Children's IQ Can Be Affected By Mother's Exposure To Urban Air Pollutants, Study Suggests

ScienceDaily (July 20, 2009) — Prenatal exposure to environmental pollutants known as polycyclic
aromatic hydrocarbons (PAHs) can adversely affect a child's intelligence quotient or IQ, according to new
research by the the Columbia Center for Children's Environmental Health (CCCEH) at the Mailman School
of Public Health. PAHs are chemicals released into the air from the burning of coal, diesel, oil and gas, or
other organic substances such as tobacco. In urban areas motor vehicles are a major source of PAHs.
The study found that children exposed to high levels of PAHs in New York City had full scale and verbal
IQ scores that were 4.31 and 4.67 points lower, respectively than those of less exposed children. High PAH
levels were defined as above the median of 2.26 nanograms per cubic meter (ng/m3).
"These findings are of concern because these decreases in IQ could be educationally meaningful in terms of
school performance," says Frederica Perera, DrPH, professor of Environmental Health Sciences and
director of the CCCEH at Columbia University Mailman School of Public Health and study lead author.
"The good news is that we have seen a decline in air pollution exposure in our cohort since 1998, testifying
to the importance of policies to reduce traffic congestion and other sources of fossil fuel combustion
byproducts."
The study included children who were born to non-smoking Black and Dominican American women age 18
to 35 who resided in Washington Heights, Harlem or the South Bronx in New York. The children were
followed from in utero to 5 years of age. The mothers wore personal air monitors during pregnancy to
measure exposure to PAHs and they responded to questionnaires.
At 5 years of age, 249 children were given an intelligence test known as the Wechsler Preschool and
Primary Scale of the Intelligence, which provides verbal, performance and full-scale IQ scores. The
researchers developed models to calculate the associations between prenatal PAH exposure and IQ. They
accounted for other factors such as second-hand smoke exposure, lead, mother's education and the quality
of the home caretaking environment. Study participants exposed to air pollution levels below the average
were designated as having "low exposure," while those exposed to pollution levels above the average were
identified as "high exposure." A total of 140 children were classified as having high PAH exposure.
"The decrease in full-scale IQ score among the more exposed children is similar to that seen with low-level
lead exposure," noted Dr. Perera. "This finding is of concern because IQ is an important predictor of future
academic performance, and PAHs are widespread in urban environments and throughout the world.
Fortunately, airborne PAH concentrations can be reduced through currently available controls, alternative
energy sources and policy interventions."
The study findings are published in the August 2009 issue of Pediatrics.
This research was funded by the National Institute of Environmental Health Sciences (NIEHS), a
component of the National Institutes of Health, the U.S. Environmental Protection Agency and several
private foundations.

Management Of Asthma During Pregnancy Can Optimize Health Of Mother And Baby, Study
Suggests
ScienceDaily (Apr. 30, 2009) — Pregnant women with asthma, the most common condition affecting the
lungs during pregnancy, should actively manage their asthma in order to optimize the health of mother and
the baby, according to new management recommendations published in the current issue of the New
England Journal of Medicine.
Though studies suggest asthma during pregnancy can increase health risks for mom and baby, our research
shows that women who manage their asthma can have as healthy a pregnancy as women who don't have
asthma," said Michael Schatz, MD, lead author of the NEJM recommendations and chief of the Allergy
Department at Kaiser Permanente Medical Center, San Diego, Calif. "Many studies suggest that asthma can
increase the risk of pregnancy complications, including preeclampsia, low birth-weight babies or preterm
birth, however, women with well-controlled asthma in pregnancy generally have good pregnancy
outcomes. Women who have asthma and are considering pregnancy should speak with their doctors to
develop a therapy plan."
The recommendations are based to a large degree on a 12-year Kaiser Permanente study of 1,900 pregnant
women, and a Maternal Fetal Medicine Units network study of 2,620 women from 16 university hospital
centers around the country. Both studies concluded that women with actively managed asthma are just as
likely to have healthy pregnancies and babies as women who don't have asthma.
At any given time, 8 percent of pregnant women have asthma. During pregnancy, asthma worsens in about
one-third of these women, improves in one-third, and remains stable in one-third. Uncontrolled asthma can
cause a decrease in the amount of oxygen in the mother's blood, which can lead to decreased oxygen in the
fetal blood. Since a fetus requires a constant supply of oxygen for normal growth and development, this can
lead to impaired fetal growth and survival. Women who are pregnant or planning to become pregnant
should work with their doctors to develop a therapy plan, stay away from items that might trigger an
allergic or asthmatic reaction, and never stop taking asthma medications without speaking to their doctor
first.
The report provides recommendations designed to help clinicians who care for pregnant asthmatic women,
including asthma assessment, management of triggering factors, medication management, treatment of
asthma attacks, obstetric management and patient education.
"The article does point out that there is still more information that we would like to have about the
interrelationships between asthma and pregnancy and the use of asthma medications during pregnancy,"
said Mitchell Dombrowski, MD, Chief of Obstetrics, St. John Hospital and Medical Center, and Professor,
Wayne State University, Detroit, Michigan. "However, using the information we do have allows us to make
practical recommendations that studies and clinical experience have shown result in healthy mothers and
infants."

