How to Provide Care for Ill or Premature Babies
Last updated on September 25th, 2017 at 10:37 am
Neonatal care in hospital
Special care is sometimes provided on the ordinary postnatal ward and sometimes in a specialist newborn (neonatal) area. Having a baby in neonatal care is naturally worrying for parents and every effort should be made to ensure that you receive the information, communication and support that you need. Not all hospitals provide specialist neonatal services, so it may be necessary to transfer your baby to another hospital.
Why babies need special care
Babies can be admitted to neonatal services for a number of reasons:
they are born early – one baby in 13 (8 out of 100) is born early, and babies born before 34 weeks may need extra help with breathing, feeding and keeping warm- they are very small and have a low birthweight
- they have an infection
- their mother has diabetes
- the delivery was very difficult or they have jaundice
- they are waiting for, or recovering from, complex surgery
Contact with your baby
The environment of the unit may seem strange and confusing, especially if your baby is in an incubator or on a breathing machine. There may also be tubes and wires attached to their face and body. Ask the nurse to explain what everything is for and to show you how you can be involved in your baby’s care. Once your baby is stable, you will be able to hold him or her. The nurses will show you how to do this and your baby will benefit greatly from physical contact with you.
Feeding
To begin with, your baby may be too small or too sick to feed themselves. You may be asked to express some of your breast milk, which can be given to your baby through a tube. A fine tube is passed through his or her nose or mouth into the stomach. This won’t hurt them.
Breast milk has particular benefits, especially for sick or premature babies, as it is enriched with proteins (notably antibodies), fats and minerals. If your baby is unable to have your breast milk to begin with, it can be frozen and given to them when they are ready.
When you go home, you can express milk for the nurses to give while you are away. There is no need to worry about the quantity or quality of your milk. Some mothers find that providing breast milk makes them feel that they are doing something positive for their baby.
Find out about expressing your breast milk.
Incubators
Babies who are very small are nursed in incubators rather than cots, to keep them warm. You can still have a lot of contact with your baby. Some incubators have open tops, but if your baby’s incubator doesn’t you can put your hands through the holes in the side of the incubator to stroke and touch your baby.
When your baby is stable, the nurses will be able to help you take your baby out of the incubator and show you how to have skin-to-skin contact. You should carefully wash and thoroughly dry your hands before touching your baby. You can talk to your baby as well – this can help both of you.
The charity Bliss has information explaining the equipment on a neonatal unit.
Newborn babies with jaundice
Jaundice in newborn babies is common because their livers are immature. Severely jaundiced babies may be treated with phototherapy (light therapy). The baby is undressed and put under a very bright light, usually with a soft mask over their eyes. The special light helps to break down the chemical that causes jaundice. It may be possible for your baby to have phototherapy by your bed so that you don’t have to be separated.
This treatment may continue for several days, with breaks for feeds, before the jaundice clears up. In some cases, if the jaundice gets worse, an exchange transfusion of blood may be needed (some of your baby’s blood will be removed and replaced with blood from a donor). This is not common. Some babies have jaundice because of liver disease and need different treatment. A blood test that checks for liver disease is done before phototherapy is started.
Find out more about treatment for newborn jaundice.
Babies with jaundice after two weeks
Many babies are jaundiced for up to two weeks following birth. Jaundice can last up to three weeks in premature babies. It is more common in breastfed babies and does no harm. It is not a reason to stop breastfeeding.
It is important to see your doctor if your baby is still jaundiced after two weeks. You should see the doctor within a day or two. This is particularly important if your baby’s poo is chalky white. A blood test will distinguish between “breast milk jaundice”, which will go away by itself, or jaundice that may need urgent treatment.
Babies with disabilities
If your baby is disabled in some way, you will be coping with a lot of different feelings. You will also need to cope with the feelings of others, such as the baby’s father, your relations and friends as they come to terms with the fact that your baby has a disability.
More than anything else at this time, you will need to talk to people about how you feel, as well as about your baby’s health and future.
