Men’s Brains Respond Differently to Hungry Infant’s Crying

Researchers have uncovered firm evidence for what many mothers have long suspected: women’s brains appear to be hard-wired to respond to the cries of a hungry infant.

Researchers asked men and women to let their minds wander, then played a recording of white noise interspersed with the sounds of an infant crying. Brain scans showed that, in the women, patterns of brain activity abruptly switched to an attentive mode when they heard the infant cries, whereas the men’s brains remained in the resting state.

“Previous studies have shown that, on an emotional level, men and women respond differently to the sound of an infant crying,” said study co-author Marc H. Bornstein, Ph.D., head of the Child and Family Research Section of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the institute that conducted the study. “Our findings indicate that men and women show marked differences in terms of attention as well.”

The earlier studies showed that women are more likely than men to feel sympathy when they hear an infant cry, and are more likely to want to care for the infant.

Dr. Bornstein collaborated with Nicola De Pisapia, Ph.D., Paola Rigo, Simona DeFalco, Ph.D., and Paola Venuti, Ph.D., all of the Observation, Diagnosis and Education Lab at the University of Trento, Italy, and Gianluca Esposito, Ph.D., of RIKEN Brain Science Institute, Japan.

Their findings appear in NeuroReport.

Dr. Bornstein says this research not only helps understand the specific wiring of the brain, but helps understand how the brain has developed. (MP3 – 00:01:12, 1,140 KB)

Transcript – Dr. Bornstein says this research not only helps understand the specific wiring of the brain, but helps understand how the brain has developed.

Previous studies have shown differences in patterns of brain activity between when an individual’s attention is focused and when the mind wanders. The pattern of unfocused activity is referred to as default mode, Dr. Bornstein explained. When individuals focus on something in particular, their brains disengage from the default mode and activate other brain networks.

For about 15 minutes, participants listened to white noise interspersed with short periods of silence and with the sounds of a hungry infant crying. The patterns of their brain activity were recorded by a technique known as functional magnetic resonance imaging.

The researchers analyzed brain images from 18 adults, parents and nonparents. The researchers found that when participants listened to the typical infant cries, the brain activity of men and women differed. When hearing a hungry infant cry, women’s brains were more likely to disengage from the default mode, indicating that they focused their attention on the crying. In contrast, the men’s brains tended to remain in default mode during the infant crying sounds. The brain patterns did not vary between parents and nonparents.

Infants cry because they are distressed, hungry, or in need of physical closeness. To determine if adults respond differently to different types of cries, the researchers also played the cries of infants who were later diagnosed with autism. An earlier study of Dr. Bornstein and the same Italian group found that the cries of infants who develop ASD tend to be higher pitched than those of other infants and that the pauses between cries are shorter. In this other study, both men and women tended to interrupt their mind wandering when they heard these cries.

“Adults have many-layered responses to the things infants do,” said Dr. Bornstein. “Determining whether these responses differ between men and women, by age, and by parental status, helps us understand instincts for caring for the very young.”

In an earlier study, Dr. Bornstein and his colleagues found that patterns of brain activity in men and women also changed when they viewed an image of an infant face and that the patterns were indicative of a predisposition to relate to and care for the infant.

Such studies documenting the brain activity patterns of adults represent first stages of research in neuroscience understanding how adults relate to and care for infants, Dr. Bornstein explained. It is possible that not all adults exhibit the brain patterns seen in these studies.

Source: National Institutes of Health (NIH)

FDA Awards Grants to Encourage Pediatrics Medical Device Development

The U.S. Food and Drug Administration today announced the awards of three grants to boost the development and availability of medical devices for children.

A panel of five experts with experience in medicine, business, and device development reviewed 10 applications for the grants, which will be administered by the FDA’s Office of Orphan Products Development. The recipients and grant amounts include:

• James Geiger, M.D. and Andre Muelenaer, M.D. of the University of Michigan Pediatric Device Consortium and the Pediatric Medical Device Institute Pediatric Medical Device Consortium, $1.1 million a year for two years.
• Michael Harrison, M.D. and the University of California, San Francisco Pediatric Device Consortium, $500,000 a year for two years.
• Barbara Boyan, Ph.D. and the Atlanta Pediatric Consortium, $900,000 a year for two years.

