Monday, 06 September 2010 02:21

The birth of a healthy baby is a miracle. The child emerges with ten fingers and toes, perfectly formed to touch and kick in a big, new world. Nose and taste buds yearn for the first meeting with mother's nutritious milk. A baby even opens its eyes trying to focus on the blurry faces of parents looming close, cooing their hellos and declarations of love.

"Wait," thinks one baby out of 1,000. "Something is missing. You're cooing and kissing but I can't hear a thing!?" Indeed, no adults seem to notice that in spite of all this activity, all is silent to the baby.

After the birth, our baby is pulled out of its mother's warm and protective arms into the hands of a pediatrician for examination. Seemingly, with a fine tooth comb, he makes sure that all is complete and well, and that there are no defects or deficiencies to be addressed before the baby leaves the hospital. The physician looks into every opening, fold and crevice, tests the limb joints and reflexes, listens for the heartbeat and breathing, and almost always gives the delighted parents the clean bill of health, congratulations and the measuring tape with the baby's length noted.

Why was this baby, and nearly 50% of all babies with later-discovered hearing loss, sent home from the hospital after delivery with undetected hearing loss? The reason is that hearing loss detection tests were not routinely performed on infants until recently, when Government sponsored universal screening programs were initiated for newborns.

Why is it important to identify infants with hearing loss?
The ability to detect hearing problems in newborn infants is crucial. Studies have shown that being able to process auditory information early in life is crucial for later development of reading and spoken language skills. Hearing loss is associated with social and emotional developmental lags in children as well as poor academic achievement.

What is the incidence of congenital hearing loss?
Congenital hearing loss can be found in two to three infants per 1,000 live births. That means that there are approximately 5,000 babies born in the United States each year with bilateral permanent hearing loss.

How do you define hearing loss in newborns?
Newborns are checked for moderate to severe bilateral permanent hearing loss. Current testing after birth does not pick up loss that is progressive or acquired later in life. The current testing programs detect hearing losses at a threshold of 30-40 dB in the frequency important for speech recognition (500-4,000 Hz)

What are the characteristics of children that are most likely to have hearing loss?
Babies who were determined to be at high risk for hearing loss include children that were admitted to the neonatal intensive care unit for more than 2 days, (1-2 cases of hearing loss for every 200 babies), premature infants, children with craniofacial anomalies, family history of hearing disorders, children whose mothers developed infections in utero, and children who are born with certain syndromes. However, it was found that close to half of all the children not in the high risk group were missed. Therefore, about 50% of all children with hearing problems were sent home from the hospital with undetected hearing loss.

What are the current state requirements to have children checked prior to leaving the hospital?
Currently in all 50 states, Guam, and the District of Columbia regulations direct testing of all children for hearing loss before leaving the hospital. All states and US territories have Early Hearing Detection and Intervention (EHDI) programs funded by the Federal Government which delineate the screening protocols, follow-up care and collection of data. This data collection has been initiated only since the 1990's. The US Department of Health and Human Services now has clear guidelines which include a universal protocol that screening should occur before 1 month of age, follow-up for infants not passing the test no later than 3 months of age and follow-up intervention prior to 6 months of age for infants identified with hearing loss. Due to initiation of these programs, the number of infants screened for hearing loss increased from 46.5% in 1999 to 97% in 2007.

What are some of the causes of hearing loss in infants?
Hearing loss can be divided into 4 categories:

1.Central
This is due to deafness caused by problems along the auditory pathway to the brain or in the brain.
High levels of bilirubin (breakdown product of blood cells—often causing jaundice in the newborn.)
Hypoxia (low oxygen levels)
Intraventricular hemorrhage (bleeding within the brain.)
2.Conductive
This is caused by problems with the outer ear, middle ear, the tympanic membrane, or the bones of the ear and affects all frequencies equally. This may also be due to congenital cholesteatoma (growth in the middle ear.)
3.Sensorineural
This is caused by problems in the inner ear or auditory nerve. About 50% of these are due to various genetic diseases and syndromes (Alport's Syndrome, Turner's, Usher's, Waardenburg's syndrome). Scientists have now mapped genes that cause hereditary hearing loss, in families. In 20-30% of cases, sensorineural defects can also be due to infectious causes such as cytomegalovirus ( most common), group B strep infections, herpesvirus, rubella, toxoplasmosis, and syphilis. Mothers can acquire these infections during pregnancy and pass it to the fetus in utero. Children can show no signs at birth but go on to develop deafness later on in life. Unknown causes (idiopathic) and anatomic causes are also in this category.
4.Mixed
This includes a combination of the above etiologies.
What are the most common tests used for screening?
There are 2 infant tests available called the AABR and the TEOAE. Both diagnose sensorineural hearing loss in newborns. There is no evidence that one test is superior to the other to date, although some studies have shown a lower rate of false positives with AABR. Children with positive testing are referred for further testing and details are obtained about genetic and family history.

