Registered Charity no. 1037513
Patron - The Most Reverend Archbishop Desmond Tutu, OMS, DD, FKC.
Permanent brain injury in very low birthweight & preterm infants
At normal birthweights, the rate of severe developmental brain damage is 1 to 2 per 1,000 live births.
- At birthweights below 1.5Kg, the rate rises to over 200/1000.
- The cost to the nation is put at £4 billion by the Little Foundation.
- The European Cerebral Palsy Study of the Little Foundation and the Castang Trust, has established from Magnetic Resonance Imaging of the brain damage that it occurs around or before 40 weeks gestation.
- The consequences of low birthweight, brain damage, and mental impairement has become global.
However, cerebral palsy is a tip of an iceberg. In the UK 54,000 children are born at low birthweights (<2.5 Kg or 5 Lbs). A high proportion of these, especially of the very preterm infants, will not achieve their full potential for school learning, or health. Some will have behavioural defects because of disturbances in brain development prenatally. Despite the advances in medicine and science, the prevalence of cerebral palsy amongst low birthweight infants, increased three-fold from 1967 to the early 1990s. Government programmes in the Thames Valley Gateway to London need to address the health and nutrition of the mother if they are to succeed.
The work sponsored by the Foundation has produced a good biochemical explanation for the brain damage and chronic ill health. There are modifiable nutritional factors of special relevance to the brain that offer a hope of being able to help protect and treat such damage in the early stages.
Low Birthweight - Health Markker
In June 2004, Lord Morris asked the Government 'in view of the high incidence of impaired neurodevelopment and chronic ill health amongst low birthweight babies, would the Government tell Parliament of the progress in reducing the incidence since the 1950s'. The Government statistician furnished the reply that:
- In 1953, the incidence was 6.6% in England.
- In 1973, the new national statistics put the incidence nationwide at 6.6%.
- In 2000, it was 7.6% nationwide.
- The UNICEF report in 2005 puts the UK at 8% on a par with Rumania and Kazakhstan and worse than Cuba (5.7%).
A most promising research assistant is currently studying 372 pregnancies in relation to nutrition as one of the modifiable factors determining pregnancy outcome and the risk of chronic ill health and mental impairment to the new born. Evidence on ADHD points to a deficiency of omega 3 fatty acids which we are seeing in infants born at very low birthweights. One of the trustees has given £10,000 to help continue this important work the outcome of which will lead to better guidance for all women planning and entering pregnancy.
The concern of the foundation is that the 1970s the Neuberger report for the Medical Research Council advised that research should be done on the reasons for the reduction of low birthweight and its associated handicaps. The 1989 House of Commons Select Committee on Children and the 1991 Committee on Maternity services all echoed the same recommendation. To date no concerted action has been taken although several independent research groups have recognised the problem and are active in research and action programmes.
HIV-1 in pregnancy and the long term effect on the mother and child.
There are 900 women in the East-end of London, each year diagnosed with HIV, 500 of whom have the virulent virus. In the majority, the first they know, is when they are screened at their first visit to the maternity hospital. This is likely to plunge the women into a state of denial and or despair. That alone affects her mentality, nutrition and health care. The virus itself adds another burden by burning her immune cells.
There is a good support system for such mothers but our research of the Arch Bishop Desmond Tutu Fellow has found new evidence, which could lead to ways of improving maternal and fetal health. The immune system in the mother is severely compromised by HIV-1, as is that of her fetus resulting in reduced immune competence at birth. A key essential fatty acid accounts on its own for one third of the molecules in the immune cell's membranes that are responsible for action. In HIV-1 the levels are reduced and this reduction is related to reduced immune competence. Restoration of this state should help both the mother and the child.
One of the Trustees has given £14,000 for the continuation of this research in the UK. Matching funding is needed to help develop it to help protect the mother and the unborn child from the emotional, viral, nutritional and drug adversities. Much more is needed to apply this knowledge to South Africa where as many as one in three pregnant women may have an HIV-1 infection, 11 million children are HIV-1 orphans.
The time bomb in Bangladesh - The Worst Man-made Disaster Ever: Arsenic is transferred from the mother to the child in her womb
Low level chronic arsenic poisoning (arsenicosis) - melanosis, keratosis, non-healing ulcer, gangrene, non-pitting oedema, conjunctivitis, cancer (organ level internal & external), death.
Discoveries on the present state against the WHO upper limit which is 10 micrograms (mg) per litre (L) of arsenic in drinking water:
- 30 million children, in Bangladesh are being poisoned with arsenic whilst still in the womb of the mother.
- Drinking water samples from 9 tube wells in Chadpur Bangladesh ranged from 230-950 mg/L of arsenic.
- New deep tube wells to provide, safe, As free drinking water: 4 undetectable.
- One contained traces, 4 contained 293, 788, 544, 734 and 850.
- In 48 people 52% had blood levels of arsenic above the WHO upper limit of 5mg/L.
- In 18 mothers at the delivery all were above the WHO 5mg safe level (mean 15mg/L). In their infants at birth, the mean level was 7mg/L.
The lower level found in the fetus shows some placental protection but confirms that arsenic is being transferred from the mother to the fetus at unsafe levels. This transfer is critically important. Prenatal development is the most sensitive period when many gene expression and maturation processes are permanently set.
Children under 5 are now showing signs of arsenicosis. We urgently need to conduct a more detailed survey of the threat to the unborn child and of the children born after the introduction of the original arsenic wells and to introduce rainwater harvesting as with New Zealand experience to protect families and especially pregnant women.
Women Refugees in Disasters
It is not unusual for maternal and infant mortality to rise and for opportunist abuse of the women to take place.
Maternal and infant mortality rises as does the threat to the unborn child, and assaults on women. Even those who are supposed to be taking care of them often abuse women. In some cases sex is demanded in exchange for food for the children. We can only praise the efforts of the International Community and hope the focus of attention in the aftermath of the Tsunami disaster has kept such abuse to a minimum. A special care team should be established to protect women in such situations and provision made to ensure that the health and nutrition of expectant mothers: this is not current practice. Work by the Foundation for Burmese refugees in Thailand found no evidence from the nutrition of the women in the camps that would explain delayed visual maturation in the infants. It is plausible that the responsibility arose from the trauma associated with the displacement, which could have affected the development of the fetus. Vision is one of he earliest developments seen in the embryo.
There needs to be a special commission by UNHCR to examine ways and means of guaranteeing the security of women in such disasters and ensure proper and relevant nutrition and health for young women of reproductive age and especially those pregnant and lactating.
How often have you seen the television cameras focusing on the emaciated child or infant, even at the breast of its mother? They never spare a thought for the mother. Powerless, she is watching her child sink into death whilst she gives her last drops of milk that have already scavenged her body's resources for remaining nutrients.