Neonatal healthcare refers to the provision of medical care for newborns up to 28 days after birth. There are three levels in neonatal care. Level I consists of caring for healthy newborns. Level II provides intermediate or special care for premature or ill newborns. Infants at this level may need special therapy, or simply need more time before being discharged. Level III, or neonatal intensive care, treats newborns that cannot be treated in the other levels and are in need of advanced technology to survive. Common diagnoses and pathologies treated in Level III include anemia, apnea, respiratory distress syndrome, hydrocephalus and more.
One of the most common issues with newborns is premature birth. The normal gestation period for humans is about 40 weeks. Any birth that happens before the due date, or before 37 weeks, is defined as a premature birth. The most common reasons for premature birth are a ruptured amniotic sac, a weak cervix, abnormalities in the uterus, diabetes, high blood pressure and poor nutrition.
The institutions and physicians at the South Texas Medical Center are at the forefront of care for newborns with critical or special needs. Not only can patients benefit from exceptional service and a safe environment during delivery, they can also take advantage of the family-centered approach the institutions at the South Texas Medical Center provide.
U.S. judge halts major part of Texas law restricting abortions
By Reuters Staff
AUSTIN, Texas (Reuters) - A U.S. judge struck down parts of a law seen as restricting abortions in Texas, saying in a decision on Friday that a provision requiring clinics to have certain hospital-like settings for surgeries was unconstitutional.
"The act's ambulatory-surgical center requirement places an unconstitutional undue burden on women throughout Texas," U.S. District Judge Lee Yeakel said in his decision.
The so-called ambulatory surgical center requirement was to have gone into effect on Sept. 1. It would require clinics to meet a set of buildings standards that abortion rights advocates said were unnecessary, especially when an abortion is medically induced.
Advocacy groups who brought the suit, including Whole Women's Health, had argued the requirement was costly and had no medical benefit, seeing it as mostly intended to shut clinics that could not afford to make the changes.
The state argued the requirement reduces complications and increases patient care when complications occur.
African-Americans may be getting inferior breastfeeding advice
By Ronnie Cohen
NEW YORK (Reuters Health) - Mothers who give birth in areas with higher concentrations of African-Americans are less likely to get breastfeeding support on maternity wards than mothers in other communities, a new study shows.
Breastfeeding provides well-documented health benefits to infants and their mothers. But African-American women are about 16 percent less likely to nurse their newborns than white women, according to research from the Centers for Disease Control and Prevention (CDC).
The study of 2,727 American hospitals and birth centers sought to uncover the reasons for the racial disparities.
"What this study suggests is that hospital practices, not just women's choices, beliefs or values, contribute to the observed racial disparities in infant feeding," sociologist Elizabeth Armstrong told Reuters Health in an email.
"Where a woman lives - and consequently gives birth - affects how her infant is nourished. Black babies and their mothers are less likely to start off in environments that support the optimal level of care for infant feeding and mother-baby bonding," she said.
Armstrong, a professor at Princeton University in New Jersey, was not involved in the current study.
The CDC researchers gathered data on optimal maternity care from hospitals and birth centers across the U.S. and compared areas with a higher percentage of black residents to areas with a lower percentage.
Facilities in zip codes with more black residents were more likely to give tests to their staff on breastfeeding support, the researchers wrote in the CDC's Morbidity and Mortality Weekly Report.
At the same time, maternity wards in areas with more African-Americans were less than half as likely to limit the use of breastfeeding supplements, such as formula. A 2006 report from the Government Accountability Office showed that when hospitals hand out free formula samples, mothers tend to breastfeed less.
Hospitals in neighborhoods with more African-Americans were also 7 percent more likely to give newborns pacifiers, which can inhibit breastfeeding.
And facilities in areas with higher concentrations of whites were nearly 14 percent more likely to promote early initiation of breastfeeding and nearly 12 percent more likely to work to keep newborns next to their mothers in the hospital. Both factors are known to promote breastfeeding.
Hospitals in neighborhoods with more blacks were significantly less likely to offer breastfeeding support after mothers returned home.
"This study shows the best support is not where it's most needed," Dr. Miriam Labbok told Reuters Health in a telephone interview. "If we could just change the hospital practices, I think we could have a lot more equity."
A pediatrician, Labbok is the founding director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill and was not involved in the current study.
Lead author Jennifer Lind told Reuters Health that it's too early to understand the reasons for the racial differences.
"Because this is the first stab or look into the whole issue, we really don't know why we're seeing these disparities," she said in a telephone interview. Lind is an epidemiologist with the CDC.
"We found that hospital practices during childbirth have a major impact on whether a mother is able to start and continue breastfeeding," she said. "We think it's really important that all hospitals - regardless of where they're located - apply policies and practices proven to be supportive of breastfeeding so that more babies are able to reap the numerous benefits."
