Crisis, Coalitions, Shinrin-Yoku

Serbia, officially the Republic of Serbia, is a landlocked country in Southeast Europe, at the crossroads of the Pannonian Plain and the Balkans. It shares land borders with Hungary to the north, Romania to the northeast, Bulgaria to the southeast, North Macedonia to the south, Croatia and Bosnia and Herzegovina to the west, and Montenegro to the southwest, and claiming a border with Albania through the disputed territory of Kosovo. Serbia has a population of roughly 7 million inhabitants. Its capital Belgrade is also the largest city.

Serbia is an upper-middle income economy, ranked 64th in the Human Development Index domain. It is a unitary parliamentary constitutional republic, member of the UN, CoE, OSCE, PfP, BSEC, CEFTA and is acceding to the WTO. Since 2014, the country has been negotiating its EU accession, with the aim of joining the European Union by 2025. Serbia formally adheres to the policy of military neutrality.

The country provides universal health care and free primary and secondary education to its citizens. The healthcare system in Serbia is organized and managed by the three primary institutions: The Ministry of Health, The Institute of Public Health of Serbia “Dr Milan Jovanović Batut” and the Military Medical Academy. The right to healthcare protections is defined as a constitutional right in Serbia. The Serbian public health system is based on the principles of equity and solidarity, organized on the model of compulsory health insurance contributions. Private health care is not integrated into the public health system, but certain services may be included by contracting.

Source:https://en.wikipedia.org/wiki/Serbia

COMMUNITY

UNICEF delivered a life-saving machine for newborns

A valuable donation to the Institute for Health Care of Children and Youth of Vojvodina provided by Delhaize Serbia

Belgrade, 4 November 2021

The Institute for Health Care of Children and Youth of Vojvodina from Novi Sad received today a therapeutic hypothermia device for asphyxiated newborns, provided by the Delhaize Serbia company as part of the So Small They Could Fit Inside a Heart campaign.

The therapeutic hypothermia device for asphyxiated newborns is intended for treating babies who suffered oxygen deprivation during birth. This device prevents brain damage in these babies by applying a modern controlled cooling method and is worth2,419,000 dinars.

“This valuable device is used for applying a proven therapeutic method in preventing brain damage in newborns, thus saving lives of asphyxiated babies. In the previous period, the Institute received valuable equipment from UNICEF, which helped equip the Institute. However, in order to reach the highest standards in developmental care, professional support we receive from UNICEF experts and partners is equally important. I would also like to thank the Delhaize Serbia company, which provided funds for the purchase of this life-saving device. UNICEF is our reliable partner that knows that many newborn babies need daily support of the health care system, regardless of the crisis, and we are grateful for it,” stated the Director of the Institute, Doc. Dr. Jelena Antić.

In Serbia, 65 thousand children are born every year, 4000 of whom are premature babies, and every day seven new babies require some form of urgent support. Premature birth is responsible for more than 60% of infant deaths in Serbia. The So Small They Could Fit Inside a Heart campaignwas launched by UNICEF late last year in order to provide additional equipment for neonatal units in Serbia, which will also contribute to reducing the mortality of premature babies in the country.

“The Institute for Health Care of Children and Youth in Novi Sad provides care to the most vulnerable babies from all over Vojvodina. For years, it has ensured that every newborn child gets the highest quality support in order to survive and thrive. The Institute is a good-practice example in the country when it comes to the provision of family-oriented developmental care, which also includes conditions for the continuous and irreplaceable contact between mum or dad and baby from the first days of baby’s life.

This is one of the few institutions in Serbia that has managed to preserve this practice during the pandemic, which opens up opportunities for us to jointly support other neonatal intensive care units in Serbia to persist in that endeavour. Maintaining the highest standards of child health care, despite the challenges imposed by the COVID19 pandemic, is a common priority, and we would like to thank Delhaize Serbia for providing the funds to support the most vulnerable, but also the bravest among us, who fight like true “little giants”, said Jelena Zaganović Jakovljević, UNICEF Early Childhood Development Specialist.

The COVID-19 epidemic has also been affecting pregnant women, newborns and children lately, so it is particularly important to invest efforts in adequate treatment of the infected and combating the epidemic, which is not sparing the youngest either. UNICEF has supported the equipping of neonatal units in Serbia, so that the most vulnerable among us, prematurely born babies and ill newborns, are given adequate support to survive and thrive. Starting from 2017, UNICEF has invested a total of 59,628,463 dinars in modernising the operation of the neonatal service in Serbia. The So Small They Could Fit Inside a Heart campaign was supported by the Ministry of Health of the Republic of Serbia.

“Delhaize Serbia has recognised UNICEF as the right partner and supported the modernisation of neonatal units in Novi Sad and Kragujevac, because we are aware of how important it is to help the most vulnerable babies that are also affected by the Corona virus crisis. Helping such small babies to get a chance at life is a reflection of our belief that help should be provided to those who need it most,” said Milica Popović, Corporate Communications Manager at Delhaize Serbia.

In all Maxi, Mega Maxi, Tempo and Shop&Go stores across Serbia, customers have the opportunity to round their bill up to the amount they wish, and in this way support the provision of equipment to neonatal units in our country.

Delhaize Serbia donated a total of 200,000 euros to UNICEF for equipping neonatal units in our countryFrom this donation, another therapeutic hypothermia device for asphyxiated newborns will be provided to the Kragujevac Neonatal Care Centre, which will also receive the first ambulance for prematurely born and ill newborn babies. Since the start of the campaign, this is the largest private sector donation in the So Small They Could Fit Inside a Heart campaign.

Source:https://www.unicef.org/serbia/en/press-releases/unicef-delivered-life-saving-machine-newborns

Coalition for Preemies – We Help Polish Parents of Preemies and Rescue Ukrainian NICUs

Maria Katarzyna Borszewska-Kornacka, MD, Elzbieta Brzozowska, Adriana Misiewicz, Joanna Nycz

Coalition for Preemies is an organization operating in Poland for ten years – initially as a social movement that brought together people and institutions working for the health of premature babies in Poland, and from 2019 as a Foundation.

The goals of the Foundation have been unchanged for many years – to work for the smallest of the youngest – premature babies and their parents. Our goal is education – starting with the health of pregnant women and preventing premature births, ending with the health of premature babies, their development, and rehabilitation. We reach out to parents of premature babies to help them care for their premature babies and to the general public to help them understand that a premature baby is the most vulnerable person who needs our help. Nobody who has not encountered a premature baby in their environment knows what complications the baby and its loved ones face and how much effort is needed to ensure healthy development.

During the pandemic, we got involved with an international campaign initiated by EFCNI #zeroseparation. It aimed to restore the possibility of visiting preemies in neonatal departments for their parents. In Poland, as part of the #zeroseparation campaign, we included parents of preemies in the group “zero” for vaccination against COVID-19 – the group that could be vaccinated first together with medical staff. We wanted parents of premature babies to be protected from the virus as soon as possible and to be able to visit their children in hospitals. It was possible thanks to the immediate decision of the Ministry of Health after we sent a request on this matter.

In 2021, we launched advice for parents of premature babies with specialists as part of the “Ask for a premature baby” campaign – it consists of a telephone conversation or via online communicators. Parents can talk to a neonatologist, psychologist, pediatric neurologist, lactation consultant, and physiotherapist.

Currently, we are involved in helping premature Ukrainian babies. Together with the Neonatus Foundation, the Tęczowy Kocyk Foundation, and the blogger MatkoweLove, we organized a fundraiser. With the collected money, we finance the purchase of the necessary equipment and medicines for Ukrainian neonatal units and transport the equipment to the neediest hospitals in Ukraine. The President of our Foundation- prof. Maria Katarzyna Borszewska-Kornacka is in constant contact with the national consultant for neonatology in Ukraine, and therefore we know what their needs are. First shipments of medical equipment, drugs, and milk were sent to Lviv, Kyiv, Charkov, Brovary, Ivano-Frankovsk, and Dniepro.

It is possible to donate to the Coalition for Preemies Foundation: https://www.koalicjadlawczesniaka.pl/numer-konta-fundacji-koalicja-dla-wczesniaka-i-dane-do-przelewow-z-zagranicy/

We have also started the “Package for a Newborn” campaign, the purpose of which is to equip Ukrainian babies born in Warsaw with necessities such as clothes for newborns, sizes 50-68, including bodysuits, rompers, socks, hats, nipples, small toys, cosmetics, and hygiene articles.

We also plan to prepare a warehouse of clothes/things useful for newborns, which will be issued in response to the specific needs of single Ukrainian mothers in Poland. From the warehouse, mothers will be able to receive rockers, carriers, scarves for carrying babies, prams, changing mats, bathtubs, and breast pumps.

Since the outbreak of war, we have had over a dozen requests to help in transferring newborns from Ukraine to Poland.

Initially, there were babies of US and UK citizens born in Ukraine, followed by several neonatal transfers or personal admissions of Ukrainian newborns from the border zone brought personally by parents.

Our triage center has different scenarios comprising both stabilization and subsequent transfer to different Polish neonatal/pediatric centers and diagnostic and treatment approaches on site.

Requests regarding medical transfers of premature babies were formulated predominantly by aid organizations, governmental or family activities, and not specifically by medical referrals.

Recently we have received several inquiries about the possibility of admission of newborns/small infants with chronic and/or rare genetic problems. Until now, the utility of the database created for the quick electronic exchange of medical data regarding the transfer of newborns from Ukraine to Poland seems suboptimal as there was perhaps no need for such transfers on a larger scale.

Further information can be found on the Foundation website: Source:https://www.koalicjadlawczesniaka.pl/aktualnosci/

Serbia to Use Cash to Boost Birth Rate, Avert Population Decline

By Misha Savic  November 24, 2021

Serbia will triple a cash incentive to parents for their first-born child and prop up support for bigger families to fight a crippling demographic decline, President Aleksandar Vucic said.

“We’re vanishing as a nation,” the Balkan country’s leader told reporters on Wednesday as he announced tripling the one-time incentive for mothers for their first child to 300,000 dinar ($2,862) as of January. Serbia will also increase its existing cash and other support to families to have and raise more children, he said.

The plan comes as Vucic, whose party and allies control an absolute majority in Serbia’s parliament, is gearing up for general elections expected in the spring. Mainstream opposition parties boycotted a previous ballot in 2020 but are likely to challenge Vucic’s dominance in the race that will also include his job.

The average monthly net wage equals $616 in the nation of 6.9 million. The population is falling by around 30,000 a year amid a low birth rate and emigration. The median age is almost 43 years, among the highest in Europe. 

Serbia’s current birth rate of 1.5 needs to go up to at least 2.15 just to maintain the current population size, Vucic said.

Additional steps will help young people to stay in colleges and universities even if they become parents while studying, he said. The government is weighing giving grants to young couples of as much as $22,000 to help them buy their first home and start a family, he said.

“We’re getting older and older, and our economic progress will depend on how we ensure the nation’s progress with the demographic measures,” Vucic said. 

Source:https://www.bloomberg.com/news/articles/2021-11-24/serbia-to-use-cash-to-boost-birth-rate-avert-population-decline

Ukraine crisis: Premature babies born into war as deliveries forced to take place in hospital basement

I’m incredibly sad,’ doctor says, ‘babies are going to die because they cannot live in these conditions’

As women are forced to give birth in the basements of hospitals in war-torn Ukraine, health officials have raised fears that not all newborn babies can survive in such conditions.

Devastating images coming out of the Eastern European nation show the makeshift wards being used after medical staff work tirelessly to convert basements of maternity hospitals – all the while, using them as bomb shelters.

Most at risk are premature babies, who require special medical attention in their first few days, weeks or even months of life.

More than 1,000 babies are born in Ukraine per day, according to data from research platform Macrotrends. Of those, around 100 will need some form of neonatal intensive care.

Footage from one perinatal care unit in Kyiv, published by ITV News, showed parents and their

At one point, a man is filmed attending to a tiny baby in an incubator.

The machine beeps momentarily as he reaches for some medical equipment, then the clip cuts to night time where nurses and parents can be seen sat underneath what looks like the building’s water or gas pipes.

Speaking to the broadcaster, Dr Olena Kostiuk, a neonatologist associate professor in Ukraine’s capital city, described how the basement unit was set up in just a few days.

“It’s usually a technical room for water, for electricity and heating… never, never, ever is this space used in this way,” she said. “Very sick babies, babies which we cannot move… they permanently live in the basement.”

Pregnant women and newborn babies in the basement of a maternity hospital converted into a medical ward, and used as a bomb shelter during air raid alerts in Kyiv.

Clearly frustrated, and upset, Dr Kostiuk said plainly that “babies are going to

“I’m incredibly sad,” she added, “for myself the biggest problem is, I don’t know when it’s going to finish and how long our pregnant women, our babies delivered in a basement, our babies have no normal support.”

Over in the city of Zhytomyr, as reported by The Independent earlier today, staff of the maternity ward at Pavlusenko hospital – all taking cover under Russian missile fire – helped a pregnant woman who had started giving birth on the floor of the bomb shelter after the shock of a nearby explosion sent her into labour.

Medical workers show a newborn baby to a woman who gave birth in a maternity hospital basement converted into a medical ward in Mariupol, Ukraine

It came after an airstrike in the city on Tuesday which struck a military base just 200 metres away from the hospital, seriously damaging multiple wards.

Among those worst hit was the maternity wing, where 45 women and 15 newborn babies were being cared for at the time. All were subsequently evacuated to the basement, where they remain.

The Russian strike on Zhytomyr, in Ukraine’s northwest, also hit a residential area and killed at least two people, emergency services said afterwards.

Dr Cora Doherty, a neonatologist speaking on behalf of the British Association of Perinatal Medicine (BAPM), said she had seen the footage from Kyiv’s perinatal centre and was concerned the babies’ care was being compromised.

“We know that if babies do not get the proper care around the time at birth, that particularly if they’re ill, there is an increased risk of death in those babies,” she told ITV News.

And she added: “That’s essentially the, you know, the future denigrate generation there. So, it is really, really important that we support both these mothers and their babies in their plight.”

Four “loud explosions” were heard in the centre of Kyiv late on Wednesday night, with the Kyiv Independent taking to Twitter to advise its readers to take cover in their “nearest shelter” at around

It came as Russian troops appeared to take “complete control” of Kherson, the first major city to be captured during Vladimir Putin’s war.

Igor Kolykhayev, Kherson’s mayor, said in a Facebook post on Wednesday that the Black Sea port had been lost.

He urged the Kremlin’s soldiers not to shoot at civilians and publicly called on Ukrainians to walk through the streets only in daylight and with no more than one other person.

Cars will only be allowed to enter the city to bring food and medicine and other essentials. They must drive at minimum speed and be prepared to stop to be searched by Russian troops, he said.

Mr Kolykhayev added: “Ukrainian flag above us. And to keep it the same, these requirements must be met. I have nothing else to offer yet.”

Source:https://www.independent.co.uk/news/world/europe/ukraine-premature-babies-hospital-basement-b2027609.html

ALEKSANDRA MLADENOVIC X NENAD MANOJLOVIC – TI MENI, JA TEBI

Oct 21, 2021      IDJVideos.TV

Official music video for “Ti Meni, Ja Tebi” by Aleksandra Mladenović and Nenad Manojlovi

HEALTH CARE PARTNERS

SHEA NICU White Paper Series: Practical approaches for the prevention of central line-associated bloodstream infections\

Pediatrics AUTHOR: SHEA PUBLISHED:MARCH 4, 2022 CURRENT – CLABSI, Clinical Practice, Guidelines, Immunocompromised Patients, Infection Prevention

ABSTRACT:

This document is part of the “SHEA neonatal intensive care unit (NICU) white paper series.” It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: “Practical approaches to Clostridioides difficile prevention” published in August 2018 and “Practical approaches to Staphylococcus aureus prevention,” published in September 2020.

Source:https://www.healio.com/news/primary-care/20220318/shea-publishes-white-paper-on-clabsis-in-nicu

American Nurse Journal/Cedars-Sinai Hospital: Fostering nurse-physician collaboration

February 1, 2022

Author(s): Sarah Low, MSN, RN, OCN, CMSRN; Emily Gray, MSN, RN-BC; Amanda Ewing, MD, FACP; Patricia Hain, MSN, RN-BC, NE-BC, FACHE; and Linda Kim, PhD, MSN, RN, PHN, CPHQ

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Eat, Sleep, Console Approach

A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome

Grisham, Lisa M. NNP-BC; Stephen, Meryl M. CCRN; Coykendall, Mary R. RNC-NIC; Kane, Maureen F. NNP-BC; Maurer, Jocelyn A. RNC-NIC; Bader, Mohammed Y. MD

Advances in Neonatal Care: April 2019 – Volume 19 – Issue 2 – p 138-144

doi: 10.1097/ANC.0000000000000581

Abstract:

Background: 

The opioid epidemic in the United States has resulted in an increased number of drug-exposed infants who are at risk for developing neonatal abstinence syndrome (NAS). Historically, these infants have been treated with the introduction and slow weaning of pharmaceuticals. Recently, a new model called Eat, Sleep, Console (ESC) has been developed that focuses on the comfort and care of these infants by maximizing nonpharmacologic methods, increasing family involvement in the treatment of their infant, and prn or “as needed” use of morphine.

Purpose: 

The purpose of this evidenced-based practice brief was to summarize and critically review emerging research on the ESC method of managing NAS and develop a recommendation for implementing an ESC model.

Methods: 

A literature review was conducted using PubMed, Cochrane, and Google Scholar with a focus on ESC programs developed for treating infants with NAS.

Finding/Results: 

Several studies were found with successful development and implementation of the ESC model. Studies supported the use of ESC to decrease length of stay, exposure to pharmacologic agents, and overall cost of treatment.

Video Abstract Available at:

PREEMIE FAMILY PARTNERS

HAPPY MOTHERS DAY VIDEO

Acknowledging and Supporting NICU Moms this Mother’s Day

Leah Sodowick, B.A., Pamela A. Geller, Ph.D., Chavis A. Patterson, Ph.D.

Each year on the second Sunday in May, people across the United States and around the globe honor and celebrate mothers (Our use of the term “mothers” includes anyone who identifies as a mother, grandmother, gestational parent, or caregiver.) on Mother’s Day. This holiday is full of joy, celebration, pride, and gratitude for many. There may be hugs, handmade and store-bought cards, photos posted and shared on social media, breakfast in bed, family gatherings, flower bouquets, and tokens of appreciation. Mother’s Day can be challenging and emotionally fraught for some, including mothers with an infant hospitalized in a neonatal intensive care unit (NICU). With the help of NICU staff and providers, mothers can anticipate and cope with the challenges and emotions that they may experience this Mother’s Day, on May 8th. This article will discuss the emotions and challenges NICU mothers may experience on the holiday and suggest ways to acknowledge, support, and celebrate NICU mothers and caregivers.

Parents in the NICU may grieve the loss of anticipated postpartum plans and experiences, such as caring for and bonding with their baby at home. Mothers in the NICU may also grieve the loss of expected holiday events and experiences (1). Grief is one of the many normal and common reactions NICU parents may have. On Mother’s Day and the days surrounding this holiday, mothers in the NICU may feel disappointed, disheartened, and sorrowful if their expectations, visions, and anticipations for Mother’s Day do not match their current reality—one that is often characterized by long hours at their baby’s bedside and concern and worry about their baby’s health and survival. Current realities may also involve difficult decision making about treatment options and endof-life care. NICU parents may be juggling multiple responsibilities, such as caring for older children and work. Parents may also experience physical separation from their baby when the gestational parent is recovering from childbirth, the baby is in an isolette, the baby is undergoing a surgical procedure, or when parents leave the hospital to go home or to their temporary residence. Furthermore, by spending time in the NICU, mothers may miss traditional family gatherings and their usual Mother’s Day celebrations (1). Not being present for these events may exacerbate feelings of isolation as many families begin to reunite after separations due to COVID-19 restrictions.

Some mothers in the NICU may have difficulty or delays in forming their maternal identity due to limited opportunities for caregiving and interacting with their infant, shared caregiving responsibilities with NICU staff providers, disrupted mother-infant bonding, perceived lack of control, and increased psychological distress (2–5). Difficulty or delays in forming maternal and parental identity are part of an array of normal reactions and experiences that a parent may have. In a qualitative examination of NICU mothers’ perceptions of the development of their maternal role in the context of NICU, the thematic analysis revealed that some respondents characterized themselves as mothers only while they were in the NICU; they reported not feeling like mothers when they left the hospital because they were not with their babies or serving as a primary caretaker (3). Researchers have found that mothers’ perceived loss of parental role was one of the most stressful aspects of their infant’s NICU hospitalization (6,7)predictors, and child outcomes associated with NICU-related stress for mothers of infants born very preterm (VPT. For mothers in the NICU who have not yet fully developed their maternal identity or perceive a loss of their parental role, Mother’s Day may feel conflicting and isolating. Of note, mothers in the NICU who have experienced neonatal losses or are anticipating and planning for neonatal loss may experience an intensification of grief and have particularly difficult emotional experiences on Mother’s Day.

We encourage NICU staff and providers to thoughtfully acknowledge and celebrate mothers and caregivers in the NICU this Mother’s Day. Listed below are some suggestions:

Acknowledge Mother’s Day Staff and providers can communicate their acknowledgment of Mother’s Day, even when it may not be a “happy” Mother’s Day for mothers and other caregivers in the NICU. If this is the case, instead of wishing mothers a “happy” Mother’s Day, one can express, “I am thinking about you today on Mother’s Day.”

Validate and reflect emotions – NICU staff and providers can help mothers and caregivers cope with emotions that may arise during this holiday by validating and reflecting on mothers’ expressed feelings. Offering opportunities for parents to share their feelings by asking open-ended questions about how they are feeling and allowing time to listen to the responses can be very empowering for parents. Responding with statements that validate their experience also can be very helpful. For example, one could respond to a mother who expresses grief about the loss of expected Mother’s Day experiences by stating, “it makes sense why you would feel especially sad and disappointed today.”

Provide opportunities for caretaking – If possible, NICU staff and providers can find ways for parents to interact with their babies more on Mother’s Day. For example, mothers could be encouraged to take on a meaningful hands-on caretaking task, like feeding or bathing their baby or changing a diaper. Mothers also can be encouraged to engage in skin-to-skin care.

Encourage mothers to communicate with their babies – On Mother’s Day, NICU mothers can communicate and bond with their babies by reading them a book, story, or poem. Mothers could write and share a personal letter to their babies about their love, their family, and what it means to be their mother. Mothers may also wish to sing to their babies.

Praise mothers’ efforts to care for their babies – On Mother’s Day (and regularly), NICU staff and providers are encouraged to acknowledge and praise mothers’ efforts to care for their babies in the NICU. A simple phrase like “you are doing a great job” can be meaningful and impactful to mothers who may be lacking confidence and feeling uncertain about their maternal role.

 Encourage mothers to attend parent support groups – NICU staff and providers can encourage mothers to attend parent support groups on Mother’s Day. Peer sharing of positive and negative maternal experiences in NICU support groups can strengthen social relationships and networks, provide therapeutic benefits, foster feelings of safety and comfort, and encourage parent advocacy (3,9). On Mother’s Day, NICU parent support groups can feature topics related to Mother’s Day. Mother’s Day themed activities, such as scrapbooking, crafting, and even expressive writing or journaling that allow for both positive and adverse feelings can also be incorporated.

Create cards or keepsake gifts for mothers – There are several ways Mother’s Day can be celebrated in the NICU. One way to celebrate the holiday is for NICU staff to take a photo of each baby or each mother with their baby and put it inside of a card that can be placed by the baby’s bedside. Staff may also wish to create small keepsake gifts for mothers. At Denver Health Medical Center, NICU nurses make keychains to give to each mother (8). Each keychain contains a photo of the mom with their baby. Provide scent cloths for mothers Small pieces of soft fabric with the baby’s and the mother’s familiar scent can bring comfort to mothers and babies and help facilitate bonding. The cloth can be placed in the baby’s be against the mother’s skin to absorb scent and then exchanged. The scent cloths can even be shaped like hearts.

 Enlist volunteer assistance from past NICU graduate families – Staff and providers can consider enlisting volunteer assistance from past graduate families of the NICU to help support and celebrate mothers in the NICU on Mother’s Day (1). Former NICU mothers and caregivers with first-hand lived experience and expertise could write cards with encouraging and supportive messages to current NICU mothers and assist with running parent activity groups. It is important to remember that each mother in the NICU will experience Mother’s Day differently, and some families may not be open to celebrating or participating in Mother’s Day activities.

