Antibiotic ‘cerebral palsy link’

Antibiotics appeared to treble the risk of cerebral palsy

A study has linked a small number of cases of cerebral palsy to antibiotics given to women in premature labor.

The UK study found 35 cases of cerebral palsy in 769 children of women without early broken waters given antibiotics.

This compared with 12 cases among 735 children of women not given the drugs. Advice is being sent to the study’s 4,148 mothers and a helpline set up.

Medical experts stressed pregnant women should not feel concerned about taking antibiotics to treat infections.

These findings do not mean that antibiotics are unsafe for use in pregnancy The Royal College of Obstetricians and Gynaecologists

The Oracle study was the largest trial in the world into premature labor and was set up to investigate whether giving antibiotics – which might tackle an underlying symptomless infection – to women with signs of premature labor would improve outcomes for babies.

One in eight babies in the UK is born prematurely and prematurity is the leading cause of disability and of infant death in the first month after birth.

Premature labor

In 2001, ORACLE found the antibiotic erythromycin had immediate benefits for women in premature labor (before 37 weeks gestation) whose waters had broken. It delayed onset of labor and reduced the risk of infections and breathing problems in babies.

Erythromycin and the other antibiotic studied – co-amoxiclav – showed no benefit or harm for the women whose waters were still intact, however, and doctors were advised not to routinely prescribe them in such circumstances.

To study the longer-term outcomes, the Medical Research Council-funded scientists followed up the children seven years later.

Pregnant women should not feel concerned about taking antibiotics to treat infections Chief Medical Officer Sir Liam Donaldson

Unexpectedly, both antibiotics appeared to increase the risk of functional impairment – such as difficulty walking or problems with day to day problem solving – and treble the chance of cerebral palsy in the children of the women whose waters had not broken.

Of the 769 children born to mothers without early broken waters and given both antibiotics, 35 had cerebral palsy, compared with 12 out of 735 whose mothers did not receive antibiotics in the same circumstances.

The reasons behind this link are unclear, particularly as there was no increased risk of cerebral palsy in women whose waters had broken.

Hostile environment

The researchers believe cerebral palsy is unlikely to be a direct effect of the antibiotic but rather due to factors involved in prolonging a pregnancy that might otherwise have delivered early.

Researcher Professor Peter Brocklehurst of Oxford University said: “We have a suspicion that infection is implicated in premature labour.

“Antibiotics may merely suppress levels of infection to stop preterm labour, but the baby remains in a hostile environment.”

Infections during pregnancy or infancy are known to cause cerebral palsy.

In a letter to doctors and midwives advising them about the findings, Chief Medical Officer Sir Liam Donaldson says: “Pregnant women should not feel concerned about taking antibiotics to treat infections.

“It is important to note that these women had no evidence of infection and would not routinely be given antibiotics.”

Where there is obvious infection, antibiotics can be life-saving for both mother and baby, the CMO says.

The Royal College of Obstetricians and Gynaecologists said: “These findings do not mean that antibiotics are unsafe for use in pregnancy. Pregnant women showing signs of infection should be treated promptly with antibiotics.”

Cerebral palsy can cause physical impairments and mobility problems.

It results from the failure of a part of the brain to develop before birth or in early childhood or brain damage and affects one in 400 births.

A helpline is available for study participants on 0800 085 2411 between 0930 and 1630 BST. NHS Direct has information available for other members of the public.

A spokeswoman from the special care baby charity Bliss said: “This highlights the importance of fully understanding both the immediate and long-term impact of the care and treatment that both mother and baby receive at this crucial time.”

China arrests 12 in milk scandal

Parents are queuing up for health checks on their babies

Police in China have arrested 12 more people in the scandal over contaminated milk powder, which has killed three babies and sickened thousands.

The new arrests bring the total number of people detained to 18, police in the north-eastern province of Hebei said.

