Lexington has outbreak of whooping cough, which can be deadly for babies and prevented with vaccine that some adults need too

By Melissa Patrick
Kentucky Health News

An outbreak of whooping cough has been declared in Fayette County after nine cases have been confirmed by the local health department since late April.

Whooping cough, known medically as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing. It affects people of all ages but can be most serious in infants, young children and those with chronic diseases.

The disease is largely preventable by vaccination, but vaccination rates for pertussis and other diseases prevalent in childhood have been declining.

"All Central Kentucky caregivers should be on the lookout for signs and symptoms of pertussis, or whooping cough, while ensuring their kids are up to date on their vaccines or fully vaccinated with the booster," the Lexington-Fayette County Health Department said in a news release. 

The latest Fayette County cases include one at Lafayette High School, one at St. Peter and Paul Catholic School and a community case involving a person in their 80s, according to the release.

Dr. Sean M. McTigue, medical director for pediatric infection prevention and control at Kentucky Children's Hospital, said symptoms of pertussis in children, adolescents and adults first look like an upper respiratory infection, including nasal congestion, runny nose and possible fever, and then lead to a "very intense and prolonged cough." 

 

"The cough is characterized by prolonged coughing fits that typically end with a loud “whoop” when catching breath afterwards," he said. "These coughing spells can be so intense that a patient may fracture ribs or rupture blood vessels in the eyes." 

The early symptoms of whooping cough can last for one to two weeks and the "coughing fits" usually last one to six weeks, but can last for up to 10 weeks, according to the Centers for Disease Control and Prevention. People are contagious from the start of symptoms and for at least two weeks after the coughing begins, says the CDC.

"Any school-age children with symptoms of pertussis should stay home from school and visit their health-care provider for evaluation, even if they have previously been vaccinated," said the release.

Some adults need vaccine boosters

While most of the Fayette County cases have been seen in adolescents, McTigue said, "Pertussis is more dangerous to young infants." 

"In young infants, pertussis more often presents with apnea," a sleeep disorder, he said. "This means that the infant stops breathing for a period of time. This can be long enough to cause severe damage or death if not noticed promptly. For this reason it is extremely important that all infants be vaccinated against pertussis." 

Between 2010 and 2020, the CDC reports, up to 20 babies died from pertussis each year in the United States.

It's recommended that pregnant women should get a single dose of the pertussis vaccine during every pregnancy, preferably at 27 through 36 weeks.

"Being vaccinated during pregnancy will allow the mother to pass antibodies along to the infant prior to delivery as another key part of prevention for the most vulnerable," said McTigue.

He added that it is also important for anyone in contact with infants to get a booster of the combined tetanus-diptheria-pertussis vaccine, known as Tdap.

"Because vaccination does not start until 2 months of life and is not completed until later, the best prevention also includes all contacts being vaccinated as well," he said. "This includes booster vaccines given every 10 years as Tdap, which has replaced the tetanus booster." 

The best way to prevent whooping cough is through vaccination. The childhood vaccine is called DTaP. Infants should receive a series of DTaP immunizations at 2, 4, and 6 months, with boosters at 15-18 months and 4-6 years. Children should then get a single dose of Tdap vaccine at 11 or 12. Boosters are required every 10 years to maintain efficacy.

"Achieving immunization rates greater than 95% is desirable to prevent the active transmission of vaccine-preventable diseases," Brice Mitchell, spokesman for the Cabinet for Health and Family Services, said in an email.

Kentucky's vaccination rates have fallen below that level.

 

Data from the School Immunizations Survey dashboard, which also includes data for each school, show that during the 2023-24 school year, 91% of the state's kindergarteners had received at least four doses of the DTaP vaccine; 85.6% of seventh graders had received at least one dose of Tdap; and 93.3% of 11th graders had received at least one dose of Tdap. 

All these rates have fallen since the Covid-19 pandemic; Kentucky seventh graders have had rates below 90% since the 2020-21 school year. 

The rates are even lower in the Kentucky Immunization Registry, which has vaccination data for residents of Kentucky counties aged 2, 6, 13, 17, and 65 or older. For 2022, the rates were:

• 2-year-olds with 4 or more doses of DTaP: 63.9%
• 6-year-olds with 4 or more doses of DTaP: 52.8%
• 13-year-olds with at least one dose of Tdap: 63.4%
• 17-year-olds with at least one dose of Tdap: 73.4%
• Adults 65+ with at least one dose of Tdap: 31.3%

The latest available statewide vaccination rate among pregnant women was also low, Mitchell said: "During the 2021-2022 respiratory virus season, Tdap vaccination rates were 45.8% among pregnant women nationally, and 42.6% in the South region, where Kentucky is located."

So far in 2024, 46 confirmed cases of pertussis have been reported in Kentucky. Of those 46 cases, 22 have been confirmed since April 1 in the following counties: Fayette (12), and 1 case each in Boone, Boyd, Clark, Clay, Floyd, Jefferson, Jessamine, Logan, Pulaski and Warren, according to data provided by the Kentucky Department for Public Health.

Bipartisan 'momnibus' bill aims to improve health of mothers, kids

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, spoke with other female legislators at a press conference Wednesday to announce their "Momnibus" bill. (Legislative photo)

Kentucky Health News

Legislators are accustomed to seeing "omnibus" bills that deal with many subjects, sometimes related, sometimes not. Now the Kentucky General Assembly has a "momnibus" bill intended to improve the health of children and mothers, including expectant ones.

House Bill 10 was developed by an informal, bipartisan group of female legislators concerned about the state's poor maternal health, said its main sponsor, Rep. Kim Moser, R-Taylor Mill.

"Addressing Kentucky's high maternal mortality rate and saving mothers and babies is obviously a priority for all of us," Moser said at a Wednesday press conference. Kentucky had the nation's sixth highest maternal death rate, 38.4 deaths per 100,000 live births, from 2018 through 2021. The national rate for that period was 23.5 per 100,000.

More than 90% of the state’s maternal deaths are preventable, Dr. Jeffrey M. Goldberg, legislative advocacy chair of the Kentucky chapter of the American College of Obstetricians and Gynecologists, told a state Senate committee last year. Just over 14 percent of Kentuckians lack access to adequate prenatal care, according to the March of Dimes.

Moser, a mother of five who was a neonatal intensive-care nurse, spoke from her own experiences: “I’ve really worked with mothers and babies and sick newborns, in their newborn phase, oftentimes through their first year, and I was able to really see some of the reasons for poor health disparities, especially in our poor areas of our state.”

Citing the advocacy group Every Mother Counts, Moser said “The leading causes of maternal death in the U.S. [are] lack of access to health care, including a shortage of caregivers, a lack of insurance, inadequate postpartum supports and certainly socioeconomic disparities, including the stress of racism and discrimination.” In Kentucky, she added, the risks are greater because of the prevalence of heart disease and diabetes.

