“UAB-Led Study Shows Simple Steps Could Reduce Stillbirths by up to 1 Million (The University of Alabama at Birmingham)” plus 3 more

UAB-Led Study Shows Simple Steps Could Reduce Stillbirths by up to 1 Million (The University of Alabama at Birmingham)
February brings study skills workshops in Florham Park (Florham Park Eagle)
CRC to get groin study (Carteret County News-Times)
Non-embryonic stem cells limited, UW study finds (Dunn County News)

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UAB-Led Study Shows Simple Steps Could Reduce Stillbirths by up to 1 Million (The University of Alabama at Birmingham)

Posted: 17 Feb 2010 02:11 PM PST

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February 17, 2010

BIRMINGHAM, Ala - New findings in a study led by the director of the University of Alabama at Birmingham (UAB) Division of Neonatology show that that training birth attendants in essential newborn-care techniques reduced stillbirths by more than 30 percent - and potentially could save as many as 1 million lives worldwide each year.

Ninety-eight percent of the 3.7 million neonatal deaths and 3.3 million stillbirths each year occur in developing countries. This project, spearheaded by UAB's Waldemar A. Carlo, M.D., was designed to train birth attendants, including doctors, midwives, nurses and traditional birth attendants, in communities and hospitals in 96 communities worldwide. The findings were published in the Feb. 18 edition of the New England Journal of Medicine.

"The birth attendants were trained to do several easy steps that are critical for babies to survive at birth and be kept alive through the first week of life," said Carlo, the lead author who worked with a large group of American and international colleagues. "We selected the World Health Organization course on essential newborn care because it contains what we believed are the essential interventions necessary to sustain life in many infants and created an educational package that included interventions that could be used by any birth attendant anywhere in the world."

Using the train-the-trainer model, local instructors trained birth attendants from rural communities in Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan and Zambia. They used the World Health Organization (WHO) newborn-care course (routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of the small baby and common illnesses) and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation).

The goal was to see if training birth attendants to use these interventions would reduce perinatal and neonatal mortality in the first week of life in infants weighing at least 1500 grams in rural communities in developing countries.

"Major global causes of perinatal mortality are birth asphyxia and low birth weight/prematurity," Carlo said. "We wanted to find out if these low-cost interventions, including neonatal resuscitation training and kangaroo care, effectively reduced deaths from these causes worldwide. A preliminary smaller study in Zambia has shown that improved skill and knowledge in birth attendants in perinatal care reduced neonatal mortality."

Kangaroo care is a technique used on a newborn, usually a preterm infant, wherein the infant is held, skin-to-skin, with an adult. It is used to provide closeness of the newborn with mother and/or father to ensure physiological and psychological warmth and bonding. The kangaroo position also provides ready access to nourishment. The mother's body responds to the needs of the infant directly, helping regulate the infant's body temperature more smoothly than an incubator; her milk adjusts to the nutritional and immunological needs of her fragile infant, and the baby sleeps more soundly.

The train-the-trainer program used various teaching methods, including clinical practice sessions and demonstrations for the trainers. Carlo and his colleagues also developed instructions on the essential techniques with visual cues to assist birth attendants who could not read. The essential newborn-care intervention was assessed with a before-and-after design. The neonatal resuscitation program intervention was assessed as a cluster randomized control trial.

The stillbirth rate decreased significantly for nurses/midwives and traditional birth attendants following essential newborn care training. The stillbirth rate also decreased among home deliveries. There was not a significant decrease in all-cause first week mortality or stillbirth for those using the in-depth neonatal resuscitation program.

Carlo said it is plausible that the observed reduction in stillbirths may be due to essential newborn-care training. Live-born infants without obvious signs of life may have been misidentified as stillbirths before this training; such misclassifications have been reported in the literature. After training, resuscitation was more likely, and stillbirths decreased.

