Can my kids eat too many eggs?

Posted on January 31, 2011 by Jennifer Gunter

“Eggie night” is a big hit in our house. It is the holy trifecta of meals:

  1. Cheap
  2. Fast and even faster clean-up
  3. No McChemicals

Yes, my husband moans about it, being less enamored with the beauty of the egg than my kids and I, but he can forage for himself.

The great thing about eggs is that they are a relatively good bang for the calorie buck and high in protein (important for repairing lungs affected by bronchopulmonary dysplasia). However, as my kids got bigger their egg consumption/meal grew from 1-2 eggs per child to 4-5 eggs. As that’s 320-400 calories, I always thought it was right on mark for a 7-year-old, but then I began to wonder about the fat. With 5 g of fat per egg, that’s 20-25 grams of fat per dinner. Less than a Cheeseburger Happy Meal (with fries, because who really gets the apple slices?), which packs a whopping 550 calories and 28 grams of fat.

So I asked our pediatric endocrinologist. She was a tad surprised at the 5 eggs, but quickly recovered.

First question. Any family history of early heart disease or high triglycerides? Fortunately no. This is important because eggs (and the cheeseburger and fries) are a pretty healthy dose of fat. A well functioning system can handle that fat load, process it, and as long as it’s not an every day thing, deal with it. Someone with a family history of early heart diseases/high lipids is probably not so good at dealing with fat.

Second question. What kind of eggs? We eat farm fresh eggs. The chickens peck the earth and eat bugs and seeds and the stuff that chickens are supposed to eat (the picture above is their hen house, and the one to the right are the actual eggs. The source of this goodness is a local farm called Tara Firma Farms). This pecking for grubs and bugs and seeds is important because pastured eggs are higher in omega-3 fatty acids, especially DHA (docosahexaenoic acid) and omega-3 fatty acids actually help prevent against heart disease. Pastured eggs have 130 mg of  omega-3′s versus 40 mg for regular eggs. So, while you are eating more fat, you are also getting more of the good fat.

Third question. Do they eat many other eggs during the week? Maybe 1 on Sunday morning, but otherwise no. Don’t want 20-25 g of fat per meal every meal.

With that in mind, the endocrinologist and I are comfortable staying with eggie night. I still use 9 eggs, but now I don’t use two of the yolks. Reduces the fat (and unfortunately the calories), but still maintains a good whack of the protein. I always serve farm fresh eggs (and there is always a fight over who gets the blue one), but now with a side of fresh fruit (pears, because that is the only fruit they will both eat).

Even though the pastured eggs are clearly superior, they are also $6 a dozen, and for many people that’s just too much to spend when you can buy a dozen at the supermarket for $1. However, even regular supermarket eggs are a far superior choice calorie, fat, and chemical wise compared with a Happy Meal.

Remember, this blog is not intended as direct medical advice

Posted in Uncategorized | Tagged , , | 2 Comments

Five key facts about secondary health insurance

Posted on January 25, 2011 by Jennifer Gunter

Some people have two types of health insurance, either commercial and Medicaid/Medicare or two different commercial plans (usually when each parent has health insurance through work). While this can help ease financial burdens, knowing the rules will help prevent hassles and headaches down the road.

  1. The primary insurance is billed first and the secondary insurance picks up what’s left (under the terms of their policy).
  2. Always present both insurance cards and make sure the staff knows which is your primary insurance.
  3. Medicaid is ALWAYS the secondary insurance (frequently called the “carrier of last resort”).  Many preemies are eligible for Medicaid at birth based on birth weight.
  4. If you have 2 commercial insurances, you don’t get to pick which is your baby’s primary insurance. Primary insurance is determined by the parent whose birthday falls earlier in the calendar year (how’s that for crazy?).
  5. Having 2 commercial insurance plans is not like having 2 cars, you don’t get to pick chose which one you use. You must satisfy ALL the requirements of the primary insurance before the secondary kicks in. So, if your primary denies a service or medication, your secondary insurance will only cover it if you have a denial letter from the primary (so it doesn’t prevent any hoop jumping).
Posted in Uncategorized | Tagged , , | 3 Comments

Thyme oil vs. alcohol hand sanitizer: which is better?

