DC Child Accident & Safety Blog

One in 100 newborns has a malformed heart. It's the most common birth defect. Now, a federal advisory panel recommends a simple and painless test for all newborns to detect such defects before the babies are released from the hospital.

Pulse oximetry measures the amount of oxygen in the blood via a small light sensor taped to a baby's wrist, hand or foot. It's inexpensive ($5-$10), fast (five minutes) and can detect a life-threatening condition otherwise difficult to find in a physical exam. An infant's cardiovascular system might appear normal in the first few days after birth, even though it continues to mature.

According to WebMD, only two states -- Maryland and New Jersey -- legally mandate the test. Some hospitals elsewhere do it voluntarily, but it's not in widespread use.

The federal panel's advice has been endorsed by the American College of Cardiology, the American Heart Association and the American Academy of Pediatrics.

If you're expecting, and you don't live in Maryland or New Jersey, make sure your hospital knows you want the test to be performed before your bring junior home. The chances of heart problems are low, but it's better know if there is one -- and to address it -- before it presents far from where it can be treated.

The Empowered Patient Coalition has put together a moving short video of some of the many children killed from malpractice and other medical errors. Watch it here.

Then check out the Coalition's website for tools on how you can be a safer, smarter patient for yourself and your loved ones.

Helen Haskell and Dr. Julia Hallisy are mothers of children harmed by medical error who founded the Empowered Patient Coalition to try to make the medical system better and safer for future patients.

Another touching video on turning medical tragedy into something positive was put together recently by Mary Ellen Mannix, a mom who lost a baby to medical mistakes in 2001. She went on to start James's Project, which focuses on patient safety to improve infant mortality and maternal health. Watch the video here.

Pop quiz: Which of the following promote tooth decay?

(A). sugar;
(B). genetics;
(C). low immunity;
(D). watching "American Idol."

The correct answer, of course, is "all of the above" ... with a qualifier for (D). (You have to be snacking on Raisinettes or another sticky fruit while watching the show.)

Although sugar remains the primary suspect in the creation of cavities, people can be genetically disposed toward tooth decay, and low immune function can contribute, as can dietary habits generally considered healthful--sticky fruits such as raisins, although preferable to sucking on a Popsicle, also leave teeth vulnerable to the ravages of sugar residue.

So what can a concerned parent do?

It's hard enough for parents to control so many factors conspiring to turn their kids' mouths into a gaping maw of dental disaster, but now there's something else to consider. According to the Los Angeles Times, several studies have shown that cavity-causing bacteria can be passed from primary caregivers to wee ones.

Children are most susceptible as infants and toddlers, when their immune systems are works-in-progress. But any age before children have the motor skills necessary to brush well by themselves requires parental invervention for maximum protection.

If you want to hold the line on sharing the bacterial love that can compromise your child's oral health not only as a youngster but after the arrival of permanent teeth and into adulthood, first take care of yourself. Expectant mothers should address any dental decay or gum problems before Junior arrives to reduce the likelihood of transmitting disease. And the use of an antibacterial mouthwash during the lower-immune period of infancy and toddlerdom might be wise.

In addition, the dentist should become a close, personal friend of your child probably earlier than you expect. Measures you should take include:

• schedule the first visit to a pediatric dentist at the time the first tooth appears or by the first birthday;


• limit the contents of bottles and sippy cups to water except at mealtime;


• limit snacking to a short interval--bacteria like any kind of sugar, whether from fruit, milk, honey or the refined white sugar in candy;


• assist your child with tooth-brushing until he or she is old enough to tie shoes or write cursive--generally 7 to 9 years old.

New York state has created a new fund to pay medical expenses for infants who are neurologically damaged as a result of malpractice and other medical mistakes, but opponents say it means families will have to fight with state authorities to obtain treatments as their children age.

The fund, which is due to go into effect on Oct. 1, 2011, allows medical costs to be provided on an annual basis to injured parties. Parents or guardians can still pursue medical malpractice actions on the basis of emotional distress and other losses.

Between 150 and 200 babies are expected to qualify annually for the new fund, according to Jason Helgerson, Gov. Andrew Cuomo's chief Medicaid reform adviser. Participation in the fund is mandatory for those seeking either Medicaid recompensation or filing medical malpractice suits.

Helgerson says the fund will offer a more accurate means of providing care for injured infants because it isn’t subject to inaccurate estimates made by judges and juries trying to arrive at an accurate figure for health-care costs under the current malpractice award system.

But opponents of the fund maintain that the system was championed by health-care providers and will subject the families of neurologically damaged infants to on-going battles with the state for treatments as their children age.

Under the new statute, the fund describes "birth-related neurological injuries" as "an injury to the brain or spinal cord of a live infant caused by the deprivation of oxygen or mechanical injury occurring in the course of labor, delivery or resuscitation or by other medical services provided or not provided during delivery admission that rendered the infant with a permanent and substantial motor impairment or with a developmental disability."

