I know, I know…Let them sleep on their backs…No wait, only on their stomachs…No wait, on their backs but no pillows…or blankets…No smoking…No pets…Never in bed with you…

Perhaps it’s no wonder why the Amercian Academy of Pediatrics is constantly revising guidelines [...]]]> Source:  U.S. National Institutes of Health; Journal of the American Medical Association, February 3, 2010

I know, I know…Let them sleep on their backs…No wait, only on their stomachs…No wait, on their backs but no pillows…or blankets…No smoking…No pets…Never in bed with you…

Perhaps it’s no wonder why the Amercian Academy of Pediatrics is constantly revising guidelines for infant sleep.  There is a wealth of information seemingly linking SIDS (Sudden Infant Death Syndrome) with, well, everything.  The latest?  Serotonin. Huh?  Okay, back to biochemistry class we go.  Serotonin is a neurotransmitter, don’t worry about what kind, it’s presence or absence in sufficient quantities is  broadly responsible for the regulation of mood, appetite, sleep, muscle contraction, and some cognitive functions including memory and learning. Modulation of serotonin at synapses is thought to be a major action of several classes of pharmacological antidepressants.  As an interesting aside (well interesting to me anyway) certain foods, carbohydrates mostly -pasta, chips also seem to have a serotonin level response.

So why all the chemistry talk? Because researchers studying the brains of infants who have died from SIDS have found that they were producing low levels of serotonin. No, they weren’t depressed, well not emotionally anyway.  However, to the extent that serotonin may be responsible for breathing they may be onto something.  How much lower?  26% lower according to this study. Measures of an enzyme required to manufacture serotonin (tryptophan hydroxylase for those of you playing the home game) were also 22% lower in the brains of the SIDS death infants studied.

Yes, they are still currently recommending the whole back sleeping thing. For a complete list of sleeping guidelines see http://www.nicdh.nih.gov/sids/ or speak with your pediatrician or obstetrician.

~Posted by D.M. Schwadron, Esquire

Admittedly it was a small, focused study of 36 newborns, 17 of whose mothers smoked during pregnancy.  It is, however, alarming and instructive.  Babies that had been exposed to cigarette smoke in utero (While in Mommy’s belly) demonstrated abnormal heart rates and blood pressures.

But that’s not all. . .rather than [...]]]> Source:  BBC Health; Karolinska Institute (Sweeden)

Admittedly it was a small, focused study of 36 newborns, 17 of whose mothers smoked during pregnancy.  It is, however, alarming and instructive.  Babies that had been exposed to cigarette smoke in utero (While in Mommy’s belly) demonstrated abnormal heart rates and blood pressures.

But that’s not all. . .rather than dissipate with age, the abnormalities appear to have worsened from one week to age one. According to lead researcher, Dr. Gary Cohen, “Babies of smokers have evidence of persistent problems in blood pressure regulation that start at birth and get worse over time” and “[E]arly life exposure to tobacco can lead to long lasting reprogramming of the infant blood pressure control mechanism.”

And Dr. Cohen adds, this might be the mechanism which explains why infants of smokers are at increased risk for SIDS (Sudden Infant Death Syndrome) or “Cot death” as it is known in the UK.

~Posted by D.M. Schwadron, Esquire

Controversy on the MS (Multiple Sclerosis) front.  Multiple Sclerosis is an inflammatory disease of the central nervous system which can cause severe disability and death.  A joint Belgian and Dutch study tracking 330 women with MS over the course of 18 years suggest that for [...]]]> Source: Journal of Neurology, Neurosurgery and Psychiatry, BBC Health, MS Society

Controversy on the MS (Multiple Sclerosis) front.  Multiple Sclerosis is an inflammatory disease of the central nervous system which can cause severe disability and death.  A joint Belgian and Dutch study tracking 330 women with MS over the course of 18 years suggest that for those who became pregnant and gave birth, severe disability associated with MS took longer to develop.

This is stark contrast to prior studies which have long supported the notion that MS worsens following pregnancy and birth.  The MS Society has issued a statement suggesting “flaws” in the study and too small a sample size. But there was some concession that the release of hormones during pregnancy could have a beneficial effect on the immune system and its ability to fight MS.

