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Hip Dysplasia In Newborns

1:30 to read

Developmental Hip Dysplasia (DDH) occurs in 1 in 1000 births.  In a normal hip the upper end (ball) of the femur (thigh bone) fits firmly into the hip socket.   DDH refers to different abnormalities of the hip noted in infancy when the hip joint has not formed normally. This may   range from a mildly unstable hip in an infant to an infant that is born with a completely dislocated hip.   DDH is screened for from the time an infant is born until they are walking, in hopes of picking up any abnormality at a young age. 

 

The majority of babies with DDH are female (75%), and it is also more common in infants who are in the breech (butt down) position during the 3rd trimester of a woman’s pregnancy.  Other risk factors for DDH include: a family history of DDH and improper swaddling of an infant. 

 

You may notice that your pediatrician examines your baby’s hips at every visit.  They will perform the Ortolani maneuver and the Barlow test where the doctor is trying to see if they can feel a dislocated or unstable hip. In these tests they are actually putting pressure on the hip to check for a “click or clunk” which suggests a hip problem or instability.

 

For female babies who have been breech it is recommended that they not only have a physical exam checking for DDH, but that they also undergo an ultrasound of the hips after 6 weeks of age and prior to 6 months.  Ultrasound for male babies who have been breech is not “routinely recommended” but may be ordered if the baby has any signs of hip instability.

 

The incidence of hip instability and dysplasia seems to have also increased since parents began routinely swaddling their babies. It is now recommended that babies sleep in a sack rather than having them swaddled with their legs extended. For the hips to develop normally a baby needs to be able to move their legs around which will drive the femur into the hip socket, so that the socket gets deeper. A shallow, flat hip socket may lead to hip dysplasia.

 

In most cases that are detected early the treatment is a brace called a Pavlik harness that will hold the femur into position within the hip socket. A baby stays in the harness for 6-12 weeks in order that the hip joint will develop normally. For babies that may develop hip dysplasia after 6 months of age an orthopedist will probably recommend closed reduction to put the hip back into place. This is done under anesthesia and then the baby is placed in a cast that also pushes the femur into the hip socket.  The baby may have to wear this cast for 4 - 5 months. 

 

Every time your pediatrician takes off your baby’s diaper during their exam it is not really about a diaper change. That hip exam is really important!

 

Your Baby

Does Your Unborn Baby Hear You?

2.00 to read

More than twenty years ago I remember reading that fetuses can learn to recognize their mothers and father’s voices and then respond to those voices as newborns. I thought… well maybe… but it seemed to me that voices from outside of the womb would sound muffled from inside. Of course, I don’t remember my in utero experience so I don’t really know how words sound.

Over the years though, scientists have continued to examine how and what babies learn before they are born.

A recent study by researchers at the University of Helsinki in Finland have determined that fetuses not only hear and recognize voices but they can become familiar with different words and different pitches used when saying those words.

The study involved 33 moms-to-be, and examined their babies after birth. While pregnant, 17 mothers listened at a loud volume to a CD with (2), four-minute sequences of the made-up words “tatata” or “tatota.” The words were said with several different pitches. The moms-to-be listened to the recordings beginning at 29 weeks of pregnancy -about 7 months along- until birth. They heard them around 50 to 71 times.

Following birth, researchers tested the babies for normal hearing and then performed an electroencephalograph (EEG) brain scan to see if the newborns would respond to the made-up words and different pitches. And sure enough, the brain scans showed increased activity from the babies who had been listening to the CD in utero when the words were played to them after birth. Not only did they respond to the words, but also seemed to recognize the different pitches used when they heard them.  

The babies born to the mothers who had not listened to the CDs while pregnant showed little reaction to the words or pitches.

 “We have known that fetuses can learn certain sounds from their environment during pregnancy,” Eino Partanen, a doctoral student and lead author on the paper, said via email.

“We can now very easily assess the effects of fetal learning on a very detailed level—like in our study, [we] look at the learning effects to very small changes in the middle of a word.”

Some experts believe the finding shows that not only can a third-trimester fetus hear and recognize voices; he or she can also detect subtle changes and process complex information.

“Interestingly, this prenatal exposure also helped the newborns to detect changes which they were not exposed to: the infants who have received additional prenatal stimulation could also detect loudness changes in pseudo words but the unexposed infants could not,” Partanen says.

“However, both groups did have responses to vowel changes (which are very common in Finnish, and which newborns have been many time previously been shown to be capable of).”

You may be wondering why is it even important that scientists know if fetuses can recognize voices or words.  Partanen says because sounds heard in utero may shape the developing human brain in ways that affect speech and language development after birth.