“Congress provides FDA with this funding so that we can help connect innovators and their ideas to experienced professionals who can assist them through development,” said Debra Lewis, O.D., acting director of the FDA’s Office of Orphan Product Development. “Development of medical devices for children lags up to a decade behind similar devices used in adults.”

Children differ in terms of size, growth, and body chemistry and present unique challenges to device designers. In addition, the activity level and ability to manage some implantable or long-term devices may vary greatly among children. While this program is administered by the Office of Orphan Products Development, it is intended to encompass devices used in all pediatric diseases, not just rare diseases.

Legislation passed by Congress in 2007 established funding for grants to nonprofit groups to help stimulate projects to promote the development and availability of pediatric medical devices. These grants are meant to encourage the development of multiple pediatric device projects. While a small portion of the grants fund specific projects, the real spirit of this grant program is to provide information clearinghouses to promote multiple projects.

This is the second round of this type of biennial grants to be awarded. Those receiving these grants will:

  • encourage innovation and connect qualified individuals with good pediatric device ideas to potential manufacturers
  • mentor and manage pediatric device projects through their development, including prototype design and marketing
  • connect innovators and physicians to existing federal and non-federal resources
  • assess the scientific and medical merit of proposed pediatric projects and provide assistance and advice on business development, training, prototype development and post-marketing needs.

As part of the legislation, each of the grant recipients will coordinate among the FDA, device companies, and the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development to facilitate research and any necessary applications for device approval or clearance.

Past grant awardees have assisted in the development of devices to treat scoliosis, pediatric valvular heart disease, and projectile vomiting in newborns, among other diseases.

 

Source: FDA

Rotavirus Vaccine Leads to Lower Doctor Visits and Health Care Costs

Vaccinating infants against rotavirus has resulted in dramatic decreases in health care use and treatment costs for diarrhea–related illness in U.S. infants and young children, according to a new study by the Centers for Disease Control and Prevention. The study is published in the current issue of the New England Journal of Medicine.

“This is good news for parents and our health system overall,” said Dr. Umesh Parashar, medical epidemiologist and team leader for the Viral Gastroenteritis Team in CDC′s Division of Viral Diseases. “Rotavirus vaccine is one of the most effective ways to prevent severe diarrhea–related illness in young children and keep them healthy.”

Rotavirus is a major cause of severe diarrhea in infants and young children in the United States. Before vaccines were introduced in 2006, rotavirus was responsible for about 400,000 visits to doctor′s offices, 200,000 emergency room visits, 55,000 to 70,000 hospitalizations, and 20 to 60 deaths each year in children under 5 years old.

RotaTeq and Rotarix, the two U.S. licensed rotavirus vaccines, were 85 to 98 percent effective at preventing severe rotavirus disease in clinical trials in middle and high income countries, including the United States.

This new study used data from a large U.S. insurance database for 2001 to 2009 to assess rotavirus vaccine coverage and its impact on health care use and treatment costs for diarrhea–related illness in children under 5 years old. The study examined direct benefits to vaccinated children and indirect protective benefits to unvaccinated children. National declines in health care use and treatment costs were estimated by applying the declines seen in this study to children under 5 years old in the U.S population.

By the end of 2008, 73 percent of children under 1 year of age, 64 percent of 1–year–olds, and 8 percent of 2– to–4–year–olds had received at least one dose of rotavirus vaccine. Rotavirus–related hospitalizations decreased substantially compared with pre–vaccine levels in children under 5 years old—75 percent decline for 2007–2008 and 60 percent decline for 2008–2009.

