Low Birth Weight and Preterm Multiple Births

Low Birth Weight and Preterm Multiple Births.

 

Over the past two decades, there has been a dramatic rise in the number of multiple births in Canada. Between 1994 and 2003, the rate of multiples (per 100 total births) increased 35%. The recent increase has a significant impact on perinatal health. Although multiples represent only 1 in 34 births, they account for 1 in 5 preterm births, 1 in 4 low birth weight births and 1 in 3.5 very low birth weight births. Families with twins or higher order multiples have special needs that are not always fully understood or appreciated. While babies are a special gift to a family, with multiples there is a greater risk of immediate and long-term health risks, plus substantial social, emotional and other consequences for the family. Compared to single born babies, multiple birth infants are at greater risk of suffering from long term disability, particularly cerebral palsy and of dying during the first year. Even when the babies are healthy, many parents experience overwhelming challenges in caring for, feeding and transporting two, three or more infants. As multiple birth children grow, they are also more likely to experience slower language development, behavioural disorders, challenges in school, and relationship difficulties. It is possible to reduce the risks and associated costs, and to improve health outcomes and the functioning of families by linking multiple birth families to a range of appropriate supports and services.

FREQUENCY OF MULTIPLE BIRTHS

• There are about 120,000 multiple birth children in Canada under the age of 13 and 48,000 multiple birth children age 5 and under.

• Each year there are close to 10,000 twin babies and 400 higher order multiple birth babies born in Canada.

• Approximately 41% of multiple birth children born in Canada live in the province of Ontario.

TYPES OF MULTIPLES

There are two types of multiples: monozygotic and dizygotic. Although the expressions “identical” and “fraternal” are commonly used by the media and general population, experts and parents of multiples consider these terms to be inaccurate labels that can have a negative impact on the multiples. For instance, using the term identical to describe monozygotic (MZ) multiples causes confusion. Although genetically identical, no two children are the same. Parents distinguish between their MZ babies by identifying their differences, and strive to foster their children’s individuality. Similarly, the term fraternal means a close brotherly relationship, and therefore does not describe boy/girl or all girl dizygotic (DZ) multiples.

• MONOZYGOTIC (MZ) multiples result from the splitting of a fertilized egg during the first two weeks after conception. Monozygotic twins have the same genetic makeup and therefore are of the same sex.

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• DIZYGOTIC (DZ) twins resulting from the fertilization of two different eggs.They can be either the same or of different sex, and genetically they are no more alike than any siblings.

• TRIZYGOTIC (TZ) – Triplets resulting from three fertilized eggs. No more genetically alike than singleton siblings.

• QUADRAZYGOTIC (QZ) – Quadruplets resulting from four fertilized eggs. No more genetically alike than singleton siblings.

• HIGHER ORDER MULTIPLE BIRTHS is the term used for births involving three or more babies (e.g. triplets, quadruplets, quintuplets). There can be many variations of zygosity within a higher order multiple set. For example, a set of quintuplets can consist of two MZ (monozygotic) children and three TZ (trizygotic) children resulting from four fertilized eggs.

INFLUENCING FACTORS

The odds of having multiples are influenced by many factors, and multiple birth rates have changed throughout the years due to some of those factors. The widespread use of fertility drugs and high-tech procedures such as in vitro fertilization (IVF), and increased maternal age are considered to be the major contributing factors to the increase in multiple births.

Multiple Births by Maternal Age

• Multiple births are more frequent among women in their thirties and forties. In 2002, approximately 55% of multiple birth babies were born to women age 30 and older. Infertility Treatments

• Approximately 35% of multiple pregnancies result from infertility treatments (fertility drugs and/or reproductive technologies). However, it is estimated that over 80% of higher order multiples result from these treatments.

• The incidence of monozygotic multiples is doubled in multiples conceived through the use of ovulation stimulation treatments.

Maternal Weight

• Women with a pre-pregnancy Body Mass Index (BMI) of 30 or greater are at a significantly increased risk of conceiving dizygotic multiples.

