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Your Body, Your Life: News from the Medical Campus

Care for preemies, HIV and homelessness, and food and development

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Jason Wang, a MED assistant professor of pediatrics and public health, found that while doctors and hospitals go to heroic lengths to save the lives of premature babies, they fail to provide adequate critical follow-up care.

More help for preterm babies

What’s up?
More and more babies are being born prematurely in the United States. According to a 2006 Institute of Medicine study, 12.5 percent of U.S. births are preterm, or before 37 weeks of gestation — an increase of 30 percent since 1981. And approximately 60,000 of these infants are born at very low birth weight, under 3.3 pounds.

Doctors and hospitals routinely put great effort and expense into keeping underweight infants alive in neonatal intensive care units. But after these babies leave the hospital, they remain at high risk of developing several health complications, including vision and hearing loss. Research by Jason Wang, a School of Medicine assistant professor of pediatrics and public health, indicates that relatively simple and inexpensive follow-up care that could minimize such complications is being neglected.

A team of researchers led by Wang studied the records of more than 2,000 children born at very low birth weight between 1996 and 1998 to South Carolina parents enrolled in Medicaid. They focused on the percentage of those children receiving routine follow-up care, such as hearing and vision examinations and treatment.

What was found:
The researchers discovered that even among babies with diagnosed hearing loss, only 20 percent received a hearing aid within six months, a timetable recommended by the American Academy of Pediatrics. In addition, 77 percent of these infants were not given the recommended ophthalmologic examination between the ages of one and two.

Why it matters:
Wang notes that babies with low birth weight are also at risk for more subtle health issues, such as learning disabilities. He says the great efforts being made to save these babies’ lives should be matched by a commitment to supporting families with easily accessed and coordinated routine follow-up care.

“We know these babies are a vulnerable population that requires multiple services,” says Wang. “We can’t let them fall through the cracks.”

Word to the wise:
Wang emphasizes that while his study looked at families on Medicaid, it did not compare follow-up care between that population and those who don’t receive the federal assistance. The population was chosen because the researchers would have access to a full set of data on visits to physicians and hospitals.

Wang also points out that his results are a snapshot of follow-up care in just one state, and may not reflect the situation nationwide.

“This is not to place blame, but to try to figure out how to solve a problem,” says Wang. “People across the country ought to examine this issue.”

What’s next:
Wang is working with grants from the Robert Wood Johnson Foundation and the National Eye Institute to look into the reasons parents don’t receive follow-up care for preterm infants — from lack of insurance or transportation to insufficient information — and to design an intervention.

Where to find more:
The research was published in the February 2008 issue of the journal Pediatrics.

Heroin, homelessness, and HIV

What’s up?
Since the mid 1990s, antiretroviral drugs have dramatically reduced mortality among patients with HIV. But recent studies have suggested that patients who have contracted the virus from injection drug use don’t fare as well.

Alex Walley, a clinician investigator in internal medicine at Boston Medical Center, wondered if those researchers had focused on the wrong thing. So, between 1996 and 2005, he and collaborators from Boston Medical Center and Beth Israel Deaconess Medical Center studied about 600 Boston-area HIV patients who also had problems with alcohol. Every six months, the researchers interviewed the patients about many topics, including whether they’d recently been homeless, drinking heavily, or using cocaine or heroin. They also took samples of the patients’ blood.

What was found:
Over the course of the study, 99 patients died. Walley and his fellow researchers determined that recent heroin or cocaine use and homelessness had a much stronger association with mortality than either alcohol use or past injection drug use. “The past history of these patients was less important than their recent behavior” when it came to survival rates, he says.

Why it’s important:
What matters in the treatment of HIV, says Walley, are “modifiable risk factors.” In other words, “If you come into my office with HIV, I can’t do anything about your past drug use.” But, he says, patients will live longer if their current drug use and homelessness is addressed in conjunction with the prescription of antiretroviral medications.

Word to the wise:
The researchers were not able to track the cause of death with any statistical significance because of the relatively small number of deaths among study participants.

What’s next:
Walley has received a grant to start a program that combines substance abuse treatment with HIV medical care. Patient enrollment began this week.

Where to find more:
The research was published in the January 2008 issue of the journal AIDS.

“Food insecurity” linked to delayed development

What’s up?
About 17 percent of all American households with children under the age of six are “food insecure,” meaning they have a limited or uncertain availability of enough food for an active and healthy life, according to 2005 statistics from the U.S. Department of Agriculture. Now, a study led by Ruth Rose-Jacobs, a MED assistant professor of pediatrics, has determined that food insecurity puts children at greater risk for delayed development in language, cognitive function, and coordination.

A national network of pediatricians and public health researchers, known as the Children’s Sentinel Nutritional Assessment Program (C-SNAP) and begun at Boston Medical Center in 1988, conducted the study. Researchers interviewed caregivers in 2,010 low-income families with children between four months and three years of age at pediatric clinics and emergency rooms in Boston, Little Rock, Baltimore, Minneapolis, and Philadelphia. The screenings included questions meant to assess household food security. Researchers also asked caregivers to report whether they were concerned about the child’s development in areas such as language and social and emotional behavior.

What was found:
Overall, 21 percent of the children lived in food-insecure households and 14 percent were developmentally at risk. Caregivers in food-insecure households were two thirds more likely than those in food-secure households to report that their children were at developmental risk.

Why it matters:
Previous research has demonstrated that the first three years of a child’s life are marked by dramatic changes in cognitive, linguistic, social, and emotional development, all of which impact school readiness and, later, adult well-being. Children need adequate nutrients during this period of rapid brain development.

“This is a problem that could actually be easily addressed with many interventions already in place, such as food stamps and WIC, the special supplemental nutrition program for women, infants, and children,” says Rose-Jacobs, who argues for broader expansion of these interventions and standard screenings for both developmental status and food insecurity, particularly among low-income households.

Word to the wise:
“From this study, we can say that food-insecurity and developmental risks are linked, but we cannot say that one causes the other,” says Rose-Jacobs. “Further longitudinal assessments would be needed to evaluate causation.”

What’s next:
Rose-Jacobs and the C-SNAP researchers now plan to investigate whether a family’s enrollment in programs such as WIC or Head Start and their inability to pay for housing or heat and electricity affect their household food security and children’s developmental risks.

Where to find more:
The research was published in the January 2008 issue of the journal Pediatrics.

Chris Berdik can be reached at cberdik@bu.edu.

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