Swaddling resurgence ‘damaging hips’


Baby

Parents are risking their babies‘ health because of a surge in the popularity of swaddling, according to an orthopaedic surgeon.

The technique involves binding the arms and legs with blankets and is used to help calm a baby and prevent crying.

But Prof Nicholas Clarke, of Southampton University Hospital, said swaddling was damaging developing hips.

The Royal College of Midwives and other experts advised parents to avoid tightly swaddling a child.

Restricts movement

Swaddling has been widely used in many cultures globally. It is thought the blanket wrapping can simulate the feelings of being in the womb and calm the child.

But the technique holds the legs out straight and restricts movement, which can alter the development of the hip joint.

“Start Quote

Swaddling should not be employed in my view as there is no health benefit but a risk for adverse consequences of the growing and often immature hips”

Andreas Roposch Great Ormond Street Hospital

Writing in the journal Archives of Disease in Childhood, Prof Clarke argued: “There has been a recent resurgence of swaddling because of its perceived palliative effect on excessive crying, colic and promoting sleep.

“In order to allow for healthy hip development, legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints.

“The babies’ legs should not be tightly wrapped in extension and pressed together.”

Jane Munro, of the Royal College of Midwives, said it was a “seemingly innocuous” thing to do, but it posed “significant problems” for the baby.

She said there was also the risk of the baby overheating and a raised risk of cot death.

She added: “We advise parents to avoid swaddling, but it is also crucial that we take into account each mother’s cultural background, and to provide individualised advice to ensure she knows how to keep her baby safe, able to move and not get overheated.”

Video guidance

Andreas Roposch, a consultant orthopaedic surgeon at Great Ormond Street Hospital, said: “Similar effects may be seen in all devices or manoeuvres that place the legs in a purely straight position for prolonged periods in this critical age of early infancy.

“Swaddling should not be employed in my view, as there is no health benefit but a risk for adverse consequences of the growing and often immature hips.”

Rosemary Dodds, of parenting charity the NCT, advised against tight swaddling.

“It is helpful to raise awareness of hip dysplasia in relation to swaddling. Some parents and babies seem to like swaddling, but it is important that babies do not overheat and their legs are not restricted.

“Videos are available on the NCT website showing parents who want to swaddle their baby how to do so safely.”

Children of obese mothers ‘have higher heart risk’.


Children born to obese and overweight mothers are more likely to die early of heart disease, a study has found.

Scottish research showed a 35% higher risk of dying before the age of 55 in adults whose mothers were obese in pregnancy.

It is not known how much of the link is down to genetics, influences in the womb or later lifestyle.

But the authors say their findings, in the British Medical Journal, are of “major public health concern”.

One woman in five in the UK is obese at their antenatal booking appointment.

Continue reading the main story

“Start Quote

This study emphasises the need for everyone, but in particular pregnant women, to try to eat healthily and be active”

Doireann MaddockBritish Heart Foundation

Premature deaths

The analysis included 28,540 women whose weight was recorded at their first antenatal check-up and their 37,709 children now aged between 34 and 61.

One in five mothers was classed as overweight with a body mass index (BMI) between 25 and 29.9 and 4% were obese with a BMI above 30.

There were 6,551 premature deaths from any cause and heart disease was the leading contributor.

The risk of premature death was 35% higher among people born to obese mothers compared with those whose mothers had had normal weight in pregnancy. This was after adjusting the results for factors such as the mother’s age at delivery, social class and infant birthweight.

The results also revealed that children born to obese mothers went on to be at 42% increased risk of being treated in hospital for a heart attack, stroke or angina.

Appetite control

Study leader Prof Rebecca Reynolds, of the University of Edinburgh, said the results highlighted the importance of current advice to maintain a healthy weight, eat sensibly and keep active during pregnancy.

She added that more work was needed to unpick the reasons for the increased risk and to look at the impact of weight gain over pregnancy.

“It would be nice to know how much of this risk is modifiable.”

Previous research has shown a link between obesity in pregnancy and changes in appetite control and metabolism in children.

Prof Sir Stephen O’Rahilly, of the University of Cambridge, warned that obesity runs in families.

“Obese people are at higher risk of heart disease, so it is very likely that the people in this study whose mothers were obese were fatter than those whose mothers were lean.”

‘Eat healthily’

The researchers did not measure or account for this.

The Royal College of Midwives said it was important for women to start their pregnancy at a normal weight.

But Louise Silverton, RCM director for midwifery, said not all pregnancies are planned and midwives work hard to support women avoid excess weight gain and lose weight sensibly after birth.

Drastic dieting is not recommended.

Doireann Maddock, senior cardiac nurse at the British Heart Foundation, which part-funded the study, said: “This study emphasises the need for everyone, but in particular pregnant women, to try to eat healthily and be active.”

Source: BBC

 

Pregnancy rhesus disease errors too common.


_66344404_anti-d_injection_for_rhesus_disease-spl-1

Some pregnant women are being denied a routine treatment to protect their unborn child, say investigators.

A simple injection can prevent a life-threatening condition known as rhesus disease, which occurs if the mother and her baby have incompatible blood groups.

All pregnant women should be screened and any found to have rhesus-negative blood should be offered the anti-D jab.

A UK-wide audit of NHS hospitals shows this is not happening.

Avoidable errors

Over a period of 15 years from 1996 to 2011 there were 1,211 errors where women who should have received immediate treatment with the anti-D injection did not.

Rhesus disease

  • Also known as haemolytic disease of the foetus and newborn (HDFN)
  • Happens when the mother has rhesus-negative blood (RhD-negative) and the baby in her womb has rhesus-positive blood (RhD-positive)
  • Because these two blood groups are incompatible, the mother’s immune system sees the baby as “alien” and switches to “destroy” mode
  • Women who are RhD-negative should receive the anti-D jab to stop them making antibodies that could attack the baby
  • All pregnant women should be screened to check if they are RhD-negative

In half of these cases, the woman either did not receive the treatment at all or received it late – mostly because the nurse, midwife or doctor on duty at the time failed to follow basic protocols.

Laboratory errors accounted for just over a quarter of the cases.

In a fifth of cases, the anti-D was given entirely inappropriately – either mistakenly to the wrong mother or to a woman who did not need it.

In nine cases, babies suffered the full-blown effects of the disease. One died and three needed blood transfusions.

The study authors from the University of Manchester are concerned that anti-D errors are still too common despite clear treatment guidelines.

Lead researcher Dr Paula Bolton-Maggs said: “Our findings show that over the 15 year reporting period the same mistakes were being made repeatedly by clinical and laboratory staff.

“These are clinically significant problems that require active attention at a national and local level as reported errors could be avoided by putting in place appropriate checks.”

Louise Silverton, of the Royal College of Midwives (RCM), said: “We welcome this audit report.

“The RCM expects each maternity unit to have systems in place to ensure that all women requiring the anti-D prophylaxis injection receive it regardless of their length of postnatal stay, especially where they live outside the unit’s catchment area.

“This is especially important given the increase in births and pressure on maternity services.

“We need more midwives and more midwifery visits in the community so they can administer anti-D at home under the agreed time limits and spend time with women after they have given birth.”

Source:BBC