DiversityNursing Blog

By KAREN BARROW

www.nytimes.com 

Elisabeth Bing, who helped lead a natural childbirth movement that revolutionized how babies were born in the United States, died on Friday at her home in Manhattan. She was 100.

Her death was confirmed by her son, Peter.

Ms. Bing taught women and their spouses to make informed childbirth choices for more than 50 years. (“We don’t call it natural childbirth, but educated childbirth,” she once said.)

She began her crusade at a time when hospital rooms were often cold and impersonal, women in labor were heavily sedated and men were expected to remain in the waiting room, pacing.

Ms. Bing pushed for change. She worked directly with obstetricians, introducing them to the so-called natural childbirth methods developed by Dr. Fernand Lamaze, which incorporated relaxation techniques in lieu of anesthesia and enabled a mother to see her child coming into the world.

Along with Marjorie Karmel, Ms. Bing helped found Lamaze International, a nonprofit educational organization.

She became known as “the mother of Lamaze,” championing the technique in her book “Six Practical Lessons for an Easier Childbirth” (1967) and on the lecture and television talk-show circuits.

Today, Lamaze and other natural childbirth methods are commonplace in delivery rooms, and Lamaze classes, with their emphasis on breathing techniques, are attended by an estimated quarter of all mothers-to-be in the United States and their spouses each year.

For years Ms. Bing led classes in hospitals and in a studio in her apartment building on the Upper West Side of Manhattan, where she kept a collection of pre-Columbian and later Native American fertility figurines.

Ms. Bing preferred the term “prepared childbirth” to “natural childbirth” because, she said, her goal was not to eschew drugs altogether but to empower women to make informed decisions. Her mantra was “Awake and alert,” and she saw such a birth as a transformative event in a woman’s life.

“It’s an experience that never leaves you,” she told The New York Times in 2000. “It needs absolute concentration; it takes up your whole being. And you learn to use your body correctly in a situation of stress.”

There was one secret she seldom shared, however: Her own experience giving birth to her son, Peter, was decidedly unnatural. As Randi Hutter Epstein reported in her book “Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank” (2010), she continually asked her doctor, “Is my baby all right? Is my baby all right,” until the doctor said he could not concentrate with her chatter and gave her laughing gas and an epidural.

“I got everything I raged against,” Ms. Bing told Ms. Epstein. “I had the works.”

Elisabeth Dorothea Koenigsberger was born in a suburb of Berlin on July 8, 1914. Her parents, of Jewish descent, had converted to Protestantism years before her birth, but the family nevertheless felt the virulent anti-Semitism sweeping Germany before World War II. She was kicked out of a university two days into her freshman year, and two of her brothers — a historian and an architect — could not find work because of their Jewish background, she told The Journal of Perinatal Education in 2000.

After Ms. Bing’s father died in 1932, the family left the country; most members settled in England, while one sister moved to Illinois. In London, Ms. Bing studied to become a physical therapist and began work at a hospital. Mostly she helped patients with paralysis, multiple sclerosis and broken bones, but every morning she also visited the maternity ward, to give massages to new mothers and help them exercise. At the time, women were not allowed out of bed for as many as 10 days after giving birth.

She became interested in natural childbirth in 1942 when a patient handed her Dr. Grantly Dick-Read’s influential book “Revelation of Childbirth,” published that year (and later titled “Childbirth Without Fear”). Dick-Read proposed that pain during childbirth was caused by fear, and that a woman could avoid anesthesia by following a series of relaxation techniques aimed at reducing that fear.

Ms. Bing became intrigued and hoped to train with Dick-Read in the north of England, but with the war on and travel all but impossible, she began her own independent study. She read as much as she could and observed obstetricians and their patients — heavily anesthetized women who, she saw, had little control over the birth of their children.

“What I saw I disliked intensely,” she said in her interview with the perinatal journal. “I thought there must be better ways.”

Ms. Bing, who drove an ambulance during the war, began pursuing her interest in natural childbirth after 1949, when she moved to Jacksonville, Ill., to be with her sister, who had recently married. There, while working with handicapped children, Ms. Bing met an obstetrician who, she discovered, knew very little about natural childbirth. Resolving to champion the techniques, she began approaching obstetricians and having them send patients to her for one-on-one classes.

