From WebMD Health News
from WebMD — a health information Web site for patients
Kathleen Doheny
August 27, 2009 — Seven symptoms often reported to doctors are associated with ovarian cancer, according to a new study from the U.K., dispelling the idea that the deadly cancer is a ''silent killer'' with few clues until the advanced stages.
''Ovarian cancer is not silent, it's noisy," lead author William Hamilton, MD, a consultant senior lecturer at the University of Bristol, tells WebMD in an email interview. "It's just we're not very good at deciphering the noise." Ovarian cancer accounts for 4% of all cancers in women, Hamilton says, but it has the worst prognosis of all gynecologic cancers. His study is published online in BMJ.com.
Ovarian Cancer Study Details
In the study, Hamilton and his colleagues evaluated 212 women, aged 40 and above, with a diagnosis of primary ovarian cancer and compared them with 1,060 healthy women. The women went to 39 different general practice doctor's offices in Devon, England.
The researchers looked at the medical records for a year before the cancer was diagnosed and did the same for the healthy women. They took note of what symptoms the women had complained about and at what time.
Ovarian Cancer Study Findings
Seven symptoms were found associated with ovarian cancer, including:
Abdominal distension
Urinary frequency
Abdominal pain
Postmenopausal bleeding
Loss of appetite
Rectal bleeding
Abdominal bloating
The researchers calculated what they term the ''positive predictive value'' for each symptom -- that is, the chances that a woman with a specific symptom actually does have ovarian cancer.
The symptoms had low positive predictive values -- less than 1% -- except abdominal distension, which had a value of 2.5%.
The 2.5%, Hamilton tells WebMD, means that "one woman in 40 with this symptom will have ovarian cancer." That is a value he considers high, he says. ''It's roughly the same as the risk of lung cancer when you cough blood and the same as colon cancer when you pass blood rectally."
When they evaluated more closely, the researchers found that three of the ovarian cancer symptoms -- abdominal pain, abdominal distension, and urinary frequency -- were reported at least six months before the diagnosis and were significantly associated with ovarian cancer.
Ovarian Cancer Symptoms and Screening
Women often use the term bloating for distension, Hamilton writes. But medical experts generally consider distension as a progressive increase in abdominal size; bloating is an intermittent increase and decrease.
Under current guidelines in the U.K., Hamilton notes in the paper, abdominal distension is not a symptom that warrants "urgent investigation."
In the U.S., bloating is one of the symptoms that is likely to persist in women with ovarian cancer compared to women in the general population, according to the American Cancer Society. If a woman complains of bloating, her doctor will likely do a thorough physical exam, and perhaps a CA-125 blood test, which measures a protein found in the blood of many women with ovarian cancer, or a transvaginal ultrasound.
Routine screening with CA-125 and transvaginal ultrasound isn't done in the general population, according to the ACS, nor is routine screening for ovarian cancer recommended by the American Cancer Society or other medical organizations. But the tests are often offered to women at high risk of ovarian cancer, such as those with a very strong family history of the disease.
Ovarian Cancer Symptoms: Other Opinions
The study results add to several other studies also finding that ovarian cancer isn't as "silent" as experts thought, says Andrew Li, MD, a gynecologic oncologist at Cedars Sinai Medical Center, Los Angeles. "I think this reinforces what a lot of other studies have shown, that there are symptoms of ovarian cancer, and that patients and physicians should be aware of them."
Although Hamilton's team found three symptoms to be present more than six months before diagnosis of ovarian cancer, Li says the clinical picture he encounters with his patients is typically different. ''Patients are in their usual state of health and in a three- or four-week period, they develop these symptoms -- mostly the three [pain, distension, and frequency]."
In an editorial accompanying the study, researcher Joan Austoker of the University of Oxford notes that the overall five-year survival rate from ovarian cancer is poor, about 30% to 40%. That increases to more than 70% for women diagnosed early, she notes, but currently just one-fifth of patients are diagnosed early.
