Cartoon: A Snowballing Winter, In The Eyes Of A Medically Fragile Child

Boston Medical Center pediatrician Dr. Jack Maypole directs a program for parents of children who are “medically fragile.” Their conditions include prematurity, autism, seizure disorders and cerebral palsy. Many use wheelchairs.

This winter’s wild weather has proven a tiresome inconvenience for many of us, but for the population Dr. Maypole serves, it threatens far worse. He writes:

“In this cartoon diary, I attempt to capture whatever I can of the additional challenges and stressors experienced by parents (often single mothers) caring for a family member with complex illness or special needs. I submit this to you with hopes it will shed a little light — and perspective — on the daily struggles of these often heroic parents doing more with less than many of us.”

(Click here and zoom in to see the cartoon larger.)

(Courtesy of Boston Medical Center pediatrician Dr. Jack Maypole)

(Courtesy of Boston Medical Center pediatrician Dr. Jack Maypole)

Study: A Little Longer In Womb, A Bit Better In School

By Karen Weintraub
Guest contributor

Don’t be too eager to deliver that baby.

Doctors have long viewed babies born at 37 or 38 weeks as full term, but new research suggests that infants are better off staying in a healthy womb longer, if possible.

A study published this morning in Pediatrics found that babies born at 37 or 38 weeks scored slightly but significantly worse on third grade English and math tests than their counterparts born at 39-41 weeks. A typical pregnancy is 40 weeks.

The study has implications for doctors and parents who often choose to have early deliveries for the sake of convenience or at the slightest hint of any problem with the pregnancy.

The womb really is the best place for an infant, said Dr. Jonathan Davis, chief of Newborn Medicine at The Floating Hospital for Children at Tufts Medical Center, who was not involved in the research.

“The message is: unless you really feel that there’s an irreversible or really dangerous thing going on, you should wait until at least 39 weeks to deliver,” he said.

Doctors often encourage earlier deliveries to avoid problems during birth, Davis said. “I really believe the reason they intervene so often is because they’re worried about getting sued.” But this and other recent research suggests doctors need to take a longer view. Continue reading

Study: Prematurity Raises Risks Of Mental Illness

Reuters reports, based on an Archives of General Psychiatry study that analyzed more than a million medical records in Sweden:

Babies born prematurely have a much higher risk of developing severe mental disorders including psychosis, bipolar disorder and depression, according to a study to be published on Monday.

Scientists in Britain and Sweden found that people born very prematurely – at less than 32 weeks’ gestation – were three times more likely than those born at term to be hospitalized with a psychiatric illness at aged 16 and older.

The researchers think the increased risk may be down to small but important differences in brain development in babies born before the a full 40 week gestation period.

The numbers on bipolar disorder are particularly striking: a sevenfold increase in risk. As the mother of a son born at 32 weeks, I’m filing this one under “Interesting but do not freak out,” and reminding myself that these disorders overall remain relatively rare. And I’m focusing on this quote from Chiara Nosarti of King’s College London, the lead researcher:

She stressed, however, that: “The majority of individuals who are born prematurely have no psychiatric or cognitive problems, are absolutely healthy and well functioning.”

The Pessary For Prematurity: An OB’s New Look At An Old Technique

Dr. Adam Wolfberg, a specialist in high-risk obstetrics, knows more than most about the highly technical world of maternal-fetal medicine and the extreme interventions often required to save infants born prematurely. About half a million babies — 1 in every 8 — are born pre-term in the U.S. and much of Wolfberg’s work focuses on how to prevent and manage such births.

Lately, though, he’s been thinking about a particularly low-tech, centuries-old device that is getting new attention as a method to prevent premature delivery: the pessary, described by researchers as “a tiny inverted cereal bowl with a hole cut in the center” more typically used hold up sagging pelvic organs. Writing in the Huffington Post, Wolfberg details the latest, promising research:

In this excellent study, published in the prestigious British journal The Lancet, obstetricians at five Spanish hospitals randomized 385 women with a short cervix to use of pessary or nothing. Pessaries are centuries-old devices that women place in their vagina to support their uterus and pelvic organs and prevent symptoms of pressure when these organs “fall” (prolapse) typically later in life. A handful of small studies using pessaries to prevent preterm delivery (the idea is that the pessary supports the cervix or lower uterus) have been published over the past 50 years, but none has had the size or scientific rigor to convince the obstetric community.

The cervical pessary (The Lancet)

In their study, the Spanish group used the Dr. Arabin pessary, named after the German scientist who developed it… The Dr. Arabin pessary is approved for sale in Europe but not in the U.S…”

Continue reading

Top Maternity Hospitals in Mass. Stop Early Elective Deliveries

By Martha Bebinger

Many of us know a mom who chose to have her baby before its due date. There are lots of reasons why one might choose to do this: the health of the mom or the baby, her doctor’s schedule, the demands of her husband’s work, or even to hit a specific birthday. But if that perfect day falls before the 39th week of pregnancy, and there’s no medical reason for an early delivery, many hospitals in Massachusetts are saying no, you have to wait.