Ms. Bing had planned to return to England in about a year and was on her way back when she stopped in New York to visit friends. There she met Fred Max Bing, an exporter’s agent, and decided to stay. The two were married in 1951.

Besides her son, Ms. Bing is survived by a granddaughter. Her husband died in 1984.

In New York, Ms. Bing again started giving private childbirth education classes. They caught the attention of Dr. Alan Guttmacher, the chief of obstetrics at Mount Sinai Hospital, which had opened its first maternity ward in 1951. He asked her to teach a formal class there.

In her search for other childbirth alternatives, Ms. Bing began to learn about the psychoprophylactic method developed in the mid-1950s by Lamaze, a French obstetrician. Lamaze refined Dick-Read’s approach by incorporating breathing exercises he had observed in the Soviet Union, where anesthesia was a luxury poor women in labor could scarcely afford.

In 1960, Ms. Bing, by then a clinical assistant professor at New York Medical College, and Ms. Karmel founded the American Society for Psychoprophylaxis in Obstetrics, known today as Lamaze International.

Ms. Karmel, an American, had become a natural-childbirth crusader after seeking out Lamaze in Paris to help her deliver her first child, and her best-selling book, “Thank You, Dr. Lamaze” (1959), largely introduced the method to Americans and drew Ms. Bing’s attention.

(In the late 1950s, Ms. Bing had persuaded Ms. Karmel to smuggle into the United States an explicit French educational film, “Naissance,” depicting a woman giving natural birth. When New York City hospitals and the 92nd Street Y refused to show it in prenatal classes — they considered it obscene — the two women held a private screening at Ms. Karmel’s home on the Upper East Side. Ms. Karmel died of breast cancer in 1964.

At the heart of the methods the women promoted was the idea of family teamwork, with the father helping the mother by coaching her in responding to her contractions with breathing exercises and massaging her back, and being present during the delivery.

But in her book, Ms. Bing cautioned, “You certainly must not feel any guilt or sense of failure if you require some medication, or if you experience discomfort or pain.”

Some obstetricians were skeptical of the methods and thought Ms. Bing, not being a physician, was ill qualified to be instructing patients. But the natural-childbirth movement found a receptive public. Women coming of age in the 1960s embraced the idea of taking a more active role in childbirth and wanted fathers to participate more as well.

“It was a tremendous cultural revolution that changed obstetrics entirely,” Ms. Bing said in an interview in 1988.

Ms. Bing was modest about her role in the movement. “It wasn’t really a movement by Lamaze or Read or me,” she told the Disney-owned website Family.com. “It was a consumer movement. The time was ripe. The public doubted everything their parents had done.”

But she rejoiced in the outcome. “We are not being tied down anymore,” she said in 2000. “We’re not lying flat on our backs with our legs in the air, shaved like a baby. You can give birth in any position you like. The father, or anybody else, can be there. We fought for years on end for that. And now it’s commonplace. We’ve got it all.”

Lamaze, himself, did not acknowledge Ms. Bing, never responding to her requests for an interview even though she had made his name part of the American vernacular. During their only meeting, at a lunch in New York, he directed all his comments to a male obstetrician at the table.

“I’ve never thought of myself as someone with a legacy of any kind,” Ms. Bing said in an interview at an Upper West Side cafe. “I hope I have made women aware that they have choices, they can get to know their body and trust their body.”

“If my ideas supported feminist ideas,” she continued, “well, that’s all right. But I’ve never been politically active.”

Written by Catharine Paddock PhD

www.medicalnewstoday.com 

A new study that offers insights into early language development suggests babies prefer listening to other babies rather than adults as they get ready to produce their own speech sounds.

The study, led by McGill University in Canada and published in the journal Developmental Science, observed the reactions of infants aged from 4-6 months who were not yet attempting speech, as they listened to baby-like and adult-like sounds produced by a voice synthesizer.

They found when the vowel sounds the babies listened to sounded more baby-like (for instance, higher pitch), the infants paid attention longer than when the sounds had more adult-like vocal properties.

