Jennie Smith

BOSTON – Two award-winning researchers have received funding from the AGA Research Foundation to support their research into less invasive diagnostic techniques for GI patient care. The researchers shared updates on their findings at the 2016 AGA Tech Summit, which is sponsored by the AGA Center for GI Innovation and Technology.

Update on AGA-Boston Scientific Career Development Technology & Innovation Award
Guan Xu, Ph.D., of the University of Michigan, Ann Arbor, received the 2015 AGA–Boston Scientific award to support his investigation of an experimental, optically induced ultrasonic imaging technique called photoacoustic imaging, or PAI, in Crohn’s disease.

PAI uses pulsed laser light to penetrate tissues at different depths, allowing researchers to distinguish the absorption spectra indicative of the different chemical compositions seen in inflammatory and fibrous intestinal strictures.

Though a number of experimental modalities are being investigated to characterize intestinal strictures less invasively, tissue biopsy is still considered the only reliable way to determine whether strictures are inflammatory or fibrous. Inflammatory strictures can be treated medically, while collagen-based fibrotic strictures must be removed surgically or treated with endoscopic dilation.

Dr. Xu joined Michigan’s radiology department as a postdoctoral research fellow in 2012 and is now a research investigator there. He previously helped develop a photoacoustic ultrasound imaging system for finger arthritis, designed for use in a clinical setting.

Dr. Xu and colleagues in the radiology, pathology, engineering and internal medicine departments at the University of Michigan are now investigating in animal models whether PAI is as accurate as tissue biopsy in distinguishing the two types of intestinal strictures seen in Crohn’s. They are also designing a capsule PAI device that can be fitted to an endoscope.

The PAI technology builds on and extends the ultrasound technology that is currently the standard of care, explained Dr. Xu, saying “We are standing on the shoulders of giants.”

At the Tech Summit, Dr. Xu presented an update of his research. Preliminary results have revealed significant differences in photoacoustic signal intensity among normal, inflammatory, and fibrotic bowel tissues in rats, and also strong correlations between photoacoustic images and histology in human stricture tissues. A prototype capsule PAI probe has been developed and it will soon be tested on mouse and rabbit models.

In an interview, Dr. Xu expressed “sincere gratitude to the AGA Research Foundation and Boston Scientific for the support of our preliminary study. We will work toward translation of our system to clinics.”

If Dr. Xu and his colleagues’ work is successful, clinicians may one day be able to distinguish between inflammatory and fibrotic intestinal strictures in Crohn’s disease patients without needing to perform endoscopic biopsy. The team’s findings may also prove useful in the preclinical investigation of antifibrotic medical therapies.

Update on AGA-Covidien Research & Development Pilot Award in Technology
Dr. David A. Katzka received the 2015 AGA–Covidien (now Medtronic) award, for his ongoing research into a simple, inexpensive technology as a possible alternative to repeat endoscopy and biopsy to monitor therapeutic response in people with eosinophilic esophagitis (EoE).

EoE is thought to result from exposure to food antigens, leading to inflammation and stricture formation. Current treatment recommendations include topical steroids and elimination diets, both of which are effective. However, response to withdrawal or reintroduction of problem foods often needs to be reassessed with repeat endoscopy and biopsy, which is both costly and time consuming.

Dr. Katzka, head of the Esophageal Interest Group at the Mayo Clinic in Rochester, Minn., has been developing the Cytosponge, an easily swallowed encapsulated mesh that expands in the stomach. Upon retrieval (by means of an attached string), the sponge provides a sample of esophageal mucosa. The technology was originally developed as a screening modality for esophageal cancer and Barrett’s esophagus. Unlike with endoscopy, no sedation is required.

A preliminary feasibility study in 20 patients with EoE who underwent both Cytosponge and endoscopic biopsy found good correlation of eosinophils between the two technologies, and a high sensitivity (84%) in diagnosing EoE. Genetic analysis of patient specimens obtained with Cytosponge showed consistency with previous transcriptome data seen on biopsy specimens. Importantly, patients favored the Cytosponge as faster and easier to tolerate than endoscopy.

Dr. Katzka’s research team is now studying a larger patient group to compare the Cytosponge with endoscopic biopsy as a reliable and independent means of monitoring disease activity and response to therapy. Genomic analysis is also being performed on specimens so that as molecular predictors of response to therapy are further developed and become available, these tests may be also be performed – with the idea of limiting or eliminating the need for endoscopy.

Dr. Katzka reported recruitment of 79 EoE patients in addition to the 20 patients from the pilot study. Thirty-five of these patients had active EoE and 44 were in remission. The accuracy of the Cytosponge in comparison to biopsy remained high, with 81% sensitivity and 79% specificity.

Furthermore, five patients were diagnosed with active disease with the Cytosponge who were not diagnosed by biopsy. The endoscopic abrasion scores were all 0 or 1. The procedure was well tolerated, with near universal preference for undergoing the Cytosponge procedure rather than sedated endoscopy. A trial to use the sponge for monitoring diet therapy is underway, with 35 patients currently being recruited.

The study has also expanded to become multicenter, starting with Dr. Evan Dellon at the University of North Carolina, where 15 patients have undergone the procedure with central processing of pathology at the Mayo Clinic.

Announcement of 2016 AGA-Medtronic Research & Development Pilot Award in Technology
The 2016 AGA-Medtronic award winner is Wa Xian, Ph.D., assistant professor at the University of Texas Health Science Center, Houston. In naming Dr. Xian as the awardee, Dr. Michael L. Kochman said that her work proposes to test the hypothesis that inflammatory bowel disease is caused by genetic defects in the intestines’ epithelial barriers to gut microbes. Dr. Xian will build on her previous work of cloning colonic stem cells to test the genetic defect hypothesis, said Dr. Kochman, professor of medicine at Penn Medicine.

Kari Oakes contributed to this report.

BOSTON – Two award-winning researchers have received funding from the AGA Research Foundation to support their research into less invasive diagnostic techniques for GI patient care. The researchers shared updates on their findings at the 2016 AGA Tech Summit, which is sponsored by the AGA Center for GI Innovation and Technology.

Update on AGA-Boston Scientific Career Development Technology & Innovation Award
Guan Xu, Ph.D., of the University of Michigan, Ann Arbor, received the 2015 AGA–Boston Scientific award to support his investigation of an experimental, optically induced ultrasonic imaging technique called photoacoustic imaging, or PAI, in Crohn’s disease.

PAI uses pulsed laser light to penetrate tissues at different depths, allowing researchers to distinguish the absorption spectra indicative of the different chemical compositions seen in inflammatory and fibrous intestinal strictures.

Though a number of experimental modalities are being investigated to characterize intestinal strictures less invasively, tissue biopsy is still considered the only reliable way to determine whether strictures are inflammatory or fibrous. Inflammatory strictures can be treated medically, while collagen-based fibrotic strictures must be removed surgically or treated with endoscopic dilation.

Dr. Xu joined Michigan’s radiology department as a postdoctoral research fellow in 2012 and is now a research investigator there. He previously helped develop a photoacoustic ultrasound imaging system for finger arthritis, designed for use in a clinical setting.

Dr. Xu and colleagues in the radiology, pathology, engineering and internal medicine departments at the University of Michigan are now investigating in animal models whether PAI is as accurate as tissue biopsy in distinguishing the two types of intestinal strictures seen in Crohn’s. They are also designing a capsule PAI device that can be fitted to an endoscope.

The PAI technology builds on and extends the ultrasound technology that is currently the standard of care, explained Dr. Xu, saying “We are standing on the shoulders of giants.”