Fetal Short-term Memory Found In 30-week-old Fetuses

ScienceDaily (July 15, 2009) — Memory probably begins during the prenatal period, but little is known
about the exact timing or for how long memory lasts. Now in a new study from the Netherlands, scientists
have found fetal short-term memory in fetuses at 30 week
The study provides insights into fetal development and may help address and prevent abnormalities.
Published in the July/August 2009 issue of the journal Child Development, it was conducted by researchers
at Maastricht University Medical Centre and the University Medical Centre St. Radboud.
The scientists studied about 100 healthy pregnant Dutch women and their fetuses, measuring changes in
how the fetus responds to repeated stimulation. After receiving a number of stimuli, the fetus no longer
responds to the stimulus as observed by ultrasonography and the stimulus is then accepted as "safe." This
change in response is called "habituation." In a second session, the fetus "remembers" the stimulus and the
number of stimuli needed for the fetus to habituate is then much smaller.
Based on their research, the scientists found the presence of fetal short-term memory of 10 minutes at 30
weeks. They determined this because a significantly lower number of stimuli was needed to reach
habituation in a second session, which was performed 10 minutes after the first session. They also found
that 34-week-old fetuses can store information and retrieve it four weeks later. Fetuses were tested at 30,
32, 34, and 36 weeks, and again at 38 weeks. The 34- and 36-week-old fetuses habituated much faster than
the 38-week-old fetuses that had not been tested before. This implies that these fetuses have a memory of at
least 4 weeks—the interval between the test at 34 weeks and that at 38 weeks.
"A better understanding of the normal development of the fetal central nervous system will lead to more
insight into abnormalities, allowing prevention or extra care in the first years of life and, as a consequence,
fewer problems in later life," according to the study's authors.

Babies With Mild Facial Paralysis From Forceps Typically Do Not Need Treatment
ScienceDaily (July 20, 2009) — Mild facial nerve paralysis caused by the use of forceps during
birth generally resolves on its own and does not require treatment, according to a report in the
July issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives
journals.
Facial nerve palsy (inability to move some facial muscles) occurs in approximately 0.8 to 7.5 of 1,000
births overall and 8.8 of every 1,000 births in which forceps are used, according to background information
in the article. "Previous observations indicate that while most cases of facial nerve palsy caused by birth
trauma implicate the use of forceps, up to 33 percent occur in spontaneous vaginal delivery without
instrumentation," the authors write. The injury is caused when the forceps blade or a bone in the mothers'
pelvis puts pressure on the baby's head in the area of the facial nerve.
Melanie Duval, M.D., of McGill University, Montreal, Quebec, Canada, and Sam J. Daniel, M.D.,
M.Sc., F.R.C.S.C., of McGill University and Montreal Children's Hospital, reviewed the medical
records of 28 babies with facial nerve palsy caused by forceps use between 1989 and 2005.
In all 28 cases, the palsy was classified as mild to moderate. "Except in one neonate, no
treatment was initiated in any of the patients," the authors write; one child received a 14-day
course of oral prednisone, a corticosteroid. "All 21 neonates with adequate long-term follow-up
recovered fully after an average period of 24 days."
"There is discrepancy in the literature on the investigations and/or treatment options to be
undertaken in facial palsy owing to birth trauma," the authors conclude. Some authors
recommend surgery to explore the nerve, whereas most consider observation to be sufficient in
uncomplicated cases. The current results add to evidence that the recovery rate is high without
treatment. "This confirms that corticosteroid treatment or surgery should be withheld in neonates
presenting with uncomplicated facial nerve palsy resulting from forceps trauma."

