http://www.merckmedicus.com/conference-reports/10/ESPGHAN-Irish-scientists-have-identified-a-novel-milk-derived-component-that-may-help-resolve-cow-s-milk-protein-allergy?
presented at the Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition
Irish scientists have identified a novel milk-derived component that can specifically suppress secretion of IL-4 by differentiated Th2 cells. The presence of such a component in hypoallergenic infant formula may act to suppress the over-activated Th2 response associated with allergy and find usefulness in enhancing resolution of cow’s milk protein allergy. Researchers at the Immunomodulation Group, Dublin City University, and colleagues presented their paper at ESPGHAN, held in May in Amsterdam.
In Europe, 20% to 30% of infants are diagnosed with an atopic disease. The majority of first atopic responses are directed towards food proteins that are observed during the first months of life, such as cows milk protein. Cows milk protein allergy (CMPA) affects 2.2% to 7.5% of infants worldwide and is a growing public health problem in Western Europe and the USA. Existing hypoallergenic formula solutions adopt avoidance strategies such as the extensive hydrolysis of whey or casein proteins (using proteolytic bacteria or enzymes). However, allergic responses are associated with a dominant T helper type 2 (Th2) response, which plays a key role in triggering IgE production by B cells. The aim of the Irish study was to assess whether novel milk-derived component can suppress Th2 responses which may enhance resolution of CMPA and lower the risk of developing a further allergy.
Murine spleenocytes were isolated from the spleens of 8-14 week old BALB/c mice and purified for CD4+ T-cells using magnetic negative isolation. After extensive cell activation and differention, The novel milk-derived component was added during T helper cell differentiation. Th1 and Th2 subsets were confirmed using ELISA analysis of cytokine production after 3 days. The novel milk-derived component specifically suppressed the secretion of IL-4 from differentiated Th2 cells in a dose dependent manner. A regenerated form of the novel milk-derived component also had the same effect. Interestingly, the novel component had no effect on Th1 cells and the level of secretion of IFNγ was not affected by the presence of the component. This suggests that the component specifically suppresses Th2 responses.
Tuesday, May 12, 2015
Sunday, May 10, 2015
Oh Mother!
Oh mother of mine
How can I describe you in a line
For you are so divine
And makes us feel always on cloud nine
Whenever our lethargy makes you whine
For you made us so with your intoxicating love wine
With your affection you entwine
With devotion that you combine
Our character you refine
You seek pleasure when we shine
We are always blessed in mother’s shrine
Pradeep Alur.
Monday, April 6, 2015
Brain imaging in cooled encephalopatic neonates does not differ between four and 11 days after birth
http://onlinelibrary.wiley.com/doi/10.1111/apa.13016/abstract;jsessionid=2C705A58BFCBA24FA7668F6E33B7183C.f02t02
Aim
The optimal timing of magnetic resonance imaging (MRI) in encephalopathic infants treated with hypothermia is unknown and this study examined whether early scans differed from later scans.
Methods
We assessed paired MRI scans carried out on 41 cooled encephalopathic infants at a median of four and 11 days using two scoring systems: the Rutherford injury scores for the basal ganglia and thalami (BGT), white matter and the posterior limb of the internal capsule and the Bonifacio injury scores for the BGT and watershed area.
Results
Both systems produced consistent injury severity scores in 37/41 infants on both days, with Rutherford scores predicting poor outcome in six early scans and seven later scans (Kappa 0.91) and Bonifacio doing the same in seven and nine scans (Kappa 0.85). A white matter/watershed score of two or a BGT score of one indicated severe changes by day 11 in three infants but lower scores did not.
Conclusion
MRI scans indicated that the Rutherford and Bonifacio systems produced similar scores in 37/41 cooled encephalopathic infants at a median of four and 11 days. Infants with an early white matter/watershed scores of two or a BGT score of one may worsen and should be rescanned.
Aim
The optimal timing of magnetic resonance imaging (MRI) in encephalopathic infants treated with hypothermia is unknown and this study examined whether early scans differed from later scans.
Methods
We assessed paired MRI scans carried out on 41 cooled encephalopathic infants at a median of four and 11 days using two scoring systems: the Rutherford injury scores for the basal ganglia and thalami (BGT), white matter and the posterior limb of the internal capsule and the Bonifacio injury scores for the BGT and watershed area.