Nationwide checks on milk powder are continuing, and police have confiscated more than 200kg (440lb) of melamine.

The additive is blamed for causing severe renal problems and kidney stones in babies across the country.

Of those arrested, six allegedly sold melamine, while the rest are accused of selling contaminated milk.

Suppliers to the dairy companies are believed to have added the banned chemical, normally used in plastics, to watered-down milk to make it appear higher in protein.

Widening crisis

Premier Wen Jiabao held a special cabinet meeting on Wednesday to address the baby milk crisis.

The State Council, or cabinet, admitted that regulations had failed to improve food standards.

“The Sanlu infant milk powder incident reflects chaos in the dairy products market and loopholes in supervision and administration which has not been vigorous,” it said.

Chinese parents who can afford it have been buying imported milk powder, with some in southern China crossing into Hong Kong to stock up on foreign brands.

Anger spreads

The milk scandal has sparked widespread anger among Chinese mothers, many of whom are reliant on cheap baby formula to feed their infants.

It has also raised questions about China’s ability to police its food production industries after a series of health scares – and fatalities – in recent years.

These have ranged from the contamination of seafood to toothpaste and, last year, to pet food exported to the United States.

Thousands of inspectors are checking milk production plants and selling stations across the country.

Parents are lining up for health checks on their babies.

They are also expressing anger at why Sanlu, the company first found to have sold contaminated milk, took so long to make the problem public.

At least 6,244 babies have been made ill by the milk powder, and three have died, but those numbers are predicted to rise.

Tests have shown that 69 batches of formula from 22 companies contained the banned substance.

Two of the companies involved have exported their products to Bangladesh, Yemen, Gabon, Burundi, and Burma, although it is not clear if contaminated batches are involved.

One mother told him that she was angry with both the milk producers and with what she called the “useless” quality inspection departments.

Chinese to tighten dairy testing

Babies affected developed urinary problems, including kidney stones

China says it will launch nationwide testing of all dairy products following the deaths of three babies from contaminated milk formula.

More than 6,200 babies have fallen ill after drinking milk tainted with the toxic chemical melamine, officials say.

Tests have shown that 69 batches of formula from 22 companies contained the banned substance.

The Chinese government has described the dairy market as “chaotic” and said its supervision is flawed.

Two of the companies involved have exported their products to Bangladesh, Yemen, Gabon, Burundi, and Burma, although it is not clear if contaminated batches are involved.

Kidney failure

The third fatality occurred in the eastern province of Zhejiang, Health Minister Chen Zhu said. The two earlier deaths had been reported in Gansu province.

More than 1,000 children were still in hospital, Mr Chen said, of whom more than 150 were suffering acute kidney failure.

He said all affected infants would receive free medical care.

In response, Li Changjiang, head of China’s quality control watchdog, said 5,000 inspectors would be dispatched nationwide to monitor companies and begin testing for melamine in all dairy products, he said.

It is believed that the melamine, which is used in the production of plastics, was added to the fresh milk to make it appear to have a higher protein content.

In a statement, the Chinese cabinet said the incident reflected “chaotic industry conditions and loopholes in the supervision and management of the industry”, state-run Xinhua news agency reported.

“It is necessary to learn lessons, properly deal with the incident, improve the inspection and supervision system and strengthen the management of the dairy industry,” it said.

Companies caught up in the scandal include the giant milk company Mengniu Dairy.

It says it is recalling three batches of formula made in January, after government tests found melamine in its product.

The dairy has also suspended trading of its shares on the Hong Kong stock exchange.

Bosses fired

The company at the heart of the scandal, the Sanlu Group, has fired its chairwoman and its general manager, the Xinhua agency said.

Chinese Health Minister Chen Zhu said all the seriously ill children had become ill after drinking Sanlu powered milk.

Correspondents say that melamine appears to have been added at milk collection stations, before being passed on to Sanlu.

