Emerging Issues in Pediatric Health Technology
Human milk banks
An increase in demand and the establishment of guidelines is believed to be the catalyst for renewed interest in human milk banks. Donor breast milk in comparison to infant formula is thought to provide additional health benefits.
Canada’s only human milk bank is located in Vancouver. In the 1980s, there were more than 20 across Canada, but fears of HIV infection led to their closure.
North American milk banks now screen, pasteurize, and dispense donated human milk to babies who have severe allergies or intolerance to formula.
- Breastfeeding and maternal and infant health outcomes in developed countries. AHRQ. 2007. http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf
- Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2007;92:F169-F175. http://fn.bmj.com/cgi/content/full/92/3/F169
- Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review. Arch Dis Child Fetal Neonatal Ed. 2003 Jan;88(1):F11-4. http://fn.bmjjournals.com/cgi/content/abstract/88/1/F11
Increasing cost of nitric oxide
Inhaled nitric oxide is currently available through a Canadian licensed manufacturer, INO Therapeutics. In 2005, the cost of inhaled nitric oxide increased from $7.50 per hour to $95 per hour.
Inhaled nitric oxide improves the blood supply to the lungs in premature babies when used in conjunction with ventilator support and other agents. It is intended to help some full-term babies suffering respiratory failure who have not responded to the usual methods of support. It is also believed to reduce the need for extracorporeal membrane oxygenation, a costly and highly invasive surgical procedure.
In Canada, inhaled nitric oxide is indicated for the treatment of near and full-term babies (≥34 weeks) who are suffering from respiratory failure.
Nitric oxide for respiratory failure in
infants born at or near term. Cochrane Database of Systematic Reviews 2006, Issue 2. http://www.cochrane.org/reviews/en/ab000399.html
Biliary atresia
Biliary atresia is a leading cause of death from liver disease, affecting about one in every 10,000 to 20,000 infants in Canada. Without treatment, biliary atresia can progress to liver failure and death within the first two years of life. Early detection and prompt intervention is critical to the success of treatment. However, late referral and diagnosis are still observed in Canada.
An infant screening stool card, consisting of photos of different-coloured stool samples, is being used by parents and medical staff to observe the stool colour of infants.
Universal screening in Taiwan using the stool card has lead to earlier diagnosis and better outcome in infants with biliary atresia.
Universal screening for biliary atresia using an infant stool color card in Taiwan. Hepatology. 2008;47(4):1233-1240: http://www3.interscience.wiley.com/journal/117870818/abstract?CRETRY=1&SRETRY=0
Sudden arrhythmia death in the young
Sudden arrhythmia death (SAD) is a genetic heart condition that can cause sudden and unexpected death in young, apparently healthy, Canadians. Recognizing the early warning signs and seeking early medical attention can reduce the risk of SAD.
Community screening programs operating in the UK, using electrocardiogram tests, have been effective in reducing rates of SAD. These programs are also raising public awareness of inherited cardiac rhythm disorders, which are reported in as many as one in 625 live births.
While there are no screening programs in Canada, three studies involving genetics and arrhythmias in 10 centres across Canada, including three pediatric centres, are underway.
Cardiac risk in the young: mobile screening programme: http://www.c-r-y.org.uk/mobile_screening.htm