When babies are born prematurely, caregivers and hospital staff rightly worry. However, as Dr. Mercurio, a professor of neonatology from Yale School of Medicine, explains, ‘the outcomes will be good’ for most of these babies.

Premature babies are born before 37 weeks of pregnancy. Each year, this is the case for about 15 million babies across the world and 10% of babies born in the United States. For caregivers, a premature birth and the time spent in the hospital afterward can be exceedingly worrying and stressful. But the care of premature babies has improved immensely in the last 50 years.

Dr. Mark Mercurio, a professor of pediatrics (neonatology) and the chief of Neonatal-Perinatal Medicine at Yale School of Medicine in New Haven, CT.

Dr. Mercurio is also the director of the Program for Biomedical Ethics and the director of the Yale Pediatrics Ethics Program explains why taking care of premature babies is challenging, how this care has changed during his career, and what research he is keen to see. He also mentioned what he wants caregivers of premature babies to know.

Better equipment and a better understanding

There are many challenges, really, but we could break these down into the technical and medical challenges and then the psychological and ethical aspects.

There are technical challenges in part just because the patients are so small.

This can make things more difficult. For example, most people are familiar with the fact that sometimes it can be hard to place an IV in an adult or an older child. So you can imagine the technical difficulties in someone who weighs just a pound or two.

In terms of the medical aspects, every organ system is immature.

A primary example is the lungs. The challenge is to ensure that enough oxygen can get into the blood via the lungs, and this is often much more difficult with premature, underdeveloped lungs. To accomplish this, there are various modes of assisted ventilation that might be needed.

In the brain, there is a possibility of injury because the baby is born very early. That has to do with the immaturity of the brain structurally at the time of delivery and possibly further injury during the intensive care course.

We know that premature babies, especially those born extremely premature, are at increased risk for long-term problems with brain function.

A third example would be the gastrointestinal system, which is also immature. So, getting adequate nutrition into these children can sometimes be a challenge.

The care of premature babies has changed in many ways over the years

We are constantly evaluating the data. We are constantly evaluating outcomes. There are controlled trials [happening all the time] to establish which is the better way to [provide care].

So, care evolves based on the new data, based on the outcomes of the studies that we do, and that is always a work in progress. Neonatology, like all of medicine, is rightfully always changing as we learn more.

I think we ventilate babies very differently. For example, the use of respiratory support for babies with immature lungs has evolved significantly over the course of my career and has gotten much better.

We have better equipment, and we also have a better understanding of how to go about it.

Obviously, prevention is always better than a cure, so research into the causes and prevention of prematurity, which is more in the realm of maternal-fetal medicine and obstetrics than in neonatology.

Within neonatology, research that will be very helpful in the years going forward would be that which yields a better understanding of what interventions and what treatments we can use to reduce the neurologic problems and the developmental problems that these children are sometimes left with long term.

In broad strokes, the biggest ethical questions that the neonatologist, and the nurses, and all the clinical staff face, and that the families face as well, is trying to understand how hard to press on with critical care measures when the outlook is poor — when to keep trying and when to say that we shouldn’t push anymore.

That’s sometimes a very, very hard question to answer.

Some of these children are not going to survive. And some of those who survive are going to be left with significant developmental problems, such as permanent cognitive impairment.

[So, we need to understand] when we should push hard, how those decisions should be reached, and how the interaction between the medical staff and the parents should influence decision making.

“The most important thing for parents to know is that most of these children will survive and most will do very well. There will be some who will not survive, and there will be some who will have long-term issues. But they are a small percentage overall.”

– Dr. Mark Mercurio

OPEC+ members will consider whether to extend existing oil cuts for three to four months or to increase output gradually from January during their two days of talks that start on Monday, OPEC+ sources told Reuters.
Officials from the Organization of the Petroleum Exporting Countries, Russia and others, a group known as OPEC+, held an initial round of talks on Sunday before formal discussions began but failed to reach agreement on policy for 2021.

OPEC+ had been due to ease existing production cuts by 2 million barrels per day (bpd) from January 2021, but a second coronavirus wave has reduced demand for fuel around the world, prompting a rethink among members of the group.

OPEC+ is now considering extending the existing cuts of 7.7 million bpd, about 8% of global demand, into the first months of 2021, a position supported by OPEC’s de-facto leader Saudi Arabia and other major producers in the group, sources said.

