Archive for month: August, 2020

Infants in the NICU were more likely to stay asleep during recordings of their mothers reading, finds new research.
Babies who spend their first days or weeks of life in the Neonatal Intensive Care Unit may not sleep as soundly as those who go home.
Now, researchers are examining whether one simple difference could help soothe these infants to sleep: the sound of their mother’s voice.
When they were played recordings of their mothers reading children’s books, babies in the NICU slept better and woke up less often, according to a new abstract presented at the annual meeting for Sleep Medicine.
“In the hospital, we take care of babies who are not in their usual environment, which can hinder their ability to have normal sleep,” says lead author Renée Shellhaas, M.D., M.S., a pediatric neurologist at University of Michigan C.S. Mott Children’s Hospital.
“Even though we do our best to make the ICU as quiet an environment as possible, there are hospital disruptions that are unavoidable. Alarms, monitors, ventilators, bedside care and even just the building’s heating and cooling noises may be disruptive. We designed this study to see how the sound environment in the NICU potentially influences sleep and to see if there are relatively simple interventions that may make a difference.”
“What we found was that babies in the NICU were more likely to stay asleep when the recordings of their mothers’ voices played than they were without them.”
"If we can find simple tools to help babies in the unit get higher quality sleep, they could make a big difference to infants’ health and development, especially for those who must stay in the hospital for an extended time."
 
University of Michigan C.S. Mott Children’s Hospitallabblog.uofmhealth.org/rounds/moms-voice-may-help-babies-sleep-better-nicu

Infants with diabetes can drop insulin syringes. Researchers from Bergen and Exeter have been leading the work, which causes children worldwide to replace insulin syringes with tablets.
"All infants diagnosed with diabetes before 6-7 months of age should be given a rapid gene test to change treatment as soon as possible from insulin to sulfonylurea tablets. They can expect a long and very good effect of the treatment of blood sugar control, and the treatment is safe," says Professor Pål Rasmus Njølstad at the University of Bergen.
It was in 2004 discovered that relatively high doses of sulfonylurea tablets could be used to treat diabetes in infants. This principle has given a new life for children with this type of diabetes, because 90% can stop insulin injections and even achieve better blood sugar control, at least for one year without the same low blood sugar problem. However, it has been unknown whether this treatment can be maintained in the long term, especially as sulfonylureas fail in half of those with type 2 diabetes after five years of treatment.
The results are now available from an international multi-center study from centers in Bergen, Exeter, Rome, Paris, and Krakow. This included 81 people who 10 years ago had changed the treatment from insulin to sulfonylurea tablets. It was found that the failure effect of treatment, which is often seen in type 2 diabetes, rarely exists in this type of infant diabetes. Sulfonylurea is safe in this treatment, even with the relatively high doses needed. An excellent control of blood glucose was retained after ten years of treatment. Some children initially experienced a certain recovery of neurological features, but most of them did not have any clear improvement in the problems.
"These findings will give many children a new and better quality of life," says Njølstad. "This is one of the few examples of lasting effect of precision medicine."

ScienceDaily
www.sciencedaily.com/releases/2018/06/180607101013.htm

Researchers at Loma Linda University Health found that kidney transplantationcan be safely performed using organs testing positive for the hepatitis C virus (HCV) antibody but negative for active viral infection.
Their findings, published July 24 in the American Journal of Transplantation, could expand the number of kidneys available for those in need.
“One way of increasing the kidney donor pool is to utilize more organs from HCV positive donors,” said the study’s lead author, Michael E. de Vera, MD, director of Loma Linda University (LLU) Transplant Institute. “Currently, HCV positive donors are defined by donors that have previously had HCV even if they were cured. Now there has been a call to redefine the definition of an HCV positive donor in hopes that more organs can be used from these donors.”
Co-author of the study, Michael Volk, MD, director of transplant hepatology at LLU Tansplant Institute, participated in a 2017 American Society of Transplantation consensus conference, which encouraged the use of organs testing positive for HCV — those with only a positive antibody, as well as those testing positive for the virus. This recommendation stems in part from the availability of newer and better medications to cure people of the virus.
 
“These organs testing positive for HCV are frequently discarded and often come from younger donors,” Volk said. “This approach has the potential to save lives by increasing the numbers of transplants.”
Although there is a record number of deceased organ donors, de Vera said the gap between the number of kidney transplants performed and the number of patients on the waiting list remains substantial.
There are now nearly 95,000 kidney patients on the waiting list, but less than 20,000 kidney transplants occurred in 2017, according to the United Network for Organ Sharing.
 
The problem is even wider in California, where nearly 2,300 people received a kidney in 2017, while nearly 19,000 remained on the waitlist.
 
HCV is tested in organ donors by checking for the presence of HCV antibodies (Ab) and HCV RNA, de Vera said. The presence of HCV antibodies shows that the virus at some point affected the host, but does not reveal if the host was cured. The presence of HCV RNA, on the other hand, indicates active infection. Many organ donors are HCV Ab positive but HCV RNA negative, and doctors have been reluctant to transplant kidneys from these donors for fear of transmitting HCV to the recipient. As a result, many of these kidneys have not been used in the past.
 
