The March for Science, Washington, D.C. — On April 22, 2017 — Earth Day — thousands of scientists, science advocates and general enthusiasts rallied on the grounds of the Washington Monument in Washington, D.C., at the first-ever March for Science. The organizers estimate that over 600 sister marches also occurred around the world.
The march may be “unprecedented,” sociologist Kelly Moore told Rachel Ehrenberg for a blog post giving a historical perspective on scientists’ activism. “This is the first time in American history where scientists have taken to the streets to collectively protest the government’s misuse and rejection of scientific expertise.” The March for Science took place next to the Washington Monument, opposite the White House. Grounds opened at 8 a.m. and filled up quickly. Astronaut Leland Melvin told an entertaining anecdote about getting his start in science in sixth grade when his mom gave him “an age-inappropriate, non-OSHA-approved chemistry set.” At one point, a chemical explosion blew up her living room. But, “that’s what got me hooked on science,” he said. Pediatrician Mona Hanna-Attisha took the stage with Amariyanna “Mari” Copeny, aka “Little Miss Flint.”
DNA from 2,000-year-old stallions is helping rewrite the story of horse domestication.
Ancient domesticated horses had much more genetic diversity than their present-day descendants do, researchers report in the April 28 Science. In particular, these ancient horses had many more varieties of Y chromosomes and fewer harmful mutations than horses do now. Previous studies based on the genetics of modern horses concluded that domestication must have squeezed out much of the diversity seen in wild horses before the Ice Age. But the new findings suggest that the lack of diversity is a more recent development. “Today, Y chromosomes of all horses are pretty much the same,” says evolutionary geneticist Ludovic Orlando of the Natural History Museum of Denmark in Copenhagen. As a result, scientists thought that ancient people started domesticating horses by breeding only a few stallions to many different mares.
“But when we look in the past — wow! — this is a whole new planet,” Orlando says.
Horses are thought to have been domesticated by about 5,500 years ago. Orlando’s group examined DNA from the bones of 15 Iron Age stallions from the ancient Scythian civilization: Two stallions were from a 2,700-year-old grave site in Russia and 13 were sacrificed in a burial ritual about 2,300 years ago in Kazakhstan. The team also looked at a 4,100-year-old Bronze Age mare from the Sintashta culture in Russia. Nearly all of the stallions had a different type of Y chromosome, Orlando says.
That finding challenges the idea that only a few stallions participated in the early stages of domestication. Loss of Y chromosome diversity among horses must have happened within the last 2,300 years, Orlando says, and maybe as recently as 200 to 300 years ago, when people started creating specific horse breeds. Using genetic data from modern animals to figure out what went on in the past is like flipping to the end of a novel and reading only the ending; it shows how things ended up but doesn’t indicate how the story started or unfolded. Examining ancient DNA can fill in those gaps to give a better indication of how domestication took place and how ancient people interacted with animals, says Laurent Frantz, an evolutionary biologist at Queen Mary University of London. Modern horses also carry mutations that can be harmful (SN: 1/10/15, p. 16), including ones involved in dementia and seizures. But the ancient horses didn’t have those mutations, indicating that those DNA changes happened sometime within the last 2,300 years.
“It really shows an awful lot has changed very recently, and it’s incredibly dangerous to model the deep past from modern genetics,” says zooarchaeologist Alan Outram of the University of Exeter in England. “You really need to carry out the ancient DNA studies.”
Orlando and colleagues also determined some genetic traits that were cultivated by the Scythians. Genes involved in mammary gland development and function had variants associated with greater milk production, perhaps indicating that the Scythians milked their horses. Outram and others have evidence that horse milking started at least 5,000 years ago (SN: 3/28/09, p. 15).
Also changed were genes involved in the function of neural crest cells. Those embryonic cells migrate to different parts of the body during early development and help form parts of the brain, some facial features and other tissues. One recent hypothesis is that changes in how neural crest cells work could lead to common characteristics shared by domestic animals, such as floppy ears, juvenile faces and spotted coats (SN: 8/23/14, p. 7).
Genetic results from the ancient horses provide evidence that the hypothesis might be true, says Frantz. Geneticists will have to work with experimental biologists to confirm that neural crest cells are involved in changing the appearance of domesticated animals. But, Frantz says, “this is the first step toward testing that hypothesis correctly.”
Simulating the assembly of the solar system around 4.56 billion years ago, researchers propose that the Red Planet didn’t form in the inner solar system alongside the other terrestrial planets as previously thought. Mars instead may have formed around where the asteroid belt is now and migrated inward to its present-day orbit, the scientists report in the June 15 Earth and Planetary Science Letters. The proposal better explains why Mars has such a different chemical composition than Earth, says Stephen Mojzsis, a study coauthor and geologist at the University of Colorado Boulder. The new work is an intuitive next step in a years-long rethink of the early solar system, says Kevin Walsh, a planetary scientist at the Southwest Research Institute in Boulder, Colo., who was not involved with the new simulation. “We only became comfortable within the last 10 years with the idea that planets move around, possibly a lot,” he says. “Planets may not have formed where we see them today.”
