Milivoj Jovančević - Poliklinika Salvea

Omega-3 fatty acids and early brain development

Milivoj Jovančević — Mon, 15 Jan 2024 12:27:39 +0000

Omega-3 polyunsaturated fatty acids are particularly important in the diet of pregnant women and young children for two major reasons. Firstly, these fatty acids play a crucial role in cell building and the regulation of vital processes. Secondly, the human body cannot synthesize them on its own and is entirely dependent on dietary intake.

Importance of omega-3 fatty acids in prenatal development

During prenatal development, brain cells form at an astonishing rate of approximately 250,000 cells per minute. By the middle of pregnancy (around the twentieth week of fetal development), billions of neurons are already created.

The influence of a child’s nutrition on brain development is most significant during the prenatal period. Quality nutrition and good health are closely linked throughout life, but this connection is most pronounced in the early years. Poor nutrition can lead to weaker cognitive development, reduced attention and concentration, and lower success in later life. At birth, the brain reaches 70% of its adult size and 25% of its adult weight.

In the subsequent period, new brain cells (neurons) continue to form and migrate to their final destinations. Stimulated by external inputs, brain cells create connections (synapses), enabling them to communicate with each other. Given these rapid and complex processes of brain development, it is crucial to provide children with everything they need for optimal growth and development. The fastest brain growth in a human’s life occurs in the last trimester of pregnancy.

Sources of omega-3 fatty acids for pregnant women

During this period, it is advisable to avoid consuming long-lived predatory fish due to the higher concentration of mercury naturally found in the environment. Smaller oily fish, such as sardines, are an excellent source of omega-3 fatty acids. These fats are broken down in the body into docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA makes up over 50% of the brain’s building material and about 65% of the retina. Besides being a structural component of the brain, these breakdown products of omega-3 fatty acids participate in complex processes of gene activation regulation by accessing DNA.

Thus, their importance in the complex processes of brain development is immense. In addition to consuming foods rich in these fats (good sources include olive oil, almonds, flaxseed, and hemp oil), it is recommended to take omega-3 supplements in the form of capsules or oil during the last trimester of pregnancy (when brain growth is the fastest) and breastfeeding. Recent studies have shown that taking omega-3 fatty acids during pregnancy significantly reduces the incidence of preterm births.

When it comes to brain health and creating optimal conditions for its growth and development, preterm birth presents numerous complications that can have adverse effects. Human milk contains about 30 times more DHA than the milk of other mammals.

By consuming omega-3 fatty acids, a mother can increase the concentration of DHA in her milk and replenish her reserves, which are significantly depleted after childbirth. The importance of these fats is such that all substitute milk formulas are additionally enriched with them.

Sources of omega-3 fatty acids

Sardines, trout, shrimp
Walnuts
Tofu
Eggs
Flax and chia seeds
Olive, almond, flaxseed, and hemp oil

Omega-3 and the immune system

The immune system is closely connected with the brain, so disorders in one system directly affect the functioning of the other. In the complex processes of mutual regulation, omega-3 fatty acids play a vital role. They can reduce the production of undesirable pro-inflammatory hormones (reducing the inflammatory response), strengthen the immune system, and help with allergies, rheumatism, psoriasis, and inflammatory bowel diseases.

A portion of children with autism has associated immune system issues, making it particularly important to prevent inflammation (e.g., they often have inflammatory bowel disease) to prevent inflammatory products from spreading through the blood to the brain and causing additional harm.

There are numerous reports in the literature about the therapeutic benefits of omega-3 fatty acids in children with learning difficulties, hyperactivity, autism spectrum disorders, and delayed speech development. However, these benefits have yet to be confirmed by studies that meet the strictest criteria of scientific research and conclusion.

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RSV – How to Protect Your Child and Prevent the Spread of Infection

Milivoj Jovančević — Thu, 04 Jan 2024 09:41:32 +0000

Respiratory syncytial virus (RSV) causes symptoms similar to a mild cold but can lead to bronchiolitis and pneumonia in high-risk children. Shortly after infection, the virus causes significant swelling of the mucous membranes in the smallest branches of the bronchi. This results in a dry, hacking cough, difficulty and rapid breathing with the inward pulling of the abdomen and ribcage during inhalation, and a lack of oxygen in the blood. A bluish color may appear on the lips, around the eyes, or on the fingertips. Wheezing can be heard during exhalation. The highest incidence of RSV infections occurs from late autumn to spring.

