweden to characterize immune cell expansion and microbiome colonization of the gut, with a focus on bifidobacteria. Their results showed that infants lacking bifidobacteria, and HMO-utilization genes (which are expressed by bifidobacteria and other beneficial microbes), had higher levels of systemic inflammation, including increased T helper 2 (Th2) and Th17 responses. “Infants not colonized by Bifidobacteriaceae or in cases where these microbes fail to expand during the first months of life there is evidence of systemic and intestinal inflammation, increased frequencies of activated immune cells, and reduced levels of regulatory cells indicative of systemic immune dysregulation,” the investigators wrote. The interventional part of the study involved 60 breastfed infants in California. Twenty-nine of the newborns were given 1.8 x 1010 colony-forming units (CFUs) of B. longum subsp. infantis EVC001 daily from postnatal day 7 to day 28, while the remaining 31 infants were given no supplementation. Fecal samples were collected on day 6 and day 60. At day 60, supplemented infants had high levels of HMO-utilization genes, plus significantly greater alpha diversity (P = .0001; Wilcoxon), compared with controls. Infants receiving EVC001 also had less inflammatory fecal cytokines, suggesting that microbes expressing HMO-utilization genes cause a shift away from proinflammatory Th2 and Th17 responses, and toward Th1.

Company Signs Agreement with University

JUL 6 2021

Neotech Products has entered into a mutually beneficial agreement with Wichita State University. This exciting collaboration will provide Neotech with the resources of an institution well known for advanced research, including clinical work through their partners. Wichita State, a national leader in aerospace research, will benefit from the experience of a well-established and innovative medical device company as it expands research in the area of medical products. They will work closely with Neotech’s new product development team to explore product ideas that will impact the end user. “Wichita State is committed to using our aviation expertise for expanding research in other industries,” said Rick Muma, President of Wichita State University. “As a clinician in internal medicine and infectious diseases and a public health practitioner, I understand the need to continually innovate through collaboration in the healthcare sector. Partnerships with companies like Neotech Products do just that.” With this partnership, Neotech will have access to advanced facilities and technologies, including: Labs for materials and adhesive testing and research; Electron microscopes; CT scanning (for materials); Pull and compression testing; A wide array of 3D printing and scanning; VR visual design space. The partnerships’ first collaboration is a locking mechanism for the NeoBar ET Tube Holder. The idea originated with Dr Mohammed Ansari, a neonatologist with ties to the Wichita area. Wichita State teamed up with Dr Ansari and brought the idea to Neotech to drive the project forward. We’re extremely excited to see where it leads. Overall, the purpose of the partnership between Neotech and Wichita State is to utilize the combined expertise of both institutions to bring medical products to market that will truly make a difference.

Out-of-Pocket Costs for Childbirth More Than $3000

JUN 30 2021

Families with private health insurance pay around $3,000 for newborn delivery and hospitalization, while adding neonatal intensive care can push the bill closer to $5,000, based on a retrospective look at almost 400,000 episodes. The findings suggest that privately insured families need prenatal financial counseling, as well as screening for financial hardship after delivery, reported lead author Kao-Ping Chua, MD, PhD, assistant professor and health policy researcher in the department of pediatrics and the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan, Ann Arbor, and colleagues. “Concern is growing regarding the high and rising financial burden of childbirth for privately insured families,” the investigators wrote in Pediatrics. “Previous studies assessing this burden have focused on out-of-pocket spending for maternal care, including hospitalizations for delivery. However, there are no recent national data on out-of-pocket spending across the childbirth episode, including both deliveries and newborn hospitalizations.” To address this knowledge gap, Dr Chua and colleagues turned to Optum’s deidentified Clinformatics Data Mart, comprising 12 million privately insured individuals across the United States. The investigators identified 398,410 childbirth episodes occurring between 2016 and 2019. Each episode was defined as one delivery and at least one newborn hospitalization under the same family plan. Out-of-pocket cost included copayment plus coinsurance and deductibles. Primary outcomes included mean total out-of-pocket spending and proportion of episodes exceeding $5,000 or $10,000. Subgroup analyses compared differences in spending between episodes involving neonatal intensive care or cesarean birth. The mean out-of-pocket spending was $2,281 for delivery and $788 for newborn hospitalization, giving a total of $3,068 per childbirth episode. Coinsurance and deductibles accounted for much of that cost, at 55.8% and 42.1%, respectively, whereas copayments accounted for a relatively minor portion (2.2%). Almost all episodes (95%) cost more than zero dollars, while 17.1% cost more than $5,000 and 1.0% cost more than $10,000. Total mean out-of-pocket spending was higher for episodes involving cesarean birth ($3,389) or neonatal intensive care ($4,969), the latter of which cost more than $10,000 in 8.8% of episodes. “Because details on plan benefit design were unavailable, the generalizability of findings to all privately insured Americans is unclear,” the investigators noted. “However, the proportion of childbirth episodes covered by high-deductible health plans in this study is consistent with the prevalence of such plans among Americans with employer-sponsored insurance.” The findings suggest that financial reform is needed, Dr. Chua and colleagues concluded. “To avoid imposing undue financial burden on families, private insurers should improve childbirth coverage,” they wrote. “An incremental step would be providing first-dollar coverage of deliveries and newborn hospitalizations before deductibles are met. Ideally, however, insurers would waive most or all cost-sharing for these hospitalizations, consistent with the approach taken by Medicaid programs and many developed countries.”

VProbiotic Supplementation Regulates Newborn Immune System

JUN 30 2021

Supplementing breastfed infants with bifidobacteria promotes development of a well-regulated immune system, theoretically reducing risk of immune-mediated conditions like allergies and asthma, according to investigators. These findings support the importance of early gut colonization with beneficial microbes, an event that may affect the immune system throughout life, reported lead author Bethany M. Henrick, PhD, director of immunology and diagnostics at Evolve Biosystems, Davis, Calif., and adjunct assistant professor at the University of Nebraska, Lincoln, and colleagues. “Dysbiosis of the infant gut microbiome is common in modern societies and a likely contributing factor to the increased incidences of immune-mediated disorders,” the investigators wrote in Cell. “Therefore, there is great interest in identifying microbial factors that can support healthier immune system imprinting and hopefully prevent cases of allergy, autoimmunity, and possibly other conditions involving the immune system.” Prevailing theory suggests that the rising incidence of neonatal intestinal dysbiosis – which is typical in developed countries – may be caused by a variety of factors, including cesarean sections; modern hygiene practices; antibiotics, antiseptics, and other medications; diets high in fat and sugar; and infant formula. According to Dr Henrick and colleagues, a healthy gut microbiome plays the greatest role in immunological development during the first 3 months post partum; specifically, a lack of bifidobacteria during this time has been linked with increased risks of autoimmunity and enteric inflammation, although underlying immune mechanisms remain unclear. Bifidobacteria also exemplify the symbiotic relationship between mothers, babies, and beneficial microbes. The investigators pointed out that breast milk contains human milk oligosaccharides (HMOs), which humans cannot digest, but are an excellent source of energy for bifidobacteria and other beneficial microbes, giving them a “selective nutritional advantage.” Bifidobacteria should therefore be common residents within the infant gut, but this is often not now the case, leading Dr Henrick and colleagues to zero in on the microbe, in hopes of determining the exactly how beneficial bacteria shape immune development. It is only recently that the necessary knowledge and techniques to perform studies like this one have become available, the investigators wrote, noting a better understanding of cell-regulatory relationships, advances in immune profiling at the systems level, and new technology that allows for profiling small-volume samples from infants. The present study involved a series of observational experiments and a small interventional trial. First, the investigators conducted a wide array of blood- and fecal-based longitudinal analyses from 208 infants in Sweden to characterize immune cell expansion and microbiome colonization of the gut, with a focus on bifidobacteria. Their results showed that infants lacking bifidobacteria, and HMO-utilization genes (which are expressed by bifidobacteria and other beneficial microbes), had higher levels of systemic inflammation, including increased T helper 2 (Th2) and Th17 responses. “Infants not colonized by Bifidobacteriaceae or in cases where these microbes fail to expand during the first months of life there is evidence of systemic and intestinal inflammation, increased frequencies of activated immune cells, and reduced levels of regulatory cells indicative of systemic immune dysregulation,” the investigators wrote. The interventional part of the study involved 60 breastfed infants in California. Twenty-nine of the newborns were given 1.8 x 1010 colony-forming units (CFUs) of B. longum subsp. infantis EVC001 daily from postnatal day 7 to day 28, while the remaining 31 infants were given no supplementation.

Vaping and Pregnancy: Inhaled Toxins Among Reasons for Pause

JUN 30 2021

Researchers are trying to understand how e-cigarette use affects pregnancy and birth outcomes. This question may become more relevant as younger vapers, among whom the devices gained considerable popularity, start having children. Limited emerging data from animal experiments and human epidemiologic studies suggest that vaping may have negative effects on fertility and pregnancy. “Even if these impacts are less severe than conventional smoking, we really should be thinking about alternate options that may be safer for our patients than inhalation of this aerosol,” said Blair J. Wylie, MD, MPH, a maternal-fetal medicine physician at Beth Israel Deaconess Medical Center in Boston. Dr Wylie reviewed what is known about vaping, including chemicals other than nicotine that have been detected in vape aerosols, and pregnancy at the 2021 virtual meeting of the American College of Obstetricians and Gynecologists. “There’s a lot we don’t know,” she said. “These products were only introduced recently, in 2003. They are marketed aggressively to our youth and have gained tremendous popularity among that population. And it’s only a matter of time, I think, before we see a lot of use in our own patient population.” In a separate study presented at the ACOG meeting, Nicole Izhakoff, a researcher at Florida International University, Miami, and colleagues evaluated the association between e-cigarette use during pregnancy and unfavorable birth outcomes, such as preterm birth, low birth weight, or extended hospital stay for the newborn. The investigators used 2016-2017 survey data from the Pregnancy Risk Assessment Monitoring System. In all, 71,940 women completed the survey, including 859 who reported e-cigarette use during pregnancy. After adjusting for age, race, ethnicity, insurance, maternal education, prenatal care, abuse during pregnancy, and complications during pregnancy, the researchers estimated that the odds of an unfavorable birth outcome were 62% greater among women who used e-cigarettes during pregnancy, compared with those who did not. The researchers lacked information about simultaneous use of alcohol, traditional tobacco, or other drugs, however. “Physicians of all subspecialties, especially those of obstetrics-gynecology and pediatrics, need to increase the implementation of screening for past or current e-cigarette use in at-risk patients,” Ms. Izhakoff and coauthors concluded. “Further research regarding the long-term health effects of e-cigarettes is warranted.”

Vaping and Pregnancy: Inhaled Toxins Among Reasons for Pause

JUN 15 2021

Researchers are trying to understand how e-cigarette use affects pregnancy and birth outcomes. This question may become more relevant as younger vapers, among whom the devices gained considerable popularity, start having children. Limited emerging data from animal experiments and human epidemiologic studies suggest that vaping may have negative effects on fertility and pregnancy. “Even if these impacts are less severe than conventional smoking, we really should be thinking about alternate options that may be safer for our patients than inhalation of this aerosol,” said Blair J. Wylie, MD, MPH, a maternal-fetal medicine physician at Beth Israel Deaconess Medical Center in Boston. Wylie reviewed what is known about vaping, including chemicals other than nicotine that have been detected in vape aerosols, and pregnancy at the 2021 virtual meeting of the American College of Obstetricians and Gynecologists. “There’s a lot we don’t know,” she said. “These products were only introduced recently, in 2003. They are marketed aggressively to our youth and have gained tremendous popularity among that population. And it’s only a matter of time, I think, before we see a lot of use in our own patient population.” In a separate study presented at the ACOG meeting, Nicole Izhakoff, a researcher at Florida International University, Miami, and colleagues evaluated the association between e-cigarette use during pregnancy and unfavorable birth outcomes, such as preterm birth, low birth weight, or extended hospital stay for the newborn. The investigators used 2016-2017 survey data from the Pregnancy Risk Assessment Monitoring System. In all, 71,940 women completed the survey, including 859 who reported e-cigarette use during pregnancy. After adjusting for age, race, ethnicity, insurance, maternal education, prenatal care, abuse during pregnancy, and complications during pregnancy, the researchers estimated that the odds of an unfavorable birth outcome were 62% greater among women who used e-cigarettes during pregnancy, compared with those who did not. The researchers lacked information about simultaneous use of alcohol, traditional tobacco, or other drugs, however. “Physicians of all subspecialties, especially those of obstetrics-gynecology and pediatrics, need to increase the implementation of screening for past or current e-cigarette use in at-risk patients,” Ms. Izhakoff and coauthors concluded. “Further research regarding the long-term health effects of e-cigarettes is warranted.” Wylie coauthored another study related to this topic that was published online May 24, 2021, in the Journal of Maternal-Fetal & Neonatal Medicine. The researchers examined birth weights of children whose mothers use e-cigarettes alone, those whose mothers used both e-cigarettes and conventional cigarettes, and those whose mothers smoked conventional cigarettes only. Their estimates were imprecise, but signaled that e-cigarette use may reduce birth weight. The use of e-cigarettes alone appeared to have less of an impact on birth weight than the dual use of conventional cigarettes and e-cigarettes did. Wylie cautioned that outcomes like birth weight are “pretty crude measures of whether an exposure is okay or not in pregnancy. Many of these toxins that we know that are in the aerosols can cause harm, but they may not be reflected in the absolute value of the birth weight.” In addition, clinicians should avoid focusing on the wrong question when caring for patients. “I think the wrong question is: Is vaping safer than smoking?” Wylie said in an interview. “Metals are going into your lungs. Plastics are going into your lungs. It is hard for me to think that we are going to identify that as our champion smoking cessation strategy in pregnancy.”