Results
Both systems produced consistent injury severity scores in 37/41 infants on both days, with Rutherford scores predicting poor outcome in six early scans and seven later scans (Kappa 0.91) and Bonifacio doing the same in seven and nine scans (Kappa 0.85). A white matter/watershed score of two or a BGT score of one indicated severe changes by day 11 in three infants but lower scores did not.
Conclusion
MRI scans indicated that the Rutherford and Bonifacio systems produced similar scores in 37/41 cooled encephalopathic infants at a median of four and 11 days. Infants with an early white matter/watershed scores of two or a BGT score of one may worsen and should be rescanned.
Thursday, March 12, 2015
Picc Lines in Lower Limbs-Do They Increase Thrombotic Risk?
http://www.jpedsurg.org/article/S0022-3468(15)00123-2/abstract?rss=yes
Background
PICC lines are now used routinely to provide central access for neonatal intensive care unit (NICU) patients. Neonates are known to be at risk for venous thromboembolism (VTE) related to central catheters. No literature exists about VTE PICC-related morbidity in the NICU abdominal surgery subgroup.
Methods
With REB approval, a retrospective review of a NICU database of PICC insertions performed at a tertiary children's hospital was conducted (January 2010–June 2013). Information about PICCs and complications was recorded. For patients with a major thrombotic complication, charts were reviewed. A major thrombotic complication was defined as a thrombosis which required medical and/or surgical intervention.
Results
692 PICCs were inserted (485 in the upper extremity, 142 in the lower extremity, and 65 in the scalp). Seventy-four patients had significant intraabdominal pathology, and 5 had a major thrombotic complication. All patients with a major thrombotic complication had a lower extremity PICC which was at or below L1 (L1-S1) running parenteral nutrition.
Conclusions
In the current study, only neonates with abdominal pathology and a lower extremity insertion site suffered major thrombotic complications from PICC lines. Given all patients' PICC tips were below the recommended location, more rigorous surveillance (with repositioning if required) may avoid these complications for future patients.
Monday, January 12, 2015
Wednesday, January 7, 2015
http://www.engadget.com/2015/01/07/babybe-brings-premature-children-closer-to-their-mothers/
BabyBe is using Intel's connected device platform Edison to actually better the lives of people, specifically premature babies and their mothers.
The most important component is the "Cradle" a pad embedded with air bladders and heating elements, sheathed in a medically-safe polyurethane.
It's soft and a little odd feeling. It's supposed to mimic the density and texture of human skin, but kind of ends up falling into uncanny valley territory. The air-sacks inside mimic the heartbeat and chest movement of the mother, who can't hold her fragile premature child.
Tuesday, January 6, 2015
Fish Oil For Parenteral Nutrition Associated Cholestasis.
http://jn.nutrition.org/content/early/2014/12/17/jn.114.204974.abstract
Parenteral Fish Oil–Containing Lipid Emulsions May Reverse Parenteral Nutrition–Associated Cholestasis in Neonates: A Systematic Review and Meta-Analysis
Hye Won Park3, Na Mi Lee5, Ji Hee Kim6,Kyo Sun Kim3, and Soo-Nyung Kim4,*
Abstract
Background: Growing evidence indicates that fish oil–containing lipid emulsions have a beneficial effect on parenteral nutrition–associated cholestasis (PNAC) in adults; however, data are limited in neonates to confirm the effect of fish oil on PNAC.
Objective: We conducted a meta-analysis of studies that addressed the effect of fish oil–containing lipid emulsions on reversing and preventing PNAC.
Methods: We searched MEDLINE, the EMBASE database, and the Cochrane Library for this systematic review and meta-analysis. The methodologic assessment of studies was performed with Jadad scale and the Newcastle-Ottawa Scale. Comprehensive Met-Analysis version 2.0 was used for the statistical analysis. We performed a meta-analysis with the primary outcomes of reversal of PNAC and the occurrence of PNAC in newborn infants, including preterm infants, after parenteral administration of fish oil–containing lipid emulsions.