HB 10 would:

• Add pregnancy to the list of "qualifying life events" that allow people to get health-insurance coverage outside normal enrolment, which could encourage more prenatal care.
• Create the Lifeline for Moms Psychiatry Access Program, for which Kentucky has received a $750,000 grant. Moser said she will also ask for an appropriation in the state budget “to make sure that’s a sustainable program.” It would be required to operate a hotline from 8 a.m. to 5 p.m. Mondays through Fridays.
• Expand the HANDS (Health Access Nurturing Development Services) home-visitation program for new and expectant parents to include breastfeeding counseling and assistance, education on safe sleep, as well as expanding the program to include telehealth, which Moser said she believes will help “reach moms in underserved areas or areas where she may have a transportation issue.”
• Require the Cabinet for Health and Family Services to study and make recommendations about the role of doulas, who provide assistance with the birth experience. 
• Strengthen an advisory council that provides policy guidance to increase collaboration, improve data collection, and suggest additional improvements.

Some Kentucky Republican legislators began paying more attention to such issues after the U.S. Supreme Court eliminated the federal right to abortion, activating a state "trigger law" that bans abortion except to save the mother's life or prevent permnent damage to a life-sustaining organ. 

"The wide gulf between abortion-rights and anti-abortion lawmakers was felt when Moser invited Addia Wuchner, executive director of the Kentucky Right to Life Association, to speak at the end of the press conference," reports Rebecca Grapevine of the Courier Journal. "That prompted most of the assembled Democratic lawmakers . . . to quietly walk out of the room."

State Rep. Sarah Stalker

One Democrat who remained, Rep. Sarah Stalker of Louisville, told the Courier Journal, "If we're going to force people to have children when they are not prepared to, when they are not ready to, when they are not interested in the family, it is critical that we give them the access to the health insurance . . . It doesn't help me and it doesn't help Kentucky, you know, Kentuckians at large and particularly women, to dig in my heels."

The second listed sponsor of the bill is Rep. Nancy Tate, R-Brandenburg, a leading anti-abortion legislator. Other Republican sponsors are Reps. Danny Bentkey of Russell, Emily Callaway of Louisville, Stephanie Dietz of Edgewood, Robert Duvall of Bowling Green, Ken Fleming of Louisville, Mark Hart of Falmouth, Kiom KIng of Harrodsburg, Amy Neighbors of Edmonton, Rebecca Raymer of Morgantown, Tom Smith of Corbin, Nick Wilson of Williamsburg and Susan Witten of Louisville.

Besides Stalker, the bill's Democratic sponsors are Reps. Lindsey Burke and Cherlynn Stevenson of Lexington. Democratic Reps. Lisa Willner of Louisivlle and Rachel Roberts of Newport initially attended the press conference but left and are not listed as sponsors.

Information for this story was also provided by the Kentucky Lantern.

UK has $3 million grant to study impact of mothers' opioid use on babies; Ky. 3rd in rate of babies with opioid-withdrawal syndrome

Photo: healthychildren.org

By Lindsay Travis
University of Kentucky

A team of researchers at the University of Kentucky is working to better understand the impact of opioid-use disorder on mothers and babies.

Every 24 minutes in the United States, a baby is born with neonatal opioid withdrawal syndrome (NOWS) after being exposed via  a mother with opioid-use disorder.

In Kentucky, about 2 percent of babies born in 2020 had symptoms of NOWS — the third-highest rate in the U.S. In Appalachia Kentucky, that frequency increases to 7.7 percent — 77 of every 1,000 babies.

Early delivery can complicate pregnancies with opioid-use disorder and give children an increased risk of impaired neural development, including cognitive, motor, social and emotional abilities.

UK’s research team wants to understand how inflammation and dysregulation in the placenta caused by opioid use are linked to negative cognitive consequences in the baby.

The study titled “POPI: Placenta, Opioids and Perinatal Implications” is funded by a $3 million grant from the National Institute on Drug Abuse, part of the National Institutes of Health. Additional funding is possible, pending progress with the research.

Part of the research team, led by Ilhem Messaoudi, left
center (University of Kentucky photo by Jorge Castorena)

“This study is going to have a tremendous impact on Kentuckians, many of whom know first-hand the profound devastation opioid use has on the overall health of the commonwealth,” said Ilhem Messaoudi, chair of the Department of Microbiology, Immunology and Molecular Genetics in the College of Medicine and a principal investigator on the grant.

“NIDA specifically called for research on the placenta-brain axis — the idea that what happens during pregnancy and the placenta’s health will have long-term ramifications on the offspring, including brain development,” said Messaoudi. “The team assembled to find answers for our smallest Kentuckians all bring a variety of expertise to this study including to maternal-fetal medicine, pathology, neuroscience and neonatology.”

Pregnant women who seek care at UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program will be eligible to enroll in the study. PATHways, a comprehensive treatment program, is designed to help pregnant and postpartum mothers who are living with substance use disorders.

“Kentucky has one of the highest maternal mortality rates in the country combined with a high rate of opioid use disorder. PATHways provides us a unique opportunity to support pregnant mothers and invest in those lives through this kind of project that blends a variety of scientific specializations,” said Dr. John O’Brien, chief of the Division of Maternal-Fetal Medicine at UK HealthCare, a professor in the Department of Obstetrics and Gynecology in the College of Medicine and co-principal investigator on the grant.

As part of the study, researchers will collect ultrasound data, blood samples, the placenta and umbilical cord blood and conduct neurodevelopment assessment on babies for one year after birth. The data will help them determine the impact of maternal opioid use disorder on both the health of the placenta and the baby’s brain.

“In previous studies, using a rat model, we’ve learned maternal opioid use disorder increases inflammation in the brain and alters microglia — cells that are like the housekeepers of the brain,” Messaoudi said. “The alteration can affect the way the brain continues to develop.”

Investigators can measure that change in the brain through another type of immune cells found in the blood, called monocytes. The team will track neurobehavioral outcomes through a series of assessments in the newborn period and at age 3, 6 and 12 months.

O'Brien said, “Our hope is this research project will provide health-care professionals the knowledge and evidence necessary to improve the care of pregnant mothers with opioid use disorder, reduce risks and optimize neonatal outcomes.”

The study also includes researchers in the College of Medicine’s departments of Pediatrics and Pathology and Laboratory Medicine, as well as the Spinal Cord and Brain Injury Research Center and the Dr. Bing Zhang Department of Statistics in the College of Arts and Sciences.

If you or someone you know is pregnant and dealing with substance-use disorder, contact UK's Polk-Dalton Clinic at 859-218-6165 to make an appointment for prenatal care.

'Toddler formulas' for infants and young children offer little nutritional benefit, writes a UK specialist in pediatric digestion

Photo by tun723, iStock/Getty Images Plus via UK

By George J. Fuchs III, M.D.

