“Diabetic mothers-to-be have high risk of giving birth to children with congenital abnormality,” The Guardian said today.

The news is based on UK research that compared the rates of birth defects in women with and without diabetes. It found that about 7% of pregnancies in women with diabetes were affected by birth defects that were not caused by problems with the number or structure of the chromosomes. This was 3.8 times higher than the rate in women without diabetes. The study also found that women who have worse control over their blood sugar around the time of conception were at greater risk.

It has been known for some time that diabetes in pregnancy is associated with a higher risk of various complications, and this large study provides further evidence on the link between diabetes and birth defects. UK medical guidance already addresses this risk, and recommends that from adolescence onwards, women with diabetes should be routinely given information on the importance of planning any future pregnancies and on getting specialist care and advice when they decide to have a baby. Women with very poor control of their diabetes are also advised not to become pregnant until their blood sugar control has improved.

Women with diabetes are likely to already be aware of these risks. However, this study provides another reminder that diabetic women who are thinking about becoming pregnant should discuss their options with their doctor first.

Where did the story come from?
The study was carried out by researchers from Newcastle University, the Regional Maternity Survey Office in Newcastle, and the South Tees NHS Trust. It was funded by Diabetes UK, the Department of Health, the Healthcare Quality Improvement Partnership, and the four primary care trusts in northeast England. The study was published in the peer-reviewed medical journal Diabetologica.

The Guardian provided good coverage of this story, and put it into context of what is already known about how a woman’s diabetes can affect her pregnancy. The shorter news article in The Independent covered the basics of the story, but could be taken to suggest that the study was the first to discover the risk. In fact, this risk has been known for some time.

What kind of research was this?
Pregnancies in women with diabetes are already known to be at increased risk of various complications, including stillbirth and birth abnormalities. This cohort study aimed to clarify the extent to which diabetes increases the risk of major birth defects, and how this risk is affected by other factors such as maternal age, smoking and socioeconomic status.

A cohort study is the best way to assess this type of question, which could not be answered by a randomised controlled trial. Clearly, women with diabetes differ from women without diabetes in terms of their medical condition, but the two groups may also vary in other ways. It is important that researchers take such differences into account during their analyses.

What did the research involve?
The researchers used data collected on approximately 401,000 pregnancies that occurred between 1996 and 2008. They looked at whether mothers had diabetes, and if their babies had birth defects. The researchers then looked at whether birth defects were more common in babies born to mothers with diabetes.

The researchers obtained their data from the north of England, collected by the Northern Diabetes in Pregnancy Survey (NorDIP) and the Northern Congenital Abnormality Survey (NorCAS). NorDIP contains data on pregnancies in women diagnosed with diabetes at least six months before conception. It does not include women with gestational diabetes (diabetes that only occurs in pregnancy).

The study excluded multiple pregnancies (twins or triplets) and included pregnancies where the baby died at or before 20 weeks of pregnancy, or where the pregnancy was terminated due to a foetal abnormality. It included all eligible births in the study region in the study period. Abnormalities were classified according to standard definitions, and could be recorded up to the age of 12 years. Some birth abnormalities are caused by problems with the number or structure of chromosomes (the structures in the cell that contain our DNA). These abnormalities were looked at separately.

The researchers looked at the effect of various diabetes-related factors including how well the woman’s blood sugar was controlled at around the time of conception, whether she had type 1 or type 2 diabetes, and diabetes complications diagnosed before pregnancy (such as kidney or eye problems). They also looked at the effect of maternal age at the time of delivery, gestational age at time of delivery, folic acid intake before conception, foetal gender, number of previous babies, pre-pregnancy care, and smoking during pregnancy. Any significant factors were taken into account in the analyses to determine the effect of the individual factors.

What were the basic results?
Among the 401,149 pregnancies, 1,677 were in women with pre-existing diabetes. Most of these women (78.4%) had type 1 diabetes. Overall, 9,488 pregnancies were affected by at least one major birth defect, and 129 of these were in women with diabetes.

