infants

Infants Outperform AI in “Commonsense Psychology”

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Summary: When it comes to detecting what motivates a person’s actions, infants outperform current artificial intelligence algorithms. The findings highlight fundamental differences between computation and human cognition, pointing to shortcomings in current machine learning and identifying where improvements are needed for AI to fully replicate human behavior.

Source: NYU

Infants outperform artificial intelligence in detecting what motivates other people’s actions, finds a new study by a team of psychology and data science researchers.

Its results, which highlight fundamental differences between cognition and computation, point to shortcomings in today’s technologies and where improvements are needed for AI to more fully replicate human behavior.

“Adults and even infants can easily make reliable inferences about what drives other people’s actions,” explains Moira Dillon, an assistant professor in New York University’s Department of Psychology and the senior author of the paper, which appears in the journal Cognition. “Current AI finds these inferences challenging to make.”

“The novel idea of putting infants and AI head-to-head on the same tasks is allowing researchers to better describe infants’ intuitive knowledge about other people and suggest ways of integrating that knowledge into AI,” she adds.

“If AI aims to build flexible, commonsense thinkers like human adults become, then machines should draw upon the same core abilities infants possess in detecting goals and preferences,” says Brenden Lake, an assistant professor in NYU’s Center for Data Science and Department of Psychology and one of the paper’s authors.

It’s been well-established that infants are fascinated by other people—as evidenced by how long they look at others to observe their actions and to engage with them socially. In addition, previous studies focused on infants’ “commonsense psychology”—their understanding of the intentions, goals, preferences, and rationality underlying others’ actions—have indicated that infants are able to attribute goals to others and expect others to pursue goals rationally and efficiently. The ability to make these predictions is foundational to human social intelligence.

Conversely, “commonsense AI”—driven by machine-learning algorithms—predicts actions directly. This is why, for example, an ad touting San Francisco as a travel destination pops up on your computer screen after you read a news story on a newly elected city official. However, what AI lacks is flexibility in recognizing different contexts and situations that guide human behavior.

To develop a foundational understanding of the differences between humans’ and AI’s abilities, the researchers conducted a series of experiments with 11-month-old infants and compared their responses to those yielded by state-of-the-art learning-driven neural-network models.

To do so, they deployed the previously established “Baby Intuitions Benchmark” (BIB)—six tasks probing commonsense psychology. BIB was designed to allow for testing both infant and machine intelligence, allowing for a comparison of performance between infants and machines and, significantly, providing an empirical foundation for building human-like AI.

Specifically, infants on Zoom watched a series of videos of simple animated shapes moving around the screen—similar to a video game. The shapes’ actions simulated human behavior and decision-making through the retrieval of objects on the screen and other movements.

Similarly, the researchers built and trained learning-driven neural-network models—AI tools that help computers recognize patterns and simulate human intelligence—and tested the models’ responses to the exact same videos.

Their results showed that infants recognize human-like motivations even in the simplified actions of animated shapes. Infants predict that these actions are driven by hidden but consistent goals—for example, the on-screen retrieval of the same object no matter what location it’s in and the movement of that shape efficiently even when the surrounding environment changes.

This shows a drawing of a brain on a computer
The ability to make these predictions is foundational to human social intelligence. Image is in the public domain

Infants demonstrate such predictions through their longer looking to such events that violate their predictions—a common and decades-old measurement for gauging the nature of infants’ knowledge.

Adopting this “surprise paradigm” to study machine intelligence allows for direct comparisons between an algorithm’s quantitative measure of surprise and a well-established human psychological measure of surprise—infants’ looking time.

The models showed no such evidence of understanding the motivations underlying such actions, revealing that they are missing key foundational principles of commonsense psychology that infants possess.

“A human infant’s foundational knowledge is limited, abstract, and reflects our evolutionary inheritance, yet it can accommodate any context or culture in which that infant might live and learn,” observes Dillon.

Frequently asked questions about COVID-19 vaccines for infants, toddlers

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COVID-19 vaccines are now available for children as young as age 6 months in the United States.

The FDA has authorized and the CDC has recommended Moderna’s two-dose series at 25 g per dose for children aged 6 months through 5 years and Pfizer-BioNTech’s three-dose series at 3 g per dose for children aged 6 months to 4 years.

