TORONTO – A seriously ill child who defied death a year ago after her parents had offered her heart to another infant is on life-support in a Toronto hospital.

Kaylee Vitelli is on a respirator after experiencing severe seizures while on a walk with her mom on Tuesday evening.

A family spokesman says the family has been told to prepare for the worst.

Kaylee captured national attention last April when her parents – fearing their first-born would soon die of a rare genetic condition – offered her heart for transplant.

Against all odds, Kaylee rallied and became well enough to go home with her parents a few weeks later.

Kaylee suffers from Joubert syndrome, a malformation of the brain and brain stem accompanied by frequently interrupted breathing.

More than one million baby slings have been recalled in Canada and the U.S. after three babies died while in the slings.

Health Canada and the U.S. Consumer Product Safety Commission (CPSC) are advising people to immediately stop using the Infantino SlingRider and the Wendy Bellissimo infant sling, which are both meant for children younger than four months, because children in them could suffocate.

The CPSC says it’s aware of three reports of children dying in the slings in 2009: a five-week-old infant in Philadelphia, Pa.; a six-day-old infant in Salem, Ore.; and a three-month-old infant in Cincinnati, Ohio.

The Infantino SlingRider is a soft fabric baby carrier with a padded shoulder strap that is worn by parents and caregivers to carry an infant weighing up to 20 lbs. Infantino is printed on the plastic slider located on the strap.

Wendy Bellissimo branded sling carriers were sold exclusively at Babies ‘R’ Us and have a sewn-in label on the inside of the sling strap that says in part Wendy Bellissimo Media, Inc. and lists item numbers 3937500H7 and 3937501H7.

Infantino LLC sold the slings in Canada and the U.S. from January 2003 through March 2010 at Walmart, Burlington Coat Factory, Target, Babies ‘R’ Us, BJ’s Wholesale, various baby and children’s stores and other retailers, and on the web at Amazon.com.

People who own the slings should call Infantino at 1-866-860-1361 to receive a replacement product.

WASHINGTON – More than 1 million baby slings made by Infantino were recalled Wednesday after claims linking them to three infant deaths.

The U.S. Consumer Product Safety Commission said babies could suffocate in the soft fabric slings. The agency urged parents to immediately stop using the slings for babies under 4 months old.

The recall involves 1 million Infantino “SlingRider” and “Wendy Bellissimo” slings in the United States and 15,000 in Canada.

Infantino President Jack Vresics said the company has been working closely with the commission on its sling concerns.

“Our top priority is the safety of infants whose parents and caregivers use our products,” Vresics said in a statement. He said the company would offer a free replacement baby carrier, activity gym or shopping cart cover to any affected consumer.

The slings wrap around the chest so on-the-go parents can carry their babies or just stay close as they bond with their infants.

Earlier this month, CPSC issued a broad warning about sling-style baby carriers, saying they pose a potential suffocation risk to infants, especially babies under 4 months. Babies who had a low birth weight, were born prematurely or had breathing problems such as colds were also at risk.

At the time, the commission did not single out a specific type of sling or manufacturer. It said it had identified or was investigating at least 14 deaths in the last 20 years associated with baby slings.

In Wednesday’s announcement, CPSC said three of the deaths occurred last year and were linked to Infantino slings. It did not say exactly how the babies died.

In its general sling warning earlier this month, CPSC said infants can suffocate in two different ways:

-A sling’s fabric can press against a baby’s nose and mouth, blocking the baby’s breathing and suffocating a baby within a minute or two.

-The other scenario involves slings where the baby is cradled in a curved or “C-like” position, nestling the baby below the mother’s chest or near her belly. That curved position can cause a baby who doesn’t have strong neck control to flop its head forward, chin-to-chest, restricting the infant’s ability to breathe. “The baby will not be able to cry for help and can slowly suffocate,” warned the commission.

Slings have been promoted by baby experts as a way to calm fussy babies or for nursing moms who can breast-feed their little ones in the sling.

Consumer Reports raised concerns about slings back in 2008, and had called on CPSC to issue a recall of the Infantino SlingRider. Safety advocates criticized the curved position that the baby can fall into while inside the sling.

Baby experts and breast-feeding advocates insist that not all slings are dangerous. They say carriers that keep a newborn baby solidly against the mother’s body in an upright position are safe.

The Infantino slings being recalled were sold from 2003 through 2010 at several retailers, including Target, Babies R Us and Burlington Coat Factory. Consumers can call Infantino at 866-860-1361 to receive a free replacement product.

There are no federal safety rules for baby slings.