University of Kentucky

A recent report from the American Academy of Pediatrics as part of my work on the AAP Committee of Nutrition addresses the claims made by the manufacturers of so-called “toddler formulas," purporting to bolster the immune system and improve brain development. Simply put, a nutritionally complete super formula that gives your child a brain boost and protects them from diseases is too good to be true.

Nutrition is integral to a child’s cognitive and physical development, especially in the first years of their life. Additionally, these years represent a narrow window of time during which nutritional status and the right nutrients at the right time are primary determinants of health and risk of obesity, diabetes and other diseases in childhood and through adulthood.

While the benefits of breastfeeding in the first six months of life are well-documented, there are numerous reasons why some infants must subsist on iron-fortified formulas. The composition of infant formulas is standardized and regulated by the Food and Drug Administration per the Infant Formula Act of 1980 and the manufacturing facilities are regularly inspected.

Recently, liquid nutritional products referred to as “formulas” have been developed for the older infant and toddler and increasingly promoted by manufacturers. Older infant-young child formulas (OIYCF) are marketed under identities such as “transition formulas,” “toddler formulas” or “growing-up milks." These formulas are not to be confused with medical or therapeutic formulas for conditions such as chronic gastrointestinal diseases, metabolic disorders or food allergy, the use of which are prescribed and monitored by pediatric specialists.

Unlike infant formulas, there are no standard criteria for the composition of OIYCFs. Some of these formulas have been criticized as having elements considered to be unnecessary or potentially detrimental, including high or low protein, and higher sodium content relative to cow milk and added sweeteners. OIYCFs are considered by some to be “sugar-sweetened drinks” and have been associated with greater intakes of sweetened beverages as well as sweetened dairy products, such as fruit yogurts and cream cheese desserts.

Advertisement practices for OIYCFs often convey them as a necessary “next stage” or “next step” for optimal nutritional intake. Manufacturers of OIYCF make claims that are not required to be based on scientific evidence or be reviewed or approved by the FDA. Claims of improved brain development or immune function have incorrectly shown to influence parents’ belief that OIYCFs are healthier than breast milk or cow milk. OIYCFs are not nutritionally complete and are marketed to parents of healthy children as a replacement or substitute for cow’s milk.

The diets of young children are generally adequate for most micronutrients, although possible gaps exist, especially for vitamins D and E and fiber. Nearly all store-purchased cow milk in the United States is fortified with vitamin D, thus eliminating the need for a supplemental formula. Additionally, OIYCFs are considerably more expensive than cow milk and can represent a significant cost burden to families, especially when consumed daily. Parents and caregivers are advised to provide nutritionally balanced diets that include fortified foods; children consuming a diet of solid foods that provide sufficient iron and vitamin content have no need for supplemental formulas.

If you are concerned about your child’s nutritional intake, ask their pediatrician for recommendations for a balanced, nutrient-rich diet to help ensure proper cognitive and physical development during formative early years.

Dr. George Fuchs is a pediatric gastroenterologist at Kentucky Children’s Hospital and a professor in the UK Colleges of Medicine and Public Health.

Cases of whooping cough (pertussis) increase in Kentucky

By Sarah Ladd
Kentucky Lantern

Kentucky is seeing an uptick in cases of pertussis, more commonly called whooping cough, a highly contagious respiratory illness.

The state Cabinet for Health and Family Services said in a Friday newsletter: “Recent cases have occurred primarily in Central Kentucky but cases are being seen throughout the commonwealth.”

Whooping cough can be a life-threatening illness and is most dangerous for babies, according to the the Centers for Disease Control and Prevention. It can, however, affect people of any age.

Whooping cough is highly contagious, according to the CDC. Vaccines are available to children as young as 2 months old and can help prevent it.

Early symptom onset to recovery can take around 12 weeks, according to the state Department for Public Health, which says symptoms of whooping cough include:

• Runny or stuffy nose
• Uncontrollable coughing
• Vomiting from coughing
• Fever below 100.4 Fahrenheit
• Apnea (life-threatening pauses in breathing) and cyanosis (turning blue or purple) in infants and young children

Infection with the coronavirus increases by factor of 7 expectant mothers' chance of death; also threatens their unborn children

Photo: Rogelio V. Solis, The Associated Press, via The Washington Post

If you're pregnant and get infected with the coronavirus, your risk of dying is seven times greater than those of expectant mothers who are not infected, according to a study published Monday in the journal BMJ Global Health.

The study "pooled patient data from more than 13,000 pregnant individuals included in 12 studies from 12 countries, including the United States," Sabrina Malhi reports for The Washington Post. "Along with a higher death rate, infected pregnant people had a greater risk of being admitted to an intensive care unit, needing a ventilator or developing pneumonia if they have a coronavirus infection. Infants born to those with a coronavirus infection during pregnancy also had a greater risk of developing severe outcomes. They were twice as likely to need treatment in the intensive care unit after birth and had an increased risk of being born preterm."

Vaccination rates for pregnant people are low, probably because “the assumption is that if a person is pregnant, they are probably young and, for the most part, healthy,” said Emily R. Smith, the study’s lead author and an assistant professor of global health at George Washington University in Washington, D.C. Malhi notes, "Being pregnant, even if a person has no underlying medical conditions, puts them at increased risk of developing severe illness if they are infected with the coronavirus."

Many pregnant women are misinformed about Covid-19 vaccines. "As of May 2022, about 29 percent of women who were pregnant or planned on becoming pregnant believed some form of misinformation surrounding the coronavirus vaccine, according to a poll from the Kaiser Family Foundation," Malhi notes. "Some of the unsubstantiated claims about the vaccine’s impact included effects on fertility and breastfeeding."

The poll vaccine hesitancy "can emerge when someone is having a child or trying to become pregnant," Malhi reports. "Kathryn Gray, a maternal-fetal medicine specialist at Brigham and Women’s Hospital in Boston, said misinformation surrounding vaccines can be partly attributed to anti-vaccine rhetoric on social media."

Parents in 21 more counties get CPR kits for infants, for total of 32; hundreds still available, with money from health insurers

The CPR Anytime® training kits are given to parents.

Three times as many Kentucky counties will get cardiopulmonary resuscitation kits for infants, funded by the Kentucky Association of Health Plans, representing health-insurance companies in the state.

The American Heart Association is delivering the life-saving CPR kits to health-care facilities to give to new parents. Each kit includes an inflatable mannikin and video that teaches infant CPR in as little as 20 minutes.
 
The initiative, launched in May 2022, has provided 3,000 kits to neonatal intensive-care units in 11 counties. A $150,000 grant from KAHP is funding 4,350 more kits, nearly 2,500 of which have been distributed in 21 counties: Bath, Bell, Boyd, Casey, Clark, Estill, Floyd, Garrard, Harlan, Hyden, Jackson, Johnson, Madison, Montgomery, Nicholas, Perry, Pike, Powell, Rockcastle, Rowan, and Warren.