The abdominal distension symptom, she concludes, warrants urgent attention.
Ovarian Cancer Symptoms: Advice
If a woman has abdominal distension, Hamilton suggests asking the doctor for a thorough examination, a transvaginal ultrasound, and a blood test for CA 125.
"The scan is very accurate, but CA 125 somewhat less so, in that the blood test misses some cancers," he says.
An estimated 21,550 women in the U.S. will learn they have ovarian cancer in 2009, according to the American Cancer Society. About 14,600 are expected to die from the disease.
Sunday, August 30, 2009
Friday, August 14, 2009
Breastfeeding May Cut Breast Cancer Risk
From WebMD Health News
Kathleen Doheny
August 13, 2009 — Women with a family history of breast cancer who have ever breastfed reduce their risk of getting premenopausal breast cancer by nearly 60%, according to a new study.
''For women with a family history of breast cancer, this suggests an extra benefit [of breastfeeding] is, it may reduce the risk of breast cancer," says Alison Stuebe, MD, an assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill, the lead author of the study. It is published in the Archives of Internal Medicine.
While previous studies have also suggested a link between breastfeeding and reduced breast cancer risk, results have been mixed, Stuebe writes. Studies in which women who already have breast cancer are asked about their breastfeeding history can be flawed by "recall bias," she says.
''Our goal was to collect information before the diagnosis and follow women," Stuebe tells WebMD.
Stuebe and her colleagues drew information from 60,075 women who were participants in the Nurses' Health Study II from 1997 to 2005 and had given birth.
The women answered questions about demographics, body measurements, and lifestyle factors every two years, and described their breastfeeding practices. They were asked about family history of breast cancer and if they had been diagnosed with invasive breast cancer.
By the end of the follow-up in June 2005, Stuebe's team found 608 cases of premenopausal invasive breast cancer, with 99% of the cases verified by medical records. The woman's average age at diagnosis was 46.
''Overall, in the whole group of women we studied, women who had breastfed were 25% less likely to develop premenopausal breast cancer than women who had never breastfed," says Stuebe, who conducted the research while at Brigham and Women's Hospital and Harvard Medical School in Boston.
Family History of Breast Cancer
When the researchers looked separately at the women without a family history and those with a family history of breast cancer (mother, sister, or grandmother), they found ''almost the entire effect could be accounted for by women with a family history," she tells WebMD.
Among those with a family history, those who had breastfed had a 59% reduced risk for premenopausal breast cancer compared to those who never breastfed. The breastfeeding did not have to be exclusive breastfeeding, without formula use.
To understand better the difference between the overall risk reduction and the reduction in those with a family history, Stuebe offers this analogy: Suppose the Los Angeles Lakers and a group of 5-year-olds had a free-throw contest. Overall, the group may have made, say, 60% of the free throws. But when you look separately at the successful free throws made by the basketball stars vs. those made by the kids, the results will undoubtedly be driven entirely by the Lakers.
The risk reduction for women with a family history of breast cancer who breastfeed, Stuebe says, is comparable to that found in high-risk women who take hormonal treatments such as tamoxifen.
''For women without a family history," she tells WebMD, ''it may be that their rates of breast cancer are so low we don't detect a difference or there may not be a protective association."
The protective effect began with three months of breastfeeding, she tells WebMD. That's three months total, she says, not just for a single child. So a mother may have breastfed two children for a month and a half each and gotten the benefit, for instance.
Second Opinion
''It is a huge reduction in risk," says Amanda Phipps, a pre-doctoral research associate at the Fred Hutchinson Cancer Research Center in Seattle, of the nearly 60% decreased risk in women who breastfeed and have a family history of breast cancer.
''I find it very interesting," says Phipps, who has researched the link, too. "But I think because it is a rather novel finding it would need to be replicated in the literature."
In a study published in Cancer last year, Phipps and her colleagues found that certain breast cancer types may be rarer among women who breastfeed their babies for at least six months.