Jennifer Brickley, with her daughter Audrey, says too many women plan deliveries as they do hair or spa appointments. (Martha Bebinger/WBUR)

The number of early deliveries, from induced labor or C-sections, has been on the rise across the country for more than a decade now, including in Massachusetts. One reason is that we’ve come to expect that babies born “a little bit early” will be fine.

“Before the benefit of the neonatal intensive care unit, people were very conservative and would not induce or do repeat C-sections before 39 weeks,” says Dr. Glenn Markenson, the director of maternal and fetal medicine at Bay State Medical Center in Springfield. “But as they saw how well babies were doing with pediatric care, and they were getting pressured by patients because of social situations, there was a creep down from 39 weeks to 38 weeks, sometimes 37 weeks.”

With access to such excellent care, we overlook the facts — babies are in these expensive neonatal units because they’re having problems.

“Early-term infants have higher rates of respiratory distress. There are also issues with feeding,” says Dr. Lauren Smith, medical director at the Department of Public Health. “The most recent evidence shows that babies born before 39 weeks may also have developmental issues, so when you add up the increased risks and you weigh that against a situation when it’s purely elective, then you really can’t justify it.”

A growing number of hospitals in Massachusetts, and across the country, are saying no to elective inductions and C-sections before 39 weeks. The change is happening quietly and some new mothers don’t like it.
Continue reading

Preemie Parents Share More Jaw-Dropping Stories Of What Not To Say

I can’t count how many times my jaw dropped as I read the scores of comments and stories that flowed in over the weekend in reaction to Friday’s post, 10 Things Not To Say To The Parents of Preemies. A few times, I said “incredible” out loud, with an expletive between the “in” and the “credible.”

I also learned a great deal. For example, if a friend were pregnant with twins and one died, I’m not sure it would occur to me to say “At least you still have one,” but now I know that would definitely be the wrong comment. And I think one one of the briefest comments was also one of the most useful:

4 words, and then keep your mouth shut: “Your baby is beautiful.”

The flip side: Two reports of nurses who joked that babies looked like E.T. Wrong, wrong, wrong. They need to be sent for re-education.

Several commenters suggested that preemie parents should cut some slack for the people who say the wrong things; they’re trying, they just don’t know how to navigate the emotional minefield. Continue reading

FDA Fights Back In Dispute Over Pricey Drug For Premature Birth

FDA: Power to the pharmacists!

Responding to critics outraged over the exorbitant price of Makena, a new version of a cheaper, older drug to prevent pre-term birth, the FDA issued a statement saying that pharmacists can “compound” the drug themselves, thereby side-stepping the cost controversy surrounding the newly approved medication, marketed by KV Pharmaceuticals, reports NPR’s Health Blog.

Hey, KV Phamaceuticals, that new, $1,500-a-dose drug of yours is about to get some competition!

The Food and Drug Administration said in an unusual statement that it’s quite all right for pharmacists to go ahead and make their own version of the medicine, given by injection to help some women avoid preterm delivery of their babies. Many of them had been doing that for years anyway and charged $20 or less per dose.

But KV, based in St. Louis, pursued formal approval of the medicine, hydroxyprogesterone caproate, to avoid premature deliveries. Starting this month, KV began selling it as Makena at a price of $1,500 a shot. For women who need the drug, given weekly for about 20 weeks, the tab would come to around $30,000, as the Washington Post reported the other day. The price hike led to a backlash from just about everyone except KV shareholders.

Now the FDA has cleared the air about whether pharmacists can make the medicine. The agency’s answer boils down to an emphatic yes.

New, ‘Electronic Apgar’ To Predict Health of Premature Babies

Researchers says they've developed a better system to predict the future health of premature babies

Stanford University researchers say they’ve developed an electronic version of the traditional Apgar score for newborns that can more accurately assess and predict the future health of premature infants.

The new system, called the “PhysiScore,” comes up with a “prediction algorithm” by taking into account information like the newborn’s gestational age and birthweight and then filtering in a stream of real-time data routinely collected in neonatal intensive care units – heart rate, respiratory rate and oxygen saturation. According to the research, published today in Science Translational Medicine, the PhysiScore out performed the Apgar, the standard, low-tech method to assess babies that has been used for more than half a century, as well as three other assessment systems that require needles or other invasive laboratory measures.

And the PhysiScore might even be a cost-cutter: Suchi Saria, the Stanford graduate student who led the research as part of her doctoral thesis in computer science wrote in an email: “The tool can be cheaply implemented on a bedside monitor utilizing existing resources in the NICU. A tool such as ours can help identify more accurately which infants need to be moved to a specialty hospital over being kept at the local nicu so it can save money by giving more accurate information based on which treatment plan/transport decisions can be optimized.” Continue reading