Below, Healio Pediatrics Editorial Board Member Leonard R. Krilov, MD, FAAP, FIDSA, FPIDS, chief of pediatric infectious diseases at NYU Langone Hospital – Long Island, answers some frequently asked questions about the vaccines.

Leonard R. Krilov

Healio: Is one vaccine preferred over the other?

Krilov: I think it’s a little too soon to answer that. I think there are pros and cons to each of the two.

Moderna has the advantage that it is only two doses and will be completed in a month. On the counter side, there did seem to be more adverse reactions in terms of fever and local pain, as well as fatigue and headache or irritability and sleep disturbances with this vaccine. Will that impact compliance with the second dose or how the vaccine will be perceived? Additionally, even though it is approved as a two-dose series with follow-up, there may well be an indication for a booster for this vaccine.

On the other side of the coin, the Pfizer vaccine at one-tenth of the adult dose seems to be associated with lower rates of local reactions and fever compared with placebo. However, the Pfizer vaccine requires three doses, and would take potentially up to almost 3 months to complete the series. The preliminary data suggested minimal, if any, protection after just the first two doses.

As in any clinical trial, you cannot put two experimental products head to head. The studies were conducted at different times with differing SARS-CoV-2 infection rates in the community and the data may not be totally comparable for the two vaccines. I think it is too soon to say where the favorability is going to be. Both vaccines are recommended equally. I’ll switch hats and put my parent hat on (although my children are grown) and suggest I would probably lean toward achieving protection sooner, but the most important thing is to get the children vaccinated.

Healio: As you mentioned, Pfizer’s vaccine is three doses. What are some ways a pediatrician can make sure a parent brings their child back for two follow-up vaccine appointments?

Krilov: Ensuring compliance with the vaccine series is important and needs to be emphasized to achieve the best level of protection. In a way, compliance is inversely proportional to number of doses or number of visits, so it is a concern that needs to be addressed.

I think we need to work with parents on demonstrating the significance of the infection, as well as the safety and benefits of the vaccine. The communication with the family should address the misconception that COVID-19 is a benign disease for young children and infants. Although we have not seen the mortality in young children from COVID-19 observed in the elderly and those with significant medical conditions, there have been more than 30,000 children aged younger than 5 years hospitalized with COVID-19 and more than 440 deaths in children aged younger than 4 years from this infection. More than one-half of these cases occurred in children with no pre-existing medical conditions.

The phrase I have used in these discussions is that although the infection is milder in children, it is not necessarily mild. It can still be a significant disease in terms of the acute illness and long COVID. Symptoms persisting for months have been described in children as well as in adults. Beyond this, discussing the safety and effectiveness of the vaccine in preventing severe disease should be included.

As we are trying to return to some degree of normalcy with no masks in school and increased in-person events, which is especially important for younger children’s speech development and socialization, I think vaccination is a critical part of our toolbox to help us get there safely. Telephone or text message reminders for second or third doses can be helpful in achieving compliance.

Healio: How can pediatricians counsel parents who may be hesitant about getting their young children vaccinated?

Krilov: I think there are two components to that discussion. One is certainly to emphasize that it is a safe and beneficial vaccine for their child. The other is that we need to spend some time addressing the misconception that this is a benign disease for the younger child, as described in the previous answer. In other words, we need to educate about what we’re vaccinating against. We have to be able to convincingly demonstrate that what we’re vaccinating against is worth preventing.

I think, in a way, for the other routine childhood vaccines, we are the victim of our own success. When people don’t see a lot of the vaccine-preventable diseases, they lose track of how significant they are, or were, and so therefore, can focus on potential concerns about reactions or the vaccines not being necessary. Maybe some of that’s true for COVID-19 as well, in the sense that the focus has been on older individuals and those with underlying medical issues. But I think it’s still significant for young children.

We want children to be able to do more and more and interact — that this is an important part of our toolbox help get there, maintain that. So, I think that is the track we need to take in order to be able to work with parents on showing the significance of the infection, as well as the safety and benefits of the vaccine.

