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Coronavirus Outbreak: What Parents and Expecting Mom Should Know

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The newest coronavirus just took its first US victim as of this publication – a person near Seattle – and by now, parents and pregnant women, and many others are in panic mode.

The most recent reports indicate that over 84,100 people have been sickened with the virus and about 2,870 have died since the outbreak began in Wuhan, China in December 2019. Although the virus was mainly in China, it has since spread to at least 56 nations including 62 confirmed cases in America.

On Tuesday, representatives from the Centers for Disease Control and Prevention said that the coronavirus would most likely spread to communities in the United States.

Watch this excellent explainer video from the CDC NOW!!!

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“It’s not so much of a question of if this will happen anymore but rather more of a question of exactly when this will happen,” said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, during a news media briefing. “We are asking the American public to work with us to prepare, in the expectation that this could be bad.”

As the New York Times recently reported:

Right now, the bulk of the cases in the United States are connected to the Diamond Princess, the cruise ship that was docked in Japan after it was revealed that some guests on board had tested positive for coronavirus. For those who have been diagnosed in the United States, most had traveled to China, although two cases occurred after contact with an infected person at home.

Two cases in California, one revealed on Wednesdayanother on Friday, had no known connection to previous cases, suggesting community spread.

The paper also did a great round up of advice and here are the critical excerpts that pertain to children and pregnant women who are the main focus of this site and I highlighted the points that jumped out to me in larger font and italics:

Should parents be worried?

The good news, Dr. Meissner said, is that cases in children have been very rare.

According to a report published in JAMA in February, most people infected with the coronavirus were between 49 and 56 years old.

“It appears that when kids do get it, they have much milder symptoms,” Dr. Meissner said.

It’s also important to keep things in perspective, Dr. Mulligan added. “Flu is killing a lot more Americans, including children,” he said. “There’s no doubt the influenza virus will cause many more illnesses, hospitalizations and even deaths than this coronavirus.”

[What parents should know about this season’s flu.]

What steps should parents take at this point?

You should take the same precautions you would take to protect your child from the common cold or flu.

“We know for sure that it spreads readily from person to person, akin to influenza,” Dr. Schaffner said of the new coronavirus. “We also now think it can spread from people who are infected with the virus, but not yet showing symptoms. We don’t know if this is a frequent occurrence, but it can happen.”

As always, encourage children to wash their hands frequently and thoroughly with soap and water for at least 20 seconds. (Alcohol-based hand sanitizers can work in a pinch, but they’re generally not as effective as soap and water, added Dr. Meissner.)

Hands should be washed before children eat, after they use the bathroom, come inside from outdoors or touch something dirty like garbage. If you see someone coughing or sneezing, try to keep your kids as far away from them as possible.

“We believe that the respiratory secretions from coronaviruses can’t travel more than six feet,” Dr. Meissner explained.

Travel is also fine, Dr. Meissner added, but use common sense and caution.

For the most part, domestic trips and even most international ones are still OK (even with the isolated cases of potential community spread in California).

The C.D.C. has issued a Level 3 advisory (which means avoiding nonessential travel) for China and South Korea, and a Level 2 advisory (meaning older adults and those with chronic medical conditions should consider postponing travel, and those who are going should practice enhanced precautions) if you’re traveling to Japan, Iran or Italy.

If you’re planning a cruise for spring break, the C.D.C. also urges you to avoid ones that travel to or from Asia.

If there is an outbreak in your town, Dr. Schaffner said you should practice what’s known as social distancing.

This means staying at home and binging on TV, rather than going out and about to movies, sports events and other activities. Schools may close, at least temporarily, and people who can work from home will be encouraged to do so.

For now, Dr. Schaffner said, if you and your kids still haven’t gotten a flu shot, get one.

“We’re talking so much about the coronavirus, but in the meantime, there have been 16,000 flu-related deaths this year in the United States, with 105 in children,” he stressed. “Parents are used to the flu, so they don’t worry as much about it. But taking steps to protect their children from it are much more important.”

I’m pregnant. Should I be concerned?

Yes, but no more than you would be about coming down with the flu.