Vaccinated children had 44 to 58 percent fewer diarrhea–related hospitalizations and 37 to 48 percent fewer emergency room visits for diarrhea than unvaccinated children during the 2008 and 2009 rotavirus seasons (January to June). Even in unvaccinated children, there were substantial declines in health care use during the 2008 rotavirus season compared with pre–vaccine levels—showing indirect protective benefits.

The study estimated that about 65,000 hospitalizations of children under 5 years old from 2007 to 2009 were averted nationally with a health care cost savings of about $278 million.

“This study provides more evidence that vaccinating against rotavirus substantially reduces suffering and health care costs for this common childhood illness,” said Dr. Mark Pallansch, director of CDC′s Division of Viral Diseases. “As more children get vaccinated against rotavirus, we expect to see even greater reductions in disease among all age groups.”

Source: CDC

Flu Prevention for Children and Teens – Report

Although children and teenagers rarely die from flu–related causes, many of the deaths could have been prevented if the children had been vaccinated against the flu, according to a report by the Centers for Disease Control and Prevention.

The study reports 115 influenza–associated deaths of people younger than 18, from September 2010 through August 2011 and highlights the importance of both annual vaccination and rapid antiviral treatment.

“It′s vital that children get vaccinated,” said Dr. Lyn Finelli, chief of the CDC′s Surveillance and Outbreak Response Team. “We know the flu vaccine isn′t 100 percent effective, especially not in children with high risk medical conditions. That′s why it′s essential that these two medical tools be fully utilized. Vaccinate first; then use influenza antiviral drugs as a second line of defense against the flu. Right now we aren′t fully using the medical tools at our disposal to prevent flu illnesses and deaths in children.”

The study in CDC′s Morbidity and Mortality Weekly Report provides details on the deaths. Since 2004, states have been required to report influenza-associated deaths in children and teenagers, giving the CDC a chance to look closely at factors that can increase risk.

Among the most notable findings was the infrequent use of the most important influenza prevention measure – vaccination. Despite a recommendation for vaccination of all children 6 months of age and older having been in place since 2008, only 23 percent of the 74 children older than six months with a known vaccination history had received their flu vaccine last season.

While many people believe that healthy children can withstand a bout of flu, this is not always the case. About half of the children who died last season were previously healthy and did not have a medical condition that would put them at risk for flu complications. However, the report underscores the fact that young age in itself is a risk factor. The report identified that 46 percent of the children who died were younger than 5 years and 29 percent were younger than 2 years.

The other half of the children who died did have a medical condition that predisposed them to being at greater risk of flu complications. Of 57 children with a medical condition, 54 percent had a neurological disorder, 30 percent had pulmonary disease, 25 percent had a chromosome or genetic disorder and 19 percent had congenital heart disease or other cardiac disease.

The report also identified issues with the use of antiviral drugs, which provide effective treatment for influenza. Of the 94 children who died in a hospital or emergency department, only 50 percent were prescribed antiviral drugs. Since the 2009 H1N1 pandemic especially, CDC has recommended immediate treatment with influenza antiviral medications in severely ill patients with suspected flu.

Another report in the Sept. 16 MMWR provides a summary of influenza activity from mid–May to the beginning of September. “If trends in that report continue,” Finelli says, “we should have a vaccine that will offer good protection against the viruses we expect will circulate this season.”

This season′s influenza vaccine protects against three influenza viruses, the 2009 influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. These are the same three flu virus strains that were circulating in 2010–2011 – just the eighth time since 1969 this phenomenon has occurred. Moreover, it is important to note that vaccine immunity wanes over time so CDC is recommending that everyone get vaccinated this season, even if they got vaccinated last season, in order to be optimally protected.

Source: CDC

Violence During Pregnancy Can Lead to Reduced Infant Birth Weight

Pregnant women who are assaulted by an intimate partner are at increased risk of giving birth to infants of reduced weight, according to a population-level analysis of domestic violence supported by the National Institutes of Health.