Your GP* (doctor), a neonatologist (doctor for newborn babies), paediatrician (children’s doctor) or your health visitor can all help you. You can also contact the hospital Patient Advice and Liaison Service (PALS)** or your social services department for information about local organisations that may be able to help. You can contact your social services department in the UK through your local authority (in the UK)**.
The organisations listed here can offer help and advice – many are self-help groups run by parents**:
- Bliss, for babies born too soon, too small, too sick
- Contact a Family, for families with disabled children
- Disabled Living Foundation (DLF), for advice on all types of daily living equipment for disabled adults and children
- Genetic Alliance UK, supporting those affected by a genetic disorder
- Group B Strep Support, preventing group B strep infection in newborn babies
- Mind, for better mental health
Talking to other parents with similar experiences can often be the most effective help.
Worries and explanations
Hospital staff should explain what kind of treatment your baby is being given and why. If they don’t, ask them. It’s important that you understand what is happening so that you can work together to make sure that your baby gets the best possible care. Some treatments require your consent to go ahead and the doctors will discuss this with you.
It is natural to feel anxious if your baby needs special care. Talk over any fears or worries with the hospital staff. Hospitals often have their own counselling or support services, and a number of charities run support and advice services.
The consultant neonatologist or paediatrician should arrange to see you, but you can also ask for an appointment at any time if you wish. The hospital social worker may be able to help with practical issues such as travel costs or help with looking after children.
Read more information on serious conditions and special needs in children.
The charity Bliss has information and support for parents of babies being cared for in a neonatal unit. You can find out more at:
healthtalk.org has video interviews and articles on women talking about their experiences of having a baby in special care.
Editor’s Note: *clarification provided for our US readers.
** Resources in the United States
- US Hospitals typically offer similar Patient Liaison services – ask for Patient Relations or Patient Representatives
- Social Services in the United States can provide information to help with costs and treatments
- Children with Disabilities: UNICEF
- Genetic Alliance is the US affiliate of Genetic Alliance UK
- Note: several of the UK based organizations listed above like Bliss, Group B Strep Support, etc. have extensive websites offering detailed information that will be of assistance to parents worldwide.
Study: Premature Babies May Benefit from School Delay
Last updated on June 8th, 2017 at 10:15 pm
“Premature babies more likely to under perform at school, study finds,” reports The Independent. Results 
from a new study have prompted calls that some children should be held back a year before starting school.
Previous research has found that premature babies have worse school performance than babies born at term. A new study has investigated whether this poor performance could be due to premature babies being compared with children born at term who, even if they were born at the same time, are effectively older than they are.
In addition, children who are born prematurely may be enrolled at school a year earlier than predicted by their expected due date. For example, a premature baby born in July could start school a year earlier than if they had been born at full term in September. So they would be enrolled in school effectively a year early, leaving the child constantly struggling to keep up.
The researchers looked at performance on “key stage one” tests – a UK test of reading, writing and maths skills. They also looked at whether children were judged as having special educational needs.
The researchers found that children born premature are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.
However, the risk was greatly reduced for preterm children who, if they had been born on their expected date of delivery, would still have been in the same school year as their actual birth date put them in.
While school performance for children born preterm may improve by delaying entry to school, the social implications of being perceived to be “held back” (to be in a school year with younger children) could have an adverse effect on the child. As the researchers conclude “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.
Premature birth – reducing the risk
Premature births can happen in any pregnancy, whatever the general health and lifestyle of the pregnant woman. However, there are steps you can take to reduce the risk of having a premature birth, including:
- Avoiding potentially harmful substances such as alcohol, tobacco and drugs
- Trying to achieve or maintain a healthy weight
- Eating a healthy diet
For more information about health and wellbeing in pregnancy, visit the NHS Choices Pregnancy and baby guide.
Where did the story come from?
The study was carried out by researchers from the Neonatal Unit at North Bristol NHS Trust and the University of Bristol. No source of funding was reported.
