INTERNATIONAL CODE STATUS REPORT FOR 2016
The World Health Organization, United Nations Children's Emergency Fund, and the International Baby Food Action Network joined forces back in the late 1970s to facilitate women breastfeeding through legislative measures and social action initiatives. Part of the legislative measures includes reducing promotions for infant formula, nipples, and bottles, all that help replace breast milk.1 The International Code continues promoting exclusive breastfeeding for several reasons: (a) children who are breastfed for longer periods have lower infectious morbidity and mortality; (b) children who are breastfed have fewer dental malocclusions; (c) children who are breastfed have higher intelligence than those who are breastfed for shorter periods or those who are not breastfed; (d) breastfeeding can prevent breast cancer in the mother; (e) breastfeeding can improve birth spacing; (f) breastfeeding might reduce the mother's risk of diabetes and ovarian cancer; (g) and scaling up breastfeeding can prevent an estimated 823,000 child deaths and 20,000 breast cancer deaths every year.2 The overarching aim of the Code is to contribute to safe and adequate nutrition for infants and young children ensuring that breast milk substitutes are appropriately marketed and distributed to the public through legislative monitoring.1
To demonstrate support of the Code, countries implement provisions within the law to protect breastfeeding and provide regulations for substitutes to exclusive breastfeeding (eg, infant formula, nipples, and bottles).3 A total of 135 of 194 countries reported some or all portions of the Code implemented, which has increased by 32 countries since 2011. Identified barriers to adoption of the Code are as follows: (a) lack of political interest; (b) formula, nipples, and bottle company interests; and (c) limited knowledge and lack of resources to implement, monitor, and reinforce. Interestingly, the developed countries such as the United States, Japan, and Australia have not implemented any portion of the Code compared with developing countries such as India, the Philippines, and many African companies that have the full Code as law to facilitate a reduction in infant formula and promotion of breastfeeding.3 With all of the known benefits of exclusive breastfeeding, adoption of the Code in developed countries could only strengthen our youth and the future of our country.
ZIKA VIRUS AND THE NEONATAL INTENSIVE CARE UNIT
The 2016 Summer Olympics hosted by Rio has brought most of the world's attention to Zika virus. Zika virus disease is acquired through a mosquito-borne virus (usually Aedes species). The common symptoms experienced are fever, rash, joint pain, and conjunctivitis.4 In general, the symptoms are self-limiting in adults; however, the virus can be transmitted to the fetus, in which dire consequences can be realized. Researchers have confirmed a causal relationship between prenatal Zika virus infection and microcephaly, as well as other serious brain anomalies in neonates.5 Zika virus has also been linked to placental insufficiency and fetal growth restriction.6 Zika virus can be spread from human to human through blood and semen.7 Initially, the virus was isolated to South America; however, it is no longer contained. Puerto Rico (a territory of the United States) has been declared a site for mosquito transmission.8 Being a site for mosquito transmission means mosquitos carrying Zika virus have been discovered in the area and are spreading the virus to humans. In addition, the Centers for Disease Control and Prevention now has recommendations about how to reduce the risk of transmitting Zika virus to a fetus. Women and men who traveled to Zika virus–infected area but did not experience any symptoms of the virus need to wait at least 8 weeks before trying to get pregnant to minimize the risk of transmitting Zika virus. Women who have symptoms of the virus or test positive for Zika virus need to wait at least 8 weeks after their symptoms first appeared before trying to get pregnant. For men who had symptoms, they should wait 6 months before having unprotected sex because the virus lives in semen for a prolonged period.9 The first US death has been reported of an American woman living in Puerto Rico who miscarried her fetus during the second trimester due to complications from Zika virus–related brain damage.10 The state of New York is also increasing its screening for Zika virus by offering free testing to pregnant women who have traveled to affected countries, whether they have symptoms or not.11
The difficulties that face neonatal intensive care unit (NICU) nurses regarding Zika virus are tremendous and likely to an extent that is unknown. If or when the virus becomes more prominent in the United States, we will have to realize that some of these birth defects may not be detected until late in pregnancy, which will make the decision for an abortion a limited option in some states. Thus, the parents may present to the NICU with attachment problems, a lack of desire to keep the infant and give him or her up for adoption, and extreme distress over the potential problems they foresee their family facing in the future.12
Currently, medical care recommendations for infants who may have been exposed to Zika virus is determined explicitly on the presence or absence of microcephaly.13,14 Infants need a complete physical examination, with a measurement of head circumference, length, weight, and gestational age assessment that includes a detailed neurologic examination.15 Guidance for measuring an infant's head for microcephaly is available,14 using the qualifier of 32 cm or less at birth of a term infant as the reference value for defining microcephaly.15 In addition, within the first month, an infant with microcephaly needs to have an ophthalmologic evaluation since ophthalmologic findings such as macular abnormalities and optic nerve disorders are reported in infants with microcephaly with possible congenital infection.15 Zika virus has been shown to be present in breast milk; however, no infant to date has been infected via this transmission method.16 Therefore, proceeding forward with promoting breastfeeding is recommended.