THE IMPACT OF MULTIPLE BIRTHS

Multiple birth infants have a disproportionately high risk of preterm birth, perinatal death and illness which places enormous stress on families as well as health, social and education services.

Maternal Health

• Multiple pregnancies present significant complications for pregnant women, such as gestational hypertension, preeclampsia, anemia, gestational diabetes, premature rupture of membranes, and postpartum hemorrhage.

• Reduced activity, withdrawal from employment, and prescribed bed rest (at home or hospital) during pregnancy are common for expectant mothers of multiples. Prolonged bed rest can lead to cardiac and/or respiratory problems and muscular wasting, and recovery from these problems may take several weeks.

• Cesarean section is needed for over 50% of twin pregnancies, and is almost always required for higher order multiples.

Since infection, prolonged pain, and delayed recovery are more common with caesarean deliveries, new mothers of multiples frequently have difficulty in holding, carrying and caring for their infants.

Problems Unique to Multiple Pregnancy

• Monozygotic multiples who share one placenta (monochorionic) have a high incidence of umbilical cord entanglement, Twin-to-Twin Transfusion Syndrome (TTTS)* and fetal death.

* TTTS is a condition in which blood from one monozygotic twin fetus transfuses into the other fetus via blood vessels i the placenta. TTTS can also occur between monozygotic multiples in a triplet or more pregnancy.

• Poor and differing fetal growth between the babies is common. Perinatal Death

• Occasionally one fetus dies in early pregnancy and is reabsorbed (Vanishing Twin Syndrome).

• Compared to mothers expecting a single baby, mothers expecting multiples are nearly three times more likely to lose one, more or all of their babies before birth.

Preterm Birth

• The average length of pregnancy is 36 weeks for twins, 33 weeks for triplets, 31 weeks for quadruplets, and 29 weeks for quintuplets.

• Most multiple birth babies are born before full term (40 weeks), and 57% of twins and 98% of higher order multiples are born preterm (before 37 weeks).

• Multiple births are the fastest growing segment of the preterm birth infant population,

representing 20% of all preterm births.

• Due to their prematurity, multiple birth infants frequently have ongoing health problems such as respiratory and neuro-developmental challenges, requiring prolonged and frequent hospitalization.

Infant Death

• Infant death is 4 to 5 times more likely to occur among multiple births than among singleton births.

• Multiple birth babies are more vulnerable to Sudden Infant Death Syndrome (SIDS).

Low Birth Weight

• Low birth weight (<2500 grams, or 5.5 lbs) and very low birth weight (<1500 grams, or 3.3 lbs) occur about nine times more frequently among multiple than singleton births.

• Multiples represent about 25% of all low birth weight infants and 28% of the very low birth weight infant population.

 

• The average birth weight for each multiple birth baby is approximately:

– Twins 2,500 grams (5-l/2 pounds)

– Triplets 1,800 grams (4 pounds)

– Quadruplets 1,400 grams (3 pounds)

• Given that multiple birth infants are more likely to be born with a low birth weight, they often have short and long term health and developmental problems, require more feedings during the early weeks or months, and tend to require more care.

Disabilities

• Complications during pregnancy, delivery and in the early weeks of life may result in one, more or all of the babies having special needs.

• Compared to singletons, twins are 1.4 times more likely to have a disability. Similarly, triplets are 3 times more likely to have a severe disability and 1.7 times more likely to have a moderate disability.

• Multiples are at a significantly increased risk of having Cerebral Palsy (CP). In contrast with single born children, twins are 10 times more likely, triplets 30 times more likely, and quadruplets 110 times more likely to have CP.

• Since disabilities and/or developmental delays are more common in multiples, parents often must commit to intensive and ongoing involvement in therapies throughout the first few years.

Psychosocial and Financial Issues

• Since death is much higher among multiple births than singletons, parents who lose one, more or all of their babies face extremely difficult situations. In the case of losing all of the babies, the parents have lost not only their babies but a unique parenting experience. If there are survivors, the parents find it hard to celebrate the birth and the anguish of death at the same time. As a result, some parents find it difficult to attach emotionally with the survivor(s). For those who have experienced years of infertility, the loss of one or more of the babies can be particularly heartbreaking.