Carlo added that though the data show that training in basic neonatal care has an important role in improving perinatal outcomes in the developing world, more scaled-up research is needed to prove that the training reduces mortality in other health-care systems.

"A package of essential newborn-care interventions, if implemented worldwide, might decrease perinatal deaths by about 1 million per year," he said.

About the UAB Department of Pediatrics and Division of Neonatology

The UAB Department of Pediatrics and UAB Division of Neonatology, together with Children's Hospital of Alabama, operate the state's only Level IIIC Regional Neonatal Intensive Care Unit (RNICU) and provide the state's highest level and most comprehensive care for well newborns and preterm and term babies with medical conditions. In addition to the RNICU, UAB also is home to a Continuing Care Nursery (CCN), providing extended step-down care for premature infants and infants with medical conditions. UAB is one of the original eight National Institute of Child Health and Human Development (NICHD) research sites commissioned in 1986 and is the only facility in the country that is involved in all three of the NIH research initiatives for maternal, child and family health, the Neonatal Research Network, Maternal-Fetal Medicine Units Network and the Global Network for Women and Children Research.

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February brings study skills workshops in Florham Park (Florham Park Eagle)

Posted: 17 Feb 2010 08:11 PM PST

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CRC to get groin study (Carteret County News-Times)

Posted: 17 Feb 2010 05:53 PM PST

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Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction.

Non-embryonic stem cells limited, UW study finds (Dunn County News)

Posted: 17 Feb 2010 05:17 AM PST

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Non-embryonic stem cells limited, UW study finds

No comments posted.

Wednesday, February 17, 2010 7:07 AM CST

DAVID WAHLBERG
dwahlberg@madison.com

A new kind of stem cells, which don't involve the destruction of embryos, can't turn into brain cells as well as embryonic stem cells can, a UW-Madison study found.

Induced pluripotent stem cells, discovered in 2007 in part by campus scientists James Thomson and Junying Yu, can morph into several types of brain cells. But they don't do so as consistently or efficiently as embryonic stem cells, which Thomson was the first to create, in 1998.

The findings, by campus neuroscientist Su-Chun Zhang, raise questions about how useful induced stem cells are for researching diseases and developing cell therapies. But the limitations of the cells can probably be overcome, Zhang said.

"At this point, there is still some work to be done to generate ideal induced pluripotent stem cells for application," he said in a news release.

Zhang's study, with fellow researcher Baoyang Hu, is published in this week's edition of the journal Proceedings of the National Academy of Sciences.

Both kinds of stem cells offer promise for medical research because of their capacity to become all of the body's 220 cell types. Scientists are using the cells to create models of diseases in the lab and develop potential therapies for Parkinson's disease, diabetes, spinal cord injuries, heart disease and other conditions.

The induced stem cells, also discovered by a competing team led by Japanese researcher Shinya Yamanaka, have been considered more promising than embryonic stem cells for two main reasons.

They are made by reprogramming skin or other cells back to their embryonic state, not by creating or destroying embryos, so the cells appease ethical concerns.

The induced stem cells also can be made from a patient's own cells, potentially reducing the risk of rejection when delivering therapies made from the cells.

But whether induced stem cells are as good as embryonic stem cells at becoming heart, kidney, pancreas, brain and other kinds of cells hasn't been shown.

Based on Zhang's study, induced stem cells aren't yet up to the job, at least regarding brain cells.

The study looked at how well a dozen groups of induced stem cells and five groups of embryonic stem cells became brain cells.

The induced stem cells didn't perform as well as the embryonic stem cells. That was true even for induced stem cells created without reprogramming genes, which had been thought to be the main barrier.

It has taken years for scientists to find ways to better grow embryonic stem cells, and it will also take some time to perfect the development of induced stem cells, the study suggests.

"It tells us the techniques for generating induced pluripotent stem cells are still not optimal," Zhang said. "There is room for improvement."

Study Techniques

Wednesday, February 17, 2010