Results: Of the 36 studies identified, 7 fulfilled the inclusion criteria and were used in this meta-analysis, including 3 studies with 93 participants in which reversal of PNAC was an outcome and 4 studies with 1012 participants on preventing PNAC. The use of fish oil–containing lipid emulsions was more likely to reverse PNAC (OR: 6.14; 95% CI: 2.27, 16.6; P < 0.01), but the use of fish oil–containing lipid emulsions did not have a significant effect on the development of PNAC (OR: 0.56; 95% CI: 0.28, 1.10; P = 0.09) compared with soybean-based or olive oil–based lipid emulsions.
Conclusions: The pooled data suggest that the use of fish oil–containing lipid emulsions is effective for reversing PNAC but cannot prevent PNAC in neonates who require prolonged parenteral nutritional support.
Parenteral Fish Oil–Containing Lipid Emulsions May Reverse Parenteral Nutrition–Associated Cholestasis in Neonates: A Systematic Review and Meta-Analysis
Hye Won Park3, Na Mi Lee5, Ji Hee Kim6,Kyo Sun Kim3, and Soo-Nyung Kim4,*
Abstract
Background: Growing evidence indicates that fish oil–containing lipid emulsions have a beneficial effect on parenteral nutrition–associated cholestasis (PNAC) in adults; however, data are limited in neonates to confirm the effect of fish oil on PNAC.
Objective: We conducted a meta-analysis of studies that addressed the effect of fish oil–containing lipid emulsions on reversing and preventing PNAC.
Methods: We searched MEDLINE, the EMBASE database, and the Cochrane Library for this systematic review and meta-analysis. The methodologic assessment of studies was performed with Jadad scale and the Newcastle-Ottawa Scale. Comprehensive Met-Analysis version 2.0 was used for the statistical analysis. We performed a meta-analysis with the primary outcomes of reversal of PNAC and the occurrence of PNAC in newborn infants, including preterm infants, after parenteral administration of fish oil–containing lipid emulsions.
Results: Of the 36 studies identified, 7 fulfilled the inclusion criteria and were used in this meta-analysis, including 3 studies with 93 participants in which reversal of PNAC was an outcome and 4 studies with 1012 participants on preventing PNAC. The use of fish oil–containing lipid emulsions was more likely to reverse PNAC (OR: 6.14; 95% CI: 2.27, 16.6; P < 0.01), but the use of fish oil–containing lipid emulsions did not have a significant effect on the development of PNAC (OR: 0.56; 95% CI: 0.28, 1.10; P = 0.09) compared with soybean-based or olive oil–based lipid emulsions.
Conclusions: The pooled data suggest that the use of fish oil–containing lipid emulsions is effective for reversing PNAC but cannot prevent PNAC in neonates who require prolonged parenteral nutritional support.
Thursday, January 1, 2015
A Happy New Year
We wish you in this great New Year
That you will live without Fear
With your near and dear.
And that you
Will have a lot to Cheer
Holding your root Beer
And may this year steer
Your career to a high Gear
And free you from eerie Peer
Who
Appear to be a pain in your Rear
May for your spouse Dear
You develop a patient Ear
And
May for your child you become a sincere financier
So
They could explore many a new Frontier
And thus
Your fame spread around the Sphere
And your
Name be known for a light Year.
Pradeep Dear.
Sunday, December 21, 2014
Correlation Between Serum Caffeine Levels And Outcomes in Preterm Infants.
http://www.nature.com/jp/journal/vaop/ncurrent/full/jp2014226a.html
Serum caffeine concentrations and short-term outcomes in premature infants of 29 weeks of gestation
P Alur, V Bollampalli, T Bell, N Hussain and J Liss
Abstract
Objective:
Caffeine is effective in the treatment of apnea of prematurity but it is not well known if the therapeutic concentration of the drug has an impact on other neonatal outcomes such as chronic lung disease (CLD). The aim of this study was to determine if there is an association between caffeine concentrations and the incidence of CLD in premature infants of 29 weeks of gestation.
