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Emergency Medicine, Pediatrics, Pregnancy, Stanford News

Helping families navigate the NICU

Helping families navigate the NICU

Packard preemieEarly this morning, the baby girl that’s been growing inside me for 33 weeks decided to have a dance party in my belly. Not great timing, but it’s always a nice reminder to know she’s getting stronger every day and will soon be more than a pre-dawn percussionist in our lives. One of my biggest fears – as it is for many expecting parents – has been what might happen if I went into early labor or if something unexpected turns up when she’s born and she has to stay in the Neonatal Intensive Care Unit.

Those days, waiting for a baby to be well enough to come home from the NICU can be exhausting and confusing. And there’s often a lot to learn about the health issues many preemies suffer. So a new program at Stanford’s Lucile Packard Children’s Hospital, which admits 1,500 babies each year, aims to make that time a little less overwhelming.

The NICU Family Support Program was started last year and represents a new partnership between the hospital and the March of Dimes. The program is available at several hospitals nationwide and helps 90,000 families every year. Families gain access to print and online versions of educational materials to help them understand their babies’ health issues and treatments. A recent feature story describes the program’s holistic approach:

“We work very hard to take care of the whole family and not just the baby,” [hospital president Christopher] Dawes said in announcing the new partnership with the March of Dimes. “This program increases parents’ confidence and gives NICU staff the tools they need to support families and babies.”

. . .

“When you have a premature baby, you have to learn a whole new language. You are so inundated with terms, it’s easy to get mixed up,” said [mother of twin preemies Heather] Keller. “The March of Dimes website and written materials are a great reference that families can use throughout their journey. It’s accurate and written in a language that’s easy for families to understand, but is not complicated or condescending.”

In addition to the materials, the program offers iPads to NICU families, providing them with easy access to the March of Dimes materials and website without having to leave their babies’ bedsides.

The NICU Family Support Program is designed to help families become more involved in the care their young children receive. It’s an approach that can alleviate some of the burden parents of NICU patients feel at what is otherwise a harrowing time in their lives.

Previously: The year in the life of a preemie – and his parents, NICU trauma intervention shown to benefit mothers of preemies, Using the iPad to connect ill newborns, parents, Special care to protect newborns’ fragile brains and The emotional struggles of parents of preemies
Photo, of a Packard Children’s patient and his mom, by Doug Peck

Health and Fitness, Parenting, Pediatrics, Pregnancy, Public Health

Exercising during pregnancy may reduce children’s risk of hypertension

Exercising during pregnancy may reduce children's risk of hypertension

7619293834_c18e2bee15_zRegular physical activity during pregnancy has been shown to benefit both mom and baby: Past studies found that exercise can help expectant mothers manage weight gain, sleep better, improve circulation and reduce swelling or leg cramps and increase their endurance in preparation for childbirth. A growing body of evidence also suggests that maternal exercise can boost babies’ brain development and influence a child’s health into adulthood.

Now findings (subscription required) published in the Journal of Sports Medicine and Physical Fitness show that by exercising, moms may reduce their children’s risk of developing high blood pressure, or hypertension. The Michigan State University researchers say their findings are significant because earlier studies have shown babies with low birth weight are more likely to have poor cardiovascular health and an increased risk of hypertension. PsychCentral reports:

[Researchers] initially evaluated 51 women over a five-year period based on physical activity such as running or walking throughout pregnancy and post-pregnancy.

In a follow up to the study, they found that regular exercise in a subset of these women, particularly during the third trimester, was associated with lower blood pressure in their children.

“This told us that exercise during critical developmental periods may have more of a direct effect on the baby,” [said lead author James Pivarnik, PhD].

The finding was evident when his research team also discovered that the children whose mothers exercised at recommended or higher levels of activity displayed significantly lower systolic blood pressures at eight to 10 years old.

“This is a good thing as it suggests that the regular exercise habits of the mother are good for heart health later in a child’s life,” Pivarnik said.

