Articles Posted in Birth Injury

maternal-300x170new investigation of one of the great shames of American medical care raises big questions about why labor and delivery is more dangerous to new mothers in the U.S. than just about anywhere else in the civilized world.

To their considerable credit, National Public Radio and Pro Publica, a Pulitzer Prize-winning investigative news site, have joined forces to examine why 700 to 900 American women die each year from pregnancy related causes, and 65,000 nearly die.

The news organizations say Americans are “three times more likely to die in childbirth than women in Canada, and six times more likely than Scandinavian women.” And while U.S. maternal deaths are rising, their numbers were plunging in developed countries from England to South Korea.

marijuana-smoking-131013-300x200Although marijuana is marching toward legalization across the United States, expectant moms may wish to think long and hard still about smoking or ingesting a substance that has become as ubiquitous in some households as aspirin or a bottle of chardonnay. The New York Times has delved into this discussion, even as other news outlets recently have provided parental warnings about hype over apps for baby care and tossing some toxic homeopathic teething remedies.

Pot? Not for expectant moms

Let’s turn first, and not be blue noses about it, to why moms would consider pot while pregnant. Data show that few do (an estimated 4 percent of more than 200,000 women in one 12-year sample — though the number had doubled in recent time). For younger women, the answer may be, just because. They don’t equate it with risk but with recreation. They say they try to be cautious with it, just as they might curtail their alcohol consumption but still have a rare drink. Older and expectant moms may use pot, as many women do, because they find it helps with depression, anxiety, stress, pain, nausea and vomiting.

newborninhospital_mhi_default-300x199Some new cautions have been issued on some key aspects of children’s health care. The federal government is increasing its warnings on anesthetic use for children and expectant moms, while a newspaper investigation is raising issues with common newborn screenings and their inconsistency and inaccuracy. Meantime, a health news site is adding to questions about a much-touted program to reduce head trauma harms in kids’ athletics.

FDA warnings on anesthetics for babies, expectant moms

Let’s start with the federal Food and Drug Administration cautions on “repeated and lengthy use of general anesthetic and sedation drugs” with children younger than 3 and pregnant women. The agency says it has been studying potential harms of these powerful medications for these two groups since 1999, and will label almost a dozen common anesthetics and sedation drugs with new warnings.

Cytomegalovirus_01Although awareness has grown about viruses  like Zika that can devastate the unborn, cytomegalovirus (CMV), a much more common and equally harmful prenatal viral  infection, doesn’t get discussed with pregnant moms as much as it should. Medical counseling, testing, and administration of anti-viral medications could save more babies and their families from a lifetime of CMV woes.

More than half of adults older than 40 and one in three children by the age of 5 have been infected with CMV, a common virus in the herpes family. An estimated 1 in 150 babies gets infected at birth with CMV, with 1 in 5 of these infants sickened or harmed, including with hearing loss, microcephaly (a deformity so they have tiny heads), intellectual deficits or impaired vision.  This means CMV seriously harms as many as 8,000 youngsters annually across the United States, and it is fatal for about 400 infants.

Affected families and medical experts have told the New York Times that more needs to be done to increase CMV awareness, testing, and prevention, especially in comparison to the public health attention that has been paid to Zika and the damage it may inflict on the unborn.

Hypodermic-NeedleFederal officials have advanced a key way  to combat the zika virus, permitting clinical trials of a vaccine against the tropical infection.

The Food and Drug Administration has approved the preliminary testing  of GLS-5700, an experimental vaccine by Inovio, of Plymouth Meeting, Pa., and GeneOne Life Science, of Seoul, South Korea.

It is the first but not the only vaccine-based effort to attack zika, a rapidly spreading viral infection that afflicts most people in relatively mild fashion (fever, chills, muscle pains) but can cause severe deformities for the unborn if pregnant moms are exposed. Brazil, in particular, has struggled with hundreds of children born with microcephaly after their mothers were zika-exposed.

