Children's Hospital Oakland In the News
Pages 18, 46-47 | Baby | Spring 2014
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By Teresa Mills-Faraud
Fetal Medicine Program Guides Parents Through Stressful Times
When expecting parents learn their baby will be born with a birth defect, it can be devastating and stressful. That’s why Children’s Hospital and Research Center in Oakland developed a program two years ago that walks parents through a confusing system.
When there’s an anomaly in a pregnancy, there can be multiple appointments for a variety things, and it can be very overwhelming for the parents, says Arthur D’Harlingue, M.D., fetal medicine program medical director and neonatologist.
With the new Fetal Medicine Program, a case manager coordinates care for the mother and her unborn child. The manager does everything from making sure the pregnant mom receives all the appropriate diagnostic tests to coordinating the baby’s delivery and post-delivery care.
“It’s not like this wasn’t done before, but it wasn’t very coordinated,” D’Harlingue says. “There are conference calls every week with the parents. We make sure the family understands what doctors are saying. The case manager keeps track of everything, and they notify doctors about any developments. It’s amazing in health care how things can fall through the cracks.”
The Rise of a Deadly Prenatal Disease
A group of doctors at Lucile Packard Children’s Hospital at Stanford are among researchers nationwide who are trying to tackle a disease that, in some cases, causes pregnant women to bleed to death.
Over the years, there has been a rise in women diagnosed with placenta accreta, a complication in which the placenta, the organ that connects a pregnant woman to her fetus, attaches to the uterus.
Once a rare disease, with only one in 30,000 pregnancies affected in the 1950s, it now affects approximately one in 500 pregnancies in the United States, according to Stanford Medicine Magazine. Up to seven percent of patients die of the disease. Researchers suspect the increase can be attributed to a rise in Caesarean delivery rates. The scarring on the uterus caused by a Caesarean delivery makes women more vulnerable to the disease when they have their next child, says Deirdre Lyell, M.D., medical director of the Program for Placental Disorders within the Division of Maternal-Fetal Medicine at Lucile Packard Children’s Hospital.
The program opened in 2010 because the hospital was receiving a growing number of referrals for women with placenta accreta, she says. Now the hospital treats 15 to 20 such patients per year.
The treatment surgery can be unpredictable and challenging, Lyell says. The pregnant woman delivers early at 34 weeks, and an experienced team conducts the surgery.
“In postpartum hemorrhaging, someone can bleed to death in five minutes. That’s why we need to do it in a very controlled setting,” Lyell says.
Lyell, who also is an associate professor of obstetrics and gynecology at Stanford’s School of Medicine, is part of a multi-institution effort to find out more.
“We’re trying to understand the cause,” she says. “We’re part of a national consortium to collect maternal blood to determine why this happens.”
Page 18 | Baby | Spring 2014 | BayAreaParent.com
Juggling Two Sleep Schedules
Helping Baby and Big Sibling Sleep Peacefully
By Teresa Mills-Faraudo
When Karyn Desai’s first son was born, everything seemed so easy. He slept through the night. He took naps.
“Nicholas was a power sleeper. He was a dream baby,” says the San Francisco resident.
Eighteen months and one day later, that all changed. Her son Satya, now 2, was born.
Their once peaceful nights became chaotic with the two boys waking each other up.
Even now that Nicholas is 5, Desai still doesn’t feel like she’s found the perfect answer for a restful night in her household. Nicholas has regular problems sleeping, and he likes to get up in the middle of the night and come into Desai’s room.
“I just don’t have any resolution,” she says. “Nicholas is at least getting up quietly and not waking up the little one, and Satya is sleeping through the night.”
Parents may not worry much about sleep routines when they are preparing for their second child. They may think it will be much like the sleep dance they did with their first child. But it is completely different when you’re juggling two little ones at bedtime.
Sometimes, there isn’t one “right way” to get children to bed, says Javay Ross, M.D., a primary care physician at Children’s Hospital and Research Center in Oakland. “No matter which way you cut it, bedtime is tough. And coordinating bedtime in a
home with two young children, especially when one is an infant, can seem nearly impossible.”
The one concept that seems to work for everyone is establishing a routine.
“Sleep is an activity that can be very guided by routine. In fact, it is our body’s internal clock or ‘circadian rhythm’ that is the driving force behind our sleep-wake cycles,” Ross says.
Establishing a Routine
It is key to have a routine established for the older child before the baby is born, emphasizes Nanci Yuan, M.D., medical director at Lucile Packard Children’s Hospital’s Sleep Center. “You should have
a foundation set up and talk to the toddler a lot about how important it is for the baby to sleep.”
Newborns, Yuan notes, shouldn’t start sleep training until they are 6 months old because their brains are not mature enough to give out sleep signals. They also need to have regular feedings throughout the night, which makes a regular sleep routine difficult.
It may be helpful, Yuan suggests, to have your toddler help with the baby’s sleep routine.
“If it’s not too distracting, have the toddler help get the baby to sleep. Let him help wash the baby, sing a song, bundle the baby up,” she says. “If they are not old enough, give them a doll to mimic what you’re doing.”
Once you get the baby to sleep, you then have special time to bond with your toddler by reading to him.
The more consistent you are with this routine, the better, Ross says. “Doing this around the same time, consistently every night should help set the baby’s internal clock and hopefully bring a restful and successful bedtime.” Ross says you should also put the baby in her crib when she is just barely awake. This practice helps babies learn to soothe themselves back to sleep if they do wake up in the middle of the night.
As for your toddler, make sure he doesn’t do anything too stimulating before bed, such as play a video game or watch television.
Moving Baby into a Sibling’s Room
When Desai first tried to move 6-month-old Satya into his big brother’s room, it was a disaster. Satya wasn’t sleeping through the night and was waking up Nicholas, so they moved him back into the room. But even that didn’t work.
“Every time Satya cried, he woke up Nicholas and then everyone in the entire house woke up,” Desai says. But moving Satya back into his parents’ room until he learned how to sleep through the night was the smart thing to do, says Yuan. Research shows that having a baby sleep in his parents’ room during the first months of life reduces the risk of Sudden Infant Death Syndrome. Experts suggest waiting until a baby is 6 months to a year old before moving her to a different room.
If your baby doesn’t seem to be learning how to sleep through the night, make sure there are no medical problems.
Once your baby is ready to sleep in an older sibling’s room, Yuan suggests getting the baby to sleep first with a regular routine. After the baby is asleep, you can read to your toddler in another room and
then bring him into the room with the baby when it’s bedtime. Hopefully, by then, the baby is sound asleep.
“The hope is that the sleep routine will help both the infant and toddler maintain a cohesive night’s sleep without frequent night-time awakenings,” Ross says. “Having a well-functioning internal clock is the key to keeping anyone from being awake all hours of the night.”
Naps for Everyone
Since babies need to sleep more often than toddlers, there will be times when both children aren’t napping at the same time, Yuan says. But you can try to make sure the baby goes down for a nap at
the same time the toddler does by setting a consistent routine. You just have to be firm about it, she says.
Pages 46-47 | Baby | Spring 2014 | BayAreaParent.com