RSV is the most common cause of bronchiolitis and pneumonia in infants. Prematurely born children and those with lung and heart diseases are particularly at risk. Premature infants have underdeveloped lungs and a significantly weaker immune system due to premature birth, which also results in lower levels of protective antibodies received from the mother through the placenta.

In some children, particularly those with a family history of atopy (allergic diseases), RSV can lead to recurrent bronchitis with wheezing and asthma in subsequent years. Children with severe (hemodynamically significant) heart defects and those with Down syndrome also belong to the high-risk group for complications and severe forms of the disease.

How is the Infection Transmitted?

RSV spreads through the air via sneezing and coughing and through physical contact (touch, kissing, shaking hands) with an infected person. RSV can survive for up to 7 hours on toys, work surfaces, and other surfaces. The risk of virus transmission is higher in crowded places such as kindergartens, play areas, and shopping centers. It is believed that almost all children will have an RSV infection in the first two years of attending collective care.

Prevention of RSV

Preventing RSV transmission involves several key measures:

Hand washing for the child and caregivers significantly reduces the risk of transmission. It is also recommended to regularly clean/disinfect toys, door handles, and wash bedding frequently.
Prevent sharing personal items (spoons, glasses, pacifiers, toothbrushes, towels).
Avoid play areas and generally crowded places such as shopping centres during winter, and avoid contact with children or adults who have a cold.
If the child is in a high-risk group for severe RSV illness, it is advisable not to send an older sibling to kindergarten until the end of the RSV season (spring). Exposure to tobacco smoke also increases the likelihood of severe illness.

Discuss additional protective steps you can take with your child’s doctor.

Preventing Severe RSV Illness in High-Risk Children

High-risk children are protected with a medication called palivizumab, which contains antibodies that prevent the virus from entering the mucous membranes of the respiratory tract and multiplying. It is administered as an injection every 28-30 days for five months during the RSV season (November/December), providing protection for high-risk children from severe forms of the disease. This injection is given in the thigh muscle. To best protect your child, follow the doctor’s instructions and adhere to the therapy schedule precisely.

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What to expect after leaving the maternity hospital

Milivoj Jovančević — Wed, 03 Jan 2024 08:40:43 +0000

The return of a baby and mother from the maternity hospital is the most anticipated moment in any family. Grandparents, siblings, everyone is equally excited to finally meet the new arrival. The return from the maternity hospital is both joyful and stressful, especially for first-time mothers and young parents who have many questions and uncertainties about the first steps of baby care. To give you an insight into what the first days with the baby are like, our physician Milivoj Jovančević, MD writes in his blog about what to expect after leaving the maternity hospital!

The baby is home, now what?

Upon arriving home from the maternity hospital, you need to notify the visiting nurse and schedule her visit. She will examine the newborn and provide detailed instructions on feeding and care. There will likely be several more visits, and if everything is fine, you should plan the first visit to the pediatrician when the baby is one month old. If the visiting nurse recommends an earlier check-up, make sure to do it without delay. Very often, in the first days at home, feeding problems arise, and mothers, out of fear that the baby is not getting enough food, start supplementing with formula. Do not make this decision on your own, as it is usually unnecessary and promptly contact your pediatrician who will help you maintain breastfeeding!

Preparing for the first pediatrician visit

Find out where the nearest pediatric office that accepts new patients is located as many offices are overbooked with more than the normative 1,000 children per team. Additionally, talk to other parents about their experiences and how satisfied they are with their pediatrician. Register your child as soon as possible (with the police, the Croatian Health Insurance Fund) – certainly before the first check-up.

Schedule the check-up in advance because most offices have specific times for seeing healthy children to avoid mixing sick and healthy children. Prepare all medical documentation from pregnancy and the discharge letter from the maternity hospital. You probably have many questions for the pediatrician, but it often happens that parents forget some of them during the check-up; therefore, write down your questions on a piece of paper and bring it with you.

Bring a spare disposable diaper and one cloth diaper on which you will lay the baby during measurement and examination. The pediatrician will ask if there have been any diseases in your family (epilepsy, febrile convulsions, congenital hip dislocation, amblyopia, diabetes in younger family members, colon polyps, etc.), and you should try to recall if there have been any of these or other illnesses that occurred frequently in your family.