“The better we know how the fetus’ brain works, the more we’ll know about early development of language,” Partanen says. “If we know better how language develops very early, we may one day be able to develop very early interventions [for babies with abnormal development].” 

An abstract for the Finnish study is published on the Proceedings of the National Academy of Sciences website.

Does talking and singing to your baby before it’s born actually stimulate his or her brain activity and increase language learning? Some experts say definitely yes, others say it has no impact. But really, most moms and dads enjoy baby bump bonding whether it’s productive or not. And who knows, maybe your pre-born hears you loud and clear. 

Source: Meghan Holohan, http://www.nbcnews.com/health/unborn-babies-are-hearing-you-loud-clear-8C11005474

Your Baby

“Revolutionary” Newborn Has 3 Parents

1:45

There’s been a first in the use of in vitro fertilization (IVF) to help parents avoid passing on a fatal rare disease to their baby.

In what many medical experts are calling a “revolutionary” medical event, a baby with DNA from three donors has been born.

As first reported in New Scientist, a science and technology magazine published in the U.K., the baby boy was born on April 6, 2016 and doctors say he appears healthy. His parents were treated by U.S. fertility specialists in Mexico, where there are no laws prohibiting such methods. His mother carries a genetic mutation for Leigh syndrome, a rare neurological disorder that usually becomes apparent in the first year of life and is generally fatal.

The newborn’s mother had suffered four miscarriages and had two children who died from Leigh syndrome, one at age six and one at eight months. It’s a devastating disease for parents and children. Symptoms of Leigh disease usually progress rapidly and lead to generalized weakness, a lack of muscle tone and a buildup of lactic acid in the body, which can cause respiratory and kidney problems. Children rarely live more than six or seven years.

While the mother herself is healthy, a gene for the disease resides in her DNA, in the mitochondria that powers cells. In this mother’s case, about 25 percent of her mitochondria reportedly carries the disease-causing mutation.

In order to avoid transferring the disease, the couple sought help from Dr. John Zhang, a reproductive endocrinologist at New Hope Fertility Center in New York City. 

“This mitochondrial disease is usually a very devastating situation for the babies and the family,” Zhang told CBS News.

The controversial procedure involved using the three-parent IVF technique to ensure that the disease mutation would not be passed along to the baby. So far, it seems to have worked.

The procedure, called spindle nuclear transfer, involves removing the healthy nucleus from one of the mother’s eggs and transferring it to a donor-egg, which had, had its nucleus removed. The resulting egg – with nuclear DNA from the mother and mitochondrial DNA from a donor – was then fertilized with the father’s sperm. 

The resulting embryo contained genetic material from three parents – the mother, the egg donor, and the father.

According to New Scientist, the scientists in this case created five embryos using the technique. Only one developed normally and that embryo was implanted in the mother.

The baby has not shown any signs of developing the illness, Zhang said. His mitochondria have been tested and less than one percent carries the mutation, believed to be too low a level to lead to disease.

The controversial fertility method is not legal in the United States. Zhang told New Scientist that they conducted the procedure in Mexico because “there are no rules” there.

The procedure received widespread media attention when lawmakers in the U.K. became the first to approve its use last year.

Sian Harding, a medical professor and bioethics adviser who reviewed the ethics of the technique in the U.K., told New Scientist the case seems to have been handled according to ethical standards.

“It’s as good as or better than what we’ll do in the U.K.,” said Harding.

Much of the controversy surrounding this procedure involves safety and religious concerns.

Harding notes that this is not the first time multiple DNA has been used to try and create a healthy baby. “Last time embryologists tried to create a baby using DNA from three people was in the 1990s, when they injected mitochondrial DNA from a donor into another woman’s egg, along with sperm from her partner. Some of the babies went on to develop genetic disorders, and the technique was banned. The problem may have arisen from the babies having mitochondria from two sources.”

In Britain, where the procedure allowing DNA from three parents was approved in February 2015, leaders disagreed heatedly on the issue while it was up for debate in the House of Commons, with some raising concerns about “designer babies” and “playing God.” Leading churches in Britain – both Protestant and Catholic – opposed the procedure on religious and ethical grounds.

Medical and moral concerns about this IVF method are most likely going to continue as experts look for ways to refine the controversial procedure.

But for one couple, being able to cradle their newborn - that shows no sign of carrying the deadly Leigh disease - will forever be a precious gift. 