Healio: Should parents start scheduling appointments now, or can the COVID-19 vaccine wait until they being their children in for a well visit or some other appointment?

Krilov: Because the vaccination is going to be administered over two or three visits, it might be hard to just totally dovetail into regular scheduled visits. And given, you know, the high levels of community spread in most areas of the country right now, I see no benefit to waiting. I understand it’s an extra visit, but I think the benefits are clear and the benefits should be achieved as soon as possible. It also should be noted that the COVID-19 vaccine can be given at the same time as other scheduled vaccines to avoid delays in getting vaccinated.

Healio : Do you think young children will eventually need a booster?

Krilov: Yes, I do think it is likely a booster for these children will be needed at some point, but it will require follow-up to determine if or when. Is this going to become like influenza, requiring periodic boosters for everyone? Are we going to settle into a more seasonal endemic pattern that will make timing of or need for boosters more predictable? Will there be additional waves this fall or winter, leading to recommendations for booster doses? Two and a half years ago we were talking about no hospital beds and having portable morgues in hospital parking lots, and now it’s a much more manageable disease. But again, there are still large numbers of cases.

I think the likelihood is this virus will continue to circulate, and with that, probably we will need periodic boosters. Is it going to be the same booster or, like influenza, is it going to be modified to match circulating variants? For example, omicron variant vaccines are in development now, so will the booster be with a different variant even to boost the immunity better? Will it turn out in a way down the road like influenza if we have multiple circulating variants to be a multivariant vaccine? It is still a bit premature to know the answer, but based on how immunity seems to wane for older children and adults, I do expect we will be looking at boosters for young children.

Breastfeeding reduces risk for lower respiratory tract infections, asthma in infants

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Breastfeeding mitigated the risks for developing lower respiratory tract infections in infancy and for developing asthma and allergic rhinitis in childhood, according to a study published in The Journal of Allergy and Clinical Immunology.

“The impact of breastfeeding on certain childhood respiratory diseases is still controversial, with some studies actually showing that breastfeeding could increase the risk for some chronic lung diseases in children, such as asthma,” Christian Rosas-Salazar, MD, MPH, assistant professor of pediatrics at Vanderbilt University Medical Center, told Healio.

To better understand the effect of breastfeeding on pediatric respiratory health, Rosas-Salazar and colleagues evaluated data of 1,949 healthy infants (median age, 55 days; interquartile range [IQR], 16-78 days; 47.67% girls; 65.11% non-Hispanic white; 31.4% born via cesarean section) in a population-based cohort who were followed via passive and active surveillance, including in-person respiratory illness visits and viral testing, between November and March of their first year. Only 1,495 (76.71%) of the enrolled infants had 4-year data available.

The researchers also monitored cytokines in the upper respiratory tract (URT) and gut microbiomes of these infants, while parents reported the type of feeding they provided their infants as well as the duration of any breastfeeding.

The median duration of exclusive breastfeeding among the total infants enrolled was 6 weeks (IQR, 0-20 weeks).

The URT and gut microbiomes of the infants who had been exclusively breastfed had the lowest values of alpha diversity metrics at enrollment. Also at enrollment, the beta diversity of the URT and gut microbiomes differed by type of feeding (P < .01), and there were multiple differences in the abundance of URT and gut genera by type of feeding.

The researchers additionally found associations between the type of breastfeeding and the levels of pro-inflammatory cytokines but not with levels of pro-allergic cytokines.

Overall, 440 infants (22.58%) developed a lower respiratory tract infection (LRTI) during infancy, 209 (10.72%) developed a 1-year food sensitization, 286 (14.67%) developed 4-year current asthma and 516 (26.48%) developed 4-year ever allergic rhinitis.

Analyses also showed a dose-response effect of the type of feeding at enrollment on an LRTI in infancy and 4-year current asthma, with infants who were exclusively breastfed at enrollment having the lowest odds of these outcomes. However, there was no association between type of feeding at enrollment with 1-year food sensitization or 4-year ever allergic rhinitis.