The study was published in the peer-reviewed journal PLOS One. PLOS One is an open-access journal, which means that the article is available free of charge to read online or download.
The results of the study were well covered by the UK media. All three newspapers who reported on the study – The Independent, The Daily Telegraph and the Daily Mail – provide relevant commentary from independent childcare experts.
What kind of research was this?
This was a cohort study. Previous research has found that preterm babies have worse school performance than term babies. This study aimed to determine if some of this effect was due to preterm children being enrolled in school a year earlier than they would have been if they had been born at their expected due date. In the UK all children are offered a school placement based on their actual date of birth, rather than their expected due date.
To do this, they compared school performance in children born preterm who would have attended school in the same year if their expected date of delivery had been used rather than their actual date of delivery, to the school performance in children born at term.
A cohort study is the ideal study design to address this question.
What did the research involve?
The researchers analysed data from 11,990 children born in the Bristol area between April 1991 and December 1992 who were participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) – an ongoing cohort study.
Data on the gestational age at birth was extracted from clinical notes. The study included infants that were born between 23 and 42 weeks of gestation.
School performance was assessed using the results of key stage one (KS1) tests, which all children in mainstream education sit at the end of year two. In addition, teachers were sent a questionnaire that asked whether children had ever been recognised as having special educational needs.
The two primary outcomes were a low KS1 score (below 2, the expected standard in the “three Rs” of reading, writing and arithmetic), or having teacher-reported special educational needs.
The researchers looked to see if children who had been born preterm were at greater risk of low KS1 scores or having special educational needs, and whether this was due to them being placed in school a year earlier than if they had been born at term. To do this the researchers performed three analyses:
- One where each preterm infant was matched with up to 10 term infants based on their date of birth, and the outcomes for term and preterm infants compared
- One where each preterm infant was matched with 10 term infants based on their expected date of delivery, and the outcomes for term and preterm infants compared
- One where each preterm infant was matched to term infants based on their expected date of delivery and year of school attendance, and the outcomes for term and preterm infants compared
In this final analysis, the researchers compared the risk of low KS1 scores and special education needs only in infants who would still have been in the same school year if they had been born at their expected date of delivery rather than their actual date of delivery.
The researchers adjusted their results for a range of factors (confounders) that could influence academic performance. These included:
- Social factors (maternal age, socioeconomic group, education, car ownership, housing, crowding index [the number of household members per room] and ethnicity)
- Antenatal factors (the number of times the mother had previously given birth, and gender, weight, length and head circumference at birth of the infant)
- Factors during labour (mode of delivery, maternal high blood pressure and fever)
What were the basic results?
The study included 722 children who were born prematurely or “preterm” (at less than 37 weeks) and 11,268 children who were born at term (between 37 and 42 weeks).
Preterm infants were statistically more likely to have a low KS1 score and to receive special educational needs support.
Infants who were placed in the correct school year for their expected delivery date had higher KS1 scores than those children whose actual date of birth had put them in a different school year than their expected delivery date would have.
In children who had been born at full term, average KS1 scores were highest in the children oldest at the time of the test – i.e. children born in September. Average scores gradually decreased as the children entering the year were younger, with children born in August obtaining the lowest mean KS1 scores.
A similar pattern was seen for preterm infants, although the lowest mean KS1 scores were from children born in June.
Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of date of birth; to adjust for the fact that, on average, the oldest children did the best on the test (odds ratio (OR) for low KS1 score 1.57, 95% confidence interval (CI) 1.25 to 1.97; OR for special educational needs 1.57, 95% CI 1.19 to 2.07).
Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of expected date of delivery rather than gestational age (to adjust for the fact that children born preterm are actually younger than their date of birth would suggest). The OR for low KS1 score was 1.53, 95% CI 1.21 to 1.94; the OR for special educational needs was 1.59, 95% CI 1.20 to 2.11.