Study design:
A retrospective chart review of all the infants born 29 weeks of gestation from 2007 to 2011, who survived until discharge or 36 weeks postmenstrual age, was conducted. Caffeine concentrations were obtained weekly on infants getting the drug. Average caffeine concentrations (ACCs) were determined for the duration of caffeine therapy and correlated with CLD, length of stay (LOS), oxygen at discharge (OD), duration of ventilation (DV) and total charges for hospitalization for each patient.
Results:
Of the 222 eligible infants, 198 met the inclusion criteria. ACC for infants without CLD was 17.0±3.8 μg ml−1 compared with infants with CLD 14.3±6.1 μg ml−1 (P<0.001). Infants receiving high ACC (>14.5 μg ml−1) had lower incidence of patent ductus arteriosus, lesser number of days on ventilator and oxygen, lesser need for diuretics, lower incidence of CLD, were more likely to go home without supplemental OD and had lower LOS and lower total hospital charges (all differences were significant P<0.05) Multiple logistic regression modeling after adjusting for confounding variables indicated that higher caffeine concentrations were significantly associated with decrease in CLD. Receiver operating curve analysis confirmed a significant predictive ability of caffeine concentration for CLD with a cutoff concentration of 14.5 μg ml−1 (sensitivity of 42.6 and specificity of 86.8). The AUC (area under the curve) for the prediction of CLD was 0.632 (95% confidence interval 0.56–0.69, P=0.009). Conclusions:
Caffeine concentrations >14.5 μg ml−1 were strongly correlated with reduced CLD in infants born at 29 weeks of gestation. Higher caffeine concentrations were associated with decreased total hospital charges, DV, OD and LOS. Additional randomized trials are needed to confirm these findings, to identify ideal serum concentrations and determine possible long-term neurologic benefits.
Serum caffeine concentrations and short-term outcomes in premature infants of 29 weeks of gestation
P Alur, V Bollampalli, T Bell, N Hussain and J Liss
Abstract
Objective:
Caffeine is effective in the treatment of apnea of prematurity but it is not well known if the therapeutic concentration of the drug has an impact on other neonatal outcomes such as chronic lung disease (CLD). The aim of this study was to determine if there is an association between caffeine concentrations and the incidence of CLD in premature infants of 29 weeks of gestation.
Study design:
A retrospective chart review of all the infants born 29 weeks of gestation from 2007 to 2011, who survived until discharge or 36 weeks postmenstrual age, was conducted. Caffeine concentrations were obtained weekly on infants getting the drug. Average caffeine concentrations (ACCs) were determined for the duration of caffeine therapy and correlated with CLD, length of stay (LOS), oxygen at discharge (OD), duration of ventilation (DV) and total charges for hospitalization for each patient.
Results:
Of the 222 eligible infants, 198 met the inclusion criteria. ACC for infants without CLD was 17.0±3.8 μg ml−1 compared with infants with CLD 14.3±6.1 μg ml−1 (P<0.001). Infants receiving high ACC (>14.5 μg ml−1) had lower incidence of patent ductus arteriosus, lesser number of days on ventilator and oxygen, lesser need for diuretics, lower incidence of CLD, were more likely to go home without supplemental OD and had lower LOS and lower total hospital charges (all differences were significant P<0.05) Multiple logistic regression modeling after adjusting for confounding variables indicated that higher caffeine concentrations were significantly associated with decrease in CLD. Receiver operating curve analysis confirmed a significant predictive ability of caffeine concentration for CLD with a cutoff concentration of 14.5 μg ml−1 (sensitivity of 42.6 and specificity of 86.8). The AUC (area under the curve) for the prediction of CLD was 0.632 (95% confidence interval 0.56–0.69, P=0.009). Conclusions:
Caffeine concentrations >14.5 μg ml−1 were strongly correlated with reduced CLD in infants born at 29 weeks of gestation. Higher caffeine concentrations were associated with decreased total hospital charges, DV, OD and LOS. Additional randomized trials are needed to confirm these findings, to identify ideal serum concentrations and determine possible long-term neurologic benefits.
Thursday, December 4, 2014
Umbilical Cord Milking-Evidence in Preterm Infants
http://archpedi.jamanetwork.com/article.aspx?articleID=1919654#Abstract
JAMA Pediatr. 2014 Nov 3. doi: 10.1001/jamapediatrics.2014.1906. [Epub ahead of print]
Efficacy and Safety of Umbilical Cord Milking at Birth: A Systematic Review and Meta-analysis.