Posted on January 22, 2011 by Jennifer Gunter

Like most preemie parents, I am germ obsessed. In addition, working in a hospital is like living in a microbe spa, so I use alcohol based sanitizer liberally and I feel like I am always nagging the kids to use it as well.

But I am hearing more about “natural” sanitizers. Especially made with thyme oil. The makers of one “thyme based technology” brand, CleanWell, claim it kills 99.9% of germs.

I did a little research and checked with a friend, Jason Tetro, a crack microbiologist who blogs under the name Germ Guy. He is a hand hygiene guru (and born in Manitoba, which only adds another layer of awesome).

He says thyme oil extracts work pretty well against many bacteria and some viruses in the lab setting. With a virus, thyme oil damages the envelope, which is a protective coat around the membrane (the membrane is like the skin of a microorganism). The envelope is crucial to the ability of the virus to do its’ dirty work. So, if the envelope is damaged, the virus is basically inactivated. This is a really important point, because not all viruses have an envelope. Thyme oil is inactive against the actual membrane of a virus, so no envelope, no ability of thyme oil to work. That means thyme oil sanitizer will have no effect against the cold virus or the polio virus, as these viruses do not have envelopes.

Even though thyme oil has been tested against bacteria in a lab, it has never been tested on human skin (or if it has been tested, the results are not published anywhere that I could find). Another important point, because products interact with our skin (the oils etc.) and this could potentially alter how well they work.

Alcohol sanitizers kill all bugs by damaging proteins, the building blocks of the actual cell (remember, bacteria and viruses are a single cell). The concentration of alcohol must be at least 62% to have this instant kill effect. Alcohol hand sanitizers are even effective against the non-enveloped viruses, so unlike thyme oil, alcohol will kill the virus that causes the common cold. In addition, alcohol sanitizers have been tested on human skin, so we know they work in real life, not just the lab.

Alcohol is also natural; after all, the 2 main ingredients are sugar and yeast and in Canada, alcohol-based sanitizers are regulated as natural antiseptic products.

So we thought we would study a thyme oil sanitizer, CleanWell, head to head against an alcohol sanitizer, Purell. A nice little project for the elementary school science fair. We built an incubator box (meaning I built it), and each boy pressed their hand against some LB agar (a petri dish with nutrition to help the bacteria grow). One kid cleaned with Purell and the other with CleanWell (I supervised and timed for accuracy), and then we put the clean hands on a new set of petri dishes. Two days later we had our results (and by the way, like good scientists, we repeated the experiment to make sure we were right).

The alcohol was better.

Alcohol

The big blotches are bacilli (contaminants that probably come from the air and grew as expected on both plates). The alcohol plate has 3 distinct colonies of bacteria (large dots, and what we are most interested in looking for) that all looked the same (so probably same kind).


Thyme oil

The thyme oil plate grew a lot more bacteria (many more dots) and at least 3 different kinds (you can tell by the sizes of the colonies and the color, note two are a yellow).

To recap:

  • Alcohol (ethyl alcohol) and thyme oil sanitizers are both made with natural products.
  • Alcohol 65% tested under optimal conditions for a 7-year old, killed more bacteria overall and more types of bacteria than a thyme oil product.
  • Because of how thyme oil works, it is not possible for it to kill the cold virus.

The alcohol sanitizer wins hands down! (Sorry, I couldn’t resist). And if you want to see a photo that shows the full awesomeness of alcohol sanitizers, check out this photo from the New England Journal of Medicine.

You want clean hands? You want an alcohol based sanitizer.

Posted in Uncategorized | Tagged , , , , | 9 Comments

How can we reduce the cost of banked breast milk for preemies?

Posted on January 17, 2011 by Jennifer Gunter

Banked human breast milk is used in some NICUs across the country. There are 4 main reason why it is not used for every preemie when his own mother’s milk is not available:

  1. Cost
  2. Logistics
  3. Concerns about infection
  4. Lack of familiarity among NICU providers

Concerns about infection can be dismissed with simple education. There has never been a case of an infection transmitted by banked milk reported in the scientific literature in the United States (or anywhere else).  Donors are screened and the milk is heat treated.