Infantino says it’s working with CPSC and ASTM International, an organization that sets voluntary safety standards, to develop a standard for slings.

The CPSC specializes in product safety, and often negotiates agreements with manufacturers for recalls, when necessary.

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On the Net:

Consumer Product Safety Commission: http://www.cpsc.gov

Infantino: http://www.infantino.com

WASHINGTON – A company based in Atlanta is recalling more than 1.2 million high chairs, including about 35,000 sold in Canada.

The U.S. Consumer Product Safety Commission announced the voluntary recall by Graco Children’s Products Inc. The company says screws holding the front legs can loosen and fall out and a plastic bracket on the rear legs can crack, causing the high chair to tip over unexpectedly.

The company says 24 injuries have been reported due to the problem.

The high chairs, sold under the “Harmony” name, were produced from November 2003 through December 2009 and the model numbers may begin with the letter A, B, C, or D.

Consumers are asked to immediately stop using the high chair and contact Graco to receive a free repair kit.

ISLAMABAD, Pakistan – A Pakistani neurosurgeon says doctors are studying a pair of twin girls who were recently born connected at the head to determine whether they can separate them.

The infants were brought to a hospital in Islamabad on Monday from the city of Sahiwal in Punjab province where they were born a few days earlier. The two are connected at the head facing opposite directions.

Khaleequz Zaman, a neurosurgeon at the Pakistan Institute of Medical Sciences, said doctors will decide this week whether they can operate on the twins.

EDMONTON – Surrounded by family, a brain-injured baby died in the arms of his loving parents in an Edmonton hospital after they had spent months trying everything in their power to keep him alive.

Rebecka and Isaac May went to court in January seeking to prevent doctors from unhooking their son Isaiah from a ventilator until they could get a second independent medical opinion. When those experts told them there was no hope their boy would ever recover, they made a decision no parent should ever face.

The five-month-old boy died shortly after noon Thursday, only hours after his young parents were to appear in court again about the independent medical review of his condition. The hearing was cancelled.

“Isaiah has been a blessing to us and his spirit will always be in our hearts,” the parents said in a statement read by their lawyer, Rosanna Saccomani.

“We will never forget the miracle of his birth, the Christmas we spent together and the early spring day when we said our goodbyes. We will always cherish our son and the gift of time with him.

“We have set our tiny miracle free and he is now home in the arms of angels.”

Isaiah was born in a hospital in Rocky Mountain House last October with severe brain damage after his umbilical cord got wrapped around his throat, which deprived him of oxygen.

Doctors at Edmonton’s Stollery Children’s Hospital were planning to disconnect Isaiah from a ventilator on Jan. 20, but his parents persuaded a judge to give them time to get a second opinion.

Dr. Richard Taylor, a neonatologist from Victoria General Hospital, examined Isaiah in February.

Taylor determined that the boy could move his limbs and had gained weight, but he also found no brain reflexes and that the boy could not breathe on his own.

At one point the doctor showed the parents an MRI of their son and an MRI of a healthy infant.

“I advised Rebecka and Isaac that I was certain that Isaiah would never recover and that his body movements were likely due to activity in his spinal cord,” Taylor said in a statement.

“He would remain ventilator dependent for the duration of his life. As Isaiah would never recover, we agreed that this degree of life support was no longer appropriate.”

The parents, who are both in their early 20s, thanked Taylor and the staff at Edmonton’s Stollery Children’s Hospital for their help.

They also paid tribute to thousands of people across Canada and around the world who rallied behind them on social networking sites such as Facebook. Some right-to-life and religious groups in Canada and the United States also expressed their support.

The parents said the outpouring gave them strength in court and when they visited their son each day in hospital.

They were surrounded by aunts, uncles and grandparents as Isaiah took his last breath.

“Thank you to all who have listened to our story and supported our family,” the couple said in their statement.

“The expressions of love and compassion for our son received from thousands of people around the world helped sustain us in our darkest hours.”

Alberta Health Services initially tried to limit the time the Mays were requesting to seek a second medical opinion on Isaiah but then worked closely with the family to make it happen.

The organization expressed its condolences to the family.

“Physicians and staff who have been involved in caring for baby Isaiah were touched by the May family’s strength. Our deepest sympathies go out to the family.”

Plans for Isaiah’s funeral were pending.

WASHINGTON – Too many pregnant women who want to avoid a repeat cesarean delivery are being denied the chance, concludes a U.S. government panel that urged doctors to rethink litigation-spurred policies that have swung the pendulum back toward the days of “once a C-section, always a C-section.”

Fifteen years ago, nearly three in 10 women who had a first C-section were able to deliver their next baby vaginally, a trend called VBAC for “vaginal birth after cesarean.”