DiceA globally renowned seismologist, weary of recent scaremongering reports that a major fault in California was “locked, loaded, and ready to roll,” offered a pointed scientific evaluation of risk: “You’re about as likely to be shot by a toddler than die in an earthquake,” she observed. She explained that, in geologic terms with earthquakes, imminent can mean centuries, not milliseconds. Further, over the last 100 years, there have been an average of 40 temblor deaths annually in the Golden State; in 2015 alone, toddlers with guns killed roughly that same number of Americans.

Suddenly, the media fascination with an impending seismic catastrophe receded to more normal concern.

This much publicized discussion of risk underscores the private complexity that many patients confront in harsh, short time spans when they get multiple surgeons’ opinions on whether they should undergo major procedures. Why does one surgeon tell a young patient and his family to wait and try a lot of other treatments for his brain hemorrhages but not an operation? Then why does a second neurosurgeon tell them the boy needs a procedure NOW to save his life?

Although experts may muster masses of data and point to reams of research, simple human stories sometimes persuade us best about dangers to our health. It’s tough not to ask why football holds such veneration as America’s favorite sport, for example, when one of its skilled players gets candid about his damaged post-professional life. And just maybe a mom’s tragic tale about her now-grown daughter’s circumscribed life might warn younger women about the real dangers of drinking during pregnancy.

Ex-pro opens up about football’s brutality

Who isn’t a Redskins fan in Washington? And, at this point, who among the football-obsessed hasn’t heard about the flap over a seemingly straight-forward news update about some football stars, including Antwaan Randle El, a one-time receiver for the Skins and the Pittsburgh Steelers. To the chagrin of those who jaw, endlessly, on sports talk shows, Randle El said he regrets playing football and wished he would have played baseball, instead. He said he was glad that a school football program that he was part of recently got canceled. Yes, the game opened lots of life’s doors and made him financially better off than he ever could have imagined. But the brutal pounding he took for years has affected his health and is starting to lessen his mental cognition, especially his memory, he said.

Health officials and parents in Brazil are grappling with a surge of birth defects traced to mosquitoes. In the last year, more than 2,700 infants have been born with microcephaly, tiny heads and brains that leave children permanently disabled. That rate is about 20 times higher than recent years.

The culprit receiving tentative blame is Zika, a tropical virus named for the Ugandan forest where it was first found decades ago. The infection can cause microcephaly. Its presence was detected in the amniotic fluid of two mothers with microcephalic babies. Health officials also are finding that other moms who delivered malformed children reported Zika symptoms during their pregnancy.

Brazilians have stepped up their long-running and sometimes successful war on aedes aegypti, the mosquito that carries Zika and other diseases, including dengue fever, yellow fever, and chikungunya. Before the Zika outbreak, Brazil already was waging a pitched battle against dengue fever, which in 2015 had infected 1 million — twice the number of infections from the year previous. Dengue fever killed at least 839 Brazilians in 2015, an 89 percent increase in fatalities over the year previous.

In a sweeping and horrifically detailed indictment, the New York Times called out the U.S. military hospital system for its shockingly substandard care.

The paper looked at the records of the 40 hospitals across the country run by the armed forces that provide care for 1.35 million active-duty service members and their families, among other patients. The problem of poor care appears to stem from the fact that these hospitals are so small and see so few patients that doctors and nurses don’t get enough experience to diagnose and treat serious illnesses properly. Most of these facilities handle less than one-third as many patients as a typical civilian hospital.

These numbers are so significant that Dr. Lucian L. Leape, a leading patient-safety expert at the Harvard School of Public Health, said, “I think they should be outlawed.”

The news is not surprising, but still shocking: the nation’s military medicine system is rife with lapses in quality of care that hurt service members and their families, and very little is being done about it, according to a long investigative takeout in the New York Times.

I say not surprising, because attorneys like me who represent military families in medical malpractice lawsuits against the government for sub-standard care see a lot of the kinds of problems documented in the Times article.

Pregnancy and newborn care is especially vulnerable to errors that can have lifelong consequences when children are born with brain damage. The Times investigators reported that of the 50,000 babies born at military hospitals each year, they are twice as likely to be injured during delivery as the average for all newborns around the U.S.

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