Al-Wassia H1, Shah PS2.
Author information
1Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
2Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
Importance:
Umbilical cord milking (UCM) is suggested to improve neonatal outcomes.
Objectives:
To perform a systematic review and meta-analysis of the efficacy and safety of UCM in full-term and preterm neonates.
Data Sources:
A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database, and the reference list of retrieved articles from 1940 to 2014.
Study Selection:
Randomized clinical trials comparing UCM with other strategies of handling the umbilical cord at birth in full-term and preterm infants. Seven of the 18 initially identified studies were selected.
Data Extraction and Synthesis:
Two reviewers independently extracted data and assessed the risk for bias in included trials using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Main Outcomes and Measures:
Neonatal mortality before discharge from the hospital.
Results:
We included 7 randomized clinical trials involving 501 infants. Infants with a gestational age of less than 33 weeks allocated to UCM compared with control conditions showed no difference in the risk for mortality (risk ratio [RR], 0.75 [95% CI, 0.35 to 1.64]; risk difference [RD], -0.02 [95% CI, -0.09 to 0.04]), hypotension requiring volume expanders (RR, 0.71 [95% CI, 0.41 to 1.25]; RD, -0.09 [95% CI, -0.22 to 0.05]), or inotrope support (RR, 0.77 [95% CI, 0.51 to 1.17]; RD, -0.10 [95% CI, -0.25 to 0.05]). Higher initial levels of hemoglobin (mean difference, 2.0 [95% CI, 1.3-2.7] g/dL) and hematocrit (mean difference, 4.5% [95% CI, 1.5%-7.4%]) were identified in the UCM groups.
We found a reduced risk for oxygen requirement at 36 weeks (RR, 0.42 [95% CI, 0.21 to 0.83]; RD, -0.14 [95% CI, -0.25 to -0.04]) and for intraventricular hemorrhage of all grades (RR, 0.62 [95% CI, 0.41 to 0.93]; RD, -0.12 [95% CI, -0.22 to -0.02]) in infants assigned to UCM. Among infants with a gestational age of at least 33 weeks, UCM was associated with higher hemoglobin levels in the first 48 hours in 224 infants (mean difference, 1.2 [95% CI, 0.8-1.5] g/dL) and at 6 weeks of life in 170 infants (mean difference, 1.1 [95% CI, 0.7-1.5] g/dL).
Conclusions and Relevance:
Umbilical cord milking was associated with some benefits and no adverse effects in the immediate postnatal period in preterm infants gestational age, <33 nbsp="" p="" weeks.="">
JAMA Pediatr. 2014 Nov 3. doi: 10.1001/jamapediatrics.2014.1906. [Epub ahead of print]
Efficacy and Safety of Umbilical Cord Milking at Birth: A Systematic Review and Meta-analysis.
Al-Wassia H1, Shah PS2.
Author information
1Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
2Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
Importance:
Umbilical cord milking (UCM) is suggested to improve neonatal outcomes.
Objectives:
To perform a systematic review and meta-analysis of the efficacy and safety of UCM in full-term and preterm neonates.
Data Sources:
A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database, and the reference list of retrieved articles from 1940 to 2014.
Study Selection:
Randomized clinical trials comparing UCM with other strategies of handling the umbilical cord at birth in full-term and preterm infants. Seven of the 18 initially identified studies were selected.
Data Extraction and Synthesis:
Two reviewers independently extracted data and assessed the risk for bias in included trials using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Main Outcomes and Measures:
Neonatal mortality before discharge from the hospital.
Results:
We included 7 randomized clinical trials involving 501 infants. Infants with a gestational age of less than 33 weeks allocated to UCM compared with control conditions showed no difference in the risk for mortality (risk ratio [RR], 0.75 [95% CI, 0.35 to 1.64]; risk difference [RD], -0.02 [95% CI, -0.09 to 0.04]), hypotension requiring volume expanders (RR, 0.71 [95% CI, 0.41 to 1.25]; RD, -0.09 [95% CI, -0.22 to 0.05]), or inotrope support (RR, 0.77 [95% CI, 0.51 to 1.17]; RD, -0.10 [95% CI, -0.25 to 0.05]). Higher initial levels of hemoglobin (mean difference, 2.0 [95% CI, 1.3-2.7] g/dL) and hematocrit (mean difference, 4.5% [95% CI, 1.5%-7.4%]) were identified in the UCM groups.
