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Thesis: Substance-Exposed Newborns in Arizona: An Analysis of Medically, Ethically, and Legally Appropriate Federal and State Responses
In an attempt to discover, analyze, and compile those complex issues with which community health workers should be knowledgeable, this project explores existing federal regulations regarding substance-exposed newborns, compares Arizona’s regulations to Minnesota’s, Virginia’s, and Washington’s, and analyzes prevailing literature in the field about the various implications associated with screening and reporting substance-exposed newborns to law enforcement authorities.
Format: Essays and Theses
The Guthrie Test for Early Diagnosis of Phenylketonuria
The Guthrie test, also called the PKU test, is a diagnostic tool to test infants for phenylketonuria a few days after birth. To administer the Guthrie test, doctors use Guthrie cards to collect capillary blood from an infant’s heel, and the cards are saved for later testing. Robert Guthrie invented the test in 1962 in Buffalo, New York. Phenylketonuria (PKU) is a congenital birth abnormality in which toxic levels of the amino acid phenylalanine build up in the blood, a process that affects the brains in untreated infants.
HIP Randomized Breast Cancer Screening Trial (1963–1982)
From 1963 to 1982, researchers in New York City, New York, carried out a randomized trial of mammography screening. Mammography is the use of X-ray technology to find breast cancer at early stages. The private insurance company Health Insurance Plan of Greater New York, or HIP, collaborated with researchers Sam Shapiro, Philip Strax, and Louis Venet on the trial. The researchers’ goal was to determine whether mammography screening reduced breast cancer mortality in women. The study included sixty thousand women aged forty to sixty-four.
"Screening for Congenital Hypothyroidism" (1991), by Delbert A. Fisher
In his 1991 article Screening for Congenital Hypothyroidism, Delbert A. Fisher in the US reported on the implementation and impact of mass neonatal screening programs for congenital hypothyroidism (CH) from the early 1970s through 1991. CH is a condition that causes stunted mental and physical development in newborns unless treatment begins within the first three months of the newborn's life. In the early 1970s, regions in Canada and the US had implemented screening programs to diagnose and treat CH as quickly as possible after the infant's birth.
Subject: Publications, Technologies
"Maternal Thyroid Deficiency During Pregnancy and Subsequent Neuropsychological Development of the Child" (1999), by James E. Haddow et al.
From 1987 to the late 1990s, James Haddow and his team of researchers at the Foundation for Blood Research in Scarborough, Maine, studied children born to women who had thyroid deficiencies while pregnant with those children. Haddow's team focused the study on newborns who had normal thyroid function at the time of neonatal screening. They tested the intelligence quotient, or IQ, of the children, ages eight to eleven years, and found that all of the children born to thyroid-hormone deficient mothers performed less well than the control group.
Robert Guthrie (1916–1995)
Robert Guthrie developed a method to test infants for phenylketonuria (PKU) in the United States during the twentieth century. PKU is an inherited condition that causes an amino acid called phenylalanine to build to toxic levels in the blood. Untreated, PKU causes mental disabilities. Before Guthrie’s test, physicians rarely tested infants for PKU and struggled to diagnosis it. Guthrie’s test enabled newborns to be quickly and cheaply screened at birth and then treated for PKU if necessary, preventing irreversible neurological damage.
“The Impact of Emotional and Physical Violence During Pregnancy on Maternal and Child Health at One Year Post-partum” (2011), by Sarah McMahon, Chien-Chung Huang, Paul Boxer, Judy L. Postmus
In 2011, Sarah McMahon and colleagues published “The Impact of Emotional and Physical Violence During Pregnancy on Maternal and Child Health at One Year Post-partum,” hereafter, “The Impact,” in the journal, Child and Youth Services Review. While existing studies had indicated negative chronic effects resulting from intimate partner violence, or IPV, such as miscarriage and premature labor, there was little research specifically analyzing the separate and joint effects of psychological and physical abuse on pregnant women and fetuses.
