premature birth

RECENT POSTS

Calls For Better Pain Relief Measures For Newborns, Premature Infants

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

What could be more heartbreaking than witnessing some of the smallest, sickest babies undergoing painful medical procedures?

Yet that’s precisely the population subject to some of the most intrusive prodding and pricking, the “greatest number of painful stimuli” in the neonatal intensive care unit, or NICU.

Now the American Association of Pediatricians is calling for better, more comprehensive pain relief measures for newborns, including those born prematurely — both with medications and through alternative, non-drug measures — and for more research on effective treatments.

The AAP’s updated policy statement, published in the journal Pediatrics, asserts that “although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures.”

The AAP calls for new measures, specifically:

Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.

If you’ve ever been in a NICU, you may have seen these types of procedures take place: suctioning of various secretions from the nose and throat; blood draws from veins, arteries, feet or heels; IVs being placed; adhesive tape — used to keep all those tubes and IVs in place — removed.

A landmark 2008 study from France found that the vast majority of newborns in the NICU didn’t get pain relief; researchers found only about 21 percent of infants were given either pain medication or non-drug pain relief before undergoing a painful procedure.

Why is this important? Continue reading

Sweeping Harvard Study Finds Skin-To-Skin ‘Kangaroo Care’ Helps Preemies Thrive

If a premature baby is medically stable, a study finds the practice of holding the tiny child might well do some good. (BradleyOlin/Flickr)

If a premature baby is medically stable, a study finds”kangaroo care” — including prolonged skin-to-skin contact — might well do some good. (BradleyOlin/Flickr)

You want to hold your baby. It’s surely one of the deepest of human instincts. But if your newborn is among the nearly 10 percent who arrive prematurely in America each year, you may need to wait — until the days of tubes and high-tech monitors in the incubator have passed.

Now, a new study, apparently the most sweeping yet, offers added evidence that if a premature baby is medically stable, the age-old practice of holding the tiny child — skin to skin, heartbeat to heartbeat — might well do some good. A survey of more than 100 previous studies, it found that overall, the skin-to-skin cradling widely known as “kangaroo mother care” may cut a premature, low-birth-weight baby’s risk of death by 36 percent.

The findings may rightly spur parents to advocate for holding their preemies once they’re medically stable enough, says the study’s senior author, Dr. Grace Chan of Boston Children’s Hospital and the Harvard Chan School of Public Health.

“With this degree of evidence, it doesn’t hurt to ask,” she says. High-tech medical interventions “are necessary for many conditions,” she says. “At the same time, for your preterm, low-birth-weight baby who’s otherwise stable, this is the best thing for the baby.”

Kangaroo care is considered most useful in low-income areas where high-level-care hospitals — and incubators — are few. But Dr. Chan says it seems to offer benefits across all settings. The new study, in the journal Pediatrics, quantifies those benefits, finding both the 36 percent drop in risk of death and a 47 percent drop in infection or sepsis. It looked at newborns who weighed less than 2 kilograms, or 4.4 pounds.

My own son weighed just about that when he was born two months early, back in 2004. And I remember the joy of the brief periods when we were allowed to extract him from his incubator home for a few minutes and hold him close. Judging by that Boston hospital experience, I asked Dr. Chan, kangaroo care is fairly widely accepted, right? Continue reading

Differing Views On Antidepressants During Pregnancy

The question of taking antidepressants during pregnancy is extremely intimate and complicated. Research studies evaluating the risks and benefits are mixed. There are documented harms, like an elevated risk of pre-term birth. But there are also the documented harms of untreated depression. In other words, it’s a deeply personal health decision that requires judgement based on a body of data that offers no easy answers.

The latest on this fraught debate comes from Andrew Solomon who wrote a long piece published in last Sunday’s New York Times Magazine, “The Secret Sadness,” with this basic message: “Pregnant women who are depressed often fear taking the medication they rely on. But not treating their depression can be just as dangerous.”

Solomon, whose own depression is well documented in his powerful book, “The Noonday Demon: An Atlas of Depression,” (The Times piece will be added as a new chapter in the book) begins the magazine article with an anecdote about Mary Guest, “a lively, accomplished 37-year-old woman” who “fell in love, became pregnant and married after a short courtship.”

Struggling with depression for much of her life, Mary took various antidepressant and anti-anxiety drugs, Solomon writes, but decided to discontinue the meds during pregnancy. But Mary’s mood and behavior “spiraled downward” so, “near the end of her fifth month of pregnancy, she finally, reluctantly, resumed taking an antidepressant,” he writes.

Then, at six-and-a-half months pregnant, and convinced that something was wrong with her fetus, Mary “went to the 16th floor of the building where her parents lived and jumped to her death.” Solomon quotes Mary’s mother saying: “We feel, rightly or wrongly, that if Mary had stayed on her medications, or even gone back on them sooner, it’s possible she would have survived.”

It’s an intense, moving story.

