Women during their childbearing years are susceptible to depression. In developed countries more than 10% of women take antidepressants during their reproductive life - most commonly selective serotonin reuptake inhibitors (SSRIs). The safety of these drugs in pregnancy is critical and a study by Pedersen et al from Denmark adds to prescribing principles (BMJ 2009; 339: b3569).
The researchers correlated congenital malformations with maternal antidepressant use in half a million children and found no overall increased risk. However the drugs were associated with septal defects of the heart. This was found for all SSRIs, especially when combinations were used or different drugs were prescribed serially. The absolute increase was from a background rate of 0.5% to 0.9% for single medications and 2% for multiple prescriptions.
This risk must be weighed against the dangers of not treating major depression or using psychotherapy. The American College of O&G has stated that women can continue or start SSRI antidepressants in pregnancy but should be appraised of the risks, however small (Chambers BMJ 2009; 339: b3525).
04 January, 2010
Preterm infants and infection
Preterm infants are at risk of a host of morbidities. Most obviously their immature respiratory and metabolic systems place them at a disadvantage while their fragile cardiovascular anatomy and physiology makes them prone to cerebral and gastro-intestinal incidents.
Also linked to poor outcomes, especially in very low-birth-weight infants of less than 1500g, is infection. About 20% of these babies will develop serious infections while in intensive care units. Nosocomial infections occurring after 3 days of age carry major risks of mortality or impaired neuro-development and the smallest are the most vulnerable. There are enormous short-term costs of hospital treatment plus the long-term financial implications of looking after mentally compromised survivors.
Hard on the heels of encouraging magnesium sulphate research to reduce cerebral palsy risk come data on the use of lactoferrin to lower the risk of neonatal infections. Lactoferrin is the major whey protein in human milk and has many functions in early immune processes (Kaufman JAMA 2009; 302:1467-8). Apart from antimicrobial activity, it promotes healthy gut flora and enhances the immature immune system. It is found in higher quantities in colostrum than mature milk, again suggesting a natural boost immediately after delivery.
Manzoni et al (JAMA 2009; 302: 1421-8) studied the administration of bovine lactoferrin, with or without an adjuvant against placebo to a series of very low-birth-weight infants and found some promising results. Subjects receiving the lactoferrin had bacterial and fungal sepsis rates of 6% whereas the placebo group rate was 17%.
The smaller the infant the greater the impact of the lactoferrin so another promising door appears to be opening in the care of preterm infants.
Also linked to poor outcomes, especially in very low-birth-weight infants of less than 1500g, is infection. About 20% of these babies will develop serious infections while in intensive care units. Nosocomial infections occurring after 3 days of age carry major risks of mortality or impaired neuro-development and the smallest are the most vulnerable. There are enormous short-term costs of hospital treatment plus the long-term financial implications of looking after mentally compromised survivors.
Hard on the heels of encouraging magnesium sulphate research to reduce cerebral palsy risk come data on the use of lactoferrin to lower the risk of neonatal infections. Lactoferrin is the major whey protein in human milk and has many functions in early immune processes (Kaufman JAMA 2009; 302:1467-8). Apart from antimicrobial activity, it promotes healthy gut flora and enhances the immature immune system. It is found in higher quantities in colostrum than mature milk, again suggesting a natural boost immediately after delivery.
Manzoni et al (JAMA 2009; 302: 1421-8) studied the administration of bovine lactoferrin, with or without an adjuvant against placebo to a series of very low-birth-weight infants and found some promising results. Subjects receiving the lactoferrin had bacterial and fungal sepsis rates of 6% whereas the placebo group rate was 17%.
The smaller the infant the greater the impact of the lactoferrin so another promising door appears to be opening in the care of preterm infants.
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