At the Tech Summit, Dr. Xu presented an update of his research. Preliminary results have revealed significant differences in photoacoustic signal intensity among normal, inflammatory, and fibrotic bowel tissues in rats, and also strong correlations between photoacoustic images and histology in human stricture tissues. A prototype capsule PAI probe has been developed and it will soon be tested on mouse and rabbit models.

In an interview, Dr. Xu expressed “sincere gratitude to the AGA Research Foundation and Boston Scientific for the support of our preliminary study. We will work toward translation of our system to clinics.”

If Dr. Xu and his colleagues’ work is successful, clinicians may one day be able to distinguish between inflammatory and fibrotic intestinal strictures in Crohn’s disease patients without needing to perform endoscopic biopsy. The team’s findings may also prove useful in the preclinical investigation of antifibrotic medical therapies.

Update on AGA-Covidien Research & Development Pilot Award in Technology
Dr. David A. Katzka received the 2015 AGA–Covidien (now Medtronic) award, for his ongoing research into a simple, inexpensive technology as a possible alternative to repeat endoscopy and biopsy to monitor therapeutic response in people with eosinophilic esophagitis (EoE).

EoE is thought to result from exposure to food antigens, leading to inflammation and stricture formation. Current treatment recommendations include topical steroids and elimination diets, both of which are effective. However, response to withdrawal or reintroduction of problem foods often needs to be reassessed with repeat endoscopy and biopsy, which is both costly and time consuming.

Dr. Katzka, head of the Esophageal Interest Group at the Mayo Clinic in Rochester, Minn., has been developing the Cytosponge, an easily swallowed encapsulated mesh that expands in the stomach. Upon retrieval (by means of an attached string), the sponge provides a sample of esophageal mucosa. The technology was originally developed as a screening modality for esophageal cancer and Barrett’s esophagus. Unlike with endoscopy, no sedation is required.

A preliminary feasibility study in 20 patients with EoE who underwent both Cytosponge and endoscopic biopsy found good correlation of eosinophils between the two technologies, and a high sensitivity (84%) in diagnosing EoE. Genetic analysis of patient specimens obtained with Cytosponge showed consistency with previous transcriptome data seen on biopsy specimens. Importantly, patients favored the Cytosponge as faster and easier to tolerate than endoscopy.

Dr. Katzka’s research team is now studying a larger patient group to compare the Cytosponge with endoscopic biopsy as a reliable and independent means of monitoring disease activity and response to therapy. Genomic analysis is also being performed on specimens so that as molecular predictors of response to therapy are further developed and become available, these tests may be also be performed – with the idea of limiting or eliminating the need for endoscopy.

Dr. Katzka reported recruitment of 79 EoE patients in addition to the 20 patients from the pilot study. Thirty-five of these patients had active EoE and 44 were in remission. The accuracy of the Cytosponge in comparison to biopsy remained high, with 81% sensitivity and 79% specificity.

Furthermore, five patients were diagnosed with active disease with the Cytosponge who were not diagnosed by biopsy. The endoscopic abrasion scores were all 0 or 1. The procedure was well tolerated, with near universal preference for undergoing the Cytosponge procedure rather than sedated endoscopy. A trial to use the sponge for monitoring diet therapy is underway, with 35 patients currently being recruited.

The study has also expanded to become multicenter, starting with Dr. Evan Dellon at the University of North Carolina, where 15 patients have undergone the procedure with central processing of pathology at the Mayo Clinic.

Announcement of 2016 AGA-Medtronic Research & Development Pilot Award in Technology
The 2016 AGA-Medtronic award winner is Wa Xian, Ph.D., assistant professor at the University of Texas Health Science Center, Houston. In naming Dr. Xian as the awardee, Dr. Michael L. Kochman said that her work proposes to test the hypothesis that inflammatory bowel disease is caused by genetic defects in the intestines’ epithelial barriers to gut microbes. Dr. Xian will build on her previous work of cloning colonic stem cells to test the genetic defect hypothesis, said Dr. Kochman, professor of medicine at Penn Medicine.

Kari Oakes contributed to this report.

BOSTON – Two award-winning researchers have received funding from the AGA Research Foundation to support their research into less invasive diagnostic techniques for GI patient care. The researchers shared updates on their findings at the 2016 AGA Tech Summit, which is sponsored by the AGA Center for GI Innovation and Technology.

Update on AGA-Boston Scientific Career Development Technology & Innovation Award
Guan Xu, Ph.D., of the University of Michigan, Ann Arbor, received the 2015 AGA–Boston Scientific award to support his investigation of an experimental, optically induced ultrasonic imaging technique called photoacoustic imaging, or PAI, in Crohn’s disease.

PAI uses pulsed laser light to penetrate tissues at different depths, allowing researchers to distinguish the absorption spectra indicative of the different chemical compositions seen in inflammatory and fibrous intestinal strictures.

Though a number of experimental modalities are being investigated to characterize intestinal strictures less invasively, tissue biopsy is still considered the only reliable way to determine whether strictures are inflammatory or fibrous. Inflammatory strictures can be treated medically, while collagen-based fibrotic strictures must be removed surgically or treated with endoscopic dilation.

Dr. Xu joined Michigan’s radiology department as a postdoctoral research fellow in 2012 and is now a research investigator there. He previously helped develop a photoacoustic ultrasound imaging system for finger arthritis, designed for use in a clinical setting.

Dr. Xu and colleagues in the radiology, pathology, engineering and internal medicine departments at the University of Michigan are now investigating in animal models whether PAI is as accurate as tissue biopsy in distinguishing the two types of intestinal strictures seen in Crohn’s. They are also designing a capsule PAI device that can be fitted to an endoscope.

The PAI technology builds on and extends the ultrasound technology that is currently the standard of care, explained Dr. Xu, saying “We are standing on the shoulders of giants.”

At the Tech Summit, Dr. Xu presented an update of his research. Preliminary results have revealed significant differences in photoacoustic signal intensity among normal, inflammatory, and fibrotic bowel tissues in rats, and also strong correlations between photoacoustic images and histology in human stricture tissues. A prototype capsule PAI probe has been developed and it will soon be tested on mouse and rabbit models.

In an interview, Dr. Xu expressed “sincere gratitude to the AGA Research Foundation and Boston Scientific for the support of our preliminary study. We will work toward translation of our system to clinics.”

If Dr. Xu and his colleagues’ work is successful, clinicians may one day be able to distinguish between inflammatory and fibrotic intestinal strictures in Crohn’s disease patients without needing to perform endoscopic biopsy. The team’s findings may also prove useful in the preclinical investigation of antifibrotic medical therapies.

Update on AGA-Covidien Research & Development Pilot Award in Technology
Dr. David A. Katzka received the 2015 AGA–Covidien (now Medtronic) award, for his ongoing research into a simple, inexpensive technology as a possible alternative to repeat endoscopy and biopsy to monitor therapeutic response in people with eosinophilic esophagitis (EoE).

EoE is thought to result from exposure to food antigens, leading to inflammation and stricture formation. Current treatment recommendations include topical steroids and elimination diets, both of which are effective. However, response to withdrawal or reintroduction of problem foods often needs to be reassessed with repeat endoscopy and biopsy, which is both costly and time consuming.

Dr. Katzka, head of the Esophageal Interest Group at the Mayo Clinic in Rochester, Minn., has been developing the Cytosponge, an easily swallowed encapsulated mesh that expands in the stomach. Upon retrieval (by means of an attached string), the sponge provides a sample of esophageal mucosa. The technology was originally developed as a screening modality for esophageal cancer and Barrett’s esophagus. Unlike with endoscopy, no sedation is required.