Previously: Extreme pregnancy: A look at exercise and expectant moms, Could exercise before and during early pregnancy lower risk of pre-eclampsia?, Are women getting the message about the benefits of exercising during pregnancy? and Pregnant and on the move: The importance of exercise for moms-to-be
Photo by Nathan Rupert

Parenting, Pediatrics, Pregnancy, Technology, Women's Health

Stanford alumni aim to redesign the breast pump

Stanford alumni aim to redesign the breast pump

2014-11-21 15.02.36

Three Stanford graduates have an idea that could dramatically impact the daily life of active breastfeeding women: They plan to design and build a breast pump that is discreet, intuitive, and supportive of mothers. This may sound obvious, but nothing like it currently exists. In August of this year, Cara Delzer, MBA; Gabrielle Guthrie, MFA; and Santhi Analytis, PhD, founded Moxxly, “a consumer products company designing for women.” They’re in the final stretch of their 16-week incubation with Highway 1, which helps hardware startups move from a concept to a prototype ready for production.

“We’ve talked to women, hundreds of women, who have told us things like ‘pumping makes me feel like a cow,'” shares Delzer, Moxxly’s CEO, who I interviewed in late November. So she and her colleagues are aiming to re-imagine the pumping experience.

Delzer experienced the current, poorly-imagined pumps firsthand after the recent birth of her child: “I just remember watching my husband take piece after piece out of the pump box for the first time thinking, how in the world am I going to put this together? All those pieces, and clean them? I was already overwhelmed as a new mom, but completely overwhelmed by the pump.” Once she went back to work, she found that she was spending 25 percent of her day dealing with the logistics of pumping – mentally integrating it into her schedule, worrying about having all the parts. The experience is similar for many of today’s busy, mobile moms.

Meanwhile, Guthrie was at Stanford developing her passion for designing for women, Delzer recounts. “A lot of things that have been designed for women and girls in the past have followed this ‘shrink it and pink it’ trope where you literally make it smaller and bright pink and think, ‘Oh, now the girls will buy it.’ Well, Gabrielle doesn’t buy it.” For her masters’ thesis, Guthrie interviewed working moms, and the breast pump kept coming up as something that needed to be redesigned. She spent much of her last year at Stanford working on just that. At a hackathon, she and Analytis worked together to put the new designs into practice, and Analytis, whose PhD is in mechanical engineering, was hooked on solving this problem as well.

The three women “got together, looked one another in the eyes and said, ‘Do we believe this is a problem? Do we believe we can solve it? Do we believe the time is now?’ And it was yes, yes, yes,” said Delzer. They took on the challenge despite the fact that the breast pump is an FDA-regulated medical device and they will face a lengthy review process. They invented the name “Moxxly” with the intent of conveying spunkiness and strength, and incorporated XX to signify women.

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Global Health, Pregnancy, Stanford News, Women's Health

Stanford undergrad uncovers importance of traditional midwives in India

Stanford undergrad uncovers importance of traditional midwives in India

IMG_0348Lara Mitra grew up taking regular vacations with her family in her ancestral home, the state of Gujarat in India, but those short trips barely prepared her for her first long-term stay. She says the 10 weeks she spent studying maternal delivery practices were eye opening in many ways. The work she did while there made a big enough impact that it landed her on a list of 15 impressive Stanford students featured in Business Insider last month.

During the summer between her sophomore and junior years, in 2012, Mitra secured a human rights summer fellowship through the Stanford McCoy Family Center for Ethics in Society. She worked with the Self-Employed Womens Association (SEWA), a large non-profit organization in India that helps women become economically self-sufficient, but also gathers other information about the well-being of women in the country. Mitra worked with SEWA officials to design a study looking at how often women in Gujarati villages used hospitals to deliver their newborns instead of delivering at home. Most home deliveries are carried out with the help of a dai, a village local who acts as a midwife but usually doesn’t have formal training.