Additionally, the duration of exclusive breastfeeding had a protective dose-response effect on LRTI in infancy, 4-year current asthma and 4-year ever allergic rhinitis. Each 4 weeks of exclusive breastfeeding decreased the odds of an LRTI in infancy (OR = 0.95; 95% CI, 0.91-0.99), 4-year current asthma (OR = 0.95; 95% CI, 0.9-0.99) and 4-year ever allergic rhinitis (OR = 0.95; 95% CI, 0.92-0.99) by approximately 5%.

Exploratory analyses further showed a significant mediating effect of the beta diversity of the gut microbiome, but not of the URT microbiome, on the association between exclusive breastfeeding and 4-year current asthma.

The beta diversity of the early-life URT and gut microbiomes, as well URT cytokines in infancy, did not show any mediating effects on the associations between exclusive breastfeeding and other clinical outcomes.

Christian Rosas-Salazar

“The results of our study suggest that exclusive breastfeeding protects against the risk for lower respiratory tract infections such as bronchiolitis or pneumonia, asthma and hay fever in young children,” Rosas-Salazar said. “Furthermore, we show that these effects are likely due to the impact of exclusive breastfeeding on the early-life microbiome.”

Noting these benefits, the researchers recommended that doctors discuss the effects of breastfeeding on respiratory health with their patients.

“Health care providers should continue to strongly recommend exclusive breastfeeding to their patients, and they can add the protective effects of exclusive breastfeeding on common childhood respiratory diseases as one of the potential benefits,” Rosas-Salazar said.

Longer durations of exclusive breastfeeding likely offer the most protection, the researchers continued, with nonexclusive breastfeeding in the first few months possibly offering benefits as well.

“Understanding if exclusive breastfeeding impacts the development of lung diseases in older children or even adults is an important next step of our study,” Rosas-Salazar said.

High dose Vitamin D may help prevent influenza in infants

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https://speciality.medicaldialogues.in/high-dose-vitamin-d-may-help-prevent-influenza-in-infants/

FDA Approves Neurotoxic Flu Drug For Infants Less Than One

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FDA Approves Neurotoxic Flu Drug For Infants Less Than One

Whereas the flu is self-limiting, the FDA’s capacity for bad decisions is not…

The recent decision by the FDA to approve the use of the antiviral drug Tamiflu for treating influenza in infants as young as two weeks old, belies an underlying trajectory within our regulatory agencies towards sheer insanity.

Tamiflu, known generically as oseltamivir, has already drawn international concern over its link with suicide deaths in children given the drug after its approval in 1999. In fact, in 2004, the Japanese pharmaceutical company Chugai added “abnormal behavior” as a possible side effect inside Tamiflu’s package.  The FDA also acknowledged in its April, 2012 “Pediatric Postmarket Adverse Event Review” of Tamiflu that “abnormal behavior, delirium, including symptoms such as hallucinations, agitation, anxiety, altered level of consciousness, confusion, nightmares, delusions” are possible side effects.[i]

Recent animal research on Tamiflu has found that the infant brain absorbs the drug more readily than the adult brain,[ii]  [iii]lending a possible explanation for why neuropsychiatric side effects have been observed disproportionately in younger patients.

The very mechanism of Tamiflu’s anti-influenza action may hold the key to its well-known neurotoxicity. Known as a neuromindase inhibitor, the drug inhibits the key enzyme within the flu virus that enables it to enter through the membrane of the host cell.  So fundamental is this enzyme that viruses are named after this antigenic characteristic. For instance,  the “N” in H1N1 flu virus is named for type 1 viral neuromindase.

Mammals, however, also have neurimindase enzymes, known as ‘sialidase homologs,’ with four variations identified within the human genome so far; NEU1,NEU2,NEU3 and NUE4.  These enzymes are important for neurological health. For example, the enzyme encoded by NEU3, is indispensable for the modulation of the ganglioside content of the lipid bilayer, which is found predominantly in the nervous system and constitutes 6% of all phospholipids in the brain.

It is therefore likely that neurimindase-targeted drugs like Tamiflu are simply not selective enough to inhibit only the enzymes associated with influenza viral infectivity. They likely also cross-react with those off-target neurimindase enzymes associated with proper neurological function within the host. This “cross reactivity” with self-structures may also explain why the offspring of pregnant women given Tamiflu have significantly elevated risk of birth defects (10.6%) relative to background rates (2-3%), according to a 2009 safety review by the European Medicines Agency.

