Baby Survives With Heart Outside Of Chest

Editor's Choice
Main Category: Pediatrics / Children's Health
Also Included In: Heart Disease
Article Date: 28 Jan 2013 - 21:00 PST

Audrina Cardenas has certainly defied odds as she was finally being discharged from Texas Children's Hospital. The 3 month old baby was born with an extremely rare condition called ectopia cordis, which means she was born with her heart outside of her chest. She received her life-saving surgery in October and is now at home.

Ectopia cordis is a very uncommon congenital malformation which results in the heart developing either partially or completely outside the body, it only affects approximately eight in every million babies. Sadly, most infants who are born with the condition die within the first few days of life.

A multidisciplinary team of surgeons carried out a very risky surgical procedure to repair Audrina's heart immediately after she was born. She proved to be quite the survivor as she came out of the operation alive and well.

Dr. Charles D. Fraser, surgeon-in-chief at Texas Children's Hospital and professor of surgery and pediatrics at Baylor College of Medicine (BCM), said:

''

"This risky operation on such an uncommon condition required specialists from a variety of care teams including cardiovascular surgery, plastic surgery and general pediatric surgery. I have only seen this condition a few times in my career and these are always very tricky cases; in fact, many of these babies do not survive."

He added:

"If Audrina would not have been referred to a facility like ours that could provide this full spectrum of care from managing her in-utero to immediate heart surgery after birth, she would not be here today. Audrina is a true fighter and we are so excited that this was a good outcome."

Audrina's mother Ashley Cardenas found out about her child's condition sixteen weeks into her pregnancy. Her doctors told her that she could either choose comfort care, terminate the pregnancy, or have her child receive an extremely risky surgery immediately after birth. Cardenas opted for the surgery as it was in the best interest for her child's survival.

Cardenas said:

"After my doctors explained just how sick my baby was and what options I had, it didn't matter how scared I was, I knew I had to do anything possible to save my daughter's life. As soon as I made my decision to continue with the pregnancy, the physicians in Midland referred me to Texas Children's Hospital where a team of miracle workers provided the specialized treatment and care my baby and I both needed."

The doctors made an external chest shield to protect her heart as it continues to grow, in a few years she will have another surgery to place something even more protective and permanent. The cardiology team at Texas Children's Hospital will consistently check up on her progress.

Written by Joseph Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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GP Judgement Not Enough To Accurately Diagnose Cases Of Pneumonia

Main Category: Respiratory / Asthma
Also Included In: Primary Care / General Practice
Article Date: 23 Jan 2013 - 16:00 PST

Pneumonia cannot be accurately diagnosed solely on a doctor's analysis of symptoms and patient history, according to new findings.

A new study, published online today ahead of print in the European Respiratory Journal, found that a majority of pneumonia cases could not be accurately diagnosed by a doctor's judgement alone, compared to a chest radiograph.

The major symptoms of pneumonia include acute cough and other lower respiratory tract symptoms, such as shortness of breath. Most people showing these symptoms are diagnosed with acute bronchitis, and only a minority with pneumonia. These conditions are treated very differently; pneumonia usually requires antibiotic treatment, whereas acute bronchitis does not. An accurate diagnosis is therefore essential.

Most doctors are required to diagnose pneumonia based on a patient's medical history and physical examination, as a chest radiograph is not feasible for every patient who displays these symptoms. However, it is largely unknown how accurate this method of diagnosis is.

To test this method, researchers analysed 2,810 patients across 12 European countries. Each patient had an acute cough and their attending doctor was asked whether pneumonia was present after looking at the patient's signs and symptoms. All patients then received a chest radiograph by a different medical professional.

Out of the total study, 140 patients were diagnosed with pneumonia after a chest radiograph. Out of this group, 29% had been correctly diagnosed by their doctor as having pneumonia. Only 31 patients (1%) were incorrectly diagnosed as having pneumonia from an initial assessment that was later disproved by the chest radiograph. In patients without a doctor's diagnosis of pneumonia, 96% indeed had no pneumonia after chest radiography.

The researchers concluded that doctors accurately excluded pneumonia. However, the majority of radiographically confirmed cases of pneumonia were not identified.

Lead researcher, Saskia van Vugt, from Utrecht Julius Center for Health Sciences and Primary Care, in the Netherlands, said: "The results of the study are encouraging to some extent as the findings might support physicians to rely more on their ability to correctly exclude pneumonia which might result in better targeted antibiotic prescriptions. However, a majority of the pneumonia cases in this study were not picked up by an initial assessment alone.

