Palm-sized baby among the world's smallest

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14-week-old Melinda Star Guido holds her mother's little finger while lying in an incubator at the Los Angeles County-USC Medical Center in Los Angeles, Wednesday, Dec. 14, 2011. At birth, Melinda Star Guido tipped the scales at only 9 1/2 ounces, a tad less than the weight of two iPhone 4S. Melinda is believed to be the second smallest baby to survive in the United States and the third smallest in the world. (AP Photo/Jae C. Hong) 14-week-old Melinda Star Guido holds her mother's little finger while lying in an incubator at the Los Angeles County-USC Medical Center in Los Angeles, Wednesday, Dec. 14, 2011. At birth, Melinda Star Guido tipped the scales at only 9 1/2 ounces, a tad less than the weight of two iPhone 4S. Melinda is believed to be the second smallest baby to survive in the United States and the third smallest in the world. (AP Photo/Jae C. Hong) Haydee Ibarra, looks at her 14-week-old daughter, Melinda Star Guido, at the Los Angeles County-USC Medical Center in Los Angeles, Wednesday, Dec. 14, 2011. At birth, Melinda Star Guido tipped the scales at only 9 1/2 ounces, a tad less than the weight of two iPhone 4S. Most babies her size don’t survive, but doctors are preparing to send her home as soon as the end of the month. Melinda is believed to be the second smallest baby to survive in the United States and the third smallest in the world. (AP Photo/Jae C. Hong) This undated photo provided by Los Angeles County-USC Medical Center shows shows Melinda Guido shortly after her birth in late August with the hand of Dr. Rangasamy Ramanathan as a comparison. Melinda was born premature at 24 weeks weighing only 9.5 ounces. She's believed to be the second smallest baby to survive in the United States and third in the world. (AP Photo/Los Angeles County-USC Medical Center ) This undated photo provided by Melinda Guido’s family shows Melinda, with her mother's fingers in the scene, in the neonatal intensive care unit at the Los Angeles County-USC Medical Center. Melinda was born premature at 24 weeks weighing 9.5 ounces. She’s believed to be the second smallest surviving baby in the United States and third smallest in the world. (AP Photo/Haydee Ibarra) This undated photo provided by Melinda Guido’s family shows Melinda in the neonatal intensive care unit at the Los Angeles County-USC Medical Center. Melinda was born premature at 24 weeks weighing 9.5 ounces. She’s believed to be the second smallest surviving baby in the United States and third smallest in the world. (AP Photo/Haydee Ibarra)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); LOS ANGELES (AP) — At birth, Melinda Star Guido was so tiny she could fit into the palm of her doctor's hand. Weighing just 9 1/2 ounces — less than a can of soda — she is among the smallest babies ever born in the world.

Most infants her size don't survive, but doctors are preparing to send her home by New Year's.

Melinda was born premature at 24 weeks in late August and is believed to be the second-smallest baby to survive in the U.S. and third smallest in the world. She spent the early months cocooned in an incubator in the neonatal intensive care unit in Los Angeles.

Despite hurdles, Melinda lived to her original Thursday due date. Doctors say it is too early to say how she will fare developmentally and physically when she grows up.

For now, her 22-year-old mother sits at her bedside almost every day and stays overnight whenever she can.

On Wednesday, Haydee Ibarra caressed Melinda through the portholes of the incubator where nurses pinned up a homemade sign bearing her name. Now 3 ½ months old and weighing 4 pounds, Melinda gripped Ibarra's pinky finger and yawned.

"Melinda, Melinda," she cooed at her daughter dressed in a polka dot onesie. "You're awake today."

During her pregnancy, Ibarra suffered from high blood pressure, which can be dangerous for mother and fetus. She was transferred from a hospital near her San Fernando Valley home to the county's flagship hospital, which was better equipped to handle high-risk pregnancies.

There was a problem with the placenta, the organ that nourishes the developing fetus. The fetus, however, was not getting proper nutrition, blood and oxygen. Doctors knew Melinda would weigh less than a pound, but they were surprised at how small and fragile she was.

"The first few weeks, it was touch and go. None of us thought the baby was going to make it," said Dr. Rangasamy Ramanathan, who oversees premature infants at the Los Angeles County-USC Medical Center.

Even if she survived, doctors told Ibarra and her husband Yovani Guido, children born this extremely premature can have developmental delays and impairments such as blindness, deafness or cerebral palsy.

Ibarra, who previously had a stillborn, told doctors to do whatever necessary to help her baby.