Subject: Processes, Technologies
Dennis Lo (1963- )
Dennis Lo, also called Yuk Ming Dennis Lo, is a
professor at the Chinese University of Hong Kong in Hong Kong,
China. In 1997, Lo discovered fetal DNA in maternal
plasma, which is the liquid component of a pregnant woman's
blood. By 2002, Lo distinguished the DNA differences between pregnant women
and their fetuses, enabling scientists to identify fetal DNA in pregnant
women's blood. Lo used his discoveries to develop several
non-invasive and prenatal genetic tests, including tests for blood
Subject: People, Reproduction
The Effectiveness of Phototherapy in Premature Infants (1968)
In 1968, pediatric researchers Jerold Lucey, Mario Ferreiro, and Jean Hewitt conducted an experimental trial that determined that exposure to light effectively treated jaundice in premature infants. The three researchers published their results in 'Prevention of Hyperbilirubinemia of Prematurity by Phototherapy' that same year in Pediatrics. Jaundice is the yellowing of the skin and eyes due to the failure of the liver to break down excess bilirubin in the blood, a condition called hyperbilirubinemia.
US Endocrine Disruptor Screening Program
In 1996, the US Congress mandated that the US Environmental Protection Agency (EPA) create and regulate the Endocrine Disruptor Screening Program. The program tests industrial and agricultural chemicals for hormonal impacts in humans and in wildlife that may disrupt organisms' endocrine systems. The endocrine system regulates the release of small amounts of chemical substances called hormones to keep the body functioning normally.
Jérôme Lejeune (1926−1994)
Jérôme Lejeune was a French physician and researcher who studied genetics and developmental disorders. According to the Jérôme Lejeune Foundation, in 1958, Lejeune discovered that the existence of an extra twenty-first chromosome, a condition called Trisomy 21, causes Down Syndrome. Down Syndrome is a condition present in an individual since birth and is characterized by physical and developmental anomalies such as small ears, a short neck, heart defects, and short height as children and adults.
Virginia Apgar (1909–1974)
During the mid-twentieth century, Virginia Apgar worked as an obstetrical anesthesiologist and gave drugs to women that reduced their pain during childbirth in the US. In 1953, Apgar created a scoring system, called the Apgar score, that uses five measurements, including heart rate and breathing rate. The Apgar score evaluates newborn infants and determines who needs immediate medical attention. Apgar's work helped decrease infant mortality rates. As of 2020, hospitals around the world use the Apgar score.
Exchange Transfusion for Jaundiced Newborns in the United States
Exchange transfusion is the replacement of blood from newborn infants with elevated bilirubin level in their blood stream with donor blood containing normal bilirubin levels. Newborn infants that experience jaundice, the yellowing of the skin and eyes, have a buildup of bilirubin, a chemical that occurs during red blood cell breakdown, or hemolysis. Exchange transfusion is a therapy developed throughout the 1940s by Louis Diamond and a group of surgeons at the Children’s Medical Center in Boston, Massachusetts.
Management of Myelomeningocele Study Clinical Trial (2003–2010)
From February 2003 to December 2010, researchers of the Management of Myelomeningocele Study, or MOMS, clinical trial compared the safety and efficacy of different treatments for a specific type of spina bifida, called myelomeningocele. Myelomeningocele, the most frequent and severe form of spina bifida, is a condition in which the bony spinal column does not develop correctly, which causes an opening of the spine, exposure of the spinal cord, and formation of a small sac containing cerebrospinal fluid.
40 Weeks (2014)
In 2014, Big Belli, a media and social networking brand, released a documentary called 40 Weeks online. The documentary, directed by Christopher Henze, followed multiple women during their pregnancies. The film predominantly features three women, though it includes the stories of many. Throughout the film, women detail their accounts of the physical and emotional changes that occur during pregnancy.
"A Proposal for a New Method of Evaluation of the Newborn Infant" (1953), by Virginia Apgar
In 1953, Virginia Apgar published the article "A Proposal for a New Method for Evaluation of the Newborn Infant" about her method for scoring newborn infants directly after birth to assess their health and whether medical intervention was necessary. Apgar worked at the Presbyterian Hospital in New York City, New York, as an obstetrical anesthesiologist, a physician who administers pain medication during childbirth.
Evaluation of the Newborn Infant--Second Report (1958), by Virginia Apgar et al.
Virginia Apgar and colleagues wrote “Evaluation of the Newborn Infant—Second Report” in 1958. This article explained that Apgar’s system for evaluating infants’ condition after birth accurately predicted the health of infants. Apgar had developed the scoring system in 1953 to provide a simple method for determining if an infant needed medical attention after birth.
Subject: Reproduction, Publications
Ian Donald (1910–1987)
Ian Donald was an obstetrician who developed the technology and therapy of ultrasound diagnostics during the twentieth century in Europe. Ultrasound is a medical diagnostic technique that uses sound waves to produce images of the inside of the body. During the early 1900s, physicians had no way to see inside a woman’s uterus during pregnancy. Donald developed the first method of scanning human internal anatomy in real time, which enabled doctors to diagnose potentially fatal tumors and cysts.
“Screening for Breast Cancer with Mammography” (2013), by Peter Gøtzsche and Karsten Jørgensen
Screening for Breast Cancer with Mammography is a Cochrane systematic review originally published by Peter Gøtzsche and Karsten Jørgensen in 2001 and updated multiple times by 2013. In the 2013 article, the authors discuss the reliability of the results from different clinical trials involving mammography and provide their conclusions about whether mammography screening is useful in preventing deaths from breast cancer.
Environment and Birth Defects (1973), by James G. Wilson
Environment and Birth Defects by James Graves Wilson in the US was published in 1973. The book summarized information on the causes of malformations in newborns and aimed to acquaint policy makers with Wilson's suggestions for predicting the risks of environmental causes of birth defects, called teratogens. Wilson also provided six principles for researching teratogens, a framework revised from his 1959 article Experimental Studies on Congenital Malformations. The book has ten chapters.
Gestational diabetes is a medical condition that causes blood sugar levels to become abnormally high, which manifests for the first-time during pregnancy and typically disappears immediately after birth for around ninety percent of affected women. While many women with the condition do not experience any noticeable symptoms, some may experience increased thirst and urination.
Subject: Reproduction, Disorders
Eric Wieschaus (1947- )
Eric Wieschaus studied how genes cause fruit fly larvae to develop in the US and Europe during the twentieth and twenty-first centuries. Using the fruit fly Drosophila melanogaster, Wieschaus and colleague Christiane Nusslein-Volhard described genes and gene products that help form the fruit fly body plan and establish the larval segments during embryogenesis. This work earned Wieschaus and Nüsslein-Volhard the 1995 Nobel Prize in Physiology or Medicine.
Neonatal Respiratory Distress Syndrome and Its Treatment with Artificial Surfactant
Neonatal respiratory distress syndrome, previously called hyaline membrane disease, is a respiratory disease affecting premature newborns. Neonatal respiratory distress syndrome involves shallow breathing, pauses between breaths that last a few seconds, or apnea, and a bluish tinge to the infant’s skin. The syndrome occurs when microscopic sacs called alveoli in infant lungs do not produce surfactant, a liquid that coats the inside of the lungs and helps them inflate during breathing.
“Of Pregnancy and Progeny” (1980), by Norbert Freinkel
Norbert Freinkel’s lecture Of Pregnancy and Progeny was published by the American Diabetes Association’s journal Diabetes in December of 1980. In the lecture, Freinkel argued that pregnancy changes the way that the female body breaks down and uses food. Through experiments that involved pregnant women as well as infants, Freinkel established the body’s maternal metabolism and how it affects both the mother and the infant. Freinkel’s main focus of research in the latter part of his life was diabetes, specifically in pregnant women.