The New Nation - Internet Edition

Babies born by 36th week of pregnancy

Judith Graham

Just let me make it to 36 weeks, Colleen Carroll prayed when she went into premature labor in her 33rd week of pregnancy. If only she could delay childbirth a while longer, she believed, her baby would be fine.

On Jan. 8, one day short of 36 weeks, little Caitlin came into the world screaming. Carroll cradled her brown-haired daughter in her arms, thinking "thank God." Then, she noticed the baby was making odd, grunting noises.

It was respiratory distress. The newborn went alarmingly downhill until doctors stabilized her on a respirator in the neonatal intensive care unit at Northwestern's Prentice Women's Hospital. "You think you're in the clear, and then the baby has trouble, and you wonder why," said Carroll, a former Prentice nurse.

A growing body of recent research points to the answer: Babies born in the 34th through 36th week of a woman's pregnancy are at a much higher risk of medical complications than infants delivered at full term, or after 37 weeks.

Although most of these so-called "late pre-term" infants are healthy, a significant minority -- as many as 17 percent to 34 percent, according to a recent report -- have breathing problems, jaundice, feeding difficulties, low blood sugar, unstable body temperatures and other medical issues.

This is by far the largest and fastest-growing group of premature infants born in the U.S.: More than 350,000 are born each year. Experts aren't sure why their numbers are increasing, but they suspect that at least some physicians may be delivering babies early without solid medical justification, thinking the children won't be in danger.

Until the last few years, "no one paid a whole lot of attention to these babies" because they look big and seem almost fully developed, said Dr. Tonse Raju, neonatal specialist and medical officer at the National Institute of Child Health and Human Development.

Yet even at this late stage, a baby's brain volume is only about 60 percent of what it should be if born at full term, experts explain. The infant is still laying down fatty tissue that will help insulate him or her after birth. The lungs and guts aren't fully functional, and the liver isn't able yet to process waste adequately.

"The baby is making final preparations to be separated from mom, and these aren't just niceties: There's important maturation going on," said Dr. Robin Steinhorn, head of neonatology at Northwestern University's Feinberg School of Medicine.

A November study by researchers from the Centers for Disease Control and Prevention in the Journal of Pediatrics underscores the vulnerability of these newborns. It found that infants born at 34- to 36-weeks are six times more likely to die in the first week of life and three times more likely to die in their first year than babies born full term. Overall, the number of deaths remained small: fewer than three for every 1,000 late pre-term infants.

More commonly, these babies have medical issues that require extra attention and longer stays in the hospital. Of those born at 34 weeks, for instance, as many as three-quarters can find their way to neonatal intensive care, where intravenous tubes provide nutrition and breathing tubes keep oxygen flowing, said Dr. William Engle, a pediatrics professor at Indiana University School of Medicine.

Experts suggest several trends are responsible for the increase in late pre-term births. More women are becoming pregnant through assisted reproduction, which increases a mom's risk of carrying multiple babies and going into premature labor. More older women are trying to have children, again increasing the chance of medical complications.

Meanwhile, obstetrical practices have changed, as physicians monitor pregnant women more aggressively and act earlier on potential problems -- a strategy that has significantly reduced stillbirths and neonatal deaths. Obstetricians also may be more willing to deliver early because of medicine's extraordinary advances in caring for premature babies.

Of particular concern to experts are anecdotal reports that some babies are delivered early without strong medical justification. If an anxious mom wants to end an uncomfortable pregnancy, a doctor may agree.

"It may not be happening in every hospital or every obstetrics practice, but it's happening enough to warrant significant concern," said Dr. Alan Fleischman, medical director of the March of Dimes, which is investigating the issue in an ongoing study that has not yet been published.

Dr. Sarah Kilpatrick, head of the division of maternal fetal medicine at the University of Illinois at Chicago Medical Center, said she believes there are doctors who will deliver women as much as a month early for "relatively minor reasons" such as a slight increase in the mother's blood pressure. "We don't do that," she added.

"There are women who will tell me, if you won't deliver me here I'll fly to New York City there and do it there at 36 weeks," said Dr. Jay Iams, professor of maternal fetal medicine at Ohio State University Medical Center.