Discovery Of New Transmission Patterns May Help Prevent Rotavirus Epidemics

ScienceDaily (July 18, 2009) — New vaccines have the potential to prevent or temper epidemics
of the childhood diarrhea-causing disease rotavirus, protect the unvaccinated and raise the age at
which the infection first appears in children, federal researchers report in a new study.
The findings were based on changing patterns of rotavirus transmission in the United States,
where the disease is rarely fatal, and they have implications for combating epidemics in other
countries where the death toll is much higher.
The research, published in the July 17 issue of the journal Science, is based on mathematical
modeling that takes into account regional birth rates and predicted vaccination levels and
effectiveness. The model suggests that when 80 percent or more of children in a given population
are vaccinated, annual epidemics may occur on a less regular basis and more unvaccinated
children will be protected. Data from 2007-2008, when vaccination first reached appreciable
coverage levels in the United States, validate the model's predictions.
"Rotavirus vaccines have rapidly and dramatically reduced hospitalizations and emergency room
visits for gastroenteritis in American children," said investigator Umesh D. Parashar, M.B.B.S.,
M.P.H., of the Centers for Disease Control and Prevention's Center for Immunization and
Respiratory Diseases. "This research not only explains the effects of the U.S. rotavirus
vaccination program, but also lays the foundation for understanding the tremendous life-saving
benefits of vaccination in the developing world, where more than half a million children die from
rotavirus each year."
The study showed for the first time that the timing of rotavirus epidemics is dependent on the birth
rate in the population because they are driven by infants who have never been infected before. In
the United States, winter outbreaks would typically occur sooner in the higher birth rate states of
the Southwest and later in the Northeast, where birth rates tend to be lower.
But with the introduction of two vaccines, the first in 2006, rotavirus outbreaks may become less
frequent and less pronounced. They also may make their first appearance in children when they
are older than the previous norm of less than 5 years of age, according to the research.
In older children, later onset would likely mean fewer cases and less severity of diarrhea.
The modeling and analysis were done by a team of researchers from the Fogarty International
Center of the National Institutes of Health, the CDC, the Agency for Healthcare Research and
Quality, the Pennsylvania State University, Princeton University and the George Washington
University.
"When you can observe the immediate effects of vaccination and compare them to what the
model predicted, you have a head start on stopping this preventable disease in countries where
rotavirus unnecessarily kills hundreds of thousands of children," said Roger I. Glass, M.D., Ph.D.,
one of the study authors and director of the Fogarty Center.
Lead author Virginia Pitzer, Sc.D., of Penn State and the Fogarty Center, said, "Each population
is going to have a different demographic makeup, and there may be conditions we cannot predict
with certainty, but we believe introducing vaccination in the developing world will decrease the
terrible burden of rotavirus."

Preemies Born In Poverty Four Times Less Likely Ready For School
ScienceDaily (July 20, 2009) — Advances in neonatal care enable two-thirds of premature babies
born with respiratory problems to be ready for school at an appropriate age, but those living in
poverty are far less likely to be ready on time than their better-off peers, researchers from the
University of Chicago Medical Center report in the July issue of the journal Pediatrics.
Although several medical factors including chronic lung disease, brain hemorrhage, and male
gender were associated with lower school readiness, by far the most powerful factor determining
school-readiness level was low socioeconomic status.
“The good news is premature babies are surviving. Neonatology has done a remarkable job in
lowering mortality without increasing morbidity,” said study co-author Jeremy Marks, MD, PhD,
associate professor of pediatrics. “The bad news is poverty leads to huge disparities in school
readiness, with poor kids faring four times worse than others.”
The finding extends a study of babies born prematurely with immature lungs that the University of
Chicago researchers began in 2000.
The researchers wanted to determine how many of them were ready to begin primary school
when they reached school age, and to understand the factors associated with lack of school
readiness among these children.
The researchers were able to collect follow-up data on 137 of 167 (81 per cent) of the patients
born prematurely with respiratory distress syndrome.
“As a single-center cohort study, we were pleased to be able to track such a high portion of the
patients we had originally seen,” said Michael Msall, MD, chief of developmental and behavioral
pediatrics. “We knew that premature infants are at increased risk for abnormal
neurodevelopmental outcomes at two years. But we didn’t know what factors prevented these
children from entering school on time.”
Using assessments of each child’s understanding of basic concepts, perceptual skills, receptive
vocabulary, daily living functional skills, and whether children had sensory impairments or autism,
the researchers assigned each child a school-readiness score. The multidimensional analysis
also included standardized neurodevelopmental and health assessments, as well as measures of
the family’s socioeconomic status.
“As an academic specialist, our expertise is in improving outcomes for preemies and treating
babies with severe lung disease, intracranial bleeding and other complex diagnoses,” said
Michael Schreiber, MD, professor of pediatrics at the University of Chicago and the study’s lead
author. “However, the stresses of poverty really put our neonatal ICU graduates behind the eight
ball, developmentally.”
“We will continue to search for new and better therapies to improve the care of babies born
prematurely,” Schreiber said. "However, society must provide the additional long-term resources
these vulnerable children require if they are to ever reap the full benefits of our medical
advances."
Other contributors included Athena I. Patrianakos-Hoobler, MD, and Dezheng Huo, PhD. The
researchers had no financial relationships relevant to this study.

