Category Archives: Newborn and Infant Health

Pregnant and addicted: the tough road to a healthy family

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Amanda Hensley holds her daughter Valencia

Amanda Hensley holds her daughter Valencia

By Sarah Jane Tribble, WCPN
Kaiser Health News

Amanda Hensley started abusing prescription painkillers when she was just a teenager. For years, she managed to function and hold down jobs. She even quit opioids for a while when she was pregnant with her now 4-year-old son. But she relapsed.

Hensley says she preferred drugs like Percocet and morphine, but opted for heroin when short on cash.

By the time she discovered she was pregnant last year, she couldn’t quit.

“It was just one thing after another, you know — I was sick with morning sickness or sick from using,” said Hensley, who is 25 and lives in Cleveland. “Either I was puking from morning sickness or I was puking from being high. That’s kind of how I was able to hide it for a while.”

Hensley said she was ashamed and hurt, and she wanted to stop using but didn’t know how. She had friends who would help her find drugs — even after they found out she was pregnant. But finding help to get sober and protect her child proved much more difficult, though.

The number of people dependent on opioids is increasing and that includes women of child-bearing age, like Hensley. Researchers estimated that every 25 minutes a baby was born dependent on opioids in 2012, the most recent year for which data are available.

By the time Hensley was about six months pregnant, she was living on couches, estranged from her mother and her baby’s father, Tyrell Shepherd. Her son went to live with her mother.

That’s when Hensley reached out for help. One moment, she dialed to get her fix. The next, she called hospitals and clinics.

“Nobody wants to touch a pregnant woman with an addiction issue,” she said.

Shepherd wasn’t happy when he realized Hensley was taking opioids while pregnant. “If you don’t care about yourself,” he said, “have enough common decency to care about the baby you’re carrying. Be adult. Own up to what it is you’re doing and take care of business. Regardless of how bad you’re going to feel, there’s a baby that didn’t ask to be there.”

After being rejected by two hospitals and several clinics, Hensley let herself go into withdrawal and then went to the emergency department of MetroHealth System, Cleveland’s safety-net hospital. Continue reading

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Demand surges for addiction treatment during pregnancy

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BOSTON — As soon as the home pregnancy test strip turned blue, Susan Bellone packed a few things and headed straight for Boston Medical Center’s emergency room. She’d been using heroin and knew she needed medical help to protect her baby.

“I felt so guilty. I still do,” said Bellone, a petite, energetic woman. At 32, and six years into her heroin addiction, having a baby was the last thing on her mind. “I was not in the right place to start a family,” she said. “But once it was happening, it was happening, so I couldn’t turn back.”

Nationwide, the number of pregnant women using heroin, prescription opioids or medications used to treat opioid addiction has increased more than five-fold and it’s expected to keep rising. With increased opioid and heroin use, the number of babies born with severe opioid withdrawal symptoms has also spiraled, leaving hospitals scrambling to find better ways to care for the burgeoning population of mothers and newborns.

Among the most important principles is that expectant mothers who are addicts should not try to quit cold turkey because doing so could cause a miscarriage. Trying to quit opioids without the help of medications also presents a high risk of relapse and fatal overdose.

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Until the opioid epidemic took hold about eight years ago, most hospitals saw only one or two cases a year of what is known as neonatal abstinence syndrome. Now, a baby is born suffering from opioid withdrawal every 25 minutes in the U.S., according to the National Institute on Drug Abuse. Continue reading

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Struggling rural hospitals opt to close labor and delivery units

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Newborn preemie baby hand NICUBy Michelle Andrews
KHN

A few years ago, when a young woman delivered her baby at Alleghany Memorial Hospital in Sparta, North Carolina, it was in the middle of a Valentine’s Day ice storm and the mountain roads out of town were impassable. The delivery was routine, but the baby girl had trouble breathing because her lungs weren’t fully developed.

Dr. Maureen Murphy, the family physician who delivered her that night, stayed in touch with the neonatal intensive care unit at Wake Forest Baptist Medical Center in Winston-Salem, a 90-minute drive away, to consult on treatment for the infant.

“It was kind of scary for a while,” Murphy remembered. But with Murphy and two other family physicians trained in obstetrics as well as experienced nurses staffing the 25-bed hospital’s labor and delivery unit, the situation was manageable, and both mother and baby were fine.