The biology to explain the link is not yet clear, Phipps says.
Even so, she calls the association "exciting" because breastfeeding is an action women can take to reduce their breast cancer risk, while many other risk factors -- such as having a family history -- are not modifiable.
SOURCES:
Kathleen Doheny
August 13, 2009 — Women with a family history of breast cancer who have ever breastfed reduce their risk of getting premenopausal breast cancer by nearly 60%, according to a new study.
''For women with a family history of breast cancer, this suggests an extra benefit [of breastfeeding] is, it may reduce the risk of breast cancer," says Alison Stuebe, MD, an assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill, the lead author of the study. It is published in the Archives of Internal Medicine.
While previous studies have also suggested a link between breastfeeding and reduced breast cancer risk, results have been mixed, Stuebe writes. Studies in which women who already have breast cancer are asked about their breastfeeding history can be flawed by "recall bias," she says.
''Our goal was to collect information before the diagnosis and follow women," Stuebe tells WebMD.
Stuebe and her colleagues drew information from 60,075 women who were participants in the Nurses' Health Study II from 1997 to 2005 and had given birth.
The women answered questions about demographics, body measurements, and lifestyle factors every two years, and described their breastfeeding practices. They were asked about family history of breast cancer and if they had been diagnosed with invasive breast cancer.
By the end of the follow-up in June 2005, Stuebe's team found 608 cases of premenopausal invasive breast cancer, with 99% of the cases verified by medical records. The woman's average age at diagnosis was 46.
''Overall, in the whole group of women we studied, women who had breastfed were 25% less likely to develop premenopausal breast cancer than women who had never breastfed," says Stuebe, who conducted the research while at Brigham and Women's Hospital and Harvard Medical School in Boston.
Family History of Breast Cancer
When the researchers looked separately at the women without a family history and those with a family history of breast cancer (mother, sister, or grandmother), they found ''almost the entire effect could be accounted for by women with a family history," she tells WebMD.
Among those with a family history, those who had breastfed had a 59% reduced risk for premenopausal breast cancer compared to those who never breastfed. The breastfeeding did not have to be exclusive breastfeeding, without formula use.
To understand better the difference between the overall risk reduction and the reduction in those with a family history, Stuebe offers this analogy: Suppose the Los Angeles Lakers and a group of 5-year-olds had a free-throw contest. Overall, the group may have made, say, 60% of the free throws. But when you look separately at the successful free throws made by the basketball stars vs. those made by the kids, the results will undoubtedly be driven entirely by the Lakers.
The risk reduction for women with a family history of breast cancer who breastfeed, Stuebe says, is comparable to that found in high-risk women who take hormonal treatments such as tamoxifen.
''For women without a family history," she tells WebMD, ''it may be that their rates of breast cancer are so low we don't detect a difference or there may not be a protective association."
The protective effect began with three months of breastfeeding, she tells WebMD. That's three months total, she says, not just for a single child. So a mother may have breastfed two children for a month and a half each and gotten the benefit, for instance.
Second Opinion
''It is a huge reduction in risk," says Amanda Phipps, a pre-doctoral research associate at the Fred Hutchinson Cancer Research Center in Seattle, of the nearly 60% decreased risk in women who breastfeed and have a family history of breast cancer.
''I find it very interesting," says Phipps, who has researched the link, too. "But I think because it is a rather novel finding it would need to be replicated in the literature."
In a study published in Cancer last year, Phipps and her colleagues found that certain breast cancer types may be rarer among women who breastfeed their babies for at least six months.
The biology to explain the link is not yet clear, Phipps says.
Even so, she calls the association "exciting" because breastfeeding is an action women can take to reduce their breast cancer risk, while many other risk factors -- such as having a family history -- are not modifiable.
SOURCES:
Labor Induction at 37 Weeks Recommended for Women With Mild Hypertensive Disorders
From Medscape Medical News
Laurie Barclay, MD
August 11, 2009 — Pregnant women with mild hypertensive disorders should have labor induced once they complete 37 weeks of pregnancy, according to the results of a multicenter, parallel, open-label, randomized controlled trial reported online in the August 4 issue of The Lancet.
