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.
Using a nicotine patch during pregnancy tied to higher ADHD risk
By Kathryn Doyle
NEW YORK (Reuters Health) - Smoking during pregnancy has been linked to a higher chance of the child having attention-deficit/hyperactivity disorder (ADHD), and a new study suggests women who use nicotine replacement products may also have children with an elevated risk.
That doesn't necessarily mean that nicotine causes ADHD, the authors note.
For instance, it could be that women dependent on nicotine are more likely to have ADHD symptoms themselves, said senior author Dr. Carsten Obel, from Aarhus University in Denmark. The children of women who use nicotine replacement products to quit smoking may be at risk of ADHD because of genes or their family environment, he told Reuters Health by email.
For the new study, the researchers analyzed information from Danish databases on more than 80,000 children born between 1996 and 2002.
Mothers were interviewed while pregnant and asked if they currently smoked, used nicotine replacement products including gum, patches or sprays or had quit smoking before pregnancy without nicotine replacement. They also reported whether their husbands were current smokers.
The researchers then followed the children through 2011 and noted hospital diagnoses of ADHD or use of medication for the disorder. Roughly two percent of children in the study were diagnosed with ADHD.
Compared to children with nonsmoking parents, kids with two smoking parents were 83 percent more likely to develop ADHD, according to results published in Pediatrics.
Having a mother who smoked during pregnancy seemed to be a stronger predictor of ADHD risk than having a father who smoked.
Mothers who used nicotine replacement products had children with an increased risk of ADHD similar to the increase associated with smoking.
At this point, it is too soon to estimate how important nicotine exposure might be for ADHD risk, Obel said.
Mothers who had quit smoking and those who used nicotine replacement products both tended to have babies with higher, healthier birth weights than current smokers, he noted. Smoking during pregnancy is known to be associated with a lower birth weight for the baby.
"The nicotine patch doesn't decrease birth weight, which has been used as a target measure for a long, long time," said Yoko Nomura, who studies central nervous system development at The City University of New York's Queens College.
"We can't say the nicotine patch is useless because birth weight is so associated with many different illnesses," Nomura told Reuters Health. She was not part of the new study.
For most people, the risk of ADHD is very small to begin with, she said.
As of 2011, 11 percent of U.S. kids ages four to 17 had been diagnosed with ADHD, according to the Centers for Disease Control and Prevention.
Many factors can influence the risk of ADHD, and most of the important predictors are genetic, Nomura said.
"In order to prevent the non-genetic component of ADHD, we need to understand how smoking increases risk, and this doesn't help us learn more about that," she said.
Parents reporting their own smoking habits may not be very reliable, given the social pressure to quit during pregnancy, she noted.
"We have a long way to go before we can even conclude anything," Nomura said.
"The best advice will at this point probably be to try to stop smoking without use of nicotine replacement and preferably before getting pregnant," Obel said. "If this is not possible nicotine replacement is, based on the birth weight results, preferable in comparison with continuing to smoke."
For women who struggle to quit, even just cutting down on the number of cigarettes per day is a step in the right direction, Nomura said.
SOURCE: http://bit.ly/1nP7FcE Pediatrics, online July 21, 2014.
Pregnancy doesn't drive women doctors out of surgical training
By Ronnie Cohen
NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.
Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.
Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.
"Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.
"This study shows that surgical residents who have children during training are just as good," she added.
General surgical residency programs last five years and are known for being rigorous.
For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.
Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.
A similar proportion of male and female residents left the training program.
Of the 85 residents, 25 had children born during training.
Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.
Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.
In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.
Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."
Gauvin formerly directed the surgical residency program at the University of California, Davis.
Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.
"These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.
Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.
But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.
Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.
"Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."
"The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."
Shapiro is married to another physician, and they have two young children.
"Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."
SOURCE: http://bit.ly/1n1S0L8 and http://bit.ly/1nk9sMq JAMA Surgery, online July 16, 2014.
India faces crisis over dwindling numbers of girls, U.N. says
By Nita Bhalla
NEW DELHI (Thomson Reuters Foundation) - The dwindling numbers of Indian girls, caused by the illegal abortion of millions of babies, has reached "emergency proportions", fueling an increase in crimes such as kidnapping and trafficking, the United Nations warned on Tuesday.
