Thursday, March 15, 2007
Parents are not to blame for birth defects
By Dr. Anthony Policastro

I see a lot of newborn infants. Most of them are healthy. Most of them have minor differences that are normal findings. These may be in the form of birthmarks. They may be in the form of rashes. They may be in the form of a temporary heart murmur. There are some things that we classify as birth defects that are not normal findings. These findings have only a few causes. One of those is related to genetics. Some of these things are inherited. The best example of that is the family that has what is called polydactyly. These infants have an extra finger. Sometimes the finger is complete. Sometimes it is partial. In most cases, one of the parents had the same thing. Other genetic problems are not inherited directly. They are defects in the genes that produce problems. The most common example of this is Down's Syndrome. While some parents carry a gene for Down's syndrome, in most cases that is not true. Some of these things are environmental. The mother might have taken some kind of drug. The result is a birth defect related to that drug. The classic example of this was thalidomide. This drug created absence of arms and legs in infants. It took many cases of this before we figured it out. The third cause of birth defects is a combination of genetics and environment. There are some defects that run in families. However, they are not inherited directly like polydactyly. There appears to be a need for the right genes. Then those genes react to something in the environment. The result is a defect that is common in that family. This kind of inheritance pattern is known as multifactorial. Congenital heart disease falls into this category. Cleft palate falls into this category. Congenital hip dislocation falls into this category. The inheritance for each of these is about the same. If one family member has the defect, there is a 4 percent chance that someone else will have it. If two family members have it, the chances go up to 10 percent with the next pregnancy. In most of these cases, we do not know what the environmental trigger is for the defect. We do learn things over time. For example, at one time we knew that spina bifida was inherited as a multifactorial defect. That meant that there was something in the environment that reacted with the infant's genes to cause it. We now know that for some of those infants the environmental trigger was a low level of folic acid. That is why we now recommend folic acid supplements for women. In most cases, there is no clear cause of the birth defect. Therefore, there is nothing that could have been done to prevent it. However, that is not what I see. Just about every time I have to explain a defect to a parent, they are busy trying to figure out why. It is not because they fell down during the pregnancy. It is not because they missed some of their prenatal vitamins. It is not because they were stressed out. However, I have heard these three reasons asked about over and over again. It may be due to genes. We can't do anything about that. It may be due to environment. But, in most cases, we do not have a clue as to what should have been avoided. It may be due to a combination of the two. In any case, there is not a way for the parents to have prevented it from occurring. Blaming themselves does not help them. It does not help the baby. Understanding the fact that these things are unpredictable and then taking care of them is what is best for all involved.

Dr. Anthony Policastro is Medical Director at Nanticoke Memorial Hospital.

Healthy Children Program now offers dental benefits
The Division of Medicaid & Medical Assistance is pleased to announce that with the recent approval from the Centers for Medicare & Medicaid Services, the Delaware Healthy Children Program (DHCP) now offers dental coverage for all of its members. This is because the State Legislature recently passed a law that added dental coverage to DHCP. This legislation will enable approximately 5,200 additional children to have the opportunity to obtain regular dental care of the highest quality by providing comprehensive benefits, competitive reimbursement fees, and streamlined claims processing. Under the DHCP dental benefit, eligible children can receive a comprehensive package of dental services including oral exams, x-rays, cleanings, fluoride applications, fillings, and other restorative and specialty services. Orthodontic care is also available for children who meet specific program guidelines. "I want to thank all of the legislators who introduced and/or supported the enabling legislation, and Governor Minner for signing it into law," said Gregory B. McClure, DMD, MPH, Dental Director, Delaware Health and Social Services' Division of Public Health. "I also want to thank the organizations such as the Delaware State Dental Society and the Delaware Dental Hygienists' Association for their support and commitment to add CHIP eligible children to the Medicaid Dental program." Dental Benefits under DHCP will mirror those offered under the Medicaid Program, and reimbursement will also continue at 85 percent of Usual & Customary charges. CMS has approved an effective date of October 1, 2006, for the new CHIP dental coverage. If any dental offices provided services to DHCP-covered children on or after that date, the offices can submit claims and be reimbursed for the services. We are making quick final changes to our claims processing system which will permit DHCP dental claims to begin being processed as of Monday, March 12.

Cardiac Dolls coming to A. I. duPont
Children with cardiac problems often feel isolated. Frequent visits to the hospital, constant health concerns and limited ability to participate in normal daily activities can make a child feel different from their peers. At the Nemours Cardiac Center at Alfred I. duPont Hospital for Children, we look for ways to help children feel more comfortable. That's why on March 12-16, two Heart Shadow Buddies(tm), named Miles and Millas, will visit the hospital. The Shadow Buddies are fabric dolls our patients can relate to - they are dressed in a hospital gown with a visible cardiac incision and a red mended heart. Created by The Shadow Buddies Foundation and distributed by The Angel's Pediatric Heart House (APHH) and the Congenital Heart Information Network, the "Miles and Millas Across America" campaign is striving to send the dolls to 50 hospitals in 50 weeks to increase congenital heart defect (CHD) public awareness. On Feb. 14, Miles and Millas began their journey in Florida and are now on their way to Delaware. Accompanying the dolls is a passport diary, where families can share stories and messages of hope and encouragement, for all those affected, including the medical staff and professionals who care for the heart child, and the CHD community at large. APHH hopes that through the travels of its ambassadors - Miles and Millas - parents with a child undergoing heart surgery will find encouragement through the words and stories of other families facing similar challenges. Each child in our pediatric cardiac care unit can then receive their own free Heart Shadow Buddy from Angel's Pediatric Heart House. Every year in the United States approximately 40,000 children are born with a heart defect, making it the number one birth defect. For children in our region with CHD and other heart problems, the Nemours Cardiac Center is available, offering a full range of diagnostic and treatment services for infants, children, and teenagers. Our facilities have been specifically designed by our medical staff in order to provide the very best to our patients and their families. All diagnostic, treatment, and recovery areas are contiguous, spacious, and modern with the latest equipment necessary to care for your child.