However, children born preterm were not at significantly higher risk of low KS1 score or of having special educational needs when outcomes were compared only for children attending school in the correct year for their expected date of delivery, and children were matched based on their expected date of delivery (OR for low KS1 score 1.25, 95% CI 0.98 to 1.60; OR for special educational needs 1.13, 95% CI 0.81 to 1.56).
How did the researchers interpret the results?
The researchers concluded that “this study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their expected date of delivery) may increase their risk of learning difficulties with corresponding school failure”.
Conclusion
In the UK, all children are offered a school placement based on their actual date of birth, rather than their expected date of birth. This study has found evidence from a large UK cohort that children born preterm may benefit from school entry based on their expected date of delivery rather than their actual birth date.
The study found that children born preterm are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.
However, there was no significant increase in risk among preterm children who would still have attended the same school year even if they had been born on their expected date of delivery.
This arguably suggests that admission policies to schools should be based on a child’s expected date of delivery rather than actual birth date. However, as the researchers rightly point out, the issue of whether an older child would interact well with children who could be, or we perceived to be, younger than them also has to be considered.
As the researchers conclude: “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.
Summary
“Premature babies more likely to underperform at school, study finds,” The Independent reports. Results from a new study have prompted calls that some children should be placed back a year before starting school.
Links to Headlines
- Premature babies more likely to underperform at school, study finds. The Independent, October 17 2013
- Premature babies ‘go on to struggle in the classroom’. The Daily Telegraph, October 17 2013
- Premature children should start school a year later: Study finds babies born early have 50% more chance of failing at reading and writing. Daily Mail, October 17 2013
Links to Science
- Odd D, Evans D, Emond A. Preterm Birth, Age at School Entry and Educational Performance. PLOS One. Published online October 16 2013
Does My Child Really NEED All Those Well Baby / Child Visits?
Last updated on October 12th, 2016 at 11:25 am
This is a common question that parents discuss with each other and other parents because most of the time there is no change in status of your child and nothing of importance is noted by his/her Doctor. This is the good news we all wish to hear but there is more than the obvious monitoring going on at these visits, just as important as your child’s current good health. At an early age your baby is seen fairly frequently as growth and development is monitored closely. After all, these elements can predict the overall health of your child as he/she gets older. Developmental issues found early can be dealt with to help avoid later problems.
Also important at these early well baby visits is the frequent and regular administration of vaccines, the order of which is constantly studied to determine the best sequence for adequate immunization. There are many vaccines involved and many parents argue that it is too many for a young child. It turns out that no one vaccine will interfere with any other one and many can be given together; neither will the administration of several vaccines at the same time cause a more severe reaction. Most of these vaccines have very little in the way of significant reactions anyway and should not be feared by parents as the benefits of these vaccines far outweighs the chances of getting the illnesses or suffering any significant side effects.
At these visits a trained professional will also observe the interaction of child and parent which can help predict a smooth or difficult child rearing path. These “well child” visits also provide a time for parents to ask questions that can help allay their fears and give your child’s Doctor the opportunity to expand on these questions. There is a lot of information out there about child rearing and such issues as immunizations (previously discussed) – some real and truthful but some may very well be erroneous in nature – and might add to the normal sense of uncertainty that all parents have when raising children.
As your child gets older, the number of visits will become fewer because most of the early immunizations have already been given and that fragile newborn and early childhood period has already been observed and patterned. Of course one of the main reasons for all these visits is to pick up any early signs of illness or disease, process a very unusual situation as your child gets older but, of course, the earlier detection the better for a positive outcome.
The answer to the first question posed in this blog is that it is very important to follow the schedule of office visits set out by your Pediatrician as this schedule has been closely studied and turns out to be the optimal timing for good child care.
Ways to Track and Boost Your Baby’s Developing Vision
Last updated on September 12th, 2016 at 04:02 pm
One of the many things new parents of an infant struggle with is an inability to communicate with their new little bundle of joy, especially on a verbal level. When they cry, are they hungry, need a diaper change or is there a realistic medical problem happening with their health and welfare that needs our immediate attention … sometimes it’s difficult to tell.
