Rx For Readers: Looking after little ones

Queries from readers about medical problems getting answered by medical experts.

By JUDY SIEGEL-ITZKOVICH
Ear protection must be worn illustration (photo credit: ING IMAGE/ASAP)
Ear protection must be worn illustration
(photo credit: ING IMAGE/ASAP)
I have to take my six-month-old daughter to a bar mitzva soon, and I am worried, because I know that Israeli weddings and bar mitzvas are very noisy affairs, and I don’t want her hearing to be harmed. I see many infants, even a few weeks old, at weddings where the noise is so bad that one can’t talk to the person sitting next to you. I understand that there are decibel meters as smartphone applications.
How many decibels are harmless to babies? Or children? Or adults? Is there any way to protect her ears if the noise is above that figure? Would sitting farther from the speakers be enough? What damage, short- or long-term, is caused by noise to babies’ ears?
— S.I., Jerusalem
Dr. Ronen Perez, director of the otology unit at Jerusalem’s Shaare Zedek Medical Center, replies: Loud noise in weddings, bar mitzvas and other social events, especially in Israel, can be harmful to our ears. It can initially cause temporary damage, but with accumulative exposure, the damage may become permanent.
Hearing loss and ringing in the ears (tinnitus) are common clinical symptoms that result from such exposure to loud noise. The sound is measured in decibels; while normal speech measures about 60 decibels, noise at a loud wedding can be measured over 90 and even 100 decibels. In general, noise at an intensity of over 85 decibels can cause damage to the average ear depending on length of the time of the exposure.
The young ears of babies and children are susceptible to damage from noise just like those of adults, but because babies and children have their whole life in front of them, the accumulative exposure in much greater. In addition, babies, contrary to adults, do not have the ability to interpret the annoying loud noise as a warning sign to keep away.
There isn’t a good way to fully protect babies from dangerous exposure. Sitting away from the speakers is an important measure but not enough. Earplugs can attenuate the noise by 15 to 20 decibels, but they are often not practical, especially in children. Leaving the hall periodically to give the ear a rest is advisable. If very loud noise persists, you should consider moving the baby from the area.
My daughter had twins in her 32nd week of pregnancy at Soroka University Medical Center. They were treated well for weeks and left it in fine condition. The babies, now seven months old, weigh nine kilos and have no medical problems. She got a call from Soroka asking them to bring them in once a month for RSV infections. The nurse did not explain what RSV is and why they need the injections.
Is it a vaccination? How often does it have to be given? Why is it necessary, even for healthy twins who were born prematurely? What are the risks if they don’t get it? Do the injections protect every year or do they have to be repeated? I checked the Internet and found that the American Association of Pediatrics changed its recommendations to give the antibodies only to babies born from the 28th week. Some doctors claimed the antibodies could even be harmful after that. Why does Israel continue to give the shots to babies born before 33 weeks when the Americans decided on only 28 weeks?
— L.S., Beersheba
Dr. Oded Breuer of the pediatric pulmonology department at Hadassah University Medical Center in Jerusalem’s Ein Kerem, comments: Respiratory syncytial virus (RSV) causes respiratory illness in children, especially those babies born prematurely.
Almost every healthy child will be infected by this virus before the age of two years; in most of them, it will cause only slight symptoms such as a runny nose and cough.
But in one out of 10 children who are infected, it can cause a somewhat more significant illness with shortness of breath and wheezing. Up to 1% of babies and toddlers infected with the virus will have serious symptoms and have to be hospitalized with bronchiolitis, which is an inflammation of the bronchioles, the smallest air passages of the lungs. Some of these will even develop pneumonia with severe shortness of breath, necessitating hospitalization in an intensive care unit and risk of severe complications.
Premature babies, even if they are older and healthy, are at higher risk from RSV, thus there is a recommendation to give them shots of antibodies at the hospital once a month in the winter. The Health Ministry has determined who should get them. The guidelines can be found at the ministry’s website.
On the basis of advice from various Israeli medical societies, it was decided to give the antibodies as part of the basket of health services to babies born up to 33 weeks of gestation.
In 2014, the AAP changes recommendations for giving the shots to children and decided to lower the limit to 28 weeks. This was based on statistical information that had accumulated regarding morbidity and mortality from RSV. No new controlled study that compared giving or not giving the shot to babies was carried out, and it was decided on the basis of benefit in reducing hospitalizations and deaths vs the high cost of the antibodies.
Despite these clear American recommendations, many Western countries continue to give it also to premature babies who were born later; Israel is among them.
As a result of the change, an expert team headed by Prof. Yechiel Schlesinger (head of Shaare Zedek’s Children’s Hospital) assessed the data in 2015. It was decided to wait before making a drastic policy change so that research can be conducted in Israel. There have been reports of a rise in infections and hospitalizations of babies in the US since the policy was changed. There are differing views among pediatricians and infectious disease specialists, as the shot is safe.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@ jpost.com, giving your initials, age and place of residence.