Stopping Seizure Meds Before Hospital Discharge Appears Safe in Most Newborns

JUN 15 2021

Researchers observed no difference in functional neurodevelopment or epilepsy among children aged 24 months regardless of whether antiseizure medication was discontinued or maintained in infants at discharge once seizures ceased. Results of the comparative effectiveness study were published in JAMA Neurology. “These results support discontinuing antiseizure medications (ASMs) for most neonates with acute symptomatic seizures prior to discharge from the hospital, an approach that may represent an evidence-based change in practice for many clinicians,” Hannah C. Glass, MDCM, MAS, a pediatric neurologist, founding codirector of the neurointensive care nursery and director of neonatal critical care services at the University of California, San Francisco Benioff Children’s Hospital, and colleagues wrote. ASMs can be maintained in infants for months or years unnecessarily, according to the researchers, due to concerns over continued seizures and early-life epilepsy. Glass and colleagues investigated the impact of early discontinuation of ASM after acute symptomatic neonatal seizures resolved but prior to hospital discharge on functional neurodevelopment and risk for epilepsy at 24 months of age. This prospective, observational, multicenter comparative effectiveness study enrolled 303 infants with acute symptomatic neonatal seizures who were born between July 2015 and March 2018 and enrolled at nine Neonatal Seizure Registry centers with level IV neonatal ICUs and pediatric epilepsy programs. The study included slightly more male infants (56%) than female infants. Glass and colleagues continuously monitored infants using a conventional electroencephalogram. Dosing and treatment were employed under the advisement of local health care professionals. The researchers collected data on ASM type, discontinuation or maintenance and timing and dosage of medication. The researchers also analyzed demographic, clinical and primary seizure causation factors. Parents of the infants reported neurodevelopmental outcomes at 12, 18 and 24 months, corroborated by a medical record review. The primary outcome of the study was functional neurodevelopment at 24 months, which Glass and colleagues measured using the Warner Initial Development Evaluation of Adaptive and Functional Skills questionnaire (WIDEA-FS). Among the 303 infants, 43% of seizures was caused by hypoxic-ischemic encephalopathy, 26% by ischemic stroke, 18% by intracranial hemorrhage and the remaining 13% by another acute brain injury. The local health care professionals prescribed phenobarbital as the first loading ASM in 90% of infants. Upon discharge, a majority (64%) of patients were maintained on ASMs (P < .001). ASM maintenance occurred more often in infants with high seizure burdens, complex clinical courses and abnormal neurological findings at time of discharge. The median treatment length on ASMs in infants with maintained ASMs was 4 months compared with 6 days among those whose medication was discontinued. In the 270 children who returned at 24 months of age for follow-up, the median WIDEA-FS score was 164, with slightly higher scoring (+4 points; 2%) in children whose medication was discontinued prior to a hospital discharge (37%). However, the researchers observed no difference between the two cohorts with regard to functional neurodevelopment or epilepsy at 24 months. “Our findings suggest that staying on antiseizure medication after leaving the hospital doesn’t protect babies from continued seizures or prevent epilepsy and it does not change developmental outcomes,” Glass said in a press release. “Most of the babies in this study went home on antiseizure medications, which suggests we need to re-think standard practice. We’ve never had such robust data from multiple centers to support this type of change for newborns with seizures.”

Guidance Reviewed on 'Kangaroo Care'

MAY 30 2021

When a baby is born prematurely, immediate skin-to-skin contact could save their lives. Instead of placing low-weight newborns in an incubator, new research suggests they should be nestled up close to their mother's chest, or that of a close caregiver's, and fed exclusively on breast milk. This approach, dubbed kangaroo care, has proved to be one of the best and safest ways to treat preterm infants with low birth weights, resulting in fewer infections, higher rates of breastfeeding, and better weight gain in studies. Despite the growing number of benefits, the practice has not been widely adopted. Currently, the World Health Organization recommends continuous kangaroo care for all preterm infants, but only after they are taken away and declared clinically stable in the neonatal intensive care unit (NICU). A randomized controlled trial in five hospitals now suggests the WHO's recommendation separates babies and their mothers too soon. Instead, hospitals should implement a mother-infant care unit with beds and chairs so that hospital staff can look after new parents and babies at the same time. The study was conducted among 3,211 low-weight infants in Ghana, India, Malawi, Nigeria, and Tanzania, who were either assigned immediate kangaroo care in a specially arranged "Mother-NICU" or were separated from the parents for conventional care, with brief moments of touch allowed after the first 24 hours. In the first three days, infants who received immediate skin-to-skin contact were held for roughly 17 hours a day in the Mother-NICU. Meanwhile, those infants placed in incubators or radiant warmers received only 1.5 hours of intermittent daily contact. Compared to conventional neonatal care, those infants who received immediate touch from their parents were 25 percent less likely to die in the first month of life. Continuously held newborns were also less likely to develop hypothermia and bacterial blood poisoning, possibly because these infants had greater exposure to their mother's protective microbiome, were more likely to receive early breast milk, and were handled by fewer people. Avoiding separation stress between the mother and the infant might also have contributed to greater health outcomes. Touch between a baby and its mother has been shown to stabilize the newborn's heart rate, calm its breathing, and decrease its crying. "Keeping the mother and baby together right from birth, with zero separation, will revolutionize the way neonatal intensive care is practiced for babies born early or small," argues Rajiv Bahl, the Head of Maternal and Newborn Health Research and Development at WHO. "This study illustrates that kangaroo mother care has the potential to save many more lives if it is started immediately after birth, a finding with relevance for countries of all income levels." Today, over 96 percent of all infants with a low birth weight are born in developing countries, and these children are particularly vulnerable to infectious disease, developmental delays, and death. Conventional neonatal care is expensive and requires great skill and logistical support, which many countries with lower incomes cannot afford. Kangaroo care, on the other hand, is a safe and effective alternative much easier to implement. The findings support a recent meta-analysis that found kangaroo care after clinical stabilization results in 40 percent lower infant mortality.  Yet, many premature babies don't make it to that stage. Studies reveal nearly 50 percent of neonatal deaths in a number of Asian and African nations occur within 24 hours of delivery, and 80 percent occur in the first week of life, which means many lives are being lost before kangaroo care can be initiated. "The idea of giving skin-to-skin contact immediately after delivery to very small, unstable babies has encountered quite strong resistance, but about 75 percent of deaths occur before the infant has been judged sufficiently stable," explains Nils Bergman from the Karolinska Institutet in Sweden. If low-weight infants receive immediate kangaroo care, the authors of the new study estimate it could save 150,000 underweight newborns each year. WHO is currently in the process of reviewing its guidance on kangaroo care.

Children Born Just Weeks Early Face Higher Risk of Developmental Problems

MAY 30 2021

Children born preterm (before 37 weeks of pregnancy) remain at high risk of developmental difficulties that can affect their behaviour and ability to learn, finds a study published by The BMJ today. These difficulties were found not only in children born extremely preterm (22-26 weeks) but also in those born very and moderately preterm (between 27 and 34 weeks), say researchers. Survival of preterm babies has increased worldwide. Children born early often have developmental issues, but studies have mainly focused on those born extremely preterm (22-26 weeks' gestation) and less is known about children born very and moderately preterm (27-34 weeks' gestation). Given how important it is to identify children most at risk of developmental difficulties, researchers in France set out to describe neurodevelopment among children born before 35 weeks compared with children born at full term. Their findings are based on 3,083 French children aged 5½ born after 24-26, 27-31, and 32-34 weeks gestation who were taking part in the EPIPAGE-2 study (designed to investigate outcomes of preterm children over the past 15 years) and a comparison group of 600 children born at full term. Neurodevelopmental outcomes such as cerebral palsy, sensory impairments (blindness and deafness), and brain function (cognition), as well as behavioural difficulties and movement disorders, were assessed using recognised tests. To further assess the family and social burden of prematurity, measures such as the need for extra support at school, visits to a psychiatrist, speech therapist or physiotherapist, and parental concerns about development, were also recorded. After adjusting for other potentially influential factors, the researchers found that rates of neurodevelopmental disabilities increased as gestational age decreased. For example, among the 3,083 children assessed, rates of severe to moderate neurodevelopmental disabilities were 28%, 19% and 12% and rates of mild disabilities were 39%, 36%, and 34% among children born at 24-26, 27-31 and 32-34 weeks, respectively. Assistance at school was used by 27%, 14% and 7% of children born at 24-26, 27-31, and 32-34 weeks, respectively. And about half of children born at 24-26 weeks received at least one developmental intervention which fell to 26% for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopmental disabilities were also higher in families with low socioeconomic status. This is an observational study, so can't establish cause, and the researchers point to some limitations that may have affected their results. However, by assessing a wide range of developmental and behavioural issues, they were better able to reflect the complexity of difficulties faced by these children and their families. As such, they say their findings indicate that preterm birth "continues to pose a large burden for families, healthcare, and educational systems." Although rates of severe to moderate neurodevelopmental disabilities decreased with increasing gestational age, they point out that around 35% of the moderately to extremely preterm born children had mild disabilities requiring special care or educational services. And a considerable proportion of parents had concerns about their child's development, particularly about behaviour, which warrant attention, they add. "Difficulties faced by these groups of children and their families should not be underestimated," they conclude.

Skip Routine Probiotics for Preemies, AAP Says

MAY 30 2021

The American Academy of Pediatrics (AAP) now recommends against the routine administration of probiotics to preterm infants, particularly the most vulnerable (those whose birth weight is <1000 g), for the treatment or prevention of necrotizing enterocolitis (NEC) and late-onset sepsis. Although probiotics are increasingly given to preterm infants, the AAP notes that the data on their safety and efficacy are inconsistent. In addition, the supplements are not subject to approval by the US Food and Drug Administration (FDA). Therefore, the academy advises clinicians to use extreme caution in selecting preterm neonates to receive these microorganisms and recommends obtaining informed consent from parents after carefully discussing the risks. It also recommends that centers using probiotics conduct surveillance, inasmuch as probiotics can alter a center's flora, potentially affecting all patients. Such centers should also carefully document outcomes, adverse events, and safety. The AAP's clinical report, published online May 24 in Pediatrics, highlights wide differences between commercially available formulations and a lack of regulatory standards in this country. Absent FDA-approved drug labeling, these nutritional supplements cannot be marketed as treatment or prophylaxis, but that has scarcely stopped their use. "Despite lack of availability of a pharmaceutical-grade product, the number of preterm infants receiving probiotics in the United States and Canada is steadily increasing," write Brenda Poindexter, MD, FAAP, chief of neonatology at Children's Healthcare of Atlanta, in Atlanta, Georgia, and members of the AAP's Committee on Fetus and Newborn. Analyses of US collaborative databases indicate that approximately 10% of neonates of extremely low gestational age receive a probiotic preparation in the neonatal intensive care unit (NICU). The use of these preparations varies widely across institutions. "NEC is a devastating morbidity of prematurity, and it's multifactorial. Some babies only given mother's milk still get NEC, and the decision to use these products is a very nuanced one," Poindexter said. "I suspect some people will disagree with the report, and we tried to give folks some wiggle room." Evidence from other countries suggests that probiotics can be protective against NEC, she added, "so not to have a reliable product in this country is very frustrating."

Mother-to-Infant COVID-19 Transmission Is Unlikely

MAY 30 2021

Mothers with a history of COVID-19 exposure during pregnancy are not likely to transmit the infection to their newborns, based on data from more than 2,000 women. “Uncertainty at the onset of the COVID-19 pandemic led to varying postnatal care recommendations for newborns exposed to SARS-CoV-2 in utero,” said Margaret H. Kyle, of Columbia University, New York, and colleagues. The Columbia University Irving Medical Center, an early epicenter of the pandemic, allowed rooming-in and encouraged direct breastfeeding between infected mothers and their newborns while adopting extensive safety measures, the researchers said. In a study presented at the virtual meeting of the Pediatric Academic Societies, the researchers conducted a retrospective chart review of all newborns born at the medical center from March 22, 2020, through August 7, 2020. The study was part of Columbia University’s ongoing COVID-19 Mother Baby Outcomes (COMBO) initiative to “describe the health and well-being of mother-infant dyads with and without prenatal SARS-CoV-2 infections,” according to the researchers. During the study period, the researchers identified newborns of 327 women who tested positive for COVID-19 at any point during pregnancy and compared them to newborns of 2,125 unexposed women. Demographics were similar between the groups. Overall, the total test positivity was 0.7% for exposed newborns; 1.0% tested positive on an initial test, and 0% were positive on retest. During the newborn hospital stay and a 2-week follow-up, 0% of all newborns showed clinical evidence of infection. No significant differences were noted between exposed and unexposed newborns in clinical outcomes including gestational age, mode of delivery, 5-minute Apgar score, heart rate, respiratory rate, or temperature. Although more infants of COVID-19–exposed mothers compared with unexposed mothers had an emergency department visit within the first 14 days of life (6% vs. 3%, P = .002), none of the infants was diagnosed with COVID-19 during these visits. Cough, fever, congestion, or bilirubin were more frequent reasons for emergency department visits in the exposed infants compared with unexposed infants, but these differences were not significant. The study findings were limited by several factors, including the retrospective design and the limited follow-up period to only the first 2 weeks of life, the researchers noted. In addition, perinatal transmission rates were available only for the 202 newborns who were followed up in the hospital system, they said. However, the results suggest that the risk of mother-to-newborn vertical transmission of COVID-19 remains low, even when mothers are breastfeeding and infants are rooming in, they concluded.

Webinar Organized about Pulse Oximetry from a Neonatologist’s Perspective

MAY 22 2021

Pulse Oximetry: The Neonatologist’s Perspective is an upcoming webinar set for June 8 at 11:00 AM PDT. Panelists: Mitchell Goldstein, MD, Professor of Pediatrics Neonatal Medicine and Loma University School of Medicine and Director of the Neonatal ECMO Program, Division of Neonatology, Department of Pediatrics at Loma Linda University Children’s Hospital; Vijay Dhar, MD, Division Chief of Neonatology Children’s Hospital of Orange County, University of California, Irvine; Anand Sampath, Executive Vice President Operations and Clinical Research Masimo. Moderator: Vicki Huber RN, MSN, MBA, CHE, Chief Nursing Officer, Masimo. This live webinar brings together respected neonatologists alongside engineering experts to offer perspective and clarity regarding how Masimo Signal Extraction Technology (SET) has overcome the challenges associated with monitoring neonates. The panel will also address pulse oximetry performance including recent claims about speed to post readings, accuracy, and alarm management. Join us to discover how the right technology can make a difference for all patients—especially vulnerable neonates. Register to Attend Now: https://bit.ly/3oBurO1

Company Introduces Neonatal Transilluminator for Single Patient Use

MAY 14 2021

Neotech is proud to introduce a neonatal transilluminator developed specifically for single patient use: NeoGlo Disposable. NeoGlo Disposable is available with red or white LED lights. It is lightweight, compact, and features a USB power connector. No batteries required. “Infection in general, and especially cross contamination, is a great concern in the NICU. I approached Neotech to develop a small, inexpensive neonatal transilluminator that could be used for one patient and then discarded when the patient is sent home,” Professor Ruben Bromiker, Neonatologist said. “I’m thrilled to see this product come to fruition. Having one transilluminator per patient will also make it more available, thus encouraging the staff to use it. And studies show that the use of transillumination improves the chances of success; reducing the number of pricks we give a patient.” After the successful launch of the original NeoGlo, Neotech set out to deliver Dr Bromiker’s original, hospital-driven concept. “Dr Bromiker came to us with a fairly simple idea: an affordably-priced device that could be plugged into a USB power source,” Sara Dimmitt, Manager of New Product Development said. “It was focused on the needs of the international market. After some market research in the US, his idea evolved into a reusable neonatal transilluminator with multiple light settings. But we always intended on revisiting a disposable option. And with Philips discontinuing their Wee-Sight, it’s perfect time to introduce NeoGlo Disposable to the market.” Now, Neotech offers two great transillumination options. The original reusable and the new NeoGlo Disposable.

