US Food and Drug Administration (FDA) Releases
New Infant Formula Standards
The FDA announced new compliance standards that will apply to infant formulas intended for use by healthy infants without medical or dietary problems. The rule will go in effect by September 8, 2014. The new standards include good manufacturing techniques, requirement for companies to produce information that they support appropriate growth, and testing requirements before entering the marker. The goal is to ensure better safety for this commonly used product.
This web resource is a great resource for parents and providers. It is a booklet written for parents to help them learn about infant pain and the important role parents can play, in partnership with the health care team, to keep their baby comfortable during intensive care. It is available for no cost, in English and Spanish, both as a PDF or iBook. For more information and to download your copy go to their website.
Each premature infant’s transition from birth to home is a miraculous and inspiring journey. This seven minute video beautifully captures Ward Miles’ first year, beginning with his birth at 26 weeks of gestation. The piece perfectly conveys some of the emotions experienced by parents during their baby’s NICU course, including the joy of going home and witnessing his ongoing growth and development. It’s well worth the watch for both parents and providers!
A recent trial that compared two standard but different ranges in oxygenation for preterm infants sparked controversy when babies in the slightly lower oxygen range -- found in other studies to lower rates of retinopathy of prematurity, a serious eye problem that can lead to blindness – showed a higher rate of mortality. Parents, grandparents and caregivers have thought carefully about the issues this study raised and two viewpoints are offered here.
Listening to Mothers: Report on Pregnancy & Chldbirth
Childbirth Connection has released the report, Listening to Mothers III: Pregnancy and Childbirth. The ongoing Listening to Mothers Initiative is devoted to understanding the experiences and perspectives of childbearing women and using this knowledge to improve maternity policy, practice, education and research. Listening to Mothers III surveys 2,400 mothers who had given birth to single babies in US hospitals from July 1, 2011 through June 30, 2012. The report is available online for free.
This year's World Breastfeeding Week (WBW) theme, "Breastfeeding Support: Close to Mothers", highlights Breastfeeding Peer Counseling. Continued support is key to successful breastfeeding, even when mothers are able to get off to a good start.
National Immunization Awareness Month – August 2013
August is National Immunization Awareness Month (NIAM). The goal is to increase awareness about immunizations across the board, from newborns to the elderly. August is an ideal time to think about vaccines, as children are heading back to school and the flu season is just around the corner.
Infant Deaths Associated with the Usage of Infant Sleep Positioners
The CDC reports that 13 infants in the past 13 years have died of suffocation as a result of Infant Sleep Positioners (ISPs). These ISPs are devices that allow an infant to sleep on his/her side, rather than the supine position recommend by the AAP. Pediatricians and other healthcare providers should remember to counsel families about “safe sleep” habits at home which include infants sleeping in their own bed, supine and without soft objects or loose bedding.
Physicians at Boston Medical Center, in Boston, MA, developed a NICU graduate home visitation program for pediatric interns in order to increase awareness of some of the difficulties the families face shortly after discharge. In its third year, the program is currently run by Dr. Meg Parker, Neonatologist and Health Services Researcher. The team found the program both feasible and a valuable learning experience. Their findings are summarized in a recent publication in the Journal of Pediatrics, August 2012 Issue.
The 2012 Prematurity Report Card was released by the March of Dimes. For the 2nd consecutive year, the rate of preterm birth in the United States has declined, currently at 11.7%. Although an improvement, overall the US received a “C” grade.
In order to get more information and to see what’s happening in your state, visit the website.
Newborn Male Circumcision
The American Academy of Pediatrics published an updated policy statement and technical report on newborn male circumcision. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV.
Read the Policy Statement »
Recommendations for a
Safe Sleeping Environment
In November 2011, the AAP released an updated policy statement titled SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. (PEDIATRICS Vol. 128 No. 5 November 2011, pp. 1030-1039). The focus continues to be on "Back to Sleep" to prevent SIDS, as well as other interventions, including:
using a firm sleep surface
room-sharing without bed-sharing
avoidance of soft bedding, overheating, tobacco exposure, alcohol and illicit drugs
Support Group Search by the National Perinatal Association
The National Perinatal Association (NPA) developed a catalog of Family Advocacy Networks that is searchable by specific group, type of program (e.g. preemie support, grief/bereavement, emotional support), and by state. If you are looking for a particular support network, check out the NPA list.
Text4Baby is a new program that was launched by National Healthy Mothers, Healthy Babies Coalition (HMHB) in order to help pregnant women and new moms get information about caring for their health and thus giving their babies the best start in life. This is a free health text messaging service (even if you don't have a texting plan). It's available in English and Spanish.
