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.”

Search for clues in Madrid crash

Search for clues in Madrid crash

Examination of the wreckage began the morning after the crash

Accident investigators have begun examining the wreckage of a plane that crashed at Madrid’s Barajas airport, leaving 153 passengers dead.

They will also start to analyze the flight data and voice recorders, which have both been recovered.

Three days of official mourning have been declared in Madrid, as relatives arrive at a makeshift mortuary in the capital to identify bodies.

Nineteen people survived the crash and several are critically hurt.

Of the 19 survivors of Spanair flight JK 5022, four are listed as being in a “very serious” condition, with another six only slightly better, Spain’s El Pais newspaper reported on Thursday. Eight remain under observation with one only slightly injured, the newspaper said.

The worst is the identification of the bodies. It is the end of all hope Jesus Lopez Santana Spanish Red Cross

Spanish Prime Minister Jose Luis Rodriguez Zapatero is expected to visit the injured in Madrid’s hospitals, while King Juan Carlos will visit Barajas airport.

The king is also likely to visit anxious families waiting for the grim confirmation that their loved-ones are among the dead.

Experts at a temporary mortuary near the airport say work to identify the dead is likely to be slow and painstaking, as many of the bodies were badly burned in Wednesday’s inferno.

“The worst is the identification of the bodies,” Red Cross spokesman Jesus Lopes Santana told the El Mundo newspaper.

“It is the end of all hope and when we see the worst scenes, because the majority of the relatives break down when they hear the news.”

The Spanair flight, bound for Las Palmas in the Canary Islands, took off on Wednesday lunchtime with 172 people on board, among them 10 crew.

Initial reports suggested that a fire had broken out in one of the MD82 plane’s engines during or shortly after take-off, and the plane ended up in a field.

Spanish Transport Minister Magdalena Alvarez said the plane had earlier begun taxiing to the runway, before turning back because of a technical problem, which had caused an hour’s delay in the take-off.

Spanish media said the pilot had reported a fault with a temperature gauge, but it was thought to have been fixed.

Speaking on Thursday, Ms Alvarez said a thorough investigation would be carried out, with a full examination of the flight recorders and available pictures, but that it was very early to draw conclusions about the crash.

A special independent commission has been established to probe the cause of the crash, Spanish media reported.

Anger

Spanair has released the official passenger manifest, confirming reports that 20 children and two babies were on board the plane.

Among those who survived were three children, aged six, eight and 11, reports said. At least one of the 19 survivors has yet to be identified.

Overnight a long convoy of black hearses rolled out of the airport grounds to carry bodies to the makeshift mortuary, where the victims’ relatives had gathered, some of whom had traveled from the Canary Islands.

The convention center on the outskirts of the capital was also used as a mortuary after the Madrid train bombings four years ago.

Many of the relatives have expressed anger and disgust at Spanair, blaming it for the accident.

He says the injured include a young brother and sister, who immediately asked rescue workers about their parents.

Spanish ministers said foul play had been ruled out and the crash was considered to be an accident.

The 15-year-old plane had passed a safety inspection in January, said Sergio Allard, a spokesman for Spanair, which is owned by Scandinavian firm SAS.

Spanish media said some German, Swedish, Chilean and Colombian nationals had been among the passengers.

‘All destruction’

Spanish Prime Minister Jose Luis Zapatero cut short his holiday in the south of the country to visit the scene of the crash.

A convoy of hearses removed bodies from the scene of the crash

Speaking at the airport, he said that “the government is overwhelmed, very affected, as are all Spanish citizens, by this tragedy”.

Television images on Wednesday showed plumes of smoke rising over the field in which the remains of the plane were resting.

Emergency services chief Ervigio Corral said that rescue workers had been faced with “a desolate scene”.

“You couldn’t distinguish that there was an aircraft there apart from the remains of the tail,” he said. “There was nothing of fuselage.”

Another rescue worker, Pablo Albella, told AP news agency: “The fuselage is destroyed. The plane burned. I have seen a kilometer of charred land and few whole pieces of the fuselage. It is all destruction.”

Messages of sympathy have been sent to Spain by leaders around the world.

The presidents of Russia, France and Italy, Germany’s chancellor and Britain’s queen joined with Latin American leaders in sending their condolences.

It was the deadliest air accident in Spain since a Colombian airline’s Boeing 747 crashed in Madrid in 1983 killing 181 people.

People concerned for relatives or friends who might have been on board the plane can call Spanair’s helpline on +34 800 400 200 (calls possible from inside Spain only).

MD82 AIRCRAFT Passengers 150-170 Cruise speed 504mph (811km/h) Length 45.1m (148ft) Height 9m (29.5ft) Wing-span 32.8m (107.6ft) Maximum range 2,052 nautical miles (3,798km)

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