Things are different now. Alleghany hospital — like a growing number of rural hospitals — has shuttered its labor and delivery unit, and pregnant women have to travel either to Winston-Salem or to Galax, Virginia, about 30 minutes away by car, weather permitting.

“It’s a long drive for prenatal care visits, and if they have a fast labor” it could be problematic, said Murphy, who teaches at the Cabarrus Family Medicine Residency Program in Concord, North Carolina. (Although not essential, women typically see the physician they expect will handle their delivery for prenatal care.) Continue reading

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Restoring microbes in infants born by cesarean section

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By Carol Torgan
National Institutes of Health

At a Glance

  • Exposing babies delivered by C-section to fluids from the mother’s birth canal enriched the babies’ microbes to levels more typical of babies born vaginally.
  • Larger studies with further follow-up will be needed to determine the long-term health consequences of the microbial transfer procedure.

Cute Baby Boy Isolated on WhiteTrillions of microbes—including bacteria, fungi, and viruses—live in and on the human body. Some of these microbes cause illnesses, but many are necessary for good health.

Babies delivered via the birth canal acquire a microbial community (microbiota) that resembles that of their mother’s vagina. Babies born by cesarean section tend to acquire a microbial community that more closely resembles that of their mother’s skin.

The microbiota acquired by a newborn are thought to be essential for the development of a healthy immune system and metabolism. Continue reading

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Test could boost newborn cystic fibrosis screening

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Illustration of the lungs in blueBy Barbara Feder Ostrov
KHN

Stanford University scientists say they’ve devised a more accurate and comprehensive DNA test to screen newborns for cystic fibrosis, the most common fatal genetic disease in the United States.

Affecting about one in 3,900 babies born in the U.S., cystic fibrosis causes mucus to build up in the lungs, pancreas and other organs, leading to frequent lung infections and often requiring lifetime treatment for patients, whose median lifespan is 37 years.

Every state screens newborns for cystic fibrosis, but the current sequence of tests can miss cases, threatening babies’ lives.

The new method described in a recent article in The Journal of Molecular Diagnostics, promises to be more efficient and cost-effective, researchers said. It may also improve screening for non-white babies, for whom cystic fibrosis is rarer and harder to diagnose.

The new method promises to be more efficient and cost-effective and may also improve screening for non-white babies in whom cystic fibrosis harder to diagnose.

“I think this is a major advance. It offers the promise of potentially eliminating the false negative results that lead to missed cases,” said Dr. Philip Farrell, a former dean of the University of Wisconsin School of Medicine and Public Health, and a nationally-known expert on cystic fibrosis screening for newborns. “If you miss a case, you’ve got a baby out there who has a significant possibility of dying undiagnosed.”

Cystic fibrosis is caused by a defect in the CFTR gene, which regulates the movement of water and salt out of the body’s cells. In California, current genetic screens look for 40 of the most common mutations of the CFTR gene in newborns.

Yet any of the more than 2,000 known mutations in that gene could play a role in the disease, and there are likely others that have not yet been discovered.

The new test uses “next generation” DNA sequencing that can quickly and more cheaply look at the entire CFTR gene, not just selected mutations. It does not require an extra blood sample. Rather, it uses the tiny amount of blood drawn from the common newborn heel stick test that’s already used to screen for a number of diseases, including cystic fibrosis.

The researchers say this advance can enable testing labs to review many newborn samples at a time and reduce costs, allowing a technology previously used only to diagnose individual cases to be applied to a large population. Continue reading

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CDC warns of the danger of drinking while pregnant

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From the US Centers for Disease Control and Prevention

Alcohol and Pregnancy

Why Take the Risk?

An estimated 3.3 million US women between the ages of 15 and 44 years are at risk for exposing their developing baby to alcohol because they are drinking, sexually active, and not using birth control to prevent pregnancy, according to a new CDC Vital Signs report.

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The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol.

  • Alcohol use during pregnancy, even within the first few weeks and before a woman knows she is pregnant, can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime. These disabilities are known as fetal alcohol spectrum disorders (FASDs). There is no known safe amount of alcohol – even beer or wine – that is safe for a woman to drink at any stage of pregnancy.
  • About half of all pregnancies in the US are unplanned and, even if planned, most women will not know they are pregnant until they are 4-6 weeks into the pregnancy when they still might be drinking.