Despite laws that ban expectant parents from running tests to determine the gender of unborn children, female feticide remains a common practice in parts of India, where a preference for sons runs deep.
"It is tragically ironic that the one who creates life is herself denied the right to be born," said Lakshmi Puri, deputy executive director of U.N. Women, at the launch of a new study on sex ratios and gender-biased sex selection.
India's traditionally male-dominated culture views sons as assets - breadwinners who will provide for the family, carry on the family name and perform the last rites for their parents, an important ritual in many faiths.
Girls, however, are often seen as a liability, with families having to dig deep for a substantial dowry to ensure a desirable match. In a culture that views pre-marital sex as bringing shame to the girl's family, parents also worry about their safety.
India's 2011 census showed that while the overall female-to-male ratio has improved marginally since the last census a decade ago, fewer girls were born than boys and the number of girls younger than six plummeted for the fifth straight decade.
"The sharply declining child-sex ratio in India has reached emergency proportions and urgent action must be taken to alleviate this crisis," Puri added.
A May 2011 study in British medical journal the Lancet found that up to 12 million Indian girls were aborted over the last three decades, resulting in a skewed child sex ratio of 918 girls to every 1,000 boys in 2011, versus 962 in 1981.
Activists blame ultrasonography for the rise in abortions, saying the technology is used for sex determination.
But the crime is tough to check, they add, resulting in few convictions. There were 221 cases of feticide reported in 2013, up from 210 in 2012, the National Crime Records Bureau says.
U.N. officials said India's economic and social progress had failed in the area of sex selection, and the unbalanced sex ratio was contributing to crimes such as rape, abduction and trafficking.
The entire social structure will have to change, with a battle waged against the root causes of a preference for sons, said Lise Grande, the U.N. resident coordinator in India.
"This may be one of the hardest, most difficult struggles India faces, but it is arguably one of its most important," she added.
Babies of anxious mothers more likely to cry excessively: study
By Shereen Lehman
NEW YORK (Reuters Health) - Women with anxiety disorders may be more likely to have babies who cry excessively, suggests a new German study.
Researchers already know that the children of women with anxiety disorders are more prone to develop anxiety themselves, according to Johanna Petzoldt. She led the current study at the Institute of Clinical Psychology and Psychotherapy at Dresden University of Technology.
"We found a relationship between maternal anxiety disorders prior to, during and after pregnancy, thus, mothers with prior anxiety disorders might represent a specific risk group for having an infant that will cry excessively," Petzoldt told Reuters Health in an email.
"Early identification and monitoring of mothers with prior anxiety disorders could be an opportunity to support mother-infant dyads at risk," she said.
For the new study, Petzoldt and her colleagues enrolled 286 women who were early in their pregnancies.
The women were 28 years old, on average. About 63 percent of them were unmarried and 59 percent were pregnant for the first time.
At the beginning of the study, the researchers asked the women about any depressive or anxiety symptoms they had and when those symptoms started. Then they checked in with the women every other month until their babies were four months old and again one year later.
In the interviews that took place after the babies were born, 29 mothers reported that their infants cried excessively. Excessive crying was defined as crying that lasts three or more hours per day, at least three days per week for a duration of three weeks or longer.
The researchers found that women who had an anxiety disorder before becoming pregnant were more likely to have a baby that cried excessively compared with women without an anxiety disorder.
That was also the case when including women who developed an anxiety disorder during pregnancy or after giving birth, according to results published in the Archives of Disease in Childhood.
Unlike in previous studies, the researchers did not find a clear association between maternal depression and excessive crying among infants.
The study doesn't prove women's anxiety caused their babies to cry more - only that there was a link between the two. And the reasons for the association still aren't clear.
More research is needed to learn more about maternal anxiety and depression and infant crying, Petzoldt said.
"Women can have anxiety or depression during pregnancy and it can have negative consequences for the baby," psychiatrist Dr. Ariela Frieder told Reuters Health.
"It's very important to take an active stance to treat it. That can change the outcome and can really help the baby to do better," she said.
Frieder, from the Department of Obstetrics and Gynecology and Women's Health at Montefiore Medical Center in New York, wasn't involved in the new study.
She said women who are pregnant and believe they may have anxiety should tell their OB/GYN and the doctor can refer them to the appropriate mental health professionals. Talk therapy could be one option for treatment.