A preliminary feasibility study in 20 patients with EoE who underwent both Cytosponge and endoscopic biopsy found good correlation of eosinophils between the two technologies, and a high sensitivity (84%) in diagnosing EoE. Genetic analysis of patient specimens obtained with Cytosponge showed consistency with previous transcriptome data seen on biopsy specimens. Importantly, patients favored the Cytosponge as faster and easier to tolerate than endoscopy.

Dr. Katzka’s research team is now studying a larger patient group to compare the Cytosponge with endoscopic biopsy as a reliable and independent means of monitoring disease activity and response to therapy. Genomic analysis is also being performed on specimens so that as molecular predictors of response to therapy are further developed and become available, these tests may be also be performed – with the idea of limiting or eliminating the need for endoscopy.

Dr. Katzka reported recruitment of 79 EoE patients in addition to the 20 patients from the pilot study. Thirty-five of these patients had active EoE and 44 were in remission. The accuracy of the Cytosponge in comparison to biopsy remained high, with 81% sensitivity and 79% specificity.

Furthermore, five patients were diagnosed with active disease with the Cytosponge who were not diagnosed by biopsy. The endoscopic abrasion scores were all 0 or 1. The procedure was well tolerated, with near universal preference for undergoing the Cytosponge procedure rather than sedated endoscopy. A trial to use the sponge for monitoring diet therapy is underway, with 35 patients currently being recruited.

The study has also expanded to become multicenter, starting with Dr. Evan Dellon at the University of North Carolina, where 15 patients have undergone the procedure with central processing of pathology at the Mayo Clinic.

Announcement of 2016 AGA-Medtronic Research & Development Pilot Award in Technology
The 2016 AGA-Medtronic award winner is Wa Xian, Ph.D., assistant professor at the University of Texas Health Science Center, Houston. In naming Dr. Xian as the awardee, Dr. Michael L. Kochman said that her work proposes to test the hypothesis that inflammatory bowel disease is caused by genetic defects in the intestines’ epithelial barriers to gut microbes. Dr. Xian will build on her previous work of cloning colonic stem cells to test the genetic defect hypothesis, said Dr. Kochman, professor of medicine at Penn Medicine.

Kari Oakes contributed to this report.

The prevalence of autism spectrum disorder (ASD) in 8-year-old children in 2012 was estimated to be 14.6 per 1,000, or one in 68, according to the Centers for Disease Control and Prevention.

The estimate, published online March 31 in CDC’s Morbidity and Mortality Weekly Report (Surveill Summ. 2016. Apr 1;65[3]:1-23) is similar to that seen in CDC’s 2010 survey of 8-year-old children, where 14.7 of 1,000 were estimated affected. In CDC surveys prior to 2010, prevalence was usually seen increasing over time, from 6.6 children per 1,000 in 2002 to 9 in 2006 and 11.3 in 2008.

However, the investigators led by Deborah L. Christensen, Ph.D., of the CDC’s National Center on Birth Defects and Disabilities, Atlanta, cautioned that it was premature to conclude that overall prevalence of ASD was stabilizing, in part because of significant variation seen among the 11 study sites and because of potential underevaluation or delayed evaluation among some ethnic and racial subgroups. Also, prevalence was significantly higher at surveillance sites where both education and health records were reviewed (17.1 per 1,000), compared with sites where investigators reviewed health records only (10.7 per 1,000).

The CDC’s Autism and Developmental Disabilities Monitoring Network screens children in 11 states (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin) using health care and education sources to determine rates of ASD. The network surveillance area covered about 350,000 8-year-old children (53% white, 21% black, 20% Hispanic, 5% Asian, and 1% American Indian/Alaska Native) in 2012. Prevalence was markedly higher among boys (23.6 per 1,000, or 1 in 42) than among girls (5.3 per 1,000, or 1 in 189), a difference largely unchanged from previous studies.

ASD prevalence by ethnic or racial subgroup also did not change significantly over prior surveys, the investigators reported. However, lower estimates among black and Hispanic children could reflect “differences in awareness of ASD or access to specialty diagnostic services,” they wrote. Fewer black and Hispanic children in the survey had a comprehensive developmental evaluation by age 36 months (40% and 39%, respectively), compared with non-Hispanic white children (45%), which investigators called worrisome, as “early treatment might maximize the ability of children to function and participate in their community.”

Moreover, prevalence was seen increasing significantly over the previous survey in two states (New Jersey and Wisconsin), and decreasing significantly in one state (Missouri). Investigators suspected that variation in local health care systems’ ability to obtain comprehensive developmental evaluations might be a factor.

The wide range of ASD prevalence estimates, the investigators wrote, demands “caution in interpreting the similarity of overall estimated ASD prevalence between 2010 and 2012.”

The CDC funded the study and investigators disclosed no conflicts of interest.

The prevalence of autism spectrum disorder (ASD) in 8-year-old children in 2012 was estimated to be 14.6 per 1,000, or one in 68, according to the Centers for Disease Control and Prevention.

The estimate, published online March 31 in CDC’s Morbidity and Mortality Weekly Report (Surveill Summ. 2016. Apr 1;65[3]:1-23) is similar to that seen in CDC’s 2010 survey of 8-year-old children, where 14.7 of 1,000 were estimated affected. In CDC surveys prior to 2010, prevalence was usually seen increasing over time, from 6.6 children per 1,000 in 2002 to 9 in 2006 and 11.3 in 2008.

However, the investigators led by Deborah L. Christensen, Ph.D., of the CDC’s National Center on Birth Defects and Disabilities, Atlanta, cautioned that it was premature to conclude that overall prevalence of ASD was stabilizing, in part because of significant variation seen among the 11 study sites and because of potential underevaluation or delayed evaluation among some ethnic and racial subgroups. Also, prevalence was significantly higher at surveillance sites where both education and health records were reviewed (17.1 per 1,000), compared with sites where investigators reviewed health records only (10.7 per 1,000).

The CDC’s Autism and Developmental Disabilities Monitoring Network screens children in 11 states (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin) using health care and education sources to determine rates of ASD. The network surveillance area covered about 350,000 8-year-old children (53% white, 21% black, 20% Hispanic, 5% Asian, and 1% American Indian/Alaska Native) in 2012. Prevalence was markedly higher among boys (23.6 per 1,000, or 1 in 42) than among girls (5.3 per 1,000, or 1 in 189), a difference largely unchanged from previous studies.

ASD prevalence by ethnic or racial subgroup also did not change significantly over prior surveys, the investigators reported. However, lower estimates among black and Hispanic children could reflect “differences in awareness of ASD or access to specialty diagnostic services,” they wrote. Fewer black and Hispanic children in the survey had a comprehensive developmental evaluation by age 36 months (40% and 39%, respectively), compared with non-Hispanic white children (45%), which investigators called worrisome, as “early treatment might maximize the ability of children to function and participate in their community.”

Moreover, prevalence was seen increasing significantly over the previous survey in two states (New Jersey and Wisconsin), and decreasing significantly in one state (Missouri). Investigators suspected that variation in local health care systems’ ability to obtain comprehensive developmental evaluations might be a factor.

The wide range of ASD prevalence estimates, the investigators wrote, demands “caution in interpreting the similarity of overall estimated ASD prevalence between 2010 and 2012.”

The CDC funded the study and investigators disclosed no conflicts of interest.

