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Monitors Found Ineffective in Predicting Premature Deliveries

January 28, 2002|THOMAS H. MAUGH II | TIMES MEDICAL WRITER

Home monitors that measure contractions in pregnant women are not effective at predicting which women will go into early labor and have a premature delivery, according to Ohio researchers.

Obstetricians are eager to predict--and prevent--premature births because the infants generally have developmental delays that can affect them throughout their lives. Although earlier, smaller studies have shown that the devices are not very helpful, doctors have continued to recommend their use anyway, at a cost that can run about $100 a day.

The portable devices are worn on a belt around the abdomen. They record contractions of the uterus and transmit the data by telephone to a physician's office, where they are monitored by a specially trained nurse.

The monitors are used by women who are considered to be at high risk of premature delivery because of a previous premature birth, who are carrying more than one fetus, or who have high blood pressure. Nearly 12% of infants are born prematurely--at less than 37 weeks of gestation.

A team headed by Dr. Jay D. Iams of Ohio State University studied 306 women at high risk of premature delivery. The women wore the monitors for two hours a day twice a week during the early stages of pregnancy and at least four times a week after the 28th week.

The team reported in the Jan. 24 New England Journal of Medicine that they found virtually no difference in the number of contractions between those women who delivered prematurely and those who did not. The monitors were manufactured by Matria Healthcare Inc. The team also attempted to use ultrasound measurements of the cervix and blood testing for a protein called fetal fibronectin to predict premature labor but concluded that those were not effective either.

The study was sponsored by the National Institute of Child Health and Human Development.

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Zinc Helps Children With Sickle Cell Anemia

Zinc supplements can restore normal growth in children with sickle cell anemia, a new study has found. Children with the disease often are small for their age and do not grow to full height.

Dr. Babette S. Zemel and her colleagues at the Children's Hospital of Philadelphia studied 38 children, ages 4 to 10 years, with sickle cell disease.

Twenty-four of them were short in stature for their age, but only six had abnormally low levels of zinc in their blood.

Half of the children were randomly assigned to receive a small daily dose of cherry syrup containing 10 milligrams of zinc; the rest received cherry syrup only.

The team reported in the February American Journal of Clinical Nutrition that the children receiving the zinc showed significantly greater increases in overall height, sitting height, knee height and arm circumference after 12 months of treatment. In an editorial in the same journal, Dr. Ananda S. Prasad of the Wayne State University School of Medicine concluded that "these results provide further evidence that zinc deficiency resulting in growth retardation is a major clinical problem in patients with sickle cell disease."

The research was sponsored by Children's Hospital and the National Institutes of Health.

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Chemical Shown to Block Lethal Liver Toxins

A chemical originally developed as a weedkiller has been approved by the Food and Drug Administration as the first effective treatment for a rare but lethal liver disease called hereditary tyrosinemia type 1, or HT-1.

The genetic disorder affects an estimated 100 children in the United States and perhaps several hundred more worldwide. Children with the disorder are unable to properly break down the amino acid tyrosine; instead, their body produces a toxin that destroys the liver.

Those who survive infancy rarely reach their 20s without a liver transplant. The only therapy before now was limiting intake of tyrosine, but that amino acid is a part of proteins needed for growth.

Researchers from Rare Disease Therapeutics in Nashville discovered that a drug called Orfadin can block the formation of the toxins.

In an ongoing study of 180 patients who began taking the drug in infancy, 88% have survived at least 4 years; usually, only about 29% of children with the disease live to age 4. The drug is very costly: about $12,000 a year for an infant and as much as $60,000 per year for an older child. But the company will provide it at a lower cost or for free to families not covered by insurance through a program run by the National Organization for Rare Diseases, (800) 999-NORD.

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New Booklet Outlines Parenting Techniques

The National Institute of Child Health and Human Development has released a new parenting booklet that distills 30 years of research on effective parenting techniques. The booklet, "Adventures in Parenting: How Responding, Preventing, Monitoring, Mentoring and Modeling Can Help You Be a Successful Parent," suggests ways to become a more effective, consistent and attentive parent.

The booklet is available from the Institute free of charge by calling (800) 370-2943, or at www.nichd.nih.gov.

CDC Reports Rubella Virtually Gone From U.S.

German measles (rubella), which once infected tens of thousands of Americans each year and caused large numbers of birth defects, has been almost completely eliminated in the United States, according to the Centers for Disease Control and Prevention.

There were nearly 58,000 cases of rubella in the United States in 1969, the year the rubella vaccine was introduced. In 1999, there were only 272 cases, the researchers reported in the Jan. 23 Journal of the American Medical Assn. Almost all of those cases were in Latino adults born in other countries, especially Mexico, the CDC said.

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Medical writer Thomas H. Maugh II can be reached at Thomas.maugh@latimes.com.

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