Every woman who is pregnant or trying to get pregnant – and her partner – want a healthy baby. But they may not be aware that drinking alcohol at any stage of pregnancy can cause a range of disabilities for their child.

It is critical for healthcare providers to assess a woman’s drinking habits during routine medical visits; advise her not to drink at all if she is pregnant, trying to get pregnant, sexually active, and not using birth control; and recommend services if she needs help to stop drinking.

For this Vital Signs report, scientists from CDC’s National Center on Birth Defects and Developmental Disabilities analyzed data from the 2011–2013 National Survey of Family Growth, which gathers information on family life, marriage, divorce, pregnancy, infertility, use of birth control, and men’s and women’s health.

National estimates of alcohol-exposed pregnancy were calculated among 4,303 non-pregnant, non-sterile women aged 15–44 years.

A woman was considered to be at risk for an alcohol-exposed pregnancy if she was not sterile, her partner was not known to be sterile, and she had vaginal sex with a male, drank any alcohol, and did not use birth control in the past month.

Women can:

  • Talk with their healthcare provider about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.
  • Stop drinking alcohol if they are trying to get pregnant or could get pregnant.
  • Ask their partner, family, and friends to support their choice not to drink during pregnancy or while trying to get pregnant.
  • Ask their healthcare provider or another trusted individual about resources for help if they cannot stop drinking on their own.

Healthcare providers can:

  • Screen all adult patients for alcohol use at least yearly.
  • Advise women not to drink at all if there is any chance they could be pregnant.
  • Counsel, refer, and follow up with patients who need more help.
  • Use the correct billing codes so that alcohol screening and counseling is reimbursable.

FASDs are completely preventable if a woman does not drink alcohol during pregnancy.

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Medical advocates can help guide patients make difficult choices

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Patient advocate Dan Polk, left, provided support to client Stan Smith as Smith’s son, Travis, awaited surgery at Boston Children’s Hospital. (Courtesy of Stan and XuXia Smith)

By Barbara Sadick
KHN

Stan and XuXia Smith learned from an ultrasound midway through the pregnancy that their son would be born with an often-fatal congenital heart defect. In the first week of the baby’s life, they got more bad news: Some major organs were incorrectly formed and mislocated inside Travis’s tiny body. They faced a long journey.

“I felt like I’d been hit by a tidal wave. I couldn’t process the information I was being given fast enough, and I knew we’d need someone to help us translate and evaluate the enormous amount of information we were being bombarded with,” Stan Smith said.

The Chicago couple hired Dan Polk, a patient advocate and retired neonatologist whose specialty is working with sick babies and their families.

Polk helped the Smiths understand the complexity of their son’s condition while building an experienced health care delivery team, and he has guided them through the intricacies of Travis’s treatment. More than two years after his birth, he still has medical issues that require Polk’s counsel.

“I was trained to take care of patients but found myself spending too much time away from the bedside,” said Polk, who took up patient advocacy in 2013 after 35 years in practice. “Being an advocate for babies and parents has allowed me to do what I was trained to do: take care of patients.”

There are perhaps 250 to 300 patient advocates for hire in the United States, one professional association estimates. Some advocates such as Polk have clinical backgrounds and know how to navigate the health care system. They may accompany patients to appointments and facilitate doctor-patient conversations in patient-friendly language. They may also handle tasks such as prepping for medical appointments, finding the right doctors and even deciphering medical bills and health insurance plans.

Advocates aren’t cheap — their rates can start at $100 an hour or more, depending on experience and credentials — and insurance doesn’t cover them. Continue reading

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Infertility treatments not associated with increased risk of developmental delay – study

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Infertility treatments do not appear to contribute to developmental delays in children

From the National Institutes of Health

IVF egg thumbNIH researchers find no risk by age 3 from in vitro fertilization, other widespread treatments.

Children conceived via infertility treatments are no more likely to have a developmental delay than children conceived without such treatments, according to a study by researchers at the National Institutes of Health, the New York State Department of Health and other institutions.

The findings, published online in JAMA Pediatrics, may help to allay longstanding concerns that conception after infertility treatment could affect the embryo at a sensitive stage and result in lifelong disability.

The authors found no differences in developmental assessment scores of more than 1,800 children born to women who became pregnant after receiving infertility treatment and those of more than 4,000 children born to women who did not undergo such treatment.