These additional issues can make the grieving process more complex.

• Some centres that offer assisted conception, also offer Multifetal Pegnancy Reduction as an option to women who conceive higher order multiple pregnancies. Multifetal Pregnancy Reduction aims to increase a woman’s chance of a near term delivery of a singleton baby or twins instead of three or more babies.This procedure and associated decisions are not straight forward and the long term psychological effects may be profound. In particular, the decision whether or not to undergo this procedure can be extremely distressing. For many, after experiencing the emotional and financial strains of infertility, the decision to reduce seems to be in conflict with the goal of conception.

• The total cost of raising multiples is higher than the cost of raising the same number of singletons. Parents must purchase clothing and equipment all at once (e.g. cribs, special stroller, car seats, high chairs, etc.), preventing an opportunity to pass along hand-me-downs. The first year “start up” cost for basic essentials of infants for families with triplets is approximately $12,000 higher than families raising a single baby. This amount does not include: the cost of disposable diapers; transportation needs when a larger vehicle is required to accommodate three, four or more infant car seats; the cost of moving to larger accommodation or renovations to existing accommodation; childcare costs; or the loss of a second family income if the mother does not return to the paid labour force.

• Caring for multiples is more difficult and physically demanding than caring for one child, especially during infancy and childhood, and with higher order multiples. One Australian study showed that mothers of triplets spend an average of 197.5 hours per week (unfortunately there are only 168 hours in a week) between themselves and paid/volunteer assistance, on caring for their babies and managing the household. This situation can place extraordinary stress on the couple relationship.

• Parenting multiples presents unique situations and experiences yet information, support and advice regarding multiple births is often difficult to find.

• Compared to a single baby, the maternal and paternal attachment process takes longer and is more complex with two, three or more babies.

• Since most new mothers of multiples suffer from sleep deprivation and chronic fatigue, they are at higher risk of Post-partum Depression (PPD) than mothers of singletons.

• Parents of multiples are at risk of maternal isolation, marital stress, financial difficulties and illness. This stress, in combination with the lack of access to special information and support, places multiple birth families at an increased risk of family problems.

• As a result of the unrelenting parental demands, the associated fatigue, and the attention that multiple birth babies attract, the birth of twins, triplets or more can have a negative impact on other children in the family (e.g. behavioural changes).

• Due to the extraordinary parental stress, multiple birth infants are at a greater risk of abuse such as Shaken Baby Syndrome.

PREVENTION

In order to avoid short and long term problems, families with multiple birth children require timely access to preventative health care and social support that is specifically designed for parents of multiples.

• Physicians need to inform families who seek infertility treatments, about the known risks of multiple pregnancy, multi-fetal reduction, and parenting demands before starting therapy.

• Physicians need to refer patients to appropriate specialists for infertility management and high-risk multiple gestations.

• To ensure that the pregnancy goes as near to term as possible, women expecting multiples require:

– Early diagnosis of the multiple pregnancy (before 16 weeks) in order to :

• Identify monozygotic multiples sharing a single placenta (monochorionic)

• Put into place an appropriate obstetrical care management plan

• Allow the mother and her family adequate time to adjust

– Early nutritional counselling and dietary resources to support a weight gain of 18-27 kilos (40-60 pound)

– Education regarding preterm labour

– Obstetrical care which follows the protocols of best practice for multiple birth

• Multiple birth families need to receive special support. In particular:

– The primary antenatal care provider should identify all those involved in the care of the family and

ensure that close links are sustained throughout the pregnancy and postpartum period;

– Early prenatal classes designed for parents expecting multiples;

– Practical help and referral to local resources;

– Multiples-specific breastfeeding support.

– Links with other parents who share their unique experience (e.g. Multiple Births Canada, local parents of multiples support group).

– When the health of the mother or family circumstances indicates, limited activity, greater work restrictions and increased bed rest are often recommended. In these situations, mothers may also require in-home nursing support and household help, especially if there are older siblings.

