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

ACOG has now published a revised version of it’s guidelines for Fetal Heart Rate (FHR) monitoring. In practice Bulletin #106, ACOG has sought to improve consistency of common terms and to reduce variability (bad word choice) in FHR interpretation.

FHR was used in less than [...]]]> Source: ACOG (The American College of Obstetricians and Gynecologists) July 2009

ACOG has now published a revised version of it’s guidelines for Fetal Heart Rate (FHR) monitoring. In practice Bulletin #106, ACOG has sought to improve consistency of common terms and to reduce variability (bad word choice) in FHR interpretation.

FHR was used in less than 45% of pending deliveries in 1980 and 85% in 2002. Oddly, the rates of perinatal mortality and of cerebral palsy (CP) have remained the same despite advances in monitoring. Some of the more interesting findings include the following: false-positive rates of EFM (Electronic Fetal Monitoring) for predicting cerebral palsy exceeds 99%; Pulse oximetry has not been shown to be clinically useful for assessing fetal status; Interpretation of FHR tracing is subject to high inter (between) and intra (within)-observer variability (not a good thing).

Hyperstimulation and hypercontractility are no longer recommended terms. Only Medical Malpractice lawyers will recognize why that is so funny. (Not “Ha! Ha!” funny either).

The best recommendations are also the most obvious: woman with high-risk pregnancies should undergo continuous FHR monitoring when used during labor (as opposed to…?) nurses and physicians should review the EFM frequently–approximately every 30 minutes in the first stage of labor and every 15 minutes in the second stage.

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