Mars, like Mercury, is a runt of the inner solar system, weighing in at only about a ninth of Earth’s mass. One of the reigning theories of planetary formation, the Grand Tack model, blames Jupiter for the Red Planet’s paltry size. In that scenario, the newly formed Jupiter migrated toward the sun until it reached Mars’ present-day orbit. A gravitational tug from Saturn then reversed Jupiter’s course, sending the gas giant back to the outer solar system (SN: 4/2/16, p. 7).
Gravitational effects of Jupiter’s sunward jaunt acted like a snowplow, scientists believe, causing a pileup of material near where Earth’s orbit is today. The bulk of that material formed Venus and Earth, and the scraps created Mercury and Mars. This explanation predicts that all the terrestrial planets formed largely from the same batch of ingredients (SN: 4/15/17, p. 18). But studies of Martian meteorites suggest that the Red Planet contains a different mix of various elements and isotopes, such as oxygen-17 and oxygen-18, compared with Earth.
Planetary scientist Ramon Brasser of the Tokyo Institute of Technology, Mojzsis and colleagues reran the Grand Tack simulations, keeping an eye on the materials that went into Mars’ creation to see if they could explain the different mix.
As with previous studies, the researchers found that the most probable way of creating a solar system with the same planet sizes and positions as seen today is to have Mars form within Earth’s orbit and migrate outward. How Another possible scenario, though seen in only about 2 percent of the team’s new simulations, is that Mars formed more than twice as far from the sun as its present-day orbit in the region currently inhabited by the asteroid belt. Then as Jupiter moved sunward, its gravitational pull yanked Mars into the inner solar system. Jupiter’s gravity also diverted planet-making material away from Mars, resulting in the planet’s relatively small mass. With Mars forming so far from the planetary feeding frenzy responsible for the other rocky planets, its composition would be distinct. While this scenario isn’t as likely as Mars forming in the inner solar system, it at least matches the reality of Mars’ makeup, Mojzsis says.
Such a distant origin means that the fledgling Mars would have received far less sunlight than originally thought, a challenge to early Mars’ possible habitability. Without a sustained thick atmosphere of heat-trapping greenhouse gases, the planet would have been too cold to sustain liquid water on its surface for long periods of time, Mojzsis argues. Though large meteorite impacts could have temporarily warmed Mars above freezing, the planet wouldn’t have had a consistently warm and wet youth similar to that of the early Earth, he says.
Confirming whether Mars really was born that far out in space will require taking a closer look at Venus’ mix of elements and isotopes, which the researchers predict would be similar to Earth’s. Venus’ composition is largely unknown because of a lack of Venusian meteorites found on Earth, and that mystery won’t be unlocked anytime soon: No missions to Venus are planned.
Certain stealthy spacetime curiosities might be less hidden than thought, potentially exposing themselves to observers in some curved universes.
These oddities, known as singularities, are points in space where the standard laws of physics break down. Found at the centers of black holes, singularities are generally expected to be hidden from view, shielding the universe from their problematic properties. Now, scientists report in the May 5 Physical Review Letters that a singularity could be revealed in a hypothetical, saddle-shaped universe. Previously, scientists found that singularities might not be concealed in hypothetical universes with more than three spatial dimensions. The new result marks the first time the possibility of such a “naked” singularity has been demonstrated in a three-dimensional universe. “That’s extremely important,” says physicist Gary Horowitz of the University of California, Santa Barbara. Horowitz, who was not involved with the new study, has conducted previous research that implied that a naked singularity could probably appear in such saddle-shaped universes.
In Einstein’s theory of gravity, the general theory of relativity, spacetime itself can be curved (SN: 10/17/15, p. 16). Massive objects such as stars bend the fabric of space, causing planets to orbit around them. A singularity occurs when the warping is so extreme that the equations of general relativity become nonsensical — as occurs in the center of a black hole. But black holes’ singularities are hidden by an event horizon, which encompasses a region around the singularity from which light can’t escape. The cosmic censorship conjecture, put forth in 1969 by mathematician and physicist Roger Penrose, proposes that all singularities will be similarly cloaked.
According to general relativity, hypothetical universes can take on various shapes. The known universe is nearly flat on large scales, meaning that the rules of standard textbook geometry apply and light travels in a straight line. But in universes that are curved, those rules go out the window. To demonstrate the violation of cosmic censorship, the researchers started with a curved geometry known as anti-de Sitter space, which is warped such that a light beam sent out into space will eventually return to the spot it came from. The researchers deformed the boundaries of this curved spacetime and observed that a region formed in which the curvature increased over time to arbitrarily large values, producing a naked singularity.