During pregnancy, parts of your immune system are depressed, which makes you more susceptible to complications from viruses such as influenza and chickenpox, explained Dr. Steven Gordon, M.D., an infectious disease specialist at the Cleveland Clinic. (Pregnant women, for example, are nearly 3.5 times more likely to end up in the hospital from the flu than women who aren’t expecting, according to a study published in June 2019 in the Journal of Infectious Diseases.)

“It makes sense that a pregnant woman would be at higher risk of complications from this virus than a nonpregnant one,” he said. “But you also need to keep in mind that your risk in general of getting this disease is very, very low.”

Be safe out there!

Memorial Day Pool Opening: Juvenile Skin Cancer Avoidance Tips

Just a public service sharing of some new information from St. Jude for parents about caring for their children’s skin this upcoming Memorial Day pool-opening season through Summer and beyond:

With the official start of summer this Memorial Day weekend, pediatric skin cancer specialists at St. Jude Children’s Research Hospital are urging parents to take the necessary steps to protect their children when they are out in the sun this holiday weekend, including poolside or at the beach.

“During the Memorial Day weekend, parents should take simple steps to protect their children from extreme sun exposure, including avoiding going out when sun rays are strong and keeping infants out of the sun entirely,” said Alberto Pappo, M.D., director of the Solid Tumor Division at St. Jude Children’s Research Hospital. “Don’t assume children cannot get skin cancer because of their age. Unlike other cancers, the conventional melanoma that we see mostly in adolescents behaves the same as it does in adults.”

Research shows that sun damage contributes to melanoma in children and adolescents as well as adults. The research underscores the need for precautionary measures to avoid extreme sun exposure for children, including the implementation of routine prevention measures.

“While rare, melanoma is the most common type of skin cancer in younger patients and affects mostly teenagers. Children are not immune from extreme sun damage and parents should start sun protection early and make it a habit for life,” Pappo said.

St. Jude Children’s Research Hospital is a leader in pediatric melanoma research and treatment.St. Jude provides treatment and second opinions for patients with pediatric melanoma around the country and beyond. Each year, the St. Jude Pediatric and Adolescent Melanoma Referral Clinic brings patients and families to St. Jude for two days of expert consultation, as well as medical examinations by leading specialists, educational seminars and an introduction to melanoma-related resources.

Melanoma is the most serious form of skin cancer because it often spreads to other parts of the body. Melanoma gets its name from melanocytes—skin cells that produce a pigment called melanin, which gives skin its color.

  • About 76,700 new cases of melanoma in children and adults are diagnosed in the United States each year.
  • About 7 percent of cancers in children 15 to 19 years of age are melanomas. Melanoma is most common in people of Caucasian descent, occurring five times more often than in Hispanics and 20 times more often than in African Americans.
  • Childhood melanoma may not fit into the same routine diagnosis symptoms as adults. Instead, parents should look for the following:
    • A mole that changes, grows or doesn’t go away
    • An odd-shaped or large mole
    • A pale-colored or red bump
    • A mole or bump that itches or bleed 

For more information on melanoma, visit the St. Jude Melanoma Clinic’s fact sheet

STUDY: You can Get an MRI in Early Pregnancy

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In an analysis that included more than 1.4 million births, exposure to magnetic resonance imaging (MRI) during the first trimester of pregnancy compared with nonexposure was not associated with increased risk of harm to the fetus or in early childhood, although gadolinium MRI at any time during pregnancy was associated with an increased risk of a broad set of rheumatological, inflammatory, or skin conditions and, possibly, for stillbirth or neonatal death, according to a study appearing in the September 6 issue of JAMA.

Concern has been expressed about the safety of MRI exposure in the first trimester of pregnancy due to the heating of sensitive tissues by radiofrequency fields and exposure to the loud acoustic environment. When indicated, MRI’s diagnostic accuracy is improved with gadolinium, an intravenous contrast medium. Fetal safety of MRI during the first trimester of pregnancy or with gadolinium enhancement at any time of pregnancy is unknown.

With the use of universal health care databases in the province of Ontario, Joel G. Ray, M.D., M.Sc., F.R.C.P.C., of St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences, Toronto, and colleagues identified all births of more than 20 weeks from 2003-2015 to evaluate the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy.