As a final note, we would like to acknowledge NICU staff, providers, and readers this Mother’s Day. We recognize those who are mothers, grandmothers, and caregivers. We recognize those who have or have had infants hospitalized in the NICU. We recognize those who have lost children and those who have lost mothers. We recognize those with strained relationships with their mothers, those with strained relationships with their children, those who have chosen not to be mothers, and those who are yearning to be mothers. We honor you all and wish you a peaceful Mother’s Day.

Source:http://neonatologytoday.net/newsletters/nt-apr22.pdf

Timely examination can save premature babies from permanent blindness

By Muhammad Qasim     April 20, 2022

Rawalpindi : Over eighty-five per cent of premature babies who weigh less than 1.5 kilograms at the time of birth have a high risk of developing the disorganised growth of retinal blood vessels, which can cause vision problems including permanent blindness.

Babies born prematurely, before 266 days, have many obstacles to overcome in their first fragile weeks, one of which is eye development that can be resolved through screening and surgical procedures to help avoid serious eyesight problems like vision impairment and blindness.

Chief Consultant and Head of Retina Department at Al-Shifa Eye Hospital Dr Nadeem Qureshi said this while talking to the media persons. He said that the blood vessels of the retina develop three months after conception and complete their growth at the time of normal delivery. If an infant is born prematurely, eye development can be disrupted, as the smaller a baby is at birth, the more likely that baby is to develop difficulties, he said.

Using excess oxygen to treat premature babies in the hospitals stimulates abnormal vessel growth in the eyes, with the smallest and sickest having the highest risk of devastating effects of Retinopathy of Prematurity (ROP), he said.

He added that studies have shown that keeping the oxygen saturation at a lower level from birth can reduce the rate of advanced ROP, a blinding eye disorder.

All parents must include a vision screening in their list of baby check-ups between six and twelve months of age as every premature infant deserves the constant attention of an ophthalmologist because of his or her increased risk for eye misalignment, amblyopia, and the need for glasses to develop normal vision.

Dr Qureshi said that Al-Shifa Eye hospital has already signed MoUs with Fauji Foundation Hospital, Combined Military Hospital, and Benazir Bhutto Hospital to treat newborns with vision complications.

Al-Shifa Eye Hospital is the only facility in the SAARC region and among few in the world having the latest equipment and excellent skills to treat newborns having vision complications, he claimed. So far, the trust has treated around 6000 infants in the last seven years and the number is bound to increase as the awareness grows, he said.

He added that we are here to provide free guidance to all the state-owned and private healthcare facilities, including those in other countries, to help save thousands from plunging into darkness for life. The Retina Department of Al-Shifa Hospital has 12 surgeons, assisted by trainees, and it performs Retinal OPD, lasers, injections and surgery every day of the week, said Dr Qureshi.

Average OPD at the Retina Department is 215 patients per day, average lasers are 35 per day, average injections are 50 per day and on average 25 surgeries are conducted daily, he added. A retinal surgery costs around Rs95 thousand, but 75 per cent of patients are treated free of cost, he said.

Source:Timely examination can save premature babies from permanent blindness (thenews.com.pk)

UCSF NICU-How To Do A Swaddled Bath

(Spanish subtitles)

197,922 views   Nov 28, 2018

UCSF Benioff Children’s Hospital Oakland

Watch the dramatic moment a preemie leaves his tubes behind and starts a new life (VIDEO)

Aleteia

Paola Belletti – published on 09/14/17aa

Ward Miles Miller’s scary and moving first year of life was captured by his father.

Ward Miles Miller was born on July 20, 2012 — three months early. Fear and anxiety initially overshadowed (but didn’t suffocate) his parents’ joy and hope. The story of Ward’s first year of life is a beautiful, moving, and dramatic one, as told through the video and photos taken by his father Benjamin.

Little Ward received all the medical support possible and necessary until he was able to go home safely; he spent 107 days in the hospital, most of them in an incubator. His mom and dad, Lindsay and Benjamin Scott, are devoted and loving parents who fought for Ward and celebrated every ounce he gained as a milestone.

Today, Ward is navigating the stormy waters of life in a vessel that is stronger and more stable every day.

INNOVATIONS

Association of Abnormal Findings on Neonatal Cranial Ultrasound With Neurobehavior at Neonatal Intensive Care Unit Discharge in Infants Born Before 30 Weeks’ Gestation

JAMA Netw Open. 2022;5(4):e226561. doi:10.1001/jamanetworkopen.2022.6561

Original Investigation –  Pediatrics April 8, 2022

Key Points

Question  What is the association between neonatal cranial ultrasound findings and neurobehavioral examination at term-adjusted age?

Findings  In this cohort study of 675 infants born before 30 weeks’ gestation, abnormal findings on cranial ultrasound were associated with decreased tone, poor regulation of attention, and movement outcomes as the infants matured to term-adjusted age.

Meaning  Among very preterm infants, abnormal findings on cranial ultrasound identifiable in the first 14 postnatal days were associated with neurobehavior outcomes at or near term-equivalent age and could be used to help counsel and educate parents as well as inform treatment strategies for therapy service in the neonatal intensive care unit and after discharge.

Abstract

Importance  Cranial ultrasound (CUS) findings are routinely used to identify preterm infants at risk for impaired neurodevelopment, and neurobehavioral examinations provide information about early brain function. The associations of abnormal findings on early and late CUS with neurobehavior at neonatal intensive care unit (NICU) discharge have not been reported.

Objective  To examine the associations between early and late CUS findings and infant neurobehavior at NICU discharge.

Design, Setting, and Participants  This prospective cohort study included infants enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study between April 2014 and June 2016. Infants born before 30 weeks’ gestational age were included. Exclusion criteria were maternal age younger than 18 years, maternal cognitive impairment, maternal inability to read or speak English or Spanish, maternal death, and major congenital anomalies. Overall, 704 infants were enrolled. The study was conducted at 9 university-affiliated NICUs in Providence, Rhode Island; Grand Rapids, Michigan; Kansas City, Missouri; Honolulu, Hawaii; Winston-Salem, North Carolina; and Torrance and Long Beach, California. Data were analyzed from September 2019 to September 2021.

Exposures  Early CUS was performed at 3 to 14 days after birth and late CUS at 36 weeks’ postmenstrual age or NICU discharge. Abnormal findings were identified by consensus of standardized radiologists’ readings.

Main Outcomes and Measures  Neurobehavioral examination was performed using the NICU Network Neurobehavioral Scale (NNNS).

Results  Among the 704 infants enrolled, 675 had both CUS and NNNS data (135 [20.0%] Black; 368 [54.5%] minority race or ethnicity; 339 [50.2%] White; 376 [55.7%] male; mean [SD] postmenstrual age, 27.0 [1.9] weeks). After covariate adjustment, lower attention (adjusted mean difference, −0.346; 95% CI, −0.609 to −0.083), hypotonicity (mean difference, 0.358; 95% CI, 0.055 to 0.662), and poorer quality of movement (mean difference, −0.344; 95% CI, −0.572 to −0.116) were observed in infants with white matter damage (WMD). Lower attention (mean difference, −0.233; 95% CI, −0.423 to −0.044) and hypotonicity (mean difference, 0.240; 95% CI, 0.014 to 0.465) were observed in infants with early CUS lesions.

Conclusions and Relevance  In this cohort study of preterm infants, certain early CUS lesions were associated with hypotonicity and lower attention around term-equivalent age. WMD was associated with poor attention, hypotonicity, and poor quality of movement. Infants with these CUS lesions might benefit from targeted interventions to improve neurobehavioral outcomes during their NICU hospitalization.

Full Article:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790902

Can a new effort end ‘equipment graveyards’ at neonatal ICUs?

By Catherine Cheney /09 September 2021

Just outside of San Francisco, product engineers at a manufacturer and supplier of health technologies are hard at work on devices to save newborn lives in settings far different from this bayside facility.

The 3rd Stone Design warehouse features a display of lifesaving technologies for newborns, including a continuous positive airway pressure — or CPAP — machine that the team helped develop.

The company is part of a global coalition of organizations working to get such devices to babies in low-income countries, where they confront inequity from the moment they’re born. The coalition is called Newborn Essential Solutions and Technologies, or NEST360, and it targets neonatal intensive care units.

Infants born in sub-Saharan Africa or Southern Asia are 10 times more likely to die during the first month of life compared with those born in high-income countries, due in part to a lack of access to medical devices. About 75% of babies born prematurely can be saved with the right medical care.

“People who come up with product ideas are not the same people who figure out how to sell something, and the people who figure out how to sell it are not the same people who figure out how to service it.”

But when health facilities end up with devices that are not designed with their constraints in mind — or when staffers lack training in using these tools and there are no plans to fix products when they break — potentially lifesaving technologies can end up in what are often called medical equipment graveyards.

NEST360, which aims to reduce newborn mortality in sub-Saharan African hospitals by 50%, is trying to change that. It’s taking what it describes as a “holistic approach” to neonatal care — distributing newborn health technologies, educating clinicians and technicians on how to maintain these tools, and supporting local innovators to build the technologies that work best for their contexts.

The coalition launched in 2019, with an initial focus on Malawi, Kenya, Tanzania, and Nigeria. From the beginning, NEST360 has said there is a need for not just low-cost technology but high-quality distribution. With assistance from 3rd Stone Design, which helped develop a new nonprofit called Hatch Technologies, NEST360 may have found the end-to-end solution for distribution that it sought.

Hatch provides distribution and support services for devices designed for newborn care units in sub-Saharan Africa. And partners involved in NEST360 say they hope it can serve as a model for ensuring medical equipment reaches low birth weight and premature babies in time to save their lives.

Steve Adudans, Kenya country director at the Rice360 Institute for Global Health Technologies — which is also part of the NEST360 partnership — has seen many examples of donated medical devices piling up instead of being used in neonatal ICUs.

“We need to bury the medical equipment graveyards,” he said during an online webinar on innovations in newborn health in Africa organized by The Elma Philanthropies, one of NEST360’s funders. “That’s what NEST is about.”

The NEST360 bundle of technologies includes 18 medical devices focused on areas including temperature stability, respiratory support, and neonatal jaundice treatment. Each of them meets target product profiles for newborn care in low-resource settings developed by NEST360 in partnership with UNICEF.

Many of the NEST360 technologies that meet these operational and performance characteristics were developed by innovators focused on low-resource settings, where it is often impossible to repair products made by corporations that impose restrictive warranties, lock their software, and limit access to spare parts.

But these devices cannot fulfill their vital potential when they are introduced into a broken system, Adudans said.

NEST360 needed a solution to get products from manufacturers to distributors to facilities in the countries where it works. That’s where Hatch Technologies comes in.

Often, nations with the highest rates of neonatal mortality receive donated equipment that fails when placed in environments with unreliable electricity, temperature variation, and too much dust and dirt.

Bottom of Form

But even when countries can procure medical supplies, they often don’t know which devices would work best for their settings. So they end up with cheap devices that break because they are poor quality or high-end ones that never get fixed because maintenance is too expensive, said Dick Oranja, CEO at Hatch Technologies.

Based in Nairobi, Kenya, Hatch Technologies launched in March 2020 with a mission to transform the way newborn care devices are distributed, supported, and used in Africa. To date, Hatch has helped NEST360 distribute almost 2,000 pieces of equipment reporting over 95% functionality, meaning they are working as they should. It is starting with support from the same backers as NEST360 but is an independent nonprofit that could continue to seek support elsewhere.

Hatch uses asset tracking — with a bar code-type sticker on each of its products — to follow each shipment from the initial logistics and warehousing to shipment and ultimately the use of the device.

“Distributors will mention they provide a level of service. They have to assure their customers. But the truth of the matter is distributors do not offer targeted service,” Oranja said. “We measure customer service parameters a routine medical equipment manufacturer will not measure.”

Beyond delivering medical devices, Hatch installs the equipment, trains staffers, and stops by to see how the technology is working, based in part on its measure of the functional status of the equipment — meaning whether it is being used as intended or at all.

A number of supply chain bottlenecks prevent newborn health products from reaching babies in low-income countries during critical moments of life and death.

“People who come up with product ideas are not the same people who figure out how to sell something, and the people who figure out how to sell it are not the same people who figure out how to service it and support it,” Robert Miros, CEO at 3rd Stone Design, told Devex.

That reality is part of what led 3rd Stone Design to work with partners to develop Hatch Technologies.

NEST360’s expanded model, which includes Hatch, reflects a growing understanding that no matter how innovative medical devices are, they are only one part of the solution to saving newborn lives. The other crucial piece is distribution.

Hatch Technologies began after Miros and his colleagues formed a task team to brainstorm the effort together with other NEST360 partners and funders. They drew on the expertise of 3rd Stone Design’s Danica Kumara, a director of product management who formerly worked on medical device efforts in Southeast Asia, and Vikas Meka, a senior product manager who was formerly a senior adviser on global health innovation at the U.S. Agency for International Development.

Now that NEST360 has launched in four African countries, it intends to demonstrate a path to scale across the continent, said Rebecca Richards-Kortum, director at the Rice360 Institute for Global Health Technologies, during the webinar.

But what turned the tide on newborn survival in the United States and the United Kingdom was a network of neonatal ICUs — “a regional system with people and products that are ready to help babies,” she said.

So as NEST360 partners with Hatch Technologies to bridge the gap from manufacturers to distributors and ensure that lifesaving medical devices can reach health care facilities, it is also calling for stronger hospital systems for newborn care.

Source:https://www.devex.com/news/can-a-new-effort-end-equipment-graveyards-at-neonatal-icus-99571

The transition to the artificial uterus should be as natural as possible. Photo: Bart van Overbeeke

Without gasping for air safely in the artificial womb

   APR 07, 2022

An artificial uterus significantly increases the chances of survival for extremely premature babies. That is why researchers at TU Eindhoven are doing a lot of research on this topic. One of the biggest challenges  is preventing the fetus from breathing oxygen just after birth, because that is harmful to the not yet mature alveoli. The solution? A wound spreader, coupling elements and a biobag filled with amniotic fluid.

The development of the artificial uterus has accelerated in recent years, not least because of the Perinatal Life Support partnership, which includes TU Eindhoven. According to Professor Frans van de Vosse (Professor of Cardiovascular Biomechanics within the Faculty of Biomedical Technology) and Guid Oei (Gynecologist and part-time Professor within the Faculty of Electrical Engineering), within ten years it should be possible to significantly increase the chances of survival and quality of life of extremely premature babies via a so-called incubator 2.0.

QUALITY OF LIFE

In the Netherlands alone, 700 children are born extremely prematurely each year – between 24 and 28 weeks. Almost half die, while a large proportion retain permanent health problems because organs have not yet matured. “Think of lung problems or brain damage,” clarifies Frank Delbressine (Assistant Professor of Industrial Design). “We want to increase both the life chances and the quality of life of newborn babies with an artificial uterus.”

Delbressine is the supervisor of PhD student Juliette van Haren. Together with a group of Industrial Design students, she is concerned with, among other things, the way in which childbirth should take place. One of the biggest challenges is to prevent the fetus from gasping for air just after birth (in this case by caesarean section). The birth procedure to the artificial uterus should be as natural as possible, which is why Van Haren is developing a safe way for the premature baby to be transferred from the natural uterus to the artificial uterus.

LUNG ALVEOLI NOT FULLY GROWN

“We want to prevent the fetus from breathing oxygen, because the alveoli are not yet mature and can be damaged. A 24-week-old baby belongs in an artificial amniotic fluid environment, and we’re trying to mimic that. The transition from the real uterus to the artificial one must occur in a way that the baby barely notices, both physically and mentally, that he or she is being taken to a different location,” explains Delbressine.

The principle works as follows: a so-called wound spreader holds open the wound created by the C-section, after which a biobag filled with artificial amniotic fluid is attached to the wound spreader via a connector. The baby can then be carefully transferred to the artificial uterus at the correct temperature via a glove in the biobag. 

Delbressine: “A filled biobag may sound crazy or disrespectful at first, but this is exactly how the fetus is ‘wrapped up’ in the womb as well, we are trying to imitate that as real as possible.”

The baby can be carefully transferred to the artificial uterus via the biobag at the correct temperature, through a glove.

CERTIFICATION

The system that Van Haren is currently developing consists of several components. Think, for example, of a mechanism that supports the doctor during transfer, as the combination of fetus and fluid can become quite heavy.

Of all these parts, the wound spreader is already in medical use and therefore clinically certified. The rest of the system is completely new and must go through a rigorous clinical approval process. Delbressine: “That’s logical, what we are doing is brand new. Pioneering. It will therefore be years before we can actually start using this system.”

The two are in close contact with the working field, such as specialists from the Máxima Medical Center in Eindhoven. Van Haren: “It’s a nice interaction, we get a lot of feedback from doctors. They have the medical knowledge, we know how to design systems.”

SENSES

There is a lot involved in developing the artificial uterus itself. Elements must be taken into account that you might not immediately think about at first. Delbressine: “At 24 weeks, the senses are still developing, and babies are sensitive to light, sound and vibrations. The impulses they receive in the natural womb we try to imitate in the artificial womb. The senses need to be stimulated, but in such a way that the brain can handle it. This is still work in progress”

There is still a lot of work to be done before the system can actually be used. We’re talking years. For Delbressine and Van Haren, no problem. Their driving force is in helping children. Van Haren: “Improving the lives of premature babies and increasing their chances of living a beautiful life, that’s what we ultimately do it for.”

COOPERATION

Perinatal Life Support is a larger partnership that conducts research into a ‘Perinatal Life Support’ system. Partners are TU/e, the universities of Aachen and Milan, and the companies LifeTec Group and Nemo Healthcare. In 2024 the European funding (from Horizon 2020) ends, then the prototype of the artificial uterus must be ready. After that, the preclinical and clinical tests and the certification process will start.

Source:https://www.tue.nl/en/news-and-events/news-overview/07-04-2022-without-gasping-for-air-safely-in-the-artificial-womb/?utm_source=miragenews&utm_medium=miragenews&utm_campaign=news

Nature: free, accessible, healing

Forest Bathing | Shinrin-Yoku | Healing in Nature | Short

Learn how to create healing experiences in nature for yourself and your loved ones. Visit the link for a course on Shinrin-yoku / Forest bathing. Learn calming nature meditations, forest bathing exercises, and mindfulness activities that reconnect us with nature and ourselves. Please share the forest calm and spread some healing.

City Dweller? You can do this!

SELF GUIDED FOREST BATHING/UNIVERSITY OF WASHINGTON BOTANICAL GARDENS

We’re Going On A NATURE HUNT

Nov 24, 2020    Stories For Kids

Come join in the adventure of a nature hunt. This book is written by Steve Metziger and illustrated by Niki Sakamoto. Thanks for listening!

Medical empirical research on forest bathing (Shinrin-yoku): a systematic review

Abstract

Aims

This study focused on the newest evidence of the relationship between forest environmental exposure and human health and assessed the health efficacy of forest bathing on the human body as well as the methodological quality of a single study, aiming to provide scientific guidance for interdisciplinary integration of forestry and medicine.

Method

Through PubMed, Embase, and Cochrane Library, 210 papers from January 1, 2015, to April 1, 2019, were retrieved, and the final 28 papers meeting the inclusion criteria were included in the study.

Result

The methodological quality of papers included in the study was assessed quantitatively with the Downs and Black checklist. The methodological quality of papers using randomized controlled trials is significantly higher than that of papers using non-randomized controlled trials (p < 0.05). Papers included in the study were analyzed qualitatively. The results demonstrated that forest bathing activities might have the following merits: remarkably improving cardiovascular function, hemodynamic indexes, neuroendocrine indexes, metabolic indexes, immunity and inflammatory indexes, antioxidant indexes, and electrophysiological indexes; significantly enhancing people’s emotional state, attitude, and feelings towards things, physical and psychological recovery, and adaptive behaviors; and obvious alleviation of anxiety and depression.

Conclusion

Forest bathing activities may significantly improve people’s physical and psychological health. In the future, medical empirical studies of forest bathing should reinforce basic studies and interdisciplinary exchange to enhance the methodological quality of papers while decreasing the risk of bias, thereby raising the grade of paper evidence.

Source:https://environhealthprevmed.biomedcentral.com/articles/10.1186/s12199-019-0822-8

Windsurfing Serbia Surduk 2020 50 kts

lunelun – Dec 8, 2020 un
Windsurfing in Serbia on Danube river. Wind 50 kts, sales 3.7-4,7 m2, boards 74-100l.


Provider Crisis, Nurse Needs, WHO

Costa Rica officially the Republic of Costa Rica is a country in Central America, bordered by Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, the Pacific Ocean to the southwest, and maritime border with Ecuador to the south of Cocos Island. It has a population of around five million in a land area of 51,060 km2 (19,710 sq mi). An estimated 333,980 people live in the capital and largest city, San José, with around two million people in the surrounding metropolitan area.

The sovereign state is a unitary presidential constitutional republic. It is known for its long-standing and stable democracy, and for its highly educated workforce. The country spends roughly 6.9% of its budget (2016) on education, compared to a global average of 4.4%. Its economy, once heavily dependent on agriculture, has diversified to include sectors such as finance, corporate services for foreign companies, pharmaceuticals, and ecotourism. Many foreign manufacturing and services companies operate in Costa Rica’s Free Trade Zones (FTZ) where they benefit from investment and tax incentives.

Costa Rica provides universal health care to its citizens and permanent residents. Both the private and public health care systems in Costa Rica are continually being upgraded. Statistics from the World Health Organization (WHO) frequently place Costa Rica in the top country rankings in the world for long life expectancy. WHO’s 2000 survey ranked Costa Rica as having the 36th best health care system, placing it one spot above the United States at the time. In addition, the UN (United Nations) has ranked Costa Rica’s public health system within the top 20 worldwide and the number 1 in Latin America.

Source: https://en.wikipedia.org/wiki/Costa_Rica

COMMUNITY

Our blog this month is focused on the Global Healthcare Workforce Shortage Crisis.

Kat and I would not be writing this blog were it not for the life-saving care she received by skilled healthcare providers at and after her birth. Each and every one of you who has experienced a preterm birth knows the value of care access. Our healthcare provider workforce deserves our attention and support.

The Global Healthcare Workforce Shortage Crisis pre-existed the Covid pandemic. The pandemic has severely impacted the shortage of healthcare providers and the further development of the healthcare workforce. The need for healthcare access has substantially increased due to provider shortages, delayed medical assessment and care, postponed access to “elective” surgeries, fear of seeking treatment due to Covid exposure risks, worsening of untreated conditions, and mental health barriers resulting from the stresses the pandemic has created in our lives. 

Preterm birth accounts for 11-12% of the global births at large and connected to our preemie  survivors is a much larger population of family members, healthcare providers, teachers, scientists, community members, employers and so on that also have a critical need for healthcare access. We are and will continue to be significantly impacted by our lack of access to healthcare provider care, and it is absolutely vital that all of us have access to healthcare services that are not limited to pharmaceutical options. We must protect, value, and build our healthcare workforce by making becoming a healthcare provider affordable, accessible, safe, humane, attractive, and available to all economic classes in order to build a healthy, vital, educated, effective and sustainable healthcare workforce that represents our populations at large.

Investing in our Healthcare Workforce is essential. Thank you for supporting our healthcare workforce in ways that are meaningful to you and impactful to our Preterm Birth Family.

Elsevier Health’s first “Clinician of the Future” global report reveals current pain points, predictions for the future and how the industry can come together to address gaps

New York, March 15, 2022

“There has never been a greater need for lifting the voices of healthcare professionals. The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past 10 years, with many saying their jobs have gotten worse. One in three clinicians are considering leaving their current role by 2024, with as many as half of this group in some countries leaving healthcare entirely. This comes on top of the existing global healthcare workforce shortage, where clinicians continue to experience severe levels of fatigue and burnout since COVID-19 was declared a pandemic”.

Full Article : https://www.elsevier.com/about/press-releases/corporate/doctors-and-nurses-worldwide-point-to-roadmap-to-future-proof-healthcare

The Play’s the Thing for Nurses Coping with Pandemic’s Sting

— How the age-old themes of a Greek tragedy can spark new conversations

by Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today March 23, 2022

Last Thursday, Amy Smith, MS, APRN, took part in a virtual reading of Sophocles’ ancient Greek tragedy “Antigone.” But the production wasn’t ordinary theater.

Smith and more than 3,000 attendees sat in on a Zoom webinar of “The Nurse Antigone” as part of a new effort to help frame and spark discussions about the challenges faced by nurses, especially during the pandemic.