The National Association of Neonatal Nurses' Web site has updated links to the Centers for Disease Control and Prevention and the World Health Organization for the latest guidance on Zika virus (available at: http://nann.org/5-zika).
KEEPING YOURSELF HEALTHY
Efficacy is important to us as nurses when caring for our patients. It is also critical in helping us maintain a healthy lifestyle that includes exercise. Luckily, researchers have designed an exercise program that showed similar improvement in cardiometabolic health in sprint interval training compared with traditional endurance training, in which the sprint interval training was 5 times lower exercise volume and 5 times lower time commitment.17 In the sprint interval training session, the participant is involved in 1 minute of intense intermittent exercise within a 10-minute session. The group in the moderate-intensity continuous training (traditional endurance) exercised for 50 minutes with moderate-intensity continuous exercise. The participants were 19 sedentary men, who participated in 3 sessions of exercise per week for a total of 12 weeks, with the amount of exercise dependent on their randomly assigned group. The results indicated that both sprint interval training and moderate-intensity continuous exercise were significantly improved from the controls in measures of peak oxygen uptake, insulin sensitive index, and skeletal muscle mitochondrial content. Overall, these results demonstrate that both forms of exercise are beneficial to improving cardiometabolic health compared with not doing any exercise. In addition, it showed that 10 minutes of exercise with a minute of intense exercise is equally as effective as 50 minutes of moderate-intensity continuous training 3 times per week over a 12-week period. Therefore, not including exercising for cardiometabolic health reasons is no longer an excuse with only needing 10 minutes. Take care of yourself! You care for so many people during the day, night, and on holidays. Make sure to reserve time for yourself. Even if it is only 10 minutes.
1. World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva, Switzerland: World Health Organization; obtainable from WHO Publications Centre; 1981.
2. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–490. doi:10.1016/S0140-6736(15)01024-7.
3. World Health Organization, United Nations Children's Emergency Fund, and International Baby Food Action Network. Marketing of Breast-Milk Substitutes: National Implementation of the International Code. Geneva, Switzerland: World Health Organization; 2016. http://apps.who.int/iris/bitstream/10665/206008/1/9789241565325_eng.pdf?ua=1&ua=1
. Accessed May 10, 2016.
4. Triunfol M. A new mosquito-borne threat to pregnant women in Brazil. Lancet Infect Dis. 2016;16(2):156–157. doi:10.1016/S1473-3099(15)00548-4.
5. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med. 2016;374(20):1981–1987. doi:10.1056/NEJMsr1604338.
6. Brasil P, Pereira JP Jr, Raja Gabaglia C, et al. Zika virus infection in pregnant women in Rio de Janeiro—preliminary report [published online ahead of print March 4, 2016]. N Engl J Med. doi:10.1056/NEJMoa1602412.
7. McNeil D, Tavernise S. Zika infection transmitted by sex reported in Texas. The New York Times. February 3, 2016:A1.
8. Centers for Disease Control and Prevention. Zika virus in Puerto Rico. http://wwwnc.cdc.gov/travel/notices/alert/zika-virus-puerto-rico
. Published April 2016. Accessed May 10, 2016.
9. Petersen EE, Polen KND, Meaney-Delman D, et al. Update: interim guidance for health care providers caring for women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(12):315–322. doi:10.15585/mmwr.mm6512e2.
10. McNeil D. Puerto Rico reports first microcephaly case linked to Zika. The New York Times. May 14, 2016:A12.
11. Otterman S. New York State to offer free Zika testing to pregnant travelers. The New York Times. February 5, 2016:A23.
12. Associated Press. When Zika hits, a push for birth control and abortion? The New York Times. www.nytimes.com/aponline/2016/05/11/health/ap-us-med-zika-preventing-births-abridged.html
. Published May 11, 2016. Accessed May 12, 2016.
13. Centers for Disease Control and Prevention. Interim guidelines for the evaluation and testing of infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy. http://www.cdc.gov/zika/pdfs/zika_peds.pdf
. Accessed May 10, 2016.
14. Centers for Disease Control and Prevention. Measuring head circumference. http://www.cdc.gov/zika/pdfs/microcephaly_measuring.pdf
. Accessed May 10, 2016.
15. Simões R, Buzzini R, Bernardo W, Cardoso F, Salomão A, Cerri G. Zika virus infection and pregnancy. Rev Assoc Médica Bras. 2016;62(2):108–115. doi:10.1590/1806-9282.62.02.108.
16. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill. 2014;19(13):1–4.
17. Gillen JB, Martin BJ, MacInnis MJ, Skelly LE, Tarnopolsky MA, Gibala MJ. Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment. PLoS One. 2016;11(4):e0154075. doi:10.1371/journal.pone.0154075.