Even Mildly Premature Infants Have Increased Risk Of Common Respiratory Tract
Infection
ScienceDaily (May 12, 2009) — Even mildly premature infants (gestational ages of 33 weeks
through 36 weeks) have an increased risk of medically attended respiratory syncytial virus
infection, which is the leading cause of lower respiratory tract infection in infants and young
children and can lead to pneumonia in babies, according to a Kaiser Permanente Division of
Research study.
The RSV infection risk is higher among infants exposed to supplemental oxygen or assisted ventilation
during the neonatal period, said the researchers, explaining that the need for oxygen is sometimes
unavoidable for babies who need intensive care.
The results of the study are being presented at the Pediatric Academic Societies Annual Meeting
to be held in Baltimore on Tuesday, May 5.
"Although extreme prematurity is a known risk factor for severe RSV infection, this study helped
us to learn more about risk factors for RSV infection among mildly premature infants. We
detected an increased risk even in babies born at 37 weeks," said the study's lead investigator
Gabriel J. Escobar, MD, a hospital-based pediatrician and research scientist with the Kaiser
Permanente Division of Research in Oakland, Calif. "Further research is needed to determine
whether strategies to prevent or mitigate RSV infections are indicated in late preterm infants."
The study included 108,794 babies at least 33 weeks gestation discharged from six Kaiser
Permanente hospitals between January 1996 and December 2002. Compared to babies 38-40
weeks, babies born at 37 weeks had a 37 percent increased odds of RSV infection, while babies
born at 34-36 weeks had a 70 percent increased odds. In contrast, babies born at 41 or more
weeks had 14 percent decreased odds. Even after controlling for prematurity, babies who
received supplemental oxygen during the birth hospitalization had a 50 to 120 percent increased
odds of medically attended RSV infection in the first year of life.
Researchers used a retrospective cohort study design using logistic regression and Cox
proportional hazards modeling to control for varying follow-up lengths.
Additional researchers on the study include: Patricia Kipnis, Ph.D., Arona Ragins, MA, Sherian Xu
Li, MS, and Laura Prager, MD, Pharm D, all with Kaiser Permanente; and Jennifer Graff with
Medimmune.