Maternal mortality rates in India are still alarmingly high, so government agencies have started incentive programs such as offering free ambulance service to and from hospitals for laboring mothers and paying mothers to deliver in a hospital instead of at home, and pays dais to bring laboring mothers to hospitals. In light of all these incentives, it was unclear how often women were still delivering at home. And if they weren’t, Mitra says the question was “Are these dais, these midwife figures still useful? Is there still a job for them?” Mitra was excited to be doing the critical research and says, “It was the first time I wasn’t working in someone else’s lab and designed my own study.”

She found that women were in fact taking advantage of the government programs and delivering more often in hospitals, but the dais still played a critical role. In some situations, such as emergency deliveries, dias stepped in and delivered the children before mother and child were taken to the hospital for examination. Also, unlike in Western countries, husbands don’t play as intimate a role in the delivery, so the dai served as “birth coach” at the hospital, too. Dais also helped with prenatal and post-delivery care. Out of 70 women Mitra interviewed in 15 villages surrounding the Gujarati city of Ahmedabad, 69 said dais still served a useful role.

“More significantly, the trust women had in the dai couldn’t be replicated in doctors,” says Mitra. “Dais were part of a support system for women. The dai would do informal check-ups, and could tell if a C-section would be necessary.”

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Global Health, Immunology, Pregnancy, Public Health, Stanford News, Technology

Stanford-developed smart phone blood-testing device wins international award

Stanford-developed smart phone blood-testing device wins international award

When I worked as an epidemiologist, one of my jobs was with a program that prevented perinatal hepatitis B infections. That’s when a woman with a chronic hepatitis B infection passes it on to her baby. Babies are more likely than almost any other group to develop chronic infections that can cause them years of health problems and will most likely cut their lives short.

In the U.S., most states have comprehensive testing programs to detect pregnant women with infections and strict protocols that require delivery hospitals to treat babies born to them with vaccination and antibodies to prevent infection with the virus. But a program like this requires a huge administrative and laboratory investment – and in many poverty-stricken parts of the world, this simply isn’t possible. In fact, in California, the vast majority of cases identified by the prenatal testing program are women who were born outside the United States, including many from Asia.

So when I heard the recent news that a team of four Stanford graduate students had won the Nokia Sensing XCHALLENGE, an international competition to for diagnostic devices, for a mobile test that could detect hepatitis B infections, I was pretty impressed and curious about how it could be implemented in those places. The competition is run by XPrize, the same group that has run several competitions for space exploration, and others for super-fuel efficient vehicles and ocean clean-up efforts.

The mobile version of the winning test was one of five awarded top prizes among 90 entrants. It was developed by engineering PhD candidates Daniel Bechstein, Jung-Rok Lee, Joohong Choi and Adi W. Gani, building on work previously done by Stanford professor of materials science and engineering Shan Wang, PhD, and Stanford immunologist  Paul Utz, MD. The device works because magnetic nanoparticles are grafted onto two biological markers: the hepatitis B virus and the antibody that our bodies make in response to the virus. Current tests for hepatitis B requires a full laboratory facility. A Stanford press release describes the device:

The students used a diagnostic strip that takes a finger prick of blood. The patient’s blood flows into a tiny chamber where it mixes with magnetic nanoparticles to form magnetically tagged biomarkers.

The test strip is inserted into a small magnetic detector… The smartphone is plugged into the detector, and its microprocessor helps to perform the test. It takes only a few minutes.

If the test finds the hepatitis B antigen in the blood, the patient is infected and needs treatment. For a newborn with an infected mother, the child needs both vaccination and antibody therapy.

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Pregnancy, Research, Stanford News, Women's Health

Stanford/VA study finds link between PTSD and premature birth

Stanford/VA study finds link between PTSD and premature birth

pregnant-silhouetteScientists have long suspected that post-traumatic stress disorder raises a pregnant woman’s risk of giving birth prematurely. Now, new research from Stanford and the U.S. Department of Veterans’ Affairs confirms these suspicions.

Women with “active” PTSD, diagnosed in the year before they gave birth, were 35 percent more likely than those without PTSD to spontaneously go into labor early and deliver a premature baby, the study found. Women whose PTSD had been diagnosed further in the past were not at increased risk, however.

