Reducing Respiratory Virus in Preemies Lessens Wheezing: Study

But preventing respiratory synctial virus comes with a hefty price tag

By Serena Gordon

HealthDay Reporter

WEDNESDAY, May 8 (HealthDay News) -- Many pre-term babies suffer recurrent episodes of wheezing. Now, researchers say a common infection is a likely culprit and they may be able to prevent the breathing problems.

Wheezing episodes in late pre-term babies often are caused by infection with the respiratory synctial virus (RSV), the researchers said. And they've found that injections of an expensive RSV medication can prevent the virus -- and the wheezing.

A study of more than 400 babies born late pre-term (between 33 and 35 weeks' gestation) found that days with wheezing dropped by more than 60 percent among those who received injections of palivizumab during RSV season. The effect lasted even after treatment ended.

"In pre-term babies, RSV illnesses seem to be a risk factor for wheezing, and this treatment reduced that risk," said Dr. Robert Lemanske Jr., a professor of pediatrics and medicine at the University of Wisconsin School of Medicine and Public Health, in Madison. Lemanske wrote an editorial accompanying the new study, which was published May 9 in the New England Journal of Medicine.

RSV is a global health threat in the first year of life and the second leading cause of death after malaria, said study lead author Dr. Louis Bont, a pediatric infectious disease specialist at the University Medical Center Utrecht in the Netherlands.

"The risk of hospitalization for RSV bronchiolitis in otherwise healthy late pre-term [babies] is 5 percent," Bont said. "For other pre-terms, it is higher. About half of all otherwise healthy late pre-terms develop wheezing illness."

RSV-related wheezing reduces quality of life, and it has been linked to the development of asthma, Bont said. It's not yet clear if using palivizumab to prevent RSV will lower rates of asthma, he added.

RSV season lasts about four to five months during the fall, winter or spring, but the exact timing in the United States varies by region, according to the U.S. Centers for Disease Control and Prevention. There is no vaccine for the virus, which causes only mild symptoms in adults and older children.

The study was funded by Abbott Laboratories and the Netherlands Organization for Health Research and Development. Abbott markets palivizumab in some foreign countries.

The researchers set out to determine if RSV was the cause of wheezing illness during the first year of life. Studying 429 babies in the Netherlands, they randomly assigned half to receive a monthly injection of palivizumab during RSV season. The other half received a placebo drug.

The babies in the treatment group had 61 percent fewer days of wheezing during the first year of life. This led the researchers to conclude that RSV is a likely contributor to wheezing illness in this group of children.

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Lullabies Soothe Preemies, Parents Alike

By Maureen Salamon
HealthDay Reporter

MONDAY, April 15 (HealthDay News) -- Lullabies have been used to soothe babies since time immemorial. Now, scientists say that premature infants in particular can benefit from combining this tactic with other forms of music therapy, such as simulated womb sounds synchronized to preemies' vital signs.

Studying 272 infants in 11 hospital neonatal intensive care units (NICUs), researchers from Beth Israel Medical Center in New York City found that live music matched to babies' breathing and heart rates enhanced feeding and sleeping patterns. Parent-selected lullabies also seemed to promote bonding between parents and babies, easing the stress of the chaotic NICU environment.

"Historically, premature infants were thought to be best off left alone in a quiet, closed incubator with no stimulation," said study author Joanne Loewy, director of Beth Israel's Louis Armstrong Center for Music & Medicine.

However, she added, "In more recent times, we're seeing that the right kind of stimulation -- particularly live, interactive music -- can enhance babies' neurological function and increase their quiet-alert state. It helps them through those tough moments . . . the more we can regulate the sound environment, the better they're going to fare."

The study was released online April 15 in advance of publication in the May print issue of the journal Pediatrics.

Loewy and her colleagues examined the effects of three different types of music therapy interventions on premature babies. The infants were born at least 32 weeks into gestation and were small for their gestational age or suffered from conditions including respiratory distress and sepsis.

Three times each week for two weeks, certified music therapists used devices called Remo ocean discs and gato boxes, which replicated "whoosh" and heartbeat womb sounds while synchronized with infants' breath and heart patterns. Parents or therapists also sung the lullabies preferred by the babies' parents (called "songs of kin"), or "Twinkle, Twinkle Little Star" when parents had no preference.

Compared to babies not receiving any music therapies, babies who did showed more positive health effects such as better sleeping and feeding patterns. Those exposed to the ocean disc sounds experienced improved blood-oxygen levels and quiet-alert states. Additionally, parents' perception of stress in the NICU environment significantly decreased with the interventions, the study said.

"Many NICUs are noisy, or people put on random lullabies that are recorded," Loewy said. "What we're saying is, it's not just any old lullaby that's recorded, it's the power of the parent's voice synchronized therapeutically . . . and the other two sounds that can have a therapeutic benefit."

Dr. Joseph Awadalla, a neonatologist at Redlands Community Hospital, in California, agreed that such therapy helps premature infants thrive. He noted that womb-like sounds have been used in some hospitals for at least the last 20 years to soothe and relax babies.

"I'm aware that not all the [NICUs] do this kind of therapy," Awadalla said. "There should be no obstacle to using it -- there just needs to be an understanding from the staff that choosing it will help."

The cost of such therapy is minimal, study author Loewy said, and depends on the region of the United States a hospital is located. In the mid-Atlantic region, for example, certified music therapists cost about $65 per hour, and a typical session with each infant would last for 10 to 15 minutes, she said.

"In terms of the cost, when you're able to better regulate [a preemie's] vital signs, that's going to lead to less days in the hospital and less expense for [medications]," she added.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Joanne Loewy, D.A., director, Louis Armstrong Center for Music & Medicine, Beth Israel Medical Center, New York City; Joseph Awadalla, M.D., neonatologist, Redlands Community Hospital, Redlands, Calif.; May 2013 Pediatrics

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