Health Tip: Sleep Positions While You're Pregnant

As your pregnancy progresses, sleeping may become a little more uncomfortable each month.The American Pregnancy Association offers these suggestions to help you sleep more comfortably during pregnancy:

* Try sleeping on your side -- particularly your left side, if it's comfortable. Bend your knees, and place a pillow between your knees.
* Also try a pillow under your belly, for support.
* If heartburn bothers you, prop up your upper body with pillows.
* If you feel short of breath, lie on your side or propped up with pillows.
* You should avoid sleeping on your back and on your stomach during pregnancy.

Childhood eczema tied to asthma risk later

Children with the allergic skin condition eczema are at increased risk of developing asthma well into adulthood, according to a decades-long study.Australian researchers found that among nearly 8,600 study participants followed from the age of 7, those who'd had childhood eczema were roughly twice as likely to develop asthma by middle-age.

It's not clear whether the eczema directly contributed to asthma development in these cases. However, the findings do suggest a cause-and-effect relationship between the two conditions, according to the researchers, led by Dr. John A. Burgess of the University of Melbourne.

They report the results in the Journal of Allergy and Clinical Immunology.

The findings come from a study that began in 1968, when parents of 8,583 7-year-old children in Tasmania were surveyed about their children's health. The children also had a medical exam. At that time, 769 were found to have eczema.

The researchers found that children with eczema were twice as likely as their peers to develop asthma as teenagers, and 63 percent more likely to develop the lung condition as adults.

Other researchers have noted a phenomenon dubbed the "atopic march," which refers to the sequential development of eczema, followed by nasal allergies and finally asthma. The current findings, Burgess and his colleagues write, suggest that this march continues on well past childhood.

It's also possible that eczema directly contributes to asthma development, the researchers say. One theory is that certain immune system cells, primed for an allergic response, might migrate from an eczema patient's skin to tissue of the airways. That could make their airways more likely to inflame in response to an inhaled allergen, leading to asthma symptoms.

"Our data suggest that a causal link is possible," Burgess told Reuters Health.

"If in fact the link was causal," he added, "then aggressive treatment of childhood eczema aimed at really tight control of that disease might have an impact on the development of asthma in adolescence and in adult life."

SOURCE: Journal of Allergy and Clinical Immunology, August 2008.

Health Tip: Don't Do Your Child's Homework

A proper home atmosphere for doing homework is important for learning and keeping up in school.The Nemours Foundation offers these suggestions:

* Create an area at home just for homework. It should be well-lit, with all of the supplies that your child needs.
* Set aside a certain time every day -- such as before a snack or after dinner -- to study and do homework.
* Minimize distractions during homework time, including music, television and phone calls.
* Don't do your child's homework. The child won't learn from mistakes if they're yours. But offer help when needed. Praise your child for doing well and trying hard.
* Be involved in your child's school work, and set a good example by reading and working at home, too.

Insurance Matters When It Comes to Kids' Health Care

Insured children in the United States are much more likely than uninsured children (91 percent vs. 69 percent) to visit a doctor's office and to have a regular annual check-up (77 percent vs. 45 percent), according to new data released Thursday by the Robert Wood Johnson Foundation.

The study, conducted by University of Minnesota researchers who analyzed U.S. Centers for Disease Control and Prevention data from 2005-07, also found that:

* About 10 million American children have chronic illnesses and 3.6 million of those children are covered by Medicaid or the State Children's Health Insurance Program (SCHIP). Chronically ill children covered by public insurance receive the same level of health services as those with private insurance, but chronically ill children with no insurance receive far less care.
* Uninsured children with chronic needs are far more likely (41 percent) to have their care delayed or to receive no care, compared to insured children with chronic needs (10 percent).
* Eight percent of children with chronic health conditions enrolled in SCHIP or Medicaid don't have a personal doctor, compared to 21 percent of uninsured children.
* Sixteen percent of children with special needs who are enrolled in SCHIP or Medicaid don't receive mental health care services, compared to 43 percent of uninsured children.

The findings highlight the importance of government insurance programs such as Medicaid and SCHIP, the study authors said.