“Rural communities often face a critical shortage of health-care professionals,” said Ashley Sokoler, AHA's Kentuckiana director. “That’s why it’s so important to make CPR training available to new parents in rural areas and provide the healthcare facilities they visit with the resources needed to implement training without causing additional strain on their staff.”

Hospitals, clinics, and other healthcare providers interested in requesting kits can contact AHA Kentuckiana Community Impact Director Tracy Monks at tracy.monks@heart.org for information.

Too many pregnant Kentuckians and babies in 'maternity deserts' and Ky. has no birthing centers; midwives say they could help

Laura Browning, an Eastern Kentucky doula and midwife student, with her four children in a selfie.

By Sarah Ladd
Kentucky Lantern

During three of her four pregnancies, Laura Browning drove three hours round-trip past hospitals to get prenatal care from midwives in Lexington, the only place that offered what she needed.

She even made the trip while in labor with her first baby, feeling that “the care that I was receiving” from midwives “was worth that risk” of birthing in her car.

As deaths from pregnancy rise in the United States, Browning and other advocates say Kentucky could fill gaps in prenatal care by educating and certifying more midwives, attracting more to the doula profession and encouraging the creation of freestanding birth centers in the state.

The shortage of care for pregnant people is documented in a recent March of Dimes report, “Nowhere To Go: Maternity Care Deserts Across the U.S.”

More than 2 million Americans, most of them rural, live in “maternity care deserts,” defined in the report as having “no hospitals providing obstetric care, no birth centers, no obstetrician/gynecologist and no certified nurse midwives.”

In 2021, 14.2 percent of mothers received inadequate prenatal care, says the March of Dimes, which gave Kentucky an F on its annual report card this year, making it one of just nine states (plus Puerto Rico) to get a failing rating.

Almost half of Kentucky’s 120 counties — 48% — are maternity-care deserts, according to the March of Dimes study.

Prenatal care provided by midwives has been shown to prevent costly complications in mothers and babies, including cesarean deliveries and low birth weights. The March of Dimes reports that “midwifery care has been associated with an increased chance of having a low-intervention birth and lower cost of care due to significantly lower odds of medical intervention.”

Yet only about 8% of births in the U.S. are attended by midwives. In Kentucky, 700 to 800 babies are born every year outside hospitals, and are usually delivered with midwives present. There were 51,688 live births in Kentucky in 2020.

Certified nurse-midwives and certified midwives are accredited by the Accreditation Commission for Midwifery Education and pass national exams after graduate-level studies, according to the American College of Nurse Midwives.

The midwives and midwifery students who spoke with the Kentucky Lantern expressed passion for serving their communities and reported low rates of transfer to hospitals, easing the burden of hospital staff shortages.

Mary Harman

Also, midwives can provide important inclusive services to people who are “beyond the binary,” said Mary Harman, the only midwife within a two-hour drive from Pike County who travels that far for clients.

“Not every person needs an OB-GYN,” Harman said, but they cannot accept insurance or Medicaid, which is another barrier to their practice, Canary Nest Midwifery.

Research also suggests that freestanding birth centers, which are staffed by midwives and offer holistic birthing options for people who qualify, reduce the cost of care while producing higher patient satisfaction.

Kentucky is in the minority of states that have no freestanding birth centers. The American Association of Birthing Centers reports that more than 384 freestanding birthing centers are operating in 37 states and the District of Columbia, a 97 % increase since 2010.

Advocates attribute the lack of birthing centers to the difficulty of obtaining the state-required certificate of need in the face of opposition from hospitals that can mount costly legal battles, such as the one waged by three hospitals against a retired Army officer who tried to open a birthing center in Elizabethtown.

She prevailed in Franklin Circuit Court, which overturned a hearing officer’s denial of a certificate of need, but was forced to give up in 2017 when the hospitals won on appeal.

Rep. Jason Nemes, R-Louisville, has sponsored legislation in the past to remove the certificate-of-need requirement for birthing centers and will continue to support them. He has called the law mandating the certificate “very cumbersome.”

In 2019, the legislature did take action aimed at licensing more certified professional midwives, after the Kentucky Hospital Association and Kentucky Medical Association dropped their years of opposition.

The results have been underwhelming. In the almost four years since the law was enacted, the number of certified nurse-midwives and certified midwives in Kentucky has increased by only 12 — to 131 providers, reports the American Midwifery Certification Board.

Some hospitals have doula and midwife programs, such as the University of Kentucky’s midwife clinic and Norton Healthcare’s doula program.

Among the barriers to increasing midwifery care in Kentucky is the $1,000 cost of renewing a Certified Professional Midwife license. Compare that with $110 in Tennessee, $200 in California or $322 in New York.

Earlier this year, Kentucky took advantage of an opportunity in the American Rescue Act Plan to put in place one of the March of Dimes recommendations by increasing postpartum care under Medicaid from 60 days to 12 months. The change will allow an estimated 10,000 Kentucky mothers to maintain their health coverage for one year after giving birth.

Stark racial disparities in maternal mortality

The March of Dimes reports that deaths from pregnancy are increasing in the United States, which already has one of the highest maternal death rates among high-income countries.

About 900 women in the U.S. died from pregnancy-related issues in 2020, up 14% from 2019 and up a whopping 30% from 2018. Sixty-three percent of pregnancy-related fatalities are preventable, says the report. In Kentucky, preterm births increased in 2021 to 12%, up from 11% in 2020.

Pregnancy is especially dangerous for Black Americans, who are three times more likely to die from pregnancy than their white counterparts. Conversely, white women are more likely to have access to good prenatal care than Native, Black, Pacific Islander, Asian and Hispanic women. 

Those stark disparities are not lost on the expectant mothers who turn to doulas to guide them through their pregnancies and births. Doulas provide moral, physical or other support to pregnant people throughout pregnancy, delivery and postpartum.

Meka Kpoh, a doula in Louisville, founded the nonprofit Black Birth Justice to help mothers and babies get off to a healthy start all the way through the critical postpartum period. She has been in birth work long enough that the March of Dimes report wasn’t news to her.

She said these gaps in care should be taken seriously.

“The maternity care deserts aren’t going to just erase themselves,” said Kpoh, who is also in training to be a midwife. “It’s not going to be like next year there’s going to be a new hospital and every community has a hospital at least 30 to 40 minutes away. That’s not going to happen, at least not anytime soon. So it’s really important for there to be options for families like licensed certified home birth midwives.”

Kpoh said many of the clients she sees are driving hours from rural areas. “It’s really insane to me,” she said, “that we are their only option.”

In addition to more doulas and midwives, she said Kentucky needs freestanding birthing centers.

“Pregnant people are driving three hours just to get prenatal care, just to give birth, just to have postpartum appointments,” she said. “It’s ridiculous.”

To get the kind of care they want, Kpoh said many pregnant people end up facing a difficult choice: “Either they drive three hours to a hospital or they catch their baby by (themselves),” she said, adding: “I don’t recommend that for anyone.” 

