We're Getting More Sophisticated at Keeping Infants Alive

For all animals species of which I am aware, the first year (or species equivalent thereof) of life is the most critical to the survival of the species. Our ability to keep human infants alive is one important reason that the world's population has gone from 1 billion to more than 7 billion in just two hundred years. Human infants are especially prone to die from dehydration due to diarrhea, which can be caused by almost anything. So, when oral rehydration therapies (ORT) were introduced globally only a half-century ago, they ushered in a new era of rapid decline in infant mortality and, of course, population growth. Indeed, ORT is new enough that one of its founders, Dr. Richard Cash, is still active on the faculty at the Harvard School of Public Health.

Medicine has progressed beyond ORT to look at what the causes are of diarrhea so that the child can be appropriately treated. The Bill and Melinda Gates has been instrumental in this effort and an article in today's NYTimes illustrates some of the complexities of diagnosis and treatment.

More than 40 pathogens — viruses, bacteria and parasites — cause diarrhea in children in developing countries. According to decades-old guidelines from the World Health Organization, these children should receive oral rehydration; intravenous rehydration if they cannot keep fluids down; and a zinc supplement.

The guidelines also say that children should receive antibiotics only when there is blood in their stool. At the time the recommendations were written, the best science indicated that blood was a sign of bacterial infection, and bacterial diarrhea is usually the most dangerous.

But bacterial causes are more common than had been realized, recent studies have found, and blood is not always present. And because many children with diarrhea do not receive antibiotics under W.H.O. guidelines, some experts say, many die or end up stunted by persistent infections that could have been cured.

The problem, though, is that some physicians are worried about giving out antibiotics unnecessarily, in order to avoid problems of building up immunities to its effects. Others argue (and I would agree) that if it could be a bacterial infection (even if you can't prove it), give the child the medicine! As the story points out, that's what we adults do when we travel. I wouldn't travel abroad without my antibiotics in case of diarrhea. Why should we deny that to a child?

All the time, though, we need to remember that as we more effectively keep children alive, we need to more effectively make sure that the parents have access to contraception. Those two things go together.