“I was very surprised,” says physicist Jorge Santos of the University of Cambridge, a coauthor of the study. “I always thought that gravity would somehow find a way” to maintain cosmic censorship.
Scientists have previously shown that cosmic censorship could be violated if a universe’s conditions were precisely arranged to conspire to produce a naked singularity. But the researchers’ new result is more general. “There’s nothing finely tuned or unnatural about their starting point,” says physicist Ruth Gregory of Durham University in England. That, she says, is “really interesting.” But, Horowitz notes, there is a caveat. Because the violation occurs in a curved universe, not a flat one, the result “is not yet a completely convincing counterexample to the original idea.”
Despite the reliance on a curved universe, the result does have broader implications. That’s because gravity in anti-de Sitter space is thought to have connections to other theories. The physics of gravity in anti-de Sitter space seems to parallel that of some types of particle physics theories, set in fewer dimensions. So cosmic censorship violation in this realm could have consequences for seemingly unrelated ideas.
Even though a sprained ankle rarely needs an opioid, a new study of emergency room patients found that about 7 percent of patients got sent home with a prescription for the potentially addictive painkiller anyway. And the more pills prescribed, the greater the chance the prescription would be refilled, raising concerns about continued use.
The research adds to evidence that it’s hard for some people to stop taking the pills even after a brief use. State officials in New Jersey recently enacted a law limiting first-time prescriptions to a five-day supply, and other states should consider similar restrictions, says Kit Delgado, an assistant professor of Emergency Medicine and Epidemiology at the University of Pennsylvania. “The bottom line is that we need to do our best not to expose people to opioids,” Delgado says. “And if we do, start with the smallest quantity possible.” The research was presented May 17 at the Society for Academic Emergency Medicine’s annual meeting in Orlando.
Previous research has found that the more opioids such as hydrocodone and oxycodone are prescribed, the more likely patients are to keep taking them. But previous studies have been too broad to account for differences in diagnoses — for instance, whether people who received refills kept taking the drug simply because they still were in pain, Delgado says. He and colleagues limited their study to prescriptions written after ankle sprains to people who had not used an opioid in the previous six months. Usually, those injuries aren’t serious and don’t require opioids.
About 7 percent of 53,222 people who visited ERs with ankle sprains in 2011 and 2012 were sent home with an opioid prescription, the researchers found. Patients’ experiences varied by state: Less than 2 percent treated in Delaware were prescribed an opioid compared with 16 percent in Mississippi.
The number of pills obtained within a week of those visits also varied greatly, from as few as five to more than 60. Typical prescriptions were for 15 to 40 pills. Those who received prescriptions for 30 pills or more were twice as likely to get refills as those with prescriptions for 15 or fewer, Delgado and colleagues found.
“Because these are patients who have a uniformly minor injury, it emphasizes how much arbitrariness there is in how physicians prescribe opioids,” says Michael Barnett, an assistant professor at the Harvard T.H. Chan School of Public Health, who was not involved in the study. In February, Barnett and colleagues published a study of ER opioid prescribing in the New England Journal of Medicine, which found that higher exposures carry greater odds of long-term use. The strength of the new study, he said, is that “an ankle sprain is an ankle sprain. It’s a minor injury that requires very little treatment beyond rest, ice and elevation.”
Chemical transformations in minerals deep beneath the seafloor could explain why Indonesia’s 2004 mega-earthquake was unexpectedly destructive, researchers report in the May 26 Science.
The magnitude 9.2 quake and the tsunami that it triggered killed more than 250,000 people, flattened villages, and swept homes out to sea across Southeast Asia. It was one of the deadliest tsunamis in recorded history.
“It raised a whole bunch of questions, because that wasn’t a place in the world where we thought a magnitude 9 earthquake would occur,” says study coauthor Brandon Dugan, a geophysicist at the Colorado School of Mines in Golden.
The thick but stable layer of sediment where tectonic plates meet off the coast of the Indonesian island of Sumatra should have limited the power of an earthquake, seismologists had predicted. But instead, this quake was the third-strongest on record worldwide. Dugan spent two months aboard a boat with 30 other scientists collaborating through the International Ocean Discovery Program. The researchers drilled down 1,500 meters below the seafloor in two places off the coast of Sumatra, extracting narrow cylinders of sediment. This sediment is very slowly moving toward the fault where the 2004 earthquake occurred — a zone where one massive tectonic plate slides over another, pushing that plate downward.
Analyzing how sediment changes with depth can give scientists a snapshot of the geological processes at play near the fault zone.
In particular, deep down, the researchers identified a layer of sediment where the water had a lower salinity than the water in the sediment above or below. Since seawater seeping into the sediment would be salty, the evidence of freshwater suggests that the water must have instead been released from within minerals in the sediment.