Beyond the recognition of Tamiflu’s intrinsic toxicity, there are two additional problems with the use Tamiflu in infants:

  1. Infants do not yet have a sufficiently developed blood-brain barrier capable of keeping the chemical out of their rapidly developing brains
  2. Their detoxification systems are not sufficiently developed to remove the chemical rapidly enough to prevent harm

The FDA’s decision to include infants under one as treatable with Tamiflu is all the more disturbing when you consider that a 2010 study published in The Pediatric Infectious Disease Journal found that of 157 evaluable infants (mean age 6.3 months) treated for influenza with Tamiflu, complications due to the medication were found in the majority (54%) of the treated group.

According to the study

Complications were recorded in 84 patients (54%), the most serious of which were meningitis in 1 infant (1%), pneumonia in 9 (6%), and otitis media in 2 (1%).

Are meningitis, pneumonia and otitis media (ear infection) acceptable risks for treating influenza? Apparently for the FDA, it is.

How about death? Is that an acceptable risk of Tamiflu treatment for flu, a self-limiting disease?

In 2011, the International Journal of Vaccine Risk and Safety in Medicine published an article titled, “Oseltamivir and early deterioration leading to death: a proportional mortality study for 2009A/H1N1 influenza,” described 119 reports of Tamiflu-induced death. According to the study:  “of 119 deaths after Tamiflu was prescribed, 38 deteriorated within 12 hours (28 within 6 hours).”

The study concluded:

These data suggest Tamiflu use could induce sudden deterioration leading to death especially within 12 hours of prescription. These findings are consistent with sudden deaths observed in a series of animal toxicity studies, several reported case series and the results of prospective cohort studies. From “the precautionary principle” the potential harm of Tamiflu should be taken into account and further detailed studies should be conducted.

So, how did the FDA justify its decision to consider Tamiflu safe in infants under one year? Did it use controlled, randomized, placebo-controlled trials to ascertain safety?  Of course not. Testing drugs on infants is unethical, and no parent in their right mind would enroll their newborn in such a trial. Lacking definitive evidence of safety, the FDA’s expanded approval in children younger than one year was based on extrapolation of data from previous results in adults and older children.[iv]  This, of course, is inappropriate as it denies the aforementioned differences in the susceptibility to drug toxicity and neurotoxicity between infants and older individuals.  It also avoids proper consideration of the studies in the biomedical literature indicating its potential for severe, if not life-threatening toxicity to infants, children and adults alike.

Another concern, not addressed in the FDA announcement, is that as of Dec. 15th, 2010, the World Health Organization has acknowledged that, based on over 300 tested worldwide samples of the 2009 pandemic H1N1 flu, resistance to Tamiflu is growing.[v]  Therefore, treating an infant with Tamiflu-resistant influenza would not only do nothing to combat the infection, but would poison that child and further disable their natural immune response.

The clear winner in the FDA’s decision will be the bottom line of Roche, the manufacturer of this patented chemical.  How much longer can the FDA continue to expect those subject to its regulatory decisions to maintain the illusion that it is interested in the public welfare?

We must remember that infants do not get sick from the flu as a result of Tamiflu deficiency, or flu vaccine deficiency for that matter.  They do get sick from the immune-disrupting effects of synthetic chemicals completely foreign to human physiology (such as Tamiflu), and lack of vital hormone modulating compounds that result from adequate sunlight exposure (vitamin D3), and good nutrition.

For additional information on this topic view our research on natural anti-influenza agents.

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Nebulised hypertonic saline solution for acute bronchiolitis in infants.

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BACKGROUND: Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (= 3%) may reduce these pathological changes and decrease airway obstruction. This is an update of a review first published in 2008, and previously updated in 2010 and 2013.

OBJECTIVES: To assess the effects of nebulised hypertonic (= 3%) saline solution in infants with acute bronchiolitis.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, Embase, CINAHL, LILACS, and Web of Science on 11 August 2017. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 8 April 2017.