Renee Basham, a doula, founded the nonprofit community doula program Hope’s Embrace to help pregnant people who are often cut off from help. Basham and her 30 doulas serve those who are unhoused and those with drug addictions.

“You’re not necessarily treated well if you are by yourself,” said Basham. “And so having people … vouch for you, or speak up for you or remind you to speak up for yourself … all of that … contributes to better outcomes.”

 
The stigma of going against the norm

Anihhya Trumbo, a doula who serves the Lexington area, said there remains a stigma about birth outside a hospital.

“Kentucky is a state where it’s always been preached that doctors know best,” she said. “It’s a bit of a taboo if you go outside of what is … considered the norm here.” 

Doula and midwife-assisted birth isn’t a new thing, either, she said.

“This is something that’s been going around since the beginning of time,” said Trumbo, who is also a military veteran. “We just got Western medicine and that’s what changed the norm but home birth and having the natural birth — that’s how we got here.”

Browning was so committed to midwifery care for herself that from six weeks gestation to birth, she drove three hours for her prenatal appointments. She’s now living in Laurel County but lived in Estill at the time of that first pregnancy.

Already a doula, Browning told the Kentucky Lantern that she is in midwifery school herself now “because women should not have to drive that far for care.”

“It’s definitely a need that we have here.”

Study of 40 first-time fathers finds that fatherhood changed their brains in ways that could help them be better parents

Centers for Disease Control and Prevention photo

A growing body of research finds that children with engaged fathers do better on a range of outcomes, including physical health and cognitive performance, and a new study finds that fatherhood causes changes in the brain in ways that could influence their parenting, Darby Saxbe and Magdalena Martinez Garcia report for The Conversation, a platform for journalistic writing by academics.

Garcia, who works at the Instituto de Investigación Sanitaria Gregorio Marañón in Madrid, Spain, was the lead author on the study. Saxbe, of the University of Southern California in Los Angeles, contributed to the research.

Despite fathers' increasing participation in child care, they note, there is surprisingly little research about how fatherhood affects men, and even fewer studies focus on the brain and biological changes that might support fathering. Since pregnancy-related hormonal changes help explain why a new mother's brain might change, they explored whether fatherhood also reshapes the brains and bodies of men, in a study of first-time fathers in Spain and California.

Spanish researchers had scanned first-time mothers before conception and two months after delivery, and found that compared to childless women, "The new mothers’ brain volume was smaller, suggesting that key brain structures actually shrank in size across pregnancy and the early postpartum period," Saxbe and Garcia report. "The brain changes were so pronounced that an algorithm could easily differentiate the brain of a woman who had gone through a pregnancy from that of a woman with no children." They also found changes across the brain's gray matter, the layer that is rich in neurons, and changes in the cortex, which is linked to thinking about others, and the subcortex, which is linked to more primitive functions, including emotion and motivation.

The authors say experience-induced brain plasticity happens when you learn a new language or master a new musical instrument, and suggest that this could also happen with the new experience of caring for an infant. They note that there is a small, but growing body of research being done on this topic. 

To learn more about plasticity in new dads’ brains, the researchers studied 40 expectant fathers who were put into an MRI scanner twice: during their partner’s pregnancy, and after their baby was 6 months old. The study also included a control group of 17 childless men.

"We found several significant changes in the brains of fathers from prenatal to postpartum that did not emerge within the childless men we followed across the same time period," they report. "In both the Spanish and Californian samples, fathers’ brain changes appeared in regions of the cortex that contribute to visual processing, attention and empathy toward the baby." They offer the possibility that the brain plasticity in fathers may be tied to how much they interact with their baby, and say that raises the question of whether family policies that increase the amount of time a father can spend with their child during the early postpartum period could help to support the development of the fathering brain. 

"Spanish fathers, who, on average, have more generous paternity leaves than fathers have in the U.S., displayed more pronounced changes in brain regions that support goal-directed attention, which may help fathers attune to their infants’ cues, compared with Californian fathers," they write. However, men who show more remodeling of the brain and hormones may be more motivated to participate in hands-on care. The authors called for more research, noting that future studies with more detailed measures of postpartum caregiving can reveal more about parental brain plasticity in both men and women.

Kentucky had many fewer new cases of Covid-19 last week, but more serious cases, and it still ranks eighth among the states

New York Times map, adapted by Ky. Health News; for interactive version with data, click here.

By Al Cross
Kentucky Health News

For every eight cases of Covid-19 that were reported in Kentucky in the first week of November, only five cases were reported last week. But the weekly rate of new cases remains high, eighth among the states.

The state Department for Public Health reported 3,570 new cases last week, or 510 per day. Those figures were 37.5 percent less than the previous week.

The weekly new-case incidence rate was 10.8 per 100,000 residents, down from 12.98. Counties with rates more than double the statewide rate were Elliott, 28.5; McLean, 27.9; Mercer, 24.4.8; and Trimble, 21.9.

The New York Times, which calculates the rates differently, says the statewide rate is 16 per 100,000 and the top counties are Leslie, 65; Cumberland, 45; Russell, 41; Simpson, 39; McCreary, Green and Knott, 38; Johnson, 36; Metcalfe and Muhlenberg, 35; Powell, 34; and Nelson, 33. It ranks Kentucky eighth among the states.

The share of Kentuckians testing positive for the coronavirus in reported tests also declined, to 7.29% last week from 8.31% the week before, the state said. The figures do not include at-home tests.

The number of Kentucky hospital patients with the virus fell last week, but the number in serious condition rose. As of midnight Sunday, there were 310 Covid-19 patients, down from 332 the previous week; 42 were in intensive care, up from 40; and 19 were on mechanical ventilation, up from 13.

Hospitals are also reporting many cases of the flu and respiratory syncytial virus (RSV), which is hardest on infants and seniors. Flu cases in the state are more than doubling each week, and if current trends continue next week, new flu cases will outnumber new Covid-19 cases. 

The state said it confirmed 47 Covid-19 deaths last week, up from 41 the week before. The state's pandemic death toll stands at 17,410.

Kentucky's intensive-care units will give new parents insurer-funded kits so new parents can learn how to give CPR to infants

Training kit for giving infants cardiopulmonary resuscitation

The Kentuckiana American Heart Association and the Kentucky Association of Health Plans, the association for companies selling and managing health insurance in the state, and have introduced a new initiative to equip thousands of new Kentucky parents with kits to teach them how to give cardiopulmonary resuscitation to an infant. 

The initiative is funded by a $95,000 grant from KAHP. The AHA will distribute 3,000 Infant CPR Anytime Training® Kits to newborn intensive-care units throughout the state. The kits include an inflatable manikin along with a video course designed to provide infant choking and CPR training in about 20 minutes. 

