Epidurals can be used for both mothers and infants

For years, doctors thought infants did not need anesthesia for pain because they “didn’t feel it” at so young an age – but this has been proven untrue.

November 13, 2010 23:49
Cute baby

cute baby 311. (photo credit: courtesy)

Epidural injections have long been used to relieve the pain of childbirth, but now pediatric anesthesiologists say it is safe and effective for children and even babies. Writing in the latest issue of the Hebrew-language journal Medicine: Yeladim of The Medical group , anesthesiologist Dr. Rahel Ephrat of Schneider Children’s Medical Center in Petah Tikva writes that an epidural was first used successfully on premature babies – weighing as little as half a kilo – in 1990.

For years, doctors thought infants did not need anesthesia for pain because they “didn’t feel it” at so young an age – but this has been proven untrue.

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Special catheters are used to introduce non-opiate drugs into the spinal column’s epidural space (where there is no spinal fluid) to block pain to the lower body; pain is prevented while muscles are not intentionally paralyzed. The patient can be conscious while under an epidural. It is carried out when the patient is lying on the side and does not move. A small test dose is given initially to ensure that there is no negative reaction. Continuing to drip the drug into the space can provide pain protection for hours or even days, writes Ephrat. Removal of the catheter is not painful.

While it was thought that giving epidurals to children was “more dangerous” than giving them to adults – primarily because they cannot react as adults would – the author notes that studies around the world have not found any more risk to children. When the doctor determines that the cause of pain without epidurals is receding, simpler pain relievers (non-steroidal anti-inflammatory drugs) can be given instead and the catheter can be removed.

As epidurals have longer-term benefits compared to opiates, they can be used to relieve pain in children who suffered burns; fractures; trauma from road accidents; cancer in the lower limbs; or painful surgery. It is relatively easy to insert epidurals in children, and the procedure has fewer side effects than opiates,” she concludes. “Anyone who fears giving this treatment does so from lack of understanding.”


Some unexpected effects of lead exposure could eventually help prevent and reverse blindness, according to University of Houston (UH) Prof. Donald Fox of the College of Optometry and colleagues. Writing in the journal Environmental Health Perspectives, Fox suggests that lead – or a new drug that acts like lead – could transform human embryonic retinal stem cells into neurons that could be transplanted to treat degenerative diseases of the retina.

“We saw a novel change in the cellular composition of the retina in mice exposed to low levels of lead during gestation. The retina contained more cells in the rod vision pathway than normal,” said Fox, who also is an expert in biology and biochemistry, pharmacology, health and human performance. “The rod photoreceptors and bipolar cells in this pathway are responsible for contrast and light/dark detection. These new findings directly relate to the supernormal retinal electrophysiological changes seen in children, monkeys and rats with low-level gestational lead exposure.”

Fox said these effects occur at blood lead levels at or below 10 micrograms per deciliter – the current low-level of concern by the US Centers for Disease Control and Prevention, thus it raises more questions about what should be considered the threshold for an adverse effect on the brain and retina.

Fox has studied lead toxicity for 35 years, specifically as it relates to children’s brains and retinas. His interest in gestational lead exposure started in 1999, when he and colleague Stephen Rothenberg studied a group of children in Mexico City whose mothers had been exposed to lead throughout their pregnancies. The goal of the studies was to measure the adverse effects of lead poisoning on the nervous system of children born in a city that has high levels of lead in the air due to the use of leaded gasoline, as well as continued use of lead-containing pottery and glassware for food preparation.

More recently, he and his team tried to find possible reasons for this supernormal retinal response in children. The researchers used rodent models that covered the three levels of lead found in the blood of the Mexico City mothers – some below, some right at and some higher than the CDC “safe level.” The researchers exposed rodents to lead throughout pregnancy and the first 10 days of life – a time period equivalent to human gestation.

They found that the early-born retinal progenitor cells give rise to four neuron types, all of which were not affected by lead exposure; only the late-born neurons increased in number. The glial cells, which nurture neurons and sometimes protect them from disease, were not changed at all. The rats and mice both had “bigger, fatter retinas,” according to Fox. Interestingly, the lower and moderate doses of lead produced a larger increase in cell number than the high dose.

“This is really a novel and highly unexpected result, because lead exposure after birth or during adulthood kills retinal and brain cells, but our study showed that low-level lead exposure during gestation caused cells to proliferate, increased neurons and did not affect glia,” said Fox, who visited Israel last year.

“So, gestational exposure produces the exact opposite of what was previously shown by our lab and others. It also shows that the timing of chemical exposure during development is just as important as the amount. This work has long-term implications in retinal degeneration and diseases in which photoreceptors die. If we can figure out how low-level lead increases the number of retinal progenitor cells and selectively produces photoreceptors and bipolar cells, then perhaps a drug can be created to help those with degenerative retinal diseases,” Fox said. “Researchers may be able to use lead as a tool in transforming embryonic retinal stem cells into rods and bipolar cells that could be transplanted into diseased retinas, ultimately saving sight and reversing blindness.”

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