Four officials linked to agriculture and quality control in Hebei province, where the Sanlu group is based, have been sacked, Xinhua reported.

Parent’s anger over milk scandal

The agency also said six people had been arrested in connection with the scandal and 22 were still being questioned.

Those arrested include two villagers charged with selling melamine and adding it to milk sold to the Sanlu Group.

An owner of a private food additive shop who allegedly sold the chemical to milk dealers was also arrested, as well as two milk sellers who admitted selling the tainted product, Xinhua said. Details of the sixth arrest were not given.

Sanlu made the information about the contamination of its products public last week after its New Zealand stakeholder, Fonterra – a global supplier of dairy ingredients – informed the New Zealand government, which then told the Chinese government.

Mr Li, head of the quality control watchdog, said two companies – Yashili and Suncare – exported milk powder and they were recalling their products.

On Wednesday, Bangladesh said food and commerce officials would meet this weekend to determine whether tainted products had entered the country.

Mr Li also said that melamine had also been found in a yogurt ice bar made by Yili, one of China’s biggest dairy producers, and sold in Hong Kong.

The brand has now been recalled by the Hong Kong supermarket chain Wellcome.

Confidence undermined

Mr Li said tests for melamine had not been made before, because it was banned from food products.

China is keen to try to reassure parents that it is in control of what is happening.

This scandal has undermined confidence in food safety in China and many parents are worried about what they will feed their babies, he adds.

Analysts say the incident is an embarrassing failure for China’s product safety system, which was revamped after a spate of international recalls and warnings last year over a range of goods.

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US to review Afghan attack case

US forces in Afghanistan are to review an inquiry into an air raid last month after new video evidence emerged indicating scores of civilian deaths.

The US had earlier said that no more than seven civilians died in the attack on the western province of Herat.

However, the Afghan government and the UN said up to 90 people were killed, including many women and children.

The US-based Human Rights Watch (HRW) says such attacks are eroding support for the government and foreign forces.

HRW says civilians deaths from international air strikes nearly tripled between 2006 and 2007.

Disturbing footage

The US general in charge of NATO-led troops (Isaf) in Afghanistan said at the weekend that he was requesting the US military’s Central Command to review the investigation into last month’s air raid.

Gen McKiernan said Isaf realized there was “a large discrepancy between the number of civilian casualties reported by US and Afghan National Army soldiers, and local people”.

The US and Nato need to dramatically improve their co-ordination with each other and with the government of Afghanistan Rachel Reid Human Rights Watch

The US military subsequently said it would “appoint a senior US military officer to review the investigation into the combined Afghan National Army (ANA) and US forces operation”.

A US military statement said: “This review will consider new information that has become available since the completion of the initial investigation.”

Disturbing video footage – apparently of the aftermath of the raid – has been seen by top military figures and diplomats in Kabul.

The shaky footage – possibly shot with a mobile phone – shows some 40 dead bodies lined up under sheets and blankets inside a mosque.

The majority of the dead are children – babies and toddlers, some burned so badly they are barely recognizable.

The covers are removed for the camera one by one: a little girl of perhaps four with brown curly hair; a boy with his eyes still eerily open; another girl with huge injuries on the side of her head.

Villagers say up to 90 civilians died in last month’s attack by US forces

Another boy has his hand up as if to protect his face which was crushed under the rubble.

Clearly heard on the tape is the crying of relatives and the survivors of the bombing raid.

US forces had originally said seven civilians were killed in a “successful” US raid targeting a Taleban commander in Azizabad village in Herat’s Shindand district.

However, the UN, the Afghan government and an Afghan human rights group said the number of civilian deaths was far higher.

Their estimates of the number of civilians killed varied between 76 and 90, with the UN eventually concluding that children accounted for 60 of the dead.

The dispute over the figures had escalated into a fierce behind-the-scenes battle behind the UN and the Pentagon.