Previous studies have shown that children at this age are more attracted to vocal sounds with a higher voice pitch, the authors note in their paper.

The team says the finding is important because being attracted to infant speech sounds may be a key step in babies being able to find their own voice - it may help to kick-start the process of learning how to talk.

They say the discovery increases our understanding of the complex link between speech perception and speech production in young infants.

It may also lead to new ways to help hearing-impaired children who may be struggling to develop language skills, they note.

Baby-like sounds held infants' attention nearly 42% longer

For the study, the team used a voice synthesizer to create a set of vowel sounds that mimicked either the voice of a baby or the voice of a woman.

They then ran a series of experiments where they played the vowel sounds one at a time to the babies as they sat on their mother's lap and listened. They measured the length of time each vowel sound held the infants' attention.

The results showed that, on average, baby-like sounds held the infants' attention nearly 42% longer than the adult-like sounds.

The researchers note that this finding is unlikely to be a result of the babies having a particular preference for a familiar sound because they were not yet producing those sounds themselves - they were not yet part of their everyday experience.

Some of the infants showed their interest in other ways. For example, when they listened to the adult sounds, their faces remained fairly passive and neutral. In contrast, when they heard the baby-like sounds, they became more animated, moved their mouths and smiled.

The following video shows how one of the infants - baby Camille, who is not yet babbling herself - reacts to the various sounds. Every time she looks away, the sound is replaced by another. Her reactions show which sounds she seems to like the most.

Babies need to 'find their own voice'

The researchers say maybe the babies recognized that the baby-like sounds were more like sounds they could make themselves - despite not having heard them before.

The findings may also explain the instinct some people have when they automatically speak to infants in baby-like, high-pitched tones, says senior author Linda Polka, a professor in McGill's School of Communication Disorders, who adds:

"As adults, we use language to communicate. But when a young infant starts to make speech sounds, it often has more to do with exploring than with communicating."

Prof. Polka says babies often try speaking when they are on their own, without eye contact or interaction with others. She explains:

"That's because to learn how to speak babies need to spend lots of time moving their mouths and vocal cords to understand the kind of sounds they can make themselves. They need, quite literally, to 'find their own voice.'"

Funds for the study came from the Natural Sciences Engineering and Research Council.

Meanwhile, parents and schools looking for ways to encourage children to eat more healthily may be interested in a study carried out among kindergarten through sixth-grade students at an inner-city school in Cincinnati, OH. There, researchers discovered that children found healthy food more appealing when linked to smiley faces and other small incentives. The low-cost intervention led to a 62% rise in vegetable purchases and a 20% rise in fruit purchases.

Written by Markus MacGill

www.medicalnewstoday.com 

3D printing has come to the rescue of severe cases of a childhood disease in which the windpipe is softened, leading to collapse of the airway and breathing failure. Previously lacking any adequate intervention, tracheobronchomalacia has found an innovative fix in three babies whose condition presented them with little chance of reaching young childhood.

Researchers at the University of Michigan's C.S. Mott Children's Hospital in Ann Arbor say the three boys have become the "first in the world to benefit from groundbreaking 3D-printed devices" to stent their airways in such a way as to allow the supports to keep up with their growth.

A follow-up of all three patients published in the journal Science Translational Medicine shows the personalized bioresorbable splint implants have worked with "promising results."

Pediatric tracheobronchomalacia (TBM) sees excessive collapse of the airways during breathing that can lead to life-threatening cardiopulmonary arrests (halted heart and breathing).

The cartilage supporting the airway can strengthen as children with the condition grow, the study paper goes on to explain, but severe cases of the disease require aggressive treatment - and those children are at "imminent risk of death."

Before this new approach to provide an early treatment option for TBM, the only conventional therapies available also carried life-threatening complications of their own.

Babies needed tracheostomy tube placement with mechanical ventilation, requiring prolonged hospitalization, and complications often led to cardiac and respiratory arrest. For example, the rate of respiratory arrest owing to tube occlusion runs as high as 43% of pediatric tracheostomy procedures a year.