In women with diabetes, 71.6 per 1,000 pregnancies were affected by non-chromosomal major birth defects. This was 3.8 times higher than the rate in women without diabetes. Women with diabetes did not have an increased risk of having a baby with birth defects caused by chromosomal abnormalities.

When looking at specific factors linked to the risk of birth defects, the researchers found that women who had worse blood sugar control at around the time of conception were at increased risk of having babies with birth defects. Blood sugar control is often calculated using a measure called HbA1c level. This represents the levels of haemoglobin in the blood with a sugar molecule attached.

Doctors generally try to keep HbA1c levels below 7%. In this study, each increase of 1% in HbA1c over 6.3% was associated with a 30% increase in the odds of birth defects (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.2 to 1.4). Women who already had kidney problems as a result of their diabetes also had an increased risk of having babies with birth defects (OR 2.5, 95% CI 1.1 to 5.3).

Some other factors were associated with an increased risk of birth abnormalities when looked at in isolation, such as low intake of folic acid and lower socioeconomic status. However, once all other factors were taken into account, these were no longer statistically significant.

How did the researchers interpret the results?
The researchers concluded that the main modifiable factor associated with birth defects in women with diabetes is their blood sugar control at around the time of conception. They say that the association with diabetes-related kidney problems needs to be studied further.

Conclusion
This study supports the existence of an association between maternal diabetes and increased risk of birth abnormalities, and helps quantify the size of the association. The study’s strengths include its large size and ability to include the entire population in the study area. However, there are a number of points to note:

The researchers took into account various factors that could influence the results. However, as with all studies of this type, it is possible that unknown or unmeasured factors, other than maternal diabetes, could have affected the risk of birth defects. From this study we cannot say what effect diabetes arising in pregnancy (gestational diabetes) might have on risk of birth defects, as these women were not included in this analysis. The study relied on registry-recorded data, and there may be some omissions or inaccuracies in this data. That said, the registries used standard systems for recording data that should increase the reliability of their records.

The link between maternal diabetes and an increased risk of birth defects is already established. Better blood sugar control can help reduce this risk, although it cannot eliminate the risk completely. The National Institute for Health and Clinical Excellence (NICE) recommends that women with diabetes who are trying to conceive should aim for an HbA1c of less than 6.1%, if this can be achieved safely. It also suggests that women with an HbA1c of over 10% should avoid becoming pregnant.

NICE also recommends that:
Women with diabetes who are planning to become pregnant should be informed of the need to establish good blood sugar control before conception, and that maintaining it throughout pregnancy will reduce the risk of miscarriage, birth defects, stillbirth and neonatal death. They also say that it is important for healthcare providers to explain that these risks can be reduced, but not eliminated entirely.

The importance of avoiding unplanned pregnancy should be an essential component of diabetes education from adolescence onwards for women with diabetes. Women with diabetes who are planning to become pregnant should be offered pre-conception care and advice before they stop using contraception. This study supports the need for specialist information and planning for pregnancy in women with diabetes. Women with diabetes who are thinking about becoming pregnant should discuss this with their doctor if they have not already done so.

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FOREST GROVE -- Changing diapers and calming crying babies may not be everyone's idea of a great vacation. But Rachel Kang, 13, enjoyed her time in Xi'an, China, doing just that. So much so, in fact, that she's leaving soon for a second trip.

Last April, Sarah Kang, 33, and her oldest daughter, Rachel, went on a "coming of age" trip of sorts. Sarah wanted to take Rachel on a service trip to teach her the importance of service to others.

The two learned of the Starfish Foster Home in Xi'an through friends. Starfish was founded in 2005 by Amanda de Lange, who collaborates with government orphanages to get medical care for the most medically at-risk babies. Babies at Starfish often have severe medical problems, such as heart defects, spina bifida and cleft lip and palate. De Lange and Starfish ensure that the children get the medical services they need.