Logistics and lack of familiarity go hand in hand. There are currently 9 operating milk banks in the United States. Quite simply, it is easier to get milk for a baby in Colorado (especially if your baby is born at St. Luke’s, where the milk bank is located), than for a baby in Fargo. In addition, when the milk bank is in the same hospital, everyone is more familiar with the process. This also helps medical education, because doctor’s who train where banked milk isn’t available often fail to consider it as an option.

However, the biggest reason is cost, because that drives almost everything in health care. At almost $5 an ounce it is quite simply cost prohibitive.  Or so it seems on the surface. Studies estimate that for every 14 premature babies (< 1,500 g at birth) fed banked milk, one case of necrotizing enterocolitis could be prevented. One case of NEC is an additional $200,000 a year for the first year (never mind subsequent years). In addition, there are studies to suggest that babies move faster from intravenous nutrition to milk, when banked milk is used instead of formula. Getting rid of IVs sooner also leads to less infections, also reducing cost of the NICU stay (never mind the expense of intravenous nutrition which requires a dedicated pharmacist and a nutritionist).

One would think there might be creative ways to lower the cost of banked milk. Women who donate milk could be given tax incentives or even a reduction in their own insurance premiums (we pay plasma donors, after all). The government (federal, state, or local) or even health insurance companies could donate physical space to lower overhead. Considering Medicaid is the single largest payor of NICU bills, one would think the government would have an invested interest in improving the availability of banked milk. Private insurers as well. Getting babies home sooner is simply better for every one.

Parents can also get involved. If breast milk isn’t an option, asking or even insisting on banked milk may help get the wheels moving at an NICU where formula is the standard. If your insurance doesn’t cover banked milk, talk with your human resources director and ask, “Why not?”

An additional 6 banks are developing, which is a start. But if the Red Cross can get blood to every hospital in the United States, surely there must be some way to get banked milk to every Level 3 NICU.

Posted in Uncategorized | Tagged , , | 2 Comments

The risks with sharing breast milk

Posted on January 16, 2011 by Jennifer Gunter

Not all mothers have enough, or sometimes even any, breast milk. Unfortunately, this is more common among preemie moms – prematurity, stress, medications, and illness all affect supply.

Because the benefits of breast milk are so great, many moms are turning to other mothers who have an over abundant supply. They are hooking up via Twitter, Facebook, and blogs. “What’s the big deal?” many ask. After all, generations of the privileged were raised on wet nurses.

A study published in 2010 by Stanford researchers tells us the risks. The data comes from a milk bank, which is supplied by selfless mothers donating their milk. To donate milk, mothers must self-identify as low risk for infections (just like when you donate blood), but many are unfortunately not as low risk as they think. In fact, in this study 3.3% of donating moms were positive for one of six very serious infections: HIV, syphilis, hepatitis B, hepatitis C, human T cell lymphotropic virus type 1 (HTLV-1) and human T cell lymphotropic virus type 2 (HLTV-2).

Many women who offer up their milk say that they are screened or were tested in pregnancy, but in reality, even if they were, that was a year ago and screening for hepatitis C, HLTV-1, and HLTV-2 is not even performed during pregnancy (see ACOG guidelines).

What if they say they are low risk? Having worked in STD clinics most of my professional career, I can tell you women who get infected with these infections never, ever felt they were at risk (even those who had what I would definitely call high risk behavior, because no one ever thinks it is going to happen to them). And of course, many make assumptions that their partner is monogamous. When people give me a funny look about that one I just say two words: Tiger Woods. That kind of behavior is not limited to sports stars, not by a long shot.

What is even riskier is the mother who converts to HIV who supplying milk. In fact, the risk of transmitting HIV to a baby by breast milk in the first 90 days after she is infected with HIV is five times higher than if she were already HIV positive during pregnancy. That is why milk banks screen every sample for HIV (and the other infections). Milk bank donors also have to be a non smokers, be vaccinated against rubella and test negative for tuberculosis (TB). Milk banks also pasteurize the milk to kill CMV (a virus found in up to 30% of the population that can be particularly harmful to a preemie) and HIV, although almost all of the nutritional properties stay intact.