"They said, 'We'll take the chance. Please try.' So we said. 'OK we'll try,'" Ramanathan recalled.

Melinda was delivered by cesarean section at 24 weeks and was immediately transferred to the NICU where a team of doctors and nurses kept watch around the clock. Infants born before 37 weeks are considered premature.

Melinda was kept insulated in an incubator and was hooked up to a machine to aid her breathing. She got nutrition through a feeding tube. Her mother said her skin felt like plastic because it was so thin.

"It takes a lot of good care and a lot of good luck. Most of them don't survive," said pediatrician Dr. Edward Bell of the University of Iowa who keeps an online database of the world's smallest surviving babies who were less than a pound at birth.

The list currently contains 126 babies dating back to 1936. Since submission is voluntary, it does not represent all survivors.

Ten babies weighing less than a pound were born last year and survived. Melinda joins three other tiny survivors delivered this year in Berkeley; Seoul, South Korea; and Iowa City, Iowa. All are bigger than Melinda, who is not eligible to be listed until she gets discharged.

Most tiny babies who survive tend to be female. That's because female fetuses mature faster than males of the same gestational age. Having more developed lungs and other vital organs increases odds of survival.

Bell published a study last year that found many survivors struggle with health and learning problems. For those for whom growth data are available, many are short and underweight for their age.

There are some success stories.

The smallest surviving baby born weighing 9.2 ounces is now a healthy 7-year-old and another who weighed 9.9 ounces at birth is an honors college student studying psychology. Their progress was detailed in a study published this week in the journal Pediatrics by doctors at Loyola University Medical Center in Illinois where the girls were born.

In the past three years, Los Angeles County-USC Medical Center cared for two other babies with extremely low birth weight who survived, but Melinda holds the record at the hospital.

Prematurity comes with high costs. Ramanathan estimates it costs $3,000 to $5,000 a day to care for a premature infant.

A month after birth, Melinda was treated for an eye disorder that's common in premature babies. She faced her biggest test last month when she underwent surgery to close an artery that usually seals after birth.

Ybarra held her daughter for the first time after the surgery. Before that, she could only touch her through the incubator.

The next challenge is learning to bottle feed before discharge. Ramanathan predicted at least another two-week stay, dashing her parents' hopes of taking her home by Christmas.

Ramanathan said doctors don't know how Melinda will fare when she's older. Since she did not have major complications such as bleeding in the brain, he held out hope.

Melinda can breathe by herself, but still uses an oxygen tube as a precaution. On Wednesday, an ophthalmologist checked out her eyes and said everything looked good.

After the checkup, Ibarra lifted Melinda out of the incubator and sat in a rocking chair, cradling her.

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Follow Alicia Chang's coverage at http://www.twitter.com/SciWriAlicia

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Online:

Tiniest Babies Registry: http://bit.ly/rvglZQ

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Inspector highlights psych drug use among elderly

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WASHINGTON (AP) — Government inspectors told lawmakers Wednesday that Medicare officials need to do more to stop doctors from prescribing powerful psychiatric drugs to nursing home patients with dementia, an unapproved practice that has flourished despite repeated government warnings.

So-called antipsychotic drugs are designed to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive behavior related to dementia. Drugs like AstraZeneca's Seroquel and Eli Lilly's Zyprexa are known for their sedative effect, often putting patients to sleep.

But the drugs can also increase the risk of death in seniors, prompting the Food and Drug Administration to issue multiple warnings against prescribing the drugs for dementia. Antipsychotics raise blood sugar and cholesterol, often resulting in weight gain.

An inspector for the U.S. Department of Health and Human Services told the Senate Committee on Aging that the federal government's Medicare program should begin penalizing nursing homes that inappropriately prescribe antipsychotics, according to written testimony obtained by the Associated Press.

The Centers for Medicare and Medicaid Services provides health coverage to nearly 80 million senior, poor or disabled Americans.

HHS Inspector General Daniel Levinson proposed that Medicare force nursing homes to pay for drugs that are prescribed inappropriately, and potentially bar nursing homes that don't use antipsychotics appropriately from Medicare.

A report by Levinson's office issued in May found that 83 percent of Medicare claims for antipsychotics were for residents with dementia, the condition specifically warned against in the drugs' labeling. Fourteen percent of all nursing home residents, nearly 305,000 patients, were prescribed antipsychotics. The HHS Inspector General's office Medicare claims during a 2007 six month period.

