Your Baby

New Guidelines for Newborn Genetic Screenings

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Certain medical conditions can be present at birth but not easily identifiable. Metabolic or inherited disorders can impede a child’s normal physical and or mental development in lots of different ways. Without even knowing that they are carriers, parents can pass on the genes that produce these types of disorders. That’s where genetic screening of newborns comes in. With a simple blood test doctors can tell if the newborn has a condition that may eventually cause the child problems. Some of these disorders, if treated early, can be managed.

The federal government has not set any national standards, but many states have mandatory newborn screening programs. Parents can opt out of genetic testing if they want. Parents should discuss genetic screening with their pediatrician or child’s doctor so they can weigh the pros and cons.

Many states screen for more than 30 disorders and the screenings are often covered in the delivery and hospital charges. If a parent wants expanded testing on their newborn, they may have to pay an extra cost but it may be worth it to their baby.

To help guide states and parents determine what criteria should be used for genetic screening, the American Academy of Pediatrics and the American College of Medical Genetics and Genomics just offered new guidelines.

The new guidelines say that all newborns should be tested for the genetic diseases that are included in their state's newborn screening panel, but anything beyond that is up to parents and the decision must be made in the child's best interest.

The recommendations distinguish between genetic testing for childhood onset conditions versus those for adult onset conditions.

"There is an important role for counseling before and after genetic screening," added policy author Dr. Lainie Friedman Ross, a pediatrician and ethicist at the University of Chicago. "The focus should be on education of families, counseling them and helping them make decisions that focus on the child's best interest."

Testing for disease in the presence of symptoms is another area addressed by the new recommendations. "Clearly, if a child has symptoms, we need a diagnosis to help the family make clinical decisions that are in the child's best interest. This is important even when the disease has no current therapies," Friedman Ross added.

She also said that the results should be explained to the child when they reach the appropriate age.

New technology offers direct-to-consumer genetic screening tests, but the authors caution parents about using these products because of a lack of oversight and results are open to interpretation.

Some experts agree that being forewarned is being forearmed, but are not fans of the direst-to-consumer genetic tests.

"We highly discourage these even on adults, and particularly on children, because there is nobody there to provide counseling and interpretation," says Dr. Joyce Fox, a medical genetics doctor at North Shore University Hospital in Manhasset, N.Y. “These can also be very costly, and are likely not covered by insurance." Fox says.

Parents should educate themselves about genetic screening before the baby is born.  Most babies are born healthy and glide right through the genetic screening. But there are cases when the genetic testing panel reveals serious conditions such as PKU or Sickle Cell Anemia. 

If a baby’s screening results are negative, it means the tests did not show any signs of the conditions in the screening. On the other hand, if there are any positive results, it means there are signs of one or more of the conditions included in the screening,

A positive result does not always mean that the baby has the condition. It does mean though, that further testing is needed to make a final determination.

Early treatment for some of the conditions screened for can prevent serious future complications; so don’t delay if more tests are needed.

Pediatricians and geneticists say they approve of the new guidelines. The guidelines were published online in the journal Pediatrics.

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Sources: Denise Mann, http://consumer.healthday.com/Article.asp?AID=673692

http://kidshealth.org/parent/system/medical/newborn_screening_tests.html#cat150

Your Baby

Recall: Aveeno Baby Calming Comfort Lotion

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Johnson & Johnson on Friday said it is recalling more than 2,000 tubes of its Aveeno Baby Calming Comfort Lotion after U.S. regulators identified excessive levels of bacteria in a product sample.

J&J said the product, one of many consumer brands it has recalled in the past two years due to quality-control lapses, was being voluntarily withdrawn in Kansas and eight Southern states out of "an abundance of caution" and that its potential for harm was "remote."

The company said a test by the U.S. Food and Drug Administration showed that the lot of Aveeno lotion "exceeded the specifications for common bacteria" allowed for consumer products. But J&J said extensive testing later by an independent laboratory did not show that specifications were exceeded.

Source: http://www.reuters.com/article/2012/01/27/us-jj-aveeno-idUSTRE80Q25A2012...