We found a reduced risk for oxygen requirement at 36 weeks (RR, 0.42 [95% CI, 0.21 to 0.83]; RD, -0.14 [95% CI, -0.25 to -0.04]) and for intraventricular hemorrhage of all grades (RR, 0.62 [95% CI, 0.41 to 0.93]; RD, -0.12 [95% CI, -0.22 to -0.02]) in infants assigned to UCM. Among infants with a gestational age of at least 33 weeks, UCM was associated with higher hemoglobin levels in the first 48 hours in 224 infants (mean difference, 1.2 [95% CI, 0.8-1.5] g/dL) and at 6 weeks of life in 170 infants (mean difference, 1.1 [95% CI, 0.7-1.5] g/dL).
Conclusions and Relevance:
Umbilical cord milking was associated with some benefits and no adverse effects in the immediate postnatal period in preterm infants gestational age, <33 nbsp="" p="" weeks.="">
Saturday, November 1, 2014
Neonatal Survival After Prolonged Preterm Premature Rupture of Membranes Before 24 Weeks of Gestation
Obstetrics & Gynecology:
Brumbaugh, Jane E. MD; Colaizy, Tarah T. MD, MPH; Nuangchamnong, Nina MD; O'Brien, Emily A.; Fleener, Diedre K. RN, BSN; Rijhsinghani, Asha MD; Klein, Jonathan M. MD
Abstract
OBJECTIVE: To evaluate neonatal survival after prolonged preterm premature rupture of membranes (PROM) in the era of antenatal corticosteroids, surfactant, and inhaled nitric oxide.
METHODS: A single-center retrospective cohort study of neonates born from 2002–2011 after prolonged (1 week or more) preterm (less than 24 weeks of gestation) rupture of membranes was performed. The primary outcome was survival to discharge. Neonates whose membranes ruptured less than 24 hours before delivery (n=116) were matched (2:1) on gestational age at birth, sex, and antenatal corticosteroid exposure with neonates whose membranes ruptured 1 week or more before delivery (n=58). Analysis used conditional logistic regression for categorical data and Wilcoxon signed rank test for continuous data.
RESULTS: The prolonged preterm PROM exposed and unexposed cohorts had survival rates of 90% and 95%, respectively, although underpowered to assess the statistical significance (P=.313). Exposed neonates were more likely have pulmonary hypoplasia (26/58 exposed, 1/114 unexposed, P<.001), pulmonary hypertension (21/56 exposed, 10/112 unexposed, P<.001), and pulmonary air leak (21/58 exposed, 14/114 unexposed, P<.001). Gestational age at rupture (20.4 weeks exposed, 22.3 weeks unexposed, P=.189), length of rupture (3.7 weeks exposed, 6.4 weeks unexposed, P=.717), and lowest maximal vertical pocket before 24 weeks of gestation (0 cm exposed, 1.4 cm unexposed, P=.114) did not discriminate between survivors and nonsurvivors after exposure to prolonged preterm PROM.
CONCLUSION: With antenatal steroid exposure and aggressive pulmonary management, survival to discharge after prolonged preterm PROM was 90%. Pulmonary morbidities were common. Of note, the data were limited to women who remained pregnant 1 week or longer after rupture of membranes.
Friday, October 31, 2014
Saturday, October 4, 2014
A Theme Park In The Midair!
A Mid Air Theme Park
It was time to revel in the wedding festivities again. As my niece was
getting married, we were excited and began to look for competitive airfares to
India. This newer airlines, with which we had no previous experience, had an
enticing pricing. Nothing else mattered, except the tickets for the three. They
even offered exit row seats just for your bi-weekly paycheck! A deal we couldn’t
refuse, as we were eager to be fresh when we arrived after 20 hours of flight
time.