The findings, published today in Obstetrics & Gynecology, are based on data from 16,344 births to female veterans. All of the women had been screened for PTSD. The researchers found that 3,049 babies were born to women diagnosed with the disorder at some point prior to delivery, and of these, 1,921 births were to women who had active PTSD.

“This study gives us a convincing epidemiological basis to say that, yes, PTSD is a risk factor for preterm delivery,” the study’s senior author, Ciaran Phibbs, PhD, associate professor of pediatrics and an investigator at the March of Dimes Prematurity Research Center at Stanford University, said in a press release. “Mothers with PTSD should be treated as having high-risk pregnancies.”

The VA has already adopted Phibbs’ recommendation for their patients and is now including a recent PTSD diagnosis among the factors that flag a woman’s pregnancy as high-risk. But the findings aren’t just for veterans, Phibbs told me. “The prevalence of PTSD is higher among veterans, but it’s still reasonably common in the general population,” he said. Nor was the PTSD-prematurity link limited to women with combat experience, he said. Half of the women in the study who had PTSD diagnoses had never been deployed.

Spontaneous premature labor, the focus of this study, accounts for about half of premature births. Phibbs’ team is now investigating the other half of preterm births: They are examining whether PTSD also influences a mother’s risk of developing medical conditions that could cause her physician to recommend an early delivery for the sake of the mother’s or baby’s health.

Previously: Maternal obesity linked to earliest premature births, says Stanford studyThe year in the life of a preemie – and his parents and How Stanford researchers are working to understand the complexities of preterm birth
Photo by Stefan Pasch

Immunology, Infectious Disease, Pregnancy, Research, Women's Health

Study: Pregnancy causes surprising changes in how the immune system responds to the flu

Study: Pregnancy causes surprising changes in how the immune system responds to the flu

pregnant ladyWhen pregnant women get influenza, they tend to get really sick. Flu complications such as pneumonia are more common in pregnant women than other healthy young adults, and their risk of death from flu is higher, too.

Until now, doctors have ascribed the problem to the fact that the immune system is tamped down by pregnancy, a protective mechanism that keeps the woman’s body from rejecting her fetus. But a new Stanford study, the first ever to directly examine how a pregnant woman’s immune cells respond to flu viruses, found something unexpected: Instead of responding sluggishly, immune cells from pregnant women actually over-react to the flu. From our press release about the paper, which appears today in the Proceedings of the National Academy of Sciences:

“We were surprised by the overall finding,” said Catherine Blish, MD, PhD, assistant professor of infectious diseases and the study’s senior author. “We now understand that severe influenza in pregnancy is a hyperinflammatory disease rather than a state of immunodeficiency. This means that treatment of flu in pregnancy might have more to do with modulating the immune response than worrying about viral replication.”

In the lab, Blish’s team incubated immune cells obtained from pregnant and nonpregnant women’s blood samples with different strains of flu virus, including the H1N1 flu that caused the 2009 pandemic and also a less virulent strain of seasonal influenza. The responses they observed could help explain why flu, especially pandemic H1N1 flu, causes pneumonia in many pregnant patients:

Pregnancy enhanced the immune response to H1N1 of two types of white blood cells: natural killer and T cells. Compared with the same cells from nonpregnant women, H1N1 caused pregnant women’s NK and T cells to produce more cytokines and chemokines, molecules that help attract other immune cells to the site of an infection.

“If the chemokine levels are too high, that can bring in too many immune cells,” Blish said. “That’s a bad thing in a lung where you need air space.”

Why would influenza break the rules of how the immune system works in pregnancy? Blish thinks there’s a clue in the fact that the flu produces a fourfold increase in an expectant woman’s risk of delivering her baby prematurely. “I wonder if this is an inflammatory pathway that is normally activated later in pregnancy to prepare the body for birth, but that flu happens to overlap with the pathway and aberrantly activates it too early,” she said.

The research is a good reminder that flu season is just around the corner, and it’s time to start thinking about getting a flu shot, especially if you are pregnant or planning a pregnancy.

