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Ob/Gyns Warn Against ‘Vaginal Seeding’ Trend for Newborns

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The U.S.’s leading group of obstetricians and gynecologists is warning against a new trend where babies born by C-section are “seeded” via cotton swabs with vaginal microbes from the mother.”Vaginal seeding” is growing in popularity because it’s thought that babies born through Cesarean-section miss out on certain “helpful” vaginal microbes that might shield the infant from asthma, allergies and immune disorders.

“Vaginal seeding has become a rising trend for patients,” noted Dr. Jennifer Wu, an ob/gyn at Lenox Hill Hospital in New York City. “Patients read about the benefits of a vaginal delivery and hope to replicate these benefits with vaginal seeding.”

As explained by the American College of Obstetricians and Gynecologists (ACOG), it’s thought that contact with healthy vaginal bacteria helps stimulate the infant immune system, prevents the growth of dangerous bacteria and regulates the gut.

That contact doesn’t happen for babies born via C-section, however, so in vaginal seeding, a cotton swab with vaginal fluids from the mother is used to transfer vaginal bacteria to a newborn.

But in a statement issued Oct. 24, ACOG — the nation’s largest ob/gyn organization — said the procedure is not recommended because the known risks outweigh any potential benefits.

“Due to the lack of sufficient data, the very real risks [of vaginal seeding] outweigh the potential benefits,” Dr. Christopher Zahn, ACOG’s vice president of practice activities, said in a college news release.

“By swabbing an infant’s mouth, nose or skin with vaginal fluid after birth, the mother could potentially, and unknowingly, pass on disease-causing bacteria or viruses,” he explained.

Wu agreed. “There are very real risks attached to this practice,” she said. “Certain viruses, such as group B strep and herpes, can cause serious illnesses such as meningitis in newborns.”

And Zahn stressed that there’s a much safer way for a new mom to transfer her helpful bacteria to her newborn: Breast-feeding.

“Breast-feeding for the first six months is the best way to overcome the lack of exposure to maternal vaginal flora at birth,” Zahn said. “The bacteria present in breast milk and on the nipple is sufficient for natural colonization or seeding of the gut. There may be some initial difference in the gut [microbes] of infants based on mode of delivery, but research has shown that difference disappears after about six months,” he added.

If a woman does insist on vaginal seeding, her ob/gyn needs to make sure the patient understands the potential risks, ACOG said.

Dr. Mitchell Kramer is head of obstetrics and gynecology at Huntington Hospital in Huntington, N.Y. He agreed that breast-feeding is a good means of transmitting healthy microbes from a mom to her baby, but that “the jury is still out on [vaginal seeding] and further study is necessary before this is recommended as a routine protocol.”

SOURCES: Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; Mitchell Kramer, M.D., chairman, obstetrician/gynecologist, Huntington Hospital, Huntington, N.Y.; American College of Obstetricians and Gynecologists, news release, Oct. 24, 2017.

Docs: Infants Should Share Parents’ Room to Help Prevent SIDS

parent-and-infant-handsFrom our friends at HealthDay

Infants should sleep in the same room as their parents — but not in the same bed — to reduce the risk of sudden infant death syndrome (SIDS), new guidelines from the American Academy of Pediatrics advise.

The recommendations call for babies to share their parents’ bedroom for at least the first 6 months of life and, ideally, for the first year.

This could reduce the risk of sudden death by as much as 50 percent, the guideline authors say.

“Room sharing makes a lot of sense,” said Dr. Paul Jarris, deputy medical officer at the March of Dimes.

The rationale is that having the infant within view and reach makes for easier monitoring, comforting and feeding. Because the baby is nearby, parents might notice any potential difficulty, Jarris said.

“If we look at how strong the evidence is, parents will be well advised to adopt room sharing,” Jarris said.

It’s important, however, that infants have their own separate sleep surface, such as a crib or bassinet. They should never sleep on a soft surface like a couch or armchair, the doctors’ group warns.

Nor should babies sleep in the same bed as their mothers, the guidelines say. But, since infants do feed throughout the night, the doctors recommend that mothers feed the baby in bed.

“Babies should be brought to bed for feeding, but following feeding they should be returned to a separate sleep surface,” said report co-author Dr. Lori Feldman-Winter, a professor of pediatrics at Cooper Medical School in Camden, N.J.

“Breast-feeding can reduce SIDS by as much as 70 percent,” added Feldman-Winter.

Because moms may sometimes fall asleep during feeding, the AAP recommends keeping the parents’ bed free of pillows, loose sheets, blankets and other soft bedding that could suffocate the baby, she said.

Each year in the United States, some 3,500 babies die from sleep-related deaths, including SIDS. The number of infant deaths dropped in the 1990s after a national safe-sleep campaign that emphasized placing infants on their back. However, momentum has stalled in recent years, Feldman-Winter said.

Besides room sharing and breast-feeding, the academy’s recommendations to create a safe sleep environment also include the following:

  • Put the baby on his or her back on a firm surface, such as a crib or bassinet, with a tight-fitting sheet.
  • Keep soft bedding, including crib bumpers, blankets, pillows and soft toys, out of the crib. The crib should be bare.
  • Avoid exposing the baby to smoke, alcohol and illicit drugs.
  • Never use home monitors or other devices, such as wedges or positioners, to reduce the risk of SIDS.

Although SIDS risk is greatest from 1 to 4 months of age, evidence shows that soft bedding is still a hazard for older babies.

One pediatric specialist thinks room sharing might be difficult for some parents to accept.