Doctors are permitted to prescribe drugs for off-label uses, though it is illegal for drug companies to promote uses that haven't been cleared by the FDA. In recent years several pharmaceutical companies have paid huge fines to the Department of Justice in cases involving off-label marketing of antipsychotics.

In January 2009, Eli Lilly & Co. Inc. agreed to plead guilty and pay $1.4 billion for illegal promotion of Zyprexa, including marketing to nursing home doctors. The company told its sales representatives to use the slogan "5 at 5," to persuade doctors that giving 5 milligrams of the drug at 5 p.m. would make dementia patients sleep through the night.

AstraZeneca PLC has paid nearly $600 million in two separate settlements with federal and state prosecutors over alleged off-label promotion of its drug Seroquel.

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CDC says condom use increasing among teens

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By James B. Kelleher

Wed Oct 12, 2011 6:04pm EDT

n">(Reuters) - Safe sex may be catching on with teens.

The Centers for Disease Control and Prevention reported on Wednesday that condom use by teenagers is on the rise even though overall teen sexual activity remains unchanged.

The CDC said that eight in 10 teen males ages 15-19 surveyed as part of its National Survey of Family Growth reported they had used condoms during their first sexual experience.

That is up 9 percentage points from 2002, the last time the data was collected.

The authors of the report did not explain why condom use has jumped. But they said the rise was consistent with other trends they've seen in recent years, including a decline in teen pregnancies.

While condom use among males has spiked, the use of "other methods" of birth control, including withdrawal and sterilization, has fallen among teen boys' partners, the CDC said.

The CDC also found a significant increase in the percentage of female teens using hormonal methods other than the pill, such as injectables and contraceptive patches, to prevent pregnancy.

Six percent of teen females in the latest survey said they used a non-pill hormonal method at their first sexual experience, up from 2 percent in 2002.

CDC researchers interviewed 2,284 teen girls and 2,378 teen boys -- the largest sample of teenagers undertaken as part of their ongoing National Survey of Family Growth.

Teenagers' overall use of contraceptives has changed little since 2002, the CDC said. One exception was the number of teens who said they were employing a two-pronged approach to pregnancy control, combining the use of a condom with birth control pills or other hormonal contraceptives.

The study found that 16 percent of teen males used a condom in combination with a female partner's hormonal method, up from 10 percent in 2002.

About 43 percent of never-married female teens it surveyed, and about 42 percent of never-married male teens, reported they were sexually experienced, similar to 2002.

When CDC researchers asked teens who have not had sex why they were abstaining, the primary reason given was that it was "against religion or morals," not because they were worried about unplanned pregnancies or sexually transmitted diseases.

Overall, sexual activity among U.S. teenagers seems to be holding steady, the CDC said.

Of those teens who said they were sexually active, 78 percent of females and 85 percent of males said they employed some form of contraception during their first sexual experience, virtually unchanged from 2002.

(Editing by Jerry Norton)

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Pancreatic cancer declining, but among most deadly

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FILE - In this Jan. 6, 2004 file photo, Apple CEO Steve Jobs displays the iPod mini at the Macworld Conference and Expo in San Francisco. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. (AP Photo/Marcio Jose Sanchez, File) FILE - In this Jan. 6, 2004 file photo, Apple CEO Steve Jobs displays the iPod mini at the Macworld Conference and Expo in San Francisco. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. (AP Photo/Marcio Jose Sanchez, File) FILE - In this April 24, 2009 file photo, Dr. Ralph Steinman of Rockefeller University speaks during a news conference in Albany, N.Y. Rockefeller University in New York says Ralph Steinman, co-winner of this year's Nobel Prize in medicine, has died. The university says Steinman was diagnosed with pancreatic cancer four years ago and died on Sept. 30, three days before the announcement. (AP Photo/Mike Groll, File) FILE - In this Jan. 15, 2008, file photo, Apple CEO Steve Jobs holds up the new MacBook Air after giving the keynote address at the Apple MacWorld Conference in San Francisco. Apple on Wednesday, Oct. 5, 2011 said Jobs has died. He was 56. (AP Photo/Jeff Chiu, File) Fred Velez, of San Francisco, holds an Apple iPhone displaying an early picture of Steve Jobs, as he and others gather outside an Apple store in San Francisco on Wednesday, Oct. 5, 2011. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. Apple announced his death without giving a specific cause. He died peacefully, according to a statement from family members who said they were present. (AP Photo/Darryl Bush)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); Pancreatic cancer is notoriously lethal — there are almost as many deaths from it each year as there are new cases. The deaths this week of Apple founder Steve Jobs and Nobelist Ralph Steinman bring unusual attention to this less-well-known type of cancer.