Research has shown that breastfed babies, especially those fed just breast milk without any formula, are less likely to die of sudden infant death syndrome, or SIDS (see Reuters Health story of June 14, 2011 here: http://reut.rs/VPTRIv). African-American babies are more likely to die from SIDS, also known as "crib death."
Breastfeeding also lowers babies' risk of infection, childhood obesity, asthma and type 2 diabetes, Lind said. Mothers who nurse their babies cut their chances of being diagnosed with breast and ovarian cancer, she said.
The American Academy of Pediatrics recommends exclusive breastfeeding for six months and continued breastfeeding for another year while babies are introduced to complementary foods.
In 2011, 79 percent of new American mothers started to breastfeed their infants, but fewer than half were still breastfeeding at six months, according to the CDC.
Only 195 U.S. hospitals, accounting for 8 percent of all births, have earned the status of Baby Friendly, the gold standard for optimal maternity care established by the World Health Organization and UNICEF in 1991, Armstrong said.
"I really think what we're seeing here is very much due to the fact that hospitals put up barriers," Labbok said. "I'd say this is a very good reflection of something that's wrong, and it needs to be fixed."
She noted that African-American women continued to nurse their babies at higher rates than white women in the 1960s, when breastfeeding in the U.S. hit an all-time low.
"In general, there has been this incorrect assumption that because you're black, you don't breastfeed, and that is just out and out wrong," Labbok said. "We've really got to strive for equity. This study shows very clearly that we have some work to do."
SOURCE: http://1.usa.gov/1pRnjKa Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, online August 22, 2014.
Calorie goals, support may help limit pregnancy weight gain
By Kathryn Doyle
NEW YORK (Reuters Health) - Compared to obese expectant mothers without special care, those given individualized calorie goals and weekly group meetings gained less weight during pregnancy and had fewer oversized newborns in a new study.
"More than half of women in the U.S. start out their pregnancies overweight or obese, and approximately half of all pregnant women gain too much weight during pregnancy, which can lead to increasing overweight and obesity," said lead author Dr. Kimberly K. Vesco of the Center for Health Research at Kaiser Permanente, Northwest, in Portland, Oregon.
"Women who gain too much weight during pregnancy may retain some of that extra weight and enter their next pregnancy at a higher weight than their prior pregnancy, which can increase their risk for pregnancy complications such as gestational diabetes, high blood pressure, babies that are too big and cesarean section," Vesco, a board-certified obstetrician-gynecologist, told Reuters Health by email.
The U.S. Institute of Medicine (IOM), a government advisory body, has issued guidelines for healthy amounts of weight gain during pregnancy, although they remain controversial (see Reuters Health story of November 17, 2010, here: http://reut.rs/1AXzmJz).
The guidelines suggest that normal-weight women gain around 25 pounds during pregnancy, but that obese women limit their weight gain to between 11 and 20 pounds.
For the new study, rather than giving obese women the IOM target range, Vesco's team asked 114 of them to try to maintain their weight at the start of the study, which was early in pregnancy, and assumed the women would gain a little weight anyway.
Vesco and her team divided the participants, who were all obese and at least seven weeks pregnant when recruited into the study, into two groups. Women in one group received a single advice session from a dietician with general information about eating a healthy diet during pregnancy and usual care for the rest of their pregnancies.
The second group attended two individualized counseling sessions where the dietician gave each woman tailored diet and physical activity guidelines, recommending at least 30 minutes of moderate activity each day, geared toward helping them gain no more than three percent of their current body weight throughout pregnancy.
For a 200-pound woman, that would mean gaining no more than six pounds.
Once they had their individual goals, the women started attending weekly 90-minute group sessions covering topics including nutrition, exercise and behavioral change. They were also given a goal for physical activity in the next week. The women kept food and activity journals and tracked their weight each week.
By week 34 of pregnancy, women in the weight-control group had gained an average of 11 pounds and women in the comparison group had gained 18.5 pounds.
By two weeks after giving birth, moms in the weight control group were an average of almost six pounds lighter than when they enrolled in the study, whereas in the comparison group moms were an average of 2.6 pounds heavier.
Nine percent of babies born to mothers in the weight-control group were large for their gestational age - which increases the risk of birth injury and infant low blood sugar - compared to 26 percent of babies in the other group, according to the results published in the journal Obesity.
"A common misconception during pregnancy is that women need to eat for two," Vesco said. "That's just not true. Most pregnant women need no extra calories in the first trimester and only 200-300 extra calories in the second and third trimesters," she said.
"Our study found that limited or no weight gain may be beneficial for mom and baby, but we still need larger studies to confirm these findings before the IOM guidelines can change," Vesco said.
Doctors can help women control their pregnancy weight by weighing them, calculating their body mass index and giving them weight-gain targets for pregnancy, said Dr. Alexis Shub, a senior lecturer in the Department of Obstetrics and Gynaecology at the University of Melbourne in Australia.