Sarah said she wanted the trip to have a purpose. Teens can be somewhat self-centered, she explained, and she wanted to give her daughter a chance to "look outside herself."Once the two chose Starfish, they began planning. They would spend a week volunteering at the foster home, then visit Beijing to see the Great Wall of China. "Throughout the planning, Rachel transformed," her mom said recently.

The two made sheets and pillowcases, and collected baby clothes and other necessities for the home, which houses up to 50 babies at a time. When departure day arrived, Sarah said, Rachel packed the bare minimum amount of clothes for herself so she could carry more for the babies.

"I didn't know what was expected of me," Rachel said of her arrival at the foster care home. "A little boy named Joshua walked up and started pulling me around." She was hooked. "She wanted to cancel our trip to Beijing so we could stay another week" at the foster home, Sarah said.

Rachel and Sarah saw the good and the bad during that week. They met baby Charlotte, who they later learned is being adopted by friends of friends in Seattle. They saw babies new to the foster home who would cringe at their touch. By the end of the week, the babies were asking for attention. Several other babies that Rachel was especially attached to have died since she's been home.

Rachel also visited a Chinese hospital, which was "crowded with people lining the hallways waiting to see a doctor," she said. Sarah said they witnessed a whole new definition of poor. The day Rachel came home, she began to plan her next trip with what her mom calls "fixed determination. She talked to people about the babies like everyone should know them." Mom and daughter have given several slide-show presentations.  

Rachel began raising money for her trip by selling crafts on etsy.com. She recruited the women of her church to sew covers for changing tables and other items for the foster home. She had a friends-and-family baby shower to benefit Starfish that raised $480 and many contributions of baby clothes.

Her goal, she said, was to raise enough to pay for her airfare, plus $2,000 to donate to the foster home. She exceeded her goal, raising enough for 10 cleft lip surgeries for the babies. She leaves soon with her grandmother for a five-week trip to volunteer at Starfish.

On Monday, the chair of the board of directors for Starfish Foster Home announced on the organization's website that de Lange has been diagnosed with cancer, but assured supporters that the organization's untiring efforts would continue.

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This is the fifth installment in a weekly series on Piedmont Newnan Hospital's new facility on Poplar Road leading up to the opening this spring.) When the next U.S. Census is taken in 2020, the number of births recorded in Newnan, Ga., should show a marked increase. That's not because the local parent population is expected to swell unexpectedly, but because more Coweta parents may choose to have their babies delivered in the county they call home.

For years, many Coweta couples have received prenatal care close to home, but have chosen to have their babies delivered in some of metro Atlanta's larger hospitals -- not because the care is better, but because the other facilities are newer and nicer.

When the new Piedmont Newnan Hospital opens its doors on Poplar Road this spring, other hospitals will be looking to Coweta County for an example of the latest in comfort, care and convenience for newborns and their parents.

The physical facilities at the Women's Services department of the new hospital will be the envy of the area. But as nice as the new hospital will be, one thing won't change: the top quality care already being delivered at the current facility.

"The current high level of care provided in our nursery and NICU will truly be enhanced by our new facility," said Robert Whipple, M.D., medical director of Piedmont Newnan Hospital's Nursery and NICU. "The state-of-the-art design features, equipment and technology will further our team's clinical performance and services provided to babies born at Piedmont Newnan Hospital."

The record backs up the claims. Piedmont Newnan's Women's Services patient satisfaction scores, based on results of an independent surveyor, were among the highest of all Piedmont Hospitals both in FY10 and FY11, with a combined average ranking in the 91st percentile.

Several recent cases illustrate how the hospital's Women's Services department -- including the Neonatal Intensive Care Unit, or NICU -- scored so well with patients. In one case, a male newborn of a mother who was past her due date was born via c-section with no heart rate and no respiratory effort. The infant was intubated by the neonatal nurse practitioner, placed on a ventilator, given chest compressions and CPR, and was fully revived.

The baby was off the ventilator within a few hours of delivery and discharged with his mom when he was four days old, in good health, on room air and taking full bottle feedings.