SELECTION CRITERIA: We included randomised controlled trials and quasi-randomised controlled trials using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline, or standard treatment as a comparator in children under 24 months with acute bronchiolitis. The primary outcome for inpatient trials was length of hospital stay, and the primary outcome for outpatients or emergency department trials was rate of hospitalisation.

DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, data extraction, and assessment of risk of bias in included studies. We conducted random-effects model meta-analyses using Review Manager 5. We used mean difference (MD), risk ratio (RR), and their 95% confidence intervals (CI) as effect size metrics.

MAIN RESULTS: We identified 26 new trials in this update, of which 9 await classification due to insufficient data for eligibility assessment, and 17 trials (N = 3105) met the inclusion criteria. We included a total of 28 trials involving 4195 infants with acute bronchiolitis, of whom 2222 infants received hypertonic saline.Hospitalised infants treated with nebulised hypertonic saline had a statistically significant shorter mean length of hospital stay compared to those treated with nebulised 0.9% saline (MD -0.41 days, 95% CI -0.75 to -0.07; P = 0.02, I² = 79%; 17 trials; 1867 infants) (GRADE quality of evidence: low). Infants who received hypertonic saline also had statistically significant lower post-inhalation clinical scores than infants who received 0.9% saline in the first three days of treatment (day 1: MD -0.77, 95% CI -1.18 to -0.36, P < 0.001; day 2: MD -1.28, 95% CI -1.91 to -0.65, P < 0.001; day 3: MD -1.43, 95% CI -1.82 to -1.04, P < 0.001) (GRADE quality of evidence: low).Nebulised hypertonic saline reduced the risk of hospitalisation by 14% compared with nebulised 0.9% saline among infants who were outpatients and those treated in the emergency department (RR 0.86, 95% CI 0.76 to 0.98; P = 0.02, I² = 7%; 8 trials; 1723 infants) (GRADE quality of evidence: moderate).Twenty-four trials presented safety data: 13 trials (1363 infants, 703 treated with hypertonic saline) did not report any adverse events, and 11 trials (2360 infants, 1265 treated with hypertonic saline) reported at least one adverse event, most of which were mild and resolved spontaneously.

AUTHORS’ CONCLUSIONS: Nebulised hypertonic saline may modestly reduce length of stay among infants hospitalised with acute bronchiolitis and improve clinical severity score. Treatment with nebulised hypertonic saline may also reduce the risk of hospitalisation among outpatients and emergency department patients. However, we assessed the quality of the evidence as low to moderate.

When is the right time to start infants on solid foods?

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https://speciality.medicaldialogues.in/when-is-the-right-time-to-start-infants-on-solid-foods/

Infants Deeply Traumatized By Common Medical Procedures, New Study Suggests

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Painful Medical Procedures Traumaize Infants, New Study Suggests

A concerning new study suggests that decades of medical procedures performed on infants without pain management has had deeply traumatizing effects.

A groundbreaking study published in eLife titled, “fMRI reveals neural activity overlap between adult and infant pain,” demonstrates that the infant pain experience, despite long held assumptions to the contrary, closely resembles that of adults.

Researchers discovered that when 1-6 day old babies were exposed to the same pain stimulus as adults their brains “lit up” in almost exactly the same manner. More specifically, infant and adult pain responses were indistinguishable in 18 of the 20 regions observed through fMRI imaging. The only two brain regions that pain did not show activation in the infants were the amygdala and the orbitofrontal cortex: two regions believed to help with the interpretation of pain stimuli.

brain scans

Comparison of nociceptive-evoked brain activity in selected brain regions that are active in both adults and infants. See details

In a Time.com interview, the lead researcher of the study expressed some surprise at finding that pain activated centers in the infant brain associated with emotional processing:

 “The infant’s brain is much more developed than I was expecting,” says Slater. “I might have thought that some information might have gone to the sensory areas of the brain — telling the baby something was happening on the foot, for example — but I didn’t necessarily think it would go to areas more commonly involved in emotional processing such as the anterior cingular cortex, which is thought be involved in the unpleasantness associated with an experience.”

