Posts Tagged ‘surfactant’

Three quarters of a century young (yes – we’re 79 years old!)

Monday, December 19th, 2016

fdr-warm-springs-kidsIt’s that time of year, when magazines are full of stories and photos of the year in review, and people look back to take stock of their accomplishments. This post is taking it a step further…here is a celebration of our past 79 years!

Why the dimes? (we get this question a lot)

The March of Dimes was started in 1938 when Franklin Roosevelt’s personal struggle with polio led him to create the National Foundation for Infantile Paralysis. It was a time when polio was on the rise nationwide. The name for the fundraiser “March of Dimes” was coined by comedian and radio personality Eddie Cantor as a pun on a popular movie newsreel of the era, The March of Time. Cantor asked his radio audience to send dimes to the White House to help polio patients and support research. After billions of dimes were received, the organization became known as the March of Dimes. The end result of this effort was the development of the polio vaccines, which have almost completely rid the world of this disabling disease.

check in boxIt is very unusual for a nonprofit organization to fulfill its mission as completely as that of the March of Dimes. So, when the March of Dimes checked off the box on the successful development of the Salk and Sabin polio vaccines, we turned our focus to that of preventing birth defects and infant mortality. With thousands of birth defects on record, we’ve had our hands full.

Our work after polio

The March of Dimes has funded research looking for the underlying genetic causes of birth defects to help us better understand what can go wrong and hopefully how to prevent them. We’ve funded research into the development of surfactant therapy to treat breathing problems in premature infants, which has saved thousands of lives since 1990. We’ve successfully championed and promoted newborn screening so that more infants with devastating conditions are identified and treated in a timely manner; and we led the campaign to add folic acid to grain foods in the United States, thereby reducing serious birth defects of the brain and spine by 27%.

We began educating the public on how to have a healthy pregnancy by producing a robust website of articles, print materials, this blog, and using social media to help women understand what they can do to have a full-term, healthy baby. We began answering individual health questions from the public in 1996 and still continue to answer thousands of questions every year.

But we didn’t stop there.

Our work with babies, birth defects and infant mortality provided a natural transition into fighting premature birth, the number 1 cause of deathPassing the time while your baby is in the NICU among babies in the U.S. Nearly 1 in 10 babies is born prematurely. Despite the advances in neonatal medicine, many babies still die, and the ones who survive often face a lifetime of disability – from mild to severe. In short, it is simply something that we knew we needed to fight.

So, in 2003 we launched our Prematurity Campaign. And in 2011, we launched the first of five prematurity research centers, each one staffed by the best and brightest scientists, and each one focused on a different aspect of prematurity. The best part of this 5-pronged approach is that the researchers all talk to one another and collaborate, encouraging synergy. Our goal is to be as successful with ending prematurity as we were with eliminating polio.

We also continued in the quest to allow folic acid to be added to corn masa flour in the U.S., and…drum roll please…we were successful this year! This is very important for the Hispanic community as corn masa flour is a staple for many Hispanic families. Fortifying corn masa flour products such as tortilla chips, tacos, and tamales, with folic acid will help prevent more devastating neural tube birth defects like Spina Bifida.

Wait…there’s more…

In the meantime, another related mission has surfaced – stopping the Zika virus. The devastating effects that Zika can have on a developing baby are well documented (microcephaly, congenital Zika syndrome, and developmental delays).

The March of Dimes led a coalition of almost 100 organizations to educate Congress about the dangers of Zika and was successful in the passage of federal funding to combat the virus. We continue to raise awareness with our #ZAPzika campaign to let women know how to protect themselves. By working with the CDC, we‘re educating the public about this virus so that pregnant women can protect themselves and their babies from Zika.

Yes. We’ve been very busy. The past 78 years have gone by quite fast.

Is there anything else in our future? Glad you asked!

A new March of Dimes President.

With the start of 2017, we will be under the leadership of President, Stacey D. Stewart, MBA, a woman of experience, intelligence, creativity and integrity. We’re so excited to welcome her.

The mission of the March of Dimes is to improve the health of babies by preventing birth defects, premature birth and infant mortality.

We are confident that under the leadership of Ms. Stewart, we will once again check off the box on a mission accomplished.

 

 

Respiratory distress syndrome (RDS)

Friday, October 29th, 2010

On average, a developing baby’s lungs are considered to be mature and fully functional around 35 to 36 weeks after conception.  For babies born before that, breathing can be a serious challenge.  Respiratory distress syndrome (RDS) is the most common illness in the NICU.  RDS can be mild or quite severe, but the good news is that 99% of babies with RDS survive.  The babies who don’t survive usually are the youngest, smallest babies born before 26 weeks of gestation.

Surfactant is a foamy substance that lines the lungs in mature babies and keeps them from collapsing, making breathing in and out easier. Premature babies lack surfactant and their lungs collapse between breaths.  This makes inhaling air and exhaling carbon dioxide very difficult.  The energy it takes to expand and contract the lungs can be exhausting and overwhelming for these tiny babies.