The prevalence of autism spectrum disorder (ASD) in 8-year-old children in 2012 was estimated to be 14.6 per 1,000, or one in 68, according to the Centers for Disease Control and Prevention.

The estimate, published online March 31 in CDC’s Morbidity and Mortality Weekly Report (Surveill Summ. 2016. Apr 1;65[3]:1-23) is similar to that seen in CDC’s 2010 survey of 8-year-old children, where 14.7 of 1,000 were estimated affected. In CDC surveys prior to 2010, prevalence was usually seen increasing over time, from 6.6 children per 1,000 in 2002 to 9 in 2006 and 11.3 in 2008.

However, the investigators led by Deborah L. Christensen, Ph.D., of the CDC’s National Center on Birth Defects and Disabilities, Atlanta, cautioned that it was premature to conclude that overall prevalence of ASD was stabilizing, in part because of significant variation seen among the 11 study sites and because of potential underevaluation or delayed evaluation among some ethnic and racial subgroups. Also, prevalence was significantly higher at surveillance sites where both education and health records were reviewed (17.1 per 1,000), compared with sites where investigators reviewed health records only (10.7 per 1,000).

The CDC’s Autism and Developmental Disabilities Monitoring Network screens children in 11 states (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin) using health care and education sources to determine rates of ASD. The network surveillance area covered about 350,000 8-year-old children (53% white, 21% black, 20% Hispanic, 5% Asian, and 1% American Indian/Alaska Native) in 2012. Prevalence was markedly higher among boys (23.6 per 1,000, or 1 in 42) than among girls (5.3 per 1,000, or 1 in 189), a difference largely unchanged from previous studies.

ASD prevalence by ethnic or racial subgroup also did not change significantly over prior surveys, the investigators reported. However, lower estimates among black and Hispanic children could reflect “differences in awareness of ASD or access to specialty diagnostic services,” they wrote. Fewer black and Hispanic children in the survey had a comprehensive developmental evaluation by age 36 months (40% and 39%, respectively), compared with non-Hispanic white children (45%), which investigators called worrisome, as “early treatment might maximize the ability of children to function and participate in their community.”

Moreover, prevalence was seen increasing significantly over the previous survey in two states (New Jersey and Wisconsin), and decreasing significantly in one state (Missouri). Investigators suspected that variation in local health care systems’ ability to obtain comprehensive developmental evaluations might be a factor.

The wide range of ASD prevalence estimates, the investigators wrote, demands “caution in interpreting the similarity of overall estimated ASD prevalence between 2010 and 2012.”

The CDC funded the study and investigators disclosed no conflicts of interest.

A course of antenatal corticosteroids can reduce mortality by about half in neonates born before 24 weeks, according to findings from a recent meta-analysis.

Previous studies have established that antenatal corticosteroids, used to hasten development of the lungs and therefore improve chances of survival, are helpful when given to women at high risk of preterm delivery between 24 and 34 weeks of gestation. However, little evidence has been available to recommend their use when risk of preterm delivery became evident before 24 weeks.

herjua/ThinkstockPhotos

In the current meta-analysis, Christina Park, of McMaster University in Hamilton, Ontario, and her colleagues, reviewed data from observational studies published between 2002 and 2011 that included more than 3,600 neonates born before 24 weeks (Obstet Gynecol. 2016 Mar 7;127:715-25).

The researchers found that the odds of in-hospital mortality – the primary outcome of the study – were 52% less in those neonates that had been treated with antenatal corticosteroids (58.1% compared with 71.8%; adjusted odds ratio, 0.48), a difference that reached statistical significance. They graded the evidence in these studies as being of “moderate” quality.

A subgroup analysis comparing outcomes for neonates at 22 and 23 weeks of gestation found no difference in terms of in-hospital mortality.

Secondary outcomes such as respiratory distress syndrome and other diseases associated with preterm birth did not reach statistical significance. This finding was surprising, the researchers noted, because they had expected a reduction in morbidities would accompany lowered mortality. However, a misdiagnosis of respiratory distress syndrome may have occurred in the included studies, they wrote.

Antenatal corticosteroids may help reduce mortality in neonates delivered before 24 weeks and clinicians should consider them for women at this gestational point who would choose postnatal resuscitation. “Family counseling and planning of services are essential for these births,” they wrote, “because advances in care have opened the possibility of survival at progressively early gestations.”

Two of the researchers reported receiving grants from the Canadian Institutes of Health. They reported having no other financial disclosures.

A course of antenatal corticosteroids can reduce mortality by about half in neonates born before 24 weeks, according to findings from a recent meta-analysis.

Previous studies have established that antenatal corticosteroids, used to hasten development of the lungs and therefore improve chances of survival, are helpful when given to women at high risk of preterm delivery between 24 and 34 weeks of gestation. However, little evidence has been available to recommend their use when risk of preterm delivery became evident before 24 weeks.

herjua/ThinkstockPhotos

In the current meta-analysis, Christina Park, of McMaster University in Hamilton, Ontario, and her colleagues, reviewed data from observational studies published between 2002 and 2011 that included more than 3,600 neonates born before 24 weeks (Obstet Gynecol. 2016 Mar 7;127:715-25).

The researchers found that the odds of in-hospital mortality – the primary outcome of the study – were 52% less in those neonates that had been treated with antenatal corticosteroids (58.1% compared with 71.8%; adjusted odds ratio, 0.48), a difference that reached statistical significance. They graded the evidence in these studies as being of “moderate” quality.

A subgroup analysis comparing outcomes for neonates at 22 and 23 weeks of gestation found no difference in terms of in-hospital mortality.

Secondary outcomes such as respiratory distress syndrome and other diseases associated with preterm birth did not reach statistical significance. This finding was surprising, the researchers noted, because they had expected a reduction in morbidities would accompany lowered mortality. However, a misdiagnosis of respiratory distress syndrome may have occurred in the included studies, they wrote.

Antenatal corticosteroids may help reduce mortality in neonates delivered before 24 weeks and clinicians should consider them for women at this gestational point who would choose postnatal resuscitation. “Family counseling and planning of services are essential for these births,” they wrote, “because advances in care have opened the possibility of survival at progressively early gestations.”

Two of the researchers reported receiving grants from the Canadian Institutes of Health. They reported having no other financial disclosures.

A course of antenatal corticosteroids can reduce mortality by about half in neonates born before 24 weeks, according to findings from a recent meta-analysis.

Previous studies have established that antenatal corticosteroids, used to hasten development of the lungs and therefore improve chances of survival, are helpful when given to women at high risk of preterm delivery between 24 and 34 weeks of gestation. However, little evidence has been available to recommend their use when risk of preterm delivery became evident before 24 weeks.

herjua/ThinkstockPhotos

In the current meta-analysis, Christina Park, of McMaster University in Hamilton, Ontario, and her colleagues, reviewed data from observational studies published between 2002 and 2011 that included more than 3,600 neonates born before 24 weeks (Obstet Gynecol. 2016 Mar 7;127:715-25).

The researchers found that the odds of in-hospital mortality – the primary outcome of the study – were 52% less in those neonates that had been treated with antenatal corticosteroids (58.1% compared with 71.8%; adjusted odds ratio, 0.48), a difference that reached statistical significance. They graded the evidence in these studies as being of “moderate” quality.

A subgroup analysis comparing outcomes for neonates at 22 and 23 weeks of gestation found no difference in terms of in-hospital mortality.

Secondary outcomes such as respiratory distress syndrome and other diseases associated with preterm birth did not reach statistical significance. This finding was surprising, the researchers noted, because they had expected a reduction in morbidities would accompany lowered mortality. However, a misdiagnosis of respiratory distress syndrome may have occurred in the included studies, they wrote.

