There have been major advances over the past thirty years in the care of preterm babies. Now, even the most vulnerable infants born several months early can survive. However, these very small infants may need several months of intensive care and this brings new problems that are a major challenge to these babies, their families, and their carers.
One of the major problems associated with intensive care is the risk of serious hospital-acquired infection. Very immature infants are susceptible to infection with organisms that are not usually a major problem for older children or adults. For example, infection with Candida, the cause of thrush, is an increasingly common cause of bloodstream infection and meningitis in preterm infants. Unfortunately this infection is both difficult to diagnose and to treat, and many infected babies die or are handicapped. It is recognised therefore that we need to find better ways to prevent this infection in preterm babies.
A research group at the Tayside Institute of Child Health has embarked on a serious of national studies that will attempt to improve our understanding of Candida infection in preterm babies, and lead to better ways of preventing the infection.Their preliminary work examined several treatment and prevention strategies, and now they have embarked on a study that involves every neonatal intensive care unit in the UK and Eire. This surveillance study, the first of its kind, will determine how exactly how common Candida infections are, which strains of Candida are the biggest problem, and will identify the effects on the infected baby. The study co-ordinator, Dr Bill McGuire, in the Tayside institute for child health explained: "Candida infection is devastating for preterm infants. We need much better data on this problem and this can only be obtained with a national study of this sort".
A new screening scheme for babies that will ensure early detection of cystic fibrosis has been launched recently in Scotland after years of campaigning by Dr Anil Mehta at the Tayside institute for child health.
Dr Anil Mehta says that under the new screening scheme financed by the Scottish Executive, cystic fibrosis will be spotted on day five of a baby’s life allowing for early preventative treatment to begin within four weeks.
He explains: "Treatments are now so effective that if we catch cystic fibrosis in the first month of life, we can start treating the babies before the symptoms show."
Dr Mehta says that previously cystic fibrosis was only spotted when parents took their infants to the GP. He says: "Often cystic fibrosis wasn’t diagnosed until the child was over a year old and in many cases, the GP was unable to identify cystic fibrosis from the symptoms. This new screening, for which we have lobbied for years, will be a vast improvement for children’s health in Scotland."
Cystic fibrosis is a disease which affects the lining cells of the body. Lungs can clog with mucus and the disease can cause diabetes in childhood. One in 25 people carry the gene for cystic fibrosis and if both parents are carriers, the risk for the baby is rapidly increased such that a quarter of children will be affected.
The screening will consist of a blood test for every baby in Scotland when they are five days old. Dr Mehta explains: "One in every 2,500 babies have cystic fibrosis. Approximately 200 babies are born in Scotland every day so we estimate that we will pick up a case of cystic fibrosis every 10-15 days allowing us to give parents early warning and start treatment as soon as possible."
The second exciting innovation to come from Dr Mehta’s team is the development of a life long database to track the progress of this disease in such infants: www.cystic-fibrosis.org.uk. This database is implemented and run for the whole of the UK from the multi-million pound facility in the newly completed Tayside institute of child health.
The popular pain killer ibuprofen can knock out the positive effects aspirin has in preventing heart attacks and strokes when patients take both medicines say doctors in the medicines monitoring unit (MEMO).
Aspirin has been found to have beneficial effects in preventing cardiovascular disease. It makes the blood clotting cells less sticky so they are less likely to form clots causing heart attacks and strokes. However, laboratory research at MEMO suggests that when both ibuprofen and aspirin are taken, the ibuprofen reacts with the aspirin impeding its ability to reduce the stickiness of the blood cells.
Professor Tom MacDonald explains: "Although our findings are not conclusive, they do support the hypothesis that ibuprofen may reduce the benefits of aspirin in people with cardiovascular disease. Perhaps it would be prudent for such patients to take an alternative pain-killer at least until this issue is further clarified.
We also know that aspirin and ibuprofen taken together increases the risk of bleeding from stomach ulcers. So this combination may not only reduce the benefits of aspirin, but may also increase the risks of side effects.
An American research group recently showed that in a test tube ibuprofen blocks the aspirin from stopping the blood sticking together. They also showed that non steroidal anti-inflammatory drugs (NSAIDs) did not stop the aspirin from working. If the blocking effect happens when patients take both medicines then the consequence is likely to be that the aspirin, in potentially extending a person’s life to near what it would be if they had no heart problems, would not take effect - it would be as though they had never taken the aspirin.
Tom MacDonald and Li Wei from MEMO studied 7107 patients with cardiovascular disease who were discharged from hospital and were taking low-dose aspirin. Within this group they compared the death rate of those patients taking prescribed aspirin alone with those taking prescribed aspirin and ibuprofen.
Individuals prescribed both aspirin and ibuprofen had a double risk of death from any cause and around a 75% increased risk of death from cardiovascular disease compared with those prescribed aspirin alone. There was no increase in mortality risk for people prescribed aspirin in combination with diclofenac or other NSAIDSs.