Vol. 20 No. 6 neonatal October 2007 ITheN JournalT of EPerinatology-NeonatologyNSIVE CARE CAR SAFETY SEIZURES DIAGNOSIS BIRTHRATES BREASTFEEDING SOME MIGHT SEE A PREMATURE INFANT. WE SEE A 14-MONTH-OLD TAKING HER FIRST STEPS. At Children’s Medical Ventures, we look beyond today and imagine what tomorrow might hold. It’s what drives us in our quest to improve developmental outcomes. We provide NICU professionals and parents with the products, programs, and expertise that make a difference. So a premature infant struggling to survive today might enjoy a normal, healthy life tomorrow. For us, it’s the most www.childmed.com 800-345-6443 important job in the world. 724-387-4000 © 2007 Respironics, Inc. and its affiliates. All rights reserved. A star is born. Announcing NICU monitoring—at last. New sparkling design to complement your NICU — plus 4-parameter trending — in color. Automated charting. Flexible alarm management, including untethered alarm remote control. The latest technology. Aesthetic design. Our new arrival has all the makings of a star. Call (800) 522-7025 for a preview. www.spacelabshealthcare.com Why add probiotic Bifidobacteria to a routine infant formula? Account for 80-90% of the total intestinal flora of breastfed infants1 Help increase levels of immunoglobulins such as secretory-IgA in the gut lumen3,5,6 Acidification of the gut lumen (ie: production of lactic acid) creates an environment favoring the development and growth of beneficial bacteria2,3 May compete for adhesion sites (receptors) along the gut wall and enhance the gut barrier function4 NEW GOOD START! NATURAL CULTURES™. The 1st formula to add the live, active culture Bifidobacterium lactis . • A balanced intestinal flora helps maintain a healthy immune system3-7 • GOOD START! NATURAL CULTURES is designed to help support a healthy immune system by adding the probiotic B. lactis , which is similar to cultures found in the digestive tract of breastfed infants3-7 • For more than 15 years and in 30 countries, Nestlé has been safely nourishing infants with B. lactis-containing formulas Learn more about our NEW formula at N100E% wWhey, partially hydrolyzed – nestleinfantnutrition.com/baby now with probiotics Breastfeeding is best. But when formula is chosen, recommend GOOD START® NATURAL CULTURES right from the start. 1. Yoshioka H et al. Development and differences of intestinal flora in the neonatal period in breast-fed and bottle-fed infants. Pediatrics 1983;72(3):317–21. 2. Bakker-Zierikzee AM et al. Effects of infant formula containing a mixture of galacto- and fructo-oligosaccharides or viable Bifidobacterium animalis on the intestinal microflora during the first 4 months of life. Br J Nutr 2005;94:783–90. 3. Fooks L et al. Probiotics as modulators of the gut flora. Br J Nutr 2002;88(Suppl 1):S39–S49. 4. Caplan MS et al. Neonatal necrotizing enterocolitis: possible role of probiotic supplementation. J Pediatr Gastroenterol Nutr 2000;30 (Suppl 2):S18–S22. 5. Fukushima Y et al. Effect of a probiotic formula on intestinal immunoglobulin A production in healthy children. Int J Food Microbiol 1998;42:39–44. 6. Rautava S et al. Specific probiotics in enhancing maturation of IgA responses in formula-fed infants. Pediatr Res 2006;60(2):221–4. 7. Langhendries JP et al. Effect of a fermented infant formula containing Nestlé viable Bifidobacteria on the fecal flora composition and pH of healthy full-term infants. J Pediatr Gastroenterol Nutr 1995;21(2):177–81. 2007 TM TM NATURAL CULTURES and BIFIDUS BL are trademarks of Société des Produits Nestlé S.A., Vevey, Switzerland. All trademarks are owned by Société des Produits Nestlé S.A., Vevey, Switzerland. © Vol. 20 No. 6 neonatal October 2007 Editorial ITheN JournalT of EPerinatology-NeonatologyNSIVE CARE Emergent Issues The following review, “Cradle or Grave,” by Michelle Pridmore-Brown, appeared in the Times Literary Supplement, May 30, 2007. Pridmore-Brown reviewed the books Birth, by Tina Cassidy, Born in the USA, by Marsden Wagner and Bioethics and Women, by Mary Briody Mahowald. Here are some excerpts of what she had to say: Much of birthing women’s misery can be traced to “cephalo-pelvic disproportion.” Bipedalism severely constrains our hip size – and big brains mean that even though babies are born too early in their development for anyone’s comfort, they are still likely to get stuck in the birth canal. Rather aptly known as Eve’s curse, the brain–pelvis stand-off is an evolutionary compromise that leaves little margin for Vol. 20 No. 6 error. This stand-off accounts for the fact that most women experience far more pain during childbirth than their primate cousins; for an African proverb stating that October 2007 pregnant women have one foot in the grave; and for the fact that the skill of an attendant can easily make the difference between life and death. Up to the 1930s or so, it is estimated that about 1 per cent of birthing women died (and far more of their babies). The journalist Tina Cassidy’s book on birth describes the diverse ways in which humans have addressed, rationalized and assigned blame for the perils of birth. She motivates her excavation by using her own twenty-first-century Table of Contents experience with cephalopelvic disproportion as a point of departure; what was to be her “planned” “natural” “birth experience” (each word semantically loaded in her DEPARTMENTS telling) ended up being quite the opposite, thanks to her small pelvis, induction, an epidural and ultimately an emergency Caesarean section. 