Ultrasound

Is there a connection to Gastro-esophageal Reflux in Babies?
By Elisabeth Madsen, B.Sc, DC, MCC(Paeds)
Nov-Dec 2002.

I have noticed in my practice what appears to be a worrying trend. Many babies presenting to my clinic with persistent and severe gastro-oesophageal reflux (GER) have been exposed to multiple ultrasounds prenatally. Has anybody else seen this? Is this something we ought to study?

Gastro-oesophageal reflux (GER) in infancy

Gastro-oesophageal reflux is a common condition occurring in young babies (approximately 4 in 10 babies) whereby milk and stomach acid spill back from the stomach into the oesophagus (gullet). This apparently occurs due to an immature lax valve allowing back-flow. This back-flow is called posseting if the vomits are only small spills. Doctors believe that this posseting and vomiting can cause pain similar to that of 'heartburn', and make the baby unsettled. (Reflux is worse if the baby has a cold). Most infants will remain healthy and thrive with symptoms settling down between 6 and 10 months of age when the infant starts to become more upright.

Vomiting due to reflux may occur at any time but especially after a feed. A baby may refuse to feed despite hunger because of the pain of the inflamed gullet or he may want to feed constantly as the milk may temporarily sooth the burning. Baby may be irritable just at certain times, especially when lying down for a while, or he could be irritable all day. Some babies have reflux without vomiting. Reflux is diagnosed clinically. Investigations include barium meal, endoscopy with biopsy (to diagnose oesphagitis with inflamed gullet), and pH manometry (measurement of acidity in the gullet over 24 hour period).

Parents are told by doctors to:

1. Maintain posture; A more upright posture helps keep the acid contents in the stomach and therefore relieves the pain from the inflamed gullet. When feeding try to sit the baby up or feed with baby prone on mother's body with her back reclining at a 30 degree angle. Keep the baby upright while winding and for 30 minutes after a feed. The 30-degree prone position is the best for relief of reflux and irritability. If the baby does not like lying on his tummy try sitting him upright in a buggy or car seat to an angle of at least 60 degrees. However, the car seat encourages slumping and many babies are often irritable if left in it for long. A baby sling may also be useful in keeping a wakeful baby upright. The baby can also be propped up with pillows while changing a nappy. (diaper)

2. Feeding; After three months of age it becomes increasingly difficult to sit baby still in these positions so more attention needs to be given to thickening feeds.

3. Medications; A number of medications may help relieve reflux but should only be started after consultation with a GP.

(a) Agents to thicken feeds to reduce vomiting.
Infracol food thickener can be mixed with boiled water or expressed breast milk and given by spoon, syringe or bottle with each feed. Or Infant Gaviscon 1/2 to 1 teaspoon can be mixed with boiled water or expressed breast milk and given by spoon or syringe. It causes feces to look 'sandy' and may cause constipation.
(b) Antacid.
(c) Colief -helps digest the milk protein
(d) Homeopathic remedy - colocynth

Referral to specialist is recommended:
1. If these measures are not successful.
2. If any blood flecks (sometimes looking like 'coffee grounds') are noticed in the vomits.
3. The baby is failing to put on weight.
4. The baby has respiratory problems associated with the reflux such as cough, breathing difficulties or pneumonia.
5. The reflux symptoms persist beyond 12 months of age.

Severe cases may require stomach acid blockers or in extreme cases surgery.

The presence of a motility disturbance of the stomach has been reported in GER, but is generally felt to be less common. Abnormalities in gastric motility have been reported both using nuclear medicine looking at emptying times and by measuring antral motor activity with motility catheters.

It is felt that the majority of these gastric emptying disturbances are related to abnormalities in gastric electrical activity. This abnormal activity may consist of rapid electrical activity (tachygastria) or slowed activity (bradygastria). The authors were able to confirm an increased prevalence of abnormal electrical activity in children with GER.2

Another study showed that the epithelial permeability in the stomach to hydrogen ions differs between healthy subjects and patients with active GER.3 All, these studies show, is simply that there is impaired function. Chiropractic has been shown to affect stomach acidity and gastric motility by by having a direct stimulating affect on the thoracic sympathetic nerves and on the vagus nerve."

Ultrasound

Ultrasound scans, which were introduced in the 1960s, have long been regarded as a safe means of checking on the health of unborn children. The scanners use high-frequency sound waves to give X-ray-like images of the inside of the womb, but without using radiation. Between the 1960s and today, the number of pregnant women having scans in the UK and western Europe has increased from a handful to virtually all of them, but there is little published on adverse foetal effects. We keep getting reassured by the medical profession that it is perfectly safe, but is it?

Doctors and scientists caution that until further studies are carried out, mothers-to-be should still regard scanning as safe. If confirmed, however, new findings would mean that ultrasound scans are causing slight brain damage in thousands of babies in Britain each year.