Few doctors succumb to this kind of pressure, Iams said. But if the woman is in what he calls "the gray zone" -- for instance, she has some degree of hypertension or experienced a complication during an earlier birth or reports the baby isn't moving much -- a physician may well decide, "What am I waiting for?" and schedule a delivery.

In light of new research, physicians may want to reconsider how they weigh the benefits of scheduling Caesarean sections or inducing women against the potential health risks for late pre-term infants, said Dr. Lucky Jain, a pediatrics professor at Emory University Medical Center in Atlanta.

Sheila Nalywajko, 27, of Elk Grove Village didn't have a choice when her third son, Nathan, was born at 34 weeks in mid-December. Both of his older brothers had been delivered early because of serious medical complications.

This time, physicians at the University of Illinois Medical Center scheduled a C-section six weeks early after struggling unsuccessfully to control Nalywajko's soaring blood pressure. Though Nathan was a healthy 6 pounds at birth, he couldn't breathe on his own and had dangerously high blood pressure in blood vessels around his lungs. He spent three weeks in neonatal intensive care.

"You think you know what to expect -- and you're wrong," said Nalywajko, who said she wasn't prepared for Nathan's medical problems despite her earlier experiences. "You think, my other kids they were OK, so let's go ahead and do this. But it was terrible, what he went through in those first few weeks."

Medicine at our doorsteps: Arhar (Dal)

Jamayet Ali

Arhar is one of the major pulses grown and used in the form of split and dal. It forms an important part of vegetarian diet. It is a perennial erect shrub with many silky branches and pinkish white flowers in loose corymbose racemes, cultivated for its seeds as a pure or mixed crop throughout Bangladesh. It is also grown throughout the tropics. India has over 90 percent of the hectarage, and produces 90 percent of the world's supply. Other countries growing Arhar are Myanmar, Uganda, Kenya, Dominican Republic Panama, Puerto Rico and the West Indies. Arhar has been used as a fodder crop in some countries in South America, Africa and in Hawaii Islands. It is consumed in various ways commonly being cooked with vegetables and spices. Green pods are used as a vegetable. Raw seeds when consumed in large quantities have a soporific effect.

Botanical name of Arhar is Cajanus cajan (Linn). Although India is believed to be the native of Arhar, some doubt exists as to whether the genus was originally a native of Africa. Because, it has been found growing wild from the east coast of Africa (Zanzibar Tanzania) to the coast of Guinea. this wide distribution as well as its presence in ancient Egyptian tombs, dating back to 2200 B.C., point to an African origin of this genus as more plausible. The crop is highly adaptable to climatic variations, and grows both in dry and moist tropics. Under dry it tends to mature faster, while under humid conditions it develops a luxuriant vegetable growth and matures late. It is drought resistant and cannot tolerate water-logging. It grows in almost all kinds of soil such as black cotton soil, red, loamy, sandy or even clayey soils.

Arhar is grown mostly as a kharif crop, being sown at the commencement of the monsoon in June/July and harvested by February/March. Arhar grown in the rainy season has better cooking quality. In regions with a mild winter, it is grown as a rabi crop being sown in September-October and harvested in March-April. The crop requires very little manuring. When grown pure, Arhar crop is seldom weeded but when grown in mixture with other crops interculture befitting the principal crop is done. The crop makes slow growth until the major crop is harvested. It grows slowly during the first 45-60 days but becomes large bushy plants by flowering time. The quality of dal varies not only with the method of preparation but also according to the variety and the soil. Dal obtained from crops cultivated in black cotton soils, has been found to have better cooking quality because of the presence of considerable lime in the soil.

Analysis of the red gram dal gave: moisture, 13.4; mineral matter, 3.5; fibre, 1.5; Kcalorie, 335 (energy); protein, 22.3; fat, 1.7; and carbohydrates, 57.6 g.; calcium 73. iron, 5.8; thiamine, 0.45; riboflavin, 0.19; niacin, 2.9; tocopherol, 0.60-0.70; vitamin B 6, 0.54 mg. and carotene, 132 mg / 100g. Other mineral compositions are as follows: phosphorus, 304.0 (phytin p, 170); copper, 1.25; magnesium, 133.0; sodium, 28.5; potassium, 1104.0; sulphur, 177.0; and chlorine, 5.0 mg./100g. The dal also contains; manganese, 7.75; chromium, 0.11; zinc, 23.0; and molybdenum, 283 J.lg/ g. (Food Processes and Analysis, Mohammad Yunus, BARC, Dhaka, 46; Wealth of India, Raw Materials, vol. III, 35).