1.Automated brainstem response (AABR)
This checks the auditory pathway from the outside ear to the lower brainstem. Infants have their ears covered with earphones that emit a series of clicks. Electrodes on the infants forehead and neck measure brain wave activity in response to the clicks which is then fed into a computer that assess the brain wave activity.
2.Transient evoked otoacoustic emissions (TEOAE)
This test evaluates the function of the cochlea by placing a small microphone in the external ear canal and testing the echo responses to a series of clicks which is then placed thru a computer and compared to the standard.
With any kind of testing, the important issue is the false positive and false negative rates. Universal newborn screening has a high number of false positive rates, mostly due to motion artifacts. Other causes of false positives can be due to fluid in the ear or ear infections. False positive rates can be as high as 30% with a one step test, to less than 1% if a child is tested twice. If a child fails the test twice, an ear, nose, and throat referral is directed by the pediatrician.

Proper counseling of the parents allays the anxiety caused by false positives. The overall benefit far outweighs the risks of missing a potentially deaf child with delayed intervention.

What are the future goals to improve the medical care of infants with hearing loss?
Future goals include devising a system for providing better follow-up care on children who do not pass the initial screening and for screening children that fall below the threshold and have milder forms of hearing loss or late onset and progressive forms of hearing loss that can be missed. Also, ensuring that children with documented disorders are enrolled in intervention programs is critical. Children that have risk factors should not only be screened at birth but again throughout childhood.

Recommendations by the Joint Committee on Infant hearing recommends testing every 6 months before 3 years of age in high risk children. More Federal programs are being initiated to track follow-up care on infants and to increase education and awareness.

Summary:
Hearing loss detection in infants has markedly changed in the last decade, with over 95% of all newborns being screened. Follow-up interventions and enrollment in programs still remain a challenge. The Federal programs now in place, with universal testing and better data collation and tracking systems, are expected to bring vast changes. Improvements in overall quality of life will occur as a result of earlier detection and treatment as children avoid limitations in speech, language, and cognitive capacity. Hopefully this will obviate the damage caused by hearing limitations that affect academic performance, social interaction and deficits that negatively impact ability to work.

About Beaute de Maman

Since the beginning of her Obstetrics and Gynecology practice in 1982, Dr. Michele Brown has delivered more than 3,000 babies. She has her medical training to guide her in the development of Beaute de Maman's unique health and beauty products. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut. As a clinical attending, she actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York. Dr. Brown is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County.

Please visit: http://www.beautedemaman.com

Monday, 06 September 2010 02:21

Even though commercial trucks constitute only a small percentage of the traffic on the road, they are involved in a significant number of fatal motor vehicle accidents every year. There are a number of common issues and situations faced by truck drivers and the trucking industry that all too often lead to serious truck-related accidents.

Common Causes of Semi or Commercial Truck-Related Accidents

While there are a number of factors that may lead to a truck accident, the most common factor is driver fatigue. Some estimates indicate that as many as 40 percent of truck accidents are to some degree the fault of truck drivers that have not had sufficient sleep or rest to operate such a large and dangerous vehicle.

There are numerous reasons why a truck driver may be driving while fatigued. Drivers are under a great deal of pressure to move their cargo as quickly as possible and they generally work long hours on the road in a very sedentary job. While there are federal regulations dictating how many hours a driver can be on the road in a given period of time, those regulations may not always be complied with when a driver has a schedule to keep. According to federal regulations, a driver can drive a maximum of 11 hours after having taken at least 10 consecutive hours off. There are also a limited number of hours that a driver can work within a 7 to 8 day period.