Survivors: Kaiba, Ian and Garrett

But none of the newly developed 3D-printed devices have caused any complications for the three children treated, including Kaiba, who at 3 months old was the first to receive the new technology, 3 years ago. The stents were also inserted into 5-month-old Ian and 16-month-old Garrett.

Designed to accommodate airway growth while preventing external compression over a period of time before bioresorption, the technology allows for the particular problem of radial expansion of the airway over the critical period of growth. "If a child can be supported through the first 24 to 36 months of tracheobronchomalacia, airway growth generally results in a natural resolution of this disease," write the authors.

Senior author Dr. Glenn Green, associate professor of pediatric otolaryngology at C.S. Mott, says: "Before this procedure, babies with severe tracheobronchomalacia had little chance of surviving. Today, our first patient Kaiba is an active, healthy 3-year-old in preschool with a bright future." Dr. Green adds:

"The device worked better than we could have ever imagined. We have been able to successfully replicate this procedure and have been watching patients closely to see whether the device is doing what it was intended to do.

We found that this treatment continues to prove to be a promising option for children facing this life-threatening condition that has no cure."

Dr. Green describes in the video below how he and his colleagues at the University of Michigan worked on finding the solution.

Dr. Green strives enthusiastically for the lives of babies born with the condition, which he says in a post on the hospital's Hail to the little victors blog is often misdiagnosed as treatment-resistant asthma. He adds that it is a rare congenital condition affecting about 1 in 2,200 births, and the severe cases are even rarer, with most children growing out of the milder cases by 2 or 3 years of age.

"Kaiba's parents, April and Bryan, were left watching helplessly each time he stopped breathing, praying that something would change and doctors' predictions that he would never leave the hospital again weren't true," writes Dr. Green in 2013.

The 3D-printed splints were computational image-based designed to be customizable so that the following parameters could be made bespoke to the individual patient's anatomy on "the submillimeter scale:"

• Inner diameter, length and wall thickness of the device
• Number and spacing of suture holes.

Not being a closed cylinder, the design of the tubes gave an opening to allow placement but also expansion of the radius as the airways grew. All the inserts placed around the airways were made of polycaprolactone, a polymer that harmlessly dissolves in the body at a rate to allow the technology time to support the growing cartilage.

For Garrett's bespoke device on his left bronchus, the opening had a spiral shape to it, to allow a device to be fitted concurrently around, and grow with, his right bronchus, too.

Freedom from intensive care treatments

The Michigan team also share findings showing that the success of the devices meant the young children were able to come off of ventilators and no longer needed paralytic, narcotic and sedating drugs.

There were improvements in multiple organ systems and problems that had prevented the babies from absorbing food, so now they could be free of intravenous therapy.

The research doctors had received urgent approval from the US Food and Drug Administration to do the procedures, but it is early days for the strategy to become routine for babies with TBM. The case report published today was not designed to test the safety of the devices - so it may yet be possible that rare complications are found to result from treatment in some cases. Dr. Green says:

"The potential of 3D-printed medical devices to improve outcomes for patients is clear, but we need more data to implement this procedure in medical practice."

The specialist surgeon performing the operations, Dr. Richard Ohye, head of pediatric cardiovascular surgery at C.S. Mott, believes the cases provide the groundwork for a potential clinical trial in children with less-severe forms of TBM.

By SYDNEY LUPKIN

http://abcnews.go.com 

Formerly conjoined twins Knatalye Hope and Adeline Faith Mata celebrated their first birthday with a "Frozen"-themed party at the hospital.

A team at Texas Children's Hospital separated the girls on Feb. 17 in a 26-hour surgery. They are still in the pediatric intensive care unit and have each had a few surgeries since the separation, but their mother, Elysse Mata, decorated their room with snowflakes and balloons.

"It's been a year," Mata said, surrounded by presents as the hospital filmed her. "It went by so fast. I feel like just yesterday they were born."

Earlier in the week, Mata had a party for everyone at the hospital who helped her babies over the last year. She said she was sad to leave some of the doctors from before the separation, but she knows it's a positive thing.

"Now they're good and healthy and hopefully headed towards home," said Mata, 25, of Lubbock, Texas.

