Articles Posted in Developmental Delay

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November is National Diabetes Awareness Month, so a recent report published in JAMA Pediatrics, revealing that pregnant woman with elevated blood sugar levels are more likely to have babies with congenital cardiovascular defects, even if their blood sugar is below the cut off for diabetes, could not come at a more appropriate time.

The study was conducted over four years out of the Stanford University Medical Center, where researchers examined blood samples taken from 277 California women during their second-trimester of pregnancy. Out of the 277 women, 180 were carrying infants without congenital heart disease, and the others had infants affected by one of two serious heart defects. Specifically, 55 had tetralogy of fallot, where a baby is getting too little oxygen, and 42 had dextrotransposition of the great arteries, where the position of the two main arteries leading form the hart are swamped, preventing oxygenated blood from the lungs to circulate throughout the body.

The women’s levels of glucose and insulin were measured and used to test the association between those levels and the odds of having a baby with a heart defect. The results revealed that women who had fetuses with tetralogy of fallot had higher average blood glucose levels, but there was no significant finding in the relationship between dextrotranspostition of the great arteries and glucose levels.

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According to a recent lawsuit filed in the U.S. District Court of Tennessee, defendant health care providers failed to properly handle the delivery of the minor plaintiff, resulting in extended fetal oxygen deprivation and brain injury at birth. Specifically, the complaint alleges that during the mother’s labor and delivery, medical personnel failed recognize and respond to clear signs of declining fetal response, indicating the need for an emergency C-section.

The mother plaintiff gave birth to her first child via Cesarean section, and shortly thereafter she became pregnant again. According to the lawsuit, despite her risk factors, including short stature; previously unsuccessful attempt at vaginal birth; and a brief time between the two pregnancies; the mother plaintiff was advised that she was a good candidate for a vaginal birth after C-section (VBAC).

The mother plaintiff went into labor early, and within the first half hour the EFM strip indicated minimal variability and loss of accelerations (two signs of fetal compromise). According to the lawsuit, rather than being admitted to the Labor & Delivery ward, the fetal monitoring was stopped and the mother plaintiff was advised to walk around the hospital for an hour or so. About two hours later, she was admitted whereupon labor progression was slow and the fetal monitoring continued to show repetitive late decelerations. After several hours, a C-section delivery was ordered.

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Cerebral palsy is a term used to cover a group of brain and nervous system disorders affecting 10,000 babies annually. About 50% of all cerebral palsy cases involve full-term or near full-term infants. According to the American Medical Association, there are ways to prevent cerebral palsy in full-term and premature infants.

One way to prevent CP in a full-term infant is to prevent chorioamnionitis. Chorioamnionitis is an inflammation or infection in the amnion and/or chorion, the membranes that surround and protect a fetus before birth. It affects 1-10% of term births and is often associated with prolonged labor.

Risk factors for chorioamnionitis include: prolonged labor, maternal age (less than 21 years old), prolonged rupture of membranes, first pregnancy, and multiple vaginal examinations during labor. If it is timely diagnosed (typically after a mother exhibits a fever, increased heart rate, uterine tenderness and/or foul smelling amniotic fluid), chorioamnionitis can be treated with intravenous antibiotics (usually ampicillin or clindamycin, plus gentamicin). Undiagnosed chorioamnionitis, which may be the result of medical malpractice, can lead to serious complications including bacteremia, meningitis and respiratory distress syndrome which, depending upon the severity, can restrict fetal oxygenation and lead to cerebral palsy.

In preterm infants, administering a drug called magnesium sulfate 24 hours before delivery may also reduce the risk of cerebral palsy. Studies suggest that “mag sulfate” has a neuroprotective effect.
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In the State of New York, children with developmental delays following birth are referred to the New York State Department of Health “Early Intervention” Program.

To be eligible for services, a child must be less than three years old and have a “confirmed disability” or “established development delay” that is (1) physical, (2) cognitive, (3) communicative, (4) social-emotional, and/or (5) adaptive.
Following an evaluation and development of an individualized family service plan (IFSP) services begin almost immediately. Typically within days.

“Many of our clients receive services from Early Intervention,” said New York cerebral palsy lawyer Michael A. Bottar, Esq., of Syracuse-based Bottar Law, PLLC. “EI does a great job providing physical, occupational and speech therapy to children diagnosed with cerebral palsy, Erb’s palsy, Down syndrome and other physical/cognitive deficits including blindness, deafness, and poor muscle tone or feeding. It is comforting to know that children, many of whom have disabilities because of something that went wrong during childbirth, have a safety net.”

In addition to therapy, EI provides family education and counseling, parent support groups, audiology, psychological services, nursing services, nutrition services, vision services, social work services and assistive technology devices and services. Additional detail about EI can be found in The Parent’s Guide to Early Intervention (pdf).
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Premature birth is a very serious problem because preemies are at high risk for permanent disability, including lung disease, cerebral palsy, blindness and deafness. According to Anthony S. Bottar, a Syracuse birth injury lawyer representing New York children diagnosed with cerebral palsy following a complicated labor and delivery, “approximately 10% of babies born prematurely will have a permanent disability.”

Preterm births occur in 12% of pregnancies,” Bottar added. November is prematurity awareness month. During prematurity awareness month, many local organizations including Binghamton-based Mothers & Babies, partnered with the March of Dimes to raise awareness about premature birth injuries caused when a baby does not reach 37 weeks of gestation (the threshold for prematurity).

A baby born between 35 and 37 weeks is considered “moderately premature.” A baby born between 29 and 34 weeks is considered “very premature.” A baby born between 24 and 28 weeks is considered “extremely premature.” Extremely premature babies face the greatest challenges. Approximately 17% of babies born at 23 weeks will survive. At 24 and 25 weeks, approximately 39% and 50% will survive, respectively.

Of children born before 26 weeks, statistical disabilities include: 22% severe disability (cerebral palsy but not walking, profoundly low IQ, blindness and/or deafness), 24% moderate disability (cerebral palsy but walking, special needs IQ, some visual or hearing impairment), 34% mild disability (low IQ, slight vision deficits), 20% no problems.
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