55 New Chemicals Found in Pregnant Women, Their Newborns

MAY 14 2021

Fifty-five chemicals never before reported in humans were found in pregnant women, according to a study from the University of California San Francisco. The chemicals likely come from consumer products or industrial sources, researchers say. Findings were published online in Environmental Science and Technology. Co-first authors Aolin Wang, PhD, and Dimitri Panagopoulos Abrahamsson, PhD, postdoctoral fellows in UCSF's obstetrics and gynecology department, and colleagues found 109 chemicals in the blood of pregnant women, including 42 "mystery chemicals" whose sources and uses are not known. The chemicals were also found in their newborns, tests from umbilical cord blood show, suggesting the chemicals cross through the placenta. Among the chemicals, 40 are used as plasticizers, 28 are used in cosmetics, another 25 are used in consumer products, 29 as pharmaceuticals, 23 as pesticides, three as flame retardants, and seven are PFAS [per- and polyfluoroalkyl substances] compounds used in multiple applications including carpeting and upholstery, the authors report. Senior author Tracey Woodruff, PhD, MPH, characterized their discoveries as "disturbing." "We know it's a chemical registered to be manufactured and it's used in commerce, but we don't know where," she explained. "That's very disturbing that we can't trace them and that shows a failure in public policy and government." "Exposures are occurring without our consent," said Woodruff, a former US Environmental Protection Agency scientist, who directs the Program on Reproductive Health and the Environment (PRHE) and the Environmental Research and Translation for Health (EaRTH) Center, both at UCSF.

Blood Markers May Help Predict Delivery Time

MAY 14 2021

Scientists have identified markers in blood that may indicate labor is approaching, according to a new study. Through an analysis of blood samples gathered during the second and third trimesters of 53 women, researchers identified a combination of factors that predicted the approach of labor to within a two week window, according to the report published in Science Translational Medicine. “Currently it is hard for an obstetrician to give an accurate time when a woman is going to go into labor,” said coauthor Dr Brice Gaudilliere of Stanford University. “This can be an issue both for pregnancies that turn out to be preterm and those complicated by being post term.” “By measuring various factors that represent many physiological systems that are important in the maintenance of pregnancy—in particular the immune system—we are able to predict when labor will occur without relying on an estimate of the gestational age,” Gaudilliere said. Gaudilliere and his colleagues analyzed blood samples from 53 women who went into labor spontaneously, including five who delivered preterm. Blood was collected two or three times from the women during the last 100 days of their pregnancies, with each sample analyzed for 7,142 metabolic, protein and single-cell immune features. The data was plotted against the number of days before labor that each sample was collected, and via mathematical modeling, the researchers identified which features in the blood best predicted the onset of labor. Once they had isolated the factors that appeared to presage the onset of labor within a window of two weeks, Gaudilliere and his team tested their results on the pregnancies of 10 more women, which confirmed the researchers were on the right track. Overall, the researchers found that a surge in steroid hormone metabolites and interleukin-1 receptor type 4 preceded labor, coinciding with a switch from immune activation to regulation of inflammatory responses. Gaudilliere and his team hope that the study’s findings will yield a test that obstetricians can use to predict labor within the next two to three years.

Neonatal Nurses, Doctor Help Woman Who Delivered Baby on Plane

MAY 14 2021

Three neonatal intensive care nurses and a family physician were in the right place — on an airliner traveling to Hawaii — at the right time — when a woman unexpectedly delivered a baby prematurely on the flight. The medical professionals sprang into action to keep baby Raymond, who came into the world at 29 weeks, healthy until the flight got to Honolulu, according to a news release from Hawaii Pacific Health. Dale Glenn, MD, a family physician with Hawaii Pacific Health, said there was an emergency call for a doctor halfway through the Delta flight that left Salt Lake City for Honolulu on April 28. “I let the flight attendant know that I'm a physician and she said we have a woman having a baby, so I hurried over to see what I could do,” he said, according to the release. Three NICU nurses from North Kansas City Hospital — Lani Bamfield, Amanda Beeding, and Mimi Ho — answered the call. "I went to see what was going on and see her there holding a baby in her hands, and it's little," Bamfield said, according to the news release. The mom, Lavinia "Lavi" Mounga of Orem, Utah, said she was more than a little surprised. "I just didn’t know I was pregnant," Mounga said in a video interview released from Hawaii Pacific Health, according to Q13 Fox of Seattle. "And this guy just came out of nowhere." The nurses and the doctor improvised to keep Raymond safe for the rest of the flight. Glenn said they used shoelaces to cut and tie the umbilical cord, made baby warmers out of bottles that were microwavable, and measured the baby’s heart rate with an Apple Watch. “We didn’t have the usual tools found in a neonatal intensive care unit, so there were a lot of vital signs we couldn’t track,” Glenn said.

Latest Emollient Data Discouraging for Atopic Dermatitis Prevention

MAY 14 2021

Emollients don't prevent atopic dermatitis (AD), but they might have untapped potential as treatment, two new studies suggest. The results of a prevention study, in which parents slathered their babies with petrolatum, are particularly discouraging. Earlier studies had led researchers to hope this approach could stop not only AD but perhaps other related allergic conditions. Instead, the babies who were in the petrolatum group in the Barrier Enhancement for Eczema Prevention Study (BEEP) were more likely to develop food allergies as well as skin infections than babies who received standard skin care. "So, the parents of newborn babies should not be advised to use emollients to prevent eczema developing," said Joanne Chalmers, PhD, a senior research fellow at the Center of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom. In another study, an experimental nanofiber dressing impregnated with palmarosa oil significantly improved symptoms of the condition. Both studies were presented at the International Society of Atopic Dermatitis (ISAD) 2021 Annual Meeting. The BEEP results were also published in The Lancet. A "sizeable body of evidence" supports the use of emollients for the treatment of mild AD and flares, Chalmers said. Skin barrier dysfunction precedes the development of AD. Mutations in the filaggrin gene are associated with skin barrier dysfunction and the development of AD. There is no cure, and treatments are burdensome. On the basis of these data, Chalmers and her colleagues thought applying emollients to babies was worth a try. They approached families with newborn babies who were at high risk of developing AD because they had at least one first-degree relative with AD, allergic rhinitis, or asthma.

Latest Data Added to Poster

MAY 4 2021

Mallinckrodt plc, a global biopharmaceutical company, announced that data from its Phase 4 observational registry comparing the safety and effectiveness of INOmax (nitric oxide) gas, for inhalation, in term and near-term (TNT) neonates to that in preterm (PT) neonates with pulmonary hypertension (PH) will be presented in a poster at The Pediatric Academic Societies (PAS) 2021 Virtual Meeting. The safety and efficacy of INOmax in premature neonates has not been evaluated by the US Food and Drug Administration. INOmax has been on the market in the US since 2000 and is indicated to improve oxygenation and reduce the need for extracorporeal membrane oxygenation in term and near-term (>34 weeks gestation) neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension in conjunction with ventilatory support and other appropriate agents. The primary outcome measure of the registry was the number of PT neonates and TNT neonates with a significant response to INOmax, which was defined as at least a 25 percent improvement (decrease) from baseline in oxygenation index or surrogate oxygenation index (OI/SOI) during INOmax treatment. A total of 50 (90.9 percent) PT and 75 (88.2 percent) TNT neonates achieved a ≥25 percent decrease in OI/SOI during treatment with INOmax. Efficacy in the PT group demonstrated non-inferiority (95 percent confidence interval: 0.0267 [-0.0333, 0.0868], with a pre-defined margin of -0.1452). In addition, the proportion of neonates with ≥25 percent decrease in OI/SOI was similar across severity groups with no significant difference in time to improvement between groups. "These registry findings help expand our understanding of a potential role of inhaled nitric oxide therapy in preterm infants with hypoxic respiratory failure with pulmonary hypertension," said study author Leif D. Nelin, M.D., Division Chief of Neonatology at Nationwide Children's Hospital. Persistent pulmonary hypertension of the newborn (PPHN) is a serious and sometimes fatal cardiorespiratory complication of the transition to extra-uterine life. The registry trial was conducted to examine the utility of INOmax in pre-term neonates. Due to the seriousness of the condition, a randomized controlled trial cannot be conducted in the pre-term neonate population. Overall, 21 adverse events of special interest were reported in 17 patients, all of which were classified as serious events, and no serious adverse events were attributed to the study drug. "After ending this registry much earlier than anticipated last year based on positive findings, Mallinckrodt is extremely pleased to be able to share these important data with the healthcare community and add to the body of research and real-world data for this vulnerable patient population," said Steven Romano, M.D., Executive Vice President and Chief Scientific Officer at Mallinckrodt.

Parents Battle Hospitals Over Rights

MAY 3 2021

Ashley Lamendola was still a teen when medical staff at St. Petersburg General Hospital delivered the awful news that would change her life forever: Her newborn son, Hunter, had suffered profound brain damage and would do little more than breathe without help. “It was like an atomic bomb went off in my life,” she said. Lamendola believed the hospital was partly responsible for Hunter’s birth injuries. But Florida is one of two states that shield doctors and hospitals from most legal actions arising from births that go catastrophically wrong. Lamendola filed a lawsuit against St. Petersburg General anyway, and when it appeared she was gaining traction, the hospital advanced an extraordinary argument. It suggested that Hunter’s mother was not acting in her son’s best interest and that a critical decision about his future care should be put in the hands of an independent guardian and a judge. Lamendola, attorneys said, was pursuing her own self-interest by refusing to participate in the quasi-government program that compensates the families of children injured at birth. Under the program, known as the Birth-Related Neurological Injury Compensation Association, or NICA, the state provides $100,000 upfront and pays for “medically necessary” care for the child’s lifetime. In exchange, parents give up their right to sue hospitals and doctors, lawsuits that can result in judgments or settlements in the tens of millions of dollars. By choosing to “pursue her own speculative, complicated civil lawsuit” rather than permitting her son to accept his “vested” NICA benefits, Lamendola was trying to profit from Hunter’s injuries, St. Petersburg General attorneys argued in a court filing. They underscored the words “her own.” Had she accepted Hunter’s inclusion in NICA, “the Mother would be unable to pursue her own civil lawsuit, seeking her own separate monetary damages for the Child’s injuries,” the lawyers added. “You carry a child for nine months, and then you finally get to hold them — eventually in my case,” said Lamendola, who was employed as a customer service rep at an AutoZone when she gave birth. “And you take care of their every want and need, and you put a child before you. I mean, once you have a child, there is no more you. It’s them. It’s us. It’s that baby that needs you and needs everything from you. I didn’t understand how somebody who wasn’t me could know what he wants and needs. I knew every sound, every movement, every seizure that he had,” Lamendola said. “And to think that somebody thought they knew better than me. It was wild to me.” The battle between parents like Lamendola and hospitals like St. Petersburg General can seem like a gross mismatch: Lamendola was a single mom who made $10.50 an hour and lived with her mother. HCA Healthcare, which owns St. Petersburg General, is one of the nation’s largest for-profit hospital chains, with 180 hospitals, 280,000 employees and revenues of $51.5 billion in 2020. For hospitals facing stunningly high settlements or verdicts, NICA, the state’s no-fault program, is a valuable legal tool — a club to bat away expensive lawsuits. At the cost of $50 per live birth, hospitals can protect themselves from multimillion-dollar judgments. Paolo Annino, who heads the Children’s Advocacy Clinic at the Florida State University College of Law, said attempts to restrict a parent’s authority through the appointment of a guardian are unusual: In child welfare disputes, for example, parents must be found unfit by a judge before being stripped of their right to decide what’s best for their children. “What we have here is a scenario where there’s no allegation of offending parents at all,” he said. “The parent is, with very few exemptions, the one who makes the child’s health care decisions.” NICA came under fire this month after a series of reports by the Miami Herald and the investigative reporting newsroom ProPublica. Families complained that the $100,000 grant — unchanged since 1988 — is inadequate, and that payments for medical procedures or equipment are routinely slow walked or denied entirely. After the articles were published, state leaders professed outrage and promised a comprehensive fix to the program. Here is how NICA works: After a baby is born brain damaged, parents can file a lawsuit against the hospital and doctor. The defendants then can ask the judge to pause the suit and order the parent to file a NICA claim. That petition is heard in a separate venue by an administrative judge, who then decides if the case is “compensable.” Ultimately the administrative judge determines whether NICA applies or if the parents can resume their lawsuit. To qualify for NICA, in addition to having physical and cognitive impairments, a child must weigh at least 2,500 grams (5.5 pounds) at birth and be delivered in a hospital. When children don’t fit those criteria, parents retain the ability to sue. For the roughly 440 Florida children covered by NICA over the past 33 years, some of them now deceased, the program wasn’t really a choice. It was a mandate, with a few exceptions. One exception is when OB-GYNs fail to pay a $5,000 annual assessment. Nearly 1 in 4 licensed obstetricians statewide does not pay. Another is when a hospital doesn’t pay its $50-per-birth fee. Parents can also argue that they weren’t properly notified by their hospital or doctor of their participation in NICA with enough lead time to choose another provider. When parents like Lamendola attempt to invoke these exceptions, the fight can become fierce — and expensive.

Latest Emollient Data Discouraging for Atopic Dermatitis Prevention

MAY 3 2021

Emollients don't prevent atopic dermatitis (AD), but they might have untapped potential as treatment, two new studies suggest. The results of a prevention study, in which parents slathered their babies with petrolatum, are particularly discouraging. Earlier studies had led researchers to hope this approach could stop not only AD but perhaps other related allergic conditions. Instead, the babies who were in the petrolatum group in the Barrier Enhancement for Eczema Prevention Study (BEEP) were more likely to develop food allergies as well as skin infections than babies who received standard skin care. "So, the parents of newborn babies should not be advised to use emollients to prevent eczema developing," said Joanne Chalmers, PhD, a senior research fellow at the Center of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom. In another study, an experimental nanofiber dressing impregnated with palmarosa oil significantly improved symptoms of the condition. Both studies were presented at the International Society of Atopic Dermatitis (ISAD) 2021 Annual Meeting. A "sizeable body of evidence" supports the use of emollients for the treatment of mild AD and flares, Chalmers said. Skin barrier dysfunction precedes the development of AD. Mutations in the filaggrin gene are associated with skin barrier dysfunction and the development of AD. There is no cure, and treatments are burdensome. On the basis of these data, Chalmers and her colleagues thought applying emollients to babies was worth a try. They approached families with newborn babies who were at high risk of developing AD because they had at least one first-degree relative with AD, allergic rhinitis, or asthma. They assigned 693 infants to the emollient group and 701 to the control group. They gave the families in the emollient group a choice of Doublebase Gel (Dermal Laboratories) or Diprobase Cream (Bayer). Both products contain petrolatum and have no ingredients known to have harmful effects. These products are commonly used in the UK National Health Service. The researchers asked the families to apply the product they chose to their baby at least once daily. The products were to be applied to the whole body (excluding the scalp) until the baby reached age 1 year. They advised the families to apply emollient after every bath, even if they had already applied it earlier that day. The control group was given standard advice: avoid harsh soaps and the use emollients unless the baby developed eczema. Most families in the emollient group adhered to the regimen. Adherence dropped only slightly, from 88% at 3 months to 74% at 12 months, among those for whom complete questionnaire data were available.