Mata was shocked to learn the twins were conjoined when she was pregnant with them, she told ABC News in July.

"I was speechless, it was so unexpected,” she said.

The girls were born on April 11, 2014 at Texas Children's Hospital. They shared a chest wall, diaphragm, intestines, lungs, lining of the heart and pelvis. Their middle names are Hope and Faith because you can't have one without the other, she said.

"Nightline" was at the hospital in February as 12 surgeons operated on the Mata twins, and Elysse, her husband and 20 family members camped out in the waiting room.

Written by James McIntosh

www.medicalnewstoday.com 

Researchers testing the origins of human breast milk samples available for purchase online found that around 10% of the samples they examined contained significant amounts of added cow's milk.

The pressure on parents to feed newborn infants with breast milk may be leading many to purchase human breast milk online. However, the milk they receive from online vendors may not match up to what is being offered.

"They purchase the milk online based on a posted description of the type and quantity of the milk or the health habits of the seller," writes study author Dr. Sarah Keim. "But when they think they're getting nutritious, high-quality breast milk, some of them are actually receiving human milk mixed with cow's milk."

Human breast milk is widely recognized as providing many health benefits to young infants. According to the American Academy of Pediatrics (AAP), breastfeeding can protect against diseases and conditions such as diarrhea, diabetes and childhood obesity.

However, many new mothers find themselves unable to breastfeed. In 2012, a survey published in Pediatrics found that two-thirds of mothers nursing newborns are unable to manage breastfeeding for as long as they intended.

"Some women are unable to produce enough milk for their infant or perceive they cannot meet their infant's needs, yet they may be reluctant to feed formula," write the researchers of the new study. For these mothers, the Internet represents an alternative way of providing human milk for their children.

'You do not truly know what you are receiving'

For the study, published in Pediatrics, Dr. Keim and her colleagues purchased 102 samples of what was advertised as human milk from sellers on the Internet. These milk samples were subjected to DNA testing in order to verify their human origins and to assess whether any cow's milk was also present.

While all of the purchased Internet samples contained human DNA, 11 also contained bovine DNA. Of these, 10 contained bovine DNA concentrations significant enough to suggest that cow's milk had been added to human milk, being so high that accidental contamination was unlikely.

The inclusion of cow's milk in human breast milk can be problematic for babies. It can potentially be harmful due to cow's milk allergies, health conditions or formula sensitivities. The inclusion of cow's milk could also reduce a baby's access to the essential nutrients and fats that are in formulas and human breast milk but not cow milk.

"The truth of the matter is that you do not truly know what you are receiving when you buy milk from a stranger over the Internet," explains Dr. Keim.

"Selling breast milk gives people an incentive to add cow's milk or formula to the milk in order to sell more. When money is involved in an unregulated process like this, you cannot know for sure that the milk is safe to give to your baby."

Although the sample used in the study is acknowledged as small by the authors, they state the sample is representative of Internet sellers and has given the researchers findings that may at least generalize to milk being sold via the Internet.

"Our findings confirm the previously theoretical risk that human milk being sold via the Internet may not be 100% human milk," the authors conclude. "Because buyers have little means to verify the composition of the milk they receive, all should be aware of the possibility that it may be adulterated."

Previously, in a report published in The BMJ, experts claimed that breast milk purchased online can pose serious health risks to infants, largely due to a lack of regulation. Human milk is not tested for contamination or disease and could be stored incorrectly.

By GILLIAN MOHNEY

Source: http://abcnews.go.com

An Indiana couple is celebrating an extra-special arrival with the birth of their identical triplet daughters.

Ashley and Matt Alexander of Greenfield, Indiana, were surprised weeks ago when they learned they were expecting three new additions to their family during a routine sonogram, according to ABC affiliate WRTV-TV in Indianapolis, Indiana.

"She was checking [Ashley] and right away there were twins, and she goes, 'Let me check for a third,'" Matt Alexander told WRTV-TV in an earlier interview. "I'm like, she's just joking. I said, 'You're joking,' and she said, 'No, we don't joke about this stuff.' So [Ashley] about came off the table."