When it comes to their irreplaceable eyesight, monitoring these formidable years are vital when it comes to recognizing possible vision development problems that could affect them in the future. With a myriad of different types of diseases, conditions and terms to deal with when it comes to their valuable vision, it’s almost always difficult for parents to know where to start with this important process.
Early AOA Recommendations
The renowned American Optometric Association (AOA) is all too happy to guide parents on this important pathway. They offer valuable advice on developmental processes and better vision for growing eyes, from birth to the toddler stage. After they’re born, although their environment is full of visual stimulation, infants have not yet developed the ability to recognize two objects at once.
Their primary focus is on something 8 to 10 inches from their face, which is usually mirrored by their parent’s face in front of their own. After a couple of months, they should start tracking objects, but don’t be overly concerned if they have difficulty focusing, their eyes appear crossed or seem to wander since this is completely normal at this stage.
Five, Six, Seven, Eight – Is Everything Going Great?
After three or four months of age, babies should start to track objects and reach for them with their hands. The perception of color should start developing further now and although it’s not as advanced as their older parent’s eyes, there’s still a general consensus that these tots start to disseminate different shades, colors and start to develop better depth perception. To help boost their perception skills, at this age, parents should:
- Give them plenty of toys, blocks and other objects for them to grasp
- Play patty-cake and other games that use eye-hand coordination
- Make sure they have time to explore by letting them crawl around frequently
Nine and Ten – Let’s Do It Again – Getting To Year One
At nine months, babies will start to pull themselves up and while they’re continuing to approach their first birthday, they should be grabbing and grasping objects firmly. Once they’ve reached twelve months of age, they should be walking, but also encouraged to continue to crawl to heighten their depth perception and advance coordination skills. More ways to improve their developing vision during this time is to:
- Play hide-and-seek with their playthings
- Encourage them to continue crawling and entice them to go further distances
- Name toys and objects to begin developing word association with vision
One Or Two – Before We Buckle A Shoe
There are still a few years before we begin teaching advanced techniques like tying shoelaces, but this time is when toddlers should be developing much better eye-hand coordination techniques. Rolling a ball to them and expecting the same in return for example. They’ll probably start throwing things on their own at this point without our help. Look for better aim as they continue to develop and participate with this process. To continue enhancing their visual skills, parents should:
- Roll a ball back and forth to them
- Read to them and show them pictures in the book
- Give them balls, blocks and puzzle games to play with
If you believe your child may have possible or potential vision problems, take them to see an eye care professional as soon as possible. Eye exams are recommended initially at birth, at six months and then not again until they’re three years of age. But these rules aren’t set in stone and the majority of eyesight issues can be corrected, especially when caught early.
Study: Iron Pills in Pregnancy Cut Low Weight Births
Last updated on August 5th, 2016 at 01:35 pm
“Daily iron in pregnancy reduces small baby risk,” BBC News reports, with a similar story in the Daily Express.
The news stories follow a major review of the best available evidence on the link between use of iron supplements during pregnancy, and pregnancy and birth outcomes.
The pooled results suggest that, compared with no supplements, taking iron supplements increases the mother’s haemoglobin levels, and halves the risk of the mother becoming anaemic during pregnancy.
Supplements also resulted in the baby being on average 41.2g heavier at birth and reduced the risk of low birthweight by 19%. The findings showed a dose-response relationship, with higher doses being associated with lower risk of maternal anaemia and lower risk of low birthweight.
Different Types of Anaemia
There are several different kinds of anaemia, with iron-deficiency anaemia being the commonest. However, anaemia can also be caused by vitamin B12 or folate deficiency.
Overall, this offers evidence to back iron supplementation during pregnancy. However, this review focussed on low, middle and high income countries. Women do need increased iron during pregnancy, but in the UK, should be able to get all the iron they need in their diet (such as from leafy vegetables).