Stethoscope and Doppler May Outperform Newer Fetal Monitoring Tools

MAY 3 2021

For intrapartum fetal surveillance, the old way may be the best way, according to a meta-analysis involving more than 118,000 patients. Intermittent auscultation with a Pinard stethoscope and handheld Doppler was associated with a significantly lower risk of emergency cesarean deliveries than newer monitoring techniques without jeopardizing maternal or neonatal outcomes, reported lead author Bassel H. Al Wattar, MD, PhD, of University of Warwick, Coventry, England, and University College London Hospitals, and colleagues. “Over the last 50 years, several newer surveillance methods have been evaluated, with varied uptake in practice,” the investigators wrote in the Canadian Medical Association Journal, noting that cardiotocography (CTG) is the most common method for high-risk pregnancies, typically coupled with at least one other modality, such as fetal scalp pH analysis (FBS), fetal pulse oximetry (FPO), or fetal heart electrocardiogram (STAN). “Despite extensive investment in clinical research, the overall effectiveness of such methods in improving maternal and neonatal outcomes remains debatable as stillbirth rates have plateaued worldwide, while cesarean delivery rates continue to rise,” the investigators wrote. Previous meta-analyses have relied upon head-to-head comparisons of monitoring techniques and did not take into account effects on maternal and neonatal outcomes. To address this knowledge gap, Dr Al Wattar and colleagues conducted the present systematic review and meta-analysis, ultimately including 33 trials with 118,863 women who underwent intrapartum fetal surveillance, dating back to 1976. Ten surveillance types were evaluated, including intermittent auscultation with Pinard stethoscope and handheld Doppler, CTG with or without computer-aided decision models (cCTG), and CTG or cCTG combined with one or two other techniques, such as FBS, FPO, and STAN. This revealed that intermittent auscultation outperformed all other techniques in terms of emergency cesarean deliveries and emergency cesarean deliveries because of fetal distress. Specifically, intermittent auscultation significantly reduced risk of emergency cesarean deliveries, compared with CTG (relative risk, 0.83; 95% confidence interval, 0.72-0.97), CTG-FBS (RR, 0.71; 95% CI, 0.63-0.80), CTG-lactate (RR, 0.77; 95% CI, 0.64-0.92), and FPO-CTG-FBS (RR, 0.81; 95% CI, 0.67-0.99). Conversely, compared with IA, STAN-CTG-FBS and cCTG-FBS raised risk of emergency cesarean deliveries by 17% and 21%, respectively. Compared with other modalities, the superiority of intermittent auscultation was even more pronounced in terms of emergency cesarean deliveries because of fetal distress. Intermittent auscultation reduced risk by 43%, compared with CTG, 66% compared with CTG-FBS, 58%, compared with FPO-CTG, and 17%, compared with FPO-CTG-FBS. Conversely, compared with intermittent auscultation, STAN-CTG and cCTG-FBS increased risk of emergency cesarean deliveries because of fetal distress by 39% and 80%, respectively. Further analysis showed that all types of surveillance had similar effects on neonatal outcomes, such as admission to neonatal unit and neonatal acidemia. Although a combination of STAN or FPO with CTG-FBS “seemed to improve the likelihood of reducing adverse neonatal outcomes,” the investigators noted that these differences were not significant in network meta­-analysis. “New fetal surveillance methods did not improve neonatal outcomes or reduce unnecessary maternal interventions,” Dr Al Wattar and colleagues concluded. “Further evidence is needed to evaluate the effects of fetal pulse oximetry and fetal heart electrocardiography in labor.”

Breastfeeding Safe for Mothers With COVID-19 Infection

APR 15 2021

Nursing mothers who receive a COVID-19 vaccine may pass protective antibodies to their babies through breast milk for at least 80 days following vaccination, suggests new research from Washington University School of Medicine in St. Louis. "Our study showed a huge boost in antibodies against the COVID-19 virus in breast milk starting two weeks after the first shot, and this response was sustained for the course of our study, which was almost three months long," said first author Jeannie Kelly, MD, assistant professor of obstetrics and gynecology. "The antibodies levels were still high at the end of our study, so the protection likely extends even longer." Based on the small study, involving five mothers who provided frozen breast milk samples after receiving the two-dose Pfizer-BioNTech coronavirus vaccine, the research provides some of the first peer-reviewed evidence that breastfeeding confers a long-lasting immune response in the nursing infants and toddlers of vaccinated mothers. "There is so much vaccine misinformation out there right now—really scary, misleading posts on social media that are designed to scare moms—so we felt like we needed to look at the science," Kelly said. "We know that these types of antibodies coat babies mouths and throats and protect against disease when a baby is drinking breast milk. So, getting vaccinated while breastfeeding not only protects mom, but also could protect the baby, too, and for months." Published March 30 in the American Journal of Obstetrics and Gynecology, the study tracked levels of COVID-19 antibodies in breast milk from a baseline before the mothers' first vaccinations and on a weekly basis for 80 days after those initial vaccinations. While other recent research has shown that COVID-19 vaccines generate antibodies that are passed to nursing infants through breast milk, this is thought to be the first study to track specific levels of these antibodies in breast milk over an extended time period. The babies of women included in the study ranged in age from one month to 24 months old. To gauge immune response in the breast milk, researchers monitored levels of the immunoglobulins IgA and IgG, which are antibodies deployed by the immune system to fight infections in babies. Findings confirm that breast milk contains elevated levels of the IgA and IgG antibodies immediately following the first dose of vaccination, with both antibodies reaching immune-significant levels within 14 to 20 days of first vaccination in all participants. "Our study is limited by a small number of participants, but the findings provide encouraging news about the potential immune benefit to breast-feeding infants after vaccination," said study senior author Misty Good, MD, an assistant professor of pediatrics, also at Washington University. "Our paper is the first that has shown COVID-19 antibodies persist in breast milk for months following the mother's vaccination." The Washington University findings are similar to prior studies on maternal vaccination, which have shown high levels of antibodies in breast milk for up to six months following vaccination for influenza and whooping cough. While further studies of maternal COVID-19 vaccination are needed to characterize the length of antibody production in breast milk and the effect on infant infection rates, recent research continues to confirm that the COVID-19 vaccine offers real benefits for protecting both mother and child. "We do know that COVID-19 infection is more severe during pregnancy and the main benefit of vaccination is to provide protection for moms before they become really sick, which can also be dangerous to their fetus," Kelly said. "There have now been almost 70,000 pregnant people vaccinated against COVID 19 with no evidence of harm." "We're now seeing a cascade of new data that indicate maternal vaccines are also going to help protect babies—both through transfer of antibodies through the placenta during pregnancy and through the breast milk during lactation," Kelly said. "This is information we didn't have a few months ago and it's really helping us better counsel our patients who are considering getting the vaccine. I'm telling my pregnant and breastfeeding moms that I strongly recommend that they get vaccinated as soon as possible."

Ocular Abnormalities Not Likely in Newborns of SARS-CoV-2-infected Mothers

APR 15 2021

Unlike pathogens such as Cytomegalovirus and Zika, SARS-CoV-2 is not likely to cause ocular problems in newborns whose mothers were infected with the virus during pregnancy, a new case series suggests. In an analysis of data from 165 infants born in Sao Paulo, Brazil, researchers found that just six newborns had positive PCR findings for SARS-CoV-2, and none of the six displayed ocular abnormalities, according to the report published in JAMA Ophthalmology. “Vertical transmission is a serious complication of viral diseases occurring during pregnancy and often may lead to ocular manifestations,” said the study’s lead author, Dr Olivia Kiappe, a retina and vitreous fellow and researcher at the Federal University of Sao Paulo. “Cytomegalovirus and Zika virus are examples of viral infections that can have devastating consequences to the eye of the newborn,” she said in an email. “This study suggests that there is not a moderate or high increased risk of ocular abnormalities in newborns of mothers with COVID-19,” Dr Kiappe said. “Although more data are needed, vertical transmission of SARS-CoV-2 seems possible and should be a concern. Considering the noninvasive nature of the ophthalmological examination, ocular manifestations should be further investigated.” To investigate the possibility that SARS-CoV-2 transmitted in utero by pregnant women could cause eye problems, Dr Kiappe and her colleagues enrolled 165 newborns whose mothers had been diagnosed with SARS-CoV-2 infections. The babies were born at three maternity hospitals in Sao Paulo between April and November of 2020. Of the 165 infants, 123 (74.5%) were born full-term, while 42 (25.4%) were born preterm. Six of the newborns had positive PCR tests of oronasopharyngeal swab samples for SARS-CoV-2. One infant tested positive within 18 days, suggesting possible horizontal transmission, the authors note, while the other five tested positive on the first day of life, suggesting vertical transmission. None of these newborns had ocular abnormalities. Among the newborns who tested negative, one presented with venous engorgement and vascular tortuosity, while seven had intraretinal hemorrhages and two were diagnosed as having retinopathy of prematurity. It will be important to do long-term follow-up on these babies because they were examined so early in life, said Dr Christopher Golden am associate professor of pediatrics at the Johns Hopkins University School of Medicine, in Baltimore. “The developing eye is at risk any time there is an infection involved, especially when the infection occurs when the mom is still pregnant,” Dr Golden said. “Infections can alter the way the nervous tissue in the eye develops.” As for the findings in children who tested negative for the virus, “they could be the result of C-section delivery or just premature delivery,” Dr Golden said. The new report is looking at “something that is really worth studying being that some of the systemic findings in COVID-19 are heavily involving vasculature and clotting and since the eye is one of the most heavily vascularized organs,” said Dr. Erin Walsh, the co-director of pediatric ophthalmology and strabismus services at Mount Sinai in New York City. “There has been a study showing some issues in the retinas of adults with COVID-19. So, I definitely think it’s worth looking for.” One issue of with the current study is “a lack of any sort of real discussion on what normal birth patterns of the retina are,” Dr. Walsh said. Moreover, “there was no comment on other systemic issues such as cardiovascular health (that might have explained the findings in the infants who did not test positive for COVID-19).” After the experience with Zika, it makes sense to look for possible eye issues relating to COVID-19, Dr Walsh said. “With all the multisystemic inflammation that’s been occurring in kids, I would bet, down the road, when rigorous studies are done, researchers might actually find some subtle or not so subtle vascular findings in the retina.”

Extreme Preemies With Neurodevelopmental Impairment at Age 2 May Improve by Age 10

APR 15 2021

More than one quarter of babies who were born extremely premature and display neurodevelopmental impairments at age 2 may improve significantly by age 10, according to a new study. An analysis of data from 802 children who were born extremely premature, revealed that 63% of 227 classified as having moderate to severe neurodevelopmental impairment (NDI) at age 2, had none to mild NDI at age 10. Among 108 children classified as having profound NDI at 2 years, 36% had none to mild NDI at 10 years, researchers report in Pediatrics. Overall, 67% of the children had no change in NDI classification between 2 and 10 years of age, 27% improved and 5% worsened, the authors note. “I hope these findings will allow parents and medical professionals to leave room for optimism when they hear a baby has been born extremely premature with profound neurodevelopmental impairments,” said Dr. Genevieve Taylor, an assistant professor in the division of neonatal and perinatal medicine at the University of North Carolina, Chapel Hill. “It’s definitely a complex issue and there are limitations to our study, but it’s exciting that in this cohort we found even in those kids classified as having severe neurodevelopmental impairment at age 2, many went on to have improved classifications at 10.” The study underscores how plastic kids’ brains are at age 2, Dr. Taylor said. “It demonstrates that kids at age 2 are still developing and that kids are resilient,” she added. “It also shows that there are some limitations of assessing neurodevelopmental impairment at age 2.” To take a closer look at how very premature children who start out with severe NDI develop over time, Dr. Taylor and her colleagues turned to data from the Extremely Low Gestational Age Newborn (ELGAN) Study, a cohort of children born extremely premature at multiple sites in the U.S. who had neurodevelopmental assessments at 2 and 10 years of age. The researchers hypothesized that NDI at age 2 would have limited predictive accuracy for NDI at age 10. Out of 1,506 infants, 80% survived. Data were sufficient for analysis in 67% of those children (802), of whom 5% were born at 23 weeks’ gestation, 15% at 24 weeks, 20% at 25 weeks, 25% at 26 weeks, and 35% at 27 weeks. When the children were 2, trained examiners administered the Bayley Scales of Infant Development Second Edition (BSID-II), performed a standardized neurologic examination, and assigned Gross Motor Function Classification System (GMFCS) scores. For children with an impairment that precluded BSID-II testing as well as those for whom more than two test items were omitted, the Vineland Adaptive Behavior Scales Motor Skills Domain was used instead of the BSID-II. At age 10, IQ was assessed with the Differential Ability Scales, Second Edition (DAS-II). The proportion of children classified as having profound NDI decreased from 13% at age 2 to 6% at age 10. The proportion classified as having moderate to severe NDI decreased from 28% to 17%. The proportion classified as having none to mild NDI increased from 58% to 77%. “Having a preemie is very scary,” said Kimberly Blair, an associate professor of psychiatry at the University of Pittsburg and senior academic director of the UPMC Matilda Theiss Early Childhood Behavioral Health Program.

Pediatricians Call on Biden to Overturn Trump Neonatal Care Order

APR 15 2021

Pediatric bioethicists are calling for President Joe Biden to revoke a Trump Administration executive order that restricts physicians’ ability to withhold therapies from extremely premature newborns. The 2020 Executive Order on Protecting Vulnerable Newborn and Infant Children “reduces the complex and nuanced discussion of the outcomes of prematurity to a single sentence and single outcome: mortality,” Dr Jennifer Kett writes in a new Pediatrics perspective. Even when physicians have no medical treatment to offer babies born before 24 weeks, the order could compel them to intervene in an effort to keep their hearts beating, said Kett, associate medical director for pediatric palliative care at Seattle Children’s Research Institute. “These are very difficult, nuanced decisions we make in consultation with families,” Kett told Reuters Health in a phone interview. “The worry is that physicians and medical teams may be less willing to consider or counsel families about other challenges of extremely pre-term birth besides survival.” Measures the order would require could extend a newborn’s painful life with no long-term hope, she said. “The order’s really focused on survival. There are other factors besides the risk of dying,” she said. The 2020 order is the most recent in a line of legislative actions dating back to the Baby Doe regulations, inspired by the prolife movement, of the 1980s, the perspective says. The Baby Doe regulations restricted the ability of families and physicians to consider quality of life in decision-making about infant care. In the decades since Baby Doe, improvements in neonatal treatments have led hospitals to offer interventions to younger and younger newborns. At the same time, clinical practice has increasingly incorporated parents into decisions about the best interests of their premature newborns, and hospital ethics committees have formed to respond to conflicts when they arise. The Trump Administration order risks undermining the progress, and it portrays the relationship between families and doctors as adversarial, the perspective says.