Try to organize the first visit to the pediatrician so that both parents can attend. Both will have a lot to do (transportation, carrying things, undressing, changing, and dressing the baby) and it is useful for both parents to hear the advice from the nurse and doctor as very important information can often be missed in the excitement.

What to expect from the check-up

Upon arrival at the office, the nurse will open a personal health record and enter the parents’ and child’s information. It is useful to provide a phone number where the nurse or doctor can contact you if needed. Inform yourself about where and how you can seek help outside office hours in case of emergencies (evenings, nights, Saturdays, Sundays, and holidays). If the child stayed in the maternity hospital for a longer period or there were complications after birth, it is recommended to make a copy of the discharge letter to be kept in the health record. After that, the nurse will measure the baby’s weight, length and head circumference. Take the opportunity to ask the nurse about any concerns regarding the baby’s feeding and care.

The first check-up without tears and nervousness

Your newborn is very small and does not understand the anxiety and haste of the parents, which often arises during the first visit to the pediatrician. However, the baby very strongly senses these emotions and can also become anxious. Sometimes this anxiety can trigger stronger colic (cramps), so a baby that was usually calm at home may start crying inconsolably and painfully in the office. Try to be aware of your raised voice and fast speech, hurried movements, and, as much as possible, slow down and soften these activities.

It is generally best to schedule the check-up two hours after feeding – the baby is still satisfied, and the stomach is not too full of milk, which could cause more regurgitation (milk coming back from the stomach into the oesophagus and mouth) during crying and the examination.

If the baby becomes very upset during measuring and weighing (inconsolable crying), ask the nurse to place you in a quiet corner where you can feed and calm the baby.

Get to know your pediatrician

After talking with you, the pediatrician will perform a detailed examination and assess the child’s physical and psychomotor progress. This is an opportunity to get to know the pediatrician, to receive as much information and useful advice as possible and to ask all the questions you have about feeding, care, and the child’s overall health.

For a one-month-old baby, the pediatrician will recommend the start of rickets prevention with vitamin D drops (if vitamin K1 and D3 administration hasn’t already started from the 7th day of life in exclusively breastfed babies) and a preventive hip ultrasound.

According to the Health Care Plan and Program for children, check-ups are scheduled at 1, 2, 4, 6, 9, and 12 months of age in the first year of life.

When discussing the vaccination schedule, you will see that vaccinations are performed during planned systematic check-ups. The doctor may also request more frequent check-ups to monitor children with certain growth and development issues more closely. Talk about vaccinations and request additional information because the first vaccination will take place at the next visit.

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Recommendations for the prevention of sudden infant death syndrome – how to prevent “crib death” (SIDS)

Milivoj Jovančević — Fri, 24 Nov 2023 13:52:42 +0000

It is estimated that sudden infant death syndrome, or SIDS for short, is the cause of 9% of infant deaths. The syndrome is also called ” crib death”, and in 2022 it appeared as a cause of death in 12 cases.

SIDS occurs during the entire period of infancy, but the most frequent cases of death are recorded between the ages of 2 and 4 months. It occurs more often in boys during the winter months.

Although the sudden death in sleep of a completely orderly and healthy infant still cannot be explained, there are observations that can be applied as recommendations for prevention, and it should be noted that the number of deaths from SIDS has been significantly reduced in the last 30 years or so.

Recommendations on the prevention of sudden infant death syndrome were made based on numerous epidemiological studies.

*Level A recommendation (proven high level of effectiveness):

Sleeping in the supine position, on the back (not on the side, not on the stomach!)
Sleeping on a hard surface
Sleeping in a room with parents, but in your own crib
No soft objects and with always tight bedding
Pregnant women should have adequate and recommended prenatal care
Avoiding exposure to tobacco smoke during pregnancy and after childbirth
Avoiding alcoholic beverages and prohibited drugs during pregnancy and after childbirth
Breastfeeding is recommended
The use of a dummy pacifier when putting to sleep comes into consideration
Avoid overheating the room where you sleep
The use of cardiorespiratory monitors as a strategic measure to reduce the risk of SIDS is not recommended

For all questions about the recommended ways of caring for an infant, you can contact the medical team of the Salvea Polyclinic, including the author of this text, Prof. Milivoj Jovančević, Ph.D.

^Source: American Academy of Pediatrics. TASK FORCE ON SUDDEN INFANT DEATH SYNDROME, Moon RY. Pediatrics 2011:1030-39 SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment.

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