Secondhand Smoke Exposure and Risk of Neurobehavioral Problems in Kids
The health consequences of secondhand smoke exposure have been well documented in both adults and children. Recently a group of investigators used U.S. data from the 2007 National Survey on Children's Health in order to explore the link between neurobehavioral disorders in children below the age of 12 and secondhand smoke exposure. Those children who were exposed to secondhand smoke at home were identified to have a greater risk of having two or more nuerobehavioral problems (i.e. learning disabilities, conduct disorders, and attention-deficit/hyperactivity disorders).
In April 2011, the American Academy of Pediatrics (AAP) released its most updated technical report on Child Passenger Safety.The biggest change in the guidelines is that a child should remain in a rear-facing seat until two years of age. Additional information is also available through the AAP website. The installation of a car seat can be challenging, and studies show that most are not installed properly. Many communities have programs in place to help install car and toddler seats safely. You can contact your local police station or visit one of the websites below for more information.
Supporting Moms with Post Traumatic Stress Disorder
Among the least-known tragedies of prematurity are the estimated 76% of moms who experience post-traumatic stress disorder (PTSD) after a baby's neonatal ICU stay, with far-reaching consequences for families and communities. But a new nonprofit organization is addressing the unmet need for community-based peer support, which studies suggest can cut this statistic in half. Hand to Hold - whose pilot program based in Austin, TX will serve as a national model - provides resources and support programs to parents of preemies, babies born with special healthcare needs and those who have experienced a loss.
Founded by a mother of preemies, Hand to Hold focuses on empowering parents to advocate for their children; encouraging counseling when needed; providing resources and information for managing insurance and financial issues; educating parents about the challenges their babies may face and preparing them to meet those needs; and sharing the resources and support necessary to help all children enjoy a full and satisfying life.
Breast milk feeding is the optimal form of nutrition for infants born prematurely. For the tiniest infants, breast
milk can be literally lifesaving by conferring protection
from both bloodstream infections and from necrotizing enterocolitis, a potentially devastating intestinal complication of prematurity.
Providing breast milk to premature infants can be challenging. Many mothers are sick or recovering from emergent surgeries, severe blood loss and medical conditions. For these reasons, pasteurized, banked donor human milk can provide an important alternative to premature formulas. Brigham and Women's Hospital in Boston started a Banked Donor Milk Program and approximately 65 infants have received Donor Milk since.
Severe Combined Immunodeficiency, X-Linked (SCID-X1), "Bubble Boy Disease"
"Bubble boy disease," formally known as severe combined immunodeficiency disease (SCID), is now part of national U.S. Newborn screening guidelines, adopted by Secretary of Health and Human Services Kathleen Sebelius last month. SCID was named for David Vetter, a Texas boy who spent his short life inside a sterile plastic cocoon to avoid infections. Read the full text of the article »
On the treatment front, investigators at Children's Hospital Boston have launched a new gene-therapy trial for children with the "bubble boy syndrome," reflecting fresh hopes that the strategy of delivering working genes can be used to treat many intractable ailments. Without treatment, which is currently possible only by bone-marrow transplantation, most children die before age one.
In this new SCID-X1 trial, researchers will take stem cells from a patient's own bone marrow, deliver a functioning gene into those cells in the lab and then infuse them back into the patient. If all goes well, the cells will start producing a protein that will multiply and provide a functioning immune system. Read the full text of the article »
The loss of a baby as a result of Sudden Infant Death Syndrome (SIDS), formerly known as "crib death", is one of the most devastating losses a family can endure. The cause of SIDS is still not completely understood, however, SIDS deaths most often occur among infants who are below 6 months of age during periods of napping or sleeping. Babies can die of SIDS during daytime naps, when the infant might be cared for outside the home, as well as during overnight sleep. Several care strategies have been identified and have led to reduced rates of SIDS.
The AAP Healthy Child Care America has taken an educational approach to SIDS prevention, recently creating a new online module, Reducing the Risk of SIDS in Child Care! This free course is designed to educate everyone who cares for babies, including child care providers, health care professionals, parents, grandparents, and relatives, regarding what they can do to provent SIDS.
In 1 hour, participants will learn how to create a safe sleep environment to reduce the risk of SIDS and other sleep related deaths. With an easy to use format, this course is available 24/7 from your home or office computer. Child care providers will receive a certificate of completion for 1.0 contact hour. Health care professionals can also receive credit.
Extremely Preterm Infants Might be at Increased Risk of Autism
Autism Spectrum Disorders (ASD) are a group of behavioral and communication disorders, normally affecting about 1 out of 150 children. These disorders, sometimes called "autism" or "pervasive developmental disorder" (PDD) usually are recognized beginning in the toddler years. Five previous studies have shown increased risk of ASD among infants born preterm or at low birth weight. In the April 2009 issue of the Journal of Pediatrics, a Boston researcher (Dr. Karl Kuban) and his colleagues reported a study of babies born before 28 weeks of gestation that showed a much higher than expected rate (21%) on a screening test for autism (M-CHAT) that is administered at age two that did not simply seem to reflect neurological problems. The M-CHAT is a screening test for autism, not a diagnostic one, so these babies will have to be further tested to determine whether they meet criteria for ASD. This is an important study, however, because it makes us aware that even though most infants born very premature won't have autism, they must be evaluated as they grow and develop with the possible increased risk of ASD in mind.