"In our own research we have found that many obese women do not recognise that they are obese, and many overestimate the appropriate weight gain for pregnancy - so education by health care professionals is very important," she told Reuters Health by email.
"It is laudable that research is taking place to answer questions that affect so many women and babies that we see every day in clinical practice, and that managing weight gain for these women may have a long term role in their own health and the health of their children," said Shub, who was not involved in the study.
But, she noted, more than 1000 women declined to be in the trial, so those that participated were highly motivated. A less motivated group would likely have been less successful, she said.
Most women, not just those who are obese, can benefit from setting a weight gain goal and following a healthy eating plan, Vesco said.
Implementing this approach, with 90-minute weekly meetings and behavioral specialists, could be done in the real world but it would require ongoing resources and commitment from a health plan, and it's unclear how much it would cost, she said.
"Women who are obese when they get pregnant should talk to their practitioner and together set their weight gain goals," Vesco said. "They can seek dietary advice from their practitioner or a dietician."
SOURCE: http://bit.ly/XVvpam Obesity, online August 28, 2014.
Fishery mislabeling could mean more mercury than buyers bargain for
By Janice Neumann
NEW YORK (Reuters Health) - That Chilean sea bass from the local grocery store could have twice the methylmercury that's expected - if it comes from a region other than indicated on the label, a new study says.
While fish certified by the Marine Stewardship Council (MSC) is generally considered safe, seafood from regions with high levels of contamination are not. And researchers studying samples from U.S. retail stores found that many fish are indeed the species they are claimed to be, but not from the region claimed.
"Chilean sea bass is already known to sometimes have high mercury levels," lead author Peter Marko, of the University of Hawai'i at Manoa, Honolulu, told Reuters Health.
"If women are pregnant or nursing, they probably shouldn't buy that fish, to be safe," he said.
Past research has found that fish sold in retail markets is not always the species it's advertised to be. And that even within a given species, mercury levels can vary widely.
Methylmercury, the type of mercury found in fish, is an organic compound that can be absorbed into living tissue.
Pregnant and nursing women and kids have been advised by the U.S. Food and Drug Administration to avoid shark, tilefish, swordfish and King Mackerel because these species have a mean mercury level of 0.73 to 1.45 parts per million. The FDA's limit for mercury in fish for human consumption is 1.0 ppm.
Normally, the mercury content of Chilean sea bass, also known as Patagonian toothfish, is 0.35 ppm, according to the FDA.
In the current study, published in the journal PLOS One, researchers used sea bass tissue samples from retailers in 10 U.S. states. They measured the total amount of mercury in 25 of the MSC-certified and 13 of the uncertified Chilean sea bass samples.
They found that fish labeled as certified had less than half the mercury (0.35 ppm) of uncertified fish (0.89 ppm).
But when the researchers excluded the fish that actually belonged to other species and were not genetically sea bass, they found no significant difference in the mercury levels of certified and uncertified fish.
"We then said, 'that can't be because certified is supposed to come from South Georgia, where the mercury level is low, why do we see such a difference in mercury?'" said Marko, referring to a fishery area close to the South Pole and known to have less mercury contamination than fish from waters off South American. "It's these fishery stock substitutions," he said.
The researchers tested the DNA of the fish and found those from outside the MSC-certified South Georgia/Shag Rocks fishery had twice as much mercury (0.63 ppm) as those genetically confirmed to be South Georgia stock (0.31 ppm).
"Regular mercury exposure is potentially dangerous to developing nervous systems, so this and other studies like it are of greatest concern to pregnant women, children, and women planning on having children," Marko said in an e-mail.
"Our study demonstrates that accurate labeling of seafood - not just with respect to what species but also what country or region the seafood came from - is essential to consumers, particularly in the aforementioned demographic, to make informed choices at the seafood counter," he said.
Marko pointed out that fish from South American waters can have two-to-three times as much mercury as fish from MSC-certified regions.
Roberta White, professor and chair of Environmental Health at Boston University School of Public Health, who was not involved in the study, told Reuters Health in a phone interview the findings were another reminder that consumers need to be careful when purchasing fish.
"What's really disturbing is how do people choose to eat fish that are safe?" said White, who has studied the effects of industrial pollutants on the brain.
"Everybody wants people to eat fish because it is good for the brain and heart, but we also don't want them to be poisoning their children because they're pregnant," she said.
White said future studies needed to focus on different species of fish and the genetics within species, as well as variations in neurotoxicants. Other contaminants in fish could also pose a health danger, including Polychlorinated Biphenyls (PCBs), which are synthetic organic chemicals, organic tin and different pesticides, she said.
"As this article points out, sometimes you think something is safe because of the way it's labeled and maybe it isn't, but that's true of all our food," White said.
"This is where you have to start, the simple stuff," White said. "I think what's important about the study is the public health message that we need to be careful about this and figure it out," said White.
SOURCE: http://bit.ly/1vBpKRH PLOS One, online August 5, 2014.