In another case, 33-week premature twins were born at PNH with respiratory distress, requiring stabilization after birth and placement on nasal CPAP machines. They remained in the nursery for the next month as they learned to feed and gain weight, allowing their mom to stay close to home so she could visit and care for her growing premature babies.

"The stories of excellent patient care, provided to both the mothers who entrust us with their deliveries and their babies, are abundant," said Alison Middleton, neonatal nurse practitioner and manager, Piedmont Newnan Hospital Nursery and NICU. "Our Women's Services team of highly qualified, talented individuals is thrilled that we will be able to take this high level of care with us to our new hospital and grow this service for the women in our community."

Care is taken in the Labor and Delivery Suite to create a non-institutional feel while providing patients with a safe environment for birthing. The suite boasts an upgraded hospitality feel with wall coverings in the corridors and custom light fixtures.

The headwalls of the patient rooms are constructed of wood with fabric laminated in glass used as a focal element, allowing medical gases and electrical outlets to be concealed on the patient's headwall until required.

Special attention has also been given to ensure that mom's support person will be very comfortable during the delivery process through the provisions of warm, soft sleeper seating and workspaces for long deliveries.

Great facilities can't deliver better care to mothers and newborns without a great team of physicians, nurses and medical support personnel. Piedmont Newnan is already among the leaders in this area.

Currently, care is provided by a team of nine in-house neonatal nurse practitioners (NNPs) who are on site and available for work seven days a week, 24 hours a day. They are always ready to assist with high-risk deliveries and oversee the care of all newborns.

The highly-skilled NNP team at Piedmont Newnan is the only such team available onsite 24 hours a day, seven days a week within the entire Piedmont Healthcare system. The neonatal nurse practitioners specialize in the care of newborns. They are advanced practice nurses with master's degrees and are certified in neonatology and/or pediatrics. Piedmont Newnan has a staff of nine NNPs with a combined neonatal experience of approximately 150 years.

This team also works with all Women's Services staff members to provide learning opportunities and enhance the skills of other medical professionals in the area. Having this highly skilled, neonatal nurse practitioner-led resuscitation team sets Piedmont Newnan apart from other area hospitals. Hospital officials say that in the area of nursing and support staff:

n All Labor and Delivery nurses are certified in Advanced Cardiac Life Support (ACLS) and fetal monitoring. n All staff members, including patient care technicians, maintain Neonatal Resuscitation Program credentials through the American Academy of Pediatrics.

n The majority of Labor and Delivery and Mother/Baby staff members have approximately five years or greater of experience; some have experience of 20 years or more. n All staff is charged with constant growth and learning to provide the very best in care.

In the area of emergency pediatric services, Piedmont Newnan's Emergency Services department provides high-quality emergency care to pediatric patients. If pediatric patients require inpatient care, Piedmont Newnan works to ensure a smooth transfer to a pediatric hospital that specializes in the inpatient care of pediatric patients.

Piedmont Newnan's Women's Services staff also provide community education on childbirth, breastfeeding, infant safety and CPR. The Women's Services department also has a Lactation Center staffed by a board-certified lactation consultant and a certified breastfeeding counselor who are both available for consultation.

The center also provides breast pump sales and rentals and other breastfeeding supplies such as nursing bras, pads and breast milk storage. The physicians, nurses and medical staff of the Women's Services department at Piedmont Newnan Hospital say they are dedicated to providing "a continuation of exceptional care for women and newborns."

When the new hospital opens, many more area families and newborns are sure to experience that "exceptional care" for themselves.

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LODI, CA - A complaint investigation report with the California Department of Social Services accuses a Lodi daycare provider of putting several babies in car seats and leaving them in dark closets, bedrooms and bathrooms with the doors shut.

California Department of Social Services workers filed the complaint after they made an unannounced visit to the home of Dorothy Bernhoft Tuesday. Department of Social Services Spokesperson Michael Weston said the investigation was spurred by a complaint made to their office. The complaint states that Bernhoft had nine infants and one child over 2 years old in her care.