7 Editorial: Emergent Issues Cassidy unpacks various notions of the “natural” and shows the extent to which 11 News birth is in fact not just some timeless event, but culture- and class-mediated – whether it occurs among the !Kung San of the Kalahari (women give birth alone) or 14 Spotlight on Ventilation in Marco Polo’s China (where fathers were put to bed for forty days with their Products newborns) or seventeenth-century Europe, when “barber surgeons” wrested the 16 practice from persecuted but far more competent midwives, or early twenty-first- 17 Product Review century Brazil, where up to 90 per cent of wealthy women opt for an elective C- section. Religious beliefs, too, have obviously had a significant role in birth – in persecuting midwives as witches, in adjudicating who was most worth saving ARTICLES (mother or baby), and in interpretations of pain. Cassidy’s romp through modern history bears repeating because it also reminds us that “science,” or at least medical 19 Head Lag and Car Safety Seats obstetrics, is often a vigilante affair. For instance, after the move from midwives to doctors, mortality rates initially shot up, as did rates of postpartum debility. Hospital 24 Neonatal Seizure in the births starting in the eighteenth century were a huge liability; impatient obstetricians Delivery Room zealously used their instruments to wrest babies from only partially opened wombs; and doctors often did not wash their hands and so transmitted deadly puerperal 27 Prenatal Diagnosis fever from woman to woman – or, indeed, from corpse to woman. Even in the early twentieth century, after germ theory was known about, hospitals were still the worst 29 Falling Birthrates in Russia places to give birth and yet, paradoxically, they became the birthing place of choice for an ever-increasing number of women; infant mortality jumped 50 per cent 31 Breastfeeding in City Hospitals between 1915 and 1929 in the United States in lockstep with the widespread across- 35 Antenatal Screening class shift from home to hospital. 43 Alloimmune Thrombocytopenia Where Cassidy is a wide-eyed outsider with a lively style, Wagner is a pediatrician, perinatologist, policy wonk, expert witness at countless trials, and World Health 47 Uterus Transplants Organization (WHO) adviser, he is a whistleblower with a clear agenda: namely, to convince his public that, in the US, obstetrics is still a vigilante practice and that the 50 Consent for Research public is being duped in much the same way as it was in previous eras. In a nutshell, the birthing industry is in the midst of yet another dangerous fad: too much medical 56 Universal Healthcare intervention in the names of two cultural values: convenience and control. Wagner believes these values are dangerous in the obstetrical context. Proof that things are amiss in the US: it has the second worst newborn mortality figures in the industrialized world, despite having the most expensive maternity system. Women are 70 per cent more likely to die in childbirth in the US than in Europe. Continued on page 26… neonatal INTENSIVE CARE Vol. 20 No. 6 Ⅲ October 2007 7 Editorial Advisory Board Arie L. Alkalay, MD Ivan Frantz, III, MD Rahmi Ors, MD Clinical Professor of Pediatrics Professor of Pediatrics Chief, Division of Neonatology UCLA School of Medicine Chief, Division of Newborn Medicine Ataturk School of Medicine Published seven times each year by Los Angeles, CA Tufts University School of Medicine Erzurum, Turkey Boston, MA M. A. Arif, MD Michael O’Shea Goldstein and Associates, Professor of Pediatrics & Head, Philippe S. Friedlich, MD Wake Forest University School of Inc. Neonatology Assistant Professor of Pediatrics Medicine National Institutes of Child Health Keck School of Medicine Winston-Salem, NC 10940 Wilshire Blvd., Suite 600 Karachi, Pakistan University of Southern California Los Angeles CA 90024 Los Angeles, CA G. Battisita Parigi, MD Muhammad Aslam, MD Associate Professor of Pediatric Surgery Phone: 310-443-4109 Clinical Fellow in Newborn Medicine G. Paolo Gancia, MD University of Pavia Fax: 310-443-4110 Harvard Neonatal-Perinatal Fellowship Neonatologist, Terapia Intensiva Italy Program Neonatale-Neonatologia E-mail: [email protected] Children’s Hospital Boston Cuneo, Italy Richard Paul, MD Harvard Medical School/ Harvard Chief, Maternal & Fetal Medicine University, Boston, MA.