"Tests that could support a doctor's ability to detect or exclude pneumonia are urgently needed. We should also remember that GPs tell patients to revisit them if symptoms get worse or persist, as a 'safety net' for initially missed cases.

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'Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography', SF van Vugt, Th JM Verheij, PA de Jong, CC Butler, K Hood, S Coenen, H Goossens, P Little, BDL Broekhuizen, on behalf of the GRACE Project Group
European Respiratory Journal. DOI: 10.1183/09031936.00111012 Please use one of the following formats to cite this article in your essay, paper or report:

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Anti-Depressants In Pregnancy Not Linked To Stillbirth And Infant Deaths

Editor's Choice
Academic Journal
Main Category: Pregnancy / Obstetrics
Also Included In: Depression
Article Date: 02 Jan 2013 - 11:00 PST

A pregnant woman taking anti-depressant SSRI (selective serotonin reuptake inhibitor) drugs does not have an increased risk of stillbirth or infant mortality.

The finding was published in JAMA and came from new research involving almost 30,000 females from Denmark, Finland, Iceland, Norway and Sweden who were taking SSRI drugs during pregnancy.

The researchers found no notable link between SSRI drug use and risk of neonatal death, postneonatal death, or stillbirth, even after controlling for variables such as maternal psychiatric disease.

On the other hand, prior research demonstrated that kids have a higher chance of being born with high blood pressure in the lungs if the mother was taking anti-depressants during pregnancy, and a different study, published in The Lancet, indicated that children whose moms were taking SSRI drugs during pregnancy may be born with withdrawal syndrome.

Backround information in the report stated:

"Depression during pregnancy is common with prevalences ranging between 7 percent and 19 percent in economically developed countries. Maternal depression is associated with poorer pregnancy outcomes, including increased risk of preterm delivery, which in turn may cause neonatal morbidity and mortality.

Use of selective serotonin reuptake inhibitors during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown."

The team of experts, led by Olof Stephansson, M.D., Ph.D., of the Karolinska Institutet, Stockholm, Sweden, set out to analyze whether a pregnant woman taking SSRI drugs has a higher chance of neonatal death, stillbirth, and postneonatal death.

The women observed in the study had single births between 1996 and 2007. The information on their SSRI drug use was gathered from prescription registries. Patient and medical birth registries were used to obtain information on pregnancy, maternal characteristics, and neonatal outcomes.

The relative risks of neonatal death, postneonatal death, and stillbirth linked to SSRI exposure during pregnancy were approximated by the scientists, while adjusting for variables including prior psychiatric hospitalization and maternal characteristics.

Results showed that out of the 1,633,877 births examined, there were 3,609 neonatal deaths, 1,578 postnatal deaths, and 6,054 stillbirths. There were 1.79% (29,228) of women who were taking SSRI drugs during pregnancy.

The team discovered that mothers who took an SSRI had higher rates of stillbirth (4.62 vs. 3.69 per 1000) and postneonatal death (1.38 vs. 0.96 per 1000) compared to subjects who were not exposed.

The SSRI group and the group who was not exposed to the drugs had similar rates of neonatal death (2.54 vs. 2.21 per 1000). "Yet in multivariate models, SSRI use was not associated with stillbirth, neonatal death, or postneonatal death. Estimates were further attenuated when stratified by previous hospitalization for psychiatric disease," the researchers said.

The authors concluded:

"The present study of more than 1.6 million births suggests that SSRI use during pregnancy was not associated with increased risks of stillbirth, neonatal death, or postneonatal death. The increased rates of stillbirth and postneonatal mortality among infants exposed to an SSRI during pregnancy were explained by the severity of the underlying maternal psychiatric disease and unfavorable distribution of maternal characteristics such as cigarette smoking and advanced maternal age.

However, decisions regarding use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness."

Written by Sarah Glynn
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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"Selective Serotonin Reuptake Inhibitors During Pregnancy and Risk of Stillbirth and Infant Mortality
Olof Stephansson, MD, PhD; Helle Kieler, MD, PhD; Bengt Haglund, PhD; Miia Artama, PhD; Anders Engeland, PhD; Kari Furu, PhD; Mika Gissler, PhD; Mette Nørgaard, MD, PhD; Rikke Beck Nielsen, MSc; Helga Zoega, PhD; Unnur Valdimarsdóttir, PhD
JAMA, January 2013, doi:10.1001/jama.2012.153812. Please use one of the following formats to cite this article in your essay, paper or report:

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