Antenatal corticosteroids may help reduce mortality in neonates delivered before 24 weeks and clinicians should consider them for women at this gestational point who would choose postnatal resuscitation. “Family counseling and planning of services are essential for these births,” they wrote, “because advances in care have opened the possibility of survival at progressively early gestations.”

Two of the researchers reported receiving grants from the Canadian Institutes of Health. They reported having no other financial disclosures.

Women undergoing vaginal hysterectomy are more likely to receive cold-knife morcellation if they have an enlarged uterus, leiomyoma, or no prolapse, according to new research.

Electromechanical morcellation, a technique used during laparoscopic hysterectomy to cut the uterus into small pieces for removal, has come under heavy scrutiny in recent years due to risk of disseminating undiagnosed uterine cancers. However, morcellation can also be performed manually during a vaginal hysterectomy. While current recommendations stress caution for all types of morcellation, the risks and prognostic factors for cold-knife morcellation are poorly understood.

©monkeybusinessimages/Thinkstock

In a retrospective cohort study, Dr. Megan Wasson, of the Mayo Clinic Arizona in Phoenix, and her colleagues examined a cohort of 743 women who underwent hysterectomy with either intact uterine removal (383 women) or with cold-knife morcellation (360 women).

Dr. Wasson and her colleagues found that women were significantly more likely to undergo morcellation, compared with intact uterine removal if they had larger uterine weight (adjusted odds ratio, 7.25; P less than .001), lack of prolapse (aOR, 3.87; P less than .001), or the presence of leiomyoma (aOR, 2.77, P = .035).

Women with prior vaginal delivery were significantly less likely to receive morcellation (aOR, 0.79, P = .005).

Younger age, lower parity, and nonwhite race were also associated with a higher likelihood of undergoing morcellation (Obstet Gynecol. 2016;127:752–7).

“This study identified prognostic factors associated with an increased likelihood of morcellation required at the time of vaginal hysterectomy,” Dr. Wasson and her colleagues wrote, stressing that higher uterine weight was the strongest predictor. “The ability to preoperatively predict uterine weight and size is essential for surgical planning given that a large uterus is most predictive of needing morcellation at the time of vaginal hysterectomy.”

The findings, they wrote, may help clinicians identify those patients who need additional counseling about the potential risks of morcellation, as well as patients who may need to avoid vaginal hysterectomy to negate the risks of morcellation.

The investigators identified limitations to their study, including that the majority of the women (88%) were white, and that candidates for vaginal hysterectomy were carefully chosen by expert surgeons, leading to likely selection bias.

The investigators reported having no financial disclosures.

Women undergoing vaginal hysterectomy are more likely to receive cold-knife morcellation if they have an enlarged uterus, leiomyoma, or no prolapse, according to new research.

Electromechanical morcellation, a technique used during laparoscopic hysterectomy to cut the uterus into small pieces for removal, has come under heavy scrutiny in recent years due to risk of disseminating undiagnosed uterine cancers. However, morcellation can also be performed manually during a vaginal hysterectomy. While current recommendations stress caution for all types of morcellation, the risks and prognostic factors for cold-knife morcellation are poorly understood.

©monkeybusinessimages/Thinkstock

In a retrospective cohort study, Dr. Megan Wasson, of the Mayo Clinic Arizona in Phoenix, and her colleagues examined a cohort of 743 women who underwent hysterectomy with either intact uterine removal (383 women) or with cold-knife morcellation (360 women).

Dr. Wasson and her colleagues found that women were significantly more likely to undergo morcellation, compared with intact uterine removal if they had larger uterine weight (adjusted odds ratio, 7.25; P less than .001), lack of prolapse (aOR, 3.87; P less than .001), or the presence of leiomyoma (aOR, 2.77, P = .035).

Women with prior vaginal delivery were significantly less likely to receive morcellation (aOR, 0.79, P = .005).

Younger age, lower parity, and nonwhite race were also associated with a higher likelihood of undergoing morcellation (Obstet Gynecol. 2016;127:752–7).

“This study identified prognostic factors associated with an increased likelihood of morcellation required at the time of vaginal hysterectomy,” Dr. Wasson and her colleagues wrote, stressing that higher uterine weight was the strongest predictor. “The ability to preoperatively predict uterine weight and size is essential for surgical planning given that a large uterus is most predictive of needing morcellation at the time of vaginal hysterectomy.”

The findings, they wrote, may help clinicians identify those patients who need additional counseling about the potential risks of morcellation, as well as patients who may need to avoid vaginal hysterectomy to negate the risks of morcellation.

The investigators identified limitations to their study, including that the majority of the women (88%) were white, and that candidates for vaginal hysterectomy were carefully chosen by expert surgeons, leading to likely selection bias.

The investigators reported having no financial disclosures.

Women undergoing vaginal hysterectomy are more likely to receive cold-knife morcellation if they have an enlarged uterus, leiomyoma, or no prolapse, according to new research.

Electromechanical morcellation, a technique used during laparoscopic hysterectomy to cut the uterus into small pieces for removal, has come under heavy scrutiny in recent years due to risk of disseminating undiagnosed uterine cancers. However, morcellation can also be performed manually during a vaginal hysterectomy. While current recommendations stress caution for all types of morcellation, the risks and prognostic factors for cold-knife morcellation are poorly understood.

©monkeybusinessimages/Thinkstock

In a retrospective cohort study, Dr. Megan Wasson, of the Mayo Clinic Arizona in Phoenix, and her colleagues examined a cohort of 743 women who underwent hysterectomy with either intact uterine removal (383 women) or with cold-knife morcellation (360 women).

Dr. Wasson and her colleagues found that women were significantly more likely to undergo morcellation, compared with intact uterine removal if they had larger uterine weight (adjusted odds ratio, 7.25; P less than .001), lack of prolapse (aOR, 3.87; P less than .001), or the presence of leiomyoma (aOR, 2.77, P = .035).

Women with prior vaginal delivery were significantly less likely to receive morcellation (aOR, 0.79, P = .005).

Younger age, lower parity, and nonwhite race were also associated with a higher likelihood of undergoing morcellation (Obstet Gynecol. 2016;127:752–7).

“This study identified prognostic factors associated with an increased likelihood of morcellation required at the time of vaginal hysterectomy,” Dr. Wasson and her colleagues wrote, stressing that higher uterine weight was the strongest predictor. “The ability to preoperatively predict uterine weight and size is essential for surgical planning given that a large uterus is most predictive of needing morcellation at the time of vaginal hysterectomy.”

The findings, they wrote, may help clinicians identify those patients who need additional counseling about the potential risks of morcellation, as well as patients who may need to avoid vaginal hysterectomy to negate the risks of morcellation.

The investigators identified limitations to their study, including that the majority of the women (88%) were white, and that candidates for vaginal hysterectomy were carefully chosen by expert surgeons, leading to likely selection bias.

The investigators reported having no financial disclosures.

Newborns delivered by cesarean section have different microbial colonization patterns than babies delivered vaginally, and several studies have suggested that their immunologic and metabolic development may be disadvantaged as a result.

Preliminary results from a recent proof-of concept study in 18 babies, published online in Nature Medicine, showed that transferring vaginal fluid to newborns shortly after delivery by C-section resulted in microbiome profiles resembling those of babies delivered vaginally (doi: 10.1038/nm.4039).