"Robust evidence to direct management of pregnant women with mild hypertensive disease at term is scarce," write Corine M. Koopmans, MD, from University Medical Centre Groningen in Groningen, the Netherlands, and colleagues from the HYPITAT study group (Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation). "We investigated whether induction of labour in women with a singleton pregnancy complicated by gestational hypertension or mild pre-eclampsia reduces severe maternal morbidity."
At 6 academic and 32 nonacademic hospitals in the Netherlands, patients with a singleton pregnancy at 36 to 41 weeks' gestation, and who had gestational hypertension or mild preeclampsia, were enrolled between October 2005 and March 2008. With use of block randomization with a Web-based application system, participants were assigned in a 1:1 ratio to induced labor or expectant monitoring. It was not possible to mask participants' assignments.
The main endpoint of the study was a composite measure of poor maternal outcome, including maternal mortality, maternal morbidity, progression to severe hypertension or proteinuria, and major postpartum hemorrhage (> 1000 mL of blood loss), with analysis by intent-to-treat and treatment effect presented as relative risk (RR). Maternal morbidity was defined as eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), pulmonary edema, thromboembolic disease, and placental abruption.
Of 756 patients randomized, 377 were assigned to receive labor induction and 379 to expectant monitoring. In addition, 397 patients authorized medical record review but refused randomization.
Poor maternal outcome occurred in 117 (31%) of women who were randomly assigned to induction of labor and in 166 (44%) of those randomly assigned to expectant monitoring (RR, 0.71; 95% confidence interval [CI], 0.59 - 0.86; P < .0001). There were no recorded cases of maternal or neonatal mortality or eclampsia.
Fewer cesarean deliveries were needed in the induction group vs the expectant monitoring group.
"Induction of labour is associated with improved maternal outcome," the study authors write. "We believe that induction of labour should be advised for women with gestational hypertension and a diastolic blood pressure of 95 mm Hg or higher or mild pre-eclampsia at a gestational age beyond 37 weeks."
Limitations of this study include absence of some useful data from the National Dutch Perinatal Registry.
"The results of our trial are important for both developed countries in which induction of labour in women with hypertensive disease beyond 36 weeks' gestation has been controversial, and for developing countries in which maternal morbidity and mortality rates are substantially increased," the study authors conclude. "Our finding that induction of labour was associated with a reduced risk of severe hypertension or HELLP syndrome and subsequent reduced need for caesarean section, emphasises the importance of frequent blood pressure monitoring during the concluding weeks of pregnancy."
In an accompanying comment, Donna D. Johnson, MD, from the Medical University of South Carolina in Charleston, notes that findings of this trial are even more clinically meaningful because less serious pregnancy outcomes were included. She recommends that overall management of maternal health be a primary goal of the obstetrician.
"In a subgroup analysis, composite maternal morbidity was not improved by induction of labour at this gestational age (36–37 weeks)," Dr. Johnson writes. "Although the study was not powered to detect differences at each gestational age, we should be hesitant to induce labour in women before 37 weeks of gestation for mild pre-eclampsia or gestational hypertension. By contrast, induction of labour at 37 weeks' gestation and beyond seems to improve obstetric outcomes in patients with gestational hypertension and pre-eclampsia, and this approach should be incorporated into clinical practice."
ZonMw, the Netherlands organization for health research and development, programme Doelmatigheidsonderzoek, supported this study. The study authors and Dr. Johnson have disclosed no relevant financial relationships.
Lancet. Published online August 4, 2009.
Laurie Barclay, MD
August 11, 2009 — Pregnant women with mild hypertensive disorders should have labor induced once they complete 37 weeks of pregnancy, according to the results of a multicenter, parallel, open-label, randomized controlled trial reported online in the August 4 issue of The Lancet.