The couple, who already have a son, had conceived the triplets naturally, so they were not expecting to see three heartbeats on the sonogram.

Ashley Alexander told WRTV-TV she has a plan to tell the girls apart.

"I'm painting their nails," she said. "One's going to be pink, one purple, and the other probably pale blue."

Dr. William Gilbert, the director of women's services for Sutter Health in Sacramento, California, said in an earlier interview with ABC News there was no definite rate for the number of identical triplets born every year.

"It's hard to calculate a conservative estimate," Gilbert said about the rate of naturally conceived identical triplets. "One in 70,000 - that would be on the low end. The high end is one in a million."

By Laura Smith-Spark

Lawmakers on Tuesday voted in favor of a law that sets the stage for the United Kingdom to be the first country in the world to allow a pioneering in vitro fertilization technique using DNA from three people.

The technique could prevent mitochondrial diseases but also raises significant ethical issues.

The measure was passed in the House of Commons, 382 to 128, Speaker John Bercow said.

A further vote must be held in the UK's upper house, the House of Lords, before the measure can become law.

Passage of the law is opposed by Catholic and Anglican church leaders, in part because the process involves the destruction of an embryo.

One in 6,500 babies in the United Kingdom are thought to develop a serious mitochondrial disorder, which can lead to health issues such as heart and liver disease, respiratory problems, blindness and muscular dystrophy.

Problems with mitochondria, the "powerhouse" cells of the body, are inherited from the mother, so the proposed IVF treatment would mean an affected woman could have a baby without passing on mitochondrial disease.

But the cutting-edge IVF technique, which involves transferring nuclear genetic material from a mother's egg or embryo into a donor egg or embryo that's had its nuclear DNA removed, raises ethical questions.

The new embryo will contain nuclear DNA from the intended father and mother, as well as healthy mitochondrial DNA from the donor embryo -- effectively creating a "three-parent" baby.

The amount of donor DNA in the mitochondria will, however, be much less than the parental DNA in the nucleus, which determines the baby's characteristics.

Called an ethical watershed

The Church of England's national adviser on medical issues, the Rev. Dr. Brendan McCarthy, described the step as representing an ethical watershed and said more research and wider debate were needed.

"We accept in certain circumstances that embryo research is permissible as long as it is undertaken to alleviate human suffering and embryos are treated with respect. We have great sympathy for families affected by mitochondrial disease and are not opposed in principle to mitochondrial replacement," he said.

"Our view, however, remains that we believe that the law should not be changed until there has been further scientific study and informed debate into the ethics, safety and efficacy of mitochondrial replacement therapy."

Bishop John Sherrington, in a statement posted online by the Catholic Church in England and Wales, urged lawmakers not to rush into taking such a serious step.

"It seems extraordinary that a licence should be sought for a radical new technique affecting future generations without first conducting a clinical trial," he said. "There are also serious ethical objections to this procedure which involves the destruction of human embryos as part of the process."

The California-based Center for Genetics and Society, in an open letter to UK lawmakers last month, said that although the proposed goal was noble, "the techniques will in fact put women and children at risk for severe complications, divert resources from promising alternatives and treatments, and set a policy precedent that experimentation on future generations is an acceptable biomedical/fertility development."

Incurable diseases

A team at the Wellcome Trust Centre for Mitochondrial Research, led by professor Doug Turnbull and based at Newcastle University in northern England, has been leading the research into the pioneering IVF technique.

The center points out that mitochondrial diseases cannot be cured and that in many families, several people are affected.

A Wellcome Trust fact sheet states that "nuclear DNA is not altered, and so mitochondrial donation will not affect the child's appearance, personality or any other features that make a person unique -- it will simply allow the mitochondria to function normally and the child to be free of mitochondrial DNA disease.

"The healthy mitochondria will also be passed on to any children of women born using the technique."

According to the latest estimates from the research team, published in The New England Journal of Medicine, almost 2,500 women of childbearing age in the UK are at risk of transmitting mitochondrial disease to their children, while in the United States, the number is more than 12,400.

This equates to an average of 152 births per year in the UK, and 778 births per year in the United States, the team said. 