The study included 1,424,105 deliveries. In pregnancies that lasted a minimum of 21 gestational weeks, 1 in 250 had an MRI in pregnancy, including 1 in 1,200 in the first trimester and 1 in 3,000 with gadolinium contrast. Maternal MRI in the first trimester was not associated with a higher risk of stillbirth or neonatal death, congenital anomalies, neoplasm, or hearing loss.

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STUDY: Doctors No Longer Have to Remove Ovaries During a Hysterectomy

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A relatively new study has found that women do not have to lose their ovaries during non-cancerous surgeries involving removal of a woman’s reproductive system.

Traditionally, during hysterectomies to treat benign conditions, doctors remove the Fallopian tubes and the ovaries in order to reduce the patient’s ovarian cancer risk. Doing this maneuver actually induces early menopause and lowers a woman’s libido.

However, according to Yale School of Medicine research, ovarian cancer often originates in the Fallopian tube and not the ovaries, and thus removal of the ovaries may not be necessary.

This could mean a woman can possibly produce an offspring from her eggs (using the magic of modern medicine) even after having a hysterectomy. This is good news for younger women who’ve had to have the procedure done.

Assistant professor in Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine Xiao Xu published the results of the study in the February issue of the journal Obstetrics & Gynecology.

In fact,  her team’s findings were backed  by American College of Obstetricians and Gynecologists (ACOG) which issued a statement in 2015 suggesting  bilateral salpingectomy with ovarian conservation — surgical removal of both Fallopian tubes while retaining the ovaries — may be a better option for ovarian cancer prevention in women at low risk for ovarian cancer.

Using data from the 2012 National Inpatient Sample, Xu and her co-author, Vrunda Bhavsar Desai, M.D. studied 20,635 adult women undergoing hysterectomy for benign conditions who were at low risk for ovarian cancer or future ovarian surgery.

“We found that among women undergoing inpatient hysterectomies in 2012 who were at low risk for ovarian cancer, very few of them received bilateral salpingectomy  with preservation of the ovaries,” Xu said. “The rate of bilateral salpingectomy with ovarian conservation was 5.9% in this population.

Not enough doctors are providing this option to their patients but this study could help establish a baseline.

Xu added that the rate of bilateral salpingectomy with ovarian conservation varied widely among 744 hospitals across the country, ranging from 0% to 72.2%.

“The wide variation in hospital practice may result in differential access to prophylactic procedures depending on where patients access care,” said Xu. “This can have longer-term health implications given the benefits of ovarian conservation.”

Study: More Fetal Deaths linked to Home Births

Earlier this month, actress Thandie Newton announced that she gave birth to her third child at home. She is among the growingnumber of women opting for home births in the United States in the last decade, according to the Centers for Disease Control.  
A recent study presented at the Society for Maternal-Fetal Medicine’s annual meeting on February 7 stated that patients delivered at home by midwives had a roughly four times higher risk of neonatal deaths than babies delivered in the hospital by midwives. The increased neonatal mortality risk is associated with the location of a planned birth, rather than the credentials of the person delivering the baby, the report noted.
Using CDC data of 14 million linked infant birth and neonatal death,  researchers at New York-Presbyterian/Weill Cornell Medical Center found the absolute risk of neonatal mortality was 3.2/10,000 births in midwife hospital births, and 12.6/10,000 births in midwife home births, and it further increased in first-time mothers to 21.9/10,000 births in midwife home deliveries. Neonatal mortality was defined as neonatal deaths up to 28 days after delivery.
“This risk further increased to about seven-fold if this was the mother’s first pregnancy, and to about ten-fold in pregnancies beyond 41 weeks,” said Amos Grunebaum, M.D.
Grunebaum and co-author Frank Chervenak, M.D. said that obstetric practitioners have an ethical obligation to disclose the increased absolute and relative risks associated with planned home birth to expectant parents who express an interest in this delivery setting, and to recommend strongly against it.
They suggest that hospitals make their policies more welcoming to mid-wives and create more comfortable birthing environments, to eliminate the need for “unnecessary obstetric interventions”, a release about the study stated. 
Interesting. What are your thoughts on this study and the authors suggestion which seemingly implies hospitals should do more to obviate the need for midwives who will assist in a home birth?

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