Your Baby

Soothing Your Sick Infant

A sick baby is rarely a happy baby, so what’s a parent to do? Check in with your pediatrician, of course, and follow all treatment instructions. Beyond that, you'll have to wait for the illness to run its course. Fortunately there are tips for helping your child feel better and recover faster.The holidays can be a great time for relatives and friends to meet the “new” baby in the family. It can also be a time for baby’s first outing into crowded shopping malls, restaurants, and movie theaters where babies can be exposed to viruses and bacteria that make it difficult to escape common illnesses such as colds and flu.

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A sick baby is rarely a happy baby, so what’s a parent to do? You'll want to check in with your pediatrician, of course, and follow all treatment instructions. Beyond that, you'll have to wait for the illness to run its course. Fortunately there are tips for helping your child feel better and recover faster. Provide Plenty of Liquids: Make sure that your child is getting plenty of liquids to prevent dehydration. Depending on whether you are breastfeeding or bottle-feeding, offer your infant the breast or bottle often to provide both hydration and comfort. Your infant may also enjoy a bottle filled with cool water. Make Sure Baby Gets Plenty of Rest: Lots of rest and sleep will soothe your sick baby and help her heal. Put your baby to bed early, if you can, and encourage naps. Avoid situations that will over-stimulate your baby -- and possibly expose others to her germs -- and keep her as quiet as possible. Use Nose Drops When Needed: If your baby's nose is particularly congested, you can use over-the-counter saline drops or spray to thin mucus. Check with your doctor first and ask which specific products she recommends. Use two drops in each nostril before feeding and bedtime, or whenever your baby seems particularly congested Use a Nasal Syringe: After you use nose drops or spray, use a nasal syringe to clear your baby's nose of mucus so she can breathe more easily. Clear your baby’s nostrils two to three times a day. A Humidifier Helps Breathing: Running a cold-mist humidifier in your infant's room will help keep air moist and ease congestion. (Cool-mist humidifiers are recommended over warm because warm-mist devices present the danger of scalding.)  Be sure to follow the manufacturer's instructions for changing filters and keeping the humidifier clean, and fill with fresh water every day to prevent mold and bacteria. Give a Warm Bath: A warm bath not only soothes your sick infant, it will ease aches and pains, and steam from the warm water will also help clear congestion. Dry your baby thoroughly afterward to prevent chills. Give a Gentle Chest Massage: If your baby's chest is congested, a gentle massage will help loosen mucus. Place your baby face down across your lap, and gently tap her back with your cupped hand. Elevate the Head: Keep your infant's head slightly elevated to make breathing easier. By far the best way to soothe your sick baby is to give her lots of love and attention. Hold her and engage in quiet play, give her an infant massage, or read and sing to her.  If you are breastfeeding, she may want to nurse more, which will reassure and comfort her. If she likes being in a snugly or sling, bundle her up and do some chores, or take a walk. Talk to her and reassure her, whether she is old enough to understand or not, as your voice will help relax and soothe your sick infant. Prevention Is the Best Remedy Dr. Julia Piwoz from the pediatric infectious diseases division of the Joseph M. Sanzari Children's Hospital in Hackensack, N.J., says while there is no vaccine for the common cold, there is a vaccine against influenza that can be used for even very small children. "Current immunization guidelines recommend that children ages 6 months to 23 months be immunized against the flu," says Dr. Piwoz. "In addition, children 2 years and above with certain health conditions should be immunized, but the vaccine can also be given to healthy children as well as adults." It’s also important to make sure that anyone handling your baby is not sick, and has washed their hands before picking up your little one. Keep plenty of alcohol-based wipes on hand just in case.

Your Baby

C-section May Raise Kids’ Asthma Risk

Children born via cesarean delivery are at increased risk for developing asthma, particularly if their parents have allergies according to a new study. The report in the February 2009 issue of Thorax looked at data involving nearly 3-thousand children. C-section has been thought to be a risk factor for asthma, although the relationship is controversial said Dr. H.A. Smith from the National Institute for Public Health and the Environment in Bilthoven, the Netherlands in the report.