Medical care will be decided on a case-by-case basis. In the event the fund is reduced to 20 percent or less of its annual size, the law contains a default stipulation allowing suits to be brought for medical expenses.

The establishment of the fund was included in a host of recommendations by a Medicaid Redesign Team (MRT) appointed by Gov. Cuomo to halt escalating Medicaid costs. Another recommendation from the task force called for capping noneconomic damages in medical malpractice cases at $250,000. That proposal was fiercely opposed and eventually scrapped.

Source: New York Law Journal

The use of fetal heart rate monitors lowers the rate of infant mortality, according to a new study. Previous studies were too small to definitively prove the effectiveness of fetal monitoring, and some obstetricians maintained that the technology had been adopted too quickly.

But the new study, which was presented at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting in San Francisco, used data from the 2004 National Birth Cohort to get a large enough sample (1,945,789 singleton births that met the studies inclusion criteria) to gauge its effectiveness.

The study found that in 2004, 88% of singleton pregnancies had fetal heart-rate monitoring and associated the monitoring with significantly lower infant mortality (3.8 per thousand live births without monitoring vs. 3.0 with monitoring), which in turn was mainly driven by a 53% decrease in early neonatal mortality. The decreased risk was associated with both low- and high-risk pregnancies.

Source: Science Daily

You’ll find an abstract of the study here.

Virtually all pregnant women in the U.S. are exposed to multiple and varied chemicals – some long banned, others currently used – that may harm the fetus during sensitive periods of development, according to a new study by researchers at the University of California San Francisco.

The study found that the bodies of virtually all pregnant women in the U.S. carry multiple chemicals, including some banned since the 1970s and others used in common products such as non-stick cookware, processed foods and personal care products.

The researchers used data from the National Health and Nutritional Examination Survey (NHANES) to determine whether 163 chemicals were in the blood or urine of 268 U.S. pregnant women sampled between 2003 and 2004.

According to the study - the first to look at a broad range of chemicals specifically in pregnant women - 99% to 100% of pregnant women carried polychlorinated biphenyls (PCBs), organochlorine pesticides, perfluorinated compounds (PFCs), phenols, polybrominated diphenyl ethers (PBDEs), phthalates, polycyclic aromatic hydrocarbons (PAHs) and perchlorate.

The health risks for mother and child associated with exposure to this many chemicals at detectable levels is not known. Low-level exposures to some of these chemicals during the prenatal period can cause long-term health effects, including birth defects, reproductive problems and cancer.

Surprisingly, DDE – a breakdown product of the long-banned DDT pesticide – was found in every woman and at some of the highest levels measured for any of the chemicals. Other chemicals found at high levels include perfluoroctane sulfonic acid (PFOS), which is found in food packaging and non-stick cookware; triclosan, found in antibacterial soap and products; and mono-ethyl phthalate (MEP), found in cosmetics and fragrances. Animal or human studies show all of these chemicals can interfere with the endocrine system.

In addition, many of the pollutants measured in the study can pass through the placenta from the mother to the developing fetus and have been measured in cord blood, fetal blood and amniotic fluid.

Source: Environmental health News

You can view the original report here.

A Canadian study is showing a positive way forward for making childbirth safer for mothers and babies, and reducing the devastating impact of malpractice on newborn children.

The Canadian “Managing Obstetrical Risk Efficiently” (MOREOB) patient safety program has a measurable, positive impact on the health of mothers and babies, according to a study published in the Journal of Obstetrics and Gynaecology Canada.

According to the study, the program results in a significant reduction in severe morbidity for newborns, as measured by the rate of serious complications such as respiratory distress syndrome, sepsis and severe intraventricular hemorrhage. For mothers, there was a significant reduction in third- and fourth-degree vaginal tears and length of stay in hospital.

MOREOB is a comprehensive, three-year, patient safety, professional development and performance improvement program for caregivers and administrators in hospital obstetrics units. The program structure's first priority is safety, followed by effective communication, teamwork, decreased hierarchy in emergencies, practice for emergencies, and reflective learning. It integrates evidence-based professional practice standards and guidelines with current and evolving patient safety concepts, principles and tools.

By learning and working together in their own practice environment, health-care teams use the shared knowledge, skills, attitudes and behaviors that contribute to safe, effective, patient-centered care in an efficient, collaborative, healthy practice environment.

“MOREOB is an innovative program that seeks to ensure that every pregnant woman receives optimal care. With the results of this new study, it is hoped that many other North American hospitals will emulate Alberta, and make MOREOB a key component of their hospitals’ training, standards and approach to obstetrical patient care,’ said Dr. André Lalonde, Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada.

Source:
Society of Obstetricians and Gynaecologists of Canada
You can view SOGC's press release here.