Martin Valigursky/Thinkstock

But it is still unknown whether promoting colonization in this way approximates the microbial transfer that occurs during labor, or whether it affects later health outcomes in these infants. The researchers, led by Maria G. Dominguez-Bello, Ph.D., of New York University in New York City, stressed in their study that considerably more time and research are needed to answer these questions.

Still, as the practice gains more attention in the press and in parenting blogs, patients are asking clinicians to perform vaginal fluid transfer or “vaginal seeding” following C-sections.

BMJ highlights concerns

A Feb. 23 editorial in the BMJ stressed that clinicians not recommend vaginal seeding, because of insufficient evidence and because of the potential for unrecognized infections to be transmitted from mother to newborn (BMJ. 2016;352:i227. doi: 10.1136/bmj.i227).

“It might seem reasonable to perform this simple and cheap procedure, even without clear evidence of benefit, but only if we can be sure that it is safe,” wrote a group of clinicians led by Dr. Aubrey J. Cunnington of Imperial College London. For now, they wrote, breastfeeding and avoidance of unnecessary antibiotics should be stressed to promote early microbiome development.

But even if clinicians and hospitals refuse to perform seeding – which can be done by placing gauze in the vagina prior to delivery and then using it to swab the newborn – “mothers can easily do it themselves,” Dr. Cunnington and colleagues said in their editorial.

The potential demand for vaginal seeding raises a host of issues, according to three U.S.-based ob.gyns., all of whom said they agree with the caution expressed in the BMJ editorial, but have varying approaches to how to advise their patients.

“From a clinician’s point of view, I think it’s really important to not wait for a woman to say, ‘Should I do this?’ but instead for doctors to proactively say, ‘You may have read about this and we don’t recommend it,’ ” Dr. Lauren Streicher,of Northwestern University, Chicago, said in an interview.

“The real concern is that since you don’t need a doctor to do it, mothers are going to take it upon themselves,” Dr. Streicher said, particularly as the practice gains more attention in the lay press, or if vaginal seeding gets endorsed or promoted by someone famous, something she said is all but inevitable.

Patients need to be aware that there are risks inherent in either mode of delivery, Dr. Streicher noted, and vaginal delivery comes with the risk of transmitting undiagnosed group B streptococcus, chlamydia, gonorrhea, or herpes viruses.

Dr. Layne Kumetz, an ob.gyn. in Beverly Hills, Calif., said in an interview that her patients tend to be educated and “early adopters” when it comes to medical trends. She said she has already received patient queries about vaginal seeding and counseled patients on the potential risks. As a mother herself, she has also noticed active discussion about vaginal seeding on parenting blogs.

But Dr. Kumetz said that pending much more study, “routine practicing of the procedure is simply not appropriate.”

She added, “The long term implications about whether this will alter the health of newborns have not been determined, whether this is a safe procedure has not been determined, [and] what the proper protocol should be in terms of women wishing to have this procedure performed has not been determined.”

The women in the pilot study who had used vaginal seeding, Dr. Kumetz noted, had been carefully selected and screened, had been treated with antibiotics prior to their C-sections, and were group B strep negative. In the general population, meanwhile, nearly a third of patients are group B positive, she said.

Dr. Kumetz said she would not bring up the seeding with patients who don’t ask, nor was it something that the hospitals she’s working with are willing to perform.

Emphasize alternatives

Dr. Eliza Bennett of the University of Wisconsin–Madison said that requests for vaginal seeding had become more frequent, even months before the pilot study was published. The procedure is allowed at her hospital, but is available only by request.

Dr. Bennett stressed that she, like Dr. Kumetz, does not discuss the practice with patients unless they bring it up themselves. For women who do request it, nurses have been trained in the practice, she said, and “we have established really strict exclusion criteria,” including repeat screening for group B strep, HIV, genital herpes, and sexually transmitted infections during pregnancy.

Dr. Bennett said she would much rather emphasize the safer, evidence-based practices already in place at her hospital to promote microbiome development in C-section newborns. These include delaying the first bath until after 12 hours, placing babies directly on mothers’ skin in the operating room in the first minutes post delivery, and “offering the ability for moms to breastfeed right in the OR,” she said.

Like Dr. Streicher and Dr. Kumetz, Dr. Bennett said she’s not expecting to see data resolving the questions about the risks and benefits of vaginal seeding anytime soon.

“Instead of focusing on vaginal seeding, we should continue to focus our efforts on decreasing cesarean delivery rates and ensuring and encouraging appropriate candidates to have the opportunity to have a trial of labor after cesarean delivery,” she said.

Avoiding C-section, she added, “confers multiple maternal and fetal benefits beyond the microbiome.”

Newborns delivered by cesarean section have different microbial colonization patterns than babies delivered vaginally, and several studies have suggested that their immunologic and metabolic development may be disadvantaged as a result.

Preliminary results from a recent proof-of concept study in 18 babies, published online in Nature Medicine, showed that transferring vaginal fluid to newborns shortly after delivery by C-section resulted in microbiome profiles resembling those of babies delivered vaginally (doi: 10.1038/nm.4039).

Martin Valigursky/Thinkstock

But it is still unknown whether promoting colonization in this way approximates the microbial transfer that occurs during labor, or whether it affects later health outcomes in these infants. The researchers, led by Maria G. Dominguez-Bello, Ph.D., of New York University in New York City, stressed in their study that considerably more time and research are needed to answer these questions.

Still, as the practice gains more attention in the press and in parenting blogs, patients are asking clinicians to perform vaginal fluid transfer or “vaginal seeding” following C-sections.

BMJ highlights concerns

A Feb. 23 editorial in the BMJ stressed that clinicians not recommend vaginal seeding, because of insufficient evidence and because of the potential for unrecognized infections to be transmitted from mother to newborn (BMJ. 2016;352:i227. doi: 10.1136/bmj.i227).

“It might seem reasonable to perform this simple and cheap procedure, even without clear evidence of benefit, but only if we can be sure that it is safe,” wrote a group of clinicians led by Dr. Aubrey J. Cunnington of Imperial College London. For now, they wrote, breastfeeding and avoidance of unnecessary antibiotics should be stressed to promote early microbiome development.

But even if clinicians and hospitals refuse to perform seeding – which can be done by placing gauze in the vagina prior to delivery and then using it to swab the newborn – “mothers can easily do it themselves,” Dr. Cunnington and colleagues said in their editorial.

The potential demand for vaginal seeding raises a host of issues, according to three U.S.-based ob.gyns., all of whom said they agree with the caution expressed in the BMJ editorial, but have varying approaches to how to advise their patients.

“From a clinician’s point of view, I think it’s really important to not wait for a woman to say, ‘Should I do this?’ but instead for doctors to proactively say, ‘You may have read about this and we don’t recommend it,’ ” Dr. Lauren Streicher,of Northwestern University, Chicago, said in an interview.

“The real concern is that since you don’t need a doctor to do it, mothers are going to take it upon themselves,” Dr. Streicher said, particularly as the practice gains more attention in the lay press, or if vaginal seeding gets endorsed or promoted by someone famous, something she said is all but inevitable.

Patients need to be aware that there are risks inherent in either mode of delivery, Dr. Streicher noted, and vaginal delivery comes with the risk of transmitting undiagnosed group B streptococcus, chlamydia, gonorrhea, or herpes viruses.

Dr. Layne Kumetz, an ob.gyn. in Beverly Hills, Calif., said in an interview that her patients tend to be educated and “early adopters” when it comes to medical trends. She said she has already received patient queries about vaginal seeding and counseled patients on the potential risks. As a mother herself, she has also noticed active discussion about vaginal seeding on parenting blogs.

