Amniotic fluid 'may heal premature baby gut'

Amniotic fluid, a clear liquid that surrounds the unborn baby (fetus) during pregnancy, may hold the key to healing a fatal gut disease which affects premature babies, doctors say.

Severe inflammation, called necrotizing enterocolitis, can destroy the gut's tissues and lead to major organ failure.

Early animal tests, published in the journal Gut, showed that stem cells inside amniotic fluid could heal some of the damage and increase survival.

Further tests are still needed before it is tried in premature babies.

Pregnancy fluid 
Babies born too soon are not ready for the world outside the womb and their guts are ill-prepared to deal with food.

About one in 10 premature babies in a neonatal intensive care will develop necrotizing enterocolitis.

The inflammation can cause tissue death and lead to a hole in the baby's intestines which can result in a serious infection.

Breast Milk
Breast milk can reduce the risks, but the only major treatment is surgery to remove the diseased tissue. However, 40% of those needing an operation will not survive.

Dr Simon Eaton

"It is quite a problem and we think it is on the increase," said Dr Simon Eaton, from the Institute of Child Health at University College London.

He was part of a team investigating the use of stem cells, which are able to become any other type of cell in the body from nerve to bone, taken from the amniotic fluid which surrounds a developing foetus in the womb.

In experiments on laboratory rats, which are programmed to develop fatal necrotizing enterocolitis, injections of stem cells appeared to increase survival times.

Dr Eaton stated: "We're able to prolong survival by quite a long way.

"What appears to be happening is a direct effect on calming inflammation and also stimulating resident stem cells in the gut to be more efficient at repairing the intestines."

The study showed the intestines were also working better after the treatment.

Dr Paolo De Coppi

Cancer risk?
Fellow researcher Dr Paolo De Coppi said: "Stem cells are well known to have anti-inflammatory effects, but this is the first time we have shown that amniotic fluid stem cells can repair damage in the intestines.

"Although amniotic fluid stem cells have a more limited capacity to develop into different cell types than those from the embryo, they nevertheless show promise for many parts of the body including the liver, muscle and nervous system."

Far more testing would be required to work out if the treatment would work in babies and if it would be safe.

The stem cells would have to be taken from a donor as it would not be practical to store fluid from every birth, just in case. This means there is the risk of rejection.

As the stem cells are capable of becoming other types of cells there is also concern that they may pose a cancer risk.

However, in the future doctors hope they could harness a drug instead.

"It's not the cells, they're delivering something and if we knew what that was then we could deliver that directly," said Dr Eaton.

Overprotective parents may impact heart anxiety in adults with congenital heart conditions

Adults with congenital heart disease are more likely to suffer heart-focused anxiety — a fear of heart-related symptoms and sensations — if their parents were overprotective during their childhood and adolescence.

Dr. Lephuong Ong from Orion Health Services in Vancouver, and colleagues from University Health Network and York University in Toronto, Canada, suggest that health care professionals could encourage greater independence for adolescents and adults with congenital heart disease to improve their psychosocial adjustment. Dr. Ong’s work1 is published online in Springer’s International Journal of Behavioral Medicine.

Approximately one percent of all infants are born with congenital heart defects and over 90 percent of these children survive into adulthood, thanks to recent medical advances. As well as their medical condition, these patients face mental health issues including anxiety, neurocognitive deficits, body image concerns and difficulties with relationships. Research suggests that levels of parental protection are likely to be higher in children with congenital heart disease compared with healthy children.

Ong and team investigated the relationship between patient recollections of parental overprotection — defined as intrusion, excessive contact, infantilization and prevention of independent behavior — and heart-focused anxiety in adults with congenital heart disease. The researchers assessed heart defect severity, heart-focused anxiety and perceived parental overprotection during childhood for a sub-sample of 192 adults participating in the study.

Their analyses showed that levels of heart-focused anxiety rose as levels of parental overprotection increased. Disease severity was also linked to higher anxiety levels. Surprisingly, levels of parental overprotection did not vary with disease severity.

The authors conclude: “Adults with congenital heart disease, who report their parents as being overprotective, might have learned to form negative interpretations of their symptoms and use maladaptive coping behaviors, like avoidance and fearful responding, when experiencing cardiac symptoms or when faced with situations that trigger cardiac-related sensations. Clinicians could consider providing recommended activity guidelines for parents and their children to reduce limitations on activities that are deemed medically appropriate, to encourage independence among adolescents and young adults with congenital heart defects.”

Bipolar diagnosis in children may do more harm than good

Troubled children diagnosed with bipolar disorder may see more improvement with a different diagnosis, according to researchers at The Hastings Center.

The researchers support an emerging approach, which gives many of those children a new diagnosis called Severe Mood Dysregulation (SMD) or Temper Dysregulation Disorder with Dysphoria (TDD).

The findings come soon after proposed revisions to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) were opened to public comment.

In a paper published in Child and Adolescent Psychiatry and Mental Health, Erik Parens and Josephine Johnston examine the evolution of the diagnosis of bipolar disorder in children and its dramatic increase since the mid 1990s, after the criteria for diagnosis broadened.

They emphasize that there is vigorous debate in pediatric psychiatry about whether symptoms in children accurately reflect the criteria for bipolar disorder, particularly for mania.

The increase in cases has led to concerns about accurately defining psychiatric disorders in children as well as the safety and efficacy of resulting pharmacological treatment.

It is difficult to diagnose psychiatric disorders in children, Parens and Johnston write, and many children receiving bipolar diagnoses exhibit behaviors that do not closely fit the disease's criteria.

"Using new labels such as SMD or TDD reflects that physicians do not yet know exactly what is wrong with these children or how to treat it," said Johnston. "Facing up to this uncertainty could lead to better treatment recommendations and more accurate long-term prognosis." A new diagnostic category would also help reframe the research agenda.

Their findings come from an interdisciplinary series of workshops funded by a grant from the National Institute of Mental Health. Participants included psychiatrists, pediatricians, educators, bioethicists, parents, and social scientists. Erik Parens is a senior research scholar and Josephine Johnston a research scholar at The Hastings Center, a bioethics research institution.

Among the workshop conclusions:

• The bipolar label may fit poorly many of the children who have received it over the last decade.
• There is debate about what children's symptoms represent. For example, what is characterised as mania in children is very different from its features in adults. Mania is a hallmark feature of bipolar disorder, formerly known as manic-depressive disorder.
• The bipolar label, which has a strong genetic component, can distract from addressing the family or social context.
• Physicians must be forthcoming with families about uncertainties and complexities in the diagnosis and treatment of bipolar disorder in children.
• Current training practices and reimbursement policies may leave some psychiatrists and pediatricians unable to deliver the comprehensive care that these children need.

The authors also note that, while experts sometimes disagree about labels, the workshop group universally agreed that "children and families can suffer terribly as a result of serious disturbances in children's moods and behaviours," and that these troubled children desperately need help.

They also write, "It is a deeply regrettable feature of our current mental health and educational systems that some DSM diagnoses are better than others at getting children and families access to needed care and services."

The Hastings Center is a nonpartisan bioethics research institution dedicated to bioethics and the public interest since 1969. The Center is a pioneer in collaborative interdisciplinary research and dialogue on the ethical and social impact of advances in health care and the life sciences.

The Center draws on a worldwide network of experts to frame and examine issues that inform professional practice, public conversation, and social policy. Learn more about The Hastings Center at: www.thehastingscenter.org

To read the full paper, click on this link