"SCHIP and Medicaid provide an important safety net for America's families, especially for families with chronically ill children. These programs allow kids to get the care they need, so they can feel better, grow stronger and thrive in school," Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a news release.

"When children who need care do not receive it, their conditions worsen and are harder and more expensive to treat later. Because of Medicaid and SCHIP, millions of kids can get regular check-ups, take the medications they need to stay well and see a doctor when they are sick. Parents of any uninsured child should find out if their family is eligible for low-cost or free insurance before sending their kids back to school," Lavizzo-Mourey added.

Currently, more than nine million children in the United States are uninsured, according to U.S. Census Bureau data. Most uninsured children live in families where at least one parent works full-time.

Childhood Dairy Intake Boosts Bone Health Later On

Having two or more servings of dairy products a day starting as a preschooler may lead to better bone health as an adolescent, a new report says.The study, expected to be published in The Journal of Pediatrics, found higher levels of bone mineral content and bone density in teens who consumed dairy at least twice a day since the ages of 3 to 5. These adolescents' average bone mineral content was 175 grams higher than adolescents who had consumed less than two dairy servings a day, even after researchers adjusted the results for factors that affect normal bone development, such as the child's growth, body size, and activity level.

The study highlights the significant role dairy plays in childhood as "a key source of proteins, calcium, and other micronutrients including phosphorus and vitamin D," study researcher Lynn Moore, of Boston University School of Medicine, said in a news release issued by the journal.

The researchers also found that children who combined their 2 or more servings of dairy with 4 ounces of meat or other nondairy protein during a day had bone mineral contents more than 300 grams higher than those children with lower intakes of both dairy and other proteins.

The findings come from analyzing data and family food diaries from the Framingham Children's Study, which gathered information from 106 children, 3 to 5 years of age at the beginning of the study, over a 12-year period. Information from the U.S. Department of Agriculture was also used to determine the children's average daily intake of dairy and other foods.

Kids' Obesity Linked to Ear Infections

Damage caused by chronic ear infections in children may alter their sense of taste, making fatty and sweet foods more desirable and increasing the risk of obesity.That's the conclusion of four new studies presented Thursday at the American Psychological Association's annual meeting in Boston.

In the first study, Kathleen Daly, a professor of otolaryngology at the University of Minnesota, found that "middle ear nerve damage may play a role in affecting taste in children with recurrent ear infections or chronic ear disease who get [drainage] tubes. This damage may increase intake of fattening foods."

For the study, Daly's team followed children from birth to 2 years of age who had been treated with tubes for ear infections.

"There was a trend, but not significant, for recurrent ear infection to lead to overweight," Daly said. "Other studies have reported a similar relationship between ear infections and overweight. We did not find evidence for the reverse hypothesis: larger and heavier children were more prone to ear infections and tubes than smaller and lighter children."

In the second study, led by John Hayes of Brown University, researchers found that among 110 middle-aged women with a sense of taste consistent with nerve damage, those who preferred sweet and high-fat foods tended to have larger waists.

"Surprisingly, we found that the single best predictor of body weight was not how much saturated fat they took in and not how often they ate high-fat foods, but was how much they liked high-fat and sweet foods," Hayes said.

Hayes noted that taste can vary genetically, but also through exposure to environmental changes. "Particularly with damage to the taste system and we think this happens from ear infections," he said.

Another study by Hayes' group found that preschoolers with a history of severe ear infections ate fewer vegetables, more sweets and tended to be heavier.

In the third study presented Thursday, led by Howard Hoffman, an epidemiologist at the U.S. National Institute on Deafness and Other Communication Disorders, researchers found that removing the tonsils had an effect on whether children would be overweight.

"Taste does have an impact on selection of food and diet," Hoffman said. "A tonsillectomy may damage one of the nerves that carry taste information. In addition, ear infections can also alter taste. Altering taste does have an effect on the preferences for food," he said.

Hoffman's team reexamined data on 13,887 children who took part in the National Health Examination surveys during the 1960s. The researchers found that children who had had their tonsils removed were at greater risk of being overweight. Among children aged 6 to 11 who'd had a tonsillectomy, they were 40 percent more likely to be overweight at the time of the survey, compared with children who did not have a tonsillectomy.