For tens of millions of years, Dugan proposes, minerals sat on the seafloor taking in water — baking it into their crystal structure. Then, more sediment settled on top. It got toasty under such a thick blanket of sediment, heating up the minerals beneath. The temperature increase triggered a chemical transformation within the sediment, pushing water out of the mineral crystals and into tiny pores between the grains. The sediment sampled in this study is still dehydrating. By the time any of it reaches the plate boundary, Dugan says, it’ll be buried under kilometers of more sediment and will probably be completely dehydrated.
At first, the liberated water would have softened the material, actually decreasing the risk of a big earthquake by allowing it to absorb more force, Dugan says. As the sediment got closer to the fault over millions of years, though, the water flowed away, leaving it brittle and unstable — the perfect setup for a mega-quake.
The timing of this sediment dehydration process can make or break a quake. Had the sediment near the fault been in a softened state when the quake struck in 2004, the tremor might not have been as deadly, Dugan says. But since enough time had passed for it to become brittle again, the tectonic plates were able to rapidly slip past each other for a much greater distance during the quake. That massive motion displaced the seafloor itself, setting a tsunami into motion. “It’s really the tsunamis from these earthquakes that prove to be the deadliest and most dangerous,” says Roland Bürgmann, a seismologist at the University of California, Berkeley who wasn’t part of the study. And quakes that displace the seafloor are far more likely to trigger tsunamis.
The findings could apply to other faults with similarly thick sediment, such as the Cascadia Subduction Zone in the Pacific Northwest, suggests study coauthor Andre Hüpers, a geophysicist at the University of Bremen in Germany.
But more evidence is needed before applying such analysis to faults beyond this one, says Bürgmann. The argument for what happened along the Sumatran fault is compelling, he says. “But nonetheless, it’s only one data point. It doesn’t yet make for a pattern.”
The first thing you’ll notice is the noise. Monitors beep steadily, relentlessly, ready to sound a car-alarm blare if a baby is in trouble.
The air has an astringent odor — not clean exactly, but reminiscent of an operating room (there’s one next door). Ceiling lights shine fluorescent white. Half are off, but glare from the monitors throws out extra light. It’s midday on a Friday, but it’ll be just as bright at midnight.
Here on the fourth floor of Yale New Haven Children’s Hospital, 10 tiny beds hold 10 tiny infants, each with Band-Aid–like patches stuck to their bodies to continuously monitor health. Between beds, nurses squeeze through narrow aisles crammed with folding chairs and plastic incubators. This space, one of five in the hospital’s neonatal intensive care unit, has the people and equipment needed to keep sick babies alive — heart rate monitors, oxygen tanks, IV poles to deliver medications. Until recently, Yale’s NICU and hundreds like it across the country were considered the place to be for newborns withdrawing from opioid drugs. But now, as the number of drug-dependent babies surges, doctors here and elsewhere are searching for better options.
“We’re really focused on trying to get these kids out of the NICU,” says Yale pediatrician Matthew Grossman. “We’re looking at moms and the dads as the first line of treatment.”
The nationwide rate of babies withdrawing from opioids has soared — up nearly 400 percent from 2000 to 2012. The booming numbers are the bleak by-product of the United States’ ongoing battle with the drugs: Sales of prescription opioid pain relievers alone quadrupled from 1999 to 2010, and overdose deaths tripled from 2000 to 2014. When pregnant women use opioids, the drugs pass from bloodstream to baby. After exposure in the womb to Vicodin, methadone or heroin, for example, babies can become dependent. At birth, when the drug flow stops, babies can go through agonizing withdrawal — body shakes, intestinal problems, constant crying. The condition is known as neonatal abstinence syndrome, or NAS. But there’s no clear consensus on how to care for these struggling babies, Grossman says. Usually they’re whisked off to the NICU and treated with opioids. The drugs ease symptoms, but they prolong exposure to “really powerful and potentially dangerous medications,” he says.
At Yale, NAS babies used to spend weeks in the NICU — they still do in many U.S. hospitals. But in the last few years, Grossman and others have begun to question this method of care. Infants suffering from opioid withdrawal might actually do better back in parents’ arms, away from the high-tech hubbub. Comfort is key. Quiet, dark environments, swaddling, breastfeeding, rocking and holding, no unnecessary tests — it’s baby care 101.
That’s hard to do in the busy, loud NICU, says Grossman. Plus, there’s no place for parents to stay. They can visit, perched on folding chairs wedged between beds, says Yale pediatrician Rachel Osborn, but moms and dads “often feel like they’re extraneous and in the way.”
Faced with these and other obstacles, Grossman, Osborn and others are radically redefining their methods. They’re examining traditional practices, testing new ideas and getting back to basics. The results have been dramatic.
