Preemies from low-income families at high risk for dangerous brain bleeds

ScienceDaily (Oct. 11, 2012) — Babies born prematurely to low-income parents have a disproportionately high risk for developing dangerous brain bleeds that require multiple surgeries and extensive follow-up, according to a small Johns Hopkins Children's Center study.
The findings -- published online Sept. 28 in the journal Pediatric Neurosurgery
and based on an analysis of 38 patients referred to Johns Hopkins for treatment of brain hemorrhages related to premature birth -- offer a sobering reminder of the role socio-economic factors can play in health outcomes, the researchers say.
The link between poverty and premature birth has been well-documented, the investigators say, but the new findings go a step further and focus on the consequences of one particularly dire and fairly common complication of prematurity -- brain hemorrhages.
"Our study shows just how detrimental and far-reaching the effects of prematurity can be, medically and otherwise, highlighting the critical need to better identify high-risk pregnancies and reduce the number of premature births," says Edward Ahn, M.D., pediatric neurosurgeon and senior author on the research.
"Brain hemorrhages can have a lifelong impact on a child's neurological and cognitive development, but also create a financial burden on the families, many of whom in our study were already economically challenged," Ahn adds.
The premature brain's blood vessels are highly vulnerable to rapid changes in blood and brain pressure that occur around birth. While some brain bleeds are small and contained within the blood vessel, others can spread further and significantly damage the brain, particularly if not diagnosed and treated promptly. Serious hemorrhages require surgery, intensive follow-up and, often, long-term care to deal with the neurological and developmental after-effects of the condition.
The study tracked 38 babies treated at Hopkins Children's between 2007 and 2010 for complications of brain hemorrhages they had suffered during preterm birth. Most infants in the study (65 percent) were from low-income families and received public health insurance(63 percent). Household income is not part of a standard medical record, but the researchers used zip code and Medicaid status as proxies for income. Medicaid is the public health insurance program for low-income children.
In addition to the higher risk for brain bleeds, the study showed babies from lower-income homes and those with public health insurance had fewer scheduled follow-up appointments and more emergency room visits, compared with babies with private health insurance and with those from higher income homes. The researchers note the differences were clear, even though they didn't reach statistical significance due to the small number of patients in the study.
"If a family foregoes a scheduled follow-up and instead ends up in the ER with a serious, yet likely preventable complication, the medical and financial consequences can be far worse not only for the family but for the health care system as a whole because ER care is more expensive than routine check-ups," Ahn says.
The investigators said their findings need to be replicated on a wider scale in order to further tease out the reasons behind the disproportionate risk.
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The above story is reprinted from materials provided by Johns Hopkins Medicine, via Newswise.
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Hospital Food Contaminated With Dangerous Diarrhea Bug C. diff

By Charlene Laino
WebMD Health News

Reviewed by Laura J. Martin, MD

Oct. 19, 2012 -- A new report suggests that hospital food is frequently contaminated with the dangerous diarrhea bug Clostridium difficile (C. diff).

Houston researchers found that about one-fourth of nearly 100 hospital food samples they tested were positive for C. diff. Among the worst culprits: turkey, chicken, and egg products, vegetables and fruits, and desserts. Almost all were cooked.

It's only one hospital. And no cases of human infection were linked to the food.

But together with past research, the findings suggest that contaminated food may be an important route of spread of C. diff in hospitals, says researcher Hoonmo Koo, MD, an infectious diseases specialist at Baylor College of Medicine in Houston, Texas.

Moreover, the temperatures at which hospital foods are cooked may be too low to kill the bug, he says.

An infectious diseases expert not involved with the research says the major C. diff strains that contaminate food are different from the ones responsible for human disease.

"You should be more concerned about whether your doctor or nurse is washing their hands before touching you than about anything coming up from the cafeteria," says Stuart Cohen, MD, professor of medicine at the University of California School of Medicine, Davis. Contaminated hands are a proven risk factor for infection.

Each year, C. diff strikes about 500,000 Americans, mostly in hospitals and nursing homes. C. diff disease can range from mild diarrhea to life-threatening intestinal inflammation known as colitis. The bug produces toxins that damage the gut.

Most cases of hospital-acquired C. diff happen in people taking so-called broad-spectrum antibiotics. These kill many different types of bacteria (including good bacteria), which allows C. diff to overgrow. During this time, patients can get sick from C. diff picked up from contaminated surfaces or spread from a health care provider's hands.

C. diff is linked to about 14,000 deaths every year, according to the CDC.

The new study was presented at the annual meeting of the Infectious Diseases Society of America in San Diego.

C. diff has been recovered from pigs, cows, and chickens, and the bug has been found in retail meat and salad greens. A few studies have found that the C. diff strains found in animals are the same ones causing human disease, but others have found the opposite.

A 2008 CDC study concluded that "although they share similar clinical features, evidence suggests that the predominant strains causing C. diff [disease] in humans and different animal species are distinct."

Overall, though, surprisingly few studies have examined the possible link between C. diff disease in food, animals, and humans, according to both the CDC and Koo.

So the researchers tested about 2 tablespoons of each food item served over 80 days at a university hospital in Houston. The number that tested positive for C. diff:

Four of eight (50%) turkey samplesFour of 12 seafoods (33%)Two of 17 beef servings (12%)One of eight pork servings (13%)Six of 14 chicken and egg products (43%)Six of 27 vegetables and fruits (22%)None of two grainsThree of five desserts (60%)

The researchers did not actually trace any case of illness to contaminated food, Cohen notes.

"I'm not surprised that many of the foods tested positive," he says, pointing to the studies finding C. diff in retail meats.

But whether it is causing infection is another story, Cohen says.

"It may be contributing but it is not a driving force," he says.

To be on the safe side, though, make sure your food is cooked thoroughly, as high temperatures should kill the spores, Cohen says.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

SOURCES: Infectious Diseases Society of America Meeting 2012, San Diego, Oct. 17-21, 2012. Hoonmo Koo, MD, assistant professor of medicine, infectious diseases division, Baylor College of Medicine, Houston. Stuart Cohen, MD, professor of medicine, infectious diseases division, University of California School of Medicine, Davis.

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