Previously: Text message reminders shown effective in boosting flu shot rates in pregnant women, Ask Stanford Med: Answers to your questions about seasonal influenza and Flu shots for moms may help prevent babies from being born too small
Photo by Meagan

Patient Care, Pediatrics, Pregnancy, Stanford News, Women's Health

A prenatal partnership that benefits patients, medical students

A prenatal partnership that benefits patients, medical students

prenatal partnership

Over on the Lucile Packard Children’s Hospital Stanford blog, writer Julie Greicius highlights an elective program at Stanford’s medical school that fosters personal connections between prenatal patients and Stanford medical students. The course is designed to offer doctors-in-training the opportunity, early on, to be on the other side of patient care. Emily Ballenger, who’s expecting twins later this month, and medical student Sunny Kummar have partnered up through the program, with Sunny offering extra support by attending prenatal appointments, the babies’ birth, and the first few pediatric appointments.

Relationship building is fundamental to patient-centered care, and with this program the doctor-to-be has the opportunity to identify with the patient experience in his or her supportive role. Without the pressures of being in the medical provider role, the student has the opportunity to practice listening, empathy and compassion.

The value of programs such as this is that they shift the paradigm of the traditional-doctor patient relationship. The scale is tipped from being purely clinical to one focused more on listening and learning from each other. The patient, the doctor-in-training, and their future patients all stand to benefit.

Ballenger’s obstetrician is Susan Crowe, MD, who has long supported the program. “I encourage my patients to participate because it’s a win for future care of obstetric and pediatric patients,” she says in the piece. “I really believe that the patient-centered care we strive for can be better achieved if we train our physicians to really learn from and listen to our patients themselves. One of the biggest strengths of the program is that the patient perspective comes first. It sets the groundwork for that way of thinking in terms of training our medical students.”

Medical schools around the country offer similar programs, recognizing that it’s the human connection that initially draws young doctors to medicine, and Stanford has offered this program since at least 1991. The course directors are Yasser El Sayed, MD, obstetrician-in-chief at Stanford Children’s Health, and Janelle Aby, MD, clinical associate professor of pediatrics.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Countdown to clinics: The 5 best things about jumping into third year
Photo courtesy of Lucile Packard Children’s Hospital

Parenting, Pediatrics, Pregnancy

Losing Jules: Breaking the silence around stillbirth

My birthday is coming, and I’m dreading it. I can’t celebrate; I’d like to go to bed and wake up twenty-four hours later. It’s not because I’m a year older. It’s because it’s the anniversary of the death of my second child, Jules.

My experience is nothing unique. Death anniversaries haunt most people: the anniversary of the death of a parent; the anniversary of a friend’s suicide, the day a father or husband died in battle. My nightmare began on the morning of my birthday, three years ago. I was beginning my 38th week of pregnancy, and I felt great. All signs pointed to a normal, healthy baby. I woke up early the morning of July 30 and my water broke. With great excitement, I grabbed my overnight bag and headed to the hospital with my husband and my (then) 4 1/2 year old son, Miles.

Although I’m not religious, I baptized Jules with my tears and told him how much I loved him. Then I did the hardest thing I’ve ever had to do in my life: I put him down, and I left.

We checked into the obstetric intake bay, and the nurse began to hook me up to a fetal monitor. She couldn’t get it to work and remarked that it must be malfunctioning. She brought in another monitor, and she couldn’t pick up the baby’s heartbeat on that one either. Then she brought in an MD with an ultrasound. I looked at the image of my beautiful son on the screen. There was no pulsing heart in his rib cage. He was dead.

I went into the kind of shock that people describe as “a bad movie.” Everything slowed down and became tunnel-like. I felt removed from the situation, almost observing the scene from a distance as the staff wheeled me to a room at the end of the maternity ward to deliver my stillborn child. I remember the rose a nurse placed on the outside of the door to mark that this room was different. She closed the door when the sounds of newborns drifted down the hall to my room. She was extremely compassionate and held me through some of my labor pains. I asked for Pitocin to speed the birth, and Jules was born quickly. His death was ruled a cord accident.