Milk banks are run with the same precision as blood banks, hence the expense: $3.50-$4.50 an ounce (although ounce per ounce, donor milk is still a bit cheaper than blood). That is why affording milk bank milk is unreasonable unless covered by your insurance (often for a preemie in the NICU), or if you have the money of a celebrity, like Neil Patrick Harris).

So is donor milk safe? If it comes from a milk bank, absolutely. But otherwise, ask yourself if you would give your baby a blood transfusion from an unscreened donor? Most donors are motivated by altruism, but there is at least a 3.3% chance that milk from an acquaintance could do far more harm than good.

Would you give your baby donor milk from someone you met on line?

Posted in Uncategorized | Tagged , , | 10 Comments

Our Synagis was denied, should we pay out of pocket?

Posted on January 15, 2011 by Jennifer Gunter

Synagis is the monthly injection of antibodies to bolster the immune system against infection with RSV, a virus that can cause significant inflammation of the airways, especially for preemies and children with congenital heart defects. Since the guidelines for Synagis were changed by the American Academy of Pediatric (click here for the recommendations) many more preemies have been denied the medication.

How to handle an appeal for Synagis has been addressed in a couple of earlier posts (How to write a Synagis appeal letter Part 1 and Part 2), with some excellent commentary on Part 2 by an anonymous insurance insider. However, many parents have still been denied and are left wondering, should I pay for the Synagis myself?

To answer this question, I turned to Dr. Nicholas Bennett MA(Cantab), PHD, MB/BCHir, a fellow in pediatric infectious diseases at SUNY Upstate Medical University. Dr. Bennett’s first point was to make sure you find out why the Synagis was denied. You want to make sure it was because your baby is truly ineligible, and not because the birthdate or some other piece of information was entered incorrectly.

Dr. Bennett suggests that your baby’s doctor call one of the medical directors of the insurance company, because a personal conversation can go a long way. Often there are individual nuances about your baby’s health that can really only be explained person to person. Dr. Bennet says that he has had success with “other medications after getting through to medical directors and making a case for my patients, even after several denials.” I have also found this to be true, if I can make a strong enough case. Dr. Bennett suggests doctors think about all the reasons a particular baby is at high risk for RSV, not just the fact they are a preemie, and use that information. A pediatric pulmonologist (lung specialist) or infectious diseases expert may be helpful in providing more ammunition. Stressing that an individual baby is at high risk of hospitalization can help, because ultimately one admission is more expensive than 5 months of Synagis.

If after the original application, 2 appeals, and a personal call to the medical director your baby is still denied, then Dr. Bennett says it might be that your baby “truly doesn’t have a strong reason to get Synagis, in which case then by definition they are at a lower risk of getting sick.” And if they are at lower risk, then you have less to be worried about.

If your doctor can’t convince the medical director that your baby should have Synagis, then it might be worth a second opinion from a pulmonologist or an infectious diseases expert (if that hasn’t happened) before you think about paying out of pocket, because a season of Synagis is about $5000. If this expert really feels your baby should have Synagis and you have been denied, file a complaint with your State Insurance Commissioner and also talk with your human resources person if your insurance is through work, because they need to know what is happening (that has personally worked for me several times when I lived in Colorado). For example, there is no reason a preemie with chronic lung disease who is less than 2 years of age should be denied.

Keep in mind that hand washing/using alcohol sanitizer and staying away from other kids is the best form of prevention and that daycare = RSV. Synagis isn’t a get-out-of-jail-free card for RSV, it just reduces the risk your baby will be sick enough to need hospitalization (but it certainly doesn’t eliminate that risk).