The check-in was a breeze, and the security did not
displease. As we placed our luggage in the overhead bins, we began to settle in
our ordained seats. Am I adipose? No airlines has ever made me feel this way I suppose!
I began to doubt my body frame and my BMI of 22? Is it the slice of pizza I ate
a month ago causing this? Or may be it was my Scott Evest, I thought filled with
gadgets. I took off the evest. Yet, the same feeling persisted. I may have to
take off my pants to fit in snuggly! Though, it was desirable, but may be unbearable
for others. It was a level four pushup exercise to free yourself from the skin-tight
seat. My arms were stronger by the end of the journey. These seats seemed to compensate for seat belt non-compliance, I thought.
I have seen many companies vying for movie theme toys to
please their customers. However, this airlines went up a notch and incorporated a movie theme to
entertain their passengers. After waiting, which seemed long like an uncut
Benhur movie, I finally got a chance to use the toilet. I quickly realized that
you have to be a Spider Man to accomplish the purpose of your visit. The whole
floor was wet. It was difficult to discern if it was the result of aimless
target practice of the previous human or just plain water. I just couldn’t take
the chance. I had to take the support of the faucet and the side wall, and
raise myself with my already stronger arms (now I understood why they made
seats as tiny they are) and place my feet on the side panels, and balance myself
and execute the job with utmost precision. I profusely thanked the airlines for
such a personable experience. May be people should carry long poles to walk on in
to this spider man theme park in midair!
A stride back to my seat was no solace either. The guy behind my seat kept tapping my seat hysterically to
the extent that I had to turn back and ask him if he needed my attention. He felt
ashamed to have woken up a Spiderman! I have heard of interactive movies, but never
really comprehended. The tiny smudged tv screen in the front provided such an
unique experience. When you choose a movie after several taps, it begins with an
advertisement. The movie begins and freezes. You had to tap the screen several
times to restart the movie. It kept me busy to interact with the screen to keep
the movie going. It is possible that my ashamed co-passenger might have had a
mature scene freeze with his son ogling at it leading to his frantic banging on
the screen to wake up this freshly trained Spiderman.
As I was attempting another peaceful nap, a flight attendant came to ask me if I needed something to
drink. I was not sure what the Spiderman drank normally. After a prolonged ponder,
I asked for a mango juice and water. She confirmed that I wanted “wother”. I affirmed
and said “water”. She reaffirmed and said she would get me “mongo and VOTHER”. I
was at a loss, but appreciated. She came back promptly after half an hour with
a glass of juice, which looked like mango juice. There was no glass of water.
Hoping that she would bring it later, I sipped the MONGO juice imposter. It was very
bitter and disgusting. I immediately asked her, if the juice was spoiled and
fermented as it was very bitter. Then she said it may be due to WOTHkER. I was
confused as I heard a different pronunciation each time. She then showed me the
VODKA (Wother or Wothker), which I believe she decided I wanted it sub consciously.
She went above and beyond her call of duty (probably the airline motto!), and decided to serve him
more than he asked for. I am a congenital teetotaler and this lady wanted to
give it a damn break. I had to purify
myself. I had no other choice but to visit the only theme park with unlimited
number of free passes.
Monday, July 28, 2014
Revised 2014 Guidelines for RSV Prphylaxis
http://aapnews.aappublications.org/content/35/8/1.1.full
Palivizumab prophylaxis is not recommended for otherwise healthy infants born at or after 29 weeks, 0 days’ gestation.
In the first year of life, palivizumab prophylaxis is recommended for preterm infants born before 32 weeks, 0 days’ gestation with chronic lung disease of prematurity defined as greater than 21% oxygen for at least 28 days after birth.
Clinicians may administer palivizumab prophylaxis in the first year of life to certain infants with hemodynamically significant heart disease. In addition, consultation with a cardiologist for decisions about prophylaxis is recommended for patients with cyanotic heart disease.
Clinicians may administer up to a maximum of five monthly doses of palivizumab during the RSV season to infants who qualify for prophylaxis in the first year of life (including those in Florida). Qualifying infants born during the RSV season will require fewer doses. For example, infants born in January would receive their last dose in March.
Palivizumab prophylaxis is not recommended in the second year of life except for children who require at least 28 days of supplemental oxygen after birth and who continue to require medical intervention (supplemental oxygen, chronic corticosteroid or diuretic therapy).