The Infant Pain Response: More Than A Reflex; Possibly A Source of Trauma

What is deeply concerning about this finding is that infants have long been considered by the conventional medical profession to be  incapable of experiencing pain while undergoing the many routine medical procedures to which they are exposed in early life. In the case of the smallest and sickest of babies (who are required to be in a level 3 neonatal intensive unit for the first 14 days of their lives), a 2014 study found that they experience an average of 11.4 painful medical procedures a day, but with only 36.6% receiving pain management therapy. Also concerning is research that is now emerging exposing the fact that a surprisingly wide range of common medical procedures are not supported by the body of published biomedical research, nor human clinical trials.

Clearly, hospital born infants, and especially those requiring intensive care, are subject to an intense range of potentially painful and traumatic experiences that the standard of care does little to mitigate, primarily because it does not acknowledge them beyond their biomedical definition as bodies, ignoring that they are experientially and existentially situated persons with sentience and subjectivity. Additionally, with the increasing prevalence of obstetrician-assisted birth (C-sections), blood draws, and vaccination, the experience of iatrogenic pain and trauma has become the norm, and not the exception. Given the inevitability of infant medical interventions, pain management strategies could be considered a medico-ethical necessity. Moreover, precautions should be taken to minimize unnecessary medical procedures, i.e. overdiagnosis and overtreatment.

According to the study,

“Doctors long believed that infants do not feel pain the way that older children and adults do. Instead, they believed that the infants’ responses to discomfort were reflexes. Based on these beliefs, it was a routine practice to perform surgery on infants without suitable pain relief up until the late 1980s. Even now, infants may receive less than ideal pain relief. For example, a review found that although newborns in intensive care units undergo 11 painful procedures per day on average, more than half of the babies received no pain medications. Some guidelines continue to emphasize that for infants cuddling and feeding are more important sources of comfort than pain-relieving drugs.”

While not specifically mentioned in the study, the practice of male infant circumcision may constitute the most egregious example of a medically unnecessary procedure. It is arguably responsible for extensive psychological and emotional damage within the male psyche due to the unacknowledged pain and trauma it has exacted in the millions that have involuntarily undergone it without adequate pain management.

Indeed, male infant circumcision is 1 of 6 of the most commonly performed medical procedures and responsible for 1.108 million hospital stays in 2011. The United States has the highest circumcision rate in the world, with an estimated rate of 69-97%, followed by 70% in Australia, 48% in Canada, and 24% in the United Kingdom. This is all the more concerning considering that circumcision is one of the least medically justified interventions from the perspective of evidence-based medicine. Learn more by reading: “The Foreskin: Why Is It Such A Secret in North America?” Amazingly, it has only been less than two decades that the American Academic of Pediatrics recommended anesthesia be used during the procedure. This only happened after research emerged showing behavioral differences in infant and mother-infant dyad behaviors between anesthetized and unanesthetized infants:

Before anesthesia was the standard of care, a trial comparing outcomes between anesthetized and unanesthetized infants undergoing circumcision noted a change in the infant’s behavior on postoperative day 1,13 and additional studies have documented the negative impact that circumcision has on mother-child interactions.14 and 15 Based on mounting evidence that infants who are circumcised have significant pain and stress responses, the AAP recommended in 1999 that if neonatal circumcision is performed, anesthesia should be used.16 [Source]

Considering what has been revealed by the new study, we must ask: how many infants have had been deeply traumatized not only via partial dismemberment of an important component of their reproductive and eliminative anatomy, but through the pain and anxiety associated with such a medical ritual which lacks unequivocal clinical research support for safety, efficacy, and any of its purported health benefits?

We hope that research like this will raise a flag of extreme caution when it comes to the increasingly prevalent over-medicalization of our most vulnerable populations. In other words, the solution is not simply to increase conventional pain management strategies which have many unintended, adverse effects — even with seemingly more benign over-the-counter drugs like Tylenol, which was recently found to have psychotropic properties such as flattening affect. The focus, therefore, should be on reducing overdiagnosis, overtreatment, and the uncritical implementation of a standard of care which errs on the side of aggressive and invasive procedures.

Brazil declares emergency after 2,400 babies are born with brain damage, possibly due to mosquito-borne virus

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Brazilian health authorities are sounding the alarm about a mosquito-borne virus that they believe may be the cause of thousands of infants being born with damaged brains.