So before you think about paying out of pocket, ask for an opinion from a specialist. Consider all the other steps you can take to protect your baby. And finally, here is a study that might help put your mind at rest. Preemies born less than 32 weeks were followed for 30 months, some received Synagis and some did not. Overall, the rate of hospitalization was the same for the 2 groups; however, the risk of hospitalization was 6 times higher for a preemie less than 6 months of age who did not receive Synagis compared with those babies who did receive the medication (supporting the American Academy of Pediatrics recommendations for Synagis for babies less than 32 weeks).

Posted in Uncategorized | Tagged , , , | Leave a comment

Five ways to make blood draws less painful for a preemie

Posted on January 10, 2011 by Jennifer Gunter

Yes, a painless or at least less painful blood draw is possible, and the sooner you start, the greater benefit you’ll see.

Preemies are easily sensitized to pain in the NICU. Studies show painful procedures (heel sticks, blood draws, lumbar punctures, etc.) as a newborn can prime the nervous system, so subsequently painful experiences are felt more acutely (think of it like turning up the volume on the pain signals).

There are five interventions that can reduce the burden on your baby’s nervous system and help him (and you) feel better:

  • Kangaroo care. Holding your baby close to you is very comforting. Your baby will know your smell and touch, even if he can’t yet see.  Mom or dad’s familiar touch is comforting and who doesn’t feel better with a cuddle?
  • Swaddling. This helps a baby stay organized. Pain is a trauma makes the nervous system disorganized, which can have consequences on nervous system development. Keeping your baby as organized as possible during the event (or regrouping as soon as possible afterwards) will help their nervous system get back on track the fastest.
  • Sugar. Yes, glucose – a 30% solution, which is almost 3X more sugar than Coke (I was surprised to find out that Coke is only 11% sugar!). Apparently we are hardwired from before birth to love sugar (it makes out brain churn out endorphins, the chemicals that make us feel good).
  • A pacifier. They are called that for a reason. Non-nutritive sucking (medical term for using a pacifier) also helps the nervous system reorganize.
  • EMLA, which is a combination of two topical anesthetics (numbing creams). There is more experience with EMLA in kids than preemies in the NICU; however, in one NICU study EMLA did not perform anywhere near as well as sugar in a head-to-head comparison against venipuncture (blood draws). EMLA also has to be applied 60 minutes before the procedure and needs to be sealed under an occlusive dressing. Finally, repeated applications in a premature baby can lead to increased methemoglobin levels (an altered form of hemoglobin, the actual molecule that carries oxygen – high methemoglobin levels also happen with carbon monoxide poisoning).

What to do? Hold your baby when ever possible and don’t be shy about asking for glucose or a pacifier. If it is a procedure where you can’t do kangaroo care, make sure your baby gets swaddled as long as that won’t interfere with performing the procedure and sugar (swaddling and sugar was routine at our NICU for eye exams). Even during a lumbar puncture your baby may be able to suck on a sugar coated pacifier. If your baby is on a ventilator or for whatever other reason can’t take a sugar solution, ask about EMLA.

And don’t forget about EMLA once you get home. The fact is, you can’t keep giving your baby a mega-dose of glucose every time they need an eye exam or needle stick. After several years of physically restraining Victor for all his blood draws (and driving to different labs so he wouldn’t freak out in the car, “Surprise, a new office with needles!”), I remembered the EMLA. Now we have the most pleasant experience, although it still doesn’t prevent him for asking for M&Ms or a toy!

Parting pointer: keep EMLA in a kit to take if you ever need to go to the emergency room, especially if it isn’t a kid friendly ER. When I head in with Oliver at 2 a.m. to the ER knowing blood work is almost a guarantee, I put the EMLA on before we leave, so by the time we get there, his arms are good and ready.

***************************************************

Remember, this blog is not direct medical advice. All prescription medications should be used only under the supervision of a physician.

Posted in Uncategorized | Tagged , , , , | 5 Comments

Heavy metal poisoning and vaccines: what is the truth?

Posted on January 9, 2011 by Jennifer Gunter

Even though the Wakefield study (the only study to draw a connection between vaccines and autism) has been proven to be a fraud and there are 41 studies proving vaccines do not cause autism, many still believe vaccines cause neurological harm. I read on one site where a mother of a premature baby still didn’t believe in vaccination because of “heavy metal poisoning. I see that term a lot, “heavy metal poisoning”, so I thought it worthy of some investigation.