“We’re treating the families with respect and the babies like babies,” Grossman says. The parents have everything the baby needs, he says. “It’s not a whole lot more complicated than that.” State of alarm Maine, Vermont and West Virginia reported the highest rates of neonatal abstinence syndrome, opioid withdrawal linked to maternal drug use. Maine, Maryland, Massachusetts and Rhode Island rates are from 2012; the rest are 2013.
Click or tap the map below to learn more. Tough going Families today are much more likely to deal with opioid use — and its consequences for newborns — than they were a decade ago.
In 2004, NAS rates were consistently low across the country: For every 1,000 babies born, roughly one was diagnosed with NAS. By 2013, when pediatrician Nicole Villapiano and colleagues examined rural versus urban data, rates were up across the board. But rural areas had been hit the hardest, with nearly 8 per 1,000 babies diagnosed with NAS, the researchers reported in February in JAMA Pediatrics.
In an urban hospital near Rhode Island’s Providence River, Villapiano witnessed infant opioid withdrawal firsthand. She was first assigned to the newborn nursery service at Women and Infants Hospital in Providence in 2011. “I imagined it’d be a joyful time, seeing babies going off with their families, having wonderful lives.”
Reality quickly dashed that hopeful picture. On any given day, she might see several babies at a time struggling with withdrawal. “These children were miserable,” says Villapiano, now at the University of Michigan in Ann Arbor. “Their cries were persistent and their irritability was profound.”
NAS isn’t easy to define. Babies suffer a wide range of symptoms. They’re sweating, shaking, stiff. Stools are loose, eating and sleeping are difficult, and crankiness is common. Babies with NAS can also have breathing problems, seizures and low birth weights.
The syndrome was first described in heroin-exposed infants. Scientists now know that all sorts of opioids used during pregnancy can trigger the condition, including “maintenance” drugs like methadone or buprenorphine used to treat opioid addiction, and even painkillers commonly prescribed during pregnancy, such as codeine and hydrocodone.
Not all infants exposed to opioids in utero go through withdrawal — and exactly what conditions lead to NAS is still unclear. The particular opioid and how much a pregnant woman uses, whether she takes certain antidepressants and even the number of cigarettes she smokes per day all seem to factor in, Stephen Patrick of Vanderbilt University in Nashville and colleagues reported in Pediatrics in 2015. A nonsmoking woman on oxycodone for a few weeks, for example, might have roughly a 1 percent chance of delivering a baby with NAS. For a pack-a-day smoker on antidepressants and buprenorphine for six months, the risk could be more than 30 percent.
Because opioids are such a broad family of addictive drugs, opioid-using moms don’t fit neatly into one category, says Ju Lee Oei, a neonatologist at the University of New South Wales in Sydney. “We need to be aware that Mrs. Smith down the road who’s getting a bit of codeine for her back pain could have a baby with NAS,” Oei says. Some women give birth to NAS babies while recovering from opioid addiction — even though they’re doing everything doctors advise, says pediatrician Alison Holmes of Children’s Hospital at Dartmouth-Hitchcock in Lebanon, N.H.
“Sometimes people think, ‘Oh, these mothers are such horrible addicts,’ ” Holmes says. But a lot of the time, “they’re staying on their methadone, they’re staying on their buprenorphine, they’re keeping symptoms under control — but their babies are still going to withdraw.”
No one knows exactly what opioid exposure does to fetal brains, or how these kids will fare in the future. Certain brain regions may not grow correctly, previous studies have suggested. Children can also have vision trouble and may develop behavior and attention problems. One long-term Australian study published in February linked a diagnosis of NAS with poor academic performance — all the way up to age 12 or 13.
Whether that’s caused by NAS is hard to say, says Oei, a coauthor of the study. Poverty, poor childhood nutrition and prenatal exposure to alcohol or other drugs could also come into play. But the results are a red flag for all those newly diagnosed babies. “You expect your baby to go to school and get good grades,” Oei says. But from as early as third grade, “these kids don’t seem to be able to do that.”
Still, research on NAS outcomes and potential treatments remains full of gaps, a 2015 report from the U.S. Government Accountability Office found. And there’s no nationally accepted treatment protocol for NAS. “Everyone’s doing it their own way,” says Scott Wexelblatt, a pediatrician at Cincinnati Children’s Hospital Medical Center.
Time for a change The traditional way to assess NAS was published more than 40 years ago by neonatologist Loretta Finnegan, now at the College on Problems of Drug Dependence in Philadelphia. Every four to eight hours, sometimes more frequently, nurses evaluate symptoms using a detailed scoring list: the Finnegan Neonatal Abstinence Scoring System. Hit a certain score, and doctors will start up the withdrawal-easing opioids, typically morphine or methadone. But there’s a push and pull between managing withdrawal and dosing babies with more drugs, Wexelblatt says. “We don’t want to expose babies to opioids unless we really need to.”