Now that rate has dropped to one in 10, in part because a third of hospitals and half of physicians ban women from attempting VBAC, a panel of specialists convened by the National Institutes of Health said Wednesday.

But VBAC remains a safe alternative for the right candidates, and when those women try labour, between 60 per cent and 80 per cent of the time they do give birth vaginally, the NIH panel concluded. It urged that doctors offer mothers-to-be an unbiased look at the pros and cons, so they can decide for themselves.

“We believe that many women should have an opportunity to give it a try,” said panellist and Delaware obstetrician Dr. Nancy Frances Petit of the U.S. Uniformed Health Services.

Overall, nearly a third of U.S. births are by cesarean, an all-time high. Cesareans can be lifesaving but they come with certain risks – and the more C-sections a woman has, the greater the risk in a next pregnancy of problems like placenta abnormalities or hemorrhage.

Decades ago, doctors almost always recommended a repeat C-section, worried that the rigours of labour could cause a uterus scarred from the first surgery to rupture. But in 1980, government experts concluded that many mothers could safely deliver vaginally the next time, citing evidence that their risk of a uterine rupture was less than one per cent.

Yet the last decade saw the pendulum swing back again: Among 19 states that track VBAC, 92 per cent of women had a repeat cesarean for their next delivery in 2006. And in 1999, the American College of Obstetricians and Gynecologists issued guidelines saying VBAC should be attempted only in hospitals equipped for immediate emergency surgery – and many smaller and rural hospitals aren’t.

What sparked the latest shift? It’s partly concern over litigation, the NIH panel said, because while a uterine rupture remains very rare, it can be devastating to the family and end in a high-dollar lawsuit.

Case-by-case decisions are crucial, the panel said, because there may be instances where another C-section is better for the baby but not for mom or vice versa.

Who’s a good candidate? The panel said that needs further study. But in general, VBAC is for women who’ve had one prior C-section done with a “transverse” scar, the most common kind today, said panel chairman Dr. F. Gary Cunningham of the University of Texas Southwestern Medical Center at Dallas. Women should be otherwise low-risk, he said: Not carrying multiples or a large baby, being obese or having high blood pressure or diabetes.

“There’s still a lot we don’t know about which women will be successful in having a VBAC, but we believe it’s essential that women’s desires and preferences be respected throughout the decision-making process,” Cunningham said.

Don’t try to pre-judge candidates, said Dr. Emily Spencer Lukacz of the University of California, San Diego.

“All women who have prior cesarean delivery should talk to their providers about VBAC,” so they can decide on a case-by-case basis if it makes sense, Lukacz said.

It can be difficult for women to find a doctor or hospital that offers VBAC, said Debra Bingham of Lamaze International. She points to California, which now lists VBAC availability for every hospital on a website: www.calhospitalcompare.org.

WASHINGTON – Eleven days after her son Benjamin’s birth by C-section, Linda Coale awoke in the middle of the night in pain, one leg badly swollen. Just as her doctor returned her phone call asking what to do, she dropped dead from a blood clot.

Pregnancy-related deaths like Coale’s appear to have risen across the U.S. over the past decade, nearly tripling in the state with the most careful count – California. And while they’re very rare – about 550 a year out of four million births nationally – they’re nowhere near as rare as they should be. The maternal mortality rate is four times higher than a goal the federal government set for this year.

“It’s unacceptable,” says Dr. Mark Chassin of The Joint Commission, the agency that accredits U.S. hospitals and which recently issued an alert to hospitals to take steps to protect mothers-to-be. “Maybe as many as half of these are preventable.”

Two years after Coale’s death near Annapolis, Md., her sister says topping that list should be warning women about signs of an emergency, like the clot called deep vein thrombosis, or DVT, that can kill if it breaks out of the leg and moves to the lung.

“All she wanted to do was have her own family, and when she finally gets that privilege, she’s no longer with us,” says Clare Johnson, who says her sister’s only risk was being pregnant at age 35.

Maternal mortality gets little public attention in the U.S., aside from last year’s worry over the swine flu that killed at least 28 pregnant women. Among the leading preventable causes are hemorrhage, DVT-caused pulmonary emboli and uncontrolled blood pressure.

It’s not clear what’s fuelling the overall increase, although better counting is playing some role. But there are some suspects: A jump in cesarean deliveries that now account for almost a third of births. One in five pregnant women is obese, spurring high blood pressure and diabetes. More women are having babies in their late 30s and beyond.

“It can be a death here, a death there,” says Dr. Elliott Main of the California Maternal Quality Care Collaborative, whose research is helping to uncover the rise. “Any one doctor or any one hospital hasn’t really seen this change.”