Babies and Families Love Skin-to-Skin Kangaroo Care!
Once viewed simply as a nice way for babies and parents to cuddle, skin-to-skin contact, also called Kangaroo Care, is now recognized as offering benefits to both babies and their parents. Several recent randomized clinical trials showed Kangaroo Care is associated with improved temperature, more quiet sleep and less time crying as well as improved exclusivity and duration of breastfeeding following discharge. Furthermore, Kangaroo Care has been linked with enhanced breast milk production, improved parent-child relationship, and slightly better test scores on developmental tests at 6 months. Although further studies are needed, this early work suggests that skin-to-skin holding (Kangaroo Care) might offer substantial benefits to babies and mothers.
Chwo MJ, Anderson GC, Good M, Dowling DA, Shiau SH, Chu DM. A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity. Journal of Nursing Research 2002 Jun; 10(2):129-42.
Feldman R, Eidelman AI, Sirota L, Weller A. Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics 2002 Jul;110:16-26.
Hake-Brooks SJ, Anderson GC. Kangaroo care and breastfeeding of mother-preterm infant dyads 0-18 months: a randomized, controlled trial. Neonatal Network 2008 May-Jun; 27:151-9
Kostandy RR, Ludington-Hoe SM, Cong X, et al. Kangaroo Care Reduces Crying Response to Pain in Preterm Neonates: Pilot Results. Pain Management Nursing 2008; 9:55-65.
Spanish-Language Site Focuses on Prematurity as Key Issue
The March of Dimes has relaunched its Spanish-language web site nacersano.org to offer up-to-date, doctor-vetted maternal and neonatal health information. Some of the topics covered include staying healthy during pregnancy, labor and delivery, newborn care, and prematurity. Among the new features are Latin American recipes rich in folate, a "Just for Dads" feature, and stories of Latino families related to prematurity and folic acid.
HealthyChildren.org is the only parenting Web site backed by 60,000 pediatricians committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. Whether you're looking for general information related to child health or for more specific guidance on parenting issues, you can rest assured that our information comes from the nation's leading child health experts and that we have scientific research supporting our recommendations.
20 Minutes with Neonatologist, David Adamkin, MD
University of Louisville neonatologist, David Adamkin, has dedicated his career to sick babies, particularly to low and very low birthweight babies, their nutritional needs, and strategies to help them grow and thrive. Kentucky ranks among the highest in the US for low birthweight babies, with about 9 percent of babies weighing less than 5 lbs 8 oz. The smaller a baby is, the greater his risk of neurodevelopmental problems.
An expert in infant nutrition, Adamkin has found, through clinical experience and research, that aggressive feeding makes a difference for these babies, especially in the first 2 to 3 weeks after birth. He has outlined his feeding guidelines and strategies in the new book "Nutritional Strategies for the Very Low Birthweight Infant."
CDC Report Finds Variations in NICU Admission
of Very Low Birth Weight Infants
New findings published in CDC's Morbidity and Mortality Weekly Report (MMWR) suggest that there is wide variation among states in the prevalence of NICU admission for infants with very low birth weight (VLBW) - and points to the need to further address state data to identify barriers to NICU admission. The report looked at NICU admissions of VLBW infants in 19 states during 2006. Current standards call for NICU care for all VLBW babies, since it has been shown to reduce mortality for this group. However, just 77.3% of VLBW infants in the study were admitted to NICUs, with some variations by ethnicity.
The country has seen an alarming number of cases of pertussis in recent weeks. Go to Healthy Mothers, Healthy Babies Web site for a "Q&A" and interview with Dr. Ari Brown to address topic and prevention strategies in an easy-to-read format.
Probiotics Reduce Necrotizing Enterocolitis in Preemies
Australian researchers said giving probiotics to preterm, very low birth weight babies reduced the rate of necrotizing enterocolitis by 65%. The data published in Pediatrics agreed with earlier study findings, and researchers said that based on the strong evidence "withholding probiotics from high-risk neonates is now almost unethical."
The AAP is pleased to announce the creation of a new, comprehensive online resource for pediatricians and families that addresses the topic of immunizations. This new site replaces the Childhood Immunization Support Program Web site and contains information about vaccine-preventable diseases, vaccine safety information, and tools and resources to help pediatricians effectively and efficiently administer immunizations in their offices.