Researchers say that women who gave birth to one or more children prior to the onset of their MS Symptoms were 34% less likely to progress than those women who remained childless.  Moreover (legal speak for “also) women who had children AFTER their MS became symptomatic were 39% less likely to progress than childless women.

Put this one down as too early to say, but consider those lifetime decisions carefully now that there is more information emerging. As always, consult your physician before electing to become pregnant, with or without symptomatic MS.

~Posted by David Marc Schwadron, Esquire

It’s not just for currently pregnant women anymore. The Scottish Spina Bifida Association has noticed an alarming trend in the rate of infants born with Spina Bifida.  Myelomeningocele (Spina Bifida) is a birth defect in which the backbone and spinal canal do not close before birth.  Associated symptoms include hydrocephalus (water on the [...]]]> Source:  BBC Health/Scotland

It’s not just for currently pregnant women anymore. The Scottish Spina Bifida Association has noticed an alarming trend in the rate of infants born with Spina Bifida.  Myelomeningocele (Spina Bifida) is a birth defect in which the backbone and spinal canal do not close before birth.  Associated symptoms include hydrocephalus (water on the brain), paralysis and severe infection.  The condition is,very often, terminal.

Researchers suggest that taking folic acid up to 3 months prior to conception (becoming pregnant) could prevent up to 75% of the cases of Spina Bifida.

Scotland has the highest rate of children born with Spina Bifida in the entire United Kingdom.  (I know what you are thinking. No, it’s not the Scotch, apparently).  It’s generally due to the limited number of therapeutic abortions performed in Scotland.

As always, consult with your doctor before taking any supplement.  Here’s one to seriously consider.

posted by David Marc Schwadron, Esq.

Premature babies (low gestational age neonates) are subject to less stress, inflammation and chronic lung disease when 30% oxygen is used instead of 90% oxygen during resuscitation.  This according to researchers from University Hospital La Fe, Valencia (yes, like the oranges), Spain.

You’d think more oxygen would be better, right? Wrong.  The air you are [...]]]> Source: Reuters

Premature babies (low gestational age neonates) are subject to less stress, inflammation and chronic lung disease when 30% oxygen is used instead of 90% oxygen during resuscitation.  This according to researchers from University Hospital La Fe, Valencia (yes, like the oranges), Spain.

You’d think more oxygen would be better, right? Wrong.  The air you are currently breathing, in the room you are in, is comprised of approximately 20% oxygen.  Little and underdeveloped lungs are not exactly equipped to handle significantly more than that.

Hyperoxia (literally too much oxygen) can cause “oxygen toxicity” similar to that deep sea divers may experience.  symptoms may include disorientation, breathing problems, and vision changes some or all of which may be permanent.

Okay then,  now you know.

posted by David Marc Schwadron, Esquire

More Premature Babies are surviving childbirth. Good news, right? Well. . .

According to medical researchers in Sweden, 70% of infants born from 22 to 26 weeks gestation (40 weeks is full term) survive through at least age one due to advances in medical technology including resuscitation, ventilation and incubation. The [...]]]> Source: BBC Health News

More Premature Babies are surviving childbirth. Good news, right? Well. . .

According to medical researchers in Sweden, 70% of infants born from 22 to 26 weeks gestation (40 weeks is full term) survive through at least age one due to advances in medical technology including resuscitation, ventilation and incubation. The study spanned from 2004-2007 with a perinatal mortality (death rate post childbirth) of 45%. In other words more than 1/2 of the 1,011 premature infants survived. Again, that’s good, right? Not necessarily.

Did I mention that over half of the babies that survived had serious health problems from which some of them eventually died? The parents of 40% of the surviving sick infants who were placed in a NICU (neonatal intensive care unit) had to make the difficult decision to withdraw intensive care and life support because of the poor prognosis.

So there is an emotional toll to consider along the physical toll. There is also a financial toll. University of Oxford Health Economists estimate the cost of an average preterm baby at 1.5 times that of their full term nursery mates. This translates to an additional $1.6 billion (yes, with a “b”) cost per year for the UK. Okay you arm chair ethics gurus, what conclusions does one draw? Yes, the cost to Sweden would have been more appropriate but it’s the BBC and I didn’t write the article.