The study analyzed medical records of more than 5 million pregnant women in California over a 10-year period. Although the results showed a pattern of low-weight births among women who experienced an assault, the study was not designed to establish cause and effect, and so could not prove that violence caused the reduced birth weights. Similarly, the study was not designed to provide a biological explanation for how violence against an expectant mother might cause her child to be of lower birth weight.

Infants born to women who were hospitalized for injuries received from an assault during their pregnancies weighed, on average, 163 grams, or one-third pound, less than did infants born to women who were not hospitalized, the study found. Assaults in the first trimester were associated with the largest decrease in birth weight.

Infants born weighing less than 2,500 grams, or 5.5 pounds, are considered low birth weight and have an increased risk of death or of developing several health and developmental disorders. Low birth weight infants also are at greater risk for sudden infant death syndrome (SIDS) as well as breathing problems, cerebral palsy, heart disorders and learning disabilities. The study found that among infants born to mothers who had experienced an assault, about 15 percent weighed less than 2,500 grams at birth. This rate was higher than the rate of low birth weight infants among pregnant women who were hospitalized after a car crash or for other injuries (8 to 10 percent) and more than double the rate among women who were not hospitalized while pregnant (6 percent).

Although women’s education level, rates of smoking, and nutritional habits are known to affect birth weight, the study concluded that the lower birth weights seen in the study could not be accounted for by these factors and were most strongly linked to the violence itself.

“These findings suggest that violence experienced by pregnant women could put their infants at increased risk for low birth weight and its subsequent health problems,” said Rosalind B. King, Ph.D., of the Demographic and Behavioral Sciences Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute that funded the study. “It follows that programs to reduce violence against women might have the added benefit of reducing the number of low birth weight infants.”

The study was conducted by Anna Aizer, Ph.D., of Brown University, Providence, R.I. Her findings were published online in the Journal of Human Resources.

Using data collected between 1991 and 2002, Dr. Aizer compared the birth records in California to the records of pregnant women hospitalized in California as a result of injuries from assault.

She found that for every 100,000 women who gave birth in that period, 31 had been hospitalized for an injury from an assault while they were pregnant. Although these data did not distinguish between domestic violence and violence from other types of assault, previous research has shown that 87 percent of pregnant women with injuries were injured by an intimate partner.

The overall rate of assaults was 31 per 100,000 women. The study documented higher rates of assault among the poor (49.5 per 100,000), black women (157 per 100,000), and those without a high school education (39 per 100,000).

Dr. Aizer theorized that higher rates of violence among poor women might be a root cause of poor health and poverty that persists in some families from one generation to the next. A connection between violence during pregnancy, adult health, and future earnings is possible because all three factors are linked to low birth weight. Poor women are at greater risk for having low birth weight infants than are other women. In turn, when they reach adulthood, individuals born at low birth weight are at increased risk for such adult health problems as diabetes and heart disease. Also, when they reach adulthood, individuals born at low birth weight infants also earn less than their counterparts who were born at normal birth weight.

“The costs of violence against women may be borne not just by the victims but by the next generation as well,” said Dr. Aizer. “Given the importance of birth weight in determining adult education and income, these results suggest that the higher levels of violence experienced by poor women may also contribute to the intergenerational persistence of poverty.”

The American College of Obstetricians and Gynecologists has developed a slide presentation for physicians, advising them on how to screen patients for intimate partner violence, how to assess patients’ safety, and where to refer patients for additional help.

via Violence during pregnancy linked to reduced birth weight, September 8, 2011 News Release – National Institutes of Health (NIH).

Opioids in Early Pregnancy Doubles Risk of Birth Defects, Says Study

Babies born to women who take opioid pain killers such as codeine, oxycodone or hydrocodone just before or in early pregnancy are at increased but modest risk of birth defects, according to a study conducted by the Centers for Disease Control and Prevention.