Care of NAS babies varies widely in hospitals across the United States, according to a study in the May–June Academic Pediatrics. Some newborns may be getting too much opioids. To see if standardizing care could help infants get off the drugs faster, Wexelblatt and colleagues trained nurses on Finnegan scoring and outlined a detailed protocol for weaning.
That simple step made a big difference. Hospitals that adopted the protocol cut infant stays from an average of 31.6 days before the intervention to 23.7 days afterward, Wexelblatt’s team reported in 2015 in Pediatrics. Duration of opioid treatment dropped as well. By 2016, hospital stays were down to 20 days, he says.
Now, 54 hospitals — almost all delivery hospitals in Ohio — use the weaning protocol, Wexelblatt says. The team has since refined its methods, focusing on family support and nonmedication options for care, like swaddling and breastfeeding. And as of 2013, every delivering mom in the Cincinnati region gets urine-tested for opioids upon admission so that care can start early, if needed. Ohio’s strategy is paying off: Doctors are using fewer opioids to treat NAS babies and the infants are getting out of the hospital faster too, early results suggest.
Researchers at Yale and Dartmouth-Hitchcock have also taken a hard look at the hospitals’ methods, starting with the Finnegan scoring system. Some aspects just didn’t make sense, Holmes and colleagues reported last June in Pediatrics. Nurses sometimes woke sleeping babies or removed them from family members’ arms for scoring, and they gave hungry babies points for crying.
“We said, ‘This is crazy,’ ” Holmes remembers. It makes more sense to just score the babies after they eat and while they’re being held. That way, she says, nurses might be able to sift the actual signs of withdrawal from the normal whines and wails of a hungry or tired baby.
Grossman and colleagues at Yale were skeptical too. Finnegan’s system looks for warning signs like vomiting and fever, but also gives points for sneezing and yawning. The final score guides doctors’ decision to dial meds up or down. “Is it truly best to give morphine to an infant who yawned 4 times instead of 3, as the [scoring system] guides us to do?” they asked in a Hospital Pediatrics commentary in February.
Grossman scoured the scientific literature, searching for clues to improve treatment. But research results bounced all over the place. “We ended up questioning everything,” he says. “It turned out there wasn’t really a good answer for anything we were doing.” Family first Around the same time Grossman was digging into research on opioid withdrawal in newborns, he had his first child, who screamed constantly. “I’m pacing in the middle of the night, thinking, if this was an NAS baby, he’d be on medication immediately.”
Instead, Grossman paced and rocked and held his son — all of the tricks parents use to soothe a cranky newborn. As he found ways to settle the baby, he thought, what if NAS babies needed something similar?
The idea jibed with his experiences at the hospital. Sometimes withdrawing infants would do great for days—their moms were there, and Finnegan scores stayed low. But if moms had to leave, babies would backslide, and scores would rocket up again. “Do these kids need more mom or more meds?” Grossman and colleagues wondered. “We started to think, ‘Well, maybe it’s more mom.’ ”
At Dartmouth-Hitchcock, Holmes and her crew were coming up with their own ideas. The team stopped interpreting Finnegan scores so rigidly, for one. But their biggest change was keeping mothers and babies together, 24-7. It’s called “rooming-in,” and previous studies in Canada and other countries had suggested it might ease babies’ transition from the womb to the world. “What withdrawing babies need is a calm, quiet, dark place where they can be held by a caring individual,” Holmes says. Her team focused on involving moms and families (and even volunteer cuddlers), and the hunch paid off. From 2012 to 2015, the average length of stay for morphine-treated NAS babies dropped from 16.9 days to 12.3 days. The fraction of babies given morphine plummeted too, from 46 percent to 27 percent. Now, two years later, that number has fallen even further — to just 20 percent, she says.
Holmes says her own kids joke about her work: “Babies like their mothers—surprise, surprise! What a discovery!” She laughs, and then adds, “They’re kind of right.”
Grossman’s team at Yale has pushed the family-focused approach even further. “Our mind-set is rooming-in on steroids,” he says. For NAS, parental care is considered more important—and more effective—than medication. Doctors ask parents: “How do we get you here or dad here or grandma here?” Grossman says. “Because that’s what your baby needs.”
His team rolled in other ideas too, like fortifying formula and pumped breast milk with extra calories. And hospital personnel stopped using Finnegan scores to guide medication dosing. Today, they base assessments on three simple parameters: whether an infant can eat, sleep and be consoled.
The patient rooms where parents can bunk with their babies are a world apart from the NICU. One room at Yale has a couch that converts into a bed and ceiling tiles with pictures of Elmo and Tweety Bird. Monitors are muted, nothing beeps incessantly and natural light pours in from the window. There’s plenty of space for parents to walk around and tend to their baby. In these rooms, “it feels like the parent is a necessary part of the care team,” Yale’s Osborn says.