(09/21/09) A national coalition of health care and information providers for pregnant women and children have an urgent message for pregnant women concerning influenza. The normal changes of pregnancy place pregnant women at increased risk of the harmful effects of flu infection, and as such, they should take increased precautions.
Newborn Intensive Care: What Every Parent Needs to Know
When the birth of a baby does not go perfectly, and a baby is born prematurely or with an illness, parents need answers to all the questions they have about their baby's condition and what will happen in the coming days, weeks and years. This newly-revised guidebook helps parents of premature and sick newborns understand their baby's illness and give them the detailed information they need to make sense of their baby's complicated situation. Editor-in-chief Jeanette Zaichkin, a neonatal nurse and author, describes complex medical issues in a way that people with little or no medical training can understand - without oversimplifying.
Program to Enhance the Health and Development of Infants and Children (PEHDIC)
The AAP was awarded the PEHDIC, a 5-year cooperative agreement with the CDC. Primarily housed with the AAP Division of Children with Special Needs, PEHDIC aims to translate critical research and guidelines, focused on preventive health care, continuity of care, and transition to adulthood, into practice as well as to expand provider and public education related to health promotion and disease prevention.
Plastics Chemical May Raise Risk of Low Birth Weight
Research found that pregnant women exposed to phtalates, a chemical found in plastics, may have a higher risk of delivering babies with low birth weights. Researchers said they found notable levels of phthalates in cord blood and first stools of more than 70% of infants in the study, with higher levels of the chemical found in babies with low birth weights.
Whooping Cough is Making a Comeback, Risking Serious Illness or Death Among Newborns
Whooping cough, also known by the medical term pertussis, is a vaccine-preventable disease that is caused by a bacterium (germ). It is highly contagious and newborns are at highest risk of being seriously ill with the infection. A baby begins to develop immunity to whooping cough (also called pertussis) after his or her first set of immunizations but is not fully immune to whooping cough until the immunization series is complete (at 6 months of age or more). This low immunity that is normal in early infancy, in addition to a baby's very small lung and airways, make babies with the infection very vulnerable to its most serious effects. Whooping cough lasts for many weeks, causing spasms of severe coughing, often with a whooping sound at the end of the cough. In newborns, the breathing problems caused by whooping cough can be very severe and can even interfere with breathing in air and cause blue spells,
pauses in breathing, vomiting, fainting (passing out), or even death. It can be spread from child to child or from an adult who typically is only mildly sick and seems only to have a cold or bronchitis. The number of cases of whooping cough in the United States has been steadily increasing since the 1980s, making more babies each year vulnerable to this life-threatening infection.
Surgeon General's Conference Sets Agenda for Preventing Preterm Birth
In June 2008, The National Institutes of Health for the Office of the Surgeon General convened a group of experts to describe the magnitude of the problem and evaluate strategies that might lead to prevention of preterm birth. Panels of experts evaluated a number of dimensions relating to preterm birth: quality of care and health services, psychosocial and behavior aspects, public communication and outreach, biomedical and epidemiological research, and professional education and training. Following this meeting, the Office of the Surgeon General released an agenda for activities in the public and private sectors to reduce the nation's rate of preterm birth. The agenda calls for a national system to better understand the occurrence of preterm birth and a national education program to help women reduce their chances of giving birth prematurely. The agenda also calls for improved methods for estimating the age of the fetus, and studies to identify biomarkers which would signal the beginning of preterm labor.
Chemical Found in Baby Bottles Might Cause Health Problems
Bisphenol A is one of the most widely used chemicals in the plastics industry. Environmentalists and some scientists claim it causes reproductive and developmental problems and prostate cancer. In August, an expert panel reported on the safety of Bisphenol A (BPA), a chemical used to make some plastics such as baby bottles, sports bottles, water jugs and children's dental sealants; it's also found in other plastics. The panel called many of those fears unfounded. The National Institutes of Health panel ruled that BPA is unlikely to cause reproductive problems, birth defects, or prostate cancer, yet it might affect nerve development and behavior. Therefore, questions remain - especially about how BPA affects the nervous system and behavior of babies and young children. Further research is needed to answer these questions.
Near-Term Babies May Face a Higher Risk of Problems
Babies born just three to six weeks before their due dates are more likely than full-term babies to have disabilities or developmental delays in kindergarten, a study (published in Pediatrics) has found. The children also are slightly more likely to be suspended or held back in kindergarten and to require special education.
The US Food and Drug Administration (FDA) issued a warning on May 20, 2011 to stop the use of SimplyThick, a thickening product that can be added to breast milk or formula, in infants born before 37 weeks. The concern is based on reports of infants who were using the product developing necrotizing enterocolitis (NEC), even once discharged home. Symptoms to watch for include bloated stomach, greenish-tinged vomiting, and bloody stools. If your child is using SimplyThick as an additive to breast milk or formula, please contact your child's doctor immediately regarding further guidance.