Preliminary consultations on Sunday between Saudi, Russian and other key ministers did not agree on strategy.

Research in humans and monkeys suggests that lipocalin-2 (LCN2), which is a hormone that plays a role in feeling full after consuming a meal, might be able to help people lose weight.

Previous studies have suggested that when mice receive LCN2 over a period of time, it reduces their appetite and body weight, improves their sugar metabolism, and increases energy expenditure.

A new paper that appears in the journal eLife  suggests that the hormone has a similar effect in primates such as monkeys and humans. This may mean that LCN2 could help people with obesity lose weight.

Obesity is an increasingly serious worldwide health concern. According to the World Health Organization (WHO), at least 2.8 million people die every year as a result of obesity or overweight.

This condition is also associated with other chronic health concerns, such as type 2 diabetes, coronary heart disease, stroke, cancer, and depression, among others.

Doctors typically class people as having overweight when they have a body mass index (BMI) of 25 or above, and they tend to class people as having obesity if they have a BMI of 30 or above.

Currently, it is difficult to reduce obesity because of researchers’ limited understanding of the body’s mechanisms that maintain a balance between weight, energy intake, and energy use.

For example, when people who have had obesity for a long time lose weight, their bodies respond by slowing down their metabolism, which can ultimately lead to weight regain.

In general, diet- and exercise-based weight loss programs tend to work in the short term, while known pharmacological therapies raise safety concerns and have a limited effect.

Lead study author Dr. Peristera-Ioanna Petropoulou and colleagues believe that conducting further research into LCN2 may lead to a new way of reducing obesity.

A retrospective, observational study has found that people who received the BCG vaccination — which prevents tuberculosis — were less likely to report symptoms of COVID-19 and less likely to have antibodies against the infection in their blood.

Scientists developed the BCG (bacillus Calmette-Guérin) vaccine more than 100 years ago to protect against the bacterial infection tuberculosis (TB).

In the United States, BCG is approved for people at high risk of developing TB and for treating some forms of bladder cancer.

But research also suggests that BCG vaccination early in life can reduce child mortality by up to 45%, mainly through reduced susceptibility to sepsis (blood poisoning) in babies, respiratory infections, and fever.

In adolescents and older people, there is also some evidence that BCG protects against viral respiratory infections.

Scientists believe the vaccine primes the “innate” immune system, the body’s first line of defense against viruses and other invading organisms. Unlike adaptive immunity, innate immunity rarely targets specific pathogens that the body has encountered in the past.

Researchers at the Cedars-Sinai Medical Center in Los Angeles, CA, wondered whether BCG might reduce susceptibility to SARS-CoV-2, the virus that causes COVID-19.

“We were interested in studying the BCG vaccine because it has long been known to have a general protective effect against a range of bacterial and viral diseases other than TB, including neonatal sepsis and respiratory infections,” says co-senior author Dr. Moshe Arditi, director of the Pediatric and Infectious Diseases and Immunology Division at Cedars-Sinai.

COVID-19 symptoms and antibodies

Between May 11 and June 18, 2020, 6,201 healthcare workers gave blood samples and answered questions about their medical history, including whether they had received BCG and vaccines against two other bacterial infections and influenza.

In total, 1,836 said they had received the BCG vaccination, 4,275 said they had not received it, and 90 were unsure.

Those with the vaccination were less likely to report experiencing symptoms of COVID-19 at any time in the past 6 months.

Overall, 3.5% of the entire cohort tested positive for SARS-CoV-2 antibodies.

Among those who reported receiving the BCG vaccine, 2.7% tested positive, while among those who said they hadn’t received it, 3.8% tested positive.

“It appears that BCG-vaccinated individuals either may have been less sick and therefore produced fewer anti-SARS-CoV-2 antibodies, or they may have mounted a more efficient cellular immune response against the virus,” says Dr. Arditi.

After adjusting for age and sex, BCG vaccination — but none of the other vaccinations — was still associated with a reduced likelihood of testing positive for SARS-CoV-2 antibodies.

In their paper, the researchers write:

“Taken together, these results indicate that a history of BCG vaccination confers a nonspecific protective effect against infection with SARS-CoV-2 and decreases the presence of self-reported COVID-19 symptoms. This appears to be specific to BCG, as [other vaccinations] […] are not associated with similar protection against infection with SARS-CoV-2.”