But Dr. Adam Urato, an assistant professor at Tufts University School of Medicine in Boston and a maternal-fetal medicine physician at Tufts Medical Center and MetroWest Medical Center in Framingham, says he’s got an important story to tell too: that antidepressants can also cause harm. Urato writes and lectures on this topic frequently, and says he feels that Solomon’s piece didn’t offer the complete picture. (Here’s Urato’s full rebuttal to Solomon’s article on the website Mad In America, published by journalist Robert Whitaker.

Solomon quotes Urato in the Times story (in fact, some of the quotes come from a post Urato wrote for CommonHealth). But Urato says his views weren’t fully reflected. Here, edited are a few of Urato’s points:

1. Anecdotes Have Limitations

No one wants a pregnant woman to kill herself. An article in which pregnant women stop their medications and kill themselves while others continue on their meds and have happy outcomes is sure to push readers in an obvious direction. However, such anecdotes are limited.

For example, the author could have told stories of women who stayed on their medications, weren’t counseled regarding the risks, and had severely impaired babies. Continue reading

‘On Point’ Caller’s Baby Born At 22 Weeks; ‘It Doesn’t Always Turn Out OK’

In this May 2 photo provided by Tundi and Nate Brady, their 5-year-old son, Dexter, plays at home in Iowa City, Iowa. Born 16 weeks premature, he spent five months in a neonatal intensive care unit after birth and is now a healthy 5 1/2-year-old whose only major medical issue is needing oxygen when he sleeps. "We were so lucky," his Tundi says. (Tundi Brady via AP)

In this May 2 photo provided by Tundi and Nate Brady, their 5-year-old son, Dexter, plays at home in Iowa City, Iowa. Born 16 weeks premature, he spent five months in a neonatal intensive care unit after birth and is now a healthy 5 1/2-year-old whose only major medical issue is needing oxygen when he sleeps. “We were so lucky,” his Tundi says. (Tundi Brady via AP)

This just in from our friends at On Point:

Our hour discussion Wednesday on a landmark new study regarding mortality rates for extremely premature infants included a lot of powerful calls from listeners who faced some of the complicated choices new parents must sometimes unexpectedly make.

One of those callers, Jennifer from Charleston, South Carolina, was kind enough to share her family’s story, and underline the confusing mix of medical and emotional choices families are forced to make.

“In 2012, I suddenly had to give birth, I had an emergency C-section, because my daughter was having heart-trouble in the womb, and she was born at 22-and-a-half weeks gestation

They really laid out all the options out on the table. I really think the most important thing is that the doctors and nurses really sit down and weigh out all the options with the mother, and the father, or whomever…

She lived for seven days. On the seventh day, she did have a lot of complications for being born that early. Her viability wasn’t the best when she was born. She wasn’t even a pound, she was 14-and-a-half ounces. She had problems with her lungs, she was bleeding in the brain, and on the seventh day, they gave us the option to remove life support. That really was the better option.

I have no regrets for my choice. A lot of people, including family members, tell us we made the wrong choice, constantly, but given the opportunity, given all the options we were given at that time, I’m glad that we did it. I think everyone needs to make their own decision.

The most important thing is that I know it’s a tough decision to go into what the best treatment options are, but it’s a case by case basis. I was very thankful for the doctors and nurses we interacted with. They were very open and honest about treatment. They were real.

You see those things on social media, ‘This baby was born this early and turned out OK.’ It doesn’t always turn out OK. I’m thankful they were so real with us.

We did what was right for us, at that point, and we saw that the quality of life was going to be too hard.”

Continue reading

Tale Of The Pediatrician Snatched To Treat The Kennedy Baby

The Kennedy family plot in Holyhood Cemetery in Brookline, on Nov. 23, 1963. The headstone marks grave of Patrick Bouvier Kennedy, third child of the slain president, who died in August at less than 2 days old. (Frank C. Curtin/AP)

The Kennedy family plot in Holyhood Cemetery in Brookline, on Nov. 23, 1963. The headstone marks grave of Patrick Bouvier Kennedy, third child of the slain president, who died at less than 2 days old, with respiratory distress. (Frank C. Curtin/AP)

Fifty years ago this week, Patrick Bouvier Kennedy, the president and first lady’s baby who was born five-and-a-half weeks premature, died while doctors at Boston Children’s Hospital tried to save him. Last week, The New York Times took a look back and recounted the medical drama with rich detail.

But apparently, according to the son of one of the doctors involved in baby Kennedy’s care (and a very distant, non-blood relative of mine), not all of the details were completely right.

The small bit of misinformation involves the moment when Dr. Samuel Levine, a pioneering New York pediatrician and professor at Cornell University Medical College, was snatched from Manhattan and flown to Boston to help treat the ailing infant, according to the doctor’s son, Ted Levine. Here’s what the Times wrote:

Pierre Salinger, the White House press secretary, conveyed a message from Mrs. Kennedy’s sister, Lee Radziwill, who urged the president to send for Dr. Samuel Z. Levine, a prominent Manhattan pediatrician who had cared for her own premature baby. Secret Service agents located him strolling in Central Park and whisked the startled physician to Boston.

Not true, says Ted, the 86-year-old son of Samuel, who was an expert in the field of pediatric nutrition. Continue reading