But Dr. Kumetz said that pending much more study, “routine practicing of the procedure is simply not appropriate.”

She added, “The long term implications about whether this will alter the health of newborns have not been determined, whether this is a safe procedure has not been determined, [and] what the proper protocol should be in terms of women wishing to have this procedure performed has not been determined.”

The women in the pilot study who had used vaginal seeding, Dr. Kumetz noted, had been carefully selected and screened, had been treated with antibiotics prior to their C-sections, and were group B strep negative. In the general population, meanwhile, nearly a third of patients are group B positive, she said.

Dr. Kumetz said she would not bring up the seeding with patients who don’t ask, nor was it something that the hospitals she’s working with are willing to perform.

Emphasize alternatives

Dr. Eliza Bennett of the University of Wisconsin–Madison said that requests for vaginal seeding had become more frequent, even months before the pilot study was published. The procedure is allowed at her hospital, but is available only by request.

Dr. Bennett stressed that she, like Dr. Kumetz, does not discuss the practice with patients unless they bring it up themselves. For women who do request it, nurses have been trained in the practice, she said, and “we have established really strict exclusion criteria,” including repeat screening for group B strep, HIV, genital herpes, and sexually transmitted infections during pregnancy.

Dr. Bennett said she would much rather emphasize the safer, evidence-based practices already in place at her hospital to promote microbiome development in C-section newborns. These include delaying the first bath until after 12 hours, placing babies directly on mothers’ skin in the operating room in the first minutes post delivery, and “offering the ability for moms to breastfeed right in the OR,” she said.

Like Dr. Streicher and Dr. Kumetz, Dr. Bennett said she’s not expecting to see data resolving the questions about the risks and benefits of vaginal seeding anytime soon.

“Instead of focusing on vaginal seeding, we should continue to focus our efforts on decreasing cesarean delivery rates and ensuring and encouraging appropriate candidates to have the opportunity to have a trial of labor after cesarean delivery,” she said.

Avoiding C-section, she added, “confers multiple maternal and fetal benefits beyond the microbiome.”

Newborns delivered by cesarean section have different microbial colonization patterns than babies delivered vaginally, and several studies have suggested that their immunologic and metabolic development may be disadvantaged as a result.

Preliminary results from a recent proof-of concept study in 18 babies, published online in Nature Medicine, showed that transferring vaginal fluid to newborns shortly after delivery by C-section resulted in microbiome profiles resembling those of babies delivered vaginally (doi: 10.1038/nm.4039).

Martin Valigursky/Thinkstock

But it is still unknown whether promoting colonization in this way approximates the microbial transfer that occurs during labor, or whether it affects later health outcomes in these infants. The researchers, led by Maria G. Dominguez-Bello, Ph.D., of New York University in New York City, stressed in their study that considerably more time and research are needed to answer these questions.

Still, as the practice gains more attention in the press and in parenting blogs, patients are asking clinicians to perform vaginal fluid transfer or “vaginal seeding” following C-sections.

BMJ highlights concerns

A Feb. 23 editorial in the BMJ stressed that clinicians not recommend vaginal seeding, because of insufficient evidence and because of the potential for unrecognized infections to be transmitted from mother to newborn (BMJ. 2016;352:i227. doi: 10.1136/bmj.i227).

“It might seem reasonable to perform this simple and cheap procedure, even without clear evidence of benefit, but only if we can be sure that it is safe,” wrote a group of clinicians led by Dr. Aubrey J. Cunnington of Imperial College London. For now, they wrote, breastfeeding and avoidance of unnecessary antibiotics should be stressed to promote early microbiome development.

But even if clinicians and hospitals refuse to perform seeding – which can be done by placing gauze in the vagina prior to delivery and then using it to swab the newborn – “mothers can easily do it themselves,” Dr. Cunnington and colleagues said in their editorial.

The potential demand for vaginal seeding raises a host of issues, according to three U.S.-based ob.gyns., all of whom said they agree with the caution expressed in the BMJ editorial, but have varying approaches to how to advise their patients.

“From a clinician’s point of view, I think it’s really important to not wait for a woman to say, ‘Should I do this?’ but instead for doctors to proactively say, ‘You may have read about this and we don’t recommend it,’ ” Dr. Lauren Streicher,of Northwestern University, Chicago, said in an interview.

“The real concern is that since you don’t need a doctor to do it, mothers are going to take it upon themselves,” Dr. Streicher said, particularly as the practice gains more attention in the lay press, or if vaginal seeding gets endorsed or promoted by someone famous, something she said is all but inevitable.

Patients need to be aware that there are risks inherent in either mode of delivery, Dr. Streicher noted, and vaginal delivery comes with the risk of transmitting undiagnosed group B streptococcus, chlamydia, gonorrhea, or herpes viruses.

Dr. Layne Kumetz, an ob.gyn. in Beverly Hills, Calif., said in an interview that her patients tend to be educated and “early adopters” when it comes to medical trends. She said she has already received patient queries about vaginal seeding and counseled patients on the potential risks. As a mother herself, she has also noticed active discussion about vaginal seeding on parenting blogs.

But Dr. Kumetz said that pending much more study, “routine practicing of the procedure is simply not appropriate.”

She added, “The long term implications about whether this will alter the health of newborns have not been determined, whether this is a safe procedure has not been determined, [and] what the proper protocol should be in terms of women wishing to have this procedure performed has not been determined.”

The women in the pilot study who had used vaginal seeding, Dr. Kumetz noted, had been carefully selected and screened, had been treated with antibiotics prior to their C-sections, and were group B strep negative. In the general population, meanwhile, nearly a third of patients are group B positive, she said.

Dr. Kumetz said she would not bring up the seeding with patients who don’t ask, nor was it something that the hospitals she’s working with are willing to perform.

Emphasize alternatives

Dr. Eliza Bennett of the University of Wisconsin–Madison said that requests for vaginal seeding had become more frequent, even months before the pilot study was published. The procedure is allowed at her hospital, but is available only by request.

Dr. Bennett stressed that she, like Dr. Kumetz, does not discuss the practice with patients unless they bring it up themselves. For women who do request it, nurses have been trained in the practice, she said, and “we have established really strict exclusion criteria,” including repeat screening for group B strep, HIV, genital herpes, and sexually transmitted infections during pregnancy.

Dr. Bennett said she would much rather emphasize the safer, evidence-based practices already in place at her hospital to promote microbiome development in C-section newborns. These include delaying the first bath until after 12 hours, placing babies directly on mothers’ skin in the operating room in the first minutes post delivery, and “offering the ability for moms to breastfeed right in the OR,” she said.

Like Dr. Streicher and Dr. Kumetz, Dr. Bennett said she’s not expecting to see data resolving the questions about the risks and benefits of vaginal seeding anytime soon.

“Instead of focusing on vaginal seeding, we should continue to focus our efforts on decreasing cesarean delivery rates and ensuring and encouraging appropriate candidates to have the opportunity to have a trial of labor after cesarean delivery,” she said.

Avoiding C-section, she added, “confers multiple maternal and fetal benefits beyond the microbiome.”

Serological evidence from French Polynesia links an outbreak of Zika virus to a spike in cases of Guillain-Barré syndrome seen there in 2013-2014.

The research, published online Feb. 29 in The Lancet, is the first to use a case-control design to demonstrate that Zika, a mosquito-borne flavivirus, is associated with Guillain-Barré syndrome (Lancet. 2016 Feb 29. doi: 10.1016/S0140-6736(16)00562-6).