Researchers assessed the association between c-section and asthma or allergies at 8 years of age. Over all, 12.4 percent of the children developed asthma at age 8, and of that number 8.5 percent had been delivered via c-section. Investigators found that overall, children delivered by c-section were 79 percent more likely to develop asthma that children born vaginally. The group also said the association between c-section and asthma was even stronger for children born to one or two allergic parents than for children born to parents without allergies.

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Your Baby

Preemies Health Problems Sometimes Inherited

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An interesting new study says that not all health problems linked to premature births may be the result of a too early delivery. Only some of the physical and mental health problems previously connected with preterm birth are actually caused by it, the study says, other health issues may simply be inherited.

Researchers analyzed the medical records of 3.3 million children born in Sweden between 1973 and 2008, and confirmed the strong link between preterm birth (generally classified as before 37 weeks' gestation) and the risk of infant and young adult death, autism and attention-deficit/hyperactivity disorder (ADHD).

However, the study authors also concluded that many other problems that have been linked with preterm birth -- such as severe mental illness, learning problems, suicide and poverty -- may instead be more closely related to other factors that people share with other family members.

"The study confirms the degree to which preterm birth is a major public health concern and strongly supports the need for social services that reduce the incidence of preterm birth," study lead author Brian D'Onofrio, an associate professor in the department of psychological and brain sciences at Indiana University Bloomington, said in a university news release.

"Yet, the findings also suggest the need to extend services to all siblings in families with an offspring born preterm. In terms of policy, it means that the entire family, including all of the siblings, is at risk," he added.

Previous studies have compared preterm infants to non-related full-term infants. This study however, compared preterm infants with full-term siblings and cousins, an approach that shed new light on the issue.

"Our study is part of a growing interest in research and public health initiatives focusing on very early risk," he added. "When you look at early risk factors, they don't just predict one type of problem; they frequently predict lots of problems with long-term implications."

The study was published in the September issue of the journal JAMA Psychiatry.

 

Nearly half a million babies in the U.S. are born premature each year.

There are a number of risk factors associated with spontaneous preterm birth but more than half of preterm births happen in pregnancies where there are no identifiable risk factors. While there is no way to predict if you will have a preterm birth, there are some common risk factors that can increase the likelihood of a preterm birth. They include:

- You have had a previous preterm delivery

- You’re pregnant with twins or other multiples

- You are younger than 17 and older than 35

- You were underweight before your pregnancy and have not gained enough weight during pregnancy

- You are African American

- You’ve had vaginal bleeding in the first or second trimester. Vaginal bleeding in more than one trimester means the risk is even higher.

- You’ve had moderate to severe anemia early in your pregnancy

- You smoke, abuse alcohol or use drugs, especially cocaine, during pregnancy

- You’ve had little to no prenatal care

- You are pregnant with a single baby that is the result of fertility treatments.

Spontaneous births can also be caused by medical conditions such as infection, having a problem with the placenta, structural abnormalities of the uterus or cervix or having abdominal surgery while pregnant to name a few.

The best thing that a mother-to-be can do for herself and her unborn baby is to start prenatal care as soon as she discovers she is pregnant. There are no guarantees that you will have a full term delivery with no complications, but you can increase the odds to your favor by getting good prenatal care, sticking to a healthy diet, exercising and keeping your body free of drugs, alcohol and cigarette smoke.

Make it a point to learn about yours and your spouse’s medical family history. There may be clues that your OB/GYN should be aware of as he or she provides your prenatal care.

Sources: http://health.usnews.com/health-news/news/articles/2013/09/25/preemies-woes-sometimes-due-to-heredity-study-says

http://www.babycenter.com/0_preterm-labor-and-birth_1055.bc

 

Your Baby

Speedy DNA Test Identifies Gene Diseases in Newborns

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Newborns are routinely screened at birth for a variety of diseases, but tests results can sometimes take up to two weeks. For some conditions that are quickly treatable time isn’t as critical, but 10 to 14 days for other test results might mean the difference between life and death.

And there are thousand of genetic diseases that newborns are not tested for, that if known about early, could help doctors provide quicker and better care.  

Something amazing is happening in genetic DNA mapping that could change newborn testing forever.

Scientists have found a way to decode babies' DNA in just days instead of weeks.