Warning over deaths

Meanwhile, Human Rights Watch said in a report released on Monday that decreased reliance on ground forces and greater use of air power was leading to “mistakes” that had “dramatically decreased” support for the Afghan government and international troops.

“Civilian deaths from air strikes act as a recruiting tool for the Taleban and risk fatally undermining the international effort to provide basic security to the people of Afghanistan,” Brad Adams, Asia director of HRW, said in a statement.

Afghan President Hamid Karzai visited Azizabad after the air strike

The group found that in 2007 at least 321 Afghan civilians had been killed in international air strikes – a rise from at least 116 in 2006.

This figure was much lower than the number of civilians killed in militant attacks, the group said. Nearly 950 people were killed by insurgents in 2008, compared with 700 in 2006.

HRW said most of the air strike casualties occurred in unplanned raids, when air power was called to give support to troops on the ground.

“The US and Nato need to dramatically improve their co-ordination with each other and with the government of Afghanistan,” HRW’s Rachel Reid told the BBC.

Afghan President Hamid Karzai has repeatedly warned the US and Nato that civilian deaths undermine his government and damage the reputation of foreign forces in the country.

Struggling with India’s gender bias

The number of female foetuses being aborted in India is rising, as ultrasound is increasingly used to predict the sex of babies.

What would you do if your husband’s family did not want you to have daughters – and insisted you took steps to make sure it did not happen?

Would you walk out or would you stay on and take a chance?

What if the bias against girls is reflected across society? Would that mean you could not make it on your own?

Vaijanti is an Indian woman who says she faces this dilemma.

She lives in the city of Agra, home to the Taj Mahal, perhaps the world’s most famous monument to a woman, the wife of a Mughal emperor.

“I had a lot of dreams in my heart,” Vaijanti says, “just like in the movies… but now I think of love as a betrayal.”

Vaijanti has taken her husband to court, saying he and his family insisted that she have an abortion because a scan showed she was expecting a girl.

Having already had one daughter, she says the pressure to abort the second child was intense.

So Vaijanti moved out of the marital home and now lives apart from her husband – with her two girls.

Gender skew

Testing and aborting for gender selection are illegal in India and Vaijanti’s husband and in-laws deny the charges against them.

Despite the obvious bitterness between her and her husband’s family, reconciliation is still possible.

Girls still face discrimination in modern Indian society

But Vaijanti was unsure of what to do next. We wanted to find out if she thought India really is a country biased against young girls.

Despite the law, some Indians clearly are using ultrasound techniques to scan for female foetuses, in order to abort them.

Figures suggest as many as a million such foetuses could be aborted every year in India.

It is unlikely nature alone accounts for this gender skew – in Delhi, for instance, only 821 girls are born for every 1,000 boys.

Many Indian families regard daughters as a liability.

Expensive dowries must be arranged for their weddings and they frequently move into their husband’s households – making it less likely they will support ageing parents.

As Vaijanti had never travelled beyond Agra, director Nupur Basu took her on a whistle-stop tour of India.

In Rajasthan, she meets Jasbir Kaur, who left her husband after facing a similar predicament.

Told she should abort her girl triplets, she decided to go ahead and have them anyway.

She is a potential role model for Vaijanti, telling her: “You must educate your girls. Don’t lose courage. Don’t feel alone.”

Although millions of Indian girls are still left out of formal education, Jasbir Kaur’s three girls are doing fine in the local school.

Icon of globalization

In Delhi, there is good and bad news. Vaijanti meets women who have come into Delhi filled with hope, but end up begging on the streets.

In many places, boys are unable to agree to find girls to marry. Because of this, the nation will soon face an unimaginable crisis Renuka Chowdhury Minister for women

She also visits a disco for the first time in her life – no den of iniquity but a place where she meets some bright young women with good cheer and strong advice.

In Bangalore, there are also two sides to the picture.

This is the city that is world famous as an icon of globalisation and woman’s empowerment.