In 2016, babies with NAS stayed in the Yale hospital just 5.9 days — a cliff dive compared with the 2008–2010 average of 22.4 days, Grossman, Osborn and colleagues reported online May 18 in Pediatrics. Even more staggering is the fraction of these babies treated with morphine: just 14 percent in 2016, down from 98 percent in 2008–2010. Taking the plunge From 2008 to 2016, the proportion of opioid-withdrawing infants treated with morphine at Yale New Haven Children’s Hospital dropped from 98 percent to 14 percent, a drastic reduction in the number of babies given the medication.
Click or tap the graph below to learn more.
Yale’s approach basically comes down to common sense, Grossman says: a quiet room, lots of holding, feeding when hungry and simply keeping babies with mom and dad. “It’s not rocket science,” he says. Medication became more of a plan B.
Still, other doctors looking to transform NAS treatment may run into barriers. Not all U.S. hospitals are set up like Dartmouth-Hitchcock or Yale New Haven, Wexelblatt says. There’s not always room for mom to stay with her baby once she’s released. And universal drug testing of moms won’t work everywhere, he warns. In Tennessee, a law passed in 2014 allowed new mothers to be prosecuted for using illegal drugs while pregnant if the newborn was harmed. The law expired last July, but such legislation drives women away from medical care, Wexelblatt says.
It could be that the best care for babies begins with care and compassion for moms. Rather than blame mothers, Holmes says, “We need to do as much as we can to support them in being good parents.”
Gravitational waves are providing new hints about how black holes get their kicks.
The Advanced Laser Interferometer Gravitational-Wave Observatory’s detection of spacetime ripples from two merging black holes on December 26, 2015, indicated that one black hole was spinning like a tilted top as it orbited with its companion (SN: 7/9/16, p. 8). That off-kilter spin could mean that the stellar explosion that produced the black hole gave it a strong kick, physicist Richard O’Shaughnessy and colleagues report in a paper in press in Physical Review Letters.
Scientists aren’t sure how black holes like those detected by LIGO pair up (SN Online: 6/19/16). Two neighboring stars may have obliterated themselves in a pair of explosions called supernovas, producing two black holes. But that scenario should lead to black holes that spin in the same plane as their orbit. It would take a sizeable jolt from the supernova, of about 50 kilometers per second, to account for the cockeyed spin, the researchers conclude.
Computer simulations of supernovas predict smaller black hole boosts, making for a cosmological conundrum. “This will be a serious challenge for supernova modelers to explain,” O’Shaughnessy, of the Rochester Institute of Technology in New York, said June 5 in a news conference in Austin, Texas, at a meeting of the American Astronomical Society.
Fossil DNA may be rewriting the history of elephant evolution.
The first genetic analysis of DNA from fossils of straight-tusked elephants reveals that the extinct animals most closely resembled modern African forest elephants. This suggests that straight-tusked elephants were part of the African, not Asian, elephant lineage, scientists report online June 6 in eLife.
Straight-tusked elephants roamed Europe and Asia until about 30,000 years ago. Much like modern Asian elephants, they sported high foreheads and double-domed skulls. These features convinced scientists for decades that straight-tusked and Asian elephants were sister species, says Adrian Lister, a paleobiologist at the Natural History Museum in London who was not involved in the study. For the new study, researchers extracted and decoded DNA from the bones of four straight-tusked elephants found in Germany. The fossils ranged from around 120,000 to 240,000 years old. The genetic material in most fossils more than 100,000 years old is too decayed to analyze. But the elephant fossils were unearthed in a lake basin and a quarry, where the bones would have been quickly covered with sediment that preserved them, says study author Michael Hofreiter of the University of Potsdam in Germany.
Hofreiter’s team compared the ancient animals’ DNA with the genomes of the three living elephant species — Asian, African savanna and African forest — and found that straight-tusked genetics were most similar to African forest elephants.
When the researchers told elephant experts what they’d found, “Everybody was like, ‘This can’t possibly be true!’” says study coauthor Beth Shapiro of the University of California, Santa Cruz. “Then it gradually became, ‘Oh yeah, I see.… The way we’ve been thinking about this is wrong.’”
If straight-tusked elephants were closely related to African forest elephants, then the African lineage wasn’t confined to Africa — where all elephant species originated — as paleontologists previously thought. It also raises questions about why straight-tusked elephants bore so little resemblance to today’s African elephants, which have low foreheads and single-domed skulls. Accounting for this new finding may not be as simple as moving one branch on the elephant family tree, Lister says. It’s possible that straight-tusked elephants really were a sister species of Asian elephants, but they exhibit genetic similarities to African forest elephants from interbreeding before the straight-tusked species left Africa.