What's more, teenage girls who'd had a tonsillectomy were 30 percent more likely to be overweight, the researchers found. Hoffman noted that tonsillectomies were a common treatment back in the 60s for chronic ear infections, which can alter the taste buds and affect eating habits.

"This data is not conclusive, but it's suggestive," he said.

In the final study, Linda Bartoshuk, of the University of Florida College of Dentistry, and colleagues collected data on 6,584 people who attended a lecture series. These men and women, between 16 and 92 years old, were asked about their history of ear infections. The researchers found that those with a history of moderate to severe ear infections were 62 percent more likely to be obese.

Dr. David L. Katz, director of the Yale University School of Medicine Prevention Research Center, thinks that alteration in taste only plays a small part in the overall obesity epidemic in the United States.

"It certainly makes sense that variations in taste, due to many factors including a history of ear infections, could influence food preferences, total food intake and weight," he said.

However, despite variation in taste perception, variation in dietary preference, and variation in the history of ear infections, researchers have projections forecasting all but universal obesity among U.S .adults within several decades should current trends persist, Katz noted.

"So while the link between taste buds and vulnerability to obesity is worthy of further exploration, the simple fact is that the entire population is vulnerable to obesity," Katz said. "The major causes of the obesity epidemic reside in the 'obesigenic' environment, rather than on our tongues."

Early monitoring for infant skin tumors needed

The rapid growth of reddish skin tumors called infantile hemangiomas requires close observation in the first months of life, according to a report in the journal Pediatrics. Treatment should be undertaken promptly.

Infantile hemangiomas are non-cancerous tumors that can grow rapidly during infancy, but usually resolve by 9 years of age. Hemangiomas are the most common tumors in infants and, aside from cosmetic concerns, most have no medical significance.

"Not all hemangiomas need treatment -- actually the majority does not -- but a significant minority does," Dr. Ilona J. Frieden told Reuters Health. "So the real message of our study is that patients with hemangiomas that are at high-risk for complication or need...treatment should be identified early and referred as soon as possible."

Frieden from the University of California, San Francisco, and colleagues determined the specific growth characteristics of hemangiomas in 433 infants with a total of 526 hemangiomas.

"Eighty percent of hemangioma size was reached" by 5 months of age in most cases, the researchers report, and overall growth was nearly always completed by 9 months of age.

During the first 18 months of life, hemangiomas affecting only the upper layers of skin were more likely to start resolving, whereas deeper hemangiomas were more likely to continue growing.

Though parents noticed most hemangiomas within 1 month of age, the investigators say, the infants were 5 months of age, on average, when they were first taken to a dermatologist.

Most hemangiomas reached 80 percent of their maximum size by the tine the infants were 5 months old, suggesting that physicians need to start referring affected infants to specialists earlier in life, the authors conclude.

"One major reason for this is that current treatments work best when instituted early," Frieden said. "By 5 months of age the majority of growth is actually over and the opportunity to prevent complications in many cases has already passed."

SOURCE: Pediatrics, August 2008.

Poor Coordination in Childhood Tied to Adult Obesity

A lack of physical control and coordination in childhood may be tied to an increased risk of obesity in later life, a new study says.he research, published online at BMJ.com Wednesday, adds to previous studies that found poorer cognitive function in childhood may be linked to obesity and type 2 diabetes in adults.

The findings, based on 11,041 individuals in the ongoing National Child Development Study in Great Britain, showed that children who showed poor hand control, poor coordination, and clumsiness at age 7 in testing were more likely to be obese adults. Those with poorer functioning motor skills at age 11 also tended to be obese at age 33.

Adjusting for factors that may influence the results, such as childhood body mass and family social class, did not change the results. However, the study did not delve into specific biological processes that may explain poorer physical control and coordination in childhood with adult obesity.

"Some early life exposures (such as maternal smoking during pregnancy) or personal characteristics may impair the development of physical control and coordination, as well as increasing the risk of obesity in later life," the authors, from Imperial College London and Orebro University Hospital & Karolinska Institute in Stockholm, wrote.