“When we began our study, there was little research on the potential effects of conception via fertility treatments on U.S. children,” said Edwina Yeung, Ph.D., an investigator in the Division of Intramural Population Health Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Our results provide reassurance to the thousands of couples who have relied on these treatments to establish their families.” Continue reading

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A sick newborn, a loving family and a litany of wrenching choices

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By Jenny Gold
KHN

SAN FRANCISCO — Anne and Omar Shamiyeh first learned something was wrong with one of their twins during their 18-week ultrasound.

The technician was like, well there’s no visualization of his stomach,” said Anne. “And I was like, how does our baby have no stomach?”

It turned out that the baby’s esophagus was not connected to his stomach. He also had a heart defect. At the very least, he was likely to face surgeries and a long stay in intensive care. He might have lifelong disabilities.

This was only the start of an eight-month ordeal for the Shamiyeh family. Continue reading

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Pediatricians recommend individualized counseling for parents of extremely premature infants

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Premature infant's tiny hand being held By Jenny Gold
KHN

For the tiniest infants — those born before 25 weeks in the womb — survival is never guaranteed, and those who make it may be left with severe disabilities.

These micro-preemies are born in what’s known as the “grey zone.”  Whether or not to resuscitate them depends on the decisions made by individual hospitals, doctors and parents. Decisions can vary greatly even among hospitals in the same area.

A new statement from the American Academy of Pediatrics aims to improve the way those decisions are made. The statement suggests that doctors individualize counseling for parents based on the particular baby’s chances of survival and the family’s goals for their child. Continue reading

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Many new mothers report no physician advice on infant sleep position, breastfeeding

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From the National Institutes of Health

Cute Baby Boy Isolated on WhiteMany new mothers do not receive advice from physicians on aspects of infant care such as sleep position, breastfeeding, immunization and pacifier use, according to a study funded by the National Institutes of Health.

Infants should be placed to sleep alone, on their backs, on a firm sleep surface, such as in a mattress in a safety-approved cribExternal Web Site Policy, covered by a fitted sheet. Soft objects, toys, crib bumpers, quilts, comforters and loose bedding should be kept out of the baby’s sleep area.

Health care practitioner groups have issued recommendations and guidelines on all these aspects of infant care, based on research which has found that certain practices can prevent disease and even save lives.

The study authors surveyed a nationally representative sample of more than 1,000 new mothers, inquiring about infant care advice they received from doctors, nurses, family members and the news media.

More than 50 percent of mothers reported they received no advice on where their infants should sleep.

Roughly 20 percent of mothers said they did not receive advice from their doctors regarding current recommendations on breastfeeding or on placing infants to sleep on their backs — a practice long proven to reduce the risk of sudden infant death syndrome (SIDS).

More than 50 percent of mothers reported they received no advice on where their infants should sleep. Room-sharing with parents — but not bed-sharing — is the recommended practice for safe infant sleep.  Continue reading

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Home visits by nurses for first-time mothers help reduce costs

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Symphonie Dawson and her son Andrew.

By Michelle Andrews
KHN

Symphonie Dawson was 23 and studying to be a paralegal while working part-time for a temporary staffing agency when she learned that the reason she kept feeling sick was because she was pregnant.

Living with her mom and two siblings near Dallas, Dawson worried about what to expect during pregnancy and what giving birth would be like, not to mention how to juggle having a baby with being in school.

(Photo courtesy of Symphonie Dawson)

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Whooping cough case up sharply in Washington state

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There have been a total of 387 cases of whooping cough reported statewide so far this year, compared to 85 reported cases during the same time period last year, the Washington State Department of Health reports.

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Newborns and infants, who cannot be immunized against the disease, are at greatest risk of serious complications. To date, 25 infants under one year of age were reported as having whooping cough and six of them were hospitalized. Of these hospitalized infants, five (83%) were three months of age or younger.

How to protect infants from whooping cough – CDC

Because the disease can make babies so sick, and they can catch it from anyone around them, they need protection. These are the three important ways you can help protect them with vaccines:

  • If you are pregnant, get vaccinated with the whooping cough vaccine in your third trimester.
  • Surround your baby with family members and caregivers who are up-to-date with their whooping cough vaccine.
  • Make sure your baby gets all his doses of the whooping cough vaccine according to CDC’s recommended schedule.

Whooping cough fact sheet from the Department of Health

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