• Creation of healthy public policies must recognize the need for and benefits of additional supports for multiple birth families. Programming must address barriers to supports and services for multiple birth families including lack of services, long waiting lists for services, and the need for service coordination.

REGULATORY BODIES IN INDIA

                                    REGULATORY BODIES IN INDIA

 In India, the central government, via the Central Drugs Standard Control Organization under the Ministry of Health and Family Welfare, largely works on developing standards and regulatory measures for drugs, diagnostics and devices; laying down regulatory measures by amending acts and rules; and regulating the market authorization of new drugs – all in an effort to standardize clinical research in India and bring safer drugs to the market.

CDSO Head Quarters New Delhi

Regulatory bodies in India involved in pharmaceutical regulation
	Body	Function
DCGI	Drug Control General India	Regulatory apex body under the government of India that oversees all
ICMR	Indian Council of Medical Research	Apex body that formulates, co-ordinates and promotes biomedical
GEAC	Genetic Engineering Approval Committee	Consists of experts in the field of genetic engineering and molecular biology; clinical trials involving the use of biotech products would be referred by DCGI to GEAC for recommendations
DBT	Department of Biotechnology	Apex body that oversees the new impetus to develop the field of modern biology and biotechnology in India
AERB	Atomic Energy Review Board	Authority that exercises regulatory control over the approval of new types of radiation equipment, and for the registration/commissioning of new radiation equipment, inspection and decommissioning of installations
BARC	Baba Atomic Research Centre	Apex body that oversees and approves all radiation related projects in India. DCGI refers all clinical trials that involve the use of radiopharmaceuticals to BARC for its expert opinion
DCC	Drugs Consultative Committee	Provides technical guidance to the Central Drugs Standard Control Organization
CDL	Central Drugs Laboratory	National statutory laboratory of the Indian government for quality control of drugs
DTAB	Drugs Technical Advisory Board	Provides technical guidance to the CDSCO

Stem Cell Breakthrough Puts Type 1 Diabetes Cure In Reach

Stem cells cures Diabetes

Stem cells are very special, powerful cells found in both humans and non-human animals. They have been called the centrepieces of regenerative medicine – medicine that involves growing new cells, tissues and organs to replace or repair those damaged by injury, disease or aging. Stem cells are the precursors of all cells in the human body. What makes stem cells special is that they are regenerative and malleable. They have the ability to replicate themselves and to repair and replace other tissues in the human body. Some tissues, like skin, need constant renewal, which could not take place without skin stem cells. Other stem cells repair damage to the body’s tissues, for example, rebuilding damaged or degenerating muscle tissue. New research also indicates that stem cell malfunction or damage may be responsible for certain cancers and even muscular-degeneration diseases like Muscular Dystrophy. Research on stem cell functioning is therefore a critical avenue to finding treatments for these and other diseases.

Most cells in the human body are differentiated, tissue specific cells. These cells have a specific identity and function that cannot be changed; they might be neural cells, skin cells, blood cells, muscle cells or some other kind of cell. Unlike other cells in the human body, stem cells are undifferentiated, which means they do not yet have a fixed identity and function. Consequently, they possess an ability to be manipulated in the laboratory in ways that may change their identity and function: they can turn into a number of different types of cells or tissues. This ability to change and be manipulated makes them powerful tools for research and therapy.

 

Stem Cell Breakthrough Puts Type 1 Diabetes Cure In Reach

 

Harvard scientists have announced a breakthrough that could eventually allow millions of diabetics to shed the yoke of daily insulin injections.

It took over 15 years of trial and error, but researcher Douglas Melton and his team have discovered a method to transform human embryonic stem cells into insulin-producing cells which can then be injected into the pancreas. The discovery has generated a new wave of momentum in the field, with research labs across the country already working to replicate and build upon Melton’s results.

“I think we’ve shown the problem can be solved,” Melton told National Geographic.

Building the Recipe

The researchers developed a 30-day, six-step process that transforms embryonic stem cells into pancreatic beta cells, the same sugar-regulating cells that are destroyed by the immune system of people with type 1 diabetes. The new cells can read the levels of sugars that enter the body after, say, a meal, and secrete the perfect dose of insulin to balance sugar levels.