When he shows the statistics at medical meetings, “everybody sits up.”

More startling, black women are at least three times more likely to die from pregnancy complications than white women, and research is too limited to tell why.

Then there are the near misses. For every death, 50 additional women suffer serious complications of pregnancy or delivery, notes Dr. Jeffrey King of the University of Louisville, a spokesman for the American College of Obstetricians and Gynecologists.

At issue are deaths directly related to pregnancy or childbirth, up to 42 days after delivery. In 2006, the latest year for which data were available, there were 13.3 maternal deaths for every 100,000 births. A decade ago, the rate hovered around seven – and by this year, the U.S. government had hoped to lower it to 3.3 deaths. California in 2006 charted 16.9 maternal deaths for every 100,000 births, up from a rate of 5.6 in 1996.

How pregnancy-related deaths are coded and counted changed during that time period, but Main says only about 30 per cent of the increase may be due to that.

At the request of California health officials, Main is finishing an in-depth study of maternal deaths that already has prompted a project to reduce hemorrhage in 30 of the state’s hospitals.

“Jumping on it early is very important,” says Main, who worries that hospitals can lose track of bleeding that happens a bit at a time until “before you know it, you’ve bled a lot.”

Among other safety steps:

-Seek early prenatal care to control underlying disorders and check for DVT risk. Pregnancy makes everyone’s blood clot more easily. At extra risk are women who have already had a clot or whose relatives have, who are obese or who have varicose veins, says Dr. Geno Merli of Thomas Jefferson University Hospital. They may need blood-thinning medication.

C-sections, like any major surgery, also add to the risk.

Andrea Darling of Skillman, N.J., suffered a DVT in her first trimester in 2002 and endured months of treatment and anxiety before her son was born healthy. Darling already was being treated for a genetic clotting disorder but says patient education helped her take extra steps to avoid a C-section.

-Hospitals should consider using compression boots on C-section patients, says King. They help keep blood from settling in the lower legs.

-C-sections can be lifesaving but women should understand how to reduce their chances of needing one – because next pregnancies tend to end in C-section, too, and repeat C-sections increase hemorrhage risk. Coming to the hospital before you’re properly dilated or seeking induction before the cervix is ready unnecessarily increases the C-section risk, Main says.

There often aren’t clear explanations for these deaths, and Maryland’s Clare Johnson tries not to wonder if anything could have saved her sister, because that’s impossible to know.

Still, she urges better education about DVT as the family watches her nephew Benjamin, now 2, grow.

“He is truly our blessing in all this,” Johnson says. “He’s truly what gets us through.”

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On the Net:

Data from California Maternal Quality Care Collaborative: http://www.cmqcc.org/maternal-mortality

MONTREAL – Toyota may be rapidly becoming a byword for corporate misadventure, but Canadian hospitals are not yet ready to slam the brakes on health-care initiatives inspired by the Japanese carmaker.

A handful of hospitals across the country have in recent years modelled new management practices after the fabled workplace culture fashioned by Toyota’s founder, Sakichi Toyoda.

The so-called Toyota Production System has spawned a cottage industry of sorts among management consultants eager to apply its focus on worker input to all manner of industries.

Quebec Health Minister Yves Bolduc made waves when, upon taking the job in 2008, he claimed the “Toyota Way” would help ease the burden on the province’s over-stretched health-care system.

But Toyota’s recall of 8.5 million vehicles because of a dangerous accelerator-pedal defect has given some pause about the wisdom of following its example.

“There’s a lesson there for us,” said Dr. Michel Tetreault, president and CEO of St. Boniface General Hospital in Winnipeg. “We have try to figure out what went wrong with Toyota.”

Along with hospitals in Quebec, New Brunswick and the Ontario cities of Kingston and Windsor, St. Boniface is among those that have undertaken Toyota-inspired reforms, also known as the “lean” health-care approach.

The idea is to focus hospital processes on the patient, stripping away anything that doesn’t serve that end.

It has been used to deal with such perennial health-care problems as emergency-room overcrowding by deleting unnecessary red tape.

Hospitals in Britain and the United States have been incorporating Toyoda’s insights for several years and studies have identified successes that include, in one case, reducing registration times from 60 minutes to zero.

At St. Boniface, Tetreault says Toyota-inspired methods allowed them to reduce by half the average time patients with chest pains have to wait for a cardiogram – to 14 minutes from a half-hour.

“The idea isn’t making a better process, the idea is getting a better patient result,” he said.