"Robust evidence to direct management of pregnant women with mild hypertensive disease at term is scarce," write Corine M. Koopmans, MD, from University Medical Centre Groningen in Groningen, the Netherlands, and colleagues from the HYPITAT study group (Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation). "We investigated whether induction of labour in women with a singleton pregnancy complicated by gestational hypertension or mild pre-eclampsia reduces severe maternal morbidity."
At 6 academic and 32 nonacademic hospitals in the Netherlands, patients with a singleton pregnancy at 36 to 41 weeks' gestation, and who had gestational hypertension or mild preeclampsia, were enrolled between October 2005 and March 2008. With use of block randomization with a Web-based application system, participants were assigned in a 1:1 ratio to induced labor or expectant monitoring. It was not possible to mask participants' assignments.
The main endpoint of the study was a composite measure of poor maternal outcome, including maternal mortality, maternal morbidity, progression to severe hypertension or proteinuria, and major postpartum hemorrhage (> 1000 mL of blood loss), with analysis by intent-to-treat and treatment effect presented as relative risk (RR). Maternal morbidity was defined as eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), pulmonary edema, thromboembolic disease, and placental abruption.
Of 756 patients randomized, 377 were assigned to receive labor induction and 379 to expectant monitoring. In addition, 397 patients authorized medical record review but refused randomization.
Poor maternal outcome occurred in 117 (31%) of women who were randomly assigned to induction of labor and in 166 (44%) of those randomly assigned to expectant monitoring (RR, 0.71; 95% confidence interval [CI], 0.59 - 0.86; P < .0001). There were no recorded cases of maternal or neonatal mortality or eclampsia.
Fewer cesarean deliveries were needed in the induction group vs the expectant monitoring group.
"Induction of labour is associated with improved maternal outcome," the study authors write. "We believe that induction of labour should be advised for women with gestational hypertension and a diastolic blood pressure of 95 mm Hg or higher or mild pre-eclampsia at a gestational age beyond 37 weeks."
Limitations of this study include absence of some useful data from the National Dutch Perinatal Registry.
"The results of our trial are important for both developed countries in which induction of labour in women with hypertensive disease beyond 36 weeks' gestation has been controversial, and for developing countries in which maternal morbidity and mortality rates are substantially increased," the study authors conclude. "Our finding that induction of labour was associated with a reduced risk of severe hypertension or HELLP syndrome and subsequent reduced need for caesarean section, emphasises the importance of frequent blood pressure monitoring during the concluding weeks of pregnancy."
In an accompanying comment, Donna D. Johnson, MD, from the Medical University of South Carolina in Charleston, notes that findings of this trial are even more clinically meaningful because less serious pregnancy outcomes were included. She recommends that overall management of maternal health be a primary goal of the obstetrician.
"In a subgroup analysis, composite maternal morbidity was not improved by induction of labour at this gestational age (36–37 weeks)," Dr. Johnson writes. "Although the study was not powered to detect differences at each gestational age, we should be hesitant to induce labour in women before 37 weeks of gestation for mild pre-eclampsia or gestational hypertension. By contrast, induction of labour at 37 weeks' gestation and beyond seems to improve obstetric outcomes in patients with gestational hypertension and pre-eclampsia, and this approach should be incorporated into clinical practice."
ZonMw, the Netherlands organization for health research and development, programme Doelmatigheidsonderzoek, supported this study. The study authors and Dr. Johnson have disclosed no relevant financial relationships.
Lancet. Published online August 4, 2009.
Saturday, August 8, 2009
Paternal Depressive Symptoms During Pregnancy May Predict Excessive Infant Crying
From Medscape Medical News
Laurie Barclay, MD
Charles P. Vega, MD, FAAFP
July 10, 2009 — Paternal depressive symptoms during pregnancy may predict excessive infant crying, according to the results of a prospective, population-based study reported in the July issue of Pediatrics.
"Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse," write Mijke P. van den Berg, MD, PhD, MA, from Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues. "From previous research it is known that maternal depression is related to excessive crying, but so far little is known about the influence of paternal depression."
