Health News of Tuesday, July 08, 2013

baby_news

The Pennsylvania girl who had a second lung transplant has developed pneumonia.

Sarah Murnaghan, 10, has pneumonia in her right lung, according to her mother, Janet Murnaghan. Doctors believe it is caused by “aspirations from her belly,” Janet wrote in a Facebook post Monday. “Yesterday was tough. Today she is more stable, but this is definitely a large setback.”

Aspiration pneumonia is inflammation of the lungs or airways leading to the lungs from breathing in foreign material, such as food and saliva. Antibiotics may be used to treat the condition.

The family announced June 28 that the girl, who has cystic fibrosis, received a second set of adult lungs after the first set failed just hours after the transplant June 12. The second transplant, which took place on June 15, appeared to be successful. The girl took a few breaths on her own, but she was put back on the ventilator because of partial paralysis of her diaphragm, a complication from the last transplant.

Sarah had diaphragm plication to treat the paralysis on July 2 at Children’s Hospital of Philadelphia. The surgical procedure involves the folding of the diaphragm, allowing more volume inside the chest cavity for the lungs to accept air. Source: USA Today

How infant’s head is flattened or misshapen

An education campaign launched in 1992 to have healthy babies sleep on their backs is credited with a 50% decrease in the infant mortality rate in the U.S. from Sudden Infant Death Syndrome. But along with the decline has come greater awareness of a condition called positional plagiocephaly, in which an infant’s head is flattened or misshapen, from too much time in the back position in the first months of life.

Other studies have put the rate of positional plagiocephaly (pronounced pley-jee-uh-SEF-uh-lee) anywhere from 3% to 61%. A new, large sample of 440 healthy infants finds 47% of babies ages 7 to 12 weeks had the condition.

By this age, plagiocephaly resulting from the use of forceps or other instruments during delivery typically would have resolved, says researcher Aliyah Mawji,an assistant professor of nursing at Mount Royal University in Calgary, Alberta, Canada.

Ongoing flat spots on the back or one side of an infant’s head “are signs that the baby has not been given enough opportunities for repositioning” to prevent pressure on the flat areas and gradually correct the head shape, says Mawji, lead author of the study in the August issue of the journal Pediatrics, published online today.

In 1999, Canadian health officials also began recommending that all healthy infants be placed on their backs to sleep, and have likewise seen reductions in the number of SIDS cases but also increases in reports of plagiocephaly, says the new study.

Of the 205 infants in the study observed to have some form of plagiocephaly, 78% were classified as having a mild form, 19% moderate; 3% severe. Most infants (63%) were affected on the right side of the head.

The right-sided preference has been documented in other studies and may be related to a “position of comfort” established by some babies when in the uterus and the birth canal, says Mawji.

According to an American Academy of Pediatrics’ 2011 clinical report on positional plagiocephaly, these conditions are “generally benign, reversible” anomalies that do not require surgical intervention, as opposed to craniosynostosis, a serious skull abnormality that can result in neurologic damage and progressive craniofacial distortion.

The vast majority of cases can be corrected with physical therapy and non-invasive measures, according to the AAP. If the condition appears to be worsening by 6 months, referrals should be made to a pediatric neurosurgeon to help determine whether a skull-shaping orthotic helmet or other interventions are needed.

The high incidence rate of positional plagiocephaly in this new study indicates that greater parent education about prevention is needed before infants arrive for the 2-month checkup, says Mawji.

Both the AAP and the National Institutes of Health stress that flat spots are much less serious than SIDS and that parents and caregivers should continue to place infants on their backs to sleep, while incorporating repositioning strategies, including:

• “Tummy time” when the infant is awake and supervised. This not only helps prevent flat spots, but it also helps the head, neck and shoulder muscles get stronger as part of normal development. Source: USA Today

An in vitro fertilization (IVF) milestone has been announced by British researchers

For the first time, a baby was born using a new embryo screening technique combs through genetic data looking for risk for diseases and other abnormalities. The researchers say the technique, known as “next generation sequencing” will revolutionize embryo selection for families turning to IVF.

“In the past few years, results from randomized clinical trials have suggested that most IVF patients would benefit from embryo chromosome screening, with some studies reporting a 50 percent boost in pregnancy rates. However, the costs of these genetic tests are relatively high, putting them beyond the reach of many patients,” lead researcher Dr. Dagan Wells, a scientist at the NIHR Biomedical Research Centre at the University of Oxford in the U.K., said in a statement. “Next generation sequencing is a way which could make chromosome testing more widely available to a greater number of patients, improving access by cutting the costs.”

Wells presented the case study of the first birth Monday at the European Society of Human Reproduction and Embryology in London.

Next generation DNA-sequencing technology is used in other areas of medicine, such as in research of differences between normal cells and cancer cells, according to the Columbia Genome Center in New York City. For the process, DNA is broken into small fragments which are turned into strings of genetic code which are then sequenced in hundreds of millions parallel reactions.

This testing can also reveal information on the chances for inheriting genetic disorders, chromosome abnormalities and mitochondrial disease, mutations within a cell’s nucleus that could lead to conditions including heart disease, motor disorders, diabetes, respiratory problems, seizures, and vision and hearing problems.

Wells said since the technology is already revolutionizing diagnostic medicine, if it’s applied to embryo selection for IVF, it can provide “an unprecedented insight into the biology of embryos.”

That’s important, because only about 30 percent of embryos currently selected for transfer in IVF actually implant in the uterus. The reason for this high failure rate is unknown, according to the researchers, but they suspect hidden genetic mutations and abnormalities may be at play.

To ensure the new technique’s accuracy, the researchers sequenced cells from 45 embryos that had previously been shown to be abnormal by a different testing technique. In a blind comparison of the two techniques, high accuracy was established. Source: CBS News

Why Parents want to know Risk posed by CT Scan

Most parents want to know about the lifetime cancer risk posed by doing a CT scan on their child in the emergency department (ED), although it seldom stops them from giving consent for the scan, a study showed.

About half of parents surveyed when their child was seen for a head injury in the ED already knew something about the risk from ionizing radiation with CT scans (47%), Kathy Boutis, MD, of the University of Toronto and its Hospital for Sick Children, and colleagues found.

More than 90% wanted to be informed of potential malignancy risks before proceeding with the scan, but after that disclosure only 6% decided to refuse the CT, the researchers reported in the August issue of Pediatrics.

In order to have those discussions, “we strongly recommend that physicians be well informed of the benefits and potential risks of CT imaging,” they wrote.

CT scans in the ED have risen fivefold despite the higher radiation dose that children are particularly sensitive to, the group noted.

“It has been suggested that parental desire for a rapid diagnosis is contributing to the increasing use of CT in children and is occurring without their full understanding of the potential risks,” they added.

Their study included 742 parents surveyed when their children (median age 4 years) presented to a tertiary care pediatric ED with an isolated head injury, before any recommendation had been made for CT. Nearly all the children ended up diagnosed with a minor head injury or concussion (97%).

Despite the fact that 12% of the children had a history of prior CT scans, 63% of the parents underestimated the lifetime risk of cancer from the imaging exam.

Parents estimated the risk of a skull radiograph series as similar to that of CT, although the best available evidence from long-term research puts x-ray lower at one in 1,000,000 compared with one in 10,000.

“The latter could result in an inappropriately equal level of concern about radiation exposure and potential malignancy risks when a physician recommends radiographs or CT, which may affect how often parents raise verbal conversations about potential risks from CT,” Boutis and colleagues noted. Source: medpagetoday

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