 “We’re excited to provide funding for this partnership with the American Heart Association. This is an extremely effective tool that will increase the chances of survival in the face of an emergency and equip new parents with the confidence to administer lifesaving techniques," Katherine Kington North, director of external affairs for KAHP, said in a news release.

 

The release notes that the at-home kits will fill voids created by staffing problems related to the Covid-19 pandemic. They will be available in English and Spanish. The AHA began deliveries of the kits in mid-May, with 1,900 distributed to date, says the release. The KAHP gift capped off National CPR Awareness Week, which ran from June 1-7 this year.

“With preterm infants, there are twice as many cardiovascular malformations as those born at full term, so the kits are especially important to those families,” Dr. Sandra Guerra, chief medical director for KAHP member WellCare of Kentucky and board chair of the Kentuckiana AHA, said in the release. 

She added, “Premature infants may also have breathing difficulties due to an underdeveloped respiratory system, and should it be necessary, parents will have the know-how to administer aid before an ambulance arrives. The physical practice that these kits provide is tremendous.”

In 2020, there were 5,705 preterm births in Kentucky, representing 11% of live births, according to the March of Dimes.

Beshear signs executive order to activate price-gouging laws for baby formula, which remains in short supply

Beshear signs executive order (Photo via Facebook)

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear signed an executive order Thursday declaring a state of emergency in order to apply state price-gouging laws for baby formula. 

“By implementing our price-gouging laws, we can make sure that families are not being charged more than they should to obtain a critical supply of formula to feed their baby,” Beshear said at his weekly news conference.

Beshear said Attorney General Daniel Cameron has not reported any claims of price gouging, or requested that the price gouging laws be activated, but other states have reported such claims and have taken steps to address them. 

Beshear encouraged any families who have experienced price gouging to contact Cameron's office. That can be done by calling 502-695-5485 or by filling out a price-gouging complaint form. 

Cameron encouraged those who use the form to report as many details as possible about the suspected gouging, including the name and address of the seller or retailer, the item purchased, the price of the item after the emergency declaration and the price of the item before the emergency declaration, if known. And if consumers are seeking a refund, he said they should keep receipts to show proof of purchase. 

“As parents, Makenze and I recognize the incredible stress and fear that the shortage is causing Kentucky families, and our office will use the full force of the law to ensure that the price charged for essential products like baby formula is no more than the law allows," Cameron said in a news release. 

Beshear acted a week after Kentucky lawmakers met to discuss the baby formula shortage, and Rep. Kim Moser, R-Taylor Mill, called in an opinion article for him to address price-gouging issues. 

State Health Commissioner Steven Stack encouraged families who are struggling to find baby formula to seek support from a number of agencies.  

“The infant formula shortage has caused worry and frustration for Kentucky’s families as they have sought to provide nutrition to our most precious citizens,” Stack said in a news release.  “We encourage families to reach out to all available resources in their community, including local health departments, pediatricians, food pantries, community action councils and other supporting agencies to meet the nutritional needs of their infants and to ensure they thrive. We also encourage all eligible families to enroll in WIC or SNAP to help during this shortage.”

Women, Infants and Children nutrition benefits are available to Kentucky residents who are pregnant, breastfeeding or have a child 5 or younger and have household income of no more than 185% of the federal poverty level, with rules governing what counts as income. Anyone who receives Medicaid or is part of the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) automatically meets income requirements for WIC. Click here for a WIC pre-screening Tool to see if you are eligible.

Cameron warned families to guard against baby formula scams and encouraged Kentuckians to only purchase baby formula from known, reputable sources; to use a credit card to make the purchase if possible; to avoid paying for formula up front if purchasing from an unknown source; and to be suspicious of sources advertising formula at prices that are too good to be true. Any suspected scams can be reported to ag.ky.gov/scams.

The shortage is largely the result of of violations at Abbott Nutrition's Michigan factory that caused the U.S. Food and Drug Administration to shut it down in February. The investigation was prompted by four bacterial infections in infants who had consumed formula from the plant. Abbot has up to 40% of the formula market in the U.S.

Abbott announced June 4 that it had resumed production at the factory after meeting initial requirements agreed to with the FDA in a consent decree May 16.

But that doesn't mean an immediate end to the shortage. Abbott says its priority is production of EleCare, a special formula for children with multiple allergies, before it ramps up production of its other products. The initial EleCare product is expected to be released "on or about June 20," Abbott's release said.

Some relief is also expected from oversea shipments of non-specialty baby formula. On June 6, President Biden announced that his administration had sourced a flight through the Operation Fly Formula initiative. His administration says the delivery will include Nestlé NAN SupremePro Stage 1 infant formula and that additional deliveries will be announced soon.

FDA Administrator Robert Califf told lawmakers on May 26 that the baby formula shortage in the U.S. will likely not be resolved until late July.

The latest dataset from Datasembly, a retail data firm, for the week ending May 29th shows a 73% out-of-stock rate for baby formula nationally and a 76% out-of-stock rate for Kentucky. 

Mothers on WIC program who need formula should call health department; others should call pediatrician, health secretary says

Photo from nbcnews.com

By Melissa Patrick
Kentucky Health News

As Kentucky families struggle to find baby formula for their infants and no immediate end in sight, Kentucky lawmakers discussed ways to improve the situation at the June 2 meeting of the Interim Joint Committee on Health, Welfare and Family Services. 

The shortage is largely the result of a U.S. Food and Drug Administration investigation of Abbott Nutrition's Michigan factory that resulted in it shutting down in February. The investigation was prompted by four bacterial infections in infants who had consumed formula from the company's Michigan plant. Abbot makes up to 40% of the formula market in the United States.  

Abbott announced Saturday that it had resumed production at the factory after meeting initial requirements agreed to with the FDA as part of a consent decree the company entered into on May 16. 

But that doesn't mean an immediate end to the shortage. Abbott says its priority is production of EleCare, a special formula for children with multiple allergies, before it ramps up production of its other products. The initial EleCare product is expected to be released "on or about June 20," Abbott's release said. 

Last week, FDA Administrator Robert Califf  told lawmakers that the baby formula shortage in the U.S. will likely not be resolved until late July. 

On June 2, Datasembly, a retail data firm, reported that the nationwide out-of-stock rate for formula in the week ending May 28 was 74%, up from 70% the week before and 45% the week before, according to Bloomberg. Kentucky's latest out-of-stock rate is 76.7%, a slight increase from 75% the week before. 

President Joe Biden has done several things to increase access to formula, including invoking the Defense Production Act to mandate increased production and importing formula manufactured overseas. 

Legislators and Beshear

The day before the health committee meeting, Rep. Kim Moser, R-Taylor Mill, a co-chair, published an opinion article that urged Democratic Gov. Andy Beshear to issue a plan for how to deal with the shortage, saying "We have heard nothing from Gov. Beshear on what families are to do." 