Workers state that they found multiple children left unattended upstairs in closets, bedrooms and bathrooms and restrained in car seats. It also states that radios were left on to hide the sound of the children. Lodi police attended the unannounced visit, but no arrests have been made.

Detectives are still investigating before sending the case to the District Attorney's Office to decide on possible charges. Weston said none of the children were hurt and that Bernhoft's license has been suspended indefinitely. Daycare owner Bernhoft was at a loss for words about the complaint. "I am no longer running a daycare," Bernhoft said.

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On January 30, West Bengal Chief Minister Mamata Banerjee dismissed the opposition charge that the recent crib deaths in state-run hospitals in Malda and Murshidabad were due to medical negligence.
Seven of the babies were just 15-days-old. Vice-principal of the hospital Dr M A Rashid said most of them came from rural hospitals in Malda district and outside with problems ranging from pneumonia to septicaemia.
 
Dr Rashid said with nine more deaths, the crib death toll has shot up to 125 in the last 16 days. He said experts belonging to Sick Newborn Care Units would shortly visit the hospital to have a look at the infrastructure.

"In Malda, 8,000 babies are born outside hospitals. In Murshidabad too, non-institutional births run into several thousands. These babies who are brought to hospitals do not die due to negligence. But if negligence occurs, the guilty will be punished," Banerjee told news channels.
 
 Pointing out that a large number of women in rural areas are married off before 18, she said in most cases, their children weigh 500 to 600 gm. "This (early marriage) is a social disease. But if they are referred to state-run hospitals, we cannot refuse them admission," she said adding those who are criticising the government over the infant deaths are doing so to "malign" it.
 
In Malda, Congress and CPI(M) are doing this in a planned manner, the CM alleged.Pointing out that 70 to 80 children have died at the B C Roy Paediatric Institute during the last Left Front rule,she said "over the past eight months, however, we have beenable to bring down infant mortality substantially".
 
As per the union government figures, Bengal now has a lower infant mortality rate than many states like Uttar Pradesh, Andhra Pradesh, Chhattisgarh, Gujarat, Haryana, Jammu and Kashmir and Karnataka, Banerjee said.

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Like many ethnic Chinese around the world, Ms Mok believes the mythical dragon is the most auspicious sign in the traditional 12-year zodiac cycle. "The dragon is special," the flawlessly groomed Hong Kong native, who works as a makeup artist, tells BBC News. "Of course, I am not willing to wait 12 years for a dragon baby, but I was willing to wait one or two years."

Ms Mok is due to deliver her second child, another daughter, in early February. In part because of greater demand for maternity services, Ms Mok plans to spend 100,000 Hong Kong dollars ($12,820; £8,333) for medical care alone. That is 50% more than the amount spent on the birth of her first child, Ashley, just three years ago during the Year of the Rat, a less auspicious year.

Many couples across Asia are making extra efforts to give birth to so-called "dragon babies" in 2012. The trend is expected to trigger a temporary fertility boom and place a strain on public services in certain cities, as well as cause some families to go on spending sprees. In Hong Kong, the government expects 5% more births in 2012, compared with 2011. Doctors and academics believe the figure may be as high as 10%.

Childcare
Having a baby during the Year of the Dragon is very expensive compared with other years
Companies selling infant formula milk, nappies and prams are expected to cash in, as well as specialist service providers. According to Chinese tradition, a woman's body is at its most vulnerable after birth.

If possible, she should enter a period of confinement at home for one month after birth, to ensure her long-term recovery. BBcare, a Hong Kong agency that provides pre- and postnatal services, expects 20% growth in revenues in 2012, compared with 2011, due to the dragon baby trend.

The largest part of its business is referring postnatal care nurses to expectant families. Average hourly rates have already risen 15%, according to Wendy Lam, an experienced nurse at BBcare. The agency says enquiries have jumped 25%, and it is forecasting more successful referrals than in previous years.

With so many mothers giving birth in Hong Kong, the company believes there will be a shortage of postnatal care workers.