In a small but significant study, researchers at Children’s Mercy Hospital in Kansas City, Missouri mapped the DNA of five children. While the study couldn’t be completed in time to save the children, the results were very promising.

By year’s end the hospital plans to begin routine gene mapping in its neonatal intensive care unit. It may also offer testing for babies elsewhere, while further studies continue, said Dr. Stephen Kingsmore, director of the pediatric genome center at Children's Mercy.

"For the first time, we can actually deliver genome information in time to make a difference," predicted Kingsmore, whose team reported the method in the journal Science Translational Medicine.

Even if the diagnosis is a lethal disease, "the family will at least have an answer. They won't have false hope," he added.

The idea is to combine faster gene-analyzing machinery with new computer software that, at the push of a few buttons, uses a baby's symptoms to zero in on the most suspicious mutations. The hope would be to start treatment earlier, or avoid futile care for lethal illnesses.

More than 20 percent of infant deaths are due to a birth defect or genetic diseases, the kind caused by a problem with a single gene. There are thousands of these diseases, and most hospitals don’t have the means to test for all of them. Once a baby shows symptoms though, fast diagnosis becomes crucial.

Sequencing whole genomes — all of a person's DNA — can help when it's not clear what gene to suspect. But so far it has been used mainly for research, in part because it takes four to six weeks to complete and is very expensive.

Wednesday, researchers reported that the new process for whole-genome sequencing can take just 50 hours; half that time to perform the decoding from a drop of the baby's blood, and the rest to analyze which of the DNA variations uncovered can explain the child's condition.

The study did not factor in the time that it took to ship the blood to Essex, England, where a new and faster DNA decoding machine is, or the time to relay the results for Children's Mercy's computer program to analyze. Kingsmore said the hospital is awaiting arrival of its own decoder, when 50 hours should become the true start-to-finish time. The study’s results only counted the time it took for the blood to be decoded or analyzed.

But, specialists not involved in the study say the long-promised usefulness of gene mapping to real-world medicine is finally close at hand.

"Genomic sequencing like this is very practical and very real now," said Dr. Arthur Beaudet of the Baylor College of Medicine, which also is working to expand genomic testing in children. "Fast forward a year, and I think this kind of thing will probably be pretty routine."

The speedy test is currently very expensive at $13,500, and more study is needed before insurers will cover it. But these costs are minimum compared to the $8,000 a day it takes to cover keeping a newborn in an intensive care unit.

Among the babies tested was a newborn with his organs on the wrong side of his body and needing emergency heart surgery. His parents had been told that it was a fluke that his older brother was born the same way, but the new test found an inherited genetic culprit that Kingsmore said will help doctors predict both boys' future treatment needs.

Three other newborns in the study died and the new test uncovered the cause of death for two of them. Kingsmore said that allowed researchers to tell parents that nothing they did during pregnancy was to blame, and to counsel them about the risks of future pregnancies.

Since the original study concluded, the team has performed rapid gene mapping with additional families. It uncovered the cause of a mother's two stillbirths, allowing for assisted reproduction to help her next pregnancy be healthy, said Children's Mercy laboratory director Dr. Carol Saunders.

Another study of genetic diagnosis, also published Wednesday, shows that analyzing more than 21,000 genes can often find the cause of unexplained cases of severe mental disability.

Researchers reported in the New England Journal of Medicine that in 16 of 100 patients, they were able to identify genetic mutations that caused the condition. The mutations were not inherited from parents, but rather occurred spontaneously in the egg or sperm.

Joris Veltman, a study author from the Radboud University Nijmegen Medical Center in Nijmegen, the Netherlands, said such an analysis could help families understand the cause and prognosis of the disease. Finding a non-inherited mutation "tells the parents that this was just bad luck, and tells the mother that she is not to blame for this, nothing went wrong during the pregnancy," he wrote in an email to the Associated Press. It also reveals that the chance of the same mutation affecting a future child would be very low, he said.

Valuable information like that might ease of the minds of parents already dealing with terrible grief. 