“Antigone” is a famed Greek tragedy for a reason. Its young titular heroine risks her life to stand up for what she believes is right, and the play focuses on her quest to properly bury and mourn her deceased brother. Many themes from the play resonate with nurses, especially today.

Smith, who acted in the performance as part of the chorus, said that she feels many nurses who took park in the inaugural event “saw in Antigone the kind of anguish that a lot of people felt when we were in the middle of the pandemic, especially in the hospital setting.”

Nurses were “unable to get past one horrible tragedy when the next person would code, or the next person would come in,” Smith said. It’s “this concept of delayed healing.”

After her own experience with the production, Smith, director of the Sexual Assault Nurse Examiner (SANE) Program at the Hofstra Northwell School of Nursing and Physician Assistant Studies, told MedPage Today that she believes many other nurses will want to take part.

The production was one of 12 that have been scheduled over the coming year. Though “The Nurse Antigone” features headliners such as author Margaret Atwood, and actresses Tracie Thoms and Taylor Schilling, in addition to a chorus comprised of working nurses, the performance itself is hardly the main event.

That’s according to Bryan Doerries, artistic director for Theater of War Productions, which for the past 14 years, has produced community-focused theater projects designed to address public health and social justice issues.

“The performance is the table dressing for the conversation that follows it,” Doerries told MedPage Today.

Some of the themes present in “Antigone” that resonate with the nurse workforce today include deferred grief, moral injury, structural violence and misogyny, as well as women speaking out and living up to standards of care, he said.

“Talking about these things requires energy, and sometimes nurses who are overworked don’t have the energy … the play provides the energy,” Doerries said.

The actors commit emotionally to the material, so that the nurses can then follow them, he explained.

Though each event is expected to be different and yield varying discussions due to the unique makeup and interpretation of each audience, the general format will remain the same, Doerries said.

The chorus of the play is performed by nurses, who are joined by a community panel, also comprised of nurses, after the reading to respond to what they heard that spoke to them, he said. There are then a series of questions posed to the audience and a discussion of themes important to nursing. The performance itself runs about 45 minutes, and the discussions that follow consist of about 15 minutes for the community panel and about 1 hour for the audience discussion.

“We’re not asking people to agree,” Doerries said. And “it’s not therapy, to be clear.”

“The point is that, once people have walked through the door of this project, the hope is that they may be open to walking through the other door to healing,” he said.

Cynda Rushton, PhD, RN, lead nursing advisor on the project, concurred.

“The use of the Greek tragedy, particularly ‘Antigone,’ seemed like a really important way to engage nurses to explore their experiences during the pandemic — and before the pandemic — and to create a space where we could really honor their challenges and sacrifices,” Rushton said.

Rushton, professor of clinical ethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, said that, as a nurse herself, she “feels very committed to helping our profession heal.”

In addition to connecting nurses with each other, another goal of the production is to “invite the public to bear witness to the experiences of nurses,” Rushton said.

Theater of War Productions, the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and the Resilient Nurses Initiative – Maryland, have partnered to co-present “The Nurse Antigone.” The production is supported by the Laurie M. Tisch Illumination Fund, and the theater’s digital programming is provided, in part, by The Andrew W. Mellon Foundation.

All of “The Nurse Antigone” events are free and have unlimited capacity, Doerries said.

The next event is scheduled for April 21, and is being hosted by the Greater NYC Black Nurses Association.

“It’s not therapy, but it is therapeutic,” Smith said of “The Nurse Antigone.” “Certainly it was for me, and I hope other people felt that as well.”

Added benefits of the production include helping others to feel like they’re not alone in their experiences, and making difficult discussions easier to have, she noted.

“The reason that the themes keep recurring is because nobody talks about it,” Smith said.

Source:https://www.medpagetoday.com/special-reports/exclusives/97836

Preterm Birth and Low Birth Weight

Health at a Glance: Latin America and the Caribbean 2020 (Book)

Globally, preterm birth (i.e. birth before 37 completed weeks of gestation) is the leading cause of death in children under 5 years of age, responsible for approximately 1 million deaths in. In almost all countries with reliable data, preterm birth rates are increasing. Many survivors of preterm births also face a lifetime of disability, including learning disabilities and visual and hearing problems as well as long-term development (WHO, 2018).

In LAC, most countries are near the regional average of 9.5% of births being preterm. Colombia is the only country significantly above average with near 15% of preterm births, followed by Brazil with 11%. The lowest rates were observed in Cuba (6%) and Mexico (7%) Most LAC countries rates are lower than the global rate, but there are opportunities for further improvements through interventions such as a national focus on improved obstetric and neonatal care, and the systematic establishment of referral systems with higher capacity of neonatal care units and staff and equipment (Howson, Kinney and Lawn, 2012). On average, 10 new-borns out of 100 had low weight at birth across LAC countries. There are very significant differences between countries in the region, ranging from a low 5% in Cuba and 6% in Chile, to the highest rate of 23% in Haiti, followed by Guyana with 16%.

Low birth weight has decreased an average of 0.4 percentage points in LAC26 countries in the 2000-15 period, suggesting that, overall, the region still has room for improvement in regards to this indicator. Chile, Brazil, Venezuela and Costa Rica are the only LAC countries to have increased low birth weight new-borns, while the largest reduction happened in Surinam, Guatemala and Honduras with more than 1 percentage point of decrease between 2000 and 2015.

Antenatal care can help women prepare for delivery and understand warning signs during pregnancy and childbirth. Higher coverage of antenatal care is associated with higher birth weight in LAC countries, suggesting the significance of antenatal care over infant health status across countries . However, the correlation does not apply equally in all countries. For instance, Trinidad and Tobago and Barbados report to have 100% and 98% of at least four antenatal care visits, but their low birth weight prevalence is 12%, over the LAC average of 10%. This might be explained partly by a low quality of care in their antenatal care visits. On the other hand, countries like Grenada, Paraguay and Bolivia show an antenatal care coverage below the LAC24 average of 87%, but also a low birth weight prevalence of 7-9%. Some of the differences between countries can be attributed to cultural practices and preferences, such as different approaches to privacy or perceptions about what antenatal and postnatal care entail.

Preterm birth can be largely prevented. Effective interventions to reduce preterm births include smoking cessation, progesterone supplementation, cervical cerclage, preterm surveillance clinics and screening, diagnosis and preparation, corticosteroids, magnesium sulphate, and tocolysis (Osman, Manikam and Watters, 2018). Most of these exist in several LAC countries and could be further developed. In addition, three-quarters of deaths associated with preterm birth can be saved even without intensive care facilities. Current cost-effective interventions include kangaroo mother care (continuous skin-to-skin contact initiated within the first minute of birth), early initiation and exclusive breastfeeding (initiated within the first hour of birth) and basic care for infections and breathing difficulties (WHO, 2018), all of which can also be scaled up in LAC countries.

Source: https://www.oecd-ilibrary.org/sites/53620b68-en/index.html?itemId=/content/component/53620b68-en

COVID-19: Health workers face ‘dangerous neglect’, warn WHO, ILO

21 February 2022

Health teams worldwide need much safer working conditions to combat the “dangerous neglect” they have faced during the COVID-19 pandemic, the UN health and labour agencies said on Monday.

Approximately 115,500 health workers died from COVID-19 in the first 18 months of the pandemic, linked to a “systemic lack of safeguards”, they noted. 

In a joint call for action from the World Health Organization (WHO) and the International Labour Organization (ILO), the UN bodies insisted that the coronavirus crisis had contributed to “an additional heavy toll” on health workers. 

“Even before the COVID-19 pandemic, the health sector was among the most hazardous sectors to work in,” said WHO’s Maria Neira, Director, Department of Environment, Climate Change and Health. 

Physical injury and burnout 

“Only a few healthcare facilities had programmes in place for managing health and safety at work,” Dr. Neira continued. “Health workers suffered from infections, musculoskeletal disorders and injuries, workplace violence and harassment, burnout, and allergies from the poor working environment.”  

To address this, WHO and ILO have released new country guidelines for health centres at national and local levels. 

“Such programmes should cover all occupational hazards – infectious, ergonomic, physical, chemical, and psycho-social,” the agencies noted, adding that States that have either developed or are actively implementing occupational health and safety programmes in health settings had seen reductions in work-related injuries and absences due to sickness and improvements in the work environment, productivity and retention of health workers. 

Workers’ rights 

“Like all other workers, should enjoy their right to decent work, safe and healthy working environments and social protection for health care, sickness absence and occupational diseases and injuries,” insisted ILO’s Alette van Leur, Director, ILO Sectoral Policies Department. 

The development comes as the agencies indicated that more than one-in-three health facilities lack hygiene stations at the point of care, while fewer than one-in-six countries had a national policy in place for healthy and safe working environments within the health sector. 

“Sickness absence and exhaustion exacerbated pre-existing shortages of health workers and undermined the capacities of health systems to respond to the increased demand for care and prevention during the crisis,” said James Campbell, Director, WHO Health Workforce Department.  

“This guide provides recommendations on how to learn from this experience and better protect our health workers.” 

Source: https://news.un.org/en/story/2022/02/1112352

Debi Nova, Pedro Capó – Quédate (Official Video)

9,183,561 views

Premiered Nov 21, 2019                    Debi Nova

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When the Brain Sees a Familiar Face

Los Angeles, Mar 18, 2022

Cedars-Sinai Investigators Show How the Action of the Eye Triggers Brain Waves to Help Remember Socially Important Information.

In a study led by Cedars-Sinai, researchers have uncovered new information about how the area of the brain responsible for memory is triggered when the eyes come to rest on a face versus another object or image. Their findings, published in the peer-reviewed journal Science Advances, add to scientific understanding of how memory works, and to evidence supporting a future treatment target for memory disorders.

While vision feels continuous, people move their eyes from one distinct spot to another three to four times per second. In this study, investigators found that when the eyes land on a face, certain cells in the amygdala, a part of the brain that processes social information, react and trigger memory-making activity.

“You could easily argue that faces are one of the most important objects we look at,” said Ueli Rutishauser,  PhD, director of the Center for Neural Science and Medicine at Cedars-Sinai and senior author of the study. “We make a lot of highly significant decisions based on looking at faces, including whether we trust somebody, whether the other person is happy or angry, or whether we have seen this person before.”

To conduct their experiments, the investigators worked with 13 epilepsy patients who had electrodes implanted in their brains to help determine the focus of their seizures. The electrodes also allowed investigators to record the activity of individual neurons within the patients’ brains. While doing so, the researchers tracked the position of the subjects’ eyes using a camera to determine where on the screen they were looking.

The researchers also recorded the study participants’ theta wave activity. Theta waves, a distinct type of electrical brain wave, are created in the hippocampus and are key in processing information and forming memories.

Investigators first showed study participants groups of images that included human and primate faces and other objects, such as flowers, cars and geometric shapes. They next showed participants a series of images of human faces, some of which they had seen during the first activity and asked whether or not they remembered them.

The investigators found that each time participants’ eyes were about to land on a human face—but not on any other type of image—certain cells in the amygdala fired. And every time these “face cells” fired, the pattern of theta waves in the hippocampus reset or restarted.

“We think that this is a reflection of the amygdala preparing the hippocampus to receive new socially relevant information that will be important to remember,” said Rutishauser, the Board of Governors Chair in Neurosciences and a professor of Neurosurgery and Biomedical Sciences.

“Studies in primates have shown that theta waves restart or reset every time they make an eye movement,” said Juri Minxha, PhD, a postdoctoral scholar in neurosurgery at Cedars-Sinai and co-first author of the study. “In this study, we show that this also happens in humans, and that it is particularly strong when we look at faces of other humans.”

Importantly, the researchers showed that the more quickly a subject’s face cells fired when their eyes fixed on a face, the more likely the subject was to remember that face. When a subject’s face cells fired more slowly, the face they had fixed on was likely to be forgotten.

Subjects’ face cells also fired more slowly when they were shown faces they had seen before, suggesting those faces were already stored in memory and the hippocampus didn’t need to be prompted.

Rutishauser said these results suggest that people who struggle to remember faces could have a dysfunction in their amygdala, noting that this type of dysfunction has been implicated in disorders related to social cognition, such as autism.

“If theta waves in the brain are deficient, this process triggered by the amygdala in response to faces might not take place,” Rutishauser said. “So restoring theta waves could prove to be an effective treatment target.”

The study was funded by National Institute of Mental Health Grands number R01MH110831 and P50MH100023, National Science Foundation Grant number 1554105, National Institute of Neurological Disorders and Stroke Grant number U01NS117839, a Center for Neural Science and Medicine Fellowship and European Research Council Grant number 802681.

Source:https://www.cedars-sinai.org/newsroom/when-the-brain-sees-a-familiar-face/

PREEMIE FAMILY PARTNERS

On parenting preemies: Gratitude, fear and a lingering sense that nothing is in your control

By Anna Nordberg  March 9, 2020

My son was born at 8:15 a.m. on Halloween, a long, skinny four pounds and crying in great angry gulps. With a kindness I’ve never forgotten, the anesthesiologist leaned down and said to me, “A lot of full-term babies don’t even sound that loud.”

The doctors laid my baby on my chest in his footprint-patterned swaddle, and for a moment he stopped crying. Then he was whisked away to the neonatal intensive care unit and I didn’t see him for 30 hours.

That’s how my life as a parent started.

In the United States, 10 percent of babies, or more than 380,000 a year, are born premature, before 37 weeks of gestation. The majority will need time in the NICU, meaning parents are shut out from many of the rituals surrounding a birth. You don’t leave the hospital with your child. Grandparents and friends can’t hold your newborn.

Now that my son is 7 and my daughter is 5 (she was born 19 months later, also premature), I think about how much support our family received in those early weeks, but how little guidance there was about how the experience could impact us over time. I wonder if who I am as a mother was influenced by that early start.

I interviewed parents of preemies, and while each experience was different, there were many consistent themes. Here are some of their stories.

The delay of grief

More than a year after my son was born, one of my closest friends had a placenta abruption and delivered her son at 34 weeks. She called me while I was in the car, and I tried to be as calm and loving as possible. Afterward, though, I pulled over in a parking lot and starting sobbing. My hands were shaking.

I cried with a force I’d never felt when my own pregnancy was going off the rails and all my focus had been on my baby. Until that morning, I hadn’t realized that my son’s premature birth, which I’d filed away as a bumpy start to an otherwise normal parenting journey, had imprinted in my brain like a trauma.

Other mothers said it was not until they had a full-term child that they fully processed their grief. “I didn’t really have a sense of loss or understand what I had missed until I had my son,” says Ame McClune, whose twin girls were born at 24 weeks and required feeding tubes and full-time nursing care for several years. “With my twins, I took it in stride because it was all I knew. Now, here was a baby I could hold and breast-feed and cuddle. I loved it. I had no idea.”

Teira Gunlock, whose daughter Lake was born at 29 weeks when Gunlock developed severe preeclampsia, was diagnosed nine months later with PTSD. “While everything worked out, it was a traumatic experience,” says Gunlock, who for six days had not been able to see her baby. “It makes me emphasize my daughter’s emotional health and growth in my own parenting more than I likely would have.”

Taking setbacks in stride, supercharged gratitude

At some point in everyone’s parenting journey, things don’t go according to plan. But preemie parents get that message early.

“Nothing is a crushing blow,” McClune says. Instead, when there are challenges, she just thinks, “Okay, how do we deal with this?”

In my experience, it was freeing to step off the hamster wheel of worry over milestones, because my children weren’t going to hit any of them. Instead, the NICU distilled things: Are we healthy? Are we happy(ish)? Are we okay? Given the anxiety many parents have over their children’s accomplishments, that perspective can feel like a gift.

Preemie parents also occupy a strange space between intense thankfulness and the early recognition that things can go wrong. In the NICU, most parents understand that there are babies in more precarious positions that their own and are sensitive to that.

The experience also yields daily opportunities for gratitude — to the nurses and doctors caring for your child; to the progress your baby is making; to the much-anticipated car-seat day when you get to take your baby home.

“I think about how lucky we are that both my daughter and my wife survived, and that hits me hard sometimes,” says Michael Zimmer, Gunlock’s husband. “We benefited from scientific advances that stemmed from a lot of tragedy in the past. That provides perspective — our daughter, and my wife, frankly — have a chance at life they might not have had 50 or even 25 years ago.”

Danger ahead

If having a preemie makes you more resilient as a parent, it can also put you in a defensive crouch, waiting for the other shoe to drop.

When we brought my son home from the NICU after two weeks, my husband and I felt the normal terror of first-time parents with our own, special terror thrown in. He had been hooked up to monitors and cared for by professionals since he was born. Once he was home, though, he had to rely only on our loving, possibly incompetent care. That first night, my husband slept on the floor next to the bassinet while I feverishly pumped milk.

Gunlock and Zimmer spent the first year on high alert after their daughter had a choking episode in the NICU, and then again a few days after she came home.

Several parents told me that the strengths of the NICU — the care your baby receives; the nurses you learn from — can also feel like a weakness when you leave, because you think you will never measure up. That fades over time, outweighed by the support and confidence you built during those early weeks, but a tiny part of you always remains on alert.

Naming the sadness

All these years after my children were born, I still feel sad my body didn’t get them over the finish line. Not guilty, not angry, just sad. Is this normal? Is this weird? I don’t know.

I regret that I never got those final weeks of nesting, that I missed my baby shower, that I never felt a contraction. To many people, I’m sure that skipping labor twice makes me lucky. But it feels strange.

Stacey D. Stewart, chief executive of the March of Dimes, a nonprofit that works to improve maternal and infant health outcomes and supports more than 50,000 families a year who are in the NICU, says there needs to be more attention given to the impact the experience has on parents’ mental health.

“You’re pregnant and then one day you’re not, sooner than it was supposed to happen,” she says. “There’s a lot of anxiety and grief and helplessness and fear. It takes an immense emotional toll.”

It can also be very isolating. “I found it incredibly lonely,” says Kate Bosanquet, who had her daughter at 31 weeks. “I missed out on most of my prenatal classes, and while my group was very sweet and continued to meet, we weren’t having the same shared experiences you hope for.”

It doesn’t help that the entire baby industrial complex caters to parents of full-term babies. There’s the books and websites telling you your baby should be doing things months before she will. The carrier that requires your child to be a monstrous eight pounds. The email updates that continue to cheerfully inform you about the progress of your pregnancy when your baby is already out in the world. It can all hurt. One mother told me she wished there was a switch to turn off all the marketing and email that assumed she’d delivered full-term. (March of Dimes has a My NICU Baby app for parents of premature and full-term babies that started out in the NICU.)

And yet many of us hope and believe that these birth stories will become a source of strength for our children.

When my son was in kindergarten and it was his turn to be “Friend of the Week,” he shared that he weighed four pounds at birth, telling his class he “surprised us” seven weeks early. To him, it was an interesting fact and also, I think, a small source of pride.

It should be. Preemie babies, and their parents, have to come so far. I hope that every mom and dad who started out that way — confused, scared, fierce, loving — feels pride in their parenting. They’ve earned it.

Source: https://www.washingtonpost.com/lifestyle/2020/03/09/parenting-preemies-gratitude-fear-lingering-sense-that-nothing-is-your-control/

Determinants of mothers knowledge about breastfeeding in neonatology intensive care

A SyllaA SanaS NaniS HassouneM LehlimiA BadrS HajjajiM ChemsiA HabziS Benomar

European Journal of Public Health, Volume 31, Issue Supplement_3, October 2021, ckab165.285, https://doi.org/10.1093/eurpub/ckab165.285

20 October 2021

Abstract

Background

Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. In Morocco the BF rate decreased from 51% to 27,8% between 1992 and 2011. The breast feeding rate in neonatal intensive care unit (NICU) is lower 12,4%. Studies showed if we improve the mothers knowledge, the BF practice rate increase in NICU. We aim to determine associated factors of mothers knowledge about BF in NICU of Ibn Rochd teaching hospital in Casablanca (Morocco).

Methods

A cross-sectional study was conducted between 04 January and 23 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan mothers who can practice the BF presents during the study period. We used face to face interview using questionnaire. A scoring system from 0 to 16 points was used to measure the knowledge. The student, ANOVA, Mann-Whitney-Wilcoxon, Kruskal Wallis, Pearson and spearman correlation tests were used to test association between BF and potential associated factors. Associated factors with p ≤ 0.05 were considered as determinants of BF. Data were analyzed using R 3.6.3.

Results

We included 111 mothers. The mean score of knowledge was 10.38 ± 2.31. Associated factors with BF knowledge were: healthcare staffs support (yes mean score =11.06 and no = 9.72; p = 0.002); getting prior information about BF (yes mean score =10.53 and no = 9; p = 0.012). The knowledge increase with age of mother (correlation coefficient = 0.26; p = 0.005) and parity (correlation coefficient = 0.30; P = 0.001).

Conclusions

Mothers and specifically younger primiparous should receive more attention from training program and healthcare staffs in NICU to improve the knowledge and practice of BF.

Key messages

  • we can enhance significantly the survival and health of newborn hospitalized in NICU by simple actions as advices, encouragement toward the newborn mothers to improve their knowledge about BF.
  • Healthcare staffs and facilities have to be the teachers and school about breast feeding.

Source:https://academic.oup.com/eurpub/article/31/Supplement_3/ckab165.285/6404982

Your Premature Baby’s Sense of Vision

Babies born preterm (before 37 weeks) are still developing their sense of vision.  Babies born before the age of 32 weeks are unable to limit the amount of light entering their eyes even when their eyes are closed.  It is therefore important to protect premature babies from bright lights.

Effects of Vision on your Baby

  • Babies born at term have a preference for looking at faces.  Older premature babies too can fixate on your face briefly if you are holding them closely (approximately 25-30cm or 10-12 inches from your face), as they are very near sighted at this stage.
  • Your baby is likely to have an incubator cover over their incubator whilst in intensive care.  This reduces their exposure to bright light and aims to recreate the conditions of the womb.  As your baby matures these incubator covers are pulled back.
  • It is important that you enjoy your baby.  Talk to them, smile, be expressive; your baby learns from watching your facial expressions.

Source: https://www.nhsggc.org.uk/kids/resources/health-a-z-resources/premature-baby-sense-of-vision/

March of Dimes/Signs of Preterm Labor

HEALTH CARE PARTNERS

Risks of Delays in Emergency Neonatal Blood Transfusions Highlighted in New Safety Report

Priscilla Lynch    March 04, 2022

New recommendations on emergency neonatal blood transfusions have been issued by the Healthcare Safety Investigation Branch (HSIB) following a number of serious adverse outcomes including brain injury and death following delays in such transfusions.

Concerns around emergency neonatal blood transfusions were highlighted in 22 of the HSIB’s maternity investigation programme reports between 2018 and 2021.

This latest HSIB national investigation explored issues influencing timely administration of blood transfusion to newborn babies following acute blood loss during labour and/or delivery. Delays in the administration of a blood transfusion in this scenario can result in brain injury caused by lack of oxygen to the baby’s brain.

Whilst it is rare, and there is a gap in data on incidences of neonatal blood transfusion delays, the impact can be significant. As a reference event, the HSIB investigation examined the experience of a couple, Alex and Robert, whose baby, Aria, was born by emergency caesarean section following an acute blood loss, and sadly died.

Specifically, the investigation examined communication between the different medical teams involved in the care of women/pregnant people and their babies during labour and birth; and national guidance for medical staff on when to consider the option of a blood transfusion for a newborn baby.

Findings

The HSIB’s investigation found that administration of a blood transfusion as part of resuscitation requires a number of preparatory steps, including collecting the blood and undertaking various checks before using it, which can cause delays in emergency situations. Inclusion in resuscitation training of a prompt for clinicians to consider the need for a transfusion, and to prepare for it if appropriate, may help reduce any delay, the HSIB said.

The investigation also found that involving members of neonatal teams in multidisciplinary training in maternity units is not routine. Standardising their inclusion in such training would promote a shared understanding of relevant clinical information and ways of working, the HSIB advised.

The HSIB’s final report made two key safety recommendations which focus on training between multidisciplinary maternity and neonatal teams, and through the Newborn Life Support training course.

  1. HSIB recommends that NHS Resolution, working with relevant specialities through the clinical advisory group, amends the maternity incentive scheme guidance for year five to include the neonatal team as one of the professions required to attend multi-professional training.
  • HSIB recommends that the Resuscitation Council (UK)’s Newborn Life Support training course highlights that neonatal resuscitation teams should consider fetal blood loss in the event of neonatal resuscitation that includes chest compressions. In addition, this consideration should be included in the guidance to support the newborn life support algorithm.