It is, perhaps sad but not at all surprising, that medical providers in Sweden tend to be “less aggressive” in their interventions with significantly premature babies than we in the States.

posted by David Marc Schwadron, Esq.

“Prematurity” during pregnancy is between 20 and 37 weeks. 72% of premature deliveries are spontaneous with 30% [...]]]> Gene mapping continues to batter the nurture end of the nature-nurture argument. In this latest round, a study presented at the 57th Meeting of ACOG (the Ob/Gyn doctors) has linked premature rupture of membranes with a single gene, MMP3.

“Prematurity” during pregnancy is between 20 and 37 weeks. 72% of premature deliveries are spontaneous with 30% due to premature rupture of membranes. So what does this mean? And why should you care?

Last question first. If you are a pregnant woman (yes, as opposed to a pregnant man) then knowing whether or not you have the gene for premature rupture of membranes might result in your Ob/Gyn taking additional precautions during your pregnancy to ensure safe, and timely, delivery of your baby. What this means is that the risk of harm to infants and to mothers may be significantly decreased just by being aware of the increased risk of premature rupture. The usual caveats apply, still early, preliminary stages and all that. But still, promising.

posted by David Marc Schwadron, Esq.

Significantly, the results were said to be similar for those infants with and without encephalopathy. The theory advanced to explain this is [...]]]> A little too close to home here, but results of a recent British cohort study suggest that infants who required resuscitation are at increased risk for low IQ scores by 8 years of age.

Significantly, the results were said to be similar for those infants with and without encephalopathy. The theory advanced to explain this is called “continuum of reproductive casualty” meaning that even mild perinatal events may have long term effects on cognition. The study ultimately examined the IQ scores of 5887 children in a British school who were around 8.6 years of age on average.

Up to 14% of neonates may require resuscitation after delivery. Mine did. It should be noted that children delivered more than 8 years ago were more likely to receive 100% oxygen during resuscitation. Such a level of forced oxygenation was associated with poorer outcomes, forcing a practice change. Still, in calling the results “surprising” clinicians have noted some limitations of the study in that only 51% of the original cohort group of 10,609 children were followed to school age (British system school age) and that the mean (average) IQ scores among the resuscitated and asymptomatic children were not different from the control group.

My neonate is currently 5.6 years of age. One to follow.

posted by David Marc Schwadron, Esq.

Despite assurances of a normal and healthy pregnancy, Dr. S decided Mrs. H should be admitted for induction as the baby might be “too large for gestational age.” On the evening of August 12, at approximately 10:16 p.m. [...]]]> Our case:*Mrs. H, a 36 year old woman became pregnant and completed all required prenatal care visits.

Despite assurances of a normal and healthy pregnancy, Dr. S decided Mrs. H should be admitted for induction as the baby might be “too large for gestational age.” On the evening of August 12, at approximately 10:16 p.m. Cervidil, a cervical stimulant, was administered to Mrs. H by a resident doctor. Cervidil was discontinued at 8:45 a.m. and Pitocin was started at 8:50 a.m., only 5 minutes later. Signs of hyper-stimulation went un-noticed by the nurses and doctors attending to Mrs. H. At 1:10 p.m. Mrs. H was taken to the OR for an emergency C-section delivery.

Blood was found in the peritoneum indicated that the uterus had ruptured causing massive internal bleeding which deprived Baby H of vital oxygen. Mrs. H survived but what was left of her uterus was removed. Baby H, at 8 lbs 4 0z was so brain damaged from the trauma that she remained ventilator dependent until her death 6 weeks later.

Why the Defendants were Negligent: The defendants deviated from acceptable standards of obstetric care in administering Cervidil and Pitocin within 5 minutes of one another. This caused hyperstimulation of the uterus and it’s rupture. Had the defendants noticed the signs of hyper stimulation, an earlier C-section may have resulted in the birth of a healthy baby girl.

The Verdict: The Lewis Law Firm was able to recover a large monetary award following settlement with the Defendants.

*names have been changed