"Rather than being explained by a single factor, an accumulation throughout life of many associated cultural, personal, and economic exposures is likely to underlie the risks for obesity and some elements of associated neurological function," they concluded.

Your Child Is Fat

School children across England will soon have their Body Mass Index (BMI) tested as part of a new effort to tackle the growing problem of childhood obesity. Parents will be sent a letter telling them whether their child is underweight, a healthy weight, overweight or very overweight. The letter will also include leaflets giving advice on eating healthily, physical activities their child might do and the risks of being overweight.So, are parents really failing to notice their little angels piling on the pounds? Yes, says the U.K.'s Department of Health. "Today, when more children are overweight compared with previous generations, it can be harder for parents to objectively identify if their child is overweight," says a spokeswoman from the Department of Health. "Research shows that most parents of overweight or obese children think that their child is a healthy weight. Some research showed that only 10% of parents with overweight or obese children described their child as overweight."

Still, it pays to break the news of a child's problem gently. Following the advice of numerous obesity experts, the Department of Health has decided that the name of the final, portliest category - very overweight - was a more sensible choice than obese. "Preliminary findings of the survey suggest that many people who would be defined clinically as obese find the use of the term obese highly offensive and would stop listening to further advice."

The softly-softly approach doesn't please everyone. "To shrink from using the word obesity is really ducking an issue," insists Dr Colin Waine, Chairman of the National Obesity Forum. "It does not have to be used in a judgmental or insulting way: if a child is obese then the parents should know that its obese. We must make parents know that the lifestyle of the family needs to be modified."

Statistics on childhood obesity in Britain make grim reading. Figures from 2006, the most recent numbers, show that nearly a third of all children aged between two and 15 are overweight or obese, an overall increase of 11% from 1995.

The U.K. childhood obesity rate is comparable to that in the U.S., where obesity in children aged between six and 11 has tripled over the past three decades, which may be why a few U.S. states already send reports on heavy kids home to parents. The College of Natural Resources at the University of California, Berkeley, published a paper in November 2006 describing the "risks and benefits of BMI reporting in the school setting", and in May 2007, Wyoming started a program in which students' report cards came complete with their BMI.

Some worry that such information should be given more discreetly: "Our feeling is that the information should be given to parents if there is a serious health concern much like any other health concern a child might have," said Meghan Cavanaugh, a spokeswoman at the Childhood Weight Control Program, the University of Buffalo. "This information should not be included on a report card or such. Medical information should be kept separate."

Based on current growth rates, obesity is predicted to cost the wider community of the U.K. around $100 billion a year by 2050, according to the Department of Health. "The Government must lead on action across society to tackle obesity. Engaging parents in this issue is essential to achieving success in instigating behavioral change."

Death From Febrile Seizure Rare in Children

Even in high-risk children, death from febrile (fever-linked) seizures is rare, say Danish researchers who analyzed data on 1.6 million children.Febrile seizure, a generalized convulsion caused by increased body temperature, affects 2 percent to 5 percent of children under age 5. About one-third of affected children have more than one seizure episode. Many parents fear their child is dying during a febrile seizure and are worried death may occur during subsequent seizures, according to background information in a news release about the study.

This study included almost 1,676,000 children born in Denmark between 1977 and 2004, who were followed from three months of age until death, emigration or Aug. 31, 2005. Among the children, there were a total of 8,172 deaths, including 232 deaths among the 55,215 children with a history of febrile seizure.

Overall, 132 per 100,000 children died within two years of a febrile seizure compared with 67 per 100,000 children without a history of the condition.

The duration of the fever episode seemed to matter, however. The death rate for children with simple febrile seizures (lasting less than 15 minutes and none recurring within 24 hours) was similar to that of children in the general population. In contrast, the death rate for children with complex febrile seizures (lasting longer than 15 minutes or recurring within 24 hours) was twice as high in the two years following the seizure than in the general population.