Investigator’s View

Commenting on the report’s findings, Melanie Ottewill, National Investigator at HSIB, said: “The need for blood transfusions during resuscitation is rare, but the impact of a delay can be devastating as we heard from Alex and Robert, Aria’s parents.

“Our report forms an important piece of literature in an area with limited research and can support any future work that explores safety issues relating to neonatal blood transfusions.

“The aim is that our safety recommendations can raise awareness of the issue and prompt clinicians to consider the option of a blood transfusion in the early stages of resuscitation.”

Previous Concerns

previous report by the HSIB identified a key safety risk in maternity care relating to delays to intrapartum intervention once foetal compromise is suspected.

The report was compiled by the HSIB after a review of 289 of its maternity investigations into intrapartum stillbirths, neonatal deaths and potential severe brain injuries, which found that in 14.9% of the cases the delay was a contributory factor.

Source: Risks of Delays in Emergency Neonatal Blood Transfusions Highlighted in New Safety Report (medscape.com)

Acknowledging Stigma and Embracing Empathy When Treating Neonatal Opioid Withdrawal Syndrome – Episode 106

03/15/2022

In this episode Kenneth Zoucha, MD, FAAP, a recognized leader in addiction medicine for the state of Nebraska, talks about the stigmas around substance use disorder and Neonatal Opioid Withdrawal Syndrome. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Tamela Milan-Alexander, MPPA, about her history with opioid use disorder, which led to a high-risk pregnancy, and her subsequent advocacy for mothers and their babies.

PEDIATRICS ON CALL Acknowledging Stigma and Embracing Empathy When Treating Neonatal Opioid Withdrawal Syndrome – Ep. 106

Source:https://www.aap.org/en/pages/podcast/acknowledging-stigma-and-embracing-empathy-when-treating-neonatal-opioid-withdrawal-syndrome/

Residency Is Broken. We’re Unionizing to Fix It.

More fair working conditions and pay are long overdue

by Dipavo Banerjee, DO, MS, and Pratiksha Yalakkishettar, MD – March 19, 2022

On its website, UMass Memorial Health states that the hospital system was created to “make health and healthcare available to everyone.” This mission is made possible by the “people of UMass Memorial Health” and their “relentless pursuit of healing in all its forms.”

As frontline resident physicians who work day in and day out to care for patients at UMass Memorial, this mission is also at the core of our values. That’s why we are bargaining for our first union contract: In order to ultimately improve residency for ourselves, those that come after us, and the people of central Massachusetts who need quality healthcare most. But unfortunately, since the bargaining process began this fall, the hospital system’s leaders have not been as responsive to our proposals as we would have hoped.

A Wave of Resident Physician Organizing

While the COVID-19 crisis dramatically exacerbated issues UMass residents face, our struggle to make ends meet and stay well during residency is nothing new. Before the pandemic, we came together and started the process of unionizing with the Committee of Interns and Residents (CIR/SEIU) to gain a voice at the table where we could better advocate for ourselves and our patients. When the pandemic struck, securing better conditions became even more urgent, as the inequities in our healthcare system were laid bare — and in light of the rapid changes that left residents scrambling to keep up within traumatizing and sometimes dangerous practice conditions.

UMass residents are not alone. In just the past few weeks, hundreds of frontline physicians at Stanford University Medical Center, the University of Vermont Medical Center, and the University of Southern California-Keck recently demanded union recognition with a supermajority of support — a landmark residents and fellows celebrated at UMass not too long ago. In labor organizing, this means over 65% of the bargaining unit voted to unionize, but so far, all of these employers have refused to voluntarily recognize their union. This refusal then forces workers to move to an arduous National Labor Relations Board (NLRB) election process, which can draw out for months and creates an array of complications. (Residents at nearby Greater Lawrence Family Health Center recently won their union through an NLRB election).

Importantly, establishing a union is only the first step. Next, the workers who are organizing must prepare to negotiate with management to approve a collective bargaining agreement, which is a contract between the workers and the organization or company that sets pay, benefits, and other conditions over a period of time. Although we have been organizing for years at UMass, our union protections won’t truly be secure until we sign our first contract.

At the Top of Our List of Demands

Among the most important demands in our contract negotiations with management is the pay we need to live and work in an area with an increasing cost of living. Currently, UMass resident physicians are barely making the state minimum wage when our hours are considered. But so far, UMass has denied residents the basic ask of a fair wage. Instead, they’ve made only a meager wage proposal that fails to keep pace with the cost of living in Worcester — where the main UMass Memorial campus is located — while continually refusing to acknowledge several of our proposals. However, this disregard is perhaps unsurprising given how undervalued resident physicians’ labor is nationwide, a fact reflected in everything from our pay and working conditions to the gaps in our labor protections and benefits.

During residency, many of us are working to establish ourselves in a new location, while in some cases starting families or bringing families with us. We must stretch our dollars to cover the cost of essentials, from rent to childcare to gas to groceries. According to RentData.org, the fair market rent for a two-bedroom apartment in Worcester was $1,450 per month in 2021, which is more expensive than 96% of areas the site calculates. At the same time, the average student loan debt for graduating physicians is almost a quarter of a million dollars.

It is disheartening, to say the least, that the hospital system has so far refused to give us what we need after all we’ve sacrificed during this global catastrophe. We have worked sometimes to the point of physical and emotional exhaustion while witnessing far too many patient deaths during multiple COVID-19 surges.

Working Conditions Impact Patient Care and Health Equity

This pandemic has made it clearer than ever that resident physician well-being and patient care are inseparable. UMass Memorial residents are willing to work 80 hours per week because we know exceptional care is critical to community well-being, but we are significantly underpaid for doing so. A meaningful pay increase and adequate health and leave benefits would mean that we would be able to better focus on caring for our patients without burning out or completely neglecting our families and our own well-being.

Fair pay and benefits for residents is also a matter of health equity. Currently, residency at UMass is unaffordable, which limits who can come work and train here. UMass Memorial cannot claim to care about the most vulnerable communities in Massachusetts while helping to entrench inequities during residency. Through our union, we hope to foster a more diverse body of residents within the historically oppressive systems of healthcare — starting with UMass.

Hospitals Must Respect Resident Physicians’ and Fellows’ Labor Power

The surge in resident physician and fellow organizing around the country shows it is long past time for hospitals like UMass Memorial Health to respect the labor power of residents — first by recognizing our unions and then by agreeing to contracts that reflect the importance of our work and patient well-being. Graduate medical education should not be a burden on would-be physicians. At UMass Memorial, we hope to ultimately make residency more sustainable financially and otherwise, so we can continue to provide the highest quality care to our communities without burning out.

We won’t stop fighting until UMass agrees to invest in its future physician workforce and to treat us with the respect and dignity we deserve. Our families can’t wait — and neither can the communities in Massachusetts who need quality healthcare the most.

Source: Residency Is Broken. We’re Unionizing to Fix It. | MedPage Today Residency Is Broken. We’re Unionizing to Fix It. | MedPage Today

Difficult Times Without Easy Solutions: Nurses Want to Be Heard!

Annette M. Bourgault, PhD, RN, CNL, FAAN Editorial February, 2022

Crit Care Nurse (2022) 42 (1): 7–9. https://doi.org/10.4037/ccn2022577

Many articles have been written during the COVID-19 pandemic about the serious workplace and personal issues experienced by nurses. Although I have mentioned some of these struggles in previous Critical Care Nurse (CCN) editorials, I have not dedicated a full column to the deplorable situation in which so many nurses find themselves. I mistakenly assumed readers were overloaded with pandemic-related information and aware that many organizations are advocating on behalf of nurses to improve the environment and overall working conditions. I now realize that many nurses at the bedside are justifiably concerned that your voices are not being heard.

A national US survey of critical care nurses reported physical and emotional symptoms of exhaustion, anxiety, sleeplessness, and moral distress.1  Working conditions have become increasingly demanding during the pandemic, patient acuity is high, the nursing shortage continues, nurse-to-patient ratios regularly exceed recognized standards, nurses are working extreme amounts of overtime, and many nurses have seen too much death, feel disrespected and undervalued, and are frustrated that they cannot provide the level of excellent care required for positive patient outcomes. In other words, many of you are working in unhealthy and unsafe work environments.

Nurses’ Reality

Nurses are angry. I hear you and I hear your pain. As a nurse, I share your deep concerns about the future of nursing. As Editor of CCN, I recognize the importance and privilege of having a national platform to call for positive change for all critical care nurses.

I should explain one of the realities of publishing, however. Early in the pandemic, I often sat down to write these editorials thinking the worst of the pandemic might be over by the time my words were printed. It is clear now that we will not be out of this mess by the time this editorial goes to press. A recent quote I encountered resonated with me: “Any effort to predict a future course beyond 30 days relies on pixie dust for its basis.” To meet deadlines for print, I am typically writing editorials 3 to 4 months before the final version will be seen by readers, leaving me to guess what lies ahead. Sometimes I miss the mark.

Thus far, COVID-19 waves have fluctuated throughout the country with respect to timing and impact. During various waves of the pandemic, we hoped for a final resolution. While our government instructed the vaccinated public to resume elements of usual life, the work environment for nurses and other health care providers continued to worsen. Nurses in one state might be breathing easier and hoping the pandemic was ending while nurses in another city or state might be experiencing a huge influx of acutely ill patients and worsening work conditions. Each wave came and went leaving more destruction in its path. Some of our international readers experienced virus-related surges before their arrival in the United States. Due to geography and other variables, some of the situations I discuss may not apply to all readers in all places at all times, and sometimes I may overgeneralize about your experience.

Our System Needs an Overhaul

One thing is clear: many critical care nurses have been working in unfathomable work environments that appear to be worsening. A major overhaul of acute and critical care nursing is needed. Nurses have told us loud and clear that they do not want to be heroes—you want a healthy, sustainable work environment. You are willing to work hard, but you also need time to care for yourselves. You deserve the simple things that other professions take for granted, such as having time to eat a meal or empty your bladder during a shift. You deserve to be fairly compensated for the difficult work you perform. You deserve to work in a healthy work environment that supports you and allows you to provide expert nursing care to the best of your ability.

In the spirit of the American Association of Critical-Care Nurses (AACN) Healthy Work Environment standards, health care organizations must strive for skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.  As the health care system is revamped, it is critical to ensure that adequate support and leadership are provided not only for bedside nurses,  but the entire team, including nurse managers.  Strong consideration should be given to other supportive roles such as clinical nurse specialists, whose engagement in patient care has been associated with improved patient outcomes and decreased cost.

No Easy Answers

This editorial does not contain answers to fix our broken health care system; there are no easy answers. Major changes will take time, not only to create a system that works for all, but to create changes that are sustainable. Across the globe, nursing associations, hospitals, schools of nursing, and others are working to make substantive changes to acute and critical care nursing practice. They also are exploring how we train new nurses and looking to models that have worked in other health care disciplines. Frontline nurses have been involved in many of these initiatives. Your input is important to help create a system that works for you.

Many nurses I talk to believe we already had a nursing crisis before the pandemic. Now we have a crisis on steroids. Our nursing shortage was exacerbated by the pandemic, and the current situation is unsustainable. If changes are not made quickly, we risk losing more nurses, including experienced, expert nurses. Intensive care unit nurse and advocate Sandy Summers expressed this well: “Without nurses, an ICU bed is just a bed.”  Obviously we cannot continue to work within this broken system; radical and meaningful change is needed. Many are trying to develop innovative ways to provide safe nursing care to acute and critically ill patients and their families.

A number of solutions have been implemented and others are under development. Some institutions have reduced documentation requirements to free up nursing time for direct patient care, which is a great example of de-implementation to remove or revise current practices to free up valuable nursing time.  There may be other opportunities to de-implement tradition-based practices that are not evidence based. Also, other practices or tasks that do not require critical thinking or high levels of nursing skill might be delegated to trained assistants.

Team nursing models are being used to manage increasing workloads with fewer registered nurses.9  In some cases, one nurse leads a team of nurses and/or health care providers from other disciplines to care for critically ill patients. I have heard stories of patient care being provided by student nurses, medical residents, and other allied health professionals. Although such solutions are intended to support nurses, they risk increasing nurse workload and stress depending on how thoughtfully they are implemented.

Although travel nurses and military nurses are being used to fill some of our patient care needs, this situation is not sustainable either. Some of you have reported working with travel nurses who have no experience caring for critically ill patients. This type of situation places additional burdens on the entire team, including local intensive care unit nurses and the nurse manager, not only to help the travel nurse become familiar with the local work environment and policies, but to become familiar with safe, evidence-based critical care nursing. The additional discrepancy in financial compensation between travel nurses and local nurses has become another great source of frustration.

Giving Nurses a Voice

Internationally, organizations such as Johnson & Johnson have been working with nurses and others to create a more sustainable workforce. Here at home, AACN has worked tirelessly throughout the pandemic to advocate for nurses, beginning with a board member’s visit to the White House in March 2020 to brief officials and the Coronavirus Task Force, demand safe work environments, and advocate for adequate personal protective equipment for frontline health care workers.

AACN also has launched campaigns, educational efforts, and well-being resources during the pandemic to provide various opportunities to improve working conditions and to give nurses a voice. Here are examples:

  • An online portal for nurses to share stories in writing or through use of video
  • The Hear Us Out Campaign to encourage vaccination in an unthreatening way
  • Healthy Work Environment resources including implementation of a fifth national survey to capture nurses’ feedback during the crisis and recommend strategies for action 
  • A national staffing initiative co-led with the American Nurses Association to identify lasting solutions to chronic challenges to provide for safe and appropriate nurse staffing in the future
  • Partnerships on the American Nurses Foundation’s Nurse Well-Being Initiative  and the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience
  • Relationships with organizations such as the Office of the Surgeon General to ensure that your voices are heard at high-profile tables of influence
  •  

Nurses collectively have a powerful voice and want to be heard. You want employers, administrators, policy makers, government, nursing associations (including AACN), schools of nursing, the public, and other stakeholders to recognize that your current work situation is unhealthy and unsustainable. We cannot afford to lose more nurses, but we also cannot continue to expect nurses to work within this broken health care system without meaningful change.

In closing, I strongly echo the sentiments expressed by Sandy Summers and others: “We must treat nurses as a vital resource.” Nurses want to be heard. They want ACTION and they need it NOW!

Source: https://aacnjournals.org/ccnonline/article/42/1/7/31660/Difficult-Times-Without-Easy-Solutions-Nurses-Want

INNOVATIONS

Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway

T Tingleff,Å Vikanes,S Räisänen,L Sandvik,G Murzakanova,K Laine

First published: 14 November 2021 https://doi.org/10.1111/1471-0528.17013

Abstract

Objective

To assess the association between preterm first birth and preterm second birth according to gestational age and to determine the role of placental disorder in recurrent preterm birth.

Design

Population-based registry study.

Setting

Medical Birth Registry of Norway and Statistics Norway.

Population

Women (n = 213 335) who gave birth to their first and second singleton child during 1999–2014 (total n = 426 670 births).

Methods

Multivariate logistic regression analyses, adjusted for placental disorders, maternal, obstetric and socio-economic factors.

Main outcome measures

Extremely preterm (<28+0 weeks), very preterm (28+0–33+6 weeks) and late preterm (34+0–36+6 weeks) second birth.

Results

Preterm birth (<37 weeks) rates were 5.6% for first births and 3.7% for second births. Extremely preterm second births (0.2%) occurred most frequently among women with an extremely preterm first birth (aOR 12.90, 95% CI 7.47–22.29). Very preterm second births (0.7%) occurred most frequently after an extremely preterm birth (aOR 12.98, 95% CI 9.59–17.58). Late preterm second births (2.8%) occurred most frequently after a previous very preterm birth (aOR 6.86, 95% CI 6.11–7.70). Placental disorders contributed 30–40% of recurrent extremely and very preterm births and 10–20% of recurrent late preterm birth.

Conclusion

A previous preterm first birth was a major risk factor for a preterm second birth. The contribution of placental disorders was more pronounced for recurrent extremely and very preterm birth than for recurrent late preterm birth. Among women with any category of preterm first birth, more than one in six also had a preterm second birth (17.4%).

Source:https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17013

Increased Severe Neonatal Hyperbilirubinemia During Social Distancing

By Sara K. Berkelhamer, Department of Pediatrics, University of Washington, Seattle
Feb 21, 2022

As a neonatologist, I was concerned about an apparent increase in the number of neonates being readmitted to the hospital with severe hyperbilirubinemia during the COVID-19 pandemic and social distancing mandate. I envisioned that the postpartum social support provided by visiting family and friends was being disrupted, impacting successful breastfeeding and the recognition of jaundice in infants. I was also worried about inadequate access to professional support coupled with apprehension to seeking medical care. As severely elevated bilirubin levels can impact an infant’s neurodevelopment, early identification and intervention (including feeding supplementation, lactation support, and phototherapy) is key to avoiding both long-term sequelae and hospitalization. Therefore, there was a need to explore if an increase in severe hyperbilirubinemia cases was truly occurring, if these cases represented more severe disease, and if risk factors could be identified to guide targeted counseling and closer follow up.

For a paper published in the Journal of Paediatrics and Child Health, my colleagues and I aimed to determine rates of severe hyperbilirubinemia admission during social distancing in comparison to historical norms. A retrospective chart review identified all readmissions for hyperbilirubinemia between January 2018 and April 2020 in Western New York. Our study team collected both maternal and infant data as well as details on the infant’s admission to the hospital and clinical course. Infants were categorized according to the period of hospital admission, which was characterized as pre-pandemic or control. In addition, 19 outpatient clinics were surveyed regarding lactation support.

Rates of Readmission Nearly Tripled

While rates of readmission for hyperbilirubinemia nearly tripled during early social distancing mandates, we found that there was no change in the severity of disease as determined by signs of dehydration, rates of suspected sepsis, peak bilirubin levels, duration of phototherapy, rates of bilirubin above exchangeable levels, use of IV immunoglobulin or exchange transfusion, and length of hospital stay.

Mothers who had infants readmitted during social distancing were observed to be younger than mothers of infants readmitted before the pandemic (25.8±3.3 vs 31.3±4.7 for COVID-19 and controls, respectively), with rates of primiparity and exclusive breastfeeding higher than national norms, but not significantly higher than controls in the cohort (62.5% vs 37.0% for primiparity; 87.5 % vs 81.5 for breastfeeding). A survey of outpatient clinics in the region identified limited options for access to lactation support via telemedicine; of the 19 clinics surveyed, only six offered a telemedicine option for lactation support.

Greater Access to Virtual Lactation Support Needed

To our knowledge, this is first study to examine increased rates of readmission for hyperbilirubinemia during the stay-at-home mandate. Our data supported our hypothesis that social distancing impacted access to healthcare, critical social support, and utilization of services for at-risk cohorts, which included young, primiparous women who breastfeed.

Based on our observations, there is a critical need for proactive identification and monitoring of at-risk mother-infant dyads during recurrent COVID-19 surges, not only during the postpartum period in the hospital but after discharge into the community. Our data further advocates for greater expansion of access to virtual lactation support, an option that has grown exponentially for physician visits during the pandemic.

Going forward, we would like to see more research on the design and application of remote lactation support, as well as on the clinical and cost efficacy of these programs. As our data represents a regional experience, we would welcome a secondary analysis comparing severity of disease in cases of hyperbilirubinemia that occurred before and during COVID-19 and the demographics associated with at-risk populations.

Source:increased-severe-neonatal-hyperbilirubinemia-during-social-distancing (physiciansweekly.com)

Building Baby Brains With smallTalk: From Foreign Language Learning at Home to Bridging Gaps in the NICU

January 28, 2022   Jessica Nye, PhD

The best language learners on the planet are children — especially babies. Your brain is most active in creating the language center of your brain, connecting neurons and creating the highways and pathways for processing language, during infancy. In fact, language learning begins in utero. The developing brain of a fetus starts to wire language circuitry around the speech sounds and rhythms of its mother’s voice. This process accelerates when a baby is born.

The brain does more language-associated wiring during the first year of life than any other time in a person’s life. These brain changes occur rapidly as a result of exposure to adult voices speaking to the baby in “infant-directed speech,” characterized by a higher pitch and more melodic, emotional tones.

Ohio-based startup smallTalk (formerly Thrive Neuromedical) is developing the SmallTalk™ platform to enrich the neurological development of babies who don’t have regular, consistent access to their parents’ voices. smallTalk has licensed technology developed at Nationwide Children’s Hospital that delivers recorded voices to infants via devices intended for use in the neonatal intensive care unit (NICU) and at home. These devices support critical brain development for language.

Around 10% of all infants spend some amount of time in the NICU, where they may be exposed to more passing adult speech and sounds of alarms and machinery than infant-directed speech during critical periods for language-associated brain development. This lack of exposure to infant-directed speech may, in part, be responsible for the documented association between NICU care and developmental language delays.

At Nationwide Children’s, where the average stay in the NICU exceeds 100 days, researchers developed and studied an infant-safe, unibody, Bluetooth-enabled speaker device to increase babies’ exposure to their caregivers’ voices with the appropriate sound characteristics to provide a clinical, therapeutic effect. The speaker can easily fit into an incubator and uses technology and volumes that is safe for babies and their sensitive ears.

Beginning this year, nurses and therapists in the NICU will be able to use a specially designed iPad application to help parents or caregivers record lullabies, songs or stories. Playlists of these recordings can be transferred wirelessly to egg-shaped speaker devices placed with the babies in the NICU and played for them several times each day.

The technology has also led to the development of an innovative foreign language learning product, the smallTalk Egg™, designed to help parents plan expose their babies to foreign language learning before age two.

“This is the only time of life when language learning actually helps babies brains develop differently. Infants in bilingual or multilingual household environments develop much broader speech sound recognition capabilities. By 1 or 2 years of age, they’re able to hear and verbalize more speech sounds and adapt to those languages very quickly,” says Dean Koch, CEO of smallTalk.

Infants can be exposed to these songs and stories passively, but studies have shown the most effective changes to the brain occur during interaction. Because the smallTalk Egg™ comes with a sensor device which fits into three different commercially available types of pacifiers, infants can request additional content by sucking on their pacifiers during 20-minute educational sessions. As the infant sucks, they are rewarded with 10 seconds of the foreign language lullaby, which then fades away. The baby recognizes this contingency quickly and will happily engage for a 20-minute learning session.

“Our research on brain imaging and how babies process speech sounds found that 20 sessions of 10-20 minutes over a month or month and a half is all that’s required to make a real, lasting, positive brain change,” says Koch.

The smallTalk Egg™, which will also be available this year, will allow parents and caregivers to bring this brain-enhancing technology into their homes. Currently, content is available in seven languages for use on the smallTalk Egg™, and there are plans to expand to include more languages spoken around the world.

Source: https://pediatricsnationwide.org/2022/01/28/building-baby-brains-smalltalk/

Discover Your Learning Style

GCFLearnFree.org

In this video, you’ll learn more about the different types of learning styles, to see which one works best for you!  Visit https://www.gcflearnfree.org/ to learn even more.

Traditionally western academic institutions have not adequately developed teaching methods that are geared towards visual, kinesthetic, and combined learning styles. The world is composed of people with diverse, meaningful, and valuable learning styles. Often academic teaching, testing, and programming is aimed towards auditory learning. I propose that we transition from labeling students as “learning disabled” and focusing on the possibility that our education systems are teaching disabled. We can do better.

SURFING COSTA RICA – SANTA TERESA SURF CLASSIC 2020

4/10/2020  by  Surfing Republica

 

Ideal; Preemie Life Course

Uzbekistan, officially the Republic of Uzbekistan, is a double-landlocked country in Central Asia. It is surrounded by five landlocked countries: Kazakhstan to the northKyrgyzstan to the northeastTajikistan to the southeastAfghanistan to the southTurkmenistan to the south-west. Its capital and largest city is Tashkent. Uzbekistan is part of the Turkic languages world, as well as a member of the Organisation of Turkic States. While the Uzbek language is the majority-spoken language in Uzbekistan. Islam is the predominant religion in Uzbekistan, most Uzbeks being Sunni Muslims.