Currently, iron supplements are recommended if pregnancy blood tests show that the mother is anaemic. They are not routinely offered to all pregnant women due to the potential for side effects. Folic acid supplements are, however, recommended while trying to conceive and during the first 12 weeks of pregnancy.
Where did the story come from?
The study was carried out by researchers from Harvard School of Public Health, Harvard Medical School and Imperial College, London. Funding was provided by the Bill and Melinda Gates Foundation. Additional support came from the Saving Brains Program, Grand Challenges Canada Grant.
The study was published in the peer-reviewed, British Medical Journal.
The news stories provide a representative view of the findings.
What kind of research was this?
This was a systematic review and meta-analysis. It pooled the results from randomised controlled trials and observational cohort studies that examined the relationship between use of iron supplements during pregnancy, and pregnancy and birth outcomes.
The researchers say that iron deficiency is the most common cause of anaemia during pregnancy worldwide. Because of this, the World Health Organization recommends the use of antenatal iron supplements in low and middle income countries, and it is also recommended in some high income countries.
Observational studies are said to have found suggested links between iron deficiency anaemia and premature birth, and clinical trials have given inconclusive results on the link between iron levels and birth outcomes.
This review aimed to address this question by identifying all observational studies and clinical trials investigating the issue, and pooling the results in meta-analysis to see whether there is a link between use of iron supplements during pregnancy and haemoglobin levels in the mother and birth outcomes. A systematic review is the best way to examine the current evidence related to this issue.
What did the research involve?
The researchers conducted a search across medical databases up to May 2012, including randomised controlled trials in pregnant women investigating the use of daily oral iron or iron and folic acid supplements compared with inactive placebo pill or no treatment.
They excluded trials that investigated multiple vitamins or minerals, or in women with significant illnesses (such as mothers infected with HIV). Trials were required to have examined maternal outcomes such as anaemia (defined as haemoglobin <110g/l) and iron deficiency (defined as serum ferritin <12 micrograms/l), and birth outcomes, such as premature birth, birthweight and infant death around the time of birth.
Their search also included observational cohort studies that prospectively followed the association between baseline anaemia and birth outcomes.
The researchers assessed the quality of included studies, and pooled their results where possible, taking into account the differences between the findings of the individual studies (heterogeneity).
What were the basic results?
Findings from clinical trials
The researchers identified 48 randomised controlled trials (27 in high income countries and 21 in low/middle income) which included a total of 17,793 pregnant women.
Most of these trials (34) compared the use of daily iron supplements to no iron or placebo. Others compared iron in combination with folic acid to no treatment, or iron in combination with other micronutrients to the micronutrients without iron.
The dose of iron in the majority of included trials ranged from 10mg to 240mg daily. Duration of supplementation varied from seven or eight weeks through to 30 weeks during pregnancy.
When they pooled the results of 36 of these trials, they found that iron supplements increased the mother’s haemoglobin concentration by an average difference of 4.59g/l compared with the control groups (95% confidence interval (CI) 3.72 to 5.46g/l). Heterogeneity between these trials was non-significant, suggesting that all trials gave broadly similar results. When they pooled the results of 19 trials they found that iron supplements (with or without folic acid) significantly reduced the mother’s risk of anaemia by 50% (relative risk (RR) 0.50, 95% CI 0.42 to 0.59).
However, there were significant differences (heterogeneity) between these trials, suggesting that the results of the individual trials were quite different from each other for this outcome. When the researchers pooled trials looking at other markers of anaemia, eight trials also found that iron supplements (with or without folic acid) reduced risk of maternal iron deficiency by 41% (RR 0.59, 95% CI 0.46 to 0.79), and six trials found they reduced risk of iron deficiency anaemia by 60% (RR 0.40, 95% CI 0.26 to 0.60).
The researchers estimated that for every 10mg increase in iron intake per day, up to 66mg/day, the risk of maternal anaemia decreased by 12% (RR 0.88, 95% CI 0.84 to 0.92).