Discovery May Bring Special Treatment For Premature Male Babies

ScienceDaily (Mar. 26, 2008) — Hunter researchers have discovered that male babies born
prematurely are more vulnerable to cardiovascular complications than female babies.
This finding may explain why male babies born prematurely are twice as likely to die as female
babies in the first 72 hours of life. It could also lead to new ways of treating premature babies
throughout the world.
Researchers from Hunter New England Health and the University of Newcastle, in collaboration
with the Hunter Medical Research Institute's Pregnancy and Reproduction Research Program,
completed two studies, looking at babies born at 24 weeks to full term.
"This is the first time that the small blood vessels (microvasculature) have been extensively
studied in a large group of premature babies," said Dr Ian Wright, a Neonatologist at Hunter New
England Health's Kaleidoscope Neonatal Intensive Care Unit.
"We discovered that changes in small blood vessels are linked with how sick the babies are after
birth. Babies who had low blood pressure and were more ill were unable to control the blood flow
in their small blood vessels. This was less of a problem as babies got older or if they were born
more mature.
"We showed that there is a sex difference, with the girls able to regulate the small blood vessel
flow, and boys unable to control it. Again, this difference resolved with time or was less of a
problem in the more mature infants.
"The finding suggests that doctors may need to trial different approaches to treating baby boys,
born prematurely, than baby girls. Earlier or more support for the circulation could be used in boys
because they are at greater risk of severe problems. Further research will address these
approaches."
These findings were published in the journals Archives of Disease in Childhood, Fetal and
Neonatal Edition and Pediatric Research. Infant mortality remains the most common cause of
childhood death. Premature birth is the main cause of infant mortality and infant disability. In
Australia, premature birth occurs in more than 17,000 pregnancies each year.
HMRI is a partnership between Hunter New England Health, the University of Newcastle and the
community.

Very Young Babies Vulnerable To Sudden Death While Seated

ScienceDaily (July 20, 2007) — Very young babies are vulnerable to sudden death, when seated,
warns a study published ahead of print in the Archives of Disease in Childhood.
Babies less than a month old are most at risk, the research indicates.
The researchers base their findings on an analysis of all sudden unexpected deaths occurring
among babies up to 12 months of age in the Canadian Province of Quebec between 1991 and
2000.
In all, 534 babies died during this period, but the cause of death was fully investigated in only
508.
In 99 cases, the cause of death came to light after further investigation, but in 409 cause of death
remained unexplained.
Seventeen (3.3%) of the 508 deaths had occurred in babies who were seated, predominantly, but
not exclusively, in car seats. Ten of these were unexplained
Premature babies were not at greater risk. But those aged under a month, were almost four times
as likely to die suddenly while seated as were older babies.
And babies under one month old in the group of unexplained deaths were more than seven times
as likely to die while seated.
The authors point out that their research indicates that the rate of deaths among seated babies is
relatively small at just over 3%. And there are no questions about the necessity or safety of car
seats.
Instead, extra care should be taken for very young babies in any type of infant seat, they say.

More Orthodontic Treatment Needed Among Children Born Prematurely

ScienceDaily (May 1, 2009) — Children born before week 33 may need more orthodontic care
than full-term children do. Premature children also have more complicated deviations in their bite.

This is shown in a new dissertation from Liselott Paulsson at the Faculty of Odontology, Malmö
University, in Sweden.
“This is a new group of children who need to be given more attention in dental care,” says the
specialist dentist Liselotte Paulsson at the Division for Odontology at Malmö University. On April
24 she defended her dissertation Premature Birth – Studies on Orthodontic Treatment Need,
Craniofacial Morphology, and Function.
Most children who are born prematurely need help with their respiration during the first few weeks
of life. This means that they breathe with the aid of a plastic tube connected to a respirator. The
tube is placed in either the mouth or the nose, so called intubation. Results of earlier studies have
indicated that children that receive this breathing support run a greater risk of developing bite
deviations. The risk is especially great for those children who have had the tube in their mouth.
Today nasal intubation is used for the most part at Swedish hospitals, but Liselotte Paulsson’s
studies show that these children also have more bite deviations than full-term children.
“In my studies the premature children had had intubation through the nose only,” she says,
pointing out that it is important that the needs of these children be attended to in dental care.
A total of 114 children participated in the studies. They were divided into three groups: children
born before week 29, children born between week 20 and 32, and full-term children born in week
40.
The children were examined when they were between eight and ten years old, and the results
show that 52 percent of the premature children needed to be treated for bite deviations compared
with 37 percent for the full-term children. The studies also show that the premature children
weighed less, had smaller head circumferences, and had smaller upper jaws.
“It shows that they have not caught up in their growth. It may be these differences that underlie
the fact that they have more bite deviations, but more research is needed before we can know
this for certain,” says Liselotte Paulsson, who hopes it will therefore be possible to follow up these
children between the ages of 16 and 17.
Even though they have more bite deviations and a greater need for orthodontic treatment,
premature children do not have more symptoms in the form of pain in the jaws or jaw joints or
headaches compared with other children.
“I’m happy to be able to give parents reassuring news on this point, and bite deviations can also
be steered in the right direction using various forms of braces,” says Liselotte Paulsson.