In a Newcastle University news release, Turnbull said his team's findings had considerable implications for other countries considering the technique. Allowing it would give "women who carry these mutations greater reproductive choice," he said.

Source: www.cnn.com

At birth, a newborn baby is still attached to its mother through the umbilical cord, which is either cut very early - within the first 60 seconds - or later, with some women opting to wait until after the cord has stopped pulsating. Though the right timing for cutting the cord - also referred to as clamping - is widely debated, a new study suggests delaying cord clamping by 2 minutes results in better development for the newborn during the first days of life.

What do you think about it? Do you think the 2 minutes makes a difference? Perhaps you can share a personal and/or professional experience about this.

The research, carried out by scientists from the University of Granada and the San Cecilio Clinical Hospital in Spain, is published in the journal Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

According to the American Congress of Obstetricians and Gynecologists (ACOG), the reason that cord clamping timing is so controversial is that a previous series of studies into blood volume changes after birth concluded that in healthy term infants, more than 90% of blood volume was attained within the first few breaths he or she took after birth.

As a result of these findings, as well as a lack of other recommendations regarding optimal timing, the amount of time between birth and umbilical cord clamping was widely shortened; in most cases, cord clamping occurs within 15-20 seconds after birth.

However, before these studies, in the mid-1950s, cord clamping within 1 minute of birth was defined as "early clamping," and "late clamping" was defined as more than 5 minutes after birth. And the ACOG have stated that "the ideal timing for umbilical cord clamping has yet to be established."

Meanwhile, the World Health Organization (WHO) advocate for late cord clamping (between 1-3 minutes after birth), as it "allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to 6 months after birth."

Waiting 2 minutes increased antioxidant capacity

To provide further evidence in the debate of early versus late cord clamping, the researchers from this latest study, led by Prof. Julio José Ochoa Herrera of the University of Granada, assessed newborn outcomes for infants born to 64 healthy pregnant women to determine the impact of clamping timing on oxidative stress and the inflammatory signal produced during delivery.

All of these women had a normal pregnancy and spontaneous vaginal delivery. However, half of the women's newborns had their umbilical cord cut 10 seconds after delivery and half had it cut after 2 minutes.

Results revealed beneficial effects of late cord clamping; there was an increase in antioxidant capacity and moderation of inflammatory effects in the newborns.

Commenting further, Prof. Ochoa says:


"Our study demonstrates that late clamping of the umbilical cord has a beneficial effect upon the antioxidant capacity and reduces the inflammatory signal induced during labor, which could improve the development of the newborn during his or her first days of life."

He adds that umbilical cord clamping is one of the most frequent surgical interventions practiced in humans, with proof of the practice dating back centuries. 

Early clamping 'not advised unless newborn needs resuscitation'

With evidence of benefits for delayed cord clamping, however, why are most newborns separated from the placenta within 15-20 seconds after birth? According to the ACOG, there are concerns over universally adopting delayed clamping because it could "jeopardize timely resuscitation efforts, if needed, especially in preterm infants."

"However," the organization states, "because the placenta continues to perform gas exchange after delivery, sick and preterm infants are likely to benefit most from additional blood volume derived from a delay in umbilical cord clamping."

There are also other concerns regarding delayed cord clamping, including an increased potential for "excessive placental transfusion, which can lead to neonatal polycythemia" - an abnormally high level of red blood cells. This is especially of concern in the presence of risk factors including maternal diabetes, intrauterine grown restriction and high altitude.

Another concern stated by the ACOG is that delayed umbilical cord clamping "may be technically difficult in some circumstances."

Still, the WHO say late cord clamping is recommended for all births, and the improved iron status associated with it "may be particularly relevant for infants living in low-resource settings with reduced access to iron-rich foods."

The organization clearly states that early cord clamping - less than 1 minute after birth - is not advised unless the newborn is asphyxiated and needs to be moved for resuscitation.

Source: www.medicalnewstoday.com

By Steven Reinberg

A brain abnormality may be responsible for more than 40 percent of deaths from sudden infant death syndrome (SIDS), a new study suggests.