Moser took several jabs at Beshear's handling of the shortage and said he should issue executive orders to increase the production of formula and address price gouging, as governors in other states have done. 

"I am calling on him to make a statement and do what he can to address this shortage because Kentucky families struggle every day to find the necessary supplies for their children," Moser wrote.

At the committee meeting, Eric Friedlander, secretary of the Cabinet for Health and Family Services, said there are already anti-price gouging statutes on the books that should continue to be enforced. 

Moser said the state attorney general's office told her that any anti-price gouging policies specific to formula need to be tailored specifically to this food product. "I think it's worth looking into, just to provide some protections," she said. 

She also noted that Agriculture Commissioner Ryan Quarles (whom she is supporting for governor) is calling for donations of formula through his Kentucky Hunger Initiative. 

Beshear answered several questions on the topic at his regular weekly news conference, in Frankfort just after the committee meeting in Northern Kentucky. "It's certainly something that I'm concerned about," he said, adding that the FDA should have seen the ramifications of shutting down the Abbott plant. 

"I'm going to push to ensure that every time the FDA makes one of these decisions, and I get they're making it in terms of immediate health, but they need to be providing a long-term analysis of the ramifications, how this impacts our economy, and different supply chains so in the very least, the president, governors, Congress is made immediately aware of what could happen," Beshear said. 

Beshear was not asked about price gouging or ways to increase formula production or price gouging, He encouraged people on Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, to call their local health department or their community WIC agency and all others to reach out to their pediatrician. 

Friedlander did likewise at the committee meeting, adding that those who are not part of the WIC program should reach out to their pediatrician.

He said the state is looking at ways to take back formula from families who have excess supplies and redistribute it, but the rules governing that are pretty stringent. He also encouraged families to check out online resources to locate formula such as the U.S. Department of Health and Human Services website at hhs.gov/formula.

Health departments, WIC and retailers

Kentucky has taken advantage of federal waivers that allow the WIC program to cover more types and sizes of formula since February. Click here to see the list of approved formulas available to WIC participants.

"We're doing pretty much everything we can to try to help families find the formula they need," Cathy Winston, nutrition manager at the Northern Kentucky Health Department, told the committee. "And it's been a real challenge." 

Moser commended the department for its efforts, but suggested more needs to be done for families not on WIC, by providing information to them about what substitutes are acceptable if they can't find the baby formula they normally use. "We have some desperate families out there," she said.

Shannon Stiglitz, a lobbyist for the Kentucky Retail Federation, walked the legislators through challenges that retailers face in the formula shortage, including supply-chain issues that started during the pandemic, the need to limit on purchases to minimize panic buying, and efforts to minimize theft. 

Stiglitz said four baby-formula manufacturers in the country is "too few," and said Abbott has contracts with 30 of the 31 states that use a single provider, exacerbating the shortage for WIC families.  

Breastfeeding as an option

Sen. Ralph Alvarado, R-Winchester, encouraged new and expectant mothers to consider breastfeeding and consult their doctors about it. 

"You won't have to worry about any of this., and you can provide your child with the nutrition that it needs, probably the best nutrition that your baby could have," said Alvarado, a physician. "So I would encourage moms to think about that. That's really the the answer for this moving forward."

Some new mothers don't want to breastfeed, or have to rely on formula for several reasons; they may have an illness, incompatibility with work schedules, or issues with lactation or their baby's latching to a breast.

FDA chief says baby formula supply is expected to remain short through late July; meanwhile, shortage gets worse in Kentucky

Photo from The Associated Press

By Melissa Patrick
Kentucky Health News

The baby formula shortage continues to worsen in Kentucky, with the state's out-of-stock rate increasing by 20 percentage points since May 8, according to the retail data firm Datasembly. 

Datasembly reports that in the week starting May 15,  the latest data available, Kentucky's out-of-stock rate for baby formula increased to 75%, up from 55% the prior week. That placed Kentucky 26th among the states, with out-of-stock rates ranging from a high of nearly 89% in Utah to a low of 45% in Illinois. The nationwide out-of-stock rate is 70%. 

Gov. Andy Beshear said at his May 26 news conference that he could not confirm the data, but said, "Certainly there is a nationwide shortage, which is real concerning." 

Kelly Potts, a spokeswoman for Datasembly, said in an e-mail that their data comes from more than 230 retailers with over 130,000 stores across the U.S., Canada and Mexico, and the out-of-stock (OOS) index only includes U.S. stores. 

"Datasembly’s proprietary data collection platform collects OOS information for each designated product based on OOS indicators . . . We collect the in-stock and out-of-stock information at the product level for each of the stores," Potts said. "For example, if a retailer offers 10 unique formula products on the shelf and the indicators point to 5 of the 10 products being out of stock, this would generate a 50% out-of-stock status." 

Beshear encouraged Kentuckians who are part of the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, to reach out to their WIC provider, which is usually the local health department, if they are struggling to get enough formula. He said those who are not part of the WIC program should reach out to their pediatrician.

WIC is available to Kentucky residents who are pregnant, breastfeeding or have a child 5 or younger and have household income of no more than 185% of the federal poverty level, with rules governing what counts as income. Anyone who receives Medicaid or is part of the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) automatically meets the income requirements for WIC. Click here for a WIC PreScreening Tool to see if you are eligible for WIC benefits. 

According to the state Department for Public Health, Kentucky has about 19,500 infants on WIC who are fully formula-fed in any given month. 

The health department said it connects WIC participants with about 350,000 containers of formula per month, accounting for about $2.2 million in WIC benefits per month, just over a third of the total benefits. 

The department said redemption of formula since the February recall by major manufacturer Abbott Laboratories has declined by about one-third, from an average utilization rate of about 82% six months before the recall to about 69% in the first quarter of the year.

The agency said it took several actions in response to the recall. 

"The Kentucky WIC Program quickly requested and began to execute all waivers available to the states as soon as the U.S. Department of Agriculture provided for them," Susan Dunlap, spokeswoman for the department, said in an e-mail. "However, that has only been a small part of their response." 

Louisville's WFPL reports that Kentucky made its first policy change to expand the types of formula covered by WIC in February, and has since updated this policy several times to add more types of formula to the list. Click here to see the list of approved formulas available to WIC participants. 

Dunlap said the state has worked to keep local health departments updated as the situation has unfolded; is pushing important updates to WIC families via the WIC Shopper smartphone app; and are in "constant contact" with Abbott about reports of regional supply deficiencies. 

In a story about the baby formula shortage that opened with the state's May 8 out-of-stock rate, Norge Garcia told the Louisville Courier Journal about his struggles to find the specific formula for 4-month-old, who was born premature and can only have one type of formula, Nutramigen, because of his weight.

"I walked the day before yesterday more than six hours looking for milk, and of the 10 cans that WIC gives us . . . we only got one," Garcia told the newspaper in Spanish.

"I went to seven Walmarts — all the Walmarts that are here in Louisville, I went to all of them," he said. "I went to Target and none of them have any. There is only milk for babies 9 months and older."