It’s also possible that a common ancestor of Asian, African and straight-tusked elephants had particular genetic traits that were, for some reason, only retained by African and straight-tusked elephants, he says.
Lister and colleagues are now reexamining data on straight-tusked skeletons to reconcile the species’ skeletal features with the new information on their DNA. “I will feel most comfortable if we can understand these genetic relationships in terms of the [physical] differences between all these species,” he says. “Then we’ll have a complete story.”
When we brought our first baby home from the hospital, our pediatrician advised us to have her sleep in our room. We put our tiny new roommate in a crib near our bed (though other containers that were flat, firm and free of blankets, pillows or stuffed animals would have worked, too).
The advice aims to reduce the risk of sleep-related deaths, including sudden infant death syndrome, or SIDS. Studies suggest that in their first year of life, babies who bunk with their parents (but not in the same bed) are less likely to die from SIDS than babies who sleep in their own room. The reasons aren’t clear, but scientists suspect it has to do with lighter sleep: Babies who sleep near parents might more readily wake themselves up and avoid the deep sleep that’s a risk factor for SIDS.
That’s an important reason to keep babies close. Room sharing also makes sense from a logistical standpoint. Middle of the night feedings and diaper changes are easier when there’s less distance between you and the babe.
But babies get older. They start snoring a little louder and eating less frequently, and it’s quite natural to wonder how long this room sharing should last. That’s a question without a great answer. In November 2016, the American Academy of Pediatrics task force on SIDS updated its sleep guidelines. The earlier recommendation was that babies ought to sleep in parents’ bedrooms for an entire year. The new suggestion softens that a bit to say infants should be there for “ideally for the first year of life, but at least for the first 6 months.”
Rachel Moon, a SIDS expert at the University of Virginia in Charlottesville who helped write the revised AAP guidelines, says that the update “gives parents a little more latitude after the first 6 months.” The vast majority of SIDS deaths happen in the first six months of life, but the studies that have found benefits for room sharing lumped together data from the entire first year. That makes it hard to say how protective room sharing is for babies between 6 and 12 months of age.
But a new study raises a reason why babies ought to get evicted before their first birthday: They may get more sleep at night in their own rooms. Babies who were sleeping in their own rooms at ages 4 or 9 months got more nighttime sleep than babies the same ages who roomed with parents, researchers reported online June 5 in Pediatrics.
The team asked hundreds of mothers to take sleep surveys when their children were 4, 9, 12 and 30 months old. Some of the 230 children slept in their own rooms when they were younger than 4 months, others moved to their own rooms between 4 and 9 months, and the rest were still sharing their parents’ rooms at 9 months. At 9 months, babies who had been sleeping alone since 4 months of age slept an average of 40 minutes more than room sharers. The researchers found no differences in sleep duration between the groups of babies at age 12 months. By 30 months of age, though, children who had been sleeping in their own rooms by either 4 or 9 months of age slept on average 45 minutes longer at night than children who had been sharing their parents’ rooms at 9 months. (Important caveat: At 30 months, total daily sleep time didn’t differ between the groups. The former room sharers were making up for missed nighttime sleep with naps.)
Parents who want their babies age 6 months and older to sleep in their own room ought to be encouraged to make the move, says study coauthor Ian Paul, a pediatrician at Penn State. “The guidelines should reflect data, not opinion,” Paul says.
He suspects that sharing a bedroom with babies interferes with everyone’s sleep because normal nocturnal rustlings turn into full-blown wake-ups. Babies and adults alike experience brief arousals during sleep. But when parents are right next to babies, they’re more likely to respond to their children’s brief arousals, which then wakes the baby up more. “This then sets up the expectation from the baby that these arousals will be met with a parent reaction, causing a bad cycle to develop,” he says.
There was another difference that turned up between the two groups of babies. Babies who roomed with parents were four times more likely to be moved into their parents’ beds at some point during the night than babies who slept in their own rooms. Bed sharing is a big risk factor for sleep-related infant deaths.
But Moon cautions that the Pediatrics study is preliminary, and doesn’t warrant a change in the AAP guidelines. She and coauthors point out in an accompanying commentary that other factors might be behind the difference in sleep between the two groups of babies. For instance, babies who slept in their own room were more likely to have consistent bedtime routines, be put to bed drowsy but awake, and have bedtimes of 8 p.m. or earlier. Those are all signs of good “sleep hygiene” for babies, and might be contributing to the longer sleep times. “We know that consistent bedtime routine and consistent bedtime are very important in terms of sleep quality in children,” Moon says. “They could very well make a difference.”
So that’s where we are. Some things are clear, like putting your baby to sleep on her back on a flat, firm surface clear of objects and having your baby nearby during the first six months. But other decisions come with skimpier science, and whether to evict your 6-month-old is one of them. Because science can take you only so far, it may just come down to the snoring, stirring and sleep deprivation.