Health care providers earn Delaware managed care contract
Unison Health Plan and Delaware Physicians Care, Inc were awarded a contract by Delaware Health and Social Services (DHSS) to provide comprehensive health care services to the state's Medicaid consumers beginning July 1. The mission of the Division of Medicaid and Medical Assistance is to improve health outcomes by ensuring that the highest quality medical services are provided to the vulnerable populations of Delaware in the most cost effective manner. DMMA administers five major health care programs: Medicaid; Delaware Healthy Children Program (also known as CHIP); Delaware Prescription Assistance Program (DPAP) - a fully state-funded program offering prescription coverage to the elderly and adults with disabilities; Chronic Renal Disease Program - a fully state-funded program which provides services to individuals with renal disease; and the Non-Citizen Healthcare Program - a fully state-funded program which provides coverage to legally residing non-citizens who are not eligible for Medicaid. In combination, these programs provide health coverage to approximately 160,000 individuals each month.

Child Health promotion Coalition Essay Contest
The Sussex Child Health Promotion Coalition today announced a Youth Essay Contest promoting the 521 Almost None Campaign for Kids. Youth ages 11-14 can enter to win great prizes like an IPOD, bike & helmet and other great fitness items. The contest runs from March 1 through March 22 when all entries are due. Entries can be submitted through the internet by logging onto to clicking on Essay Contest and following the directions. After completing the form they can attach their Essay and mail it to: Sussex Child Health Promotion Coalition, at 543 N. Shipley St., Suite D. Seaford, DE 19973. Attention: Essay Contest Entry. Essays that are received past the cut off date will not be entered. The winners of this contest will be announced at the Community Walks taking place March 31 throughout the Sussex Communities and will be published in the local papers. To find out more information on the Essay Contest, call 302-444-9247, or log onto Attention: Essay Contest Entry.

Relay for Life Friendraiser
The Western Sussex Relay for Life committee members are busy making preparations for this year's Relay for Life. This year's event will be held on May 18, at the Mears Campus in Seaford. If you have participated in previous years, you know that the Relay for Life is an overnight event that helps raise money for the American Cancer Society. During the event, teams of people walk laps and each team tries to keep at least one team member walking at all times. But, Relay is much more than a walk. It is a time to remember those lost to cancer and celebrate those who have survived. More importantly, Relay gives you the power to help in the fight against cancer. By joining together as volunteers and donors, your efforts help support the American Cancer Society as they strive toward a cancer-free future. Sign up today to become a part of the Relay phenomenon. It's not too late to register a team. If you are interested in receiving information on how to register a team or for further information, contact Mary Catherine Hopkins at 302-875-7308.

Nurses' assistant program
Take the first step toward a career in the rapidly expanding health care field by taking the nurses' assistant training certificate program, offered through Delaware Technical & Community College, Owens Campus, Georgetown. Scheduled to start on March 20, this 150-hour, state-approved program covers topics such as basic nursing skills, residents' rights, mental health and social services, basic rehabilitative services, personal care skills, safety and emergency procedures, and dementia. Graduates will be prepared to take the state certification exam, which all assistants must pass to be certified to work in Delaware. Classes begin on March 20 and will be held on Tuesdays, Wednesdays, and Thursdays from 5-10 p.m. at LifeCare at Lofland Park in Seaford. For more information, call Corporate and Community Programs at 302-854-6966.

Health and wellness program
Governor Ruth Ann Minner and the state employment benefits committee officially launched DelaWELL, a voluntary state employee health and wellness initiative that will include a confidential health risk assessment and a comprehensive education and lifestyle plan tailored for participants.The program begins with a health risk assessment through a confidential, personalized questionnaire designed to evaluate participants' health status. After completing the health risk assessment, participants will receive a personal report that includes feedback, tools and resources to assist in making lifestyle changes. The program will also offer: personalized lifestyle and disease management coaching programs for conditions such as asthma, diabetes and coronary artery disease; online health resources including a wellness library, health education centers, a drug database, health calculators, recipes and daily health news updates; periodic health-related prizes and limited financial incentives; and unlimited access to a helpline with a professional healthcare coach for those in a high risk category. DelaWELL is designed to target individuals with modifiable lifestyle health risk factors and focuses on long-term behavior changes for these individuals. The state is partnering with StayWell Health Management, an industry leader in health management programming and an independent provider of health promotion programs and services.