But the researchers emphasized that the overall risk of death among children with febrile seizures is small -- 2 deaths per 1,500 children, compared with 1 death per 1,500 children in the general population.

"Children with simple febrile seizures had a risk of death similar to the background population, whereas those with complex febrile seizures, febrile seizures triggered by a temperature below 39 degrees C, and febrile seizures occurring before 12 months of age had a twofold higher mortality lasting for about two years. The excess mortality was at least partly due to pre-existing neurological abnormalities and subsequent epilepsy ... Parents should be reassured that death after febrile seizures is very rare, even in high-risk children," the researchers concluded.

The study was published in this week's issue of The Lancet.

Men More Likely Than Women to Adopt Children

American men ages 18 to 44 are more than twice as likely as women in the same age group to have adopted a child, a new federal report says.The report uses data from the 2002 National Survey of Family Growth, which showed that more than 1.2 million men and 613,000 women had adopted children. The exact reasons why more men adopt than women aren't outlined in the report, but it may be partly due to men getting married and adopting their spouse's children from a previous relationship, the report said.

The report found that:

* Among people who've ever been married, men were more than 2.5 times as likely as women to have adopted -- 3.8 percent vs. 1.4 percent. Overall, 2.3 percent of all men had adopted a child.
* More than one in four women ages 40 to 44 who had ever used infertility services had adopted a child.
* Never-married adults ages 18 to 44 were significantly less likely to have adopted a child compared to those who were currently married. About 100,000 never-married women and 73,000 never-married men had adopted a child.
* Compared with non-Hispanic white women, Hispanic and non-Hispanic black women were more likely to be currently seeking to adopt a child.

The report was released Thursday by the U.S. Centers for Disease Control and Prevention's National Center on Health Statistics.

Detecting False Labor

You should speak with your doctor if you're concerned about the possibility that you've gone into labor, or whether you're experiencing a false alarm called "false labor," the American Pregnancy Association says.

The association offers this information that can help you decide whether a trip to the hospital is in order:

* False labor contractions occur at irregular, unpredictable intervals.
* False labor contractions are variable in duration and intensity, while true contractions last at least 30 seconds and become progressively longer.
* False labor contractions often stop no matter what you are doing, while true contractions continue during any activity.
* True labor pains start high in the abdomen, extend to the lower abdomen and around to the lower back. False labor pains, on the other hand, are usually concentrated in the lower abdomen and groin.

Managing Your Child's Migraines

If your child gets migraine headaches, the American Academy of Family Physicians offers these suggestions to help prevent them:

* Make sure your child eats meals on a regular schedule, and never skips a meal.
* Keep your child on a regular sleep schedule.
* Make sure your child gets daily exercise, but don't overdo it.
* Figure out what triggers migraines in your child, and try to avoid those factors. Common triggers include stress, too much intense exercise, or changes in weather or altitude.
* Avoid foods that are known to trigger your child's migraines. Popular culinary causes include: cheese, processed meats, chocolate, caffeine, nuts, pickles and foods high in the preservative monosodium glutamate (MSG).

Fever-related seizures in children rarely fatal

Although fever-related seizures can prove fatal for some children, such deaths are nonetheless extremely rare, a large study from Denmark shows.

The findings, reported in Saturday's issue of The Lancet medical journal, should be reassuring for parents, researchers say.

About 2 percent to 5 percent of children younger than 5 will suffer at least one febrile seizure -- generalized convulsions caused by elevated body temperature. But studies on the condition have been too small to estimate how many children actually die from fever-related seizures.

For the new study, Dr. Mogens Vestergaard, from Aarhus University in Denmark, and colleagues analyzed data on nearly 1.7 million children born in Denmark between 1977 and 2004. They identified 8,172 children who died during the study period, including 232 deaths among more than 55,000 children with a history of febrile seizure.

Overall, the researchers found, children who suffered a febrile seizure were nearly twice as likely as children in the general population to die during the two years following the seizure. Beyond that point, there was no increased risk.

And while the short-term risk of death was elevated, the actual number of children who died was extremely low, Vestergaard's team stresses. Over two years, they say, there would be two deaths per 1,500 children with febrile seizures, versus one death per 1,500 children in the general population.