Uzbekistan is a secular state, with a presidential constitutional government in place. Uzbekistan comprises 12 regions (vilayats), Tashkent City and one autonomous republic, Karakalpakstan. While non-governmental human rights organisations have defined Uzbekistan as “an authoritarian state with limited civil rights”, significant reforms under Uzbekistan’s second president‘s administration have been made following the death of the first president Islam Karimov. Owing to these reforms, relations with the neighbouring countries Kyrgyzstan, Tajikistan and Afghanistan have drastically improved. A United Nations report of 2020 found much progress toward achieving the UN’s sustainable development goals.

In the post-Soviet era, the quality of Uzbekistan’s health care has declined. Between 1992 and 2003, spending on health care and the ratio of hospital beds to population both decreased by nearly 50 percent, and Russian emigration in that decade deprived the health system of many practitioners. In 2004 Uzbekistan had 53 hospital beds per 10,000 population. Basic medical supplies such as disposable needlesanesthetics, and antibiotics are in very short supply. Although all citizens nominally are entitled to free health care, in the post-Soviet era bribery has become a common way to bypass the slow and limited service of the state system. In the early 2000s, policy has focused on improving primary health care facilities and cutting the cost of inpatient facilities. The state budget for 2006 allotted 11.1 percent to health expenditures, compared with 10.9 percent in 2005.

PRETERM BIRTH RATES – Uzbekistan

Rank: 118  –Rate: 8.7%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

The World Community has experienced increased chaos and stress these past few years, and our community members further impacted by war and climate disasters face escalating healthcare disparity and preterm birth influences. Access/exposure to media provides the opportunity to see for ourselves the challenges our Neonatal Womb Warrior/Preterm Birth community members face globally.  We have the ability to impact change. No matter how big or small our efforts seem, each and every effort to provide support and manifest positive change is both acknowledged and appreciated. Thank you. Kathy and Kat.

We need to talk about prematurity

São Paulo Ambulatory in Brazil carries out pioneering work in nurturing care for preterm infants.

By Emilia Afrange  Last updated: October 6, 2021 Date created: September 24, 2021

                                   International Psychology

The issue of premature births is a global and growing public health concern. Stressing its importance, the United Nations Sustainable Development Goals aim to reduce the rate of global maternal mortality to less than 70 deaths per 100,000 live births by 2030 (United Nations, 2015).

Prematurity is the main cause of neonatal mortality (children up to 28 days old) and infant mortality (children under 5 years old) worldwide and a relevant cause of serious morbidity, associated with long hospital stays in the Neonatal Intensive Care Unit (World Health Organization, 2019)

The sequelae of prematurity are not limited to the period immediately after birth. Premature birth survivors can face adverse health consequences throughout their lives, creating a significant burden for their families and society. Coming into the world before 37 weeks of gestation, or even earlier, can determine the baby’s biopsychosocial development, since biological birth and psychological birth do not coincide (World Health Organization, 2019)

Premature births are a serious issue in Brazil

“Born in Brazil” is a national survey on labor and birth, coordinated by the Sergio Arouca National School of Public Health (ENSP), linked to the Oswaldo Cruz Foundation (Fiocruz). The survey reveals that the rate of prematurity in the country reached 11.5%, almost twice the rate observed in European countries, with 74% of these babies being late preterm (between 34 and 36 weeks of gestation).

More recent information (2014), from the Information System on Live Births (Sinasc) and the Ministry of Health, indicate a prematurity rate in the country corresponding to 12.4% of live births. According to the general coordinator of the study, Maria do Carmo Leal, PhD, “prematurity is the biggest risk factor for the newborn to get sick and die, not only immediately after birth, but also during childhood and adulthood. The damage goes beyond the field of physical health and reaches the cognitive and behavioral dimensions, making this problem one of the greatest challenges for contemporary public health” (Oswaldo Cruz Foundation, 2011/12).

Between October 2016 and June 2019, the Brazilian Association of Parents, Families, Friends and Caregivers of Premature Babies (2019) conducted a survey with 2,900 families of premature babies. The objective was to identify possible actions to provide benefits to aid families with premature babies in the country.  Among the results, it was highlighted that the average period of hospitalization of premature babies in the NICU was 51 days; 63.7% of the babies were hospitalized for more than 60 days and 26% of them stayed between two and five months.

Care for infants born prematurely and their families in Brazil

In the city of São Paulo (SP), the Preterm Outpatient Clinic of the Escola Paulista de Medicina (EPM), of the Federal University of São Paulo (Unifesp), is a national reference in the care of children and adolescents born preterm. Since its foundation, in 1981, it has followed an efficient nurturing care model.

We work with four affiliated hospitals (Hospital São Paulo, Hospital Municipal Vereador José Storopolli, Hospital Estadual de Diadema e Hospital Geral de Pirajussara), which together register approximately 800 premature births/month. Currently, around 900 children and adolescents are being monitored at the Ambulatory. The Premature Clinic offers medical and multidisciplinary care to children and adolescents born prematurely until they reach 20 years of age.

Children born prematurely also receive support for medical treatment, and their families receive social assistance aiming at improving their health and quality of life from the ‘Instituto do Prematuro – Viver e Sorrir,’ founded in 2004 and, since then, a partner of the Clinic (Instituto do Prematuro, 2018).

Children born prematurely and their families also require psychological support. In 2007, the Psychology area at the Premature Outpatient Clinic was created, a unique experience in Brazil. A team of psychologists and psychotherapists support the psycho-emotional health of the premature baby and the mother/caregiver, stimulating the physical and emotional development of the infant, aiding the construction of the loving and empathetic mother/child bond, and supporting the multidisciplinary team helping the family.

Incoming patients are first separated into Operational Groups to address common themes that aim at the psychic expansion, e.g., narrating their anguishes and difficulties while discovering ways of dealing with them – sometimes even in a playful and grateful way. The Operational Groups are as follows:

  • Guidance Group with mothers and children from 0 to 3 years old.
  • Operational Group of mothers and children from 4 to 7 years old.
  • Operational Group of mothers and children from 8 to 10 years old.
  • Operational Group with teenagers.
  • Operational group of caregivers.

Psychological interventions are then created, which can consist of:

  • Psychological screening to verify the patient’s needs and to which type of care s/he should be referred.
  • Individual psychological care.
  • Play therapy.
  • Psychiatric referral.
  • Group service.
  •  

Periodically, meetings are held with the specialists from the Outpatient Clinic and with the EPM resident physicians, in order to promote the quality and improvement of the therapeutic practice, according to the modules created by the physician and psychoanalyst Michael Balint, MD, MS (1984).

In this way, we are able to provide an innovative system of psychological support to address the needs of children born prematurely and their families.

Source:https://www.apa.org/international/global-insights/prematurity

Improving mother and child health in Aral Sear are: Baby Gulnara’s story

UNICEF Uzbekistan-  03 February 2022

Gulnara was born after only 30 weeks of gestation. She weighed just 1,000 grams. After two months in an incubator at the Neonatal Intensive Care ward of the Nukus City Perinatal Center, she weighs 2.450 kilograms.

Gulnara’s mother was admitted with a history of miscarriage. She suffered from multiple health conditions which led to premature labor. The head of the department, Dr. Kahramon Kabulov, who performed an emergency cesarean section to assist with Gulnara’s birth, explained that Gulnara would have had slim chances for survival just a few years before. Thanks to the up-to-date, evidence-based advanced newborn care resuscitation protocols recommended by WHO and UNICEF, and the latest equipment and upgraded infrastructure, maternity staff can now save Gulnara and the other babies who are born preterm.

In 2019, within the framework of the ‘Improving Quality of Perinatal Care Service to Most Vulnerable Mothers and Newborns’ Programme, UNICEF and UNFPA had assisted three perinatal facilities in Karakalpakstan (in Nukus City, Kungrad, and Beruniy) to enhance the capacity of neonatologists, obstetricians, and resuscitation specialists to strengthen staff capacities, through comprehensive training and support. UNICEF and UNFPA have also equipped the perinatal center’s new Neonatal Intensive Care Unit with the latest medical equipment such as ventilators, oxygenators, laryngoscopes, and training equipment. Today all premature babies that come through the perinatal center have a real chance of survival.

At the Neonatal Intensive Care Unit, little Gulnara is getting better every day. She can now see lights and hear sounds and uses her strength to drink her mother’s breastmilk. Once she reaches 2.5 kilograms, she will be released to go home. Her parents have been trained on how best to care for her and are looking forward to her arrival at home.

UNICEF and UNFPA significantly contributed to the Government’s efforts to improve the quality of perinatal services in the Kungrad and Beruniy districts and Nukus City. Since the project started, 21% of all mothers and newborns in Karakalpakstan (more than 12,000 mothers and 12,000 newborns) have benefited from upgraded infrastructure and improved quality of care at the target perinatal centers.

A significant reduction in early neonatal mortality has been achieved in all three target facilities on average by 22%. It is expected that the target perinatal centers will extend their specialized service to mothers and newborns from the neighboring districts.

Source: https://www.unicef.org/uzbekistan/en/maternal-and-child-health-in-aral-sea-region

Keeping up with technology and terminology ….. Next up: Deep Learning

What is Machine Learning?

822,603 views – Aug 24, 2017 Google Cloud Tech

Got lots of data? Machine learning can help! In this episode of Cloud AI Adventures, Yufeng Guo explains machine learning from the ground up, using concrete examples.

Ziyoda va Ulug’bek Rahmatullayev – Tor ko’cha

835,425 views              Jan 3, 2022

Gravens By Design: What the Ideal NICU Would Look Like

Robert D. White, MD Director, Regional Newborn Program Beacon Children’s Hospital

It is sometimes hard to imagine the ideal NICU – the concept is still evolving, so there is no one available to visit, and even the elements of what could be optimal are evolving. For example, if this exercise were undertaken a few decades ago, it would be difficult to imagine what the digital transformation might permit – and even now, we cannot predict its full potential. Still, the effort seems worthwhile, not only for those who will soon be building a NICU that will have to meet the needs and expectations of its inhabitants for the next 20-30 years but also for those who cannot rebuild soon but could undertake an interim facelift that would be of value to all its constituents.

A NICU should be welcoming to families.

 This concept has many elements, starting even before one enters the hospital doors. It is usually easy to find the hospital, especially in the digital age, but there are often many places to park and enter the massive complex where most higher-level NICUs are located. Few people will say that finding their way from the street to the NICU is easy; it is hardest for young parents or other family members coming from an outlying community – often at night and almost always under stressful conditions. Proper signage on the street, at the preferred entrance, and through the hallways can greatly facilitate this first encounter. Written directions, both on paper and a hospital website, can also be helpful and allay anxiety even at the start of the journey.

Many hospitals have a foreboding “front door” because of where they are located, how old they are, and their restrictions to entry, but once one reaches the entrance to the NICU, none of these should be factors. The entrance should be well-lit with an attractive color scheme and devoid of stern signage. An individual to welcome and direct families and visitors should always be available. The décor should have more in common with a hotel lobby than an ICU – spacious, relaxing, and, where appropriate, informative. Both signage and artwork should reflect the diversity of cultures served by the NICU and should address parents as members of the care team rather than as visitors.

This paper is not intended to explore the operational aspect of the ideal NICU, but these are immensely important to how families can be made to feel welcome. I have vivid memories of an old NICU in Madrid where several mothers sat in a circle rocking their premature infants while talking and singing together – a stark contrast to most similar NICUs in much wealthier countries I have seen that were largely devoid of parents and dominated by the sights and sounds of technology. The Madrid parents were made to feel welcome not by the physical environment but by the policies of the NICU, and they, in turn, made it more welcoming to every new family.

The NICU should only separate babies from their parents under the most extreme circumstances.

 There is now abundant evidence of the value of early and extensive intimate contact of a baby with its parents and the safety of single-family rooms. There is no evidence that separating babies from their mothers for extended periods in the first days of life benefits either baby or parent. The ideal NICU would provide space and caregivers for all mothers after their delivery except for those who require highly specialized care. Likewise, accommodation would be provided for fathers or other support persons that will be sufficient for their comfort over extended periods.

A NICU should present sights and sounds to all inhabitants that are nurturing rather than stressful.

There was a point in the early NICU days when audio alarms and bright lights were imperative, but we have known how to minimize these stressors for decades now. Most alarms can be transmitted electronically and visually, a technique learned in every other part of the hospital and adopted in some NICUs as early as the 1980s but has only recently achieved widespread acceptance and is still not a reality for some NICUs. Similarly, there was a time before the advent of transcutaneous oximetry when constant bright lights were needed to assess skin color and perfusion. However, the pendulum swung to a constantly dim environment based on the premise that this was the expected environment in utero and, therefore, safer and less stressful for premature infants. This belief has persisted long after it was disproven (1); it is past time for the pendulum to swing back to a middle ground where babies are presented with a circadian rhythm for lighting while still protected from direct light sources.

Adult caregivers and families need appropriate lighting as well. Lighting should be of sufficient intensity and the proper spectrum to provide a circadian and alerting stimulus for caregivers (2) and a welcoming signal to families. In contrast, lighting levels and spectrum at night will minimize melatonin suppression in caregivers while still supporting alertness.

Daylight and views of the outside world and nature provide a substantial psychological benefit to many adults. However, most NICUs will not have an opportunity to improve access to these features until new construction occurs because of the misguided belief in past years that because babies did not need access to daylight, their caregivers and families did not need it either. The ideal NICU will provide windows in almost all spaces where adults spend extended periods during the day. Even hallways should have a window on at least one end rather than closing off that vista by making an office a little larger or for storage space. In the meantime, attention to the visual environment remains even more important. The walls of NICUs have the potential to be palettes conveying subtle messages through artwork, photos, and stories of NICU grads. Even ceilings and floors have been used creatively to provide additional opportunities for the eye to find the color, whimsy, distraction, and information.

Sound control has been difficult to achieve in many NICUs, even after monitor alarms were tamed. For many NICUs, there are still too many sources of noise and too few sound-absorbing surfaces. There are now alternatives to the hard flooring that transmits and reflects the sound of everything that moves across it, for example. All surfaces should absorb more noise than they generate. HVAC systems were often designed in an era when high airflow was recognized as valuable but not understood as an important source of ambient noise, above which all other desirable sounds such as voices and even monitor alarms must be heard. Design or redesigning these HVAC systems to be quiet and where air can be extensively cleaned and filtered are overdue for many NICUs.

Infection control can be improved in most NICUs.

Nosocomial infection continues to be a frustratingly common complication of neonatal intensive care. Something as basic as a handwashing sink is often designed to fail and, even when welldesigned, can be misused in a way that contributes to ongoing contamination of NICU surfaces. The ideal NICU will have sinks readily accessible in all patient care and support areas; these sinks should be hands-free, large enough for cleaning hands and forearms, have drains that are offset from the faucets, rims that do not permit objects to be placed on them (and thereby contaminated), splash guards to protect adjacent areas from splatter, quiet paper towel dispensers, and should be handicapped-accessible.

Among new sanitizing techniques being explored, ultraviolet light in the UV-C spectrum has been demonstrated to reduce bacterial and viral presence in circulating air and on certain devices, including hand-held communication devices. There is also increasing evidence that UV-A can be used to reduce contamination of surfaces in occupied spaces (3).

Support spaces should provide respite and support for families and caregivers.

In many NICUs, support spaces for caregivers and families are cramped and windowless. These spaces would be large and relaxing in the ideal NICU with abundant daylight and access to an outdoor garden. Likewise, there would be smaller individual spaces that provide privacy and an opportunity to nap, pray, exercise, or do yoga.

The patient care space should be a home away from home for those families who desire it and those babies for whom it is appropriate.

This principle comes with qualifiers. Babies whose families rarely interact with them may benefit from being in a shared space with other such babies. A few families prefer being in a space where their baby can be easily seen by caregivers, although this often is based on a misunderstanding of how little we can tell about a baby when we are not directly at the bedside and how much we depend on monitors to provide us information about a baby’s status. Most families, though, appreciate a space they can call their own with comfortable seating, a private sleep surface and shower, a refrigerator, and the opportunity to personalize the space with decorations suitable for the baby and the season. Even in a more open setting, parents should have the opportunity for privacy, especially for breastfeeding and skin-to-skin care and space to store their personal belongings.

The ideal NICU should look better than the day it opened.

To some extent, this is an unreachable goal – walls will get nicked, floors will get stained, equipment will look worn. However, accumulating items in hallways and on counters and signs taped to walls or doors is not inevitable. Instead, it is tolerated mainly by people who get desensitized to its presence and forget that for families in this crucial moment, it announces a lack of attention to details and cleanliness that we would not tolerate in other public venues or indeed in our own homes if we were expecting visitors. It is a rare NICU that cannot find ways to enhance its appearance from time to time with upgrades as mundane as light bulbs with a warmer spectrum or as heart-warming as a piece of art from a graduate or the child of a staff member. Likewise, if allowed, families and staff can transform a patient care area from a sterile medical unit to something that feels more like home.

Source:http://www.neonatologytoday.net/newsletters/nt-feb22.pdf

The proactive approach to mother-infant dyads at 22-24 weeks of gestation: Perspectives from a Swedish center

Johan Ågren    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

Abstract

The care of infants born at the lowest extreme of gestation requires dedication, skill, and experience. Most centers apply a selective approach where intensive care at these gestational ages is being offered to a varying proportion of infants depending on the views and experiences of the medical community, the individual physician, and the parents. Consequently, the outcomes differ dramatically with survival rates at 22-23 weeks ranging from 0 to greater than 50%. This paper presents the approach in a center with a long tradition of providing a comprehensive and uniformly active care to all mother-infant dyads from 22+0 weeks of gestation. Important features outlined include prenatal maternal referral and transfer, delivery room management, and initial intensive care.

Full Article/PDF: https://reader.elsevier.com/reader/sd/pii/S0146000521001506?token=B5AD098B8AEB9D5919C458B4CCF3C20E76E11BEA54DE5F07A5224485F86A29707C6DB08D3049A1707894F425ED3E7814&originRegion=us-east-1&originCreation=20220220175145

Thin Endometrium, PCOS, and Risk for Preterm Birth, Low Birthweight Infants

Jessica Nye, PhD – January 26, 2022

Women underwent controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or progestin for pituitary suppression. Hormone therapy cycle or ovulation induction cycle for endometrial preparation. 

Among pregnant women with polycystic ovary syndrome (PCOS), decreased endometrial thickness (EMT) was associated with increased risk for preterm birth (PTB), low birthweight (LBW), and small-for-gestational age (SGA) infants. These findings were published in Frontiers in Endocrinology.

Health records of women (N=1755) who had PCOS and a singleton livebirth after frozen-thawed embryo transfer (FET) between 2009 and 2019 at the Shanghai Ninth People’s Hospital in China were retrospectively reviewed for the study. Prior to pregnancy, the women underwent controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or progestin for pituitary suppression. All women underwent hormone therapy cycle or ovulation induction cycle for endometrial preparation.

Of the entire cohort of 1755 women with PCOS, 10.5% had EMT of £8 mm, 78.6% had EMT of >8-13 mm, and 10.9% had EMT of >13 mm EMT.  The 3 EMT categories were classified as “thin”, “intermediate” and “thick”, respectively, for this study. Patients in these 3 EMT cohorts were aged mean 29.9±3.3, 30.0±3.5, and 30.1±3.5 years; body mass index (BMI) was 23.44±3.70, 23.45±3.85, and 24.02±4.26 kg/m2; and 37.5%, 29.6%, and 25.0% had PCOS without any other fertility issues, respectively.

The patients differed significantly for gravidity and endometrial preparation regimen (both P <.001) among the thin, intermediate, and thick EMT categories. No significant differences in pregnancy complications were found on the basis of maternal age, BMI, parity, or other factors.

For neonatal outcomes, thin EMT associated with increased PTB (13.6% vs 9.3% vs 3.6%; P =.003), lower birthweight (mean, 3260.1 g  vs 3314.6 g vs 3443.3 g; P =.004), LBW (9.2% vs 5.6% vs 2.1%; P =.010), lower birthweight Z-score (mean, 0.33 vs 0.39 vs 0.61; P =.006), and SGA (9.2% vs 4.3% vs 1.6%; P =.001) compared with the intermediate and thick EMT cohorts, respectively.

Using multiple logistic regression models for the same 3 groups, researchers discovered that a 1 mm decrease of EMT led to a 9% decrease ([adjusted odds ratio] 1.09, 95% CI, 1.00-1.19, P = .053), 14% ([aOR]1.14, 95% CI, 1.02-1.38, P=.002), and 22% ([aOR]1.22, 95% CI, 1.07-1.38] P= .003) led to a greater likelihood of developing PTB, LBW, and SGA, respectively.

Researchers acknowledged their study was limited by not adjusting for variants of PCOS or metabolic patterns before pregnancy. Only frozen-thawed embryo transfer (FET) cycles were included in the analysis, so generalization of the study findings should be done with caution.

“Our study demonstrated that decreased EMT was an independent risk factor for PTB, LBW, and SGA in PCOS,” the researchers concluded. “This novel finding suggests that EMT may be applied as a simple indicator of neonatal complications among women with PCOS.”

Reference

Huang J, Lin J, Xia L, et al. Decreased endometrial thickness is associated with higher risk of neonatal complications in women with polycystic ovary syndrome. Front. Endocrinol. 2021;12:766601. doi:10.3389/fendo.2021.766601

Thin Endometrium, PCOS, and Risk for Preterm Birth, Low Birthweight Infants – Endocrinology Advisor

Health Equity and Cultural Competency in the NICU: Challenges and Solutions

Jan 28, 2021 National Association of Neonatal Nurses

In this Bonus General Session from 2020 NANN Virtual, Jenne Johns, MPH, takes listeners through an educational and empowering journey to encourage the delivery of high quality and equitable care to all preemie families, regardless of race, language, and socioeconomic status.

We are excited to see the emphasis and progression of efforts towards developing and conducting research that may build a foundation for understanding and addressing the unique needs of preemies as they navigate their FULL life journeys.

Addressing Preterm Birth History With Clinical Practice

Recommendations Across the Life Course

Michelle M. Kelly, PhD, CRNP, CNE, Jane Tobias, DNP, CPNP-PC, & Patricia B. Griffith, MSN, CRNP, ACNP-BC

INTRODUCTION

Preterm birth is defined as birth before the completion of 37 weeks of gestation (World Health Organization, 2018). Worldwide, preterm birthrates range from 5% to 18% (Synnes & Hicks, 2018), and two-thirds of all preterm births occur without an identifiable cause (Ferrero et al., 2016). Over the past decade, despite increased attention to perinatal management, the United States’ preterm birthrate hovered steadily at just below 10% (Martin, Hamilton, Osterman, Driscoll, & Drake, 2018). Advances in perinatal and neonatal management such as prenatal steroids, exogenous surfactant, and advanced respiratory management resulted in preterm birth survival rates in developed countries of 90% to 95% (Philip, 2005; Raju, Buist, Blaisdell, Moxey-Mims, & Saigal, 2017a).

Stable preterm birthrates and high survival rates combine to ensure that preterm born infants will reach adolescence and adulthood in significant numbers such that every health care provider, regardless of specialty, is caring for a patient who was born preterm.

Long-term health outcome research of preterm birth survivors has shown that preterm birth has implications for individual health throughout the life course (Raju et al., 2017a). The National Institutes of Health in The Adults Born Preterm: Epidemiology and Biological Basis for Adult Outcomes (Raju et al., 2017b) calls for an increase in awareness of and education for health care providers regarding the long-term health outcomes of preterm birth survivors. Health care providers report limited knowledge and training related to preterm birth survivors’ life course outcomes (Kelly & Dean, 2017; Luu, Rehman Mian, & Nuyt, 2017; Raju et al., 2017b). Limited content addressing preterm birth survivors’ life course health outcomes is evident in commonly used pediatric-focused textbooks (Kelly & Michalek, 2019).

Current recommendations from the American Academy of Pediatrics, specific to children born preterm, focus on the immediate newborn period and the high-risk infant referral to developmental follow-up (American Academy of Pediatrics Committee on Fetus and Newborn, 2008). Most preterm births occur between 32 and 36 weeks of gestation and subse- quently require limited neonatal intensive care unit (NICU) intervention and are often discharged without significant peri- natal complications. Therefore, many children born preterm are not included in high-risk developmental follow-up pro- grams and are not deemed appropriate for early intervention.

Problem Statement

No formal recommendations or guidelines exist regard- ing preterm birth implications across the life course despite the proliferation of long-term outcome research published in the last decade and the National Institutes  of Health call for increased attention to an individual’s preterm birth history (Raju et al., 2017b). Just as obesity was identified as a risk for coronary artery disease in 1998 (Mitchell, Catenacci, Wyatt, & Hill, 2011), it is time for the health care community to recognize preterm  birth history as an independent risk for developmental and educational success, as well as noncommunicable cardiovascular and respiratory diseases. Recommenda- tions for addressing preterm birth  history  throughout the life course are essential to improving health care pro- vider knowledge, and through their implementation, improving the health of those born preterm.