Property market
The dragon baby boom is also expected to give a boost to property markets in some Asian cities. In a recent research note, analysts at Citi investment bank argued there would be more births and marriages in the new lunar year, leading to an increase in property transactions in Hong Kong.

It explains that the Western calendar has 365 days, whilst the lunar year has 354 days. The extra days add up to one month every three years, creating a "leap year" in the Year of Dragon. Citi property analyst Ken Yeung cites data showing the number of marriages grew by 12% in good years, compared to just 1% in other years.

"These new marriages provide a good source of potential home buyers," he writes. "This should drive structural demand for homes in 2012, while new supply will remain tight in the near term."Property prices in mainland China and Hong Kong have fallen because of Beijing's efforts to cool economic growth.

Global markets?
The fact that the Year of the Dragon is a lucky time to give birth is widely accepted in the Chinese-speaking world, from Taiwan to Indonesia. But giving birth this year is especially expensive, compared with other times, and not everyone is jumping into the fray.

Charlie Chen, China consumer analyst at BNP Paribas, says other factors are at work when it comes to deciding when to have a baby. Like others in the financial industry, his salary and bonus are, in part, determined by the performance of global markets.

With so much uncertainty in Europe and the US, Mr Chen says he has no choice but to pass on the dragon. "I am married," he says. "Personally, I would like to have a baby in the Year of the Dragon, but I've got to postpone it because of market turmoil."

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Friday evening in a busy west London maternity hospital and I'm being wheeled briskly into theatre for my emergency caesarean. There is a sense of urgency, a situation growing more grave by the minute. Paediatricians hover and doctors consult. "Does the baby need in-utero resuscitation?" I hear someone ask. Should I have a general anaesthetic or an epidural; how much time do we have? My husband is whisked away to dress for theatre. I feel strangely calm, relieved to be in the hands of doctors duly concerned about my labour, away from the midwives who seemed anything but during the past seven hours in their care.

The anaesthetist administers an epidural. "Three minutes," the surgeon tells him, his eyes fixed on the heart monitor showing my baby's distress.

At six minutes past midnight, Amelia is born. The radio in the theatre is playing Waterloo Sunset, but apart from that there is no sound. The hearty scream I took for granted with my first two children is startlingly absent. As is the sight of a lusty pink baby that latches on within seconds. If I don't hear a cry in the next few seconds my world will collapse. I hear the faintest mewl. "Is she all right? Is she breathing?" I call, twisting my head in their direction, the rest of my body numb.

Ten minutes later I see her for the first time; she is perfect, but worryingly pale and sleepy. A paediatrician explains that Amelia was born not breathing but with a reassuringly strong heart-rate. They don't need to admit her to the neo-natal unit but want to supervise her closely for 24 hours. The rest of the night passes in a blur of paediatricians monitoring her blood sugar levels, temperature and heart rate. How could it have come to this?

Rewind to an over-stretched maternity ward several hours earlier. "You probably won't give birth until tonight," one midwife told me. "The labour ward's full anyway." And that's where my nightmare began. I'd been induced that morning and sent home; when I returned I was taken to a waiting area. By late afternoon my contractions were increasing, yet none of the midwives seemed interested. "They're so strong now," I told one. "Count them then, they should be every two minutes." She barely looked up.

More time passed before I was wired up to a heart monitor known as a CTG – cardiotocogram – to check the unborn baby's heart rate for signs of fetal distress. "Isn't it trying to tell us there's something wrong?" we asked a midwife who was passing when it beeped at regular intervals. She laughed and told us how to turn it off should it beep again.

Still no one checked my progress. My midwife seemed mildly surprised when I told her that I'd been induced. The contractions were frequent now, and still the monitor kept beeping. Finally my husband collared our midwife, hoping to get an idea of when I might go to the labour ward. Surely something should be done? She looked vague but said she would examine me. "Those contractions look pretty strong but you're hardly dilated." She stared at the monitor, baffled. "Maybe I'll call the doctor." Soon afterwards I was moved to theatre.