Monthly prophylaxis should be discontinued in any child who experiences a breakthrough RSV hospitalization.
Children with pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the lower airways may be considered for prophylaxis in the first year of life.
Children younger than 24 months of age who will be profoundly immunocompromised during the RSV season may be considered for prophylaxis.
Insufficient data are available to recommend palivizumab prophylaxis routinely for children with cystic fibrosis or Down syndrome.
The burden of RSV disease in certain remote areas may result in a broader use of palivizumab for RSV prevention in Alaska Native populations and possibly in other selected Native American populations.
Palivizumab prophylaxis is not recommended for prevention of RSV nosocomial disease.
In the first year of life, palivizumab prophylaxis is recommended for infants born before 29 weeks, 0 days’ gestation.
- Previously, prophylaxis was recommended for preterm infants born before 32 weeks’ gestation. Infants with certain risk factors born at 32 weeks, 0 days to 34 weeks, 6 days also were eligible.
- Previously, no definition of chronic lung disease was provided.
- Previously, prophylaxis also was recommended in the second year of life for certain infants with hemodynamically significant heart disease.
- Previously, fewer than five monthly doses were recommended for some infants.
- Previously, two seasons of prophylaxis were recommended.
- Previously, continued prophylaxis was recommended in a child who experienced a breakthrough RSV hospitalization.
- Previous recommendation was for two years of prophylaxis.
- Similar to previous recommendation.
- Previously, the recommendation for children with cystic fibrosis was similar; children with Down syndrome were not addressed.
- Present recommendations allow for greater flexibility for Alaska Native and Native American populations.
Monday, May 26, 2014
A Risk of Sensory Deprivation in the Neonatal Intensive Care Unit
http://www.jpeds.com/article/S0022-3476(14)00112-7/fulltext
Alan. H. Jobe.
Sound Exposures in NICU:
...........The appropriate emphasis on sound abatement in the new or renovated NICU should be on background noise, alarm noise, and other non-human noises that can startle and disrupt sleep of the preterm.13 However, the focus on noise abatement has morphed into a goal of silence in the NICU with exclusion of staff talk and lively discussions on work rounds. The result may be a severe limitation of the exposure of the vulnerable developing auditory cortex to human voices and sounds that are necessary for language development. This delay in language development for infants in single rooms is just what was observed by the Pineda article.3 In contrast, the open ward better reflects the fetal environment with human sounds and activities.
Light Exposures in NICU:
......... Circadian rhythms regulate more than sleep cycles, and there is minimal research to explore other potential effects of light on the preterm infant. Accepting that the fetus has a circadian rhythm and the dark-exposed preterm infant does not, the conservative approach to exposure of the preterm infant to light would be cycling of dim light sufficient for care at night to brighter light during the day. The covering of the isolettes with blankets continuously seems to be questionable because visual development requires light exposure. The biology suggests that judicious light exposure is appropriate until more is known about the effects of light on the preterm infant.
Alan. H. Jobe.
Sound Exposures in NICU:
...........The appropriate emphasis on sound abatement in the new or renovated NICU should be on background noise, alarm noise, and other non-human noises that can startle and disrupt sleep of the preterm.13 However, the focus on noise abatement has morphed into a goal of silence in the NICU with exclusion of staff talk and lively discussions on work rounds. The result may be a severe limitation of the exposure of the vulnerable developing auditory cortex to human voices and sounds that are necessary for language development. This delay in language development for infants in single rooms is just what was observed by the Pineda article.3 In contrast, the open ward better reflects the fetal environment with human sounds and activities.
Light Exposures in NICU:
......... Circadian rhythms regulate more than sleep cycles, and there is minimal research to explore other potential effects of light on the preterm infant. Accepting that the fetus has a circadian rhythm and the dark-exposed preterm infant does not, the conservative approach to exposure of the preterm infant to light would be cycling of dim light sufficient for care at night to brighter light during the day. The covering of the isolettes with blankets continuously seems to be questionable because visual development requires light exposure. The biology suggests that judicious light exposure is appropriate until more is known about the effects of light on the preterm infant.
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