Following an extensive review of the literature (Kelly & Griffith, 2020a; Kelly & Griffith, 2020b), a set of recommendations for pediatric and adult primary care providers were developed that incorporate findings from national and international meta-analyses, systematic reviews, executive summaries, and professional guide- lines. There is no specific phenotype of the individual born preterm; however, those born preterm experience common chronic childhood and adult conditions at an increased incidence (Kelly, 2018). Initially, those born preterm may not vary from the typical developmental course or raise significant concerns over health or development. However, children born preterm benefit from high-quality and comprehensive interventions and special educational accommodations to promote literacy, numeracy, and life skills (Msall, Sobotka, Dmowska, Hogan, & Sullivan, 2018). The following guidelines aim to enhance the identification of those born prematurely, empower health care providers to employ familiar screening strategies, and advocate for mitigations strategies with anticipatory guidance and health promotion.

METHODS

Review of Literature

In anticipation of developing these evidence-based recommendations, the authors undertook an extensive review of the existing preterm birth survivor outcome literature. The literature reviewed in preparation for the coalescing of these recommendations included meta-analyses or systematic reviews identified through a systematic search in PubMed, CINAHL, PsychInfo, and Cochrane databases, with assistance and input from a medical librarian. Including only meta-analyses or systematic reviews, umbrella reviews are designed to provide a broad picture of the research base (Aromataris et al., 2015) and may be used to inform practice guidelines or to highlight known strengths or gaps in an area of research or practice (Cantrell, Franklin, Leighton, & Carl- son, 2017). Search terms included: (“Premature birth” OR “Preterm” OR “Preterm infant” OR “Infant, premature, extremely premature”) AND (Adolescen* OR Adult) AND (“Outcome” OR “Outcome assessment” OR “Outcome assessment healthcare” OR “Outcome and process assessment” OR “Prognosis” OR “Long-term adverse effects”). Additional filters included systematic review, meta-analysis, Cochrane review, and review. Search years were from 2010 to 2019 for the school-age review and from 2010 to 2018 for the adolescent and adult review. The methodologic qual- ity of all reviews was assessed using the Joanna Briggs Insti- tute Critical Appraisal Checklist for Systematic Reviews and Research Synthesis (Aromataris et al., 2020).

These findings were published as two umbrella reviews, one focused on  adolescents and  adults  (Kelly  & Griffith, 2020a) and the other focused on school-aged children (2−12 years of age; Kelly & Griffith, 2020b). Additional details of the umbrella review methodology and search parameters are available in the publications (Kelly & Griffith, 2020a; Kelly & Griffith, 2020b). The review of school-aged outcomes included 29 reviews: 14 meta-analyses, eight systematic reviews, and seven described as both meta-analysis and systematic review (Kelly & Griffith, 2020b). The adolescent and adult outcomes include 16 reviews: five meta-analyses, five systematic reviews, and five described as both meta-analysis and systematic review, and one comprehensive review (Kelly & Griffith, 2020a). The researchers also explored literature published between the umbrella reviews publications the development of these recommendations (from 2018 to 2020) to ensure a comprehensive literature review.

Development of Recommendations

Following the extensive review of the literature, the researchers coalesced the currently available research, formal and gray literature (manuals, guidelines, curricula, and recommendations) into clinical practice recommendations. The set of recommendations aims to guide the primary care provider to elicit, understand, and incorporate a patient’s pre- term birth history across the life course. Thirty-six meta- analyses, systematic reviews, guidelines, and recommendations were incorporated into the preterm birth history recommendations (see Table 1).

The recommendations were organized into patient care categories: assessment and diagnosis, prevention and management, and referral and treatment. Assessment and diagnosis recommendations focus on identifying a pattern of risk and recognizing the relative importance that risk confers to individual health. Prevention and management recommendations address the importance of surveillance, anticipatory guidance, and patients and family education. This process should begin at birth, continue through adolescence, and into the transferal of care to the adult provider. Because of the importance of prevention and management in health care, categories were further separated into general recommendations, cardiovascular surveil- lance, and pulmonary surveillance. Referral and treatment recommendations focus on a process that ensures the necessary connections are made, and the patient is partnered with the appropriate health care team to recommend treatment plans for supportive resources. Proper screening and identification may mitigate potential medical and psychological challenges that will affect the patient’s quality of life.

The American Association of Critical-Care Nurses’ level of evidence grading system was used to assess the literature supporting the recommendations (Peterson et al., 2014). Twenty-two references were level A (meta-analysis), one was level B (well-controlled studies), 10 were level C (systematic and integrative reviews), and three-level D (peer-reviewed standards). Table 1 includes the recommendations and the references that support the specific recommendations, with the American Association of Critical-Care Nurses grading. Tables 2−4 highlight the relevant findings from each study and reference. It is important to note that the recommendations are not dissimilar to guidelines for full-term children. Rather they address the importance of recognizing preterm birth as a portion of a patient’s history that increases their risk for commonly occurring conditions.

Health care provider feedback was solicited to help refine and validate the recommendations. Specifically, the feedback was solicited from physicians and nurse practitioners practicing in neonatology, pediatric primary care, pediatric specialty care, and family medicine. The initial e-mail listing was sent to numerous contacts of the researchers across several states and health systems. Responses were anonymous, and participants were asked to share the guidelines with other health care provider colleagues. Literature suggests that most practicing physicians and nurse practitioners would not be familiar with the long-term outcome literature (Kelly  & Dean, 2017; Raju et al., 2017b), so efforts were made to facilitate a review of the supporting literature. Recruitment e-mails and recommendation documents included embedded hyperlinks of the literature used to support each recommendation. Respondents were asked to review the literature before completing the evaluation survey. Respondents were asked to report the level of agreement with each recommendation and the feasibility of implementation in practice. Open-ended comment sections were included following each patient care category and after reviewing the entire set of recommendations.

The research plan was evaluated and deemed an exempt study by the Villanova University Institutional Review Board.

Results from Review of Literature

Conditions experienced by preterm birth survivors after the NICU are not unique to the preterm birth phenomena. In an exploration of the 2011−2012 National Sur- vey of Children’s Health data, the six most commonly occurring chronic health conditions in children were the same in full-term and preterm groups (Kelly, 2018), yet the preterm group experienced these conditions more often. Aylward (2005) described these conditions experienced by those born preterm as low severity, high-frequency conditions. The adult outcome literature supports similar patterns, that preterm birth survivors experience these conditions, whether in childhood or adulthood,  with increased frequency. Because most adult patients do not share or are not asked about their preterm birth his- tory, such conditions are not attributed to being born early.

Tables 2−4 present the findings that support the preterm birth history recommendations. The findings from the literature may be summarized in a few key points.

Preterm birth history increases an individual’s risk for:

1.Impaired school performance related to math, spelling, reading, receptive language, and decreased executive function (cognitive flexibility, working memory, and verbal fluency).

2.Behavioral and mental health concerns including depression, anxiety, and attention deficit hyperactivity disorder.

3.Cardiovascular disease, specifically hypertension, which poses an increased risk for females.

4.Pulmonary disease, specifically wheezing, asthma, and reduced lung capacity. This risk exists even for those without a history of bronchopulmonary dysplasia.

5.Motor delay, visuomotor integration disorders, and coordination impairment.

Results From External Review of Preterm Birth History Recommendations:

From the approximately 75 initial e-mail addresses, 28 respondents completed the evaluation survey (response rate of 37%). Responses were excluded if less than 25% of the survey was completed (n = 10 surveys). There were some items skipped on the survey, resulting in variation in responses per item from a maximum of 28 responses to a minimum of 20 responses. Agreement and feasibility per- percentages, as reported, are listed in Table 1.

There was an overwhelmingly positive response to the recommendations in both agreement and feasibility. Only two recommendations resulted in less than 85% agreement; both items related to screening for metabolic syndrome. There was an 83% agreement with the recommendation for monitoring of body fat mass at annual visits. There was a 78% agreement with screening to include fasting glucose, serum insulin levels, and lipid profile. Although some respondents disagreed with the recommendation, both were deemed feasible by 95% of respondents, suggesting that it could be accomplished without a significant burden to the patient, provider, or practice. None of the respondent’s feedback suggested significant adjustments to the individual recommendations.

Respondents shared suggestions for implementing the recommendations, including programming a hard stop in the electronic medical record for recording preterm birth history.

Respondents’ feedback related to implementation focused on the basic availability of necessary equipment such as appropriately sized blood pressure cuffs for all ages and sizes. Adherence to current American Academy of Pediatrics Guidelines for cholesterol screening was asserted. Respondents agreed with the recommendations and the need for avoidance of air and environmental toxins. Related to respiratory conditions, implementation recommendations included a call for upstream interventions to reduce overall air and environmental toxins.

Others shared concerns for implementation related to the availability of community support and patient resources varying by geographic region, which leads to difficulty in helping families in resource-poor areas. Concerns were raised regarding the accessibility and feasibility of lifestyle modification recommendations in patients without necessary resources. Respondents encouraged referrals to special infant care clinics, yet this is only available in some regions and typically only until 2 years of age. Others questioned if providers should reflexively screen all children born preterm for autism spectrum disorders or recommend starting elementary education with individualized education plans. Access to services and the importance of communication with the school system was represented in this response: “Access to services is often the biggest hurdle, as the PCP for a child/teen, supporting their needs in school is essential; however, much of those decisions are based upon the district.” Further concerns were related to the systemic racism and inherent inequities that contribute to preterm birth rates.

Recommendations related to metabolic syndrome risk had the lowest agreement percentages; 83% for monitoring body fat at annual visits and 78% for fasting glucose, serum insulin levels, and lipid profile screenings. One participant questioned the need for annual invasive testing. Other participants voiced concerns about the early onset of metabolic syndrome and obesity in preterm birth survivors and supported the recommendations suggesting that these were interventions currently being implemented in their practice. This response represented the recognition of the importance of weight gain early in the preterm birth survivor’s life and the difficulty in discussing obesity: “When preterm infants have struggled to gain weight, I think it’s really hard to discuss watching child’s weight post-discharge.”

Several agreed that premature birth should be a history feature that follows the patient into adult care. One pediatric provider shared:

I believe my practice is very good with identifying the needs for babies born prematurely. I also believe that for most this history does follow with them throughout their stay in pediatric practice. We do have diagnosis on their problem lists, but after they transition out, I do not know how the adult world cares for these patients or if they recognize that there are developmental or psychological issues created from prematurity.

Limitations

Although the researchers attempted to coalesce the most recent publications and findings related to broad outcomes for individuals born preterm, some cohorts analyzed in meta-analyses were born before the 1990s when exogenous surfactant became available and mechanical ventilation techniques improved considerably. It is important to recognize the heterogenicity of preterm birth outcomes and the varied proximal and distal protective factors that may alter those outcomes.

Implications

This set of preterm birth history recommendations is the first comprehensive document to advocate for universal recognition and appreciation of life course health risks related to an individual’s preterm birth history. These recommendations advocate a paradigm shift toward proactive intervention, rather than the reactive practice of waiting for children to fail to meet specific milestones or begin to show comorbid tendencies. The recommendations acknowledge the need for early identification, intervention, and family support for not just the most vulnerable infants but for all who were born before the completion of 37 weeks of gestation. It is with conscious intent that the authors make recommendations for surveillance and referral rather than for specific interventions. Each individual must be evaluated and managed as dictated by the specific features of their strengths and limitations.

Healthcare providers caring for an individual born pre-term should not assume that preterm birth concerns are left in the NICU or resolve at 2 years of age. Assumptions that individuals born preterm had the benefit of neonatal follow-up or even coordinated primary care on the basis of preterm birth status should not be made. Boone, Nelin, Chisolm, & Keim (2019) found that 47% of preterm participants lacked a medical home. The evidence for creating recommendations specific to individuals with a history of preterm birth through the life course is well established. However, dissemination directed at concrete ways to improve patient care has been limited.

The research aimed to coalesce the best available evidence to guide the development of initial recommendations. It is hoped that increased attention to potential risks will result in improved outcomes and decreased noncommunicable risk-based conditions in adulthood. With any new set of recommendations, there may be unanticipated risks. The increased provider attention to potential risk could result in perceptions of vulnerability in the patient or family. To balance this risk, the researchers support providers addressing preterm birth history in the same manner a family history of heart disease is addressed. Recognize it as a risk, advocate for lifestyle modifications that mitigate the risk, and intervene as necessary.

The patient care recommended is not vastly different from that provided to children born at term. Rather, the usual practice would be enhanced by a recognition of the potential increased risks. Health care providers should focus on facilitating chronic disease prevention by promoting healthy lifestyles and recommending early and continued support services for psychosocial and neurodevelopmental difficulties (Luu et al., 2017; Nuyt et al., 2017; Raju et al., 2017a; Raju et al., 2017b). Cardiovascular and pulmonary risk are discrete conditions with well-recognized management. It is important to highlight the psychological and behavioral conditions that may accompany preterm birth history. Behavioral and mental health are critical to development and transition to adulthood. Recognition and the early support of patients with these conditions are essential.

The implementation of these recommendations may look different in each practice setting. Resources are necessary to enact these recommendations fully. Geographic variation related to access to services will challenge an already stressed system. Concrete recommendations such as changing patient intake forms and built-in data entry requirements for electronic health records are a start. Further research will be required to evaluate implementation strategies and best practices.

The preterm birth history recommendations should continue as adolescents transition to adult health care. Respondents verbalized a lack of knowledge regarding adult provider preparedness in recognizing the implication of pre-term birth history. Recognition of the hypertension risks for adults with preterm birth history may mean intervening earlier with medications to decrease stroke risk. By developing practice recommendations supported by the evidence, there is a mechanism to increase provider awareness and subsequently improve physical and mental health outcomes. Increasing awareness through current and future health care provider education is imperative in bridging this gap (Kelly & Dean, 2017; Kelly & Michalek, 2019) and decreasing the challenges associated with the transference of care (Fernandes et al., 2010). Education is just one area of focus; advocacy and support of community resources must also be addressed. As noted by the respondents, there is a discrepancy in access to appropriate and necessary services that will require a collective approach in ensuring equity in obtaining the necessary community resources.

Conclusions

Through an in-depth review of literature and contributions from health care experts in pediatric and adult care, evidence-based recommendations were made that will assist in transformational health care for children, adolescents, and adults with a preterm birth history. The goal of these recommendations is the mitigation of chronic health sequelae throughout the life course. The researchers recognize that further investigation into the education and training of adult health care providers related to the implication of preterm birth history is warranted. The first step in reducing the potential for chronic health sequelae is incorporating the question, “Were you born preterm?” into all patient health histories and appreciating the implications of a positive response.

Preemie Triplets Overcome the Odds

August 7, 2020UVM Health Network Logo

They are miracle micro-preemies triplets Cian, Declan and Rowan DeShane, survivors of extremely premature deliveries whose birthdays span not just different days and months, but two different years and decades.

Cian was born first on Dec. 28, 2019. At just 22 weeks, 6 days, he was one of the youngest infants to arrive at UVM Medical Center’s Neonatal Intensive Care Unit (NICU). He weighed only 1.08 pounds, not much more than a 16-ounce bottle of soda.

On Jan. 2, 2020 – five days later – Cian’s identical twin brother, Declan, was born. He weighed 1.47 pounds. Within moments, the boys’ sister, Rowan, entered the world at 1.08 pounds.

Remarkably, each made it through the natural birth process. “When my water broke, I burst into tears because I didn’t think they could survive being born so early. I thought it was all over,” says their mom, Kaylie, who had worked with a fertility clinic to get pregnant.

Life-Saving Interventions

To put the DeShane triplets’ very early births into perspective, a baby is considered full-term at 39 weeks. The World Health Organization defines preterm as babies born before 37 weeks of pregnancy. Less than 32 weeks is defined as “very preterm” and at or under 25 weeks is “extremely preterm.” Until the past year or so, health care organizations like UVM Medical Center did not attempt high-tech intensive medical interventions to resuscitate infants born at 23 weeks or less because their survivability rate was so low and the and the list of diseases and disabilities so long for those infants who lived.

“Every organ and system in these extremely low birth-weight babies is ill-prepared to meet the world,” explains Roger Soll, MD, a neonatologist at UVM Medical Center and the  H. Wallace Professor of Neonatology at the Larner College of Medicine. He says there isn’t any one breakthrough that accounts for his team’s recent successes with extremely preterm babies.“ We’ve perfected our team approach to an optimal system of care, starting with maternal-fetal medicine during the pregnancy and delivery, and continuing to the NICU where respiratory therapists, nurse practitioners and nurses all work together to provide round-the-clock care.”

Hannah Jackman, RN, has a vivid memory of the day Cian was born. “It seemed like there were dozens of healthcare workers in the delivery room, all in yellow gowns, awaiting three tiny triplets. I was one of them, and I remember my heart feeling like it was leaving my chest as I watched Cian’s parents sob and pray,” she says. “I wanted a miracle for this family so badly.”

For Kaylie and her husband, Brandon, the decision was easy. They told the medical team: “Do everything to save them.”

Cian was immediately intubated. Declan and Rowan were both septic at birth and given intravenous antibiotics. The infants were placed in incubators, wires connecting them to monitors so caregivers could keep track of their temperatures, heart rates and breathing. Tubes delivered medicines and fluids to their tiny veins. Pulse oximeters measured the oxygenation of their blood.

Despite the tangle of equipment, mom and dad were encouraged to hold their infants skin-to-skin. During the triplets’ months-long stay in the NICU, the couple made certain one of them was there every day. They each spent weeks at a time at the Ronald McDonald House while the other tended to their two older children at home three hours away in Norwood, N.Y. When visitors were restricted to one parent per pediatric patient due tothe COVID-19 pandemic, the couple joked that they had more than enough babies to be allowed in the NICU together on weekends.

“We were already in survival mode when COVID hit, so it was just one more thing,” Kaylie says. “We were already washing our hands constantly and being especially careful to keep them safe from any germs.”

It Takes a Team

The infants had their own primary nurses assigned to them during every shift of every day. This consistency of care meant that every potential problem was noticed and immediately attended to.

After Cian’s birth, nurse Jackman signed up to be his primary nurse during her 12-hour day shifts.

“I got to spend four months caring for this tiny but mighty human, watching in amazement as he overcame obstacle after obstacle.” Hannah Jackman, RN,University of Vermont Medical Center.

“It is a relationship like no other – these parents are trusting you with their newborn. Advocating for Declan became my biggest priority,” says Julia Watsky, RN, one of the trio of primary nurses dubbed the “dream team” who worked the night shift on Sundays, Mondays and Tuesdays. “I learned every aspect of Declan’s care – from how he liked to be positioned to knowing when

One night Ashley Ostler, RN, noticed that the normally lively Rowan was hardly reacting to her.

“Rowan is typically a sweet, feisty lady. She is not exactly patient and she makes her demands known,” observes Ostler. “She often made me laugh late at night because she really does know how to push your buttons while melting your heart with her adorable little face.”

When Rowan went limp and her abdomen became distended, Ostler rightly suspected she had developed a common but serious intestinal disease called necrotizing enterocolitis, or NEC, which required many interventions until she stabilized.

Cian also developed NEC and, at one point, his parents were asked to create an end-of-life plan. “That taught me to never think we were out of the woods,” Kaylie says.

Lindsey Flanders, RN, remembers the night when Cian’s oxygen needs kept climbing until he reached 100 percent and couldn’t go any higher. “Knowing Cian, I knew this wasn’t his norm and that he needed additional support to bring his oxygen requirement back down.” He was started on nitric oxide to relax the vessels in his lungs and that did the trick.

After 106 days in the NICU, Declan, nicknamed “the Chunkster” because he was the heaviest of the bunch, was the first to go home on April 17. “It was truly a bittersweet moment” says nurse Watsky, who made certain to be there to say goodbye to Declan, even though it was her day off. “After seeing him grow from just over 1 pound, to learning how to eat, how to breathe on his own, and so much more in between – I was so proud of him,” she says.

“Rockstar Rowan” went home on April 30. And firstborn Cian finally joined the rest of his family on May 4. “I’m so proud of the chubby, feisty, blue-eyed, beautiful boy he is,” nurse Jackman says.

The triplets left the NICU with respiratory support and monitors but eating all of their foods without issue. As of July 15: Cian was 13 pounds, 1 ounce; Declan was 14 pounds, 11 ounces; and Rowan was 10 pounds. They are hitting all of their milestones — babbling, cooing, laughing, smiling and rolling over.

The DeShanes’ relationship with UVM Medical Center is far from over. They make regular visits to see a pediatric pulmonologist and ophthalmologist. And neonatologist Deirdre O’Reilly, MD, director of UVM Medical Center’s Neonatal Medical and Developmental Follow-up Clinic, will see the preemies regularly during their first three years to assess their progress, especially regarding motor, language and cognitive skills. If there are gaps, her staff will connect them to the appropriate supportive services. “Getting adequate and targeted therapies can be life-changing for babies,” she says.

In her 13 years of practice, Dr. O’Reilly had never seen a baby born as early as Cian survive. Each of the triplets are doing better than she expected, and that success is what makes her work so worthwhile. She says: “It really is amazing, because you can learn about the numbers of premature infants that survive, but really experiencing it with the parents and seeing the joys in their faces, and the kids too, it’s just magnificent.”

Source:https://www.uvmhealth.org/healthsource/miracle-micro-preemie-triplets-overcome-odds

Breastmilk for preterm babies | pumping | exclusive human milk diet and donor human milk bank

CanadianPreemies  Aug 3, 2020

Fabiana Bacchini, CPBF’s Executive Director, talks with Natalie Millar about the importance of breastmilk for preterm babies, pumping, exclusive human milk diet and donor human milk bank. . Natalie has been a clinical dietitian for 15 years with 10 years dedicated to the Regina General Hospital NICU. She is a certified lactation consultant; co-chair of the Donor Human Milk committee of Saskatchewan and Coordinator of the Regina General Hospital’s Milk Drop for NorthernStar Mothers Milk Bank Milk. According to her two young kids, Natalie’s job is to steal milk from ladies and feed it to all the teeny babies.

Strategies to Improve Mother’s Own Milk Expression in Black and Hispanic Mothers of Premature Infants

Cartagena, Diana PhD, RN, CPNP; McGrath, Jacqueline M. PhD, RN, FNAP, FAAN; Reyna, Barbara PhD, RN, NNP-BC; Parker, Leslie A. PhD, RN, NNP-BC, FAAN; McInnis, Joleen MS, LIS, MFA Strategies to Improve Mother’s Own Milk Expression in Black and Hispanic Mothers of Premature Infants, Advances in Neonatal Care: February 2022 – Volume 22 – Issue 1 – p 59-68 doi: 10.1097/ANC.0000000000000866

Abstract

Background: 

Mother’s own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants.

Purpose: 

A review of the literature was conducted to answer the clinical question: “What evidence-based strategies encourage and improve mother’s own milk expression in Black and Hispanic mothers of premature infants?”

Methods/Search Strategy: 

Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7).

Findings/Results: 

Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area.

Implications for Practice: 

Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice.

Implications for Research: 

Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers.

Source:https://journals.lww.com/advancesinneonatalcare/Abstract/2022/02000/Strategies_to_Improve_Mother_s_Own_Milk_Expression.12.aspx

Cardiologists are using a new device to help treat micro-preemies — babies born before the 26th week of pregnancy and/or weighing less than 2 pounds — who develop a life-threatening heart defect at birth.

By: Sara Sidery • Posted: January 17, 2022

State-of-the-art technology is helping save the lives of some of Louisville’s youngest patients.

Cardiologists are using a new device to help treat micro-preemies — babies born before the 28th week of pregnancy and/or weighing less than 2 pounds — who have a heart defect caused by part of the fetal structure that remains at birth.

Joshua Kurtz, M.D., pediatric cardiologist with Norton Children’s Heart Institute, affiliated with the U of L School of Medicine, has performed numerous successful procedures to treat this defect known as a patent ductus arteriosus (PDA). It is one of the most common congenital heart defects in premature babies.

The PDA is a connection between the blood vessels that carry blood from the heart to lungs and the rest of the body. A normal part of fetal development, the opening allows the mother’s body to provide enough blood and oxygen until birth. Soon after a newborn takes its first breaths, the opening typically closes automatically, but with some premature babies, it remains open.