Later I discovered that I had shown signs of hyperstimulation, due to my induction, which can affect the baby's heart rate. I still can't help thinking about the "what ifs". What if my husband hadn't demanded some action? If another hour had passed without them checking me? There are no clear answers, even from Cathy Warwick, chief executive of the Royal College of Midwives, when I tell her about my case. "One of the things we're trying to do is to create systems where more than one person looks at the trace [of the CTG scan]. It is a very inexact science and so a lot of places are introducing double-checks, every hour. There's a real appreciation that we've got to up our game in terms of CTG training."

I have since read that around 500 babies a year are thought to die because of this problem, and an unknown number of others suffer brain damage. The next morning, a doctor told me that had Amelia been delivered much later, we'd be looking at "a very different outcome". As it was, all of Amelia's tests were clear; I was discharged a day later with a healthy baby.

Eight years ago, at the same hospital, the midwifery care I had was excellent and the standard of medical expertise there still is. Yet my experiences with midwives was startlingly different. Was it a case of bad luck? Partly, I suspect, combined with broader issues such as a national shortage of midwives, a funding crisis and soaring birthrates.

I complained to the hospital who took my case extremely seriously and the midwives' behaviour was investigated. When I met them, the clinicians said that, according to my midwife, she had beeped a doctor around an hour before that final examination, but there was no response. The hospital has stressed the importance of not muting alarms or asking patients and relatives to do so. They agreed that "the option of transferring earlier to the delivery suite to be monitored could have been discussed and put into place sooner". My midwife also apologised for the "quality of care before Amelia was born".

Almost a year later I feel profoundly fortunate to have a healthy baby, but I still shudder when I think how different things could have been.

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One of the world’s smallest surviving babies was discharged Friday from the hospital where she spent nearly five months in an incubator — but not before getting the Hollywood treatment.

Wearing a pink knit hat and wrapped in a pink princess blanket, Melinda Star Guido was greeted by a mob of television cameras and news photographers outside the Los Angeles County-USC Medical Center.“I’m just happy that she’s doing well,” said her 22-year-old mother Haydee Ibarra. “I’m happy that I’m finally going to take her home ... I’m just grateful.”

Melinda was born on August 30 weighing just 9 1/2 ounces, less than a can of soda. She was so tiny that she fit into her doctor’s hand. Melinda is believed to be the world’s third-smallest surviving baby and second smallest in the U.S.

Now weighing 4½ pounds and breathing through an oxygen tube as a precaution, doctors said Melinda has made enough progress to go home. Her brain scan was normal and her eyes were developing well. She also passed a hearing test and a car seat test that’s required of premature babies before discharge.

It’s too early to know how she will do developmentally and physically, but doctors planned to monitor her for the next six years. “I am cautiously optimistic that the baby will do well, but again there is no guarantee,” said Dr. Rangasamy Ramanathan, who oversees preemies at the hospital.

Most babies as small don’t survive even with advanced medical care. About 7,500 babies are born each year in the U.S. weighing less than 1 pound, and about 10 percent survive. Melinda has come a long way since being delivered by cesarean section at 24 weeks after her mother developed high blood pressure during pregnancy, which can be dangerous for mother and fetus.

She was whisked to the neonatal intensive care unit where she breathed with the help of a machine and received nutrition through a feeding tube. Infants born before 37 weeks are considered premature.

Even after discharge, such extremely premature babies require constant care at home. Their lungs are not fully developed and they may need oxygen at home. Parents also need to watch out for risk of infections that could send infants back to the hospital. Even basic activities like feeding can be challenging.

“They may need extra help and patience while they learn to eat,” Dr. Edward Bell, a pediatrician of the University of Iowa who runs an online database of the world’s smallest surviving babies born weighing less than a pound.

The list features 130 babies dating back to 1936 and does not represent all survivors since submission is voluntary. Melinda was not eligible to be included until she was discharged. Two years ago, Bell published a study in the journal Pediatrics that found many survivors have ongoing health and learning concerns. Most also remain short and underweight for their age.