Other researchers have had some success harvesting beta cells from cadavers and transplanting them into people with diabetes, but this method can’t round up enough of those cells to have a lasting effect.

Melton’s method produces millions of the insulin-secreting cells, which were then fed through a catheter to the kidney capsules of 37 diabetic mice.

“We can cure their diabetes right away — in less than 10 days,” Melton told NPR.

When the mice were later given glucose injections,  73 per cent showed increased levels of human insulin in their bloodstream, indicating that the beta cells were doing their job.

Taking it to the Next Level

As with many medical breakthroughs, Melton said they are still a few years away from putting this method to work in humans. One of the primary obstacles to overcome is to find a way to mask transplanted cells from an immune system that’s out to destroy them.

Susan Solomon, a chief of the New York Stem Cell Foundation, expects diabetes research to shift toward scaling Melton’s process, and overcoming the immune system problem.

“If you don’t solve the autoimmune attack that killed those cells in the first place you are basically doing stupid mouse tricks as they say,” Solomon told the Washington Post.

And with an estimated 30,000 Americans of all ages diagnosed with type 1 diabetes every year, the urgency of improving these mouse tricks is real.

 

 

 

 

 

Mistakes avoid while attending interview For freshers

FOR FRESHERS -Top 10 Mistakes to Avoid While Attending an Interview

 

You may feel comfortable and confident about your chances throughout the job application process. A well developed resume will get you an interview, but a successful interview is the key to getting the job. Prior to the interview your research should include what you should do for your interview, but has it ever occurred to you to look for what you should NOT do during your interview? I bet it has not! The Top 10 mistakes you need to be aware of that you should Absolutely NOT do when going into an interview are as followed

1. Incorrect attire

Dress more conservatively than you would usually dress on an average day. You do not want to show up to the interview in a pair of jeans, t-shirt, and tennis shoes. In order to make the best impression on your interviewers and leave a lasting impression on them you should follow these guidelines:

Brushing teeth and arriving with fresh breath/ good hygiene.

Neatly arranged hairstyle.

Clean and conventional dress shoes.

Small amount/not gaudy jewelry.

Cleaned and neat fingernails.

Appropriate amount of cologne or perfume.

Do not have gum, candy, or other matter in your mouth.

No obvious and inappropriate body piercings other than single ear piercings for women.

No visible tattoos.

Specific items for women include:

Tailored skirt or pant suit in matching neutral colors. Length of skirt should be no shorter than the Knee. Underneath suit jacket should be a tailored blouse showing no cleavage.

Matching accessories.

No clubbing wear.

No outrageous makeup.

No torn tights or nylons.

Specific items for men include:

Matching pant suit in neutral colors. That said, no crazy or wildpatterns or colors.

Wear a quality silk tie that compliments your suit.

Shirt should be long sleeved ALWAYS, in white, light blue, or conservative striped pattern.

Facial hair neatly trimmed.

Recommended no jewelry what so ever.

Shoes and belt must match. Find MUCH MORE right here!

2. Unprepared answers

 

The most common interview questions are very well known, so make sure you have the answers well prepared. Going into an interview unprepared can be a death wish! Make sure you have accurately prepared and unrehearsed can cause you to lose that great job opportunity. Here is an example of how to be prepared with an impressive answer:

“Where do you see yourself in 5 years? What are your goals?”

What not to do-

Never imply anything along the lines of ending your employment with the company you are interviewing with or moving on to bigger and better things in the near future.

How to answer-

If asked where you see yourself in a certain number of years, tell the interviewer that you have a long-term commitment to the job in which you are applying and that you will grow as the position does.

3. Unprepared questions

As important as it is to have answers to questions prepared, it is equally important to have questions prepared to ask your interviewer because it will make you look more professional and well prepared. Some interview questions you can have in mind to ask are:

Is there anything about the company you like to see improved?

When do you expect to make your hiring decision?

When do you think I can expect to hear back from you? Having these questions in mind can give You the edge against all other interviewees the company will see.

