HEALTH

New research may lead to understanding of sepsis, NEC in children

BY Michael Johnsen

STANFORD, Calif. New research from Lucile Packard Children’s Hospital and the Stanford University School of Medicine is helping physicians unravel the cause of a deadly and mysterious bowel disease that strikes medically fragile newborn babies.

The findings could lead to a better understanding of the disease and its medical management, and also shed light on the causes of sepsis, a major killer of children and young adults.

The bowel disorder, necrotizing enterocolitis, or NEC, is seen mainly among premature infants, affecting about one-in-every 2,000 births. A similar constellation of symptoms, also labeled NEC, is also seen in children born with congenital heart defects. The disease causes intestinal inflammation and impairs nutrient uptake. Complications can include perforation of the intestine and widespread infection of the abdominal cavity or blood — sepsis — as well as lasting consequences such as the need for bowel transplant or chronic intravenous feeding.

The findings, which will appear in the May issue of the journal Pediatrics, suggest that the diagnosis of NEC in premature infants versus those with heart disease may actually encompass two distinct disease processes with different origins.

“If we start accepting that we are looking at two different diseases, further research may be able to elucidate some differences in the disease process and help us tailor management,” stated senior study author Sanjeev Dutta, assistant professor of surgery and pediatrics at Packard Children’s and the School of Medicine.

Right now, because physicians have such a poor understanding of what causes the disease, they can’t tell which infants will be hardest hit, Dutta said. “At present, we’re managing all cases the same way without addressing the concept that the child with heart disease may have a different underlying cause of NEC than the child with prematurity alone. We’re giving support, but not really curing the disease.”

To gain insight into how necrotizing enterocolitis starts, Dutta and his collaborators investigated whether a pre-existing medical problem—congenital heart defects—affected the course of the disease. They reviewed medical records from 76 infants who had a congenital heart defect together with necrotizing enterocolitis and 126 infants who had necrotizing enterocolitis alone. All study subjects were patients at Packard Children’s between May 1999 and August 2007.

The researchers found that babies who had both necrotizing enterocolitis and a congenital heart defect fared better than those who had necrotizing enterocolitis alone. Even premature babies with heart defects did better than those who were premature alone. Babies who had heart defects were less likely than other affected infants to suffer intestinal perforation or abnormal narrowing of the bowel. They also were less likely to need surgery to resolve infection, to require an artificial drain through the abdominal wall for managing bowel perforation or to require removal of portions of diseased intestine.

The findings suggest that infants with heart defects may be getting the disorder because of reduced blood flow to the bowel, while those with normal hearts may get the disease for other reasons, such as a bad reaction to oral feeding in premature infants with an underdeveloped gut. Both poor blood flow and gut immaturity have been blamed for NEC before, but the relative importance of each factor has been unclear.

Another possibility suggested by the researchers is that the close medical monitoring given to infants with heart defects helps physicians detect the intestinal problem early and thus institute therapy more quickly.

Although necrotizing enterocolitis is relatively rare, “it’s a disease that has a huge impact on society,” Dutta said. “These kids can get very sick and die, or suffer permanent injury to the bowel.”

Infants who survive often require repeat hospitalizations and expensive treatments throughout their lives.

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Nationwide survey reveals that overactive bladder symptoms compromise womens’ lives

BY Michael Johnsen

CHICAGO Recent results from a nationwide survey of women between the ages of 40 and 65 show that the symptoms of overactive bladder are compromising their sense of normalcy and making their complicated lives even more difficult to manage.

The survey, conducted for The National Association For Continence by Kelton Research and sponsored by Medtronic, compared women ages 40 to 65 who have experienced symptoms of OAB, which affect as many as 33 million Americans, to women in the same age group overall.

Both groups of women say that physical health is more important than emotional health when it comes to living a normal life. In fact, nearly 9-in-10 women in each group say that being healthy is a prerequisite to achieving a sense of balance in life – far more than those who report needing adequate levels of money or time to achieve balance. Unfortunately, just over half of women surveyed describe their health as normal, with OAB sufferers reporting feeling physically normal less often than women in this age group overall – 56% of the time among OAB sufferers vs. 71% among women in general.

Women with OAB also report lower levels of normalcy in other aspects of their lives, including their relationships with friends and family, emotional state, careers and social lives than reported by women overall. In fact, despite a trying economy, more than one in four (26%) women with OAB are more concerned about managing their OAB symptoms than saving for retirement.

An overwhelming majority (78%) of women with OAB who have sought treatment did so because they were frustrated with living with the symptoms – far fewer (38%) were motivated by physical discomfort. Unfortunately, almost half (49%) of women with OAB don’t think they’ll ever be able to completely control their symptoms.

Approximately 88% of women who have treated their OAB have turned to medication. But 25% are dissatisfied with how they are managing their condition.

“This data demonstrates that a considerable number of middle-aged women are frustrated with their OAB treatment,” stated Nancy Muller, executive director of NAFC. “There needs to be more public education so people are made aware of their options for OAB treatment beyond just medications. Clearly, there’s room for more engagement for discussion by primary care providers with their patients.”

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Kaiser Family Foundation: Patients hold off medical care due to cost

BY Alaric DeArment

MENLO PARK, Calif. A health tracking poll by the Kaiser Family Foundation released Thursday finds that the recession has forced a majority of respondents to put off medical care due to the cost.

The nationwide telephone poll of more than 1,000 adults found that 42% of respondents substituted home remedies or OTC drugs for doctor visits, while 36% skipped dental care or checkups, 29% didn’t fill prescriptions and 18% cut pills in half or skipped doses.

A large majority of respondents, 59%, said healthcare reform is more important than ever, while 37% said it was unaffordable because of economic problems.

“Our polls suggest strong support for health reform, but the public can be swayed on the key details,” Kaiser president and CEO Drew Altman said. “There is still a tremendous opportunity for leadership, but also for interest groups to define the direction of the health reform debate.”

To pay for healthcare reform, 71% supported increasing taxes on families making more than $250,000 per year, but 28% supported increasing income taxes across the board. At the same time, 61% favored “sin” taxes on items such as alcohol, cigarettes, soda and junk food. Slightly more than half, 52%, opposed taxing money that employers put toward the most generous health benefits, and 62% those who have employer-sponsored health insurance opposed the idea.

Responses did, however, depend on political affiliation. More than 80% of Democrats and 60% of independents strongly or somewhat favored having a public health plan, compared to 49% of Republicans.

The foundation randomly contacted 1,203 adults aged 18 and older by phone and conducted the poll in English and Spanish. The poll had a margin error of plus or minus three percentage points.

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