Moreover, the study found, much depends on the type of febrile seizure.

Children who suffered a "simple" seizure -- lasting no more than 15 minutes, without recurrence in 24 hours -- had a death rate similar to children in the general population.

Instead, the risk was linked specifically to so-called complex seizures, which are longer-lasting or arise again within 24 hours; often, deaths among these children were related to pre-existing neurological abnormalities.

The findings seem to "refute, for infants and children who have simple febrile seizures, the idea of a shared cause between febrile seizures and sudden death," Dr. Maitreyi Mazumdar, from Children's Hospital Boston, writes in a related editorial.

At the same time, she adds, the results reinforce the message that children with complex seizures and neurologic abnormalities should be followed closely by their doctors.

SOURCE: Lancet August 9, 2008.

"Found" needles pose low infection risk for kids

Children who are accidentally stuck with an improperly discarded needle or syringe appear to be at low risk for acquiring hepatitis or HIV, new research suggests.In a study published in the journal Pediatrics, Canadian researchers found that of 274 children with needlestick injuries, none became infected with HIV or the hepatitis B or C viruses.

Nevertheless, parents should immediately seek medical advice whenever a child is stuck by a potentially contaminated needle, say Dr. Caroline Quach and her colleagues.

To insure efficacy, "most prophylactic (preventive) measures need to be given early after the injury," Quach, from Montreal Children's Hospital and McGill University, told Reuters Health.

For their study, Quach and her colleagues assessed the risk of infection among 274 children who'd been stuck by a potentially contaminated needle and were seen over a 19-year period at two major pediatric hospitals in Montreal.

The children, most of whom received therapies to prevent infection, were followed for six months. This is the longest period of time over which someone could develop antibodies against the viruses in question and therefore show they were infected, Quach explained.

After six months the investigators found no hepatitis B, hepatitis C or HIV infections among the children they were able to test.

Children frequently find discarded needles in "safe" areas such as parks and around home, Quach said. Children may pick up these needles and intentionally stick themselves "not realizing there is a potential health threat associated to a needlestick injury," she noted.

The children in her study were 8 years old, on average, and in most cases had been stuck by a discarded needle found in the street or a park. About 65 percent of the children intentionally picked up the needle.

The number of needlestick injuries followed and treated in this study "is large enough to comfort us in the low risk of transmission of infections," Quach said.

Still, she and her colleagues say, children may need to be better educated about the dangers of discarded needles.

SOURCE: Pediatrics, August 2008.

Health Tip: Keep Gestational Diabetes Under Control

Gestational diabetes occurs in women during pregnancy, and it requires careful attention to keep mother and baby safe and healthy.

When you're pregnant, your body produces hormones that impair the work of insulin. So the pregnant woman produces extra insulin, but in some women this isn't enough. They get gestational diabetes, which tends to go away when pregnancy ends.

The U.S. Department of Health and Human Services offers these guidelines if you're prone to gestational diabetes:

* Work with a dietitian to develop a meal plan that accommodates both you and baby.
* Avoid eating sweets, eat frequent small meals throughout the day, and watch your carbohydrate intake.
* Eat sufficient fresh fruits, vegetables and whole grains.
* Generally, exercise for at least 30 minutes each day is recommended. Talk with your doctor about how much and what kind of exercise is appropriate for you.
* Check your blood sugar frequently as recommended by your doctor, and record your results so you can monitor them.
* Take your diabetes medications exactly as prescribed by your doctor.

Low-Birth-Weight Babies at Risk for Salt Sensitivity

A Swiss study of 50 children found that almost half of those who were small at birth -- about 5.5 pounds or less -- had a significant increase in blood pressure when they ate a high-salt diet, a condition known as salt sensitivity."Salt sensitivity in children is low and rises with increasing age through adulthood," study author Dr. Giocomo D. Simonetti, a fellow in the division of pediatric nephrology at the Children's Hospital, University of Bern, said in an American Heart Association news release. The finding suggests that restricting salt intake in these children could improve their blood pressure.