Maternal Caffeine Consumption, Even Small Amounts, May Reduce Neonatal Size

APR 15 2021

For pregnant women, just half a cup of coffee a day may reduce neonatal birth size and body weight, according to a prospective study involving more than 2,500 women. That’s only 50 mg of a caffeine day, which falls below the upper threshold of 200 mg set by the American College of Obstetricians and Gynecologists, lead author Jessica Gleason, PhD, MPH, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md, and colleagues reported. “Systematic reviews and meta-analyses have reported that maternal caffeine consumption, even in doses lower than 200 mg, is associated with a higher risk for low birth weight, small for gestational age (SGA), and fetal growth restriction, suggesting there may be no safe amount of caffeine during pregnancy,” the investigators wrote in JAMA Network Open. Findings to date have been inconsistent, with a 2014 meta-analysis reporting contrary or null results in four out of nine studies. Gleason and colleagues suggested that such discrepancies may be caused by uncontrolled confounding factors in some of the studies, such as smoking, as well as the inadequacy of self-reporting, which fails to incorporate variations in caffeine content between beverages, or differences in rates of metabolism between individuals. “To our knowledge, no studies have examined the association between caffeine intake and neonatal anthropometric measures beyond weight, length, and head circumference, and few have analyzed plasma concentrations of caffeine and its metabolites or genetic variations in the rate of metabolism associated with neonatal size,” the investigators wrote.

 

Enrollment Completed in Clinical Trial Evaluating Effect of Exclusive Human Milk Diet

APR 07 2021

Prolacta Bioscience, the world’s leading hospital provider of 100% human milk-based nutritional products, announced today that enrollment is now complete in a clinical trial evaluating the effect of an exclusive human milk diet (EHMD), including a specialty fortifier, for term infants who have undergone a corrective procedure for single ventricle physiology (SVP), a life-threatening congenital heart defect (CHD). SVP refers to many types of CHDs that include specific anatomical conditions that result in the body having only one functioning heart ventricle. Because the body needs two healthy heart ventricles to pump blood around the body successfully, infants with SVP may have severe complications unless treated through a series of surgeries shortly after birth. “We’re hopeful that an EHMD, including a specialty fortifier, will demonstrate improved short- and long-term health outcomes for this population of fragile term infants,” said principal investigator Dr. Cynthia Blanco, MD, of the University of Texas Health Science Center in San Antonio. “This study allows us to examine the role of human milk nutrition for this specific infant population who require a great deal of nutrients to catch up on growth, heal from multiple surgeries, and avoid further health complications.” Blanco approached Prolacta about developing a fortifier for infants requiring cardiac surgery. SVP is rare, with only approximately 1,500 infants a year born in the U.S. with this condition. These infants face growth and feeding intolerance issues, which are further complicated by the infants being severely fluid restricted. To meet the specific nutritional needs of these fragile infants requiring surgery, a specialty fortifier was developed and evaluated for potential use in this specific patient population. “We were moved by Dr. Blanco’s commitment to her patients and wanted to help her feed these fragile single ventricle physiology infants undergoing a corrective procedure,” said Scott Elster, CEO of Prolacta. “It is gratifying to have the opportunity to provide human milk nutrition to other infant populations in need — regardless of the relative size of that patient population.” The study, “A Randomized Controlled Trial to Evaluate Growth Velocity and Clinical Outcomes of Infants With Single Ventricle Physiology Fed an Exclusive Human Milk Diet With Early Nutritional Fortification Following Surgical Repair,” successfully enrolled 107 infants undergoing a corrective procedure for SVP. These infants were randomly assigned to receive either Prolacta’s human milk-based fortifier as part of an EHMD, or a cow milk-based fortifier as part of a human/cow milk diet (depending on hospital protocol). The trial was conducted at major medical centers in Texas, Ohio, Oklahoma, California, Illinois, New York, and Florida.

Evolve BioSystems, Inc. Announces the Use of Activated B. infantis EVC001 to Study the Prevention of Type 1 Diabetes in Children

APR 7 2021

Evolve BioSystems, Inc. announced that its product, activated B. infantis EVC001, will be used in one of the largest international clinical studies on preventing type 1 diabetes (T1D) in genetically predisposed children.  The randomized, controlled, double-blind, multicenter trial will be conducted across eight major research centers in five European countries. The Leona M. and Harry B. Helmsley Charitable Trust is funding the study and the continuation of the established newborn screening with more than $30 million. The SINT1A study (Supplementation with B. infantis for Mitigation of Type 1 Diabetes Autoimmunity) aims to show that the daily administration of activated B. infantis EVC001 through the first year of life to children genetically predisposed to T1D will significantly reduce the development of beta-cell autoantibodies in the blood.  Beta-cell autoantibodies are produced by the immune system as part of the process that destroys insulin-producing cells in the pancreas, thus leading to T1D onset early in life. "The prevalence of T1D has grown dramatically over the past 60 years, so the results of this study could have an enormous impact on public health if the increasing incidence of T1D, and its physical, emotional and financial consequences, could be turned back," said Dr. David Kyle, Chief Scientific Officer, Evolve BioSystems, Inc. "We hope to show that a simple intervention of activated B. infantis EVC001 starting in infancy could be life-altering in reducing the prevalence of this autoimmune condition, which would have far-reaching economic and societal benefits." T1D, also known as juvenile diabetes or autoimmune diabetes, can develop in the first years of life, and affects 1.6 million Americans today. It is a lifelong disease for which there is no cure, no means of prevention, and that requires multiple daily insulin injections to manage. Gut inflammation is often caused by an imbalance in the infant gut microbiota in the first few months of life as the result of a deficiency of the key gut bacteria, Bifidobacterium infantis (B. infantis). A substantial body of evidence has connected gut inflammation with improper immune programming and the subsequent development of autoimmune conditions including T1D, atopic dermatitis, food allergies and asthma. A randomized controlled trial in Finland, previously announced in March 2020 by Evolve and in collaboration with Janssen Research & Development, LLC, one of the Janssen Pharmaceutical Companies of Johnson & Johnson, is underway to assess the impact of activated B. infantis EVC001 on inhibiting the onset of atopic dermatitis in the first year of life. SINT1A is an investigator-initiated, randomized, placebo-controlled, double-blind multi-center intervention study across eight trial sites. Research teams will operate under the direction of renowned T1D researcher Anette-G. Ziegler, Director of the Institute for Diabetes Research at Helmholtz Zentrum München and founding member of GPPAD. "There is a great deal of evidence pointing to the importance of having a healthy gut microbiome in early childhood for preventing immune-mediated diseases like type 1 diabetes," said Dr Ziegler. "By identifying children genetically predisposed to type 1 diabetes early in life and treating their gut imbalances, we could potentially protect them from developing this dangerous and costly disease." The study, among the largest T1D studies to date, will screen approximately 300,000 newborn babies for high genetic predisposition for T1D. Researchers will enroll 1,144 participants.  Within the first six weeks of life through to age 12 months, half of the study participants will receive the dietary intervention of activated B. infantis EVC001 and the other half will receive a placebo. The intervention phase will be followed by observational follow-up every six months up to a maximum age of 6.5 years to assess the presence in the blood of autoantibodies associated with T1D. The study plans to enroll its first patients in April 2021.

Maternal Caffeine Consumption May Reduce Neonatal Size

APR 1 2021

For pregnant women, just half a cup of coffee a day may reduce neonatal birth size and body weight, according to a prospective study involving more than 2,500 women. That’s only 50 mg of a caffeine day, which falls below the upper threshold of 200 mg set by the American College of Obstetricians and Gynecologists, lead author Jessica Gleason, PhD, MPH, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md, and colleagues reported. “Systematic reviews and meta-analyses have reported that maternal caffeine consumption, even in doses lower than 200 mg, is associated with a higher risk for low birth weight, small for gestational age (SGA), and fetal growth restriction, suggesting there may be no safe amount of caffeine during pregnancy,” the investigators wrote in JAMA Network Open. Findings to date have been inconsistent, with a 2014 meta-analysis reporting contrary or null results in four out of nine studies. Dr Gleason and colleagues suggested that such discrepancies may be caused by uncontrolled confounding factors in some of the studies, such as smoking, as well as the inadequacy of self-reporting, which fails to incorporate variations in caffeine content between beverages, or differences in rates of metabolism between individuals. “To our knowledge, no studies have examined the association between caffeine intake and neonatal anthropometric measures beyond weight, length, and head circumference, and few have analyzed plasma concentrations of caffeine and its metabolites or genetic variations in the rate of metabolism associated with neonatal size,” the investigators wrote. Dr Gleason and colleagues set out to address this knowledge gap with a prospective cohort study, including 2,055 non-smoking women with low risk of birth defects who presented at 12 centers between 2009 and 2013. Mean participant age was 28.3 years and mean body mass index was 23.6. Races and ethnicities were represented almost evenly even across four groups: Hispanic (28.2%), White (27.4%), Black (25.2%), and Asian/Pacific Islander (19.2%). Rate of caffeine metabolism was defined by the single-nucleotide variant rs762551 (CYP1A2*1F), according to which, slightly more women had slow metabolism (52.7%) than fast metabolism (47.3%). Women were enrolled at 8-13 weeks’ gestational age, at which time they underwent interviews and blood draws, allowing for measurement of caffeine and paraxanthine plasma levels, as well as self-reported caffeine consumption during the preceding week. Over the course of six visits, fetal growth was observed via ultrasound. Medical records were used to determine birth weights and neonatal anthropometric measures, including fat and skin fold mass, body length, and circumferences of the thigh, arm, abdomen, and head. Neonatal measurements were compared with plasma levels of caffeine and paraxanthine, both continuously and as quartiles (Q1, ≤ 28.3 ng/mL; Q2, 28.4-157.1 ng/mL; Q3, 157.2-658.8 ng/mL; Q4, > 658.8 ng/mL). Comparisons were also made with self-reported caffeine intake. Women who reported drinking 1-50 mg of caffeine per day had neonates with smaller subscapular skin folds (beta = –0.14 mm; 95% confidence interval, –0.27 to -–0.01 mm), while those who reported more than 50 mg per day had newborns with lower birth weight (beta = –66 g; 95% CI, –121 to –10 g), and smaller circumferences of mid-upper thigh (beta = –0.32 cm; 95% CI, –0.55 to –0.09 cm), anterior thigh skin fold (beta = –0.24 mm; 95% CI, –0.47 to -.01 mm), and mid-upper arm (beta = –0.17 cm; 95% CI, –0.31 to –0.02 cm). Caffeine plasma concentrations supported these findings. Compared with women who had caffeine plasma concentrations in the lowest quartile, those in the highest quartile gave birth to neonates with shorter length (beta = –0.44 cm; P = .04 for trend) and lower body weight (beta = –84.3 g; P = .04 for trend), as well as smaller mid-upper arm circumference (beta = -0.25 cm; P = .02 for trend), mid-upper thigh circumference (beta = –0.29 cm; P = .07 for trend), and head circumference (beta = –0.28 cm; P < .001 for trend). A comparison of lower and upper paraxanthine quartiles revealed the similar trends, as did analyses of continuous measures. “Our results suggest that caffeine consumption during pregnancy, even at levels much lower than the recommended 200 mg per day of caffeine may be associated with decreased fetal growth,” the investigators concluded.

Maternal COVID-19 Vaccination Protects Fetus, Infants, Study Shows

APR 1 2021

Researchers at Massachusetts General Hospital (MGH), Brigham and Women’s Hospital and the Ragon Institute of MGH, MIT and Harvard have found the new mRNA COVID-19 vaccines to be highly effective in producing antibodies against the SARS-CoV-2 virus in pregnant and lactating women. The study also demonstrated the vaccines confer protective immunity to newborns through breast milk and the placenta. The study, published in the American Journal of Obstetrics and Gynecology (AJOG), looked at 131 women of reproductive age (84 pregnant, 31 lactating and 16 non-pregnant), all of whom received one of the two new mRNA vaccines: Pfizer/BioNTech or Moderna. The vaccine-induced titers — or antibody levels — were equivalent in all three groups. Reassuringly, side effects after vaccination were rare and comparable across the study participants. “This news of excellent vaccine efficacy is very encouraging for pregnant and breastfeeding women, who were left out of the initial COVID-19 vaccine trials,” said Andrea Edlow, a maternal-fetal medicine specialist at MGH, director of the Edlow Lab in the Vincent Center for Reproductive Biology and co-senior author of the new study. “Filling in the information gaps with real data is key — especially for our pregnant patients who are at greater risk for complications from COVID-19. This study also highlights how eager pregnant and lactating individuals are to participate in research.” According to the Centers for Disease Control and Prevention, individuals who are pregnant are more likely to become severely ill with COVID-19, require hospitalization, intensive care or ventilation — and may be at increased risk for adverse pregnancy outcomes. The team also compared vaccination-induced antibody levels to those induced by natural infection with COVID-19 in pregnancy, and found significantly higher levels of antibodies from vaccination. Vaccine-generated antibodies were also present in all umbilical cord blood and breast milk samples taken from the study, showing the transfer of antibodies from mothers to newborns.

Injured Purkinje Cells Implicated in Preemies’ Locomotor Learning Deficits

APR 1 2021

Injury to Purkinje cells during fetal and early postnatal life is likely responsible for locomotor learning deficits in very premature infants, researchers say. “Using an animal model of neonatal brain injury that captures the major hallmarks of the injury seen in human newborns, our work uncovers how injury during this early period affects the function of neurons that control adaptive or anticipatory movement, namely the Purkinje cells,” Dr. Aaron Sathyanesan of Children’s National Hospital in Washington, DC said. “The main technical advance in our paper is that we devised a method to monitor the activity of Purkinje cells in animals that were performing a locomotor learning task,” he said. “Since our animal model aims to mimic injury in human newborns, which is often a brain-wide injury, we wanted to know how specific the behavioral changes were to alterations in Purkinje cell function during the early neonatal period,” he explained. “We used a method to artificially silence Purkinje cell firing during the neonatal period in mice that were not exposed to the injury paradigm,” he continued. “The results were quite striking. Both the long-term behavioral measurement and the physiological responses of the Purkinje cells during learning were quite similar to what we observed in animals that were exposed to the injury paradigm.” “This indicates that Purkinje cell activity during the neonatal period is critical for normal behavior in the long-term,” he concluded. Specifically, the researchers measured neural circuit function in the mouse model by pairing GcaMP6f fiber photometry, which measures neuronal activity during movement, with an Erasmus Ladder, which tests motor learning and performance. They introduced obstacles to movement and observed how quickly the mice learned to avoid the obstacle, according to the study published in Proceedings of the National Academy of Sciences of the USA. A series of learning trials plus brain monitoring comparing brain-injured and normal animal models enabled the team to quantify cerebellum-dependent locomotor learning and adaptive behavior. Further, as Dr. Sathyanesan noted, they found that Purkinje cell dysfunction in the brain-injured model specifically interfered with adapted learning, and that switching these cells off (chemogenetic inhibition) in normal models mimicked the effects of perinatal cerebellar injury. The authors state, “Our results uncover a direct link between perinatal cerebellar injury and activity-dependent maturation of cerebellar cortex.”