- When they looked at trials examining birth outcomes they found that iron supplements led to a 19% reduction in risk of having a low birthweight baby (RR 0.81, 95% CI 0.71 to 0.93 from the pooled results of 13 trials).
- They found that babies whose mothers were given iron supplements were an average 41.2g greater weight than babies of mothers not given iron (95% CI 1.2 to 81.2g difference). This was from the pooled results of 19 trials, which again did have quite high heterogeneity, suggesting that the results of the individual trials were quite different from each other.
- They estimated that for every 10mg increase in iron intake per day, birthweight increased by 15.1g (95% CI 6.0 to 24.2g) and risk of low birthweight baby decreased by 3% (RR 0.97, 95% CI 0.95 to 0.98).
- Iron supplementation was not found to have an effect on the risk of premature birth.
Findings from observational studies
Forty-four cohort studies were included (22 from high income countries), including 1,851,682 women. Anaemia was said to be variably defined by these studies, and measured at different times during pregnancy.
The pooled results of six of these observational studies found that anaemia during the first or second trimester of pregnancy was associated with a 29% higher risk of low birthweight baby (odds ratio (OR) 1.29, 1.09 to 1.53), but no significant association when considering only studies from high-income countries (OR 1.21, 95% CI 0.95 to 1.53).
Seven studies found that anaemia during the first or second trimester was associated with a 21% higher likelihood of premature birth (OR 1.21, 95% CI 1.13 to 1.30). The association between third trimester anaemia and premature birth was non-significant (OR 1.20, 95% CI 0.80 to 1.79), however, the results for these third trimester studies varied considerably.
How did the researchers interpret the results?
The researchers conclude that daily iron supplements during pregnancy increase maternal haemoglobin and substantially improve birthweight in a dose-response fashion, leading to a reduced risk of a low birthweight baby.
Conclusion
This was a well-conducted systematic review and meta-analysis. It looked at the findings from 48 randomised controlled trials, including almost 18,000 women, that reviewed the effects of iron supplementation during pregnancy (with or without folic acid) upon maternal anaemia during pregnancy and birth outcomes.
The pooled results of the trials provide good evidence that iron supplements increase the mother’s haemoglobin levels (by an average 4.59g/l compared with the control groups) and halve the risk of the mother becoming anaemic during late pregnancy or around the time of birth. Supplements also resulted in the baby being on average 41.2g heavier at birth and decreased the risk of the baby being of low birthweight by 19%.
The findings showed a dose-response relationship, with higher doses being associated with lower risk of maternal anaemia and lower risk of low birthweight.
There were, however, differences between the results of individual trials, possibly a result of the trials’ differing methods and included populations, meaning the risk reductions calculated may not be precise.
Evidence from observational cohort studies found an association between iron supplementation and lower risk of premature birth. However, the randomised control trials do not support this observation.
Randomised trials are the better study design to test the effect of an intervention, as cohort studies may be influenced by other confounding factors. This is because, for example, women in cohorts are choosing to take supplements, and their choice may be associated with other improved health and lifestyle factors, such as better diet, that improve outcomes for mother and baby.
The researchers acknowledge a further limitation of their review: that they lacked data for some outcomes (such as stillbirths, newborn illnesses and early death).
Overall, the study provides evidence to support the use of iron supplementation during pregnancy. However, the results of this review covers low, middle and high countries. It is true that women need increased iron during pregnancy, but woman should be able to get all the iron they need through their dietary sources (such as from leafy vegetables).
Current UK guidance recommends that iron supplements are considered if pregnancy blood tests show that the mother is anaemic. But iron supplements are not offered routinely to all pregnant women due to the potential for side effects. Folic acid supplements are, however, recommended while trying to conceive and during the first 12 weeks of pregnancy.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.
Summary
“Daily iron in pregnancy reduces small baby risk,” BBC News reports, with a similar story in the Daily Express. The news stories follow a major review of the best available evidence on the link between…
Links to Headlines
- Daily iron pill during pregnancy ‘leads to healthier babies’. Daily Express. June 21 2013
- Daily iron in pregnancy ‘reduces small baby risk’. BBC News.