The study, published in the American Journal of Obstetrics and Gynecology, found 2-3 percent of mothers interviewed were treated with prescription opioid pain killers, or analgesics, just before or during early pregnancy. The study did not examine illicit use of these medications. [Read more…]

Smoking While Pregnant Raises Risk of Infant Heart Defects by Up to 70%

Maternal cigarette smoking in the first trimester was associated with a 20 to 70 percent greater likelihood that a baby would be born with certain types of congenital heart defects, according to a study by the Centers for Disease Control and Prevention. Congenital heart defects are the most common type of birth defects, contributing to approximately 30 percent of infant deaths from birth defects annually.

The study found an association between tobacco exposure and certain types of defects such as those that obstruct the flow of blood from the right side of the heart into the lungs (right ventricular outflow tract obstructions) and openings between the upper chambers of the heart (atrial septal defects). The study is in the Feb. 28 issue of the journal Pediatrics. [Read more…]

Spina Bifida Complications Reduced by Surgery on Fetus

A surgical procedure to repair a common birth defect of the spine, if undertaken while a baby is still in the uterus, greatly reduces the need to divert, or shunt, fluid away from the brain, according to a recent study. The surgical procedure consists of closing an opening at the back of the fetal spine. The fetal surgery is a departure from the traditional approach, which involves repairing the defect in the spinal column after an infant has been born.
[Read more…]

Study Finds Succimer Ineffective for Removing Mercury as Autism Treatment

Succimer, a drug used for treating lead poisoning, does not effectively remove mercury from the body, according to researchers. Some families have turned to succimer as an alternative therapy for treating autism.

“Succimer is effective for treating children with lead poisoning, but it does not work very well for mercury,” said Walter Rogan, M.D., head of the Pediatric Epidemiology Group at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, and an author on the paper that appears online in the Journal of Pediatrics.

“Although it is not approved by the Food and Drug Administration to reduce mercury, succimer is reportedly being used for conditions like autism, in the belief that these conditions are caused, in part, by mercury poisoning,” Rogan stated. “Our new data offers little support for this practice.”

Although researchers found that succimer lowered blood concentrations of mercury after one week, continued therapy for five months only slowed the rate at which the children accumulated mercury. The safety of higher doses and longer courses of treatment has not been studied.

Most mercury exposure in the United States is from methylmercury, found in foods such as certain fish. Thimerosal, a preservative once more commonly used in vaccines, contains another form of mercury, called ethylmercury.

To conduct the study, the researchers used samples and data from an earlier clinical trial, led by NIEHS, called the Treatment of Lead-exposed Children (TLC) trial. In the TLC study, succimer lowered blood lead in 2-year-old children with moderate to high blood lead concentrations.

Using blood samples from 767 children who participated in the TLC trial, the researchers measured mercury concentration in the toddlers’ blood samples collected before treatment began, one week after beginning treatment with succimer or placebo, and then again after three month-long courses of treatment. Mercury concentrations were similar in all children before treatment. Concentrations eventually increased in both groups, but more slowly in the children given succimer. Succimer had produced a 42 percent difference in blood lead, but only an 18 percent difference in blood mercury.

“Although succimer may slow the increase in blood mercury concentrations, such small changes seem unlikely to produce any clinical benefit,” Rogan said. He and his colleagues had reported in an earlier paper that succimer has few adverse side effects, mostly rashes, and an unexplained increase in injuries in children given succimer rather than placebo.

The subjects of the study did not have unusually high blood mercury concentrations for African-American children and the study did not investigate where the mercury in the children came from.

“This research fills a gap in the scientific literature that could not be addressed any other way. We were fortunate to have samples already collected from toddlers who had been treated with succimer for lead poisoning allowing us to help answer this important question,” said Linda Birnbaum, Ph.D., director of NIEHS and the National Toxicology Program.

Reference: Cao Y, Chen A, Jones RL, Radcliffe J, Dietrich KN, Caldwell KL, et al. 2010. Efficacy of Succimer Chelation of Mercury at Background Exposures in Toddlers: A Randomized Trial. J Pediatr. Epub ahead of print. DOI:10.1016/j.jpeds.2010.08.036.