Preterm Infant Supine Sleep Positioning Becoming More Common

APR 1 2021

Although supine sleep positioning of preterm infants is becoming more common, racial disparities remain, according to a retrospective analysis involving more than 66,000 mothers. Non-Hispanic Black preterm infants were 39%-56% less likely to sleep on their backs than were non-Hispanic White preterm infants, reported lead author Sunah S. Hwang, MD, MPH, of the University Colorado, Aurora, and colleagues. According to the investigators, these findings may explain, in part, why the risk of sudden unexpected infant death (SUID) is more than twofold higher among non-Hispanic Black preterm infants than non-Hispanic White preterm infants. “During the first year of life, one of the most effective and modifiable parental behaviors that may reduce the risk for SUID is adhering to safe infant sleep practices, including supine sleep positioning or back-sleeping,” wrote Dr Hwang and colleagues. The report is in the Journal of Pediatrics. “For the healthy-term population, research on the racial/ethnic disparity in adherence to safe sleep practices is robust, but for preterm infants who are at much higher risk for SUID, less is known.” To address this knowledge gap, the investigators conducted a retrospective study using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based perinatal surveillance system. The final dataset involved 66,131 mothers who gave birth to preterm infants in 16 states between 2000 and 2015. The sample size was weighted to 1,020,986 mothers. The investigators evaluated annual marginal prevalence of supine sleep positioning among two cohorts: early preterm infants (gestational age less than 34 weeks) and late preterm infants (gestational age 34-36 weeks). The primary outcome was rate of supine sleep positioning, a practice that must have been followed consistently, excluding other positions (i.e. prone or side). Mothers were grouped by race/ethnicity into four categories: non-Hispanic Black, non-Hispanic White, Hispanic, and other. Several other maternal and infant characteristics were recorded, including marital status, maternal age, education, insurance prior to birth, history of previous live birth, insurance, method of delivery, birth weight, and sex. From 2000 to 2015, the overall adjusted odds of supine sleep positioning increased by 8.5% in the early preterm group and 5.2% in the late preterm group. This intergroup difference may be due to disparate levels of in-hospital education, the investigators suggested. “Perhaps the longer NICU hospitalization for early preterm infants compared with late preterm infants affords greater opportunities for parental education and engagement about safe sleep practices,” they wrote. Among early preterm infants, odds percentages increased by 7.3%, 7.7%, and 10.0% for non-Hispanic Black, Hispanic, and non-Hispanic White mothers, respectively. For late preterm infants, respective rates increased by 5.9%, 4.8%, and 5.8% for non-Hispanic Black, Hispanic, and non-Hispanic White mothers. Despite these improvements, racial disparities were still observed. Non-Hispanic Black mothers reported lower rates of supine sleep positioning for both early preterm infants (odds ratio [OR], 0.61; P less than .0001) and late preterm infants (OR, 0.44; P less than .0001) compared with non-Hispanic White mothers. These disparities seem “to be in line with racial/ethnic disparity trends in infant mortality and in SUID rates that have persisted for decades among infants,” the investigators wrote.

Newborns Could Develop Fetal Inflammatory Syndrome From Mothers With COVID-19

APR 1 2021

Throughout the pandemic, doctors have found that pregnant women who contract COVID-19 may be able to pass the infection to their babies. In a new case study, doctors report that newborns could develop a fetal inflammatory response syndrome associated with the virus. In more than 95% of cases, if the mother gets infected, she does well and the baby does well, too. In the case report, pediatricians describe a case of fetal inflammatory response syndrome, or FIRS. The 32-year-old mother, who went into labor prematurely at 34 weeks, showed up at the hospital with COVID-19 symptoms and tested positive for the virus. She also had severe preeclampsia. The baby was delivered quickly and required mechanical ventilation. He had a fever, neonatal respiratory distress syndrome and elevated levels of several inflammatory markers. He tested negative for COVID-19 twice, as well as other infectious diseases. The baby received an antibiotic for seven days and a platelet transfusion for low platelet counts. Ventilation was removed after the fifth day, and he began recovering at the hospital. He was discharged after 22 days with no follow-up required beyond standard prematurity care. FIRS has been documented in premature births, and this case lacked some of the typical abnormalities such as umbilical cord inflammation or placental insufficiency. However, the high inflammatory levels indicated some vascular damage and multi-organ issues, which the authors attribute to exposure to the mother’s COVID-19 infection during pregnancy. The fetal inflammatory response appeared similar to the hyperinflammatory syndrome seen in children during the pandemic, which has been called multisystem inflammatory syndrome in children, or MIS-C. The low platelet counts, in particular, could indicate an inflammatory response associated with COVID-19, the authors write. Several blood and platelet abnormalities have been documented in COVID-19 cases and MIS-C. As the pandemic continues, doctors should monitor platelet counts in newborns with inflammation, the authors suggest, especially if they may have been exposed to COVID-19. In this case, platelet counts stabilized after a transfusion.

Baby Born to Partially Vaccinated Mom Has COVID-19 Antibodies

APR 1 2021

A baby girl born three weeks after her mom got the first dose of Moderna’s COVID-19 vaccine has antibodies against the virus, a February pre-print paper reported. After getting the shot, the mom, a healthcare worker in Florida, developed COVID-19 antibodies. Testing revealed those antibodies passed through the placenta to offer some potential protection to her future child, according to the authors at Florida Atlantic University. While past reports have shown how moms who’ve had COVID-19 can deliver babies with antibodies, the authors believe theirs is the first to record how vaccines during pregnancy may do the same. Authors Dr Paul Gilbert and Dr Chad Rudnick called their report a lucky “opportunity study,” since they were able to find, and follow, a pregnant person who never tested positive for COVID but got the vaccine late in pregnancy and early in the rollout. When the baby — “a vigorous, healthy, full-term girl,” according to the paper — was born, the doctors tested her cord blood for antibodies made from the vaccine, along with conducting other typical tests like for blood type. They were able to detect COVID-19 IgG antibodies (the type that indicate recovery), suggesting the baby has some protection against the virus, though how much or how long it lasts isn’t clear. Future research should illuminate if there’s an ideal time for a pregnant person to get vaccinated to maximize protection against the virus for her child. The authors say their results were expected based on what’s known about how the vaccine, and others recommended during pregnancy like the flu vaccine, work.

Preterm Birth Rate Drops During COVID-19 Pandemic in Tennessee

APR 1 2021

Statewide stay-at-home orders put in place as Tennessee fought to control the spread of coronavirus last March were associated with a 14% lower rate of preterm birth, according to a research letter published today in JAMA Pediatrics. Preterm infants have higher morbidity and mortality risks than babies born at term. Senior author Stephen Patrick, MD, director of the Vanderbilt Center for Child Health Policy and a neonatologist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, and his colleagues had observed in March that there appeared to be fewer infants than usual in the NICU at the children’s hospital. Along with colleagues at the Tennessee Department of Health and the Centers for Disease Control and Prevention, the team aimed to test if these anecdotal observations were related to the statewide lockdown order. The study is the first in the United States to confirm the trend that more persons staying at home, essentially on forced bed rest, reduced the number of late preterm infants (34-35 weeks). “Preterm birth affects 1-in-10 infants nationwide, taking a substantial toll on children, families and communities,” Patrick said. “Our study, coupled with similar studies from Europe, provide initial evidence that COVID-19 stay at home orders were associated with reductions in spontaneous preterm birth. While encouraging, we need to ensure other pregnancy complications, like stillbirth, did not increase during this time period.” Statewide stay-at-home orders in Tennessee were announced March 22 and expired on April 30. Researchers from Vanderbilt University Medical Center, the Tennessee Department of Health and the CDC collaborated to determine if the odds of pre-term birth during the stay-at-home orders in Tennessee were lower as compared with the same periods in 2015-2019 in Tennessee. There were 49,845 births among Tennessee residents during the study period. The preterm birth rate during the 2020 stay-at-home order was lower than rates in previous years (10.2% vs. 11.3%); late preterm (35-36 weeks gestation) birth rates were also lower (5.8% vs. 6.5%). “The overall decrease in preterm birth we saw during Tennessee COVID-19 stay-at-home order was driven by reductions among infants born late preterm, 35-36 weeks gestation,” said lead author Elizabeth Harvey, PhD, MPH, Maternal and Child Health Epidemiologist at CDC Division of Reproductive Health. “Although we saw less infants born preterm, we also saw infants born during this time required more respiratory assistance at birth, which may suggest they were sicker and warrants further investigation,” she added. Future research could explore whether other US states observed similar reductions, Patrick said, and how obstetric interventions for fetal and maternal complications, or lack thereof, may have contributed.

Hospital Working to Close Health Inequity Gaps

MAR 24 2021

Sinai Chicago's implementation of an EHMD is a result of Illinois House Bill 3509, which was passed and signed into law in 2020, which provides that pasteurized donated human breastmilk and breastmilk-based fortifiers shall be covered under health insurance and the medical assistance program under the Illinois Public Aid Code for premature and at-risk infants. Sinai Chicago is the first system in Illinois to implement both an EHMD and these nutritional  products since the legislation went into effect. “As Chicago’s largest private safety net health system, we serve a high percentage of low-income, minority patients, many of whom are Black women who would not otherwise have access to this standard of neonatal nutrition that their premature infants need to survive and develop,” said Karen Teitelbaum, president and CEO of Sinai Chicago. “We’re addressing this problem head-on by making an EHMD accessible to underserved families.” Proven to reduce complications and improve health, Sinai Chicago will be using nutritional fortifiers that are 100% human milk-based as opposed to cow milk-based. Studies have shown cow milk-based fortifiers can trigger feeding intolerance and increase mortality in premature infants due to the risk of severe complications. When it comes to preterm birth, there are several racial and socioeconomic disparities that need to be addressed. While 1 in 10 babies are born prematurely each year, the preterm birth rate for Black women is 50% higher than for all other women in the U.S., and prematurity is the leading cause of death among Black infants. Premature infants are at an increased risk for problems with the lungs, brain, eyes, and other organs, as well as long-term intellectual and developmental disabilities. “Offering these products as part of an EHMD in our NICU is a monumental step forward for the premature babies born here at Sinai each year,” said Brandee Grenda, clinical nutrition manager at Sinai Chicago. “For these vulnerable babies, access to an EHMD may be the difference between life and death. Not only will this give them the best chance to survive prematurity, but also to go on to thrive as healthy infants, children, and adults.” Premature infants require 20% to 40% more calories and protein than a full-term baby to make up for the growth they missed in the third trimester. To provide this extra nutrition, NICUs often add a fortifier to mother’s own milk or donor breastmilk. However, clinical studies show a direct correlation between the use of cow milk-based fortifiers and the development of devastating, and potentially terminal complications, including necrotizing enterocolitis (NEC), a disease of the intestines. In contrast, preterm infants who receive Prolacta’s products as part of an EHMD, which comprises mother’s own milk and/or donor milk with Prolacta’s 100% human milk-based fortifiers, have fewer complications and better growth outcomes, which have been linked with healthy neurodevelopment in these fragile infants, giving them the best possible chance in life. “The health disparities in the NICU are based on a variety of factors, including race, ethnicity, and income level, among others, and we are committed to ensuring that all premature infants have access to the highest standard of care available,” Teitelbaum said. Sinai Chicago offers high-quality OB/GYN services — including Level III neonatal intensive care and maternity care recognized by the Illinois Perinatal Collaborative for Excellence as well as Blue Cross Blue Shield’s “Blue Distinction” awards — at its north campus located at Mount Sinai Hospital. Its Level III NICU provides the highest level of care available for newborns just steps from the delivery room.