Abbott and the U.S. Food and Drug Administration recently agreed how to reopen the Michigan plant where formula is made, but it will take several weeks to affect supplies. Beshear said Thursday, "We believe that we're going to see a significant boost in the coming weeks, but we've got to get to that point." 

The baby formula shortage in the U.S. will likely not be resolved until late July, FDA Administrator Robert Califf said Thursday at a Senate Health Committee hearing, The Hill reports.

"My expectation is that within two months we should be beyond normal, and with a plethora,” Califf said. “It’s going to be gradual improvement up to probably somewhere around two months until the shelves are replete again.”

Attorney general issues alert about scam sales of infant formula

Image from WKDQ.com

Attorney General Daniel Cameron issued a consumer alert Wednesday warning Kentuckians of scams related to the nationwide shortage of infant formula. 

“Scammers often attempt to take advantage of those in stressful situations, and right now that can include Kentuckians who are desperately trying to find formula for their babies," Cameron said in a news release. "We encourage parents to report suspected baby formula scams to our office immediately at ag.ky.gov/scams.”

The release notes that baby-formula scammers may use ploys similar to those used by online-purchase scammers who pose as legitimate sellers and claim to have scarce products. Often, these items are sold at prices that are too high or too good to be true.

"The items are often sold on social media platforms, independent websites, or online vendors like Facebook Marketplace or Craigslist," the release says. "Sellers often require upfront payment for the product or shipping. Payment is usually required through gift cards or online payment platforms. Consumers who are victims of these scams never receive the promised product."

To avoid such scams, Cameron's office offers these tips: 

• Purchase baby formula from known, reputable sources and, when possible, use a credit card to make the purchase.
• Avoid paying for infant formula up front, if purchasing from an unknown source.
• Be suspicious of sources advertising infant formula at prices that are too good to be true. If it seems too good to be true, it is likely a scam.

To report baby formula or other scams, contact the Attorney General’s Consumer Protection Hotline at 1-888-432-9257, or complete the online scam complaint form at ag.ky.gov/scams.

Here's what you need to know about the baby formula shortage

By Heather Chapman
Institute for Rural Journalism and Community Issues, University of Kentucky

Families nationwide are scrambling to find baby formula amid a widespread shortage. Rural families are likely having an even harder time since there are fewer local places to buy formula, and because families who use federal assistance can only buy certain formulas. It's even more difficult to find certain medically necessary specialty formulas. Here's what you need to know:

What happened: In February the Food and Drug Administration ordered Abbott Nutrition, the nation's leading formula maker, to shut down its plant in Sturgis, Michigan, after four infants were hospitalized with bacterial infections from contaminated formula and two of them died. The FDA issued a voluntary recall on three products (Similac, Alimentum, and EleCare) and warned customers not to use certain specialty formulas produced at the facility, but the warning didn't get much public attention, so parents didn't know to stock up. Formula was already low in stock since at least December because of inflation, supply-chain shortages and product recalls.

How bad is it? Formula stockpiles in stores are 43 percent lower than normal, compared to 30-40% short in April, says retail data tracker Datasembly. Only about a quarter of children are exclusively breast-fed up to the age of six months, so most parents and caregivers depend at least partially on formula. 

Why not buy another brand? Almost all formula in the U.S. is manufactured domestically because of strict FDA standards, and 90% of the nation's supply comes from four companies. Abbott makes over 40% and Perrigo Nutritionals, Mead Johnson, Gerber (owned by Nestlé) combined account for another 50%. Perrigo makes store-brand formulas for stores such as Walmart, Kroger and Walgreens formula can't be purchased by people using federal assistance through the Women, Infants and Children nutrition program, which pays for about half of all formula. In addition, many babies require specialty formulas and can become very sick if they switch.

Why not breastfeed? Many babies who require specialty formulas can also get sick from drinking breast milk. Adoptive families and many others also have difficulty accessing or affording a reliable supply of breast milk, and some survivors of sexual violence may find it traumatizing. Some mothers find it difficult to maintain a steady supply of milk, and others can't breastfeed at all because they must take medications that would taint the milk. Though state and federal laws protect women's right to breastfeed in public—including at work—many women are embarrassed, intimidated, or even discouraged from the practice, and many women are not knowledgeable about the health benefits of breast milk.

Is homemade baby formula a safe alternative? No. Homemade formulas can be too high in sodium, too low in calcium, contaminated, and/or lack critical nutrients. Babies can suffer long-term damage after using homemade formula alternatives or straight cow's milk for even a few days, according to the National Committee on Nutrition for the American Academy of Pediatrics. It's also dangerous to dilute baby formula with too much water. If there is absolutely no other alternative, formula made for toddlers can be ok for a few days for infants who are close to a year of age. 

How long could the shortage last? At least 10 weeks. On Monday the FDA agreed to allow Abbott to reopen its Sturgis plant within two weeks, as long as it passes a safety inspection. After that it will take six to eight weeks for formula to hit store shelves. However, inspectors say there are still problems at the plant. In the meantime, Abbott says it's shipping in formula from its FDA-registered plant in Ireland on a daily basis. The FDA has been allowing more formula imports meant for the U.S. since February, and is now allowing some formula meant for foreign markets to enter the U.S., but only after a safety evaluation.

Could this have been prevented? Growing evidence indicates the FDA failed to act quickly about warnings of safety violations at the Sturgis plant. A whistleblower at the plant warned the FDA in October about safety problems, weeks after the children were hospitalized with bacterial infections, but the agency didn't interview the whistleblower until December and didn't inspect the plant until Jan. 31. That dovetails with a recent Poitico investigation that revealed deep-seated issues with the FDA's plant inspections. Current and former employees described the agency as slow to make decisions and lacking enough staff or budget for years to deal with the modern food system even as its regulatory responsibilities have grown.

What is happening in Kentucky? "The state WIC Program quickly requested and began to execute all waivers available to the states as soon as the USDA provided for them. However, that has only been a small part of their response," said Susan Dunlap, spokeswoman for the state Cabinet for Health and Family Services. "They have worked to develop additional infant formula packages in the WIC system and have updated the approved product list to now include a substantial number of additional products in a variety of sizes. All of this was aimed at ensuring WIC families were able to use their benefits to access whatever formula was available on the shelves."

Also, local health departments are being updated and supported, and the state is pushing updates to WIC families via the WIC Shopper App, Dunlap said. "They have been in constant contact with Abbott about reports of regional supply deficiencies so Abbott can work to shift supply to harder hit areas of the state," she said. "However, the supply chain demand and disruption is affecting nearly all families that use infant formula."

In the meantime, if you need formula, here are some do's and don'ts:

• Check with your church or local nonprofits to see if they have any.
• Shop online from reliable sources. 
• Don't make your own.
• Don't hoard formula.
• Network with other families on social media.