Research has shown us that the earlier a baby is born the less surfactant is likely to exist in the lungs and the more likely it is for him to develop RDS.  Boys are more likely to get RDS than girls because their lungs mature more slowly. Preemies with mothers who have diabetes  or with Rh blood-type incompatibilities are at greater risk for RDS because their lungs are slower to produce surfactant.  Babies with mothers who have severe preeclampsia are more vulnerable to RDS because their normal lung development is disrupted. Babies born via cesarean delivery and without labor are at increased risk for RDS.  This is because labor produces hormones that promote lung maturation and uterine contractions may help squeeze excess fluid from a baby’s lungs, making breathing easier.

Most babies who will get RDS show symptoms within a few hours of birth.  RDS usually gets worse for a couple of days and then improves as the baby starts to produce more surfactant.  Treatment includes giving a dose or two of man-made surfactant and providing breathing assistance with oxygen, C-PAP or mechanical ventilation, depending on each baby’s needs.

While the survival rate is extremely high, severe RDS may lead to longer-term health problems.  Mechanical ventilation can be life-saving, but it is harsh. Chronic lung disease, also known as bronchopulomonary dysplasia (BPD), comes as a result of inflammation and scaring of the lungs that may result from ventilation.  Children with severe RDS also have an increased likelihood of asthma.

Meconium aspiration

Tuesday, September 21st, 2010

Meconium is the stuff that first poops are made of. It’s greenish-black, sticky and tar-like, but may be treated as gold because it shows that the baby’s intestines are working.

Sometimes the passing of the first stool happens while the baby is still in Mom’s uterus or during delivery.  Meconium aspiration happens when a newborn inhales (or aspirates) a mixture of meconium and amniotic fluid.  The inhaled meconium can partially or completely block the baby’s airways, making it difficult to breathe and causing meconium aspiration syndrome, or MAS.

If that happens, the doctor will order a number of tests to see how affected a baby might be.  The primary focus is to clear the airway as much as possible to decrease the amount of meconium that is aspirated. This is done by inserting a plastic tube into the baby’s windpipe through the mouth or nose and applying suction as the tube is slowly removed. This allows for suction of both the upper and lower airways. The doctor will continue trying to clear the airway until there’s no meconium in the suctioned fluids.

MAS can affect the baby’s breathing in a number of ways including irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the destruction of surfactant by the meconium (read our previous post on surfactant.)  The severity of MAS depends on the amount of meconium the baby inhales and, generally, the more meconium a baby inhales, the more serious the condition.

Babies with MAS may be sent to a special care nursery or a NICU to be carefully monitored for the next few days. Most babies with MAS improve within a few days or weeks and usually there is not severe permanent lung damage.  These babies, however, may be at a higher risk of having reactive airway disease (lungs that are more sensitive and can possibly lead to an asthmatic condition).  Severe cases may necessitate the baby be given mechanical ventilation, which can increase the risk for bronchopulmonary dysplasia, a lung condition that can be treated with medication or oxygen.  Rarely, MAS can lead to a collapsed lung or pneumonia.

If not at the hospital when her water breaks, it’s important for a pregnant woman to tell her doctor immediately if meconium is present in the amniotic fluid, or if the fluid has dark green stains or streaks. Doctors may use a fetal monitor during labor to monitor the baby’s heart rate for any signs of fetal distress. In some cases they may recommend amnioinfusion, adding saline to the amniotic fluid to wash meconium out of the amniotic sac before the baby has a chance to inhale it at birth.

Although MAS is a frightening complication for parents to face during the birth of their child, the majority of cases are not severe.  Did any of you face this problem?

In the NICU – what is surfactant?

Thursday, July 29th, 2010

We were recently asked about surfactant and how it helps a premature baby’s lungs.

“Surfactant” is a condensed form of the term “surface-active agent,” meaning something that reduces the surface tension of liquids. So what does that really mean? Example:  Detergents are surfactants – their lowering of the natural surface tension of water is what keeps bubbles from collapsing, and lets dishwater foam.  Mature lungs are foamy organs, largely composed of tiny, bubble-like air sacs that are prevented from collapsing by lung surfactant.  This complex mixture of fatty substances and specialized proteins is produced in the lungs, starting many weeks before birth.

Premature babies often lack lung surfactant.  The more prematurely a baby is born, the less likely it is to be producing enough surfactant to enable normal lung function.  Immature lungs resist inflation and collapse after each exhale.  The effort of breathing under these circumstances – called “respiratory distress syndrome,” or RDS – can exhaust a very small, premature newborn and lead to severe complications and even death.  Survivors of RDS may have brain damage due, in part, to being unable to get enough air.  In recent decades, respiratory treatments have contributed to the improved survival rates for premature babies, but the lungs of some babies have been injured in the process.

Lung surfactant was identified in the 1950s. During the 1980s, many research groups around the world studied surfactant from human amniotic fluid and synthetic varieties.  Such studies showed the safety and effectiveness of both rescue treatment (given to babies already developing RDS) and preventive treatment (given to very premature infants before they show signs of RDS.)

The March of Dimes is pleased to have supported early research on lung surfactant for premature infants.  Widespread use of surfactant has contributed to a significant drop in deaths from RDS and a drop in the U.S. infant mortality rates. In the past decade, the March of Dimes has invested over $2.6 million in research involving lung surfactant.

 

Updated October 2015.