4. Forgetting to do your research

One of the worst things you can do is go into an interview knowing absolutely nothing about the company you are applying with. Prior to the interview, it is vital to know and learn as much as you can possibly lean about the company. Some research you should do includes:

Preliminary company information.

If the company you are applying with has a parent corporation

What the position you are applying for entails Get the inside information to impress your interviewer with all of the knowledge you will know during your interview!

5. Not watching what you say

Everyone makes mistakes, but it is extremely important to avoid every mistake you can! Some things you may say might offend someone and blow your chances at getting that job. Make sure to carefully watch what you say, and think about what you want to say before you say it. Somethings to avoid saying in your interview include:

Asking about their pay or how much they make.

Questioning their authority

Attacking/speaking against personal beliefs

Avoiding these types of statements or questions can save yourself the pain of hearing that you did not get the interview, and keep you in the race for the job!

6. Ringing of cell phones

Probably the worst mistake you can make in an interview and the by far EASIEST one to avoid is having your cell phone ring during your interview! Having your cell phone go off during your interview is a slap in the face to your potential employer, showing them that you care more about your personal calls than their company. If your phone rings during the interview you can pretty much kiss your job good-bye, here are some solution ideas to avoid this incident:

Turn off your cell phone.

Silence your phones as soon as you pull into the parking lot of your interview.

Set an alarm so you remember to turn off/silence your phone.

By just following these simple and common sense guidelines to avoid your phone going off can save you tons of embarrassment and better yet your job!

7. Checking the time

Yes, the exact time of the day may be important to you so you can make your next task of the day on time, but to your interviewer it looks like they are wasting your time. If you check the time frequently during your interview, you will be sending a very negative vibe toward your employer and they will not hire you and waste your time.

Avoid this misunderstanding by (1) planning enough time in your day to allow more than enough time for your interview, (2) if you plan anything else during that day be sure whoever is involved in your plans knows you have an important interview to attend, and (3) don’t wear a watch to avoid any temptation to look at the time!

Let your interviewers know exactly how important this job is to you by showing them complete and utter respect during your interview and provide them with your undivided attention toward! Learn how to provide even more respect toward your interviewer

8. Asking about salary too early

We all know that money is very important to keep our lives going especially with this economy, but one of the WORST things you can doing an interview is ask about the salary you will be making. If you ask about your salary you will be showing the interviewer that you only care about the money you will be making and not about the position or the company itself.

You will find out soon enough what your salary will be, all you need to do is show patience and wait for the call that will say that “You’re hired!” and the answer about salary will follow!

9. Telling about other job offers

Getting offered a job or even multiple jobs is very exciting, but what do you do if you have another interview coming up? Well, you do NOT tell that company about your previous offers! You do not want that company to feel like you are disposable. For example, if you express that other companies have offered you a position versus a person who is desperately looking for a job and that company is their only hope, they will choose the other person who really needs the job.

Be smart, do not give the company an easy reason to dismiss you early and possibly lose your chances at a better job, higher pay, and a more successful life where you can advance in the position! Keep those other job opportunities you have received to yourself! To discover the secrets to learning how to watch what you say during an interview!

10. Tardiness

The most embarrassing thing you can possibly do for an interview is be late! Being late on your first day is bad enough, but just imagine being late for your interview, and say good bye to that job opportunity. Yes, it is very easy to get stuck in traffic, by a train, or even an unfortunate accident, but the company will see this as an excuse for your tardiness not a reason! Easy tips to eliminate all chances of being late by:

Leaving 15 minutes before you would normally plan to leave (Showing up early looks AWESOME).

Plan alternate routes to take in case the unexpected occurs.

Set an alarm to make sure you wake up on time and leave when planned.

Another helpful hint is IF you should happen to be running late (which there should be no reason for you to be) make sure you give the company a call, explain the situation briefly, express your empathy and gratitude, and assure them you will be there in a timely fashion!

By knowing these Top 10 mistakes of interviewing and following the guidelines to avoiding them you can assure yourself that you will have a very successful interview, and give yourself the BEST chances possible of getting the job you always have dreamed of having!