Story source: Mary Brophy Marcus, http://www.cbsnews.com/news/first-3-parent-dna-baby-born-rare-disease/

 

Parenting

Pregnancy May Actually Modify a Mom’s Brain

Baby, motherhood, health

Moms often feel like they have a “sixth sense” when it comes to their newborn’s needs and survival. What they may really be experiencing are the physical changes that pregnancy can have on the brain.

Researchers in Spain wanted to know if pregnancy could actually change the structure of a woman’s brain, impacting how she reacts to her newborn. What they found was that long-term changes to the brain do occur and that they may have evolved over time to improve a mother’s ability to protect and nurture her child.

The researchers used information gathered from MRI scans that compared the brain structures of 25 women before and after their first pregnancies.

After giving birth, the women had significant reductions of gray matter in areas of the brain associated with social interactions, the findings showed. Those brain regions overlapped with ones that activated when mothers watched images of their own babies.

“The changes concern brain areas associated with functions necessary to manage the challenges of motherhood," study co-lead author Erika Barba said in a news release from the Autonomous University of Barcelona.

Some women feel like they have trouble remembering things during and after their pregnancy, sometimes referred to as having “baby brain.” The good news is that researchers reported the participants had no changes in memory or other thinking functions during pregnancy. That means the loss of gray matter does not lead to problems in those areas. The brain changes, which lasted for at least two years after the women gave birth, probably help them adapt to motherhood, the study authors suggested.

According to study co-director Oscar Vilarroya: "The findings point to an adaptive process related to the benefits of better detecting the needs of the child, such as identifying the newborn's emotional state. Moreover, they provide primary clues regarding the neural basis of motherhood, perinatal mental health and brain plasticity in general."

Researchers also found that they were able to use the brain changes to predict a mother’s attachment to her baby. The changes were similar whether women got pregnant naturally or through fertility treatments.

This is the first research to show that pregnancy involves long-lasting changes -- at least for two years postpartum.

The term “mama bear” has often been used to describe the fierceness that some mothers’ exhibit when they feel their child is in danger or has been wronged. Now science may have found out why that is.

The study was published in the journal Nature Neuroscience.

Story source: Robert Preidt, http://www.webmd.com/baby/news/20161219/pregnancy-may-spur-mothering-changes-in-a-womans-brain

Your Baby

FDA Approves Newborn Screening Tests for 4 Rare Disorders

1:45

Depending on which state you live in, your newborn may be screened for a series of harmful or potentially fatal disorders when he or she is born.

With a simple blood test, doctors are often able to detect whether a newborn has certain unseen conditions that may cause problems later in life. Although these conditions are rare and most babies are given a clean bill of health, early diagnosis and proper treatment sometimes can make the difference between lifelong impairment and healthy development.

The U.S. Food and Drug Administration (FDA) recently permitted marketing of the “Seeker System,” for the screening of four rare inherited metabolic disorders. It is the first newborn screening test permitted for marketing by the FDA, for these disorders. The conditions are: Mucopolysaccharidosis Type 1 (MPS 1), Pompe, Gaucher and Fabry disease.

All of these disorders are inherited and involve deficiencies of different metabolic enzymes.  

The disorders occur in as few as 1 in 185,000 births, or as many as 1 in 1,500 births, depending on the disease, the agency said. The conditions collectively, are called Lysosomal Storage Disorders (LSDs), and can lead to organ damage and death if not treated in a timely way, the FDA added.

“The Secretary of HHS [U.S. Department of Health and Human Services] recently added Pompe and MPS I to the list of routine recommended newborn screening programs and it is anticipated that additional states will begin requiring use of screening tests to detect these disorders,” said Alberto Gutierrez, Ph.D., director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. “Accurate screening tests will help with early detection, treatment and control of these rare disorders in newborns, before permanent damage occurs. That’s why availability of LSD screening methods that have been assessed for accuracy and reliability by the FDA are so important.”

Some states now require screening of these disorders, the FDA said, including Arizona, Illinois, Kentucky, Michigan, Missouri, New Jersey, New Mexico, New York, Ohio, Pennsylvania and Tennessee.

The newly approved tests require blood samples collected from the prick of a newborn's heel within 48 hours of birth. The agency said it reviewed data from a clinical study of more than 154,000 infants in Missouri. The system identified at least one of the four disorders in 73 of the screened newborns, the agency said.

While some parents may be aware that they could be a carrier of a particular disease, many are not. Also, parents that have adopted an infant may not have a complete family medical history. Infant screenings can help bring parents peace of mind about their baby’s health or give them an early start on treatment for their child.

Story sources: HealthDay,  https://medicalxpress.com/news/2017-02-newborn-screening.html

http://kidshealth.org/en/parents/newborn-screening-tests.html

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm539893.htm

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