Links to Science
- Haider BA, et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. Published online June 21 2013
How Important is Crawling for Baby Development?
Last updated on March 7th, 2018 at 07:49 pm
This post was sparked by a recent basement storeroom clear out with my now 14-year old son….but more on that later…
All new parents probably worry about their baby’s development. Will he develop normally? Will she hit the milestones on time? And there are a lot of milestones to keep track of, as shown on the US Centers for Disease Control (CDC) website – covering areas such as social/emotional development, communication and cognition/thinking. But the area our son seemed to have an issue with was in movement and physical development….he wouldn’t crawl.
According to developmental guidelines (for example CDC.gov and WebMD), by nine months your baby should be getting into a sitting position on his own, pulling to stand, and crawling to get around and explore his surroundings. Our son, Elliott, definitely did the first two, but he wouldn’t crawl. Instead he perfected the art of rolling. Everywhere. And very quickly!
By rolling I mean rolling onto his side and then his stomach, and then his other side, and his back….and the whole thing over and over again. And he was very good at it. Each time he set out on one of these rolling journeys, he could only go in one of two directions – whichever ways his sides were facing. So he quickly learned to get to all corners of the main floor of our house by rolling in one direction for a bit and then turning and changing direction – with just a bit of a shift in his orientation so that he wasn’t going back where he came from. In this way he whizzed about the house in a rolling zigzag pattern – pretty handily getting from point A to B.
Hey Mom….look at me go!
At first this was really cute and quite a marvel. And given that he could move about quite well, we really didn’t have anything to be worried about, right? Well, it wasn’t entirely clear. Since this was more than 10 years ago – at the very early stages of internet search engines – we couldn’t easily access the huge range of information we can all get today. And some of the baby books and articles at the time suggested there could be issues with babies skipping crawling, including for hand-eye coordination and social development. Even today, a few articles on the web talk about issues with not crawling – like potential delays in building upper body strength – but the majority say crawling isn’t needed. One article even pointed out that crawling isn’t listed on the Denver Developmental Screening Test, widely used by pediatricians to assess normal infant development.
Just to be on the safe side, we tried a number of tactics to promote crawling, including little pushes on his bottom and demonstrating crawling techniques ourselves (that was a hoot!). We also took him regularly to Gymboree classes from an early age, so he saw lots of other babies crawling around – but nothing worked. Until one day someone (a class leader? another mom?) suggested trying one of the 
many collapsible fabric tunnels in the class. My mom was with me that day and she put Elliott in front of the entrance to the tunnel while I encouraged him forward from the other end. But nope….he just rolled away. After trial and error, we figured out that we had to place him a ways inside the tunnel so he couldn’t back out – and need to steady the tunnel on the sides so he couldn’t make the whole thing roll. So there he was…stuck in the middle…and was he ever MAD! He made all sorts of angry grunting and mewling sounds and eventually started crying. But he finally began to reach his arms out in front of him and began “army-style” crawling on his belly!! I was so ecstatic I bought a collapsible tunnel on the spot for more practice at home.
And so it worked. After more time in the tunnel, he learned how to crawl and began using this skill instead to go exploring around the house. But in the end, I don’t think it really mattered whether he rolled or crawled. Even before the “tunnel therapy” he was already on to later milestones like standing and taking steps while holding onto low furniture. And he never had any issues with upper body strength or fine motor skills, despite a very brief crawling stage.
The biggest problem came more than a decade later when I found the flattened fabric tunnel in that basement storeroom. I thought it was such a cute story that I shared it with now-teenage Elliott, who insisted on opening it up for a better look. But instead of thinking it was sweet, he got rather annoyed and accused us of “torturing” his baby self! Moral of the story…whatever you do in the best interests of your child – save the stories until they have kids of their own and “get” how tough parenting decisions can be.