There are some rare 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, according to doctors at Loyola University Medical Center in Illinois where the girls were born.

Soon after birth, Melinda was treated for an eye disorder that’s common in premature babies and underwent surgery to close an artery. Ibarra held Melinda for the first time after the operation in November. Her parents said the toughest part was battling traffic after work every day to see their daughter.

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Around 1,200 stillbirths a year are avoidable, a report launched today (18 January) has claimed. Preventing Babies’ Deaths: What Needs to be Done, produced by infant death charity Sands, argues that many of the 6,500 stillbirth and neo-natal deaths each year in the UK could be a prevented through better research, improved investment in antenatal care and greater awareness among parents of the risks of stillbirth.

Despite medical improvements, the stillbirth rate of one in 200 babies is the same as in the late 1990s and is among the highest rates in the developed world, according to the report, which adds that one in 300 babies dies before they are one month old.

Sands chief executive Neal Long said: "The scale of baby deaths in the UK is shocking. 17 babies are stillborn or die shortly after birth every day, with stillbirth being the largest contributor to child deaths under the age of five years."

The charity is calling for better research into the causes of stillbirth. Around a third of stillbirths are still unexplained and placenta abnormalities are poorly understood. A third of stillbirths are believed to be associated with low birth weight. The charity is calling for better targeting of women at risk of poor baby growth such as the over-35s, those classified as obese and those who smoke or misuse drugs and alcohol.

The government is being called on to improve maternity and neonatal services. The report notes that the Royal College of Midwives estimates 5,000 more midwives are needed nationally. Antenatal screening also needs to be more sophisticated. According to the report, current screening is "not dissimilar to those in use 40 years ago".

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Urgent action is needed to tackle Britain's high rate of stillbirths and deaths in the first few weeks of life, according to a report. The charity Sands said up to 1,200 stillbirths a year could be avoided. Each day, 17 babies are stillborn or die shortly after birth, a figure that has barely changed since the late 1990s.

In 2010, 4,110 babies were stillborn, another 1,850 died in the first hours or days of life and 507 died aged between one and four weeks. Sands is calling for a range of measures including research into scans and tools that may identify babies at risk, particularly later in pregnancy, and increased public awareness of the risks for expectant mothers.

Neal Long, the charity's chief executive, said: "The scale of baby deaths in the UK is shocking. A third of stillborn babies – around 1,200 – are born late in pregnancy [after 37 weeks' gestation], at gestations when they might safely be delivered. But routine antenatal care is failing to detect far too many babies who need help."

The report said there was an urgent need for new tests to understand some of the major causes of stillbirth, including problems with the placenta. Common causes of stillbirth include congenital malformations, maternal medical problems and birth complications and infections. However, a third of cases cannot be explained. "Problems with the placenta are poorly understood and require urgent research – until there is a way to test whether a placenta is functioning well, all women and their babies are potentially at risk," the report said.

Experts hope that a test could be developed to pick up problems with the placenta early on, enabling doctors to work out whether the baby needs to be delivered earlier than 37 weeks.

The report said some deaths were due to failures of care. "Around 500 babies die every year because of a trauma or event during birth that was not anticipated or well managed. These deaths, when they occur at term, should never happen and almost always could be avoided with better care."

Increased public awareness of the risks was also needed, Sands said. A third of stillbirths are associated with excess weight, smoking and being over the age of 35.

Gail Johnson, of the Royal College of Midwives, said: "It is important that all practitioners involved in maternity care are aware of the risks associated with stillbirth and that work continues to explore how stillbirth can be reduced.

"Current antenatal screening cannot identify all babies at risk, and research into how best midwives and doctors can deliver antenatal care to reduce stillbirth is welcomed."The public health minister, Anne Milton, said: "We continue to invest in research into the factors linked to stillbirth through the National Institute for Health Research's ongoing programme on women's health."Last year, a Lancet study reported that Britain had one of the worst records of stillbirths in the developed world.

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