“Room sharing is probably the most controversial recommendation,” said Dr. David Mendez, a neonatologist at Nicklaus Children’s Hospital in Miami.

Parents have strong feelings one way or the other, Mendez said. “Some parents want the baby in the bed right next to them; some parents want the baby to have its own room,” he said.

Mendez said he’s more concerned with other risk factors for SIDS, such as smoking and excess bedding.

“I would rather have the parents put the baby in a separate room if they’re smokers than room share,” he said.

“Having the baby on a firm surface on his back and keeping soft pillows and loose bedding that the baby can get tangled up in out of the bed or crib — those things probably play a much bigger role in preventing SIDS than being in the same room with the baby,” Mendez added.

The new recommendations, published online Oct. 24 in the journal Pediatrics, were to be presented Monday at the academy’s annual meeting, in San Francisco.

SOURCES: Lori Feldman-Winter, M.D., M.P.H., professor, pediatrics, Cooper Medical School, Rowan University, Camden, N.J., David Mendez, M.D., neonatologist, Nicklaus Children’s Hospital, Miami, Fla.; Paul Jarris, M.D., deputy medical officer, March of Dimes; November 2016, Pediatrics

Pregnancy Problems More Likely with Boys?

pregnant womanSerious pregnancy complications are more likely when women are carrying baby boys, new research suggests.

After analyzing more than half a million births in Australia, researchers said the baby’s gender could be linked to the health of both mother and child.

“The sex of the baby has a direct association with pregnancy complications,” said study first author Dr. Petra Verburg, of the Robinson Research Institute at the University of Adelaide in Australia.

Boy babies were more likely to be born early, which sets up infants for more health problems. Also, women carrying boys were slightly more likely to have diabetes during pregnancy (gestational diabetes), and pre-eclampsia, a serious high blood pressure condition, when ready to deliver, the study authors said.

Although it isn’t totally clear why this is so, “there are likely to be genetic factors,” Verburg said.

The findings ring true, said Dr. Querube Santana-Rivas, a neonatologist at Nicklaus Children’s Hospital in Miami, who wasn’t involved in the study. She said she sees the differences in her own practice.

“Male gender is a risk factor for a lot of the complications right after birth, especially in the premature population,” Santana-Rivas said.

The results also echo some findings from previous studies, Verburg said. A potential explanation is that the placenta, the organ that nourishes the developing fetus, is different in boys and girls.

“The placenta is critical for pregnancy success, and it is an organ that technically belongs to the baby, so it is genetically identical to the baby,” said study co-author Claire Roberts, another researcher at the Robinson Research Institute.

In previous research involving normal pregnancies, Roberts’ team found sex differences in the expression of 142 genes in the placenta. The researchers said that defects in how the placenta develops and works are linked with pregnancy complications.

For the new study, Verburg, Roberts and colleagues evaluated more than 574,000 Australian births from 1981 through 2011.

Compared to girls, boys had 27 percent higher odds of preterm birth between 20 and 24 weeks’ gestation; 24 percent greater risk for birth between 30 and 33 weeks; and 17 percent higher odds for delivery at 34 to 36 weeks, the study found. Full-term birth is between 39 and 41 weeks, according to the American College of Obstetricians and Gynecologists.

Moreover, gestational diabetes was 4 percent more likely in women carrying boys, and pre-eclampsia at term was 7.5 percent more likely with boys, the researchers said.

However, women carrying girls had a 22 percent higher risk of getting pre-eclampsia early in pregnancy, requiring preterm delivery, the study found.

Still, the research merely shows an association between gender and birth complications, not a cause-and-effect relationship. The findings shouldn’t alarm mothers-to-be, no matter what the sex of their unborn child, said Roberts.

The advice, for now, is the same as for all women who become pregnant, Roberts said. That means eating a good diet and attempting to maintain a healthy weight before conceiving.

“Even if the pregnancy was unplanned,” Verburg said, “there is still a window of opportunity for a woman to reduce her risks for pregnancy complications.” A woman can stop smoking, not drink alcohol and stay physically fit, she said.

Santana-Rivas agreed. She said the take-home message from the new study is for women to be aware of the potential risks “and to get good prenatal care.”

Depending on what future research finds, prenatal programs for pregnant women might one day vary based on whether they are carrying a boy or a girl, the researchers said.

The study was published online July 11 in PLOS ONE.

A Roadmap for Grieving Loss of Multiple-birth Children


infants-by-graveThis article by Elizabeth A. Pector, M.D., a Family Physician of Naperville, IL, discusses how the loss of a child or children (during pregnancy, at birth, or in infancy) affects the family of multiple birth children. Dr. Pector is an active member of the MOST Professional Advisory Board and a mother to two sons: one a surviving twin.

 

Intro by Dr Pector:

The death of multiple-birth children is a tragic event for parents and families.  This article, shortened from an original written in 2001, is a broad overview of the journey toward healing from loss of one or more children from a multiple pregnancy, based on expert opinion from clinicians, perinatal bereavement support professionals, and peer support organizations for multiples and bereaved parents. Every situation and every person is different. Complex considerations within twin or higher-multiple pregnancies make it even harder to predict what you might feel, and when. As you read this, focus on what applies to your situation.  (more…)

Are you ready for RSV season?

Preemie NICUAlthough RSV is the most common cause of respiratory tract infection in children under five years of age, most people are unfamiliar with the disease. RSV can be particularly serious in infants born prematurely, which of course, means most multiple births. Find information and resources on our PreemieCare page.