“The PDA causes excess blood from an infant’s heart to pump into their lungs, which can lead to fluid in the lungs or heart failure and make it difficult to breathe and grow  if not addressed,” Dr. Kurtz said. “This new advancement in technology allows us to respond quickly with a minimally invasive procedure.”

The Amplatzer PiccoloTM Occluder, approved by the Food and Drug Administration in 2019, is an alternative to open  surgery and can close the opening in a baby’s heart with fewer risks and a speedier recovery. The “PiccoloTM” device, which is the size of a small pea, is implanted by using a special IV known as a sheath in the infant’s leg and guiding the device through blood vessels to seal the connection in the blood vessels. Healthy tissue eventually grows around the small mesh piece.

Recently, a team at Norton Children’s Heart Institute successfully performed the procedure on a 2.4-pound micro-preemie who was born at 24 weeks and  had  heart failure due to the PDA. Dr. Kurtz and his colleague Dr. Edward Kim performed three additional procedures in early December, and the babies — who weighed less than 2.5 pounds — were able to continue their recovery in the neonatal intensive care unit.

The Amplatzer PiccoloTM Occluder is just one piece of advanced equipment at Norton Children’s Heart Institute that can help treat heart defects commonly seen in babies. Using the latest technology means children undergoing treatment or diagnosis in the catheterization lab will receive less radiation, speedier, and more accurate procedures, according to Dr. Kurtz.

Source:https://nortonchildrens.com/news/heart-defects-in-babies/

The Teladoc device connects consultants.

Hospital robots will save the lives of hundreds of premature babies

The technology is already enabling consultants to work at multiple sites at once, saving vital time

James Tapper Sun 21 Nov 2021

Hundreds of premature babies could be saved by using new technology trialled during the pandemic that will allow doctors to treat them remotely, leading doctors say.

Telemedicine “robots” that enable consultants to make bedside video calls have been used at Liverpool Women’s and Alder Hey children’s hospitals to treat sick babies.

Now the head of the hospitals’ neonatal unit is putting together plans to use the Teladoc devices, so that specialists can use their expertise to help teams at smaller hospitals treat children, even in emergencies.

Dr Chris Dewhurst, the clinical director of the Liverpool Neonatal Partnership, said: “This definitely has the potential to save the lives of extremely preterm infants who were born outside of specialist centres, and improve their outcomes.

“What we’ve demonstrated is that it’s easy to use, it improves the quality of care for babies and their families, improves the speed of review, and it is very close to being there in person.”

The device, which sits on a mobile frame, has cameras, a screen and even a stethoscope, and can also link to MRI scanners and thermal-imaging cameras. It allows a consultant watching from elsewhere to view a patients’ medical records on the spot.

Dewhurst and his team began using two of the devices in March 2020. “We lost seven of our 14 consultants due to shielding or isolation – 40% of the time available for clinicians to be in hospital. It [the robot] kept us going.”

On some occasions, using the robots was better than being there in person, because the device has a camera on a boom that can be placed above the baby to show what’s happening, he said. “If I was there in person, I wouldn’t be able to see that because there were people around the baby.”

About 90,000 babies a year in England need some sort of specialist care after they are born. There are 54 Neonatal Intensive Care Units (NICUs) such as the one in Liverpool that treat the most serious cases of premature babies and those with serious conditions. Another 83 hospitals have Local Neonatal Units (LNUs) that offer short-term intensive care. And there are 44 Special Care Baby Units for monitoring the least serious cases.

Doctors try to identify which foetuses might require help after birth, but that is not always possible, and 9,523 babies needed to be transferred between hospitals at least once in 2015, according to figures from the National Neonatal Audit Programme compiled by Bliss, the charity for babies born sick or prematurely.

“For babies who are extremely preterm, and have not been able to move into an NICU, then they’re not going to be looked after by people with the specialist skills. And we know that those babies have worse outcomes,” Dewhurst said.

He is bidding for funding for the devices in hospitals with SCBUs so that clinical teams can call on specialist advice quickly.

“We now need to find the funding so that babies who were born in other hospitals who need immediate intervention can have an neonatologist there immediately, within minutes, rather than them not being there at all, because they’re 40 to 50 miles away.”

A similar system has been run by the Mayo clinic in Rochester, Minnesota, where neonatologists support teams at 19 regional hospitals.

Dr Jennifer Fang, medical director for the Mayo Clinic’s teleneonatology programme, said that only babies in a critical condition needed to be transferred, and fewer parents had to go through the stress of being separated from their babies.

“What we’ve observed is that the odds of a baby needing a transfer to a higher level of care or transfer to a hospital with an NICU are reduced by anywhere from 30 to 50%,” she said.

With difficult births or injuries to babies during birth, the Mayo specialists have a target to be on hand for remote consultations within five minutes.

Before the programme, the clinic was involved in birth-injury lawsuits about every eight to nine months, Fang said. “Now that our programme’s in place, we haven’t had a single birth-injury case for the last eight years.”

A study by the clinic showed that having neonatologists involved remotely meant that clinical teams in smaller hospitals were less likely to be overwhelmed by the complexity of dealing with a sick baby. Babies were more likely to have checks on temperature, breathing and glucose levels.

Jonathan Patrick of Consultant Connect, which supplied the robots, said the devices could be used in other circumstances. “It allows you to have access to clinicians, for example, who have retired but still want to be part of the workforce, yet can’t go to hospital every day.”

A trial is underway at University Hospitals Leicester NHS Trust where consultants doing elective surgery are often split across two sites. Dr Steve Jackson, who is running the trial, said that consultants on different sites could dial in to a consultation and discuss the case on the spot rather than doing separate ward rounds.

Source:https://www.theguardian.com/society/2021/nov/21/hospital-robots-will-save-the-lives-of-hundreds-of-premature-babies

Retinopathy of Prematurity Requiring Treatment Is Closely Related to Head Growth during Neonatal Intensive Care Unit Hospitalization in Very Low Birth Weight Infants

 Bae S.P.a · Kim E.-K.b · Yun J.c · Yoon Y.M.d · Shin S.H.b · Park S.Y.e

      Neonatology  https://doi.org/10.1159/000519714

Abstract

Background: Retinopathy of prematurity (ROP) is caused by prenatal sensitization and postnatal insults to the immature retina. This process can be associated with the postnatal growth of preterm infants. We investigated whether ROP requiring treatment was associated with the postnatal growth failure of very low birth weight (VLBW) infants. 

Method: From a cohort of VLBW infants (birth weight <1,500 g) registered in the Korean Neonatal Network from January 2013 to December 2017, 3,133 infants with gestational age (GA) between 24 and 28 weeks were included in the study. Postnatal growth failure was defined when the change in each anthropometric z-score between birth and discharge was <10th percentile of the total population. Propensity score matching (PSM) at 1:1 was performed to match the distribution of GA and postnatal morbidities between infants with and without ROP requiring treatment. Prenatal factors and ROP were analyzed by conditional logistic regression. 

Results: Of 3,133 enrolled infants, 624 (19.9%) were diagnosed with ROP requiring treatment. After PSM, ROP requiring treatment was associated with postnatal growth failure assessed by head circumference (adjusted odds ratio [aOR] 1.91, 95% confidence interval [CI] 1.18–3.09), but not weight (aOR 1.45, 95% CI 0.97–2.17) and length (aOR 1.21, 95% CI 0.81–1.82). 

Conclusion: ROP requiring treatment was associated with poor head circumference growth, not with weight and length. Our findings suggest that ROP requiring treatment and poor head growth during NICU hospitalization are fundamentally related.

Source: https://www.karger.com/Article/FullText/519714

A digital decision aid for shared decision-making in prenatal counseling

February 10, 2022   Lindsey Carr, Associate Editor

van den Heuvel JFM, Hogeveen M, Lutke Holzik M, van Heijst AFJ, Bekker MN, Geurtzen R. Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing. BMC Med Inform Decis Mak. 2022;22(1):7. Published 2022 Jan 6. doi:10.1186/s12911-021-01735-z

When pregnant women and their partners experience imminent extreme premature labor, they must decide how to proceed if labor continues. With the risks of morbidity and mortality in extremely premature infants, 2 procedures are considered treatment options. Through shared decision-making with their provider, patients choose treatment based on their values and preferences; Palliative comfort care—providing warmth and comfort with no medical assistance—or early intensive care—resuscitation of the infant and initiation of neonatal intensive care (NICU).

Because the treatment options for imminent extreme premature labor center largely on patient preference, decision aids (DA) can help facilitate the patient-provider discussion and guide the shared decision-making process.

Providers often use DA tools to assist in patient education, prenatal counseling, and shared treatment decisions regarding imminent extreme premature labor, including:

  • A card set with images and illustrations of survival rates and NICU complications
  • 10-minute video clips of parents discussing treatment choice and explaining their decision
  • a tablet application
  • a virtual reality experience

Researchers in the Netherlands developed an open-access, web-based DA that informs, guides, and supports the prenatal counseling process for patients and providers.1

Dutch national guidelines for prenatal counseling in imminent extreme preterm labor were published in 2019 using the International Patient Decision Aid Standards (IPDAS) process. They conducted surveys and interviews with patients and providers to determine general views and preferences on prenatal counseling, as well as DA preferences and concerns. They concluded that, while both patients and providers wanted supportive materials to assist verbal conversation, they were not readily available.

Researchers in the Netherlands used these initial findings to inform development of a digital DA. To create the prototype, they recruited individuals previously involved in the Dutch guidelines’ development for multiple rounds of testing—6 sets of parents with children born extremely premature (between 240/7 weeks and 246/7, 2 obstetricians, 1 neonatologist, 1 expert in quality-of-care improvement, 1 DA-development professional, and 1 Dutch language expert.

An online module, complete with graphics, then became the initial prototype. Researchers tested feasibility on a group of providers and pregnant women who were not involved in earlier testing. Patients comprised of 2 groups—group 1 comprised pregnant women between 240/7 and 24 6/7 weeks gestation who presented to an outpatient clinic for a routine antenatal visit with no history of premature delivery (n=4). The second group included pregnant women admitted for imminent preterm labor <246/7 weeks gestation and received antenatal counseling (n=3).

Clinician participants included 4 obstetricians and 4 neonatologists from 2 Dutch university hospitals with NICU facilities. Both parties filled out a questionnaire consisting of a rating from 1-5 (very much disagree-very much agree), plus 3 elements they liked and 3 that could be improved.

Researchers ultimately included the following informational content into the DA:

  • General information on imminent extreme premature labor
  • explanation of the 2 options: early intensive care or palliative comfort care
  • consequences of comfort care (such as, no need for invasive procedures, expected death within hours following birth)
  • mortality and survival rates
  • risks and long-term results for extreme preterm infants to have neurodevelopmental
  • physical, visual, and hearing problems

For decision support, they included a comparison page, key points, and “my choice,” which reflected parental values and standards. Visual elements in the DA included an illustration of 2 neonates to compare size and weight after extreme preterm birth and term delivery, an image of an extremely preterm infant in an incubator (active care) with notes on all life-supporting devices, an image of parents holding an infant in blankets (comfort care) and illustrations to show possible disabilities.

In its final form, the DA became a web-based platform available to Dutch providers and patients via internet, tablet, and smartphone browsers. It has been approved by the Dutch Society of Obstetrics and Gynecology, the Dutch Pediatric Society, and the Dutch patient organization CARE4NEO.

The decision-support elements in this web-based DA tool set it apart from others currently available. Researchers noted that the DA should support, not replace, the verbal counseling conversation. It may also be used by patients prior to and following counseling.

“Focusing on the format and distribution of our DA, we developed a freely available online DA and, moreover, included features to support decision making and help parents think about their values and preferences,” the authors wrote. “This is anticipated to enhance the uptake and use of the DA amongst different types of users, and we hope to increase the involvement of parents in decision-making.”

Source:https://www.contemporaryobgyn.net/view/a-digital-decision-aid-for-shared-decision-making-in-prenatal-counseling

Kat enjoying the view at Edinburgh Castle, Scotland

KAT’s Korner

And for our younger brother and sisters:

5 Habits of People Who Are Truly Genuine and Authentic

Feb 24, 2018       SUCCESS INSIDER

Want to discover the SECRETS to evolve beyond your recurring fears and doubts so you can rise above any obstacle that comes?

TECaN, TIPS, Testimonies

Morocco,  officially the Kingdom of Morocco, is the northwesternmost country in the Maghreb region of North Africa. It overlooks the Mediterranean Sea to the north and the Atlantic Ocean to the west, and has land borders with Algeria to the east, and the disputed territory of Western Sahara to the south. Morocco also claims the Spanish exclaves of CeutaMelilla and Peñón de Vélez de la Gomera, and several small Spanish-controlled islands off its coast. It spans an area of 446,550 km2 (172,410 sq mi) or 710,850 km2 (274,460 sq mi), with a population of roughly 37 million. Its official and predominant religion is Islam, and the official languages are Arabic and Berber; the Moroccan dialect of Arabic and French are also widely spoken. Moroccan identity and culture is a vibrant mix of BerberArab, and European cultures. Its capital is Rabat, while its largest city is Casablanca.

In 2014, Morocco adopted a national plan to increase progress on maternal and child health. The Moroccan Plan was started by the Moroccan Minister of Health, Dr. El Houssaine Louardi, and Dr. Ala Alwan, WHO Regional Director for the Eastern Mediterranean Region, on 13 November 2013 in Rabat. Morocco has made significant progress in reducing deaths among both children and mothers. Based on World Bank data, the nation’s maternal mortality ratio fell by 67% between 1990 and 2010. In 2014, spending on healthcare accounted for 5.9% of the country’s GDP. Since 2014, spending on healthcare as part of the GDP has decreased. However, health expenditure per capita (PPP) has steadily increased since 2000. In 2015, the Moroccan health expenditure was $435.29 per capita. In 2016 the life expectancy at birth was 74.3, or 73.3 for men and 75.4 for women, and there were 6.3 physicians and 8.9 nurses and midwives per 10,000 inhabitants. In 2017, Morocco ranked 16th out of 29 countries on the Global Youth Wellbeing Index. Moroccan youths experience a lower self-harm rate than the global index by an average of 4 encounters per year.

PRETERM BIRTH RATES – Morocco

Rank: 160 – Rate: 6.7%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Source:https://en.wikipedia.org/wiki/Morocco

COMMUNITY

Gravens By Design: The Importance of NICU Discharge Planning Guidelines and Standards

Vincent C. Smith, MD, MPH; Kristy Love; Erika Goyer, BA

When families reflect upon their experiences preparing to transition from the NICU (Neonatal Intensive Care Unit) to home, most families generally do not use the terms “joyful,” “easy,” “perfect,” or “stress-free.” More often, families use terms like “abrupt,” “sudden,” “lonely,” and “scary.” In truth, some families wonder if they even had a discharge preparation plan at all.

They, however, should have had a plan because the American Academy of Pediatrics (AAP) has set clear expectations. The AAP recommends that the transition to home occur when the infant achieves physiologic maturity, and there is an active program for parental involvement and preparation for care of the infant at home. (1) The AAP does not, however, provide much detail about the program for parental preparation. This may be the crux of the issue or source of the problem. While we know that parents need to be prepared, we have not put programs in place to prepare them.

The National Perinatal Association (NPA) hopes to help fill that gap. NPA formed an interdisciplinary work group that developed universal, adaptable, evidence-informed guidelines for NICU discharge preparation and transition planning in response to the unmet need for a program for thoughtful discharge preparation and transition planning. NPA hopes that NICU families and staff will find the guidelines beneficial, useful, and pertinent. Ideally, these guidelines will assist staff in providing clear and consistent messages of both action and guidance for parents and families and provide a systematic approach to required tasks and advanced planning of discharge teaching prior to their anticipated discharge. NPA hopes these guidelines will provide more uniformity in discharge preparation and reduce uncertainty and stress with the discharge preparation and transition planning process.

 Using the guidelines

 Smith et al. (2013) defined NICU discharge readiness as “the attainment of technical skills and knowledge, emotional comfort, and confidence with infant care by the infant’s primary caregivers at the time of discharge”; and NICU discharge preparation as “the process of facilitating discharge readiness to make the transition from the NICU to home successfully.” (2) Discharge readiness is the desired outcome, and discharge preparation is the process.

We understand that it is impossible to create a comprehensive discharge preparation and transition planning program that will work for every family in every NICU setting. Instead, we propose guidelines and recommendations that focus on content and process. We strived to create recommendations that are both general and adaptable while also being specific and actionable. Each NICU’s implementation of this guidance will depend on the unique makeup and skills of their team and the availability of local programs and resources. Our guidelines are divided into the following sections:

 Basic information that emphasizes the content that every family will need, without taking into account each family’s and infant’s specific needs:

Discharge Education §Discharge Education Content § Family Preferred Educational Modality § Family Comprehension §Timing Of Discharge Education § Family Education Support

Discharge Planning Tools § Discharge Summary § NICU Roadmap § Discharge Planning Folder § Written Discharge Information § Supplemental Discharge Educational Materials § Journal

Discharge Planning Team § Infant Care Givers § Consistent Nursing Provider § Family Support People § Discharge Coordinator/Discharge Planner/Case Manager § Sibling Resources

Discharge Planning Process § Discharge Planning Timing § Discharge Planning Meeting § Discharge Planning Goals

Anticipatory guidance in the context of NICU discharge preparation and transition planning–refers to helping the family develop a realistic idea of what their life will be like with their infant. This means in the immediate future following discharge as well as over their life course:

Home and Family Life § Infant Behavior § Coping with a Crying Infant § Emergency Planning § Parental Mental Health § Paying for a NICU Stay

Family and Home Needs Assessment reviews family and home needs assessment to inform discharge planning § Family and Home Needs Assessment Process § Family And Home Needs Assessment Content 

Transfer and Coordination of Care deliberate transfer and coordination of care from NICU providers to community providers and the medical home § Primary Care Involvement § Primary Care Contact § NICU Contact with the Family After Discharge § Parental Mental Health §Community Resources o Community Notification

Other Important Considerations examines some important topics to consider when doing discharge planning. We are mindful of families who are § Limited English proficient § Active military§Lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+)§headed o Disabled o Culturally and/or philosophically distinct in ways that need to be considered in NICU discharge transition planning.

Implications: This is a call to action. In implementing these guidelines, we need to address diversity, equity, inclusion, accessibility, and belonging. That may mean that policies need to change. Community connections may need to be adapted. “How we are” may need to change.

Conclusion:

We know that parents whose babies are admitted to the neonatal intensive care unit (NICU) need support. Whether their baby’s stay is brief or long, uncomplicated or complex, a NICU stay changes how they care for their infant and how they will parent once they are discharged.

If parents are going to become confident and competent caregivers for their infants, they need guidance and support. The education they receive while in the NICU cannot be limited to performing caregiving tasks. It has to expand to meet their need to become a parent to a medically-fragile child. It has to meet their social and emotional needs. It must welcome them into a community of parents and providers. This is what a smart, timely, coordinated NICU discharge preparation and transition planning program implemented by an interdisciplinary NICU team can deliver.

The guidelines are available as a supplement in the Journal of Perinatology and on the NPA.

Source: http://neonatologytoday.net/newsletters/nt-jan22.pdf

Saad Lamjarred & Saber Rebai & RedOne – Sahra Sabahi | 2021 | السهرة صباحي

13,521,671 views   Jul 10, 2021

Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018

January 18, 2022

Edward F. Bell, MD1Susan R. Hintz, MD, MS Epi2Nellie I. Hansen, MPH3; et alCarla M. Bann, PhD3Myra H. Wyckoff, MD4Sara B. DeMauro, MD, MSCE5Michele C. Walsh, MD, MS6Betty R. Vohr, MD7Barbara J. Stoll, MD8Waldemar A. Carlo, MD9Krisa P. Van Meurs, MD2Matthew A. Rysavy, MD, PhD10Ravi M. Patel, MD, MS8Stephanie L. Merhar, MD, MS11Pablo J. Sánchez, MD12Abbot R. Laptook, MD7Anna Maria Hibbs, MD, MSCE13C. Michael Cotten, MD, MHS14Carl T. D’Angio, MD15Sarah Winter, MD16Janell Fuller, MD17Abhik Das, PhD18; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

JAMA. 2022;327(3):248-263. doi:10.1001/jama.2021.23580

Key Points

Question  Among extremely preterm infants born at US academic medical centers between 2013 and 2018, what were mortality, in-hospital morbidity, and 2-year neurodevelopmental outcomes?

Findings  In this observational study based on a prospective registry of 10 877 infants born at 22-28 weeks’ gestational age in 2013-2018 in 19 US academic medical centers, survival to discharge occurred in 78.3% and was significantly improved compared with a historical rate of 76.0% among infants born in 2008-2012. Among infants born at less than 27 weeks’ gestational age who survived to follow-up assessment at 2 years, 49.9% had been rehospitalized and severe neurodevelopmental impairment occurred in 21.2%.

Meaning  Among extremely preterm infants born at US academic medical centers from 2013 to 2018, survival to discharge significantly improved compared with infants born in 2008-2012, but among those born at less than 27 weeks’ gestational age, rehospitalization and neurodevelopmental impairment at 2 years were common.

Abstract

Importance  Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity.

Objective  To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months’ corrected age for extremely preterm infants.

Design, Setting, and Participants  Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks’ gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months’ corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age.

Exposures  Extremely preterm birth.

Main Outcomes and Measures  Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months’ corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices.

Results  The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment.

Conclusions and Relevance  Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks’ gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.

Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018 | Child Development | JAMA | JAMA Network

PREEMIE FAMILY PARTNERS

I Gave Birth to a Preemie During the Pandemic(Feat. @Dad, how do I?)

PBS Voices – Nov 23, 2020 – #AmericanPortraitPBS #BirthStory #Pregnancy

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Standard of Care to Incorporate Mental Health Care for NICU Families: TECaN Embarks on National Advocacy Campaign

Katie Hoge, MD, Ali Slone, MD, Ann Blake, MD, MPH

We are thrilled to announce the official launch of the Carousel Care Advocacy Campaign. This effort is led by the group TECaN (Training and Early Career Neonatologists), a subspecialty group of the American Academy of Pediatrics. This campaign focuses on the need for mental health care for NICU families throughout the NICU journey. We know that a need for mental health support for NICU families is a long-standing need preceding the COVID-19 pandemic; however, the advent of the pandemic has exacerbated these needs and brought the mental health concerns of families into sharper focus. We know from pre-pandemic research that about half of NICU parents at any given time suffer from anxiety or depression during a NICU stay and that a third of parents go on to develop PTSD after a NICU admission. We believe that the need is even higher with the onset of the pandemic and its numerous added challenges and burdens on families. Despite the high needs and impact on child and family outcomes, there is no universal NICU standard to address familial mental health. Due to this, TECaN has ambitiously resolved to take on the task of altering the standard of care within the NICU to include mental health care through all-around support and wellbeing for NICU families via the national advocacy campaign, Carousel Care (#CarouselCare).

TECaN is partnering with multidisciplinary experts from across the country to educate and empower NICU providers on addressing mental health needs for NICU families adequately. TECaN is teaming up with experts in Neonatology, Psychiatry, Psychology, Maternal, and Fetal Medicine, Palliative Care, Social Work, Child Life, Nursing, and NICU parents to create content and resources delivered throughout the campaign. The campaign, launched in October 2021, will continue to deliver content through live webinars (also viewable post live date) and supplemental materials, which can all be found on the campaign’s website through October 2022 (https:// http://www.aap.org/en/community/aap-sections/ sonpm/tecan/advocacy/). The content over the course of the year will be organized into four main phases.

Phase one focuses on the prenatal period for parents who learn that they may require a future NICU admission for their child’s survival and the general need for mental health resources from the start of the NICU journey. Webinars and supplemental materials found on our website will include topics on managing parental expectations and addressing emotional needs in the prenatal consult, understanding the scope of mental health challenges of NICU families, and special consideration populations of diversity, equity, and inclusion relating to NICU mental health. Live webinars will take place monthly from October 2021 through December 2021, and all webinars will be available for viewing on our website after their original air date.

Phase two of the campaign will focus on the time during a NICU admission. Topics will include mental health impacts upon the interrupted bonding of the parent-infant dyad, screening for parental mental health concerns throughout the NICU admission, and potential mental health interventions during the NICU stay. This content will be delivered beginning in January 2022 through March 2022.

Phase three will focus on the NICU discharge process and continuity of care after NICU admission. Topics will include establishing mental health resources for families post-discharge, comforting families during bereavement, and helping families thrive after the NICU. This content will be delivered beginning in April 2022 through June 2022.