Guillain-Barré syndrome (GBS) is an immune-mediated flaccid paralysis that can follow viral or bacterial infections. Most patients with GBS recover with intensive care in hospitals, although the syndrome can be permanently debilitating or, in rare cases, fatal.

Courtesy Wikimedia Commons/Muhammad Mahdi Karim/Creative Commons License

As a large outbreak of Zika continues in Central and South America, hospitals should be prepared for excess GBS cases, the authors of the study say, and assure adequate intensive-care capacity to treat them. Based on the 66% attack rate of Zika during the French Polynesia outbreak, investigators estimated the incidence of GBS at 0.24 per 1,000 Zika infections, but noted that it could be different in the current outbreak.

Dr. Van-Mai Cao-Lormeau of the Unit of Emerging Infectious Diseases at Institut Louis Malardé in Papeete, French Polynesia, alongside colleagues in France and French Polynesia, used a case-control design to compare serological samples from 42 patients (74% male) diagnosed at a Tahiti hospital with GBS with samples from age-and sex-matched patients who presented at the same hospital, also during the time of the outbreak, with a nonfebrile illness (n = 98) or with acute Zika disease without neurological symptoms (n = 70).

The investigators found that all but one patient with GBS had Zika virus antibodies, and all of them had neutralizing antibodies to Zika virus. By comparison, only 56% (n = 54) of the control group admitted with nonfebrile illness had neutralizing antibodies (P less than .0001).

Also, 93% of the GBS patients had Zika virus immunoglobulin M (IgM) and 88% reported symptoms consistent with Zika infection a mean of 6 days before onset of neurological symptoms. Acute Zika infection is usually characterized by rash, fever, and conjunctivitis.

Past dengue virus infection, which had been considered a possible risk factor for Zika-mediated GBS, did not differ significantly between patients in the control groups and those with GBS.

The investigators were also able to subtype the clinical characteristics of the GBS cases as consistent with acute motor axonal neuropathy, or AMAN, phenotype. However, the antibodies typically seen associated with AMAN were not seen in these patients, leading investigators to suspect that a different biological pathway was responsible.

More than a third of the GBS patients in the study required intensive care, most of these also with respiratory support, though none died.

The government of France, the European Union, and the Wellcome Trust funded the study. The researchers declared that they had no competing interests.

Serological evidence from French Polynesia links an outbreak of Zika virus to a spike in cases of Guillain-Barré syndrome seen there in 2013-2014.

The research, published online Feb. 29 in The Lancet, is the first to use a case-control design to demonstrate that Zika, a mosquito-borne flavivirus, is associated with Guillain-Barré syndrome (Lancet. 2016 Feb 29. doi: 10.1016/S0140-6736(16)00562-6).

Guillain-Barré syndrome (GBS) is an immune-mediated flaccid paralysis that can follow viral or bacterial infections. Most patients with GBS recover with intensive care in hospitals, although the syndrome can be permanently debilitating or, in rare cases, fatal.

Courtesy Wikimedia Commons/Muhammad Mahdi Karim/Creative Commons License

As a large outbreak of Zika continues in Central and South America, hospitals should be prepared for excess GBS cases, the authors of the study say, and assure adequate intensive-care capacity to treat them. Based on the 66% attack rate of Zika during the French Polynesia outbreak, investigators estimated the incidence of GBS at 0.24 per 1,000 Zika infections, but noted that it could be different in the current outbreak.

Dr. Van-Mai Cao-Lormeau of the Unit of Emerging Infectious Diseases at Institut Louis Malardé in Papeete, French Polynesia, alongside colleagues in France and French Polynesia, used a case-control design to compare serological samples from 42 patients (74% male) diagnosed at a Tahiti hospital with GBS with samples from age-and sex-matched patients who presented at the same hospital, also during the time of the outbreak, with a nonfebrile illness (n = 98) or with acute Zika disease without neurological symptoms (n = 70).

The investigators found that all but one patient with GBS had Zika virus antibodies, and all of them had neutralizing antibodies to Zika virus. By comparison, only 56% (n = 54) of the control group admitted with nonfebrile illness had neutralizing antibodies (P less than .0001).

Also, 93% of the GBS patients had Zika virus immunoglobulin M (IgM) and 88% reported symptoms consistent with Zika infection a mean of 6 days before onset of neurological symptoms. Acute Zika infection is usually characterized by rash, fever, and conjunctivitis.

Past dengue virus infection, which had been considered a possible risk factor for Zika-mediated GBS, did not differ significantly between patients in the control groups and those with GBS.

The investigators were also able to subtype the clinical characteristics of the GBS cases as consistent with acute motor axonal neuropathy, or AMAN, phenotype. However, the antibodies typically seen associated with AMAN were not seen in these patients, leading investigators to suspect that a different biological pathway was responsible.

More than a third of the GBS patients in the study required intensive care, most of these also with respiratory support, though none died.

The government of France, the European Union, and the Wellcome Trust funded the study. The researchers declared that they had no competing interests.

Serological evidence from French Polynesia links an outbreak of Zika virus to a spike in cases of Guillain-Barré syndrome seen there in 2013-2014.

The research, published online Feb. 29 in The Lancet, is the first to use a case-control design to demonstrate that Zika, a mosquito-borne flavivirus, is associated with Guillain-Barré syndrome (Lancet. 2016 Feb 29. doi: 10.1016/S0140-6736(16)00562-6).

Guillain-Barré syndrome (GBS) is an immune-mediated flaccid paralysis that can follow viral or bacterial infections. Most patients with GBS recover with intensive care in hospitals, although the syndrome can be permanently debilitating or, in rare cases, fatal.

Courtesy Wikimedia Commons/Muhammad Mahdi Karim/Creative Commons License

As a large outbreak of Zika continues in Central and South America, hospitals should be prepared for excess GBS cases, the authors of the study say, and assure adequate intensive-care capacity to treat them. Based on the 66% attack rate of Zika during the French Polynesia outbreak, investigators estimated the incidence of GBS at 0.24 per 1,000 Zika infections, but noted that it could be different in the current outbreak.

Dr. Van-Mai Cao-Lormeau of the Unit of Emerging Infectious Diseases at Institut Louis Malardé in Papeete, French Polynesia, alongside colleagues in France and French Polynesia, used a case-control design to compare serological samples from 42 patients (74% male) diagnosed at a Tahiti hospital with GBS with samples from age-and sex-matched patients who presented at the same hospital, also during the time of the outbreak, with a nonfebrile illness (n = 98) or with acute Zika disease without neurological symptoms (n = 70).

The investigators found that all but one patient with GBS had Zika virus antibodies, and all of them had neutralizing antibodies to Zika virus. By comparison, only 56% (n = 54) of the control group admitted with nonfebrile illness had neutralizing antibodies (P less than .0001).

Also, 93% of the GBS patients had Zika virus immunoglobulin M (IgM) and 88% reported symptoms consistent with Zika infection a mean of 6 days before onset of neurological symptoms. Acute Zika infection is usually characterized by rash, fever, and conjunctivitis.

Past dengue virus infection, which had been considered a possible risk factor for Zika-mediated GBS, did not differ significantly between patients in the control groups and those with GBS.

The investigators were also able to subtype the clinical characteristics of the GBS cases as consistent with acute motor axonal neuropathy, or AMAN, phenotype. However, the antibodies typically seen associated with AMAN were not seen in these patients, leading investigators to suspect that a different biological pathway was responsible.

More than a third of the GBS patients in the study required intensive care, most of these also with respiratory support, though none died.

The government of France, the European Union, and the Wellcome Trust funded the study. The researchers declared that they had no competing interests.