Neonatal Research

A great quote from Robin Ince, who was asked to sit on a panel entitled ‘Is science the new religion?’

‘The answer to “is science the new religion?” is obviously yes, so long as you redefine religion as “a self-correcting, evidence based system of exploring the universe which attempts to unearth the least wrong laws and theories that can explain what exists or might exist whilst accepting that room must always be left for doubt and further enquiry”.’

The rest of his post is thoughtful and thought-provoking also, especially to those of us who have to deal with parents of patients, and acquaintances, who claim to have researched an issue when what they really mean is they googled it.

Richard Lehman’s journal review this week is ironic and biting as usual, with some great links. His evaluation of the poor science underlying all the calls to reduce salt intake (and his links to various papers evaluating the evidence in detail) is comforting for someone who sprinkles sodium liberally on a lot of cooking.

My favorite science writer on the internet is Ed Yong, his blog ‘not exactly rocket science‘ is a treasure trove, and his ‘missing links’ section points out, every week or so, other excellent science writing. He manages to explain things to non-specialists without dumbing down (at least only enough for a non-specialist to understand). A great new post from him, about the Monarch Butterfly I found fascinating. We have Monarchs in Quebec of course, and our Monarchs migrate 4000 kilometers to overwinter in the mountains of Mexico. Its an amazing journey for such a fragile creature, even more amazing that no one butterfly makes the whole journey, they reproduce en route and the next generation is able to complete the journey.

I have updated the page with the list of publications from our group since 2003. We are now up to 280! Keep it up colleagues.

I have also updated the ‘recent presentations’ page with the ppt files that I used in my 2 recent talks in Atlanta.

For years we have heard about the mediterranean diet and the anomalous finding that despite relatively high dietary fat intake the people living in Greece, Italy, Southern France (in particular) have very low frequency of vascular disease. This has been ascribed to the particular characteristics of the ‘mediterranean diet’ with its high intake of olive oil, especially extra-virgin olive oil, which is rich in polyphenols and monounsaturated fat, and mixed nuts which are rich in polyphenols, monounsaturated fat, and polyunsaturated fat, including alpha-linolenic acid.

A recently published article in the PNEJM actually performed the first big prospective randomized trial of primary prevention of vascular disease in high risk men and women, over 55 for men, over 60 for women, with other risk factors or type 2 diabetes. The intervention was dietary advice to eat a mediterranean diet with extra extra-virgin olive oil (1 litre a week!) or extra mixed nuts (30 g a day).

They stopped the trial early as there were much more composite endpoints (myocardial infarction, stroke or cardiovascular death) in the controls.

The diet included advice to use extra-virgin olive oil as the only dietary oil (including for cooking) and at least 7 glasses of wine a week.

I think I am part way there….

Annie keeps telling me I should write something about Maggie. I can do no better than to redirect anyone who wants a more honest evaluation of her legacy than all the hagiography in the press over the last few days to this article http://www.salon.com/2013/04/09/the_woman_who_wrecked_great_britain/.

I will quote one sentence ‘Margaret Thatcher was a zealot, a friend to the worst mass murderers of the 1980s, a force for antisocial cruelty, and her violent means of ending the great British experiment in social democracy made the country a more brutal, less equal country’. Farewell Maggie.

A report from Mount Sinai hospital in Toronto of an innovative program to integrate parents much more into the day to day care of babies in the NICU. (O’Brien K, Bracht M, Macdonell K, McBride T, Robson K, O’Leary L, Christie K, Galarza M, Dicky T, Levin A et al: A pilot cohort analytic study of family integrated care in a canadian neonatal intensive care unit. BMC Pregnancy and Childbirth 2013, 13(Suppl 1):S12.) Free access to full text.This is a pilot study performed as a prospective case-control design. Babies who were no longer ventilated, but could be stable on CPAP, and had more than 50% of their feeds enterally were eligible if a parent was available to spend at least 8 hours a day in the NICU.

There was a fairly intensive educational intervention, and the parents took over a lot of the things that are currently usually done by the nurses, for 8 hours a day between the hours of 7 am and 8 pm.

‘Parents were also expected to provide care for their infant(s), especially in the areas of feeding, bathing, dressing, holding, and providing skin-to-skin care, perform basic charting, and maintain a record of their own learning regarding their proficiency in providing care for their infant(s) in the NICU. Nurses remained responsible for more technical aspects of the infant’s care, such as insertion of nasogastric catheters, placement of CPAP prongs, oral suctioning, and adjustment of oxygen concentrations.’

The primary outcome of this pilot was to a measure of growth, the change in the z score between enrollment and 21 days. It was a little better in the Family Integrated Care Infants, but not significantly. Among the other outcomes they examined, there were many more mothers breastfeeding at discharge, and perhaps fewer nosocomial infections, less retinopathy and fewer reports of adverse incidents.

Now this isn’t the most rigorous design, but I think it was appropriate for this pilot project, and it certainly suggests that integrating families more into the care of their babies may have substantial benefits on short term outcomes.

I asked Katharina Staub, a parent representative who is founder and president of the Canadian Premature Babies Foundation to comment:

As a parent of premature twins born at 27 weeks in 2008, I can only applaud this type of approach to the care of premature infants.

Having spoken to one of the mothers who participated in this initial study, it was clear that her participation in the study made for a very positive experience in the NICU. Her anxiety was reduced because of her extensive involvement in the daily care of her baby.

For parents it is empowering to be supported by the staff in the training of how to take care of your baby in the NICU. It gives you confidence to be part of the healing of their child.

What most parents view as normal with a full term child, the act of parenting, feeding, caring for the infant is not so easy in the NICU. This type of care gives a great basis for bonding with your child. It will be interesting to see the results of the Canada wide study that has started in 16 centres.

Katharina Staub Canadian Premature Babies Foundation.

This is a great TEDx talk from a girl from Kenya who…. well read the description on the Guardian page and watch the talk. Very inspiring tale, (after the nauseating start).