Masimo Monitoring Solutions Promote Newborn and Maternal Safety

MAR 8 2021

Masimo provides a variety of innovative monitoring solutions designed to improve maternal and newborn safety during childbirth and the critical first minutes of life. Masimo SET pulse oximetry’s ability to measure during motion and low perfusion has helped newborns, neonates, and pediatric patients like no other pulse oximetry. Not only has Masimo SET helped clinicians reduce retinopathy of prematurity (ROP) and improve screening for critical congenital heart disease (CCHD), but it has helped push the standard of care for babies to new heights—the evidence from CCHD studies with SET, for example, has been used in the establishment of screening guidelines used around the world. On International Women’s Day, it is especially important to recognize that, as UNICEF reports, “newborns and mothers are still dying in appalling numbers.” Every day, approximately 7,000 babies in the first month of life die, and approximately 810 women die, from preventable complications related to childbirth or pregnancy. Similarly, according to the WHO, “Although important progress has been made in the last two decades, about 295,000 women died during and following pregnancy and childbirth in 2017. The most common direct causes of maternal injury and death are excessive blood loss, infection, high blood pressure, unsafe abortion, and obstructed labor, as well as indirect causes such as anemia, malaria, and heart disease.” Masimo’s first and ongoing focus has been helping neonatologists, pediatricians, OB-GYNs, and midwives around the world provide the best care possible for newborns and their mothers. The Masimo Newborn Sensor, the first and still the only sensor of its kind, was introduced in 2004 and is designed to provide accurate arterial oxygen saturation (SpO2) and pulse rate (PR) measurements in the fastest time possible during hectic neonatal resuscitation scenarios. Alongside Newborn Sensors, Pathway, introduced in 2019 for the Root platform, helps clinicians visualize their preferred SpO2 and PR protocol during neonatal resuscitation. Eve, a software application introduced in 2014, simplifies and automates the CCHD screening process, which Masimo SET enabled. The Blue Sensor, introduced in 2004, provides accurate monitoring in cyanotic children at low SpO2 levels to help clinicians care for them and was validated specifically on infants with cyanotic disease. rainbow SpHb, noninvasive hemoglobin monitoring, introduced in 2008, can measure hemoglobin levels during pregnancy and alert clinicians to the possibility of excessive blood loss during delivery. Adding to the significant body of clinical evidence demonstrating the utility of SET pulse oximetry and other Masimo newborn and maternal solutions, a new study published in the Journal of Clinical Neonatology investigated the use of comparing Masimo perfusion index (Pi) pre- and post-ductal values on pre-term infants to aid clinicians in diagnosing hemodynamically significant patent ductus arteriosus (hsPDA). Dr Melek Büyükeren and colleagues at Hacettepe University in Ankara, Turkey found that the difference in right-hand and right-leg Pi values obtained using Masimo SET pulse oximetry was significantly higher in pre-term infants with hsPDA, leading them to conclude that the difference in Pi “has diagnostic value in hsPDA and can assist diagnosis when echocardiography is not available.” Marcelo Cardetti, MD, said, “As Head of the Neonatology Service of the Clinic and Maternity of the Center for Endocrinology and Human Reproduction (CERHU) in San Luis, Argentina, we have been using Masimo pulse oximetry monitors with SE for approximately 8 years in all high-risk newborns and also for newborn resuscitation. In addition, we use Masimo SET monitors for the detection of CHD and hypoxemia in all newborns in the mother-infant unit. Furthermore, our neonatal department is engaged in a research protocol on regional cerebral oxygenation (O3) with neonatal sensors for Masimo Root - to know what happens with cerebral oxygenation during routine clinical procedures in the NICU. This monitoring, in addition to SpO2 and perfusion index (Pi), perfectly shows us what is happening with oxygenation of seriously ill newborns in real-time and in a noninvasive way. Masimo SET’s innovative technology far overcomes the limitations of conventional oximetry and the Pi is an important clinical tool in the care of sick neonates. This monitor and the special neonatal RD sensors have been of great value for the prevention of ROP and for successful and quick, accurate, and reliable steps needed in resuscitation in the delivery room.” Hernando Baquero, MD, commented, “I am a pediatrician, neonatologist, clinician, educator and researcher in a major university in Colombia, with several publications on noninvasive neonatal SpO2 monitoring and oxygenation. The introduction in the Latin American market of Masimo SET technology dramatically improved neonatal care in our countries. In contexts with serious resource limitations, as is the case in most neonatal units in our countries, it was vital to be able to provide quality care to the most vulnerable population due to their health conditions (e.g. hypoperfusion) or their biological characteristics (e.g. prematurity). Having reliable, fast, and stable readings as provided by SET and its neonatal sensors improved the chances of many of our newborns.” Anne de-Wahl Granelli, PhD, Biomedical Scientist, RDCS(PE), Medical Centre Manager, Sweden, said, “The integration of pulse oximetry into the CCHD screening process has made a significant impact on the detection of congenital heart disease and neonatal health. In clinical studies, the use of pulse oximetry screening with SET technology significantly improved the detection of duct dependent heart disease before hospital discharge. In 2011, the U.S. Department of Health and Human Services added pulse oximetry screening of newborns for CCHD to the Recommended Uniform Screening Panel. Today pulse oximetry has become a global standard of care when screening newborns for CHD.” Sergio Golombek, MD, MPH, FAAP, Member of the Board and Past President of the Ibero-American Society of Neonatology (SIBEN), said, “I have authored and published several scientific studies in relation to newborn oxygenation and screening for CCHD. Masimo SET and new innovations and sensor development like RD sensors for noninvasive monitoring represent excellent technology that we can trust, that work promptly and accurately when we need it the most, and are designed specifically with ill newborn babies in the NICU in mind. SET technology allows us also to do the pulse oximetry test or CCHD screening on newborn babies in our units, knowing well that we can fully trust the results. The technology is very easy to use and understand, and makes us deliver better clinical care.” Katsuyuki Miyasaka, MD, PhD, Executive Advisor, Wayo Women’s University Graduate School, Tokyo and Professor Emeritus, St. Luke’s International University, Tokyo, said, “As a critical care pediatric anesthesiologist, reliable and accurate pulse oximetry is paramount to optimal patient outcomes. Some suggest pulse oximetry is the fifth vital sign. Clinicians can rely on the sensitivity and specificity provided by Masimo’s measure-through-motion technology in the management of children in the PICU. The use of pulse oximetry can lead to fewer adverse events in the recovery room by capturing accurate readings even during movement such as shivering in critically ill or unstable patients.” Mark Ansermino, MBBCh, MMed, Director of the Center for International Child Health and Professor, Department of Anesthesiology, Pharmacology & Therapeutics at the University of British Columbia, Canada, said, “Anemia is a significant public health problem that especially affects the quality of life, health status, and survival of mothers and children around the world. Having access to continuous hemoglobin monitoring technology can help provide visibility to hemoglobin levels. The noninvasive nature of the SpHb solution makes it comfortable for the mother and child and makes monitoring during childbirth feasible even in low-resource settings.” Asrat Dibaba Tolossa, MD, MPH, is Chief of Party for the Global Affairs Canada ENRICH (Enhancing Nutrition Services to Improve Maternal and Child Health) Program, a multi-year, multi-country initiative designed to improve the health and nutrition of mothers, newborns, and children. As part of the program, ENRICH has been conducting a study in central Tanzania, where maternal and child care services are often overburdened, using the Masimo Rad-67 Pulse CO-Oximeter, which provides spot-check SpHb measurements. Dr. Tolossa commented, “In our field experimentation with the Rad-67, we found out that the device can be used easily by lower-level health workers in the communities for screening and referral of patients to health facilities for further assessment and treatment. There was also a high acceptance rate by community members as the method is noninvasive.” Joe Kiani, Founder and CEO of Masimo, said, “From our inception, we have been committed to improving outcomes for the youngest and most fragile patients. Our foundational SET pulse oximetry was designed with newborns in mind. With rainbow Pulse CO-Oximetry, we have made the noninvasive monitoring of child and mother clinically more meaningful. While we stand behind the fact that we have the best pulse oximetry for all patients, especially the most fragile patients, we continue to seek new ways to help clinicians provide newborns and their mothers with the best care possible. On this International Women’s Day, we thank the caregivers who have dedicated themselves to the health of newborns and their mothers, as well as women everywhere, for their achievements, their sacrifices, and for nurturing us all.” SpHb is not intended to replace laboratory blood testing. Clinical decisions regarding red blood cell transfusions should be based on the clinician’s judgment considering, among other factors, patient condition, continuous SpHb monitoring, and laboratory diagnostic tests using blood samples. Noninvasive, continuous SpHb has CE clearance for all patients and in the U.S. has received FDA clearance for patients >3 kg but is not currently indicated for patients <3 kg. As part of its U.S. FDA 510(k) clearance, spot-check SpHb on Rad-67 is contraindicated for use on pregnant patients and not indicated for use on pediatric patients or patients with renal disease. Eve has not obtained FDA clearance and is not available in the United States.

New Study in Newborns Finds Nellcor Pulse Oximetry Technology Provides Fast Stable Oxygen Saturation Readings

FEB 9 2021

Medtronic announced the results of an independent, prospective observational study comparing the efficacy and reliability of two pulse oximeters — Nellcor Bedside SpO2 Patient Monitoring System and Masimo Radical-7 Pulse CO-Oximeter, both set at the highest sensitivity ("Neonatal" and "Fast" for Nellcor pulse oximetry technology and "Max" for Masimo) — with electrocardiography (ECG) monitoring following the delivery of 60 term newborns by Caesarian section. Pulse oximetry is a simple, noninvasive bedside test that can accurately detect the percentage of blood saturated with oxygen and measure heart rate. According to the study, a stable signal was obtained from all 60 newborns with the Nellcor pulse oximeter but from only 55 newborns with the Masimo pulse oximeter. Of the 55 newborns with stable signals from both monitors, the mean time to stable signal with the Nellcor pulse oximeter was 15 seconds compared with 27 seconds with the Masimo pulse oximeter. The average difference of 12 seconds between the monitors was statistically significant (P <0.001). The results of this prospective observational comparative study were published online in the Journal of Perinatology, the official journal of the Section on Neonatal-Perinatal Medicine of the American Academy of Pediatrics and the Neonatal-Perinatal Association of the United States. The study was conducted at the Rabin Medical Center, Petach Tikvah, Israel, a university-affiliated tertiary care center with approximately 9,000 births annually. The principal investigator of the study is Professor Ruben Bromiker, MD, Department of Neonatology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. The availability of a pulse oximeter for monitoring oxygenation and heart rate of newborns contributes to decision making during resuscitation and stabilization, and can help physicians minimize the risk of either too low or too high blood oxygen levels and associated morbidity and mortality, the authors state in the discussion section. Both the Nellcor and Masimo pulse oximeters provide relatively quick measurements of oxygen saturation and heart rate in most cases well before the so-called "golden first minute" of resuscitation. The results conclude that Nellcor showed a statistically significant difference in the time needed to deliver a stable signal between devices which could potentially impact the provision of care during neonatal resuscitation. With respect to heart rate, the study observed there was a difference of 12 beats per minute (BPM) between the Masimo monitor and the reference standard ECG in 18 of 51 (35%) newborns. In all 18 newborns, the ECG showed a heart rate >100 BPM versus <100 BPM with the Masimo monitor, which may be observed as false bradycardia with the Masimo device. In 16 of the 51 (31%) newborns, the difference in heart rate with the Masimo monitor was 40 BPM compared with the rate recorded by the comparator ECG. In contrast, the heart rate detected by the Nellcor pulse oximetry monitor correlated closely with that of the ECG, with no recording of false bradycardia and no reading having >40 BPM difference compared with the ECG. "A newborn's heart rate is a key component of physician assessment for resuscitation, and helps to identify not only those in need of intervention but also their response to treatment. Those who do not achieve a heart rate of 100 beats per minute by five minutes of life are at an increased risk of death," said Frank Chan, president, Patient Monitoring, which is reported as part of the Minimally Invasive Therapies Group at Medtronic. "This study demonstrates that physicians can rely on Nellcor pulse oximetry technology to post data quickly, offer consistency, perform well with these patients, and meet the requirements of the neonatal resuscitation program guidelines, which are especially important in the delivery room." These findings are important because, per the neonatal resuscitation program (NRP) guidelines, only one minute should be allotted for completing the initial monitoring steps to inform reevaluation and initiation of ventilation.

New NeoSmile Plus Temperature Probe Cover Available

JAN 29 2021

Neotech Products announces the NeoSmile Plus Temperature Probe Cover is now available. Unlike our original NeoSmile that uses hydrocolloid for long-lasting adhesion, NeoSmile Plus features a silicone gel base. The unique, skin friendly gel allows for the temp prob cover to be repositioned with ease. “Ever since being introduced to silicone adhesives we searched for the right product to implement it. We knew that temp probe covers could be a challenge, but wanted to bring something unique to the market. We started to work with silicone adhesives for this, thus resulting in the creation of the NeoSmile Plus,” said Sara Dimmitt, Manager of Business Development. The new NeoSmile Plus is a skin friendly option that can be moved or adjusted as needed. Yet, it securely holds the probe in place for reliable readings. The reflective foil cover helps protect the temperature probe from ambient and radiant heat in an incubator, and the foam layer provides added insulation. Various test users stated: “Easier to move; a more accurate reading than our current product.” “Sticks better than our old one and it’s smaller.” “I like the thin, low profile.” “Very impressed with this product.”

Maternal COVID Antibodies Cross Placenta, Detected in Newborns

JAN 29 2021

Antibodies against SARS-CoV-2 cross the placenta during pregnancy and are detectable in most newborns born to mothers who had COVID-19 during pregnancy, according to findings from a study presented at the virtual Society for Maternal-Fetal Medicine (SMFM) 2021 Annual Pregnancy Meeting. "I think the most striking finding is that we noticed a high degree of neutralizing response to natural infection even among asymptomatic infection, but of course a higher degree was seen in those with symptomatic infection," Naima Joseph, MD, MPH, of the Emory University School of Medicine, Atlanta, Georgia, said. "Our data demonstrate maternal capacity to mount an appropriate and robust immune response," and maternal protective immunity lasted at least 28 days after infection, Joseph said. "Also, we noted higher neonatal cord blood titers in moms with higher titers, which suggests a relationship, but we need to better understand how transplacental transfer occurs as well as establish neonatal correlates of protection in order to see if and how maternal immunity may also benefit neonates." The researchers analyzed the amount of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in maternal and cord blood samples prospectively collected at delivery from women who tested positive for COVID-19 at any time while pregnant. They used enzyme-linked immunosorbent assay to assess for antibodies for the receptor binding domain of the SARS-CoV-2 spike protein. The 32 pairs of mothers and infants in the study were predominantly non-Hispanic Black (72%) and Hispanic (25%), and 84% used Medicaid as their payer. Most of the mothers (72%) had at least one comorbidity, most commonly obesity, hypertension, and asthma or pulmonary disease. Just over half the women (53%) were symptomatic while they were infected, and 88% were ill with COVID-19 during the third trimester. The average time from infection to delivery was 28 days. All the mothers had IgG antibodies, 94% had IgM antibodies, and 94% had neutralizing antibodies against SARS-CoV-2. Among the cord blood samples, 91% had IgG antibodies, 9% had IgM antibodies, and 25% had neutralizing antibodies. "It's reassuring that so far, the physiological response is exactly what we expected it to be," Judette Louis, MD, MPH, an associate professor of ob/gyn and the ob/gyn department chair at the University of South Florida, Tampa, Florida, said. "It's what we would expect, but it's always helpful to have more data to support that. Otherwise, you're extrapolating from what you know from other conditions," said Louis, who moderated the oral abstracts session. Symptomatic infection was associated with significantly higher IgG titers than asymptomatic infection (P = .03), but no correlation was seen for IgM or neutralizing antibodies. In addition, although mothers who delivered more than 28 days after their infection had higher IgG titers (P = .05), no differences existed in IgM or neutralizing response.