According to the IUPAC (The International Union of Pure and Applied Chemistry) the term “heavy metals” is meaningless. There is actually no standard definition of “heavy metals”. While it is often a term used to describe metals and semimetals (metalloids – a substance that has the physical appearance and properties of metal but in a lab acts nothing like metal) that have been associated with potentially hazardous toxicity to humans or the environment, the term is used inconsistently in scientific and government literature, and of course by the public.

Various inorganic chemists have tried to classify metals as “heavy metals” based on density, atomic mass, atomic number, and chemical properties, and none have found definitions suitable for the scientific community (note that none of the proposed definitions mention anything about toxicity). The IUPAC says that the term “heavy metal” is meaningless and should be abandoned. So, by default “heavy metal” poisoning is impossible.

Some vaccines do contain aluminum: hepatitis A, hepatitis B, diphtheria-tetanus-pertussis, haemophilus, HPV, and pneumococcus. Aluminum is an adjuvant (helps to stimulate the immune response). Aluminum is found in almost every animal and plant (it is in the soil, so is absorbed into plants). There is less aluminum in all the vaccines given in the first 6 months of life (4 mg) than in the breast milk that same baby would drink in those same 6 months (10 mg). To put it in perspective, one tsp. of Maalox has 200 mg aluminum. Aluminum toxicity can occur, but it takes much higher doses than a tsp. of Maalox. Thimerosal - a mercury-containing preservative is the only other metal in some adult vaccines, but no children’s vaccines (they are packaged differently, so it is easy to tell, thimerosal vaccines are all single dose).

Some scientists have proposed a new definition of metals based on their biochemical basis for toxicity (using something called Lewis acid properties). Basically, this means metals that are most likely to damage cell membranes (which makes a lot of sense to me!).  There are three groupings in this new system: Class A, Class B, and Borderline or Intermediate. Class A metals are are not likely to harm cell membranes (Class B and Borderline are likely to cause harmful membrane structural changes). Aluminum is a Class A metal.

And for those who use Wikipedia? The page on “Heavy metal” (chemistry) contains multiple inaccuracies compared to what the IUPAC proposes, so I’ll have to go with the international body made up of people with PhDs in inorganic chemistry as oppossed to some unknown author with unknown interests/bias. Wiki does say that the IUPAC calls the term a “misinterpretation,” but still goes on to list many types of “heavy metals” and how they are toxic. If I were writing the Wikipedia page, it would look something like this:

Heavy metal (chemistry) – an older term first used as a non-chemical definition before 1936 to describe guns or shots of great size or great ability. Since 1936 scientists have attempted to categorize metals as “heavy” based on density, atomic weight, atomic number, and other chemical properties but to no avail. The term “heavy metal” has never been defined by any authoritative chemistry body such as the IUPAC and no relationship can be found between density (specific gravity) and any of the physiochemical concepts that have been used to define “heavy metals” and the toxicity or ecotoxicity attributed to “heavy metals.”

Can vaccines cause “heavy metal” poisoning? As there is no such thing as a “heavy metal,” the answer is a resounding no.

Can vaccines cause aluminum toxicity? No, the doses are orders of magnitude too low.

Is aluminum in low concentrations safe? Yes, it is unlikely to damage cell membranes and every plant we eat contains it.

Any website that uses the term “heavy metal” toxicity or poisoning is guilty of shoddy research, woo-mongering, or both.

Posted in Uncategorized | Tagged , , , | 7 Comments

Is the staff in your NICU vaccinated against the flu?

Posted on January 6, 2011 by Jennifer Gunter

Even though vaccination is the #1 way to prevent transmission of the flu, the rate of vaccination among health care workers is low.

By January 2010, according to the CDC, 62% of all health care workers had received the seasonal flu shot and 37.1% received the H1N1 vaccine. Only 34.7% received both seasonal and H1N1 shots (this data should be different for this season as both are combined in one shot).