Source: National Institutes of Health (NIH), October 22, 2010

Body Cooling Treatment Studied for Pediatric Cardiac Arrest

Blanketrol mattress and blanket used for body cooling.

The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, has launched the first large-scale, multicenter study to investigate the effectiveness of body cooling treatment in infants and children who have had cardiac arrest. The Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials total more than $21 million over six years.

Therapeutic hypothermia, or body cooling, has been successfully used in adults after cardiac arrest and in newborn infants after birth asphyxia, or lack of oxygen, to improve survival and outcomes, but it has not been studied in infants or children who have had cardiac arrest.

“Children who have experienced cardiac arrest can suffer long-term neurological damage or death,” said NHLBI Acting Director Susan B. Shurin, M.D., a board-certified pediatrician. “There are abundant data demonstrating the benefits of hypothermia in adults with cardiac arrest, but very limited experience in children. This study begins to assess the effectiveness of therapeutic hypothermia in children, and should lead to evidence-based guidelines that will optimize both quality and rates of survival.”

During body cooling treatment, THAPCA participants lie on mattresses and are covered with blankets. Machines circulate water through the blankets and mattresses to control the participants’ body temperatures. Researchers do not yet know how body cooling will affect participants, since many factors can contribute to brain injury after cardiac arrest. However, they believe body cooling could provide several benefits, including less inflammation and cell death.

According to a 2008 review of pediatric cardiopulmonary resuscitation in the journal Pediatrics, about 16,000 children suffer cardiac arrest each year in the United States. Their hearts stop pumping effectively, and blood stops flowing to their brains and other vital organs. In many cases, the outcome is death or long-term disability.

Cardiac arrest in infants and children has many causes, such as strangulation, drowning, or trauma. It can also be a complication of many medical conditions.

“Our goal is to minimize brain injury in infants and children who experience cardiac arrest and ultimately improve survival rates,” said co-principal investigator J. Michael Dean, M.D., M.B.A., professor of pediatrics and chief of the Division of Pediatric Critical Care Medicine at the University of Utah School of Medicine, Salt Lake City.

The THAPCA centers enroll participants in one of two randomized, controlled clinical trials. One evaluates participants who suffered cardiac arrest outside the hospital, while the other evaluates participants who suffered cardiac arrest in the hospital. Within each trial, there are two active treatment groups: therapeutic hypothermia (cooling the patient to 89.6-93.2 Fahrenheit) and therapeutic normothermia (maintaining the patient at 96.8-99.5 Fahrenheit). Both trials are trying to reduce fever, which commonly occurs after cardiac arrest and can lead to more severe outcomes.

“These trials are addressing the question: What is the optimal temperature for an infant or child after cardiac arrest?” said co-principal investigator Frank W. Moler, M.D., M.S., a professor in the Department of Pediatrics and Communicable Diseases at the University of Michigan, Ann Arbor. He added that in previous studies exploring therapeutic hypothermia, the comparison or control groups did not receive therapeutic normothermia to prevent fever.
Woman lying on a Blanketrol mattress and blanket used for therapeutic hypothermia.
Blanketrol mattress and blanket used for therapeutic hypothermia.

Participants in the THAPCA trials must be older than 48 hours and younger than 18 years and must be enrolled in the study within six hours of suffering cardiac arrest. Once a parent or guardian provides consent, the participant is randomly assigned to one of the two treatment groups. The therapeutic hypothermia group in each trial receives the hypothermia treatment for two days and then normothermia treatment for three days, which ensures that the body temperature is kept within a normal temperature range. The patients in the therapeutic normothermia groups receive normothermia treatment for all five days.

After the five-day period, the clinical care team will continue to provide study participants with optimal medical care. Participants will undergo neurological and behavioral testing a year after the cardiac arrest.

The THAPCA trials involve 34 clinical centers in the United States and Canada. The C.S. Mott Children’s Hospital at the University of Michigan serves as the lead clinical center, while the data coordinating center is based at the University of Utah School of Medicine.

Source: NIH, October 19, 2010