The pathogen, known as Zika and first discovered in forest monkeys in Africa over 70 years ago, is the new West Nile — a virus that causes mild symptoms in most but can lead to serious neurological complications or even death in others. Brazil’s health ministry said on Nov. 28 that it had found the Zika virus in a baby with microcephaly — a rare condition in which infants are born with shrunken skulls — during an autopsy after the child died. The virus was also found in the amniotic fluid of two mothers whose babies had the condition.

“This is an unprecedented situation, unprecedented in world scientific research,” the ministry said in a statement on its website, according to CNN.

Brazil is investigating more than more than 2,400 suspected cases of microcephaly and 29 deaths of infants that occurred this year. Last year the country saw only 147 cases of microcephaly.

The situation in Brazil is so overwhelming that Angela Rocha, a pediatric infectious diseases specialist in Pernambuco, one of the hardest hit states, said in an interview with CNN that women may want to hold off on getting pregnant.

“These are newborns who will require special attention their entire lives. It’s an emotional stress that just can’t be imagined…,” Rocha said. “We’re talking about a generation of babies that’s going to be affected.”

 

Until a few years ago, human infections with the virus were almost unheard of. Then, for reasons scientists can’t explain but think may have to do with the complicated effects of climate change, it began to pop up in far-flung parts of the world. In 2007, it infected nearly three-quarters of Yap Island’s 11,000 residents. In 2013, Zika showed up in Tahiti and other parts of French Polynesia and was responsible for making an estimated 28,000 people so ill they sought medical care. It arrived in Brazil in May, where tens of thousands have fallen ill.

The World Health Organization, which has been monitoring the spread of the virus closely and issued an alert about the situation in Brazil, reported this month that it had popped up for the first time in the West African nation of Cape Verde and that it had led to additional illnesses in Panama and Honduras.

In the United States, the Centers for Disease Control and Prevention has found the virus in a few travelers returning from overseas, but says there have not come across any cases of people being infected by mosquitoes in the country.

Brazil has been struggling to contain the virus for months through both public education campaigns –which urge residents to use insect repelant and limit their time outdoors — as well as by sending mosquito eradication teams house to house to treat places where aedes aegypti mosquito that carries the virus might breed. The health ministry said it was sending truckloads of larvicide — enough to treat 3,560 Olympic-sized swimming pools — to northeastern and southeastern states that have been most affected and that it would add 266,000 new community health agents to make the house calls.

Cardiac injury in infants with acute gastroenteritis: Is it ischemia or rota associated carditis

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Reports suggested that rotavirus could be found in extra-intestinal tissues including the heart following infection and fatal rotavirus myocarditis has been recently reported in 2 children.

Purpose

We hypothesized that rotavirus may have a direct injurious effect on the myocardium of infants and this injury can be detected by the presence of cardiac troponin I (TnI).

Methods

Over 8 weeks period, 50 of 150 infants(5–18 months) with acute gastroenteritis were found to have human rotavirus (HRV) gastroenteritis with rotavirus antigenemia. Sera of 150 infants were analyzed for TnI. If TnI value was above the screening limit (0.05 ng/ml), electrocardiogram (ECG) and cardiac ultrasound were performed.

Infants with primary conditions associated with elevated TnI were excluded.

Results

Thirty four infants (22.6%) had elevated TnI (0.06–2.5 ng/ml), 16 (47%) of them had HRV-GE (p = 0.054). However, none of them had any sign of myocarditis or ischemia in their ECG or cardiac ultrasound scan and their TnI levels normalized within 24–72 h after correction of dehydration.

Infants less than 1 year ,and those with dehydration, anemia or acidosis were more prone to have elevated cTnI (p = 0.008, 0.009, 0.006, 0.001, respectively). Multivariate logistic regression analysis, showed that severe dehydration and acidosis are still significantly associated with elevated TnI levels (adjusted OR, 95% CI = 22.9, 2.19–239 and 20.76, 6.15–70, respectively.

Conclusion

Our study is the first pediatric study to show that myocardial injury occurs in infants with gastroenteritis and this injury was precipitated by transient ischemia which may go unnoticed on the ECG. However, we could not document rotavirus myocarditis