Source: http://news.yahoo.com/two-day-test-spot-gene-diseases-newborns-200806055.html

Your Baby

New Support for Breastfeeding

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According to the “Call to Action,” breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections, and pneumonia. Breastfed babies are also less likely to develop asthma, and those who are breastfed for six months are less likely to become obese.Support for mothers who breastfeed has been given a helping hand by the U.S. Surgeon General.

Surgeon General Regina M. Benjamin today issued a “Call to Action to Support Breastfeeding,” outlining steps that can be taken to remove some of the obstacles faced by women who want to breastfeed their babies. “Many barriers exist for mothers who want to breastfeed,” Dr. Benjamin said. “They shouldn’t have to go it alone. Whether you’re a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed.” “Of course, the decision to breastfeed is a personal one,” she added, “no mother should be made to feel guilty if she cannot or chooses not to breastfeed.” While 75 percent of U.S. babies start out breastfeeding, the Centers for Disease Control and Prevention says, only 13 percent are exclusively breastfed at the end of six months.  The rates are particularly low among African-American infants. Many mothers who attempt to breastfeed say several factors impede their efforts, such as a lack of support at home; absence of family members who have experience with breastfeeding; a lack of breastfeeding information from health care clinicians; a lack of time and privacy to breastfeed or express milk at the workplace; and an inability to connect with other breastfeeding mothers in their communities. Dr. Benjamin’s “Call to Action” identifies ways that families, communities, employers and health care professionals can improve breastfeeding rates and increase support for breastfeeding: • Communities should expand and improve programs that provide mother-to-mother support and peer counseling. • Health care systems should ensure that maternity care practices provide education and counseling on breastfeeding.  Hospitals should become more “baby-friendly,” by taking steps like those recommended by the UNICEF/WHO’s Baby-Friendly Hospital Initiative. • Clinicians should ensure that they are trained to properly care for breastfeeding mothers and babies.  They should promote breastfeeding to their pregnant patients and make sure that mothers receive the best advice on how to breastfeed. • Employers should work toward establishing paid maternity leave and high-quality lactation support programs.  Employers should expand the use of programs that allow nursing mothers to have their babies close by so they can feed them during the day.  They should also provide women with break time and private space to express breast milk. • Families should give mothers the support and encouragement they need to breastfeed. Family members can help mother’s prepare for breastfeeding and support their continued breastfeeding, including after her return to work or school. According to the “Call to Action,” breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections, and pneumonia. Breastfed babies are also less likely to develop asthma, and those who are breastfed for six months are less likely to become obese.  Mothers who breastfeed have a decreased risk of breast and ovarian cancers. A study published last year in the journal Pediatrics estimated that the nation would save $13 billion per year in health care and other costs if 90 percent of U.S. babies were exclusively breastfed for six months. Dr. Benjamin added that, by providing accommodations for nursing mothers, employers can reduce their company’s health care costs and lower their absenteeism and turnover rates. “I believe that we as a nation are beginning to see a shift in how we think and talk about breastfeeding,” said Dr. Benjamin.  “With this ‘Call to Action,’ I am urging everyone to help make breastfeeding easier.”

Your Baby

Children's Cold & Allergy Medicine Recall: What Should You Do Now?

McNeil recalls children's Tylenol, Motrin and Zyrtec. Dr. Sue's advice on what to do now. If you follow us on twitter or Facebook, you already know that over the weekend McNeil Consumer Healthcare division announced a huge recall of some of the most popular over the counter infants' and children’s products.