The Brief Symptom Inventory was used to collect data regarding maternal and paternal depressive symptoms at 20 weeks of pregnancy, and associations between these symptoms and excessive crying were evaluated in 4426 infants at age 2 months. Excessive crying was defined with Wessel's criteria of crying more than 3 hours per day for more than 3 days in the previous week.
The risk of excessive infant crying was 1.29 higher per SD of paternal depressive symptoms (95% confidence interval, 1.09 -1.52) after adjusting for maternal depressive symptoms and other pertinent confounding factors.
"Our findings indicate that paternal depressive symptoms during pregnancy might be a risk factor for excessive infant crying," the study authors write. "This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress."
Limitations of this study include possible false paternity, reliance on a questionnaire for collecting data on crying behavior, embedding of this study within a larger prospective study, and the possibility that parents with depressive symptoms might report differently on crying behavior.
"Although our findings are subject to some limitations and need to be replicated, they emphasize the importance of taking paternal factors into account when studying early infant behavior such as excessive crying," the study authors conclude.
The Netherlands Organization for Health Research and Development supported this study. The study authors have disclosed no relevant financial relationships.
Pediatrics. 2009;124:e96-e103.
Laurie Barclay, MD
Charles P. Vega, MD, FAAFP
July 10, 2009 — Paternal depressive symptoms during pregnancy may predict excessive infant crying, according to the results of a prospective, population-based study reported in the July issue of Pediatrics.
"Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse," write Mijke P. van den Berg, MD, PhD, MA, from Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues. "From previous research it is known that maternal depression is related to excessive crying, but so far little is known about the influence of paternal depression."
The Brief Symptom Inventory was used to collect data regarding maternal and paternal depressive symptoms at 20 weeks of pregnancy, and associations between these symptoms and excessive crying were evaluated in 4426 infants at age 2 months. Excessive crying was defined with Wessel's criteria of crying more than 3 hours per day for more than 3 days in the previous week.
The risk of excessive infant crying was 1.29 higher per SD of paternal depressive symptoms (95% confidence interval, 1.09 -1.52) after adjusting for maternal depressive symptoms and other pertinent confounding factors.
"Our findings indicate that paternal depressive symptoms during pregnancy might be a risk factor for excessive infant crying," the study authors write. "This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress."
Limitations of this study include possible false paternity, reliance on a questionnaire for collecting data on crying behavior, embedding of this study within a larger prospective study, and the possibility that parents with depressive symptoms might report differently on crying behavior.
"Although our findings are subject to some limitations and need to be replicated, they emphasize the importance of taking paternal factors into account when studying early infant behavior such as excessive crying," the study authors conclude.
The Netherlands Organization for Health Research and Development supported this study. The study authors have disclosed no relevant financial relationships.
Pediatrics. 2009;124:e96-e103.
Low Oxygen Best for Resuscitation of Preterm Neonates
From Reuters Health Information
NEW YORK (Reuters Health) Aug 03 - Using 30% rather than 90% oxygen to resuscitate extremely low gestational age neonates results in less oxidative stress, inflammation, and chronic lung disease, new research shows.
Because the body's antioxidant system does not develop until late in gestation, preterm infants are at risk for adverse effects from hyperoxia. Prior research had established that preterm neonates could achieve target oxygen saturation values when resuscitated with 30% oxygen, but whether this approach offered any advantages over standard protocols involving higher oxygen levels was unclear.
Dr. Maximo Vento, from University Hospital La Fe, Valencia, Spain, and colleagues took up this topic by assessing the outcomes of 78 preterm neonates who were randomized to resuscitation with 30% or 90% oxygen. The target oxygen saturation values were 75% at 5 minutes and 85% at 10 minutes.
All of the subjects were extremely low gestational age neonates, defined as a gestational age at birth of no more than 28 weeks, according to the report in the September issue of Pediatrics.