“If that’s not your starting point, you can go off in all sorts of wrong directions. You can do the best operation in the world in five minutes, but if its on the wrong patient you’ve got a problem.”

But Toyota’s recent troubles have stirred debate among advocates of its methods in the health-care sector.

The consensus appears to be that Toyota stopped worrying about making the best cars possible and became obsessed instead by becoming the largest car manufacturer in the world.

“Toyota’s rapid growth meant they started cutting corners,” said Sylvain Landry, a professor at the Universite de Montreal who specializes in hospital logistics.

“They didn’t provide their employees with enough training, they multiplied their number of factories around the world too quickly and put a lot of pressure. They distanced themselves from the core elements of the Toyota System.”

The danger, for Landry, is that hospitals reject Toyota’s methods before giving them a chance to take root.

“It’s not the fashion of the year,” he said. “It’s long-term institutional learning and I think Toyota’s misadventures are reminding us of that.”

In Quebec, Bolduc and his staff have faced criticism recently over increasingly long wait times at Montreal emergency rooms.

It’s hospitals such as these that can benefit from the Toyota approach, which improves the way emergency rooms interacts with other areas of the hospital, Landry said.

“You can’t throw the baby out with the bath water,” he added. “We have to be careful not to become too cynical about the Toyota system.”

For Tetreault, the beauty of the Toyota system lies in its refusal to lay blame on one given person.

He points to the problems at Hotel-Dieu Grace Hospital in Windsor, where a patient is suing doctors after they removed a healthy breast in the mistaken belief it was cancerous.

“You can be tempted to make that a person issue, that this surgeon was either dumb, lazy, tired or undertrained,” Tetreault said.

“Or you can look at the system and the processes and ask what safeguards were in place for this not to happen?”

So as Canadian hospitals go full speed ahead applying Toyota’s mantra, some of the carmaker’s executives may be left wondering why they didn’t follow their own advice.

WASHINGTON (Reuters Life!) – Germs that make their home in the gut may help cause obesity and a range of health-threatening symptoms that go along with it, researchers reported Thursday.

It could be that certain bacteria cause inflammation that can affect appetite as well as inflammatory bowel conditions like Crohn’s disease and colitis, the researchers reported in the journal Science.

In other words, the germs make you overeat, Andrew Gewirtz of Emory University in Atlanta and colleagues reported.

“Previous research has suggested that bacteria can influence how well energy is absorbed from food, but these findings demonstrate that intestinal bacteria can actually influence appetite,” Gewirtz said.

“The obesity epidemic is driven by people eating too much, but why are people eating more?”

Gewirtz said the research suggests that bacteria may play a role — perhaps a population of bacteria that thrive because other, competing organisms have been wiped out by antibiotics, access to clean water and other factors of modern life.

His team stumbled on the findings by accident.

“We were studying mice that had colitis,” Gewirtz said in a telephone interview.

The team suspected some kind of germ was responsible, so they transferred mouse embryos into surrogate mothers to prevent them from being infected by their own mothers.

Babies are colonized by bacteria and other micro-organisms soon after birth and the makeup of these colonies — which persist for life in the skin and bowels — are very similar to those of the mother.

The colitis was better but the baby mice became obese and developed metabolic syndrome — a cluster of symptoms that include unhealthy cholesterol levels, too much fat around the midsection, high blood pressure and insulin resistance.

Insulin resistance means the body does not use insulin effectively to break down food and Gewirtz believes this may be the key.

PREVIOUS RESEARCH

The researchers remembered a recent study in which normal, slender mice became obese when fed gut bacteria from fat mice.

They worked with that team, including Ruth Ley of Cornell University in New York, to see what role the gut bacteria may be playing.

“What we we think is that the mice are prone to intestinal inflammation,” Gewirtz said. “If you have a lot of inflammatory signals about, insulin won’t work properly.”

Weeks of antibiotic therapy helped, and so did diets.

“If we limit their food intake they are mostly OK; they certainly are no longer obese,” he said. “They are, however, insulin-resistant.”

Gewirtz’s team is now working to see if they can identify the micro-organisms involved. They are also working to see if obese people have unique patterns of gut bacteria.

Scientists know that hundreds of species of bacteria live in the gut and an average person carries about 5 pounds (2 kg) worth. On Wednesday, Chinese scientists reported in the journal Nature that they found 1,000 different species in human intestines.

So could you treat obesity by taking an antibiotic to wipe out the offending germs that are making people overeat?

“It is very hard to replace the bacteria that you have,” Gewirtz said. Studies already show it is difficult to treat conditions like Crohn’s disease, even with months of antibiotics.

_Reut16:13 03-04-10