"During adolescence, about 18 percent to 20 percent of adolescents in the general population have the condition. However, in the study, salt sensitivity was present in 37 percent of all low-birth-weight [LBW] and in 47 percent of the children ... who were small-for-gestational-age [SGA]."

The children in the study, average age of 11, included 15 who had normal birth weights and 35 who were LBW or SGA babies. Some were born prematurely and others were born at full term but were small due to growth restriction inside the womb. Causes of intrauterine growth restriction include maternal high blood pressure and maternal smoking during pregnancy.

During the study, the children ate a controlled sodium diet for a week and then a high-sodium diet for a week. The finding that children who were small at birth are more likely develop salt sensitivity is important, because high blood pressure can damage the kidneys, brain and heart.

"These children should be followed for signs of reduced renal function and also for an elevated blood pressure," study co-author Dr. Markus Mohaupt, head of the division of hypertension, department of nephrology/hypertension, University of Bern, said in the AHA news release.

"There's nearly a 50 percent chance of favorably affecting blood pressure by simply reducing salt intake in children born SGA and nearly a 40 percent chance for those born with LBW. These individuals can be determined very easily if their family physician just gets data on their births," Mohaupt said.

Among the other important study findings:

* Salt sensitivity was inversely correlated to kidney size -- that is, smaller kidney size was associated with higher blood pressure. However, there was no association between kidney size and the organ's filtering abilities.
* Kidneys in LBW children tended to be shorter and hold smaller volume compared to kidneys in normal birth weight children.
* LBW children tend to be shorter than children of normal birth weight.

The study was published in the current issue of Hypertension.

Epidural after surgery unlikely to impact survival

An epidural for pain relief around the time of surgery is safe, a new study confirms, but it has little or no beneficial impact on survival after surgery.The new study suggests that an epidural should not be used for the goal of improving survival, Dr. Duminda N. Wijeysundera, from the University of Toronto, and colleagues conclude. However, because the strategy is safe, it's a valid treatment for other indications, such as improving pain relief and preventing lung complications.

Epidurals involve injecting a local anesthetic into the lower spine, and they are considered the most effective form of pain relief following certain types of surgery such as procedures done in the chest or abdominal cavities. Epidurals offer better post-surgery pain relief than intravenous opioid drugs and also reduce the "surgical stress response," which may have benefits for the heart and lungs, the study team notes.

To investigate the impact of an epidural on survival, the study team examined data on roughly 259,000 patients who had intermediate to high-risk non-cardiac surgery from April 1994 through March 2004 in Ontario, Canada.

Overall, 22 percent of the patients received an epidural in the "perioperative" period -- that is, the period of time extending from when the patient goes into the hospital, clinic, or doctor's office for surgery until the time the patient is discharged home.

According to Wijeysundera and colleagues, receiving an epidural was associated with a small reduction in death at 30 days. The death rate was 1.7 percent in patients who received an epidural versus 2.0 percent in those who did not.

Put another way, 477 patients had to have an epidural to avert one death, the study team notes in The Lancet medical journal.

In a commentary published with the study, anesthesiologists Dr. Michael J. Barrington and Dr. David A. Scott, note that "provision of effective analgesia is our core business: it has substantial physiological and psychological benefits, and is regarded as a fundamental human right."

"Pain after major surgery can be severe, and we think that in many cases pain relief alone is an unambiguous clinical indication for postoperative epidural analgesia," Barrington and Scott add.

SOURCE: The Lancet, August 11, 2008.

High Blood Sugar Tied to Pregnancy Complications

By Serena Gordon
HealthDay Reporter Wed May 7, 11:46 PM ET

WEDNESDAY, May 7 (HealthDay News) -- Women with high blood sugar levels during pregnancy face an increased risk of complications, even if the high blood sugar readings don't meet the criteria for gestational diabetes.
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In a large, international study, researchers found that for each standard deviation increase in blood sugar, there was a greater risk of complications, such as having a large birth weight baby or needing a Caesarean section delivery.