The abnormality is in the hippocampus, a part of the brain that influences breathing, heart rate and body temperature. This abnormality may disrupt the brain's control of breathing and heart rate during sleep or during brief waking that happens during the night, the researchers report.

"This abnormality could put infants at risk for SIDS," said lead researcher Dr. Hannah Kinney, a professor of pathology at Harvard Medical School in Boston.

Kinney can't say for sure that this abnormality is a cause of SIDS. "We don't know at this stage. This is the first observation of this abnormality," she said. "It's just an observation at this point."

Before this brain abnormality can be called a cause of SIDS, Kinney said, they have to find out what causes this abnormality and determine if it alone can cause SIDS.

For the study, Kinney's team examined sections of the hippocampus from 153 infants who died suddenly and unexpectedly between 1991 and 2012. The deaths were classified as unexplained -- which includes SIDS -- or from a known cause, such as infection, accident, murder or lack of oxygen.

Kinney's group found that 41.2 percent of infants who died for an unexplained reason compared with 7.7 percent of those whose death was explainable had an abnormality in the part of the hippocampus known as the dentate gyrus. 

Among the 86 infants whose death was classified as SIDS, 43 percent had this abnormality, the researchers added.

This change in the dentate gyrus suggests there was a problem in development at some point late in the life of the fetus or in the months after birth, Kinney said.

Kinney added that this abnormality has only been seen under the microscope after death, so a child cannot be tested for the abnormality.

"There are no signs or symptoms that predict SIDS or warn families that this problem is there or that SIDS is going to occur," she said.

The report was published online Nov. 24 in the journal Acta Neuropathologica.

"Until we understand more about this abnormality, parents should follow the safe sleep recommendations of the American Academy of Pediatrics," Kinney said.

The recommendation is to place an infant alone in a crib on the back without toys or pillows as bolsters. "The same messages we have always had are still applicable," she said.

SIDS is the leading cause of death of infants younger than 1 year of age in the United States, the researchers said.

Dr. Sayed Naqvi, a pediatric neurologist at Miami Children's Hospital, noted that this brain abnormality has been found in epilepsy, but this is the first time it has been linked to SIDS.

"This needs to be confirmed and more research done to say this is a cause of SIDS," he said. 

Marian Willinger, a special assistant for SIDS at U.S. National Institute of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a statement, "The new finding adds to a growing body of evidence that brain abnormalities may underlie many cases of SIDS." 

"The hope is that research efforts in this area eventually will provide the means to identify vulnerable infants so that we'll be able to reduce their risk for SIDS," she added.

Source: www.medicinenet.com

By George Putic

Each year, about one million babies throughout the world die of complications due to premature birth. Many of them could have been saved if given access to an incubator. But this expensive device is sorely lacking in developing countries. A young British researcher says he has found a solution -- a low-cost inflatable incubator.

Doctors say many expectant mothers in developing countries give birth prematurely, especially in refugee camps, largely because of poor diet and unhealthy living conditions.

Premature birth is the biggest killer of children worldwide. Because these tiny babies are born before their lungs are fully developed, they are more susceptible to often deadly infections. But they could survive if placed in an incubator, where they would continue to develop in the closed chamber and warm, controlled environment.

However with a price tag of around $50,000, incubators are out of reach even for some hospitals.

Design engineering student James Roberts, 23,  of Britain says his $400 inflatable incubator may help solve this problem.

“It's basically an insulated piece of air, so it's like the difference between double and single glazing, so it's easier to keep the inside at a stable heat environment, heat temperature," he said.

The inflated incubator is collapsible and when folded resembles an ordinary travel bag.

It is powered through a regular electrical line, but Roberts said he has found a solution in case there is a power outage, which often happens in refugee camps.

“I thought 'why not car batteries?' There's loads of cars out there, they're pretty readily available. So you can plug this into a car battery. It will run for 24 hours and then when the mains [regular electrical line] comes back on, the mains can then charge this battery, and then that can run the incubator," he said.

Roberts' won the $47,000 James Dyson Award earlier this year for his incubator design. He said the project is still in the development phase, but the prize money will help him start a company for the mass manufacturing of inflatable incubators.

Source: www.voanews.com