Oxidative stress was evaluated by measuring the oxidized glutathione/reduced glutathione ratio in the blood and by measuring various urinary markers of stress. Inflammation was assessed by measuring plasma levels of interleukin-8 and tumor necrosis factor-alpha.
With use of 30% instead of 90% oxygen, the number of required days of supplemental oxygen fell from 22 to 6 and the number of days of mechanical ventilation dropped from 27 to 13. The rate of bronchopulmonary dysplasia at discharge was also lower in the 30% oxygen group: 15.4% vs. 31.7%.
Both the glutathione ratios and the levels of urinary markers indicated less oxidative stress in the 30% oxygen group. Similarly, the 30% oxygen group had less inflammation, as indicated by lower levels of interleukin-8 and tumor necrosis factor-alpha.
Based on the findings, the authors conclude that extremely low gestational age neonates should be resuscitated with oxygen levels not exceeding 30%.
Further studies, however, are needed with adequate statistical power to determine if use of lower oxygen levels really helps prevent bronchopulmonary dysplasia, they add.
Pediatrics 2009;124:e1-e10.
NEW YORK (Reuters Health) Aug 03 - Using 30% rather than 90% oxygen to resuscitate extremely low gestational age neonates results in less oxidative stress, inflammation, and chronic lung disease, new research shows.
Because the body's antioxidant system does not develop until late in gestation, preterm infants are at risk for adverse effects from hyperoxia. Prior research had established that preterm neonates could achieve target oxygen saturation values when resuscitated with 30% oxygen, but whether this approach offered any advantages over standard protocols involving higher oxygen levels was unclear.
Dr. Maximo Vento, from University Hospital La Fe, Valencia, Spain, and colleagues took up this topic by assessing the outcomes of 78 preterm neonates who were randomized to resuscitation with 30% or 90% oxygen. The target oxygen saturation values were 75% at 5 minutes and 85% at 10 minutes.
All of the subjects were extremely low gestational age neonates, defined as a gestational age at birth of no more than 28 weeks, according to the report in the September issue of Pediatrics.
Oxidative stress was evaluated by measuring the oxidized glutathione/reduced glutathione ratio in the blood and by measuring various urinary markers of stress. Inflammation was assessed by measuring plasma levels of interleukin-8 and tumor necrosis factor-alpha.
With use of 30% instead of 90% oxygen, the number of required days of supplemental oxygen fell from 22 to 6 and the number of days of mechanical ventilation dropped from 27 to 13. The rate of bronchopulmonary dysplasia at discharge was also lower in the 30% oxygen group: 15.4% vs. 31.7%.
Both the glutathione ratios and the levels of urinary markers indicated less oxidative stress in the 30% oxygen group. Similarly, the 30% oxygen group had less inflammation, as indicated by lower levels of interleukin-8 and tumor necrosis factor-alpha.
Based on the findings, the authors conclude that extremely low gestational age neonates should be resuscitated with oxygen levels not exceeding 30%.
Further studies, however, are needed with adequate statistical power to determine if use of lower oxygen levels really helps prevent bronchopulmonary dysplasia, they add.
Pediatrics 2009;124:e1-e10.
Prebiotic Use Beneficial in Formula-Fed Newborns
From Reuters Health Information
NEW YORK (Reuters Health) Aug 05 - Supplementation with prebiotic oligosaccharides is well tolerated and produces short-term beneficial effects in full-term, formula-fed neonates, according to a new study.
"Prebiotic oligosaccharides are short-chain carbohydrates with a degree of polymerization between 2 and 60 and are nondigestible by human or animal digestive systems," Dr. Shripada Rao, of the University of Western Australia, Perth, and colleagues explain in the August issue of the Archives of Pediatric and Adolescent Medicine. The carbohydrates' key feature is their ability to selectively promote the growth of bifidobacteria and lactobacilli in the colon.
Human milk contains prebiotics and, therefore, breastfed infants typically receive adequate amounts to stimulate gut flora. Formula-fed infants, by contrast, may be deficient in prebiotics and might benefit from supplementation.