Scientists have called for further research to determine whether safety limits should be reviewed for ultrasound tests, which are also used to check internal organs in children and adults.

Since the early 1990s, when American researchers showed that ultrasound tissue heating can cause bleeding in mouse intestines9, and chromosomal changes10,11,12 ultrasonographers have turned down the power of scans to reduce heating. The latest discovery, by scientists at University College Dublin, is the first to find that scans create changes in cells. Patrick Brennan, who led the research, said: "It has been assumed for a long time that ultrasound has no effect on cells. We now have grounds to question that assumption."1 According to the New Scientist, two significant changes in the cells of the small intestine were detected in scanned mice compared with unscanned mice. Four and a half hours after exposure, the rate of cell division had reduced by 22 per cent and the rate of programmed cell death had approximately doubled.

Dr. Taylor, who is Professor of Diagnostic Radiology and Chief of the Ultrasound Section at Yale University School of Medicine, New Haven, Connecticut, makes the following statement in the article:1 "I would not let anybody get near my infant's head with a transducer unless I knew what the output was."1 How many parents could make an informed choice about this matter?

In the US, the FDA has recommended not using routine ultrasound unless there is bleeding, history of birth defects, or "other possible dangers". This is apparently due to the fact that ultrasound waves are known to generate heat. This heat may cause microscopic bubbles in body fluids of the foetus to oscillate and collapse. Additional concerns arose when studies showed a possible link between ultrasound and growth retardation in the foetus. This factor was noticed in animals, which had been exposed to frequent ultrasound imaging similar to that, which is performed on humans.

The same condition was observed in the development of unborn babies in a group, which underwent five or more ultrasound imaging and Doppler studies between 18 and 38 weeks. In this group, the proportion of growth-restricted foetuses was increased by one third, as opposed to a second group, which received either no imaging study or a single one at 18 weeks gestation, in which no significant changes were noted. According to their report:

"Neither early, late, nor serial ultrasound in normal pregnancy has been proven to improve perinatal morbidity or mortality. Clinical trials show that a single mid-trimester ultrasound examination detects multiple gestations and congenital malformations earlier in pregnancy, but there is currently insufficient evidence that early detection results in improved outcomes."17

A Swedish study published in 200017 estimated relative risks for being born left-handed according to ultrasound exposure in fetal life using logistic regression analysis. Eligible for the study were 6,858 men born at a hospital that included ultrasound scanning in standard antenatal care (exposed) and 172,537 men born in hospitals without ultrasound scanning programs (unexposed). During the introduction phase (1973 to 1975) there was no difference in left-handedness between ultrasound exposed and unexposed. When ultrasonography was offered more widely (1976 to 1978), the risk of left-handedness was higher among those exposed to ultrasound compared with those who were not exposed. "We conclude that ultrasound exposure in fetal life increases the risk of left-handedness in men, suggesting that prenatal ultrasound affects the fetal brain."

A study of over 1400 women in Perth 6, Western Australia compared pregnant mothers who had ultrasound only once during gestation with mothers who had five monthly ultrasounds from 18 weeks to 38 weeks. They found significantly higher intrauterine growth restriction in the intensive ultrasound group. These mothers gave birth to lower weight babies. The researchers concluded that prenatal ultrasound imaging and Doppler flow exams should be restricted to clinically necessary situations. This recommendation comes at a time when ultrasound during prenatal visits has become increasingly popular and serves as a kind of entertainment feature of office check-up visits. Several studies 6,15,18,19 say that ultrasound screening of low-risk women provides no clinical benefits for mother or baby, and did not change the
rate of adverse perinatal outcomes One study discusses readings of false positive and false negative in placenta previa and growth retardation. Another article13 states: "Preliminary data from the United Kingdom suggests a higher incidence of leukaemia is found in children exposed to diagnostic ultrasound.

Kempaainen's study20 revealed that 150 women were diagnosed by ultrasound as having placenta praevia; when they got to term only 4 women actually had it. The control group, women who were not exposed to ultrasound, also had 4 women whose placenta praevia was discovered when they went into labour. Both sets of women had caesarean sections and there was no difference in outcomes. The researchers did not investigate the amount of stress a diagnosis of placenta praevia could have caused in the 146 misdiagnosed women.

Conclusion

There are of course many factors, which influence foetal development and many theories as to what the long-term effects of ultrasonography are. Some believe the rise in asthma and allergies in the last 30 years is due to ultrasound exposure. Is there a link between increased sensitivity of the stomach epithelial tissues and in-utero exposure to ultrasound? I can find no research on this subject. Or is GER caused by somato-visceral reflexes induced by the trauma of birth? It would certainly seem the wisest choice is to avoid all routine absolutely unnecessary ultrasound scans for foetal observation. There appears to be more than enough evidence to support this recommendation. Pregnancy complications are another issue and we would have to weigh all the factors individually when attempting to determine the benefit/risk ratio.

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http://pathwaystofamilywellness.org/references.html