"We found strong independent associations between a mother's blood sugar levels during an oral glucose tolerance test and 28 weeks of gestation and the pregnancy outcomes," said the study's lead author, Dr. Boyd Metzger, the Tom D. Spies professor of metabolism and nutrition at the Feinberg School of Medicine at Northwestern University in Chicago.

What this means for pregnant women right now, however, isn't clear.

"Because the relationship between the mother's blood glucose level and risk tend to be continuous and linear, it is not clear where the risk reaches the point where treatment should optimally begin," said Metzger.

"We were hoping there would be a breakpoint," explained another of the study's authors, Dr. Don Coustan, professor and chair of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Providence, R.I. "But, the relationship between glucose levels and outcomes were continuous, which means it will be difficult to decide where to put the 'treating' point."

Coustan added that there will be a conference in June where pregnancy and diabetes experts will likely debate the pros and cons of treating hyperglycemia. For now, he said, he suspects that "doctors will still use the glucose threshold they're currently using."

One thing that was clear from the study is that higher odds of complications, like an increased risk of C-section or a large baby, are related to high blood sugar and not to other conditions, such as obesity or older maternal age, according to Metzger.

Results of the study were published in the May 8 issue of the New England Journal of Medicine.

The study included more than 23,000 pregnant women from 15 centers in nine countries. None of the women had diabetes. All of the women underwent glucose tolerance testing between 24 and 32 weeks of gestation. This test is performed by first taking a fasting blood sugar reading, then having the woman drink a high-carbohydrate liquid -- in this case a 75-gram carbohydrate drink; 100 grams is standard in the United States -- and then rechecking blood sugar levels at one and two hours to assess how the body is processing the high sugar load.

The higher a woman's blood sugar levels were, the more likely she was to have a C-section, to develop preeclampsia, have premature delivery and to have the delivery complication known as shoulder dystocia, the study found.

Babies born to women with higher glucose levels were more likely to have high insulin levels, low blood sugar, and to have a large birth weight, all indications of exposure to high glucose levels.

The odds of these complications changed continuously as blood sugar levels rose. For example, a woman with the highest levels of blood sugar (but not diabetes) had large babies 26 percent of the time, compared to just 5 percent for women with the lowest blood sugar levels.

"Basically, what they found out is that there is no threshold where you know to treat. That makes it difficult to know what to do with these findings," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

A second study in the same issue of the journal looked at the use of the oral diabetes medication metformin, versus insulin, the standard treatment for gestational diabetes. The study included 751 women, randomly assigned to receive metformin or insulin treatment.

The researchers found that metformin was well-tolerated, although almost 43 percent of the women eventually required the use of supplemental insulin. There were no serious adverse events reported for mother or baby from the use of metformin, according to the study.

Of this study, Zonszein said, "My guess is that until we have larger studies, there's not going to be a big change in recommendations, because we have so much experience with insulin." But, he added, many women and obstetricians may welcome these findings because "giving a pill is easier than giving insulin." He said another oral medication, glyburide, was also found effective in another small trial.

Some Weight-Loss Drugs Might Disrupt Brain Growth in Kids

Wed May 7, 11:46 PM ET

WEDNESDAY, May 7 (HealthDay News) -- A new class of weight-loss drugs that suppresses appetite by blocking cannabinoid receptors in the brain should be used with caution in children, U.S. scientists report.
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In research with mice, they found this class of drugs also suppresses the adaptive rewiring of the brain necessary for neural development in young animals. The findings are in the May 8 issue of Neuron.

One such drug is rimonabant (Acomplia), which was developed by Sanofi-Aventis and is awaiting approval by the U.S. Food and Drug Administration. Other pharmaceutical companies are developing similar drugs.

In this study, researchers concluded that a cannabinoid receptor-blocking drug called AM 251 affected experience-dependent cortical plasticity in the brains of juvenile mice. This plasticity is the experience-prompted adaptive rewiring of the brain that plays an critical role in the neural development of young animals.

"Our finding of a profound disruption of cortical plasticity in juvenile mice treated with AM 251 suggests caution is advised in the use of such compounds in children," wrote Mark F. Bear and his colleagues, of the Howard Hughes Medical Institute, The Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, in Cambridge, Mass.