The researchers searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL databases and proceedings of relevant conferences. Trials comparing formula milk supplementation, with or without prebiotics, that commenced no later than age 28 days and continued for at least 2 weeks were eligible for inclusion.
Main outcome measures included stool colony counts of bifidobacteria, lactobacilli, and pathogens; pH; consistency; frequency; anthropometry; and symptoms of intolerance.
Of 24 identified trials, 11 were eligible for inclusion (n = 1459). Six trials showed significant increases in bifidobacteria after prebiotic supplementation. Two studies demonstrated a trend toward increases in bifidobacteria counts.
Meta-analysis results show a significant reduction in stool pH in the prebiotic-supplemented group. Infants who received the prebiotic supplementation also had softer and more frequent stools, similar to those of breastfed infants. Lastly, the supplementation group had slightly better weight gain than controls.
Of eight trials that reported on tolerance, all but one reported that prebiotic supplementation was well tolerated. One study found that infants who received prebiotic supplementation had more frequent diarrhea (18% vs. 4%), irritability (16% vs. 4%), and eczema (18% vs. 7%) compared to control subjects.
"Colonization of intestines with healthy bacteria early in the newborn period has the theoretical potential to confer long-term health benefits; but it is too early to recommend their supplementation routinely for formula fed infants," Dr. Rao told Reuters Health by email. "Rigorously conducted randomized controlled trials focusing on long-term outcome are necessary to find out if this improved colonization results in long-term health benefits."
Arch Pediatr Adolesc Med 2009;163:755-764.
NEW YORK (Reuters Health) Aug 05 - Supplementation with prebiotic oligosaccharides is well tolerated and produces short-term beneficial effects in full-term, formula-fed neonates, according to a new study.
"Prebiotic oligosaccharides are short-chain carbohydrates with a degree of polymerization between 2 and 60 and are nondigestible by human or animal digestive systems," Dr. Shripada Rao, of the University of Western Australia, Perth, and colleagues explain in the August issue of the Archives of Pediatric and Adolescent Medicine. The carbohydrates' key feature is their ability to selectively promote the growth of bifidobacteria and lactobacilli in the colon.
Human milk contains prebiotics and, therefore, breastfed infants typically receive adequate amounts to stimulate gut flora. Formula-fed infants, by contrast, may be deficient in prebiotics and might benefit from supplementation.
The researchers searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL databases and proceedings of relevant conferences. Trials comparing formula milk supplementation, with or without prebiotics, that commenced no later than age 28 days and continued for at least 2 weeks were eligible for inclusion.
Main outcome measures included stool colony counts of bifidobacteria, lactobacilli, and pathogens; pH; consistency; frequency; anthropometry; and symptoms of intolerance.
Of 24 identified trials, 11 were eligible for inclusion (n = 1459). Six trials showed significant increases in bifidobacteria after prebiotic supplementation. Two studies demonstrated a trend toward increases in bifidobacteria counts.
Meta-analysis results show a significant reduction in stool pH in the prebiotic-supplemented group. Infants who received the prebiotic supplementation also had softer and more frequent stools, similar to those of breastfed infants. Lastly, the supplementation group had slightly better weight gain than controls.
Of eight trials that reported on tolerance, all but one reported that prebiotic supplementation was well tolerated. One study found that infants who received prebiotic supplementation had more frequent diarrhea (18% vs. 4%), irritability (16% vs. 4%), and eczema (18% vs. 7%) compared to control subjects.
"Colonization of intestines with healthy bacteria early in the newborn period has the theoretical potential to confer long-term health benefits; but it is too early to recommend their supplementation routinely for formula fed infants," Dr. Rao told Reuters Health by email. "Rigorously conducted randomized controlled trials focusing on long-term outcome are necessary to find out if this improved colonization results in long-term health benefits."
Arch Pediatr Adolesc Med 2009;163:755-764.
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