The fourth and final phase of the campaign will focus on incorporating these new standards of care into NICUs across the country in a wide range of clinical settings with variable resources. Topics will include webinars on including NICU family mental health within your NICU and caring for the caregiver. In recognition of each unit’s unique challenges, we strive to provide means for all NICUs to consider adopting these changes into clinical practice. We also recognize that it is vital to support our team members’ mental health to care for families effectively. One cannot pour from an empty cup, so we will also address caring for ourselves as providers. This content will be delivered beginning in July 2022 through October 2022.

Source:http://neonatologytoday.net/newsletters/nt-dec21.pdf

Preterm lung health study – Dr Shannon Simpson

Mar 22, 2018 Telethon Kids Institute

A Telethon Kids Institute study published today in The Lancet Child & Adolescent Health has found that survivors of very preterm birth face declining lung function as they get older, rather than growing out of any lung problems as previously believed. In the biggest study of its kind since significant improvements in neonatal critical care during the 1990s drastically improved the chances of survival for preterm babies, a team of researchers led by Dr Shannon Simpson spent eight years following the progress of 200 babies born at less than 32 weeks’ gestation, along with 67 controls born at full term.

When All Becomes New Book Trailer by Dr. Benjamin Rattray

Sep 1, 2021      Benjamin Rattray

Book trailer for When All Becomes New: A Doctor’s Stories of Life, Love, and Loss featuring Benjamin Rattray, writer and neonatologist.

Fertility Treatments Don’t Raise Odds for Smaller, Preemie Babies

January 12, 2022

Babies conceived through infertility treatment are more likely to be born early and small.

But there are reasons other than medically assisted reproduction to explain this difference, a new study concludes.

“Rather than the infertility treatment itself, our new findings highlight the importance of parents’ underlying fertility problems and health conditions, and infants’ birth characteristics, such as their birth order and whether they are a twin, on birth weight and pregnancy term,” said study co-author Alina Pelikh. She’s a research fellow at the University College London Center for Longitudinal Studies in the U.K., which worked in partnership with the University of Utah in Salt Lake City.

For the study, researchers analyzed data on 248,000 births in Utah.

They found that differences in birth weight and length of pregnancy between couples who conceived naturally and those who used in vitro fertilization (IVF), artificial insemination or fertility drugs were insignificant once family circumstances were taken into account.

The study focused on births in Utah between 2009 and 2017 and various indicators of mothers’ health, including pre-pregnancy body mass index (an estimate of body fat based on height and weight), blood pressure, age, education level and whether they had multiple births.

In all, about 5% of infants in the study were conceived through medically assisted reproduction (MAR).

Use of fertility-enhancing drugs was most common (60%), followed by assisted reproduction, including IVF (26%), and artificial insemination (14%).

Children who were conceived through MAR were 10% more likely to be born premature and had 9% greater odds of low birth weight compared to naturally conceived infants.

More invasive treatments — such as IVF and artificial insemination — were more strongly linked to adverse birth outcomes. Infants conceived using fertility drugs had outcomes more similar to those conceived naturally.

But differences in outcomes narrowed once the mothers’ health, parents’ social and economic background, and infants’ birth characteristics were factored in.

Drawing from a statewide database, researchers zeroed in on a subgroup who had given birth to children using both MAR and natural conception during different pregnancies.

“By comparing births from the same mother we were able to better isolate the impact on these births of medically assisted technologies,” said co-author Ken Smith, a professor of family studies and population science at the University of Utah.

The upshot: Once a mother’s age, pre-pregnancy BMI and infants’ birth characteristics were factored in, the siblings had similar pregnancy terms and birth weights.

That suggests that family circumstances and unobserved parental characteristics, such as genetic traits, are important when explaining the association between MAR and adverse birth outcomes.

“Obtaining similar results in highly diverse contexts — in terms of demographics, fertility rates and access to the medically assisted reproduction treatments — strengthens the argument that adverse birth outcomes among medically assisted reproduction conceived infants are unlikely to be driven by the reproductive technology itself,” said co-author Alice Goisis, an associate professor at the UCL Center for Longitudinal Studies.

“This new evidence can go on to enrich existing health guidance about the risks and benefits of infertility treatments, hopefully raising awareness among families who are thinking about using medically assisted reproduction to help them conceive,” she added.

Source:https://consumer.healthday.com/ivf-babies-and-due-dates-2656224927.html

INNOVATIONS

Preterm Birth Information for Education Professionals

11 January 2021 – E-learning resource focussing on preterm birth information recgonised with excellence award.

Camilla Gilmore and her colleagues in the Premature Infants’ Skills in Mathematics (PRISM) team, led by Professor Samantha Johnson (University of Leicester), were recently awarded a British Association of Perinatal Medicine (BAPM) Gopi Menon Award for ‘Excellence in Research or Innovation’ for the development of their PRISM e-learning resource for education professionals. The awards are given for excellence and contribution to patient and family care in the field of Perinatal Medicine. 

The e-learning resource was co-designed with teachers, educational psychologists, parents of children born preterm, and young adults who were born preterm themselves, and comprises evidence-based information about what preterm birth is, how it may affect children’s development and learning, and what can be done to support them in the classroom. The resource has been evaluated and shown to significantly improve teachers’ knowledge of outcomes following preterm birth and their confidence in supporting preterm born children in the classroom. 

Enter Below to review/access  the five learning resources have been developed to improve your knowledge and confidence in supporting prematurely born children in the classroom.

Source: https://www.nottingham.ac.uk/helm/dev/prism/

Ventilation and respiratory outcome in extremely preterm infants: trends in the new millennium

European Journal of Pediatrics (2022)

Regin, Y., Gie, A., Eerdekens, A. et al. Ventilation and respiratory outcome in extremely preterm infants: trends in the new millennium. Eur J Pediatr (2022). https://doi.org/10.1007/s00431-022-04378-y

Abstract

Ventilation and respiratory care have substantially changed over the last decades in extremely premature neonates but the impact on respiratory health remains largely unclear. To determine changes in respiratory care and disease frequency in extremely premature infants, a retrospective single-centre cohort study of extremely preterm infants was performed. All infants born alive between 24 + 0 and 27 + 6 weeks of gestation in 2000–2001 (Epoch 1), 2009–2010 (Epoch 2), and 2018–2019 (Epoch 3) were included. The primary outcome of this study was the incidence of bronchopulmonary dysplasia (BPD, diagnosed according to three different criteria) or death. Secondary outcomes included the usage of different ventilation modes, changes in pharmacotherapy, and the incidence of significant extra-pulmonary morbidities. A total of 184 neonates were included of whom 151 survived until 36 weeks of corrected GA (cGA). Oxygen or positive pressure dependence increased over time (26.1%, 41.7%, and 56.1% respectively), with higher adjusted odds in Epoch 3 for the composite outcome “BPD or death” (adjusted odds ratio: 2.55 [95%CI 1.19–5.61]). Severity-based definitions showed increasing trends in survivors only. Time spent on invasive mechanical ventilation was similar throughout the years, but the use of non-invasive ventilation significantly increased in Epoch 3 (32.0 [95%CI 25.0–37.0] vs 27.0 [95%CI 26.0–32.0] vs 53.0 [95%CI 46.0–58.0] days). Moreover, mortality-adjusted rates of severe IVH, NEC, or intestinal perforation and multiple sepsis tended to decrease.

Conclusion: In spite of significant clinical advancements and adherence to novel treatment guidelines in our neonatal intensive care unit, the incidence of BPD increased over time.

What is Known:
• Rates of BPD are stable or increase in population-based studies.
• Extremely preterm infants are particularly susceptible to developing BPD.

What is New:
• Despite increased use of evidence-based corticosteroid administration and early initiation of caffeine, the incidence of BPD has not decreased over the past decade. 
• Increased usage of non-invasive ventilation is associated with an increase of BPD incidence

Source:https://link.springer.com/article/10.1007%2Fs00431-022-04378-y

Medicaid, Doulas and Reducing Maternal and Infant Mortality Rates in the United States

Barb Himes, IBCLC, CD

First Candle’s mission is to reduce the rates of sleep-related infant mortality, which involves taking a hard look at maternal health – a critical gateway to infant health, and a reason why the American Academy of Pediatrics (AAP) includes in its infant safe sleep guidelines the recommendation that pregnant women seek out and obtain regular prenatal care. However, many factors interfere with maternal access to health care before, during, and after pregnancy, including racial/ethnic disparities and socioeconomics. Mortality rates due to pregnancy and birth complications are more than three times higher in Black than White women, and Black infants are more than twice as likely to be born prematurely or die within their first year of life than non Latinx white infants. Further complicating this is that women have also reported feeling they experience diminished autonomy or indifference in the provider-patient relationship, which could affect their outcomes and attitudes toward accessing care.

On the economic side, according to the Centers for Medicare and Medicaid Services (CMS), nearly two out of three adult women enrolled in Medicaid are of childbearing age, and Medicaid covers around 42% of births in the United States. Of those, whites make up 41.8% of women covered by Medicaid or the Children’s Health Insurance Program (CHIP), Hispanic women 28.1%, Black women 21.0%, and the rest Asian or native ethnicities.

In addition, only 21% of women in 2018 had a family income of 250% of the Federal Poverty Level (FPL) compared to 56.7% for women overall, and 20% had a family income of only 50 to 99% of the FPL. (2) The lack of financial resources can get in the way of access to health care to the degree needed throughout the birthing process and add to the risk of compromised health for infants.

But there is something that can address this combination of financial and social strain and help pregnant women get adequate care: make doulas part of the maternal health support network covered by Medicaid.

This approach advanced by the National Health Law Program’s Doula Medicaid Project monitors the status of Medicaid efforts regarding doula reimbursement in the United States, state by state. The ongoing-updated chart can be found at https://healthlaw.org/ doulamedicaidproject/. The program’s goal is to ensure that all pregnant enrollees in Medicaid who want access to a doula will have one.

 According to the latest standings, there are currently four states (Oregon, New Jersey, Minnesota, Florida) where Medicaid is actively reimbursing for doula services, and eight states are putting Medicaid doula benefits in place. Ten states report action has been proposed but has made no progress, and those remaining have been taking steps related to care, such as setting up doula registries and certification programs.

This initiative matters because it contributes to maternal health care support, directly affecting maternal outcomes in at-risk populations and providing a method of care that fosters a level of trust that can enhance health care compliance to the benefit of mother and baby.

Doulas are a trained personal support system for expectant mothers and, depending upon the care plan, can be with the mother for prenatal and postpartum visits and the birth. Research studies indicate that doula support has contributed to better birth outcomes, reduced caesarian sections, advanced breastfeeding, and bolstered maternal emotional wellbeing. (3) They also serve mothers and their partners in their homes, literally meeting families where they live.

The Doula Medicaid Project is taking place as Medicaid itself continues its Maternal and Infant Health Initiative, working with states to increase the use and quality of postpartum care visits and decrease rates of caesarian sections in low-risk pregnancies, as well as increase well-child visits.

In 2018, there were 17 maternal deaths for every 100,000 live births in the United States, a rate that is more than double that of most other developed countries, which have a more integrated system of physician and midwife support than the U.S. (4) Unlike midwives, doulas do not deliver babies. However, in this country, they share with midwives a history of providing maternal support decreased by regulations in the 20th century with the advent of physician-centric health systems.

There is room for both, and the expansion of Medicaid to cover doulas is a positive step toward improving maternal and infant health.

Source:http://neonatologytoday.net/newsletters/nt-dec21.pdf

Preterm birth leads to impaired rich-club organization and fronto-paralimbic/limbic structural connectivity in newborns

Joana Sa de Almeida 1Djalel-Eddine Meskaldji 2Serafeim Loukas 3Lara Lordier 1Laura Gui 4François Lazeyras 4Petra S Hüppi 5

Neuroimage. 2021 Jan 15;225:117440. doi: 10.1016/j.neuroimage.2020.117440. Epub 2020 Oct 8. PMID: 33039621

Abstract

Prematurity disrupts brain development during a critical period of brain growth and organization and is known to be associated with an increased risk of neurodevelopmental impairments. Investigating whole-brain structural connectivity alterations accompanying preterm birth may provide a better comprehension of the neurobiological mechanisms related to the later neurocognitive deficits observed in this population. Using a connectome approach, we aimed to study the impact of prematurity on neonatal whole-brain structural network organization at term-equivalent age. In this cohort study, twenty-four very preterm infants at term-equivalent age (VPT-TEA) and fourteen full-term (FT) newborns underwent a brain MRI exam at term age, comprising T2-weighted imaging and diffusion MRI, used to reconstruct brain connectomes by applying probabilistic constrained spherical deconvolution whole-brain tractography. The topological properties of brain networks were quantified through a graph-theoretical approach. Furthermore, edge-wise connectivity strength was compared between groups. Overall, VPT-TEA infants’ brain networks evidenced increased segregation and decreased integration capacity, revealed by an increased clustering coefficient, increased modularity, increased characteristic path length, decreased global efficiency and diminished rich-club coefficient. Furthermore, in comparison to FT, VPT-TEA infants had decreased connectivity strength in various cortico-cortical, cortico-subcortical and intra-subcortical networks, the majority of them being intra-hemispheric fronto-paralimbic and fronto-limbic. Inter-hemispheric connectivity was also decreased in VPT-TEA infants, namely through connections linking to the left precuneus or left dorsal cingulate gyrus – two regions that were found to be hubs in FT but not in VPT-TEA infants. Moreover, posterior regions from Default-Mode-Network (DMN), namely precuneus and posterior cingulate gyrus, had decreased structural connectivity in VPT-TEA group. Our finding that VPT-TEA infants’ brain networks displayed increased modularity, weakened rich-club connectivity and diminished global efficiency compared to FT infants suggests a delayed transition from a local architecture, focused on short-range connections, to a more distributed architecture with efficient long-range connections in those infants. The disruption of connectivity in fronto-paralimbic/limbic and posterior DMN regions might underlie the behavioral and social cognition difficulties previously reported in the preterm population.

Source:https://pubmed.ncbi.nlm.nih.gov/33039621/

HEALTHCARE PARTNERS

Tips to do well in the NICU

The NICU Doc – Jun 14, 2020

Do you want to know the tips to do well in the NICU? Wanna excel and blow away the attending and medical team? Are you a student or resident and you want to excel in your NICU rotation? Never taken care of preterm, premature or sick babies? Nervous about rounds in the NICU? You’re in the right place. Dr. Fort is an attending Neonatologist and I am ready to dish out the FIVE tips that will make you shine on rounds!. And stay until the end, for the BONUS tip you might not expect! Don’t forget to like and subscribe and hit notification button if you like this and want more videos. If there is a video you would like me to do, let me know in the comments section. Enjoy this video on Dr. Fort’s Baby Talk and Dad Jokes!

Sam Mesiano

University Hospitals Investigates the Fundamentals of Labor to Prevent Preterm Birth

December 09, 2021

Innovations in Obstetrics & Gynecology | Fall 2021

Preterm birth impacts 10 to 15 percent of pregnancies in the United States and is the leading cause of neonatal mortality. While there are known risk factors and some therapies intended to prevent preterm birth, much remains unknown about its cause and how it can be prevented, says Sam Mesiano, PhD, Vice Chair of Research and Director of the Division of Research in the Department of Obstetrics and Gynecology at University Hospitals Cleveland Medical Center.

Mesiano, who is also the William H. Weir Professor of Reproductive Biology at Case Western Reserve University School of Medicine, leads a research team at University Hospitals that is trying to understand how the process of birth is controlled and use that knowledge to develop more effective therapies to prevent preterm birth.

Progesterone

Nature has provided some clues. Progesterone, often referred to as the pregnancy hormone, is essential for the establishment and maintenance of pregnancy. Clinical trials suggest that treating women with extra progesterone decreases the risk for preterm birth, and this therapy is administered in women with increased risk.

Mesiano’s team is exploring the mechanism by which progesterone acts to block labor and delivery and how its blocking actions are overcome to allow birth.

“We’re trying to tease out the molecular mechanism by which progesterone maintains pregnancy and how it acts on the uterus to keep it from contracting and to keep the cervix closed,” he says. “If we understand how progesterone blocks labor, then we can then start to tease out the signaling pathways that remove its blocking action and trigger labor.”

Some early studies suggested that boosting progesterone activity in pregnant women prevents preterm birth, but more research has since been done. Mesiano reasons that the blocking action of progesterone can be exploited with more potent synthetic compounds that mimic the action of a woman’s natural progesterone.

Uterine Tissue and Mouse Models

At UH, Mesiano is using uterine tissue, cell cultures and mouse models to understand the mechanisms behind labor and to develop novel progesterone-based therapies to prevent preterm birth. They can look at the muscle cells in human uterine tissue to help determine what keeps these cells relaxed and what causes them to contract. In mouse models, the research team is studying preterm birth and testing progesterone-like drugs that could prevent it.

A New Approach

While naturally occurring progesterone may not be the definitive answer to stopping preterm birth, understanding this hormone and altering it may be the key to doing so. In a recent study published in the American Journal of Obstetrics & Gynecology, Mesiano and his team demonstrated promising results with a different form of progesterone in a mouse model.

“We take the progesterone that nature has given us, and we modify it a little bit chemically to make a different structure that will act in a more robust way in the woman,” he says. “Our lead compound was effective at preventing preterm birth in mice treated to simulate human preterm birth, and we are excited to explore its mechanism of action.”

Next Steps

“It is exciting to have proof of concept that preterm birth can indeed be prevented with a progesterone-like compound,” Mesiano says. The team is in the process of obtaining funding to study the same protocol in rhesus monkeys.

While plenty of work remains to be done before this research translates into real-world care, the compound being used in this research has already been in used in humans. It is approved in Europe for the treatment of gynecological disorders such as endometriosis and uterine fibroids. “It is an early stage drug repurposing project,” Mesiano says.

He is collaborating with experts in structural and organic chemistry at Case Western Reserve University to synthesize novel compounds that have the potential to be even more effective.

“We have a pipeline in place to test these compounds on cells and in mice, and we are now modifying what we have to see if we can improve effectiveness,” Mesiano says. “Our research wouldn’t happen as efficiently as it does if it were not for the academic environment that is built around the OB/GYN department at UH and the department of reproductive biology.”

Contact Mesiano at Sam.Mesiano@case.edu to learn more about his research on preterm birth.

Source:https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2021/12/university-hospitals-investigates-the-fundamentals-of-labor-to-prevent-preterm-birth

Stress and social support among registered nurses in a level II NICU

Anna Bry a, b,*, Helena Wigert a, b Journal of Neonatal Nursing 28 (2022) 37–41

Abstract

Excessive occupational stress and the resulting burnout are a serious and widespread problem affecting nurses and other health care professionals (Buckley et al., 2020; Maslach and Leiter, 2017; West et al., 2016). Burnout is prevalent among staff in neonatal intensive care units (NICUs), particularly nurses (Rochefort and Clarke, 2010; Tawfik et al., 2017a). High levels of stress and burnout are not only detrimental to nurses’ own health and job satisfaction, but are also important factors contributing to high staff turnover, a chronic and costly problem in hospitals (Hayes et al., 2012). Deficiencies in the psychosocial work environment leading to overburdened staff and high turnover can also compromise patient safety and quality of care in the NICU (Lake et al., 2016; Profit et al., 2014; Rochefort and Clarke, 2010).

Workplace social support, i.e. various forms of assistance, resources or encouragement received from coworkers and supervisors, is a crucial element of a healthy psychosocial work environment (Kossek et al., 2011; Maslach and Leiter, 2017). Previous studies of nurses and other health care professionals show the importance of social support in enabling them to cope with the demands of their work, including emotional distress (Adriaenssens et al., 2015; Hamama et al., 2019; Winning et al., 2018).

Nurses in pediatric and neonatal care are exposed to particular stressors related to the emotional effects of caring for child patients and the complexity of working with families (Buckley et al., 2020; Larsonet al., 2017). In today’s family-centered neonatal care, patients’ parents are encouraged to be present at the unit as much as they can, and their involvement in all aspects of their child’s care is emphasized (Davidson et al., 2017). This model has benefits for families but can add to the complexity of nurses’ work (Coats et al., 2018; Jackson and Wigert, 2013).

Understanding the sources of stress to which neonatal nurses are exposed and the strengths and weaknesses of the social support available to them is a necessary foundation for targeted improvements to their work environment. However, research analyzing neonatal nurses’ work environment is scarce. In particular, to our knowledge, no study has explored the specific work environment of nurses in a level II NICU (special care nursery), where sick newborns who do not require ventilator therapy, including graduates from a level III NICU, are cared for. These units play an important role both medically and in preparing parents for the transition to caring for their infant independently at home, a process to which nurses contribute in crucial ways. In the pre- sent qualitative study we therefore aimed at describing the aspects of their work that nurses at a level II NICU perceived as important sources of stress, as well as the types of workplace social support available to them.

Methods

Setting

This study took place at a level II NICU in a Swedish university hospital, one of Northern Europe’s largest delivery hospitals. The unit has fourteen beds in single-family rooms as well as a room with four beds for continuous monitoring. The staff includes forty registered nurses. Some infants come to the unit directly after delivery, while others are graduates of the level III NICU at the same hospital.

Participants

All registered nurses who had worked at the unit for at least three months were eligible for participation in the study. A sample comprising nurses with various levels of experience and work schedules was sought. Thirteen nurses participated in the study, having given   their informed consent. The participants had been registered nurses for be- tween 3 months and 38 years (median 6 years) and had worked in neonatal nursing for between 3 months and 38 years (median 2 years 9 months). Three worked exclusively night shifts, whereas others had a

mixed schedule.

Procedure

Data collection took place in 2019. The level of staffing and other conditions at the unit at the time were as usual. Semi-structured interviews were conducted at the unit at a time convenient to the participant. The interviewer (first author) was external to the unit and previously unknown to the participants. Each interview began by asking for an account of how the participant perceived positive and negative aspects of working at the unit. After this, specific aspects of nurses’ work environment were covered based on the interview guide. Follow-up questions were asked as appropriate, for example to elicit specific examples. Care was taken to give participants time to elaborate on topics of special concern to them.

The duration of the interviews was 26–54 min (mean 42 min). The interviews were audio-recorded and transcribed verbatim. Data collection continued until data saturation was achieved.

Analysis

Qualitative content analysis with an inductive approach as described by Graneheim and Lundman (2004) was performed. Meaning units aligned with the aim of the study were identified in the text and condensed to shorter textual units. Each condensed meaning unit was labeled with a code name. The initial coding covered all data relating to nurses’ psychosocial work environment. Further analysis focused on aspects of the data related to topics of stress and social support. Codes were grouped into categories, after which themes relating to nurses’ perceptions of stressors and forms of social support were identified.

Results

Analysis resulted in three themes describing sources of stress and three themes describing sources of support,

Inexperienced nurses’ limited knowledge of neonatal care

The participants described work at the unit as highly demanding for inexperienced nurses, who mostly had no previous training or experience in neonatal or pediatric nursing. This gap between their initial level of competence and the demands of the work was seen as a major source of stress. After a six-week orientation and trainee period, new nurses were expected to work independently. This transition was pointed out as a particularly vulnerable period for inexperienced nurses, who still felt uncertain of their skills and lacked self-confidence.

“Even as a new graduate you’re expected to know everything both by parents and by colleagues, and maybe doctors and so on. […] So it’s incredibly stressful and hard on you psychologically to be new at this unit”. (Interview 5)

Working in single-family rooms was described as contributing considerably to the demands on new nurses, since it meant that they had to attend to patients and answer parents’ questions without the presence of a colleague. Single-family rooms were also seen as slowing new nurses’ learning process, since they impeded learning by observation.

Moreover, inexperienced nurses complained of considerable stress  and apprehension due to a lack of previous notice as to when they would be assigned more advanced duties.

High and complex workload

Workload, both the sheer amount of work and the variety of tasks the nurses had to manage, was another important source of stress. Staffing at the unit was described as often barely adequate, meaning that nurses’ ability to manage their workload was highly vulnerable to unexpected events such as an influx of seriously ill patients or absences due to sickness among staff.

Several participants said they often found it impossible to leave work on time. Also, the ever-present possibility of being contacted on a day off and asked to fill in for an absent colleague was mentioned as making it more difficult to relax and recover. While some participants said they mostly coped well with their workload, others said their work drained them of energy.

“My private life feels more like recharging to be able to cope with my job: pack lunches, sleep, