The ICPCN has responded as follows to the sudden increase in children born with microcephaly in certain countries and the likely link to mothers being infected by the Zika virus during pregnancy.

"As the ICPCN we are concerned about the reported number of babies born with microcephaly and other neurological complications, especially in Brazil and in the Americas, and we are pleased that the World Health Organization (WHO) has advised that this situation constitutes an extraordinary event and public health threat. Whether or not the Zika virus will be shown to be the cause, the real tragedy is the thousands of babies born with these anomalies and the impact on so many families left caring for babies with disabilities and a possible limited life-expectancy.

While we fully support WHO Director-General Dr Margaret Chan’s call for an international response to reduce the threat; as concerned children’s palliative care advocates we call for an international response to provide palliative care, including support for the families, from the perinatal period and throughout the shortened lives of many of these very vulnerable babies.“
Joan Marston, CEO

Link to birth defects

There have been reports of pregnant mothers infected with the Zika virus during pregnancy giving birth to babies with congenital microcephaly, a condition where a baby's head is considerably smaller than normal. Studies are in progress to investigate this association. Microcephaly can be diagnosed during pregnancy with ultrasound, most successfully late in the 3rd trimester.

While this link has not as yet been fully established, the Centre for Disease Control recommends special precautions for all women who are pregnant and for those considering becoming pregnant.

Some facts

- The Zika virus is spread primarily through the bite of an infected Aedes species of mosquito.

- Symptoms are usually mild and can include fever, rash, joint pain and conjunctivitis which appear between 2 to 7 days after being bitten by an infected mosquito.

- Zika can only be confirmed via blood tests

Prevention: The best prevention is to avoid being bitten by wearing protective clothing and using insect repellent. However, it is not recommended to use insect repellent on children younger than 2 years of age.

Prevalence: Click here for a map showing where there is presently active transmission of the Zika virus.

Guidelines: ICPCN is developing a set of guidelines on providing palliative care for children with microcephaly and other neurological conditions. These guidelines will be made available on our website and will include translations in Spanish and Portuguese.

ICPCN website: http://www.icpcn.org/

The article by Ian Johnston appeared on the Independent newspaper website on 28th January 2016. The first two paragraphs:

Children and adolescents are twice as likely to exhibit suicidal or aggressive behaviour if they take commonly prescribed antidepressants, according to a new study.

Researchers also found that reports on clinical trials by drug companies frequently downplayed the most serious side-effects, which they only discovered by looking at the raw patient data.

Read the full news article:  http://www.independent.co.uk/news/science/children-given-antidepressants-are-twice-as-likely-to-become-suicidal-claims-new-study-a6838291.html

BMJ Paper

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports

By Tarang Sharma, Louise Schow Guski, Nanna Freund and Peter C Gøtzsche

Abstract:

Objective To study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors.

Design Systematic review and meta-analysis.

Main outcome measures Mortality and suicidality. Secondary outcomes were aggressive behaviour and akathisia.

Data sources Clinical study reports for duloxetine, fluoxetine, paroxetine, sertraline, and venlafaxine obtained from the European and UK drug regulators, and summary trial reports for duloxetine and fluoxetine from Eli Lilly’s website.

Eligibility criteria for study selection Double blind placebo controlled trials that contained any patient narratives or individual patient listings of harms.

Data extraction and analysis Two researchers extracted data independently; the outcomes were meta-analysed by Peto’s exact method (fixed effect model).

Results We included 70 trials (64 381 pages of clinical study reports) with 18 526 patients. These trials had limitations in the study design and discrepancies in reporting, which may have led to serious under-reporting of harms. For example, some outcomes appeared only in individual patient listings in appendices, which we had for only 32 trials, and we did not have case report forms for any of the trials. Differences in mortality (all deaths were in adults, odds ratio 1.28, 95% confidence interval 0.40 to 4.06), suicidality (1.21, 0.84 to 1.74), and akathisia (2.04, 0.93 to 4.48) were not significant, whereas patients taking antidepressants displayed more aggressive behaviour (1.93, 1.26 to 2.95). For adults, the odds ratios were 0.81 (0.51 to 1.28) for suicidality, 1.09 (0.55 to 2.14) for aggression, and 2.00 (0.79 to 5.04) for akathisia. The corresponding values for children and adolescents were 2.39 (1.31 to 4.33), 2.79 (1.62 to 4.81), and 2.15 (0.48 to 9.65). In the summary trial reports on Eli Lilly’s website, almost all deaths were noted, but all suicidal ideation events were missing, and the information on the remaining outcomes was incomplete.

Conclusions: Because of the shortcomings identified and having only partial access to appendices with no access to case report forms, the harms could not be estimated accurately. In adults there was no significant increase in all four outcomes, but in children and adolescents the risk of suicidality and aggression doubled. To elucidate the harms reliably, access to anonymised individual patient data is needed.

More information about the paper: http://www.bmj.com/content/352/bmj.i65

This conference is hosted by Perinatal Services BC, an agency of the Provincial Health Services Authority. It is an opportunity for health care professionals interested in the care of pregnant and postpartum women and their newborns to be updated on new research and clinical best practices across the continuum of perinatal and newborn care.

This conference will engage health care professionals from a wide range of disciplines in knowledge transfer and interprofessional collaboration in order to provide the best care possible and ensure healthy mothers and babies. The format will include plenaries, breakout sessions, poster sessions, and networking opportunities.

Visit: http://interprofessional.ubc.ca/HealthyMothersHealthyBabies2016/