In an editorial published with the study, Dr. Harriet Hiscock said there is no doubt that a mother's mood can impact her baby's behavior and vice versa.
Hiscock, from the University of Melbourne in Australia, agreed that more research is needed to confirm the current findings.
But in the meantime, she wrote that doctors can talk to women about anxiety and its perceived impact on their parenting style and on their infant, as long as professional support is available if needed.
"This needs to be done sensitively as the last thing we need to do is add to a mother's 'day of worry' by blaming her for her infant's crying," Hiscock wrote.
SOURCE: http://bit.ly/U6yS3l and http://bit.ly/1q3FnCP Archives of Disease in Childhood, online June 27, 2014.
Preemies treated in high-volume neonatal units more likely to survive
By Ronnie Cohen
NEW YORK (Reuters Health) - Babies born very early stand a better chance of surviving if they are treated in neonatal hospital units that see a large number of premature infants, a new study shows.
The British study included babies born before 33 weeks of pregnancy who were admitted for extra care. Full term is considered 39 to 40 weeks.
"The first hours of these babies' lives can be crucial, which means it is essential to give them expert care at this time," said lead author Sam Watson, from the University of Warwick's Medical School and Department of Economics in Coventry, in a news release.
The analysis confirms results of a 2010 U.S. study led by Dr. Judith Chung, a maternal-fetal medicine specialist at the University of California, Irvine.
"The best outcomes for high-risk infants occur in hospitals with the highest volume," Chung, who was not involved in the British study, told Reuters Health.
"If you're at an increased risk of premature delivery, you should deliver at a higher level, high-volume hospital," she said.
For the new study, the researchers analyzed data from 20,554 very premature infants delivered at 165 hospitals with neonatal units across the UK. About 4.5 percent of them died in the hospital.
Infants were 32 percent less likely to die if they were admitted to high-volume neonatal units compared to low-volume units, the researchers found.
The earliest preemies, those born before 27 weeks of pregnancy, benefited the most from high-volume units, Watson told Reuters Health.
Those babies had half the odds of dying when they were treated in neonatal units that handle a high number of premature births, compared to low-volume units, the study published in BMJ Open found.
"The effect we observe is mainly being driven by the infants born at less than 27 weeks," Watson said.
"It would be most important to deliver the youngest fetuses at the highest volume hospital," Chung said.
Unfortunately, doctors often cannot predict premature births. But expectant mothers who go into labor prematurely sometimes can and should be transferred, Chung said.
Why babies are more likely to survive in hospitals that deliver more preemies remains an open question, but researchers suspect clinical experience is key.
"It could be a case of the physicians in the high-volume units have more experience and are more skilled," Watson said. "It is also possible that economies of scale play a role, in that the larger and busier units have more resources to invest in technology and facilities."
Chung likened doctors working in neonatal units with a high volume of preemies to cardiac surgeons who perform the highest number of heart surgeries.
"The assumption is it's probably experience," she said. "If you do more of them, you're better."
Neonatologist Dr. Valencia Walker described the study results as "intuitive."
"Anything we get a chance to perfect, we will get better and better at it if we have the resources to do it," she told Reuters Health.
Walker, from the David Geffen School of Medicine at UCLA in Los Angeles, was not involved in the current study.
She pointed out that systems to determine where pregnant women deliver their babies in England and the U.S. differ significantly.
In 2003, the UK created a model of networked, regionalized units to facilitate the transfer of premature babies to higher care neonatal units. The current study highlights advantages of the system but also raises concerns about the possible result of smaller neonatal units closing, Watson said.
Walker said the U.S. has far fewer neonatal intensive care units and a different set of considerations and restrictions regarding transferring patients. In Southern California, for example, traffic can at times render transfers impossible.
Worldwide, 15 million of the 135 million babies born in 2010 were premature - defined as before 37 weeks of pregnancy - and 1.1 million died, according to a United Nations report (see Reuters story of May 2, 2012 here: http://reut.rs/1oYW0fp). Since 1995, the average rate of premature births has doubled to 6 percent in developed countries, the report found.
Nutrition, maternal age, smoking, alcohol, obesity and diabetes have all been implicated in premature births.
SOURCE: http://bit.ly/1oVSOkH BMJ Open, online July 7, 2014.