Jules was so beautiful, so perfect and so still that at first I was afraid to hold him. The staff wrapped him in a hospital blanket and put him in the baby gurney. A pediatrician came to give him a newborn exam with a mix of horror and grief on his face. Cautiously, I picked Jules up and held him and rocked him for a very long time. I desperately didn’t want to leave him there, and I desperately wanted to hold my living son, Miles, who was at a friend’s house. Although I’m not religious, I baptized Jules with my tears and told him how much I loved him. Then I did the hardest thing I’ve ever had to do in my life: I put him down, and I left.

My husband and I went through a special kind of hell in the weeks and months that followed. My milk came in, and I had to bind my swollen breasts and ice them for days. I couldn’t sleep, and when I did, I had nightmares. Worst of all, we had to explain to our son Miles that baby Jules was not coming home from the hospital. Sweet Miles began our healing when he thought about this for a few moments, and said, “So, Jules is now a twinkle in Papa’s eye.”

The community wrapped its arms around our family. Our house filled with flowers, and we had more food than we knew what to do with. What surprised me the most was how many women reached out to me to share their own stories of stillbirth. In the first 24 hours after we got home, our neighbors came over to talk to us about their baby dying in-utero near term. Over the course of the next few months, I spoke to many women who had lost babies, mainly by stillbirth, but not exclusively. I had no idea that in this age of medical advancement 1 in every 167 babies in the United States is stillborn (.pdf). Just over half a percent (.6 percent) doesn’t sound like a lot – until it’s you. Statistically, this has probably happened to someone you know, but they probably don’t talk about it. I know of three people – either in my circle or once removed – who have had stillbirths since mine.

I describe the initial weeks after Jules’ death in military terms: It felt like our family took a direct hit. Over time, I became skilled in answering people when they asked, “So, how’s your baby?” Those questions lasted for a year and a half. I sought counseling with health professionals who had experienced stillbirth or infant death. I’m not Jewish, but I went to talk to a Rabbi. She helped me to understand a beautiful philosophy: that we owe it to the dead to try and live well and fully. I’m still here, and I shouldn’t squander my time. It’s not always easy, especially when someone asks, “So, you have just the one?” But I work hard to live well and fully every day, especially on the anniversary of what would have been a joint birthday for Jules and me.

Polly Stryker works as a producer and editor at KQED Radio, an NPR affiliate in San Francisco, where she lives with her family. She is writing a book called “Losing Jules” for her son, Miles.

Previously: A call to “break the silence of stillbirth”
Image of Jules’ footprints in featured entry box courtesy of Polly Stryker

Medicine and Society, Pregnancy, Research

Study offers clue as to why parents of daughters are more likely to divorce

Study offers clue as to why parents of daughters are more likely to divorce

poppy2Here’s something that caught my attention this morning (likely because I’m the mom of two girls): A new study provides a possible reason behind reports that parents with firstborn daughters are more likely to divorce than those with firstborn sons. According to researchers from Duke and University of Wisconsin-Madison, it could be due to girls being “hardier than boys, even in the womb.”

A recent university release further explains:

Throughout the life course, girls and women are generally hardier than boys and men. At every age from birth to age 100, boys and men die in greater proportions than girls and women. Epidemiological evidence also suggests that the female survival advantage actually begins in utero. These more robust female embryos may be better able to withstand stresses to pregnancy, the new paper argues, including stresses caused by relationship conflict.

Based on an analysis of longitudinal data from a nationally representative sample of U.S. residents from 1979 to 2010, Hamoudi and Nobles say a couple’s level of relationship conflict predicts their likelihood of subsequent divorce.

Strikingly, the authors also found that a couple’s level of relationship conflict at a given time also predicted the sex of children born to that couple at later points in time. Women who reported higher levels of marital conflict were more likely in subsequent years to give birth to girls, rather than boys.

“Girls may well be surviving stressful pregnancies that boys can’t survive,” Hamoudi said. “Thus girls are more likely than boys to be born into marriages that were already strained.”

The intriguing findings appear in the journal Demography.

Image courtesy of Michelle Brandt

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