New Tool Helps Predict Preterm Birth, Neonatal Problems

JAN 29 2021

Progesterone metabolites in plasma coupled with patient factors can help identify pregnant women at risk for preterm delivery and neonatal morbidity, researchers report. This research "breaks new ground," by demonstrating that 11-deoxycorticosterone (DOC) and 16-alpha-hydroxyprogesterone (16-alpha-OHP) in plasma can predict the extent of preterm delivery-associated neonatal morbidity and length of neonatal hospitalization when measured early in pregnancy, Dr. Avinash Patil of the University of Arizona College of Medicine in Phoenix said. "Previously, much of the research in obstetrics focused purely on predicting gestational age at delivery as a surrogate (estimate) for neonatal outcomes," he said. "The findings of this research are particularly applicable to value-based healthcare models, which are increasingly prevalent for maternity care. The ability to screen a population of pregnancies and identify those at risk for poor neonatal outcomes can decrease healthcare costs while improving the health of newborns." An imbalance of progesterone metabolism has been linked to an increased risk of preterm delivery. In a prior study, Dr Patil and his colleagues found that DOC and 16-alpha-OHP, when measured during the late first trimester/early second trimester, can predict a woman's risk for spontaneous preterm delivery prior to 32 weeks. In the new study in PLOS ONE, they set out to determine if obstetric and demographic variables known during the pregnancy, when combined with these steroid-metabolite biomarkers obtained early in pregnancy, could predict the risk of preterm-delivery-associated neonatal morbidity in a low-risk population of pregnant women. The researchers quantified the two progesterone metabolites using mass spectroscopy from plasma of 58 pregnant women collected in the late first trimester or early second trimester. They combined the steroid-level data with patient demographic and obstetric history data in multivariable logistic regression models. Forty of the pregnant women delivered preterm (<37 weeks) and 18 delivered at term (greater than or equal to 37 weeks). Ten women had elevated Hassan scores of 2 or higher, with the remaining 48 had scores of zero to one. Women delivering babies with an elevated Hassan score of two to four were more likely to have a higher BMI and deliver at a lower gestational age than peers delivering babies with a low Hassan score. Neonates with an elevated Hassan score were born at a lower gestational age and birthweight, were more likely to receive antenatal corticosteroids, have a lower five-minute Apgar score, and require resuscitative measures at birth compared to babies with a low Hassan score. The final neonatal morbidity model, which incorporated antenatal corticosteroid exposure and fetal sex, was able to predict high morbidity (a Hassan scale score of 2 or higher) with an area under the ROC curve (AUROC) of 0.975, with an optimal sensitivity of 90% and specificity of 96%. The final model characteristics included a positive predictive value (PPV) of 0.82 and negative predictive value (NPV) of 0.98. With the addition of the two biomarkers to the final model, the positive likelihood ratio for neonatal morbidity as measured with a Hassan Score of two to four was 21.6 (95% confidence interval, 5.48 to 85.21) for women with a positive test result. Newborns of women who screened positive with the model had significantly longer median length of hospital stays compared with newborns of women who screened negative (53 days vs. 4.5 days; P=0.0017). The researchers caution that this "discovery work and findings need to be validated in an independent cohort before we can fully implicate the changes in these biomarkers with preterm birth and neonatal morbidity." "The test is not yet clinic ready," Dr Patil said. "Steps that remain include validation of the results and meeting federal guidelines for development of new tests. The biomarkers in the study are very promising, so we are pushing forward to accomplish these milestones and make a new test reality.

Labor Induction at 39 Weeks May Improve Neonatal Outcomes

JAN 29 2021

Labor induction at 39 weeks instead of 41 weeks may have a positive impact on neonatal outcomes, Aaron B. Caughey, MD, PhD, said at the 2020 virtual meeting of the American College of Obstetricians and Gynecologists. For much of the 20th century, term gestation has been defined as 37 weeks and beyond, said Caughey, of Oregon Health & Science University, Portland. He noted several studies showing a U-shaped distribution in neonatal outcomes during the period from 37 weeks to 41 weeks for some outcomes, including Apgar scores. However, respiratory outcomes in a study from 2008 showed an increase, with meconium stained amniotic fluid increasing from 2.27% at 37 weeks to 10.33% at 41 weeks, and meconium aspiration increasing from 0.07% at 37 weeks to 0.27% at 41 weeks. The study "that really got everyone's attention" in terms of neonatal outcomes was published in 2009 in the New England Journal of Medicine. The cohort study included 24,077 elective cesarean deliveries between 37 and 42 weeks and reviewed a range of neonatal outcomes based on gestational age. The rate of any adverse outcome decreased from 37 weeks to 39 weeks, "but then started going back up again," Caughey said. He reviewed data from another study that factored in stillbirth and the risk of expectant management based on gestational age. A composite risk of perinatal death with expectant management was 15.4 deaths per 10,000 cases at 37 weeks and 39 weeks, but increased to 19.9 at 42 weeks. "The morbidity appears to have a U-shaped distribution and the mortality seems to favor delivery at 39 weeks," he said. When it comes to induction of labor, medically indicated vs. nonmedically indicated does matter, Caughey said. Factors not considered a medical indication include impending macrosomia, increased risk for developing preeclampsia or intrauterine growth retardation, and a favorable cervix, he noted. "For indicated induction of labor, the risks and benefits of induction of labor vs. expectant management have been considered and weighed in by the field of experts that care for pregnant women," he said. With nonmedically indicated induction, experts "either decided that risks and benefits don't favor induction of labor, or we haven't come down hard on what the protocol might be. "It is important to consider the risks and benefits," said Caughey. The factors you want to include are neonatal outcomes, maternal preferences, and doctor preferences. However, "we want to be thoughtful about this intervention," because of the association of higher costs and increased risk of cesarean with induction of labor. As for timing of induction of labor, certain conditions favoring early-term induction include preeclampsia and gestational hypertension, chronic hypertension, diabetes, intrauterine growth restriction, nonreassuring fetal testing, cholestasis, placenta previa or accreta, and twins. As for late-term induction of labor, "at 41 weeks it is pretty clear that neonatal outcomes would be improved by delivery," he said. Historically, clinicians have raised concerns about the increased risk of cesarean delivery following induction of labor, but this risk has not been borne out in recent studies. Caughey said. However, in the findings from the ARRIVE trial, a large study of 6,106 women who were randomized to induction or labor or expectant management at 39 weeks, "they found a reduction in their risk of cesarean delivery compared to expectant management (18.6% vs. 22.2%). Rates of preeclampsia also were lower among induced women, while rate of chorioamnionitis, postpartum hemorrhage, and intensive care were similar between the groups. The researchers did not find significant differences in perinatal outcomes.

Russian Woman United With Baby After COVID-19 C-section and 51 Days on Life Support

JAN 15 2021

A Russian woman who was admitted to hospital heavily pregnant and with what doctors said were potentially fatal levels of COVID-19 lung damage was reunited with her newborn baby after spending 51 days on a ventilator and giving birth by C-section. Oksana Shelomentseva was hospitalised in the Siberian city of Irkutsk in the 32nd week of her pregnancy, having had a high fever for three days. A scan showed catastrophic lung damage and that her unborn baby was not receiving enough oxygen. “My temperature rose to 38 degrees Celsius and I battled with it for three days, but it became clear I could not do that independently,” Shelomentseva said. Doctors immediately performed a Caesarean section to deliver baby girl Liza, but still feared for the recovery of the mother who went on to spend almost two months on a ventilator to help her breathe. “It was a very serious case,” said Galina Shkandriy, head of the Anaesthesiology and Intensive Care Department at the hospital where Shelomentseva was treated. “The entire ward is to thank for the patient recovering from 100% lung damage,” the RIA news agency cited her as saying. “When we consulted doctors from around the city, they all said ‘you probably won’t be able to do anything because with those indicators, people don’t survive.’” “Oksana spent 51 days in intensive care in a most serious condition. We were able to save her from the most severe lung damage and multiple organ failure,” said Shkandriy. Shelomentseva was discharged on Monday and returned home to her husband and three children, including baby Liza. At 3,448,203, Russia has the world’s fourth-largest tally of coronavirus cases after the United States, India and Brazil, and has reported 62,804 deaths from the virus.

Newborns Benefit From Skin-to-Skin Contact With Father After C-Section

JAN 15 2021

There is an undeniable amount of research on the natural benefits of skin-to-skin contact for mum and baby. Essentially, skin-to-skin contact is simply that, babies’ skin against their parents’ skin immediately after birth and continuing later at home. It naturally regulates a new-born’s temperature, heart rate and breathing while elevating their blood sugar which is essential for energy. It also encourages breastfeeding and colonises the baby’s natural gut bacteria to that of its mother, making their intestinal bacteria more diverse, protecting them from illness and infection. Skin-to-skin is not just reserved for mum, however. It is vitally important that dad also partakes in this ancient art of snuggling with their new-born. In fact, this close contact with dad brings about many of the same remarkable benefits as it does with mum. Being warm and snug in your arms, is your new-born’s favourite place to be. They often cry less, sleep better and are more content when warm against your skin. Be that mum or dads. The benefits of skin-to-skin with dad are not always advertised as strongly as they are with mum considering an important facet of this connection is establishing breastfeeding. But when a father has the opportunity to hold their baby close, skin-to-skin, we see the love hormone, oxytocin, doing exactly what it needs to — creating the natural bond between parent and child and helping you to fall in love with them. This is the same hormone that makes a woman’s uterus contract in labour. Research has also shown skin-to-skin helps to develop more caring behaviour in dad and also a more sensitive approach to parenting. Furthermore, it has been shown to decrease cortisol levels in new dads which is greatly linked to anxiety. Less stress and less anxiety have a direct positive, correlation on the parent’s relationship which naturally affects the family dynamic.

Labor Induction at 41 Weeks Tied to Lower Morbidity, Mortality Than Expectant Management

JAN 15 2021

Inducing labor at 41 weeks may result in a lower risk of severe adverse perinatal and neonatal outcomes than expectant management until 42 weeks, a systematic review and meta-analysis of randomized clinical trials in PLOS Medicine suggests. Researchers examined data from three clinical trials with a total of 5,161 low-risk singleton pregnancies. They assessed a composite primary outcome of perinatal mortality, including stillbirth or neonatal mortality within 28 days of birth, and neonatal morbidity including: five-minute Apgar score below 4, hypoxic ischemic encephalopathy, intracranial hemorrhage, neonatal convulsions, respiratory distress, mechanical ventilation within 72 hours of birth, and obstetric brachial plexus injury. The analysis included individual data for 4,561 participants, including 2,281 women scheduled for labor induction at 41 weeks; four in five of these women ultimately had the scheduled induction and the rest delivered spontaneously. Among 2,280 women assigned to expectant management until 42 weeks, about 30% needed induction and the rest delivered spontaneously. In the induction group, 10 cases (0.4%) met the composite primary endpoint of perinatal death or severe neonatal morbidity; 23 cases (1.0%) occurred in the expectant management group. "The take home messages is that induction of labor will decrease the risk of adverse perinatal outcome, including mortality, without increasing the morbidity risk for the woman including cesarean delivery, perineal laceration grade III-IV and postpartum hemorrhage — especially in nulliparous women," said lead study author Dr Marten Alkmark of the University of Gothenburg in Sweden. "For parous women the risk of adverse perinatal outcome is very low with both induction of labor and expectant management," Dr Alkmark said by email. Among nulliparous women, the risk of the primary outcome was lower among those in the induction group (0.03%) than in the expectant management group (1.6%). However, the risk of the primary outcome among multiparous women was similar with induction (0.6%) and expectant management (0.3%). None of the women in the study had a history of cesarean delivery or other major uterine surgery, and all of them had low-risk singleton pregnancies with the fetus in cephalic position. Researchers also looked at perinatal secondary outcomes and found there was only one perinatal death in the induction group, a stillbirth that occurred after randomization but before induction. Seven of the eight perinatal deaths in the expectant management group were stillbirths, while one infant died because of hypoxic ischemic encephalopathy. Limitations of the analysis include the relatively small size of the study compared with other reviews of induction versus expectant management, as well as some heterogeneity in how the two trials included in the analysis defined some endpoints. "The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy, probably linked to the placenta deteriorating," said Sara Kenyon, a professor of evidence based maternity care at the University of Birmingham in the U.K. who wasn't involved in the study. "However, it wasn't clear when the optimal time to induce women is and this study suggests that, particularly for nulliparous women, that this is 41 weeks," Kenyon said by email.

Supplemental Oxygen During Childbirth May Not Be of Value to Babies

JAN 15 2021

Babies who suffer oxygen deficiencies during birth are at risk of brain damage that can lead to developmental delays, cerebral palsy and even death. To prevent this, most women in labor undergo continuous monitoring of the baby's heart rate and receive supplemental oxygen if the heart rate is abnormal, with the thought that this common practice increases oxygen delivery to the baby. However, there is conflicting evidence about whether the long-recommended practice improves infant health. Now, a comprehensive analysis — led by Washington University School of Medicine in St. Louis - looking at 16 previous trials of the practice has found no benefit in providing supplemental oxygen to mothers during labor and delivery. Infants born to women who received supplemental oxygen fared no better or no worse than those born to women who had similar labor experiences but breathed room air. Each year, 1.5 million women in the U.S. — two out of three pregnant women — receive supplemental oxygen at some point during childbirth, according to the researchers. The decades-long practice is recommended by the American College of Obstetricians and Gynecologists to treat abnormal fetal heart rates, which may indicate the baby's oxygen levels are low and pose health risks. Raghuraman added that supplemental oxygen is given mostly as a preventive measure, a practice that began during the 1960s. "Fetal monitoring can indicate a possible abnormal issue such as oxygen deprivation," she said. "But about 80% of the time, women giving birth fall into an intermediate category, in which cases are not completely benign but also not high-risk. And in cases such as these, supplementing oxygen offers no additional benefits." For the analysis, the researchers examined 16 studies published from 1982 through 2020 of randomized controlled trials in humans — including one from School of Medicine researchers — involving more than 2,052 women in childbirth. "Overall, the studies produced mixed results, with some indicating a benefit and others indicating no benefit," Raghuraman said. "That was the reason for doing a meta-analysis. By pooling the numbers of patients across the studies we could get a more definitive answer than looking at individual studies." The researchers evaluated the pH levels of the babies' blood from samples taken shortly after birth. The pH measures the body's acidity and alkalinity in blood and other fluids, with neutral equaling pH value of 7. For infants, Raghuraman said anything less than 7.1 is considered abnormal and indicates oxygen deprivation. The researchers also compared neonatal intensive care admission rates and Apgar scores — a well-established test to evaluate newborn health at one and five minutes after birth. Apgar scores check a baby's heart rate, breathing and other signs to determine if the baby needs additional medical care. "Comparing the health of the babies whose mothers received oxygen and those whose mothers didn't, we found that the differences were essentially zero," Raghuraman said.

Breastfeeding, Rooming-in Can Be Practiced by Mothers With SARS-CoV-2

JAN 15 2021

For women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, rooming-in and breastfeeding are feasible for those who can care for their infants, with postnatal transmission occurring infrequently, according to a study published online Dec. 7 in JAMA Pediatrics. Andrea Ronchi, M.D., from the Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico in Milan, and colleagues examined the risk for postnatal transmission of SARS-CoV-2 from infected mothers to their neonates following rooming-in and breastfeeding in a prospective, multicenter study involving mother-infant dyads followed up for 20 days of life. Participants included 62 neonates born to 61 mothers with SARS-CoV-2 infection who were eligible for rooming-in based on their clinical condition and negative infant nasopharyngeal swab result at birth. The researchers found that only one infant (1.6 percent) was diagnosed as having SARS-CoV-2 infection at postnatal checks. In that case, due to severe worsening of the mother's clinical condition, rooming-in was interrupted on day 5 of life. On day 7 of life, the neonate became positive for the virus and developed transient mild dyspnea. Almost all (95 percent) neonates were breastfed. "We believe that SARS-CoV-2-infected mothers in good clinical condition and willing to take care of their babies should be encouraged to practice rooming-in and breastfeeding after being carefully instructed about the appropriate droplet and contact precautions," the authors write.