It has young girls working in IT, making good careers, and scooting around town on mopeds, listening to their iPods.

But there is another Bangalore – where some families still demand the expensive dowries traditionally given by a bride’s family to the in-laws.

And while Bangalore’s senior managers may encourage women, younger men may still question their qualifications and their right to work.

Finally Nupur also takes Vaijanti to Mahatma Gandhi’s retreat, where she hears that the revered leader was concerned about the bias against women.

Writer Tridip Suhrud says Mahatma Gandhi “would have been deeply perturbed with this entire social surge of… civilization to acquire this hard militant, masculine self-identity”.

He adds: “He would have fought it with femininity.”

‘Grave situation’

We wanted to make this film after a leading development expert, Kevin Watkins, suggested India had a curiously ambivalent role in the globalisation debate.

The Taj Mahal was conceived as a monument to an emperor’s wife

Its booming economy is cause for hope, and the government is clearly concerned about both gender and economic inequality.

But if huge swathes of the populace do not share the increasing wealth, the whole Indian model of development may be called into question.

Meantime, Vaijanti’s immediate concern is India’s missing girls – unborn because of the desire to have boys.

Vaijanti and Nupur call on Renuka Chowdhury, the minister for women, who says: “This is a very, very grave situation.”

She adds: “In many places, boys are unable to agree to find girls to marry. Because of this, the nation will soon face an unimaginable crisis.”

When Vaijanti left Agra she was quiet but watchful. At the journey’s end, she is calm and eloquent as she weighs up whether to seek reconciliation with her husband’s family.

“I feel at peace… I will go back to Agra now and think about what I should do for my daughters and myself. I will go back and think about my decision.”

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A selection of your comments on this story:

Nowadays females are doing much better in many fields. I think it is time now that men pay a dowry to see how it feels. We as men would not have been here without women. In our family women have studied at a higher level than the men, so where is the difference? I have daughter and son, and as my daughter is older, I have explained to her that she will be the head of the household after us in all aspects.
Ganesh, Vijayawada, India

How very sad and so short-sighted to consider abortion because of gender. Some parts of China already face a serious shortage of women for the very same reason. Why can’t people recognise that both genders are valuable but for very different reasons? As someone who strongly advocates a woman’s right to reproductive choices, it seems to me that the worldwide problem is not gender, but rather overpopulation.
Lisa, United States

The practice of dowry-giving by the bride’s family devalues women in society and is responsible for the widespread practice of aborting female foetuses. The skewing of boys to women born to families represents a social time-bomb. The law in India must be rigorously enforced with immediate effect.
Shouvik Datta, Prague, Czech Republic

I don’t understand why in Indian and European cultures, the tradition of the woman’s family paying a dowry to the man’s came about. In Chinese culture, the dowry or “bride-gold” is paid by the man’s family – which makes a lot more sense considering how much labour and other economic benefits a housewife ends up contributing in an old-fashioned family.
Shi-Hsia Hwa, Penang, Malaysia

This article creates an impression that the cause of all the gender bias in India are males. That is not what I saw when growing up in India. Several of the discriminatory, abusive practices against females are carried on by females themselves. Many times men have no part in this, nor do they have such intentions.
Kamal, Portland, USA

India is definitely a country biased against young girls and I am stating this as a fact, being a girl born in India. It is still a matter of pride to bear a male child and people still express their deep sympathy for a girl child. It sickens and saddens me to see so much hypocrisy in our society where goddesses are worshipped in temples and female babies are aborted and killed at homes.
Anisa Chaudhary, USA

My mother was one of these ladies. She was married at the age of twelve and was pregnant by the age of thirteen and a half. My father found out that I was going to be a girl and ordered my mother to have an abortion. When she refused, he and my grandfather beat her. A tourist saw them and stopped them. My mother married this wonderful stranger who brought her here and accepted me as his daughter.
Nia, Johannesburg, South Africa