AMERICAN FOUNDATION FOR MATERNAL AND CHILD HEALTH

A Nonprofit Foundation for Interdisciplinary Research in Maternal and Child Health

Virginia Office: 500 Crestwood Drive, # 2606 Ÿ Charlottesville, VA 22903

Tel: (434) 296-9339 Ÿ Fax: (434) 296-3383 ŸE-Mail: dh@... Ÿ Web: www.aimsusa.org

ALERT!    ALERT!    ALERT!   ALERT!  ALERT!   ALERT!

I have finally received a copy of the National Children’s Study Research Plan and have found to my amazement that the NCS does not plan to collect and note information regarding the newborn infants adjustment to extrauterine life – that  there will be no noting of the initial examination of the newborn infants to be followed – no noting of the infant’s TSR (time to sustained respiration). Not even an APGAR score at one minute of life will be noted on the infant’s record.   

It is sad indeed that the NICHD has chosen to omit notation of the newborn infant’s initial adjustment to extrauterine life that could have helped to determine if obstetric interventions such as induced labor, epidural anesthesia, forceps and vacuum extraction, etc. could, in  themselves, adversely affect the dendritic arborization of newborn infants’ brain and  central nervous systems, which could, in turn, adversely affect the neurologic development of exposed offspring. 

The paper, “Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits” published in the J. Neuroscience (Feb.1, 03), and mentioned in my following letter to Dr. Scheidt, was the subject of much attention at a recent meeting of pediatric and obstetric pharmacologists among the attendees, yet the NCS does not think of the powerful obstetric related drugs as environmental exposures..

During the three years of NSC Study meetings I repeatedly stressed the need to include obstetric services staffed by professional midwives among those hospitals selected to participate in the study.  

The NCS Planning Committee has asked for public comment on its report by Sept. 25!    

IF YOU CARE don’t miss this opportunity to be heard!   Send a note to Dr. Scheidt and tell him that the NCS will fail to improve the health and well being of women and their children unless the physiologic care provided by midwives is weighed against the intervention-oriented care provided by obstetricians.

                                                                                                                        Doris Haire       

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Peter Scheidt, MD., Director                                                                            Sept 12, 2007

National Children's Study 

6100 Executive Blvd., 5C01

Bethesda, MD 20852

Dear Peter, 

After making several unsuccessful efforts to obtain a copy of the National Children's Study Research Plan from your office and the National Children's Study web site I finally have a copy of the Research Plan in my hand and I am very disturbed by what I have read so far.  As you may recall, I visited you in your office early in the planning stage of the National Children's Study to talk about the mistakes made in the earlier Collaborative Perinatal Project (CPP).   I particularly called your attention to the failure of the planners of the CPP to require careful notation of each newborn infant’s initial ability to adjust to extrauterine life.   The CPP’s failure to note the newborn infant’s ability to immediately initiate respiration without the need for resuscitaton has freed obstetricians to employ their armementarium of interventions without the inconvenience of having to inform their obstetric patients that there are inherent risks involved in every obstetric intervention..

The National Children's Study Research Plan concedes that almost one in five children in the United States is reported to have some type of developmental disability and that almost one in 50 school-age children is reported to have a serious developmental disability, including metal retardation, cerebral palsy, ADHD, and autism. (Pg 1-3)    Failure to collect data on each newborn’s time to sustained respiration is indefensible since it only involves a quick look at the clock and the notation of that time.

The fact that in many states there is currently no place on the official Birth Record to note the newborn’s one minute APGAR score or the infant’s “Time to Sustained Respiration” appears to be the result of efforts on the part of organized obstetrics to obfuscate the impact of  obstetric management.  The omission of such information from the National Children's Study spreadsheets suggests that obstetricians have brought pressure to bear on NICHD to omit any information that could implicate obstetric management.

Most scientists agree that a drop in fetal heart rate reflects a drop in fetal oxygenation.   Since no one really knows the degree of hypoxia a newborn infant can sustain before damage to the brain and neurologic system occurs, how can the planners of the National Children's Study justify failing to require that the newborn’s “Time to Sustained Respiration” be included in the data collected?   

In July I attended the Joint Meeting of the Pediatric Pharmacology and Obstetric Pharmacology Research Networks at the NIH Neuroscience Center.  I was pleased to see that the enclosed paper entitled “Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits” published in the J. Neuroscience (Feb1, 03) was the subject of much attention among the attendees.

Several pediatric pharmacologists spoke of the need to know more about how drugs administered to the pregnant and parturient woman affect the subsequent  human development of the exposed offspring.  I was pleased that several of the pediatric pharmacologists expressed their appreciation of Sumner Yaffe’s guidance over the years.   I’m very fortunate to have had Sumner as a mentor all these years.    

I would appreciate a reply to this letter before I share my concerns with others.

                                                                        Sincerely yours,

                                                                        Doris Haire