Medicinal Properties: The seed is acrid; astringent to the bowels, anthelmintic; restores loss taste; cures leprosy; "vata", and "kapha", ulcers of the mouth, tumours, bronchitis, vomiting, heart diseases, piles, cough, biliousness, "tridosha"; improves complexion; causes flatulence (Ayurveda). The seeds have a good taste; indigestible; cause constipation, griping, biliousness, diarrhoea and weakness; alexiteric; improve the liver; lessen expectoration. The leaves lessen inflammation; good in piles and for the teeth. (Yunani). the pulse and leaves are mixed and made into a paste which is warmed and then applied over the mammae to check the secretion of milk. A poultice made of the seeds will check swellings. The pulse in combination with other drugs is recommended for the treatment of snake-bite (Charaka).

In Madagascar, the plant is considered diuretic, astringent, strongly antidysenteric, detergent, laxative, and vulnarent. The buds are pectoral; the flowers bechic; the juice of the leaves laxative; the flour from the seeds resolvent; the lye detergent. In Guiana, the flour from the seeds is considered resolvent. The buds and the green pods are used in infusion as a pectoral. The boiled leaves are applied to wounds as a vulnerant; in decoction they are used as a detergent; the juice obtained by expression in the cold is used in haemorrhage. An infusion of the flowers is considered pectoral. The pulse is not an antidote to snake-venom. (Indian Medicinal Plants, K.R. Kirtikar & B.D. Basu, Vol. I, 809,810)

Medicine: The pulse is said to be easily digested and therefore suitable for invalids. It is regarded as hot and dry; it, however, produces costiveness. The leaves are used in diseases of the mouth.

Special Opinions: "Said to be heating, disagrees with some individuals, causing acidity and heartburn." (Assistant Surgeon Shib Chunder Bhuttacharji, Chanda, Central Provinces.) "The pulse and leaves are mixed and made into a paste, which is warmed and then applied over the mammae to check the secretion of milk." (Surgeon W. A Lee, Mangalore.). "The tender leaves are chewed in cases of aphthae and spongy gums." (Brigade Surgeon J.H. Thornton, B.A., M.B. Monghyr.) "A poultice made with its seeds will check swellings." (Ummegudien Native Doctor, Mettapollium, Madras.) (Dictionary of the Economic Products of India).

Medicinal values: Leaf juice is used in jaundice and diseases of the mouth. Tender leaves are chewed in cases of aphthae and spongy gums. Aqueous and alcoholic extracts of tender leaves exhibit anti-hepatoxic activity in rats. Seed paste in the form of poultice is used in snake-bites and to reduce swellings.

Leaves and seeds are also useful in coughs, bronchitis, vomiting, piles and biliousness. Seeds are also claimed to cure leprosy, tumours and heart diseases. Extracts of the leaves possess antibacterial activity. Alcoholic extract of the seeds shows hypoglycemic and hypocholesteromic activities in rats. Extract in germinating seeds is virus inhibiting. (Medicinal Plants of Bangladesh, Second Edition, Abdul Ghani, 138).

Genentech's nod for cancer drug

WASHINGTON-A drug made by Genentech Inc. received federal approval Friday to treat breast cancer, which could represent a major shift in standards for assessing the effectiveness of cancer medicines.

Going against the recommendation of its panel of advisers, the Food and Drug Administration cleared Avastin, which is already approved for treating lung and colon cancer, based on findings that it slowed tumor growth.

Approval shift: Approval for late-stage cancer treatments usually depends on a drug showing it extended or improved the quality of patients' lives. Avastin showed neither in a study, according to Genentech.

Wall Street analysts believe the decision opens the door for other cancer drugs to be approved for their tumor-shrinking capabilities.

The Y-Me National Breast Cancer Organization called Avastin an important new option for patients.