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McNeil announced that this was a voluntary recall of many of their over the counter (OTC) products including Tylenol, Motrin, Benadryl and Zyrtec. This recall includes 7 different products and 43 different flavored liquid medication. Their press release stated that the recall was being initiated "because some of these products may not meet required quality standards”. The recall was not mandated by the FDA and was not undertaken due to any adverse medical events being reported.  So, if you have given your children a recent dose of one the named products, I do not think you need to worry as it seems that the products in questions may either contain a higher concentration of active ingredient than specified on the bottle, or may also contain tiny particles or inactive ingredients that do not meet internal testing requirements. With that being said, McNeil also made a toll free number available (1-888-222-6036) that could be used to report any adverse events and also to answer questions regarding the recall. Despite the fact that adverse events have not been reported I would take this opportunity to dispose of any of the mentioned drugs and replace them with a generic equivalent. It is my understanding that all of the recalled drugs (McNeil recall website) are the infant's and children’s liquid products, which includes both infant drops and children’s suspension.  All lots that have not yet expired, including samples from the physician’s office or hospital are included in the recall.  This is the time to look for generic equivalents of these products, as McNeil alludes to the fact that it may be “some time” before their name brand products will be available for purchase. Tylenol is the number one selling brand of acetaminophen, while Motrin is the equivalent of generic ibuprofen.  Benadryl, which is diphenhydramine is the best selling antihistamine for allergies and is often used to alleviate itching from problems such as poison ivy or eczema.  Zyrtec is cetirizine which is a once daily antihistamine with less sedation than diphenhydramine. At this time of year, many parents have been using both Benadryl and Zyrtec to help combat the severe allergy season which has been affecting the entire country. While doing the radio show over the weekend, a caller called asking if she could replace her son’s Benadryl (remember diphenhydramine) with Sudafed (pseudoephedrine) which is definitely not the same drug. This shows the importance of reading labels and asking either your pharmacist or physician if you have questions. In the meantime, get the trash bags out and throw out the recalled medications, and see if you have any pharmacy discount coupons you can use to refill your medicine cabinet! That's your daily dose.  We'll chat again tomorrow. Send your question to Dr. Sue!

Your Baby

Fatty Acid Supplements in Baby Formula

1:45 to read

Studies have shown that breastfed babies score higher on mental development tests. One thought behind the higher thinking and language skills is that breast milk contains more fatty acids. So infant formulas enriched with DHA and ARA omega fatty acids from algae have found their way into the jam-packed baby formula aisle. But do these supplements actually give an infant a brainpower edge? Not according to a new study published in the journal Pediatrics.

The study says that baby formula supplemented with fatty acids doesn’t boost infants’ brainpower any more than formula without extra fatty acids. The results don't necessarily mean fatty acids in formula have no benefit. But they suggest the fats don't give children the thinking and language advantage that's been tied to breastfeeding.

Researchers explain in their study that infants raised on breast milk tend to score higher on tests of mental development than those who are fed formula.

One reason for the gap could be the higher levels of fatty acids found in breast milk, given that the fats are essential for babies' brain development.

"The differences in cognitive development between breastfed and formula-fed infants were a substantial motivating factor in adding (fatty acids) to infant formulas," according to the report.

Most baby formula is cow milk based and fortified with fatty acids and other nutrients.

Studies on the issue have had mixed results, so the researchers, led by Dr. Ahmad Qawasmi at Yale University in New Haven, Connecticut and Al-Quds University in Jerusalem, sought to get a better verdict by combining them into one analysis.

They used data from 12 trials that compared babies fed formula with fatty acid supplementation to babies fed formula without the extra fats. In total, about 1,800 infants took part in the studies, which were conducted between 1998 and 2005.

The children started drinking formula by one month of age, and around the time they turned one, they underwent exams to measure their motor skills, language abilities and mental development.

Just two of the studies included in the analysis found that babies fed supplemented formula performed better on the tests.

A third report showed a fatty acid-linked boost on some developmental measures but not others, and the remaining nine studies found no cognitive benefits in the babies getting added fatty acids.

Taken together, the studies show the extra fats provide no advantage as far as braininess goes, the researchers said. But it's still possible that adding fatty acids to formula could benefit infants in other ways, such as with a boost in eyesight or immune function, they noted.

"There also remains the possibility that (fatty acids) could impact later cognitive development or more specific aspects of cognitive development such as attention, information processing, mood, or behavior."

The American Academy of Pediatrics recommends women breastfeed exclusively for six months, followed by at least another six months of nursing while solid foods are introduced.

For various reasons not all mothers are able to breastfeed their babies, so formula is still a good option. Formulas supplemented with fatty acids may offer babies other valuable benefits.

Sources: http://news.yahoo.com/fatty-acids-formula-dont-babies-smarter-152740451....

http://bit.ly/N5q59o Pediatrics, online May 28, 2012.

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