So what about the NICU? The baseline rate of vaccination against seasonal influenza among NICU staff ranges from 15% to 41%. When the vaccine is made available to staff in the unit (i.e. having a nurse on site to give the shot), vaccination rates rise to 67%.

What’s worse is that influenza outbreaks are well-described in the NICU. An unvaccinated health care worker can help the infection spread like wildfire.

If your baby is in the hospital now, or next time you have to take them to clinic, ask every person you come in contact with if they are vaccinated against the flu. If they are not, ask them to wear a mask. In San Francisco, a new law has taken effect mandating unvaccinated hospital personnel wear a mask if they decline the flu shot.

It is hard to know how someone could dedicate themselves to helping preemies through their most critical period and at the same time knowingly be a vector for a potentially deadly infection.

Don’t be afraid to speak up. Flu season has started slowly in the US, but the H1N1 epidemic in the United Kingdom has already proven very deadly. And while were are on the subject of the flu, make sure you get vaccinated as well.

The graph shows the steadily rising # of flu-associated hospitalizations and deaths for this season.

Posted in Uncategorized | Tagged , , | 1 Comment

Fish oil may reduce retinopathy of prematurity

Posted on January 4, 2011 by Jennifer Gunter

Day 1 NICU

Retinopathy of prematurity (ROP) is a disorder involving the abnormal growth of blood vessels in the retina. The abnormal blood vessels are fragile and can break, causing bleeding. They can also grow in a disordered fashion and pull on the retina, causing it to detach from the inside of the eye. Both the bleeding and retinal detachment can cause serious vision problems. ROP affects 15,000 preemies a year: approximately 500-1,000 will be blind and many more will have some vision impairment. Babies who weigh < 1,000 g are at greatest risk.

A study published this month in Pediatrics looked at preemies needing nutrition in the intravenous. Many preemies < 1,500 g can only receive intravenous nutrition as it takes a while for the bowel to be mature enough to tolerate and digest even breastmilk. Traditionally the fat source (lipid) in IV nutrition is made from soybean and olive oil: rich in omega-6 fatty acids but no omega-3 fatty acids. However, the rods and cones (the actual structures in the retina that process light) have membranes that contain docosahexaenoic acid (DHA), an omega-3 fatty acid.

In this study, 40 preemies who weighed less than 1,250 g received IV nutrition made from fish oil, soybean oil, and olive oil (containing both omega-3′s and omega-6′s) were compared to 44 infants who had received IV nutrition containing only omegaa-6′s. The babies who received the fish oil/omega-3 enriched nutrition were 75% less likely to receive laser surgery for ROP. Also, none of these infants had gallbladder problems, which can be a consequence of getting lipids by IV, while 5 preemies who got the traditional IV lipids developed gallbladder issues.

This study is very exciting and should prompt more research. Omegaven is an IV lipid formulation made form fish, soybean, and olive oil and contains both omega 3′s and omega-6 fatty acids. It is used for children who are at risk for developing liver disease from prolonged IV nutrition (bypassing the bowel by giving food in the IV can eventually cause problems).

The weaknesses of the study are that it is small, there is no long-term follow up, and it is an observational study, meaning the group of babies who received the omega-3 fatty acids were compared to babies who previously received the older formulation. There may be other aspects of care that changed and so it is not possible to know if the reduction in ROP is only due to the different lipid formulation or due to some other factor.

This study adds to the growing body of evidence that preemies probably need omega-3 fatty acids and a study where the omega-3 formulation is compared head-to-head with the older omega-6 only formulation is definitely needed.

Can my baby get Omegaven? It is not FDA approved, meaning it can only be used in research studies or by compassionate use (must be approved by the FDA on a case by cases basis, this link explains the steps). There are several studies looking at Omegaven for preventing liver damage with IV nutrition and once it is actually FDA approved for something, it will be much easier to get. Unless there are unknown long-term complications from using an omega-3 formulation (hard to see how, then again, no one thought high concentrations of oxygen would cause damage and now we know it causes ROP), I imagine it will eventually become the standard of care for

Posted in Uncategorized | Tagged , | Leave a comment