“Our hope is that this study will convince transplant doctors that the use of these donor kidneys is safe and does not lead to HCV transmission,” said de Vera. “And hopefully, more patients will receive these life-saving organs.”
The study was titled, “Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia.”
The study looked at 32 patients who were transplanted with HCV Ab+/NAT- kidneys at Loma Linda University Medical Center from January 2017 to February 2018. All patients consented to the surgeries.
Recipient ages ranged from early 40s to late 60s, and donor ages ranged from late 20s to mid 50s. All 32 patients are doing well without evidence of hepatitis C virus infection.

New NDT study shows that `normal´ pre-dialysis blood pressure measurement is not reliable. “Without performing extended ambulatory BP recordings (44h – 48h) we approvingly accept an error rate of about 30% in the diagnosis of hypertension in dialysis patients, a highly vulnerable patient group with a dramatically elevated cardiovascular risk. This is why EURECA-m recommends ambulatory blood pressure monitoring as gold standard for the diagnosis for hypertension in hemodialysis patient.”
There is a bidirectional relationship between high blood pressure and chronic kidney disease (CKD). Hypertension aggravates CKD progression. On the other hand, CKD can cause hypertension, because our kidneys do not only `detox´ our bodies, but also regulate the blood pressure. This is, why nephrologists are `core experts´ when it comes to uncontrolled or difficult-to-treat blood pressure.
In hemodialysis patients, hypertension is very common, because the kidneys – and with them the main blood pressure regulation mechanism – stopped working.
“High blood pressure is dangerous, also in dialysis patients. It can lead to severe complications like heart attacks and strokes”, explains Professor Carmine Zoccali, president of the ERA-EDTA. “The monitoring of blood pressure levels is therefore an essential part of the care of these patients. The European Cardiovascular and Renal Medicine (EURECA-m) recommends the 48-h ambulatory blood pressure monitoring (ABPM) in these patients. Our new data strongly support this recommendation.”
The EURECA-m working group has previously published a study, in which 396 hemodialysis patients underwent 48-h ABPM. It showed that the prevalence of hypertension in dialysis patient was very high (84.3%). Although similar rates have been seen when blood pressure levels were measured in the dialysis center before the dialysis treatment, the sensitivity and specificity of 48-h ABPM proved to be higher. Sensitivity means that patients with hypertension are reliably detected and specificity means that those who do not suffer from hypertension are also correctly identified. Obviously, the `normal´, pre-dialysis measurement does not have a sufficient sensitivity and specificity in dialysis patients. About 30% of the patients are misdiagnosed, when the blood pressure is measured in the dialysis center before each dialysis treatment.
Why is that the case? The new EURECA-m study showed that 18.2% of the patients suffered from “white coat hypertension”: They do not have hypertension in “real life”, but develop high blood pressure levels as soon as their blood pressure is measured by a doctor or nurse. Vice versa, 14.1% of the patients suffered from “masked hypertension”, in which high blood pressure values occur often during the nights, only. Therefore, this hypertension cannot be detected before the daily dialysis treatment. Only the 48-h ABPM can reliably detect a `masked hypertension´ as well as the `white coat hypertension´.
“If we do not perform a 48-h ABPM, there is the risk that we treat patients with `white coat hypertension´, who do not need any medication and that we do not treat those with a `masked hypertension´ or with nocturnal hypertension, who need the treatment. In short: Without performing extended ambulatory BP recordings (44h – 48h) we approvingly accept an error rate of about 30% in the diagnosis of hypertension in dialysis patients, a highly vulnerable patient group with a dramatically elevated cardiovascular risk”, explains Professor Zoccali, ERA-EDTA president and co-author of the new study. “This is why EURECA-m recommends 48-h ambulatory blood pressure monitoring as gold standard for the diagnosis for hypertension in hemodialysis patient.”
www.era-edta.org

Abington Hospital – Jefferson Health has been recognized as a Baby-Friendly hospital by Baby-Friendly USA, Inc. This designation recognizes Abington Hospital for the optimal level of care it provides breastfeeding mothers and their babies.
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991. This initiative is centered around the Ten Steps to Successful Breastfeeding; a plan developed by global experts. Hospitals that provide mothers with the information, skills and confidence they need to successfully initiate and continue breastfeeding are recognized as Baby-Friendly. The World Alliance for Breastfeeding Action (WABA) coordinates World Breastfeeding Week, which is recognized annually August 1 to 7, to protect, promote and support breastfeeding mothers worldwide.
“We are committed to providing new mothers with the information and skills needed to confidently feed their babies,” says Dr. Steven Shapiro, Chair, Department of Pediatrics. “Abington Hospital is so proud to have achieved this designation which reflects the great efforts of our doctors, nurses and staff.”  
In order to be considered for designation, Abington Hospital completed a rigorous on-site survey. The award will be maintained by upholding the practice of the Ten Steps to Successful Breastfeeding.
The BFHI continues to grow with Baby-Friendly hospitals now in all 50 states and 24 percent of births taking place in the more than 500 Baby-Friendly designated facilities. Nearly 5,000 babies are delivered per year at Abington Hospital. The BFHI initiative used in Abington Hospital encourages the use of evidence-based care and has seen tremendous success in helping mothers reach their breastfeeding goals.
https://www.abingtonhealth.org/