There are also a host of personal issues that may lead tragic truck-related accidents. The stress and loneliness of the job leads many truck drivers into drug and alcohol abuse, which in turn impairs their ability to drive a truck safely.

In addition to personal issues, there are several common equipment or mechanical issues that can lead to truck-related accidents. Some of the common factors implicated in truck accidents involve poor or inadequate truck maintenance, unsecured or unbalanced cargo loads and speeding or other aggressive driving habits.

A trucking company is required to keep their trucks in good working order and to maintain records of inspections and maintenance. With the vast amount of cargo hauled by semi-trucks, it is imperative that brakes be inspected and serviced regularly. Often, an investigation will show that a truck was not properly serviced or that service was performed infrequently.

Another common problem is the improper loading of cargo. When thousands of pounds of cargo are loaded in a semi-trailer, it must be loaded in a way to prevent shifting or moving while in transit. If the cargo were to fall over or start sliding from side to side, the trailer could become unstable and cause the truck to flip over or lose control. In situations where a truck is hauling an open trailer, there may also be problems with debris or cargo falling or flying off the trailer and endangering other drivers.

If you have ever driven on an interstate or other highway commonly used by commercial trucks you are probably very familiar with the aggressive driving tactics of many semi drivers. Under pressure to make their deliveries on time, some commercial drivers will speed, tailgate or cut off other drivers in order to keep moving as quickly as possible. While these habits are dangerous for any driver, the fact that these drivers are using enormous vehicles makes them especially deadly if an accident occurs.

Jason's Law

Related to the issue of driver fatigue is the lack of suitable places for truck drivers to stop and rest. Often times, drivers are required to pull off the road at truck stops or other locations when they are approaching their maximum hours limit. In order to find a location to pull off the road and rest, drivers sometimes have to push on after they are already too tired to be driving. This situation gives rise to two dangerous scenarios. If a driver cannot find a truck stop or rest area to pull over, he or she may be forced to park somewhere that creates a danger to other drivers, such as an interstate ramp. Alternatively, the driver may be forced to keep driving while fatigued in search of a truck stop or other safe place to park.

Recently, a new federal law was proposed that may provide some help to truck drivers, and in turn, make the roads safer for other motorists. The law, dubbed "Jason's Law," is aimed at creating more rest stops and areas for truckers to safely pull over and rest when fatigued. The impetus behind the law was the death of a truck driver who had been unable to find a safe place to park and was later killed after pulling over to rest at an abandoned gas station.

Why Are Truck Accidents So Severe?

The injuries suffered by motorists are nearly always severe, if not fatal, when a truck accident occurs. Massive injuries resulting in paraplegia or quadriplegia are common in semi-related accidents. The reason for the high fatality rate and the massive injuries is simple the size and weight of a semi truck is so much greater than that of a passenger vehicle. Generally speaking, a commercial truck itself may weigh 20,000 pounds, but with a fully loaded trailer it may weigh as much as 80,000 pounds. Comparatively, a typical car will weigh somewhere between 5,000 and 8,000 pounds. Considering the huge weight disparity and the speeds at which these crashes may occur, it's no wonder why these accidents produce so many catastrophic accidents and so many tragic highway deaths.

How Can an Attorney Help?

In the event that you or a loved one are hurt in a truck-related accident, working with an attorney to uncover the circumstances of the crash or to pursue financial compensation is an important first step.

Pursing a lawsuit after a truck accident can be a complicated matter. Generally, there needs to be a prompt investigation into the truck's maintenance records as well as the truck driver's logs. In addition, the relevant federal regulations must be reviewed in order to determine if a violation contributed to the accident. These situations also involve complex insurance- related issues that often require the assistance of an experienced attorney.

Most importantly, these truck-related accidents probably resulted in some very serious injuries or even deaths. With the severity of the situation, it is vitally important to work with an attorney to ensure your rights are protected and to see to it that you or your loved one are able to pursue the compensation you deserve.

Article provided by Rasmussen & Miner
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