Jobs lived more than seven years after being diagnosed with a neuroendocrine tumor — a less common, slower-growing and more treatable type of pancreatic cancer than the kind that killed Steinman a week ago and actor Patrick Swayze two years ago.

The Apple chief kept details of his illness behind a firewall and declared he was cured after cancer surgery in 2004. However, five years later, gaunt and having lost a lot of weight, Jobs had a liver transplant. Experts said it was likely because his cancer had returned or spread.

A liver transplant sometimes can cure the type of cancer that Jobs had. But if it comes back, "it's usually in one to two years," said Dr. Michael Pishvaian of Georgetown University's Lombardi Comprehensive Cancer Center.

In January, Jobs announced his third and final leave of absence. He resigned in August and died on Wednesday.

Part of what makes pancreatic cancer so deadly is that the pancreas is as vital as the heart. You can live with just part of a liver or a colon, or only one kidney or lung. But the pancreas is a fish-shaped organ that makes digestive enzymes and insulin and other hormones that enable the body to make energy from food.

In the United States, pancreatic cancer is the fourth leading cause of cancer deaths. About 44,030 people will be diagnosed with it and about 37,660 people will die of it this year in the U.S., the American Cancer Society estimates.

Over the past 15 to 25 years, rates of pancreatic cancer have dropped slightly, possibly because of a decline in smoking, the cancer society says. However, cases have been rising since around 2002 and rose about 1 percent per year over the period 1998 to 2007, said the cancer society's deputy chief medical officer, Dr. Len Lichtenfeld.

Possible symptoms are fatigue, back pain, abdominal pain, unexplained weight loss, loss of appetite, jaundice and nausea, according to the Lustgarten Foundation, a private group that finances research on the disease.

This cancer often is not found until it is advanced or has spread, and overall survival is dismal: 20 percent after one year and only 4 percent after five years.

However, with a neuroendocrine tumor like the one Jobs had, "people can live a longer time; median survival is five to eight years," said Dr. Alan Venook, a pancreatic cancer specialist at the University of California, San Francisco.

The lifetime risk of developing pancreatic cancer is about 1 in 71, according to the cancer society. Men and blacks account for more cases than women and whites, possibly because of differences in smoking rates. Smokers have two to three times more risk of developing the disease. Use of smokeless tobacco also raises the risk.

Obese people, those who don't exercise much and diabetics also have more risk for pancreatic cancer. Alcohol use might play a role: Most studies haven't tied it to pancreatic cancer, but heavy drinking can lead to diabetes and liver and pancreas problems that pose a cancer risk, the cancer society says.

The best hope for a patient is that the tumor is operable. That was the case in February 2009, when U.S. Supreme Court Justice Ruth Bader Ginsburg had a small, early-stage pancreatic tumor removed at New York's Memorial Sloan-Kettering Cancer Center.

On the horizon are immune system treatments — research that Steinman, the Nobel recipient from Rockefeller University in New York, was studying in the lab and trying on his own pancreatic cancer.

The immune system has a hard time recognizing and fighting cancer because the enemy is not an invading germ but our own cells gone rogue. Treatments called therapeutic cancer vaccines are ways to modify cells to help the immune system recognize the risk.

One such vaccine by NewLink Genetics, a small biotech firm in Ames, Iowa, is in late-stage testing now for pancreatic cancer. The company website says the larger study was initiated after a mid-stage test suggested improvement in survival.

Dr. Roderich Schwarz, chief of surgical oncology at the University of Texas Southwestern Medical Center in Dallas, has enrolled a few patients in some immune therapy studies, which have not paid off in the past.

"Vaccines are coming along," and last year's approval of one for advanced prostate cancer suggests researchers may be learning to overcome some of the drawbacks of the past, he said.

"It's quite possible that vaccines will claim their territory in the treatment of these challenging tumors," Schwarz said. "It's still in the development stage rather than the proven stage."

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Online:

Cancer Institute: http://www.cancer.gov/cancertopics/types/pancreatic

Cancer Society: http://www.cancer.org/Cancer/PancreaticCancer/index

Survival rates: http://bit.ly/oAxKl5

Research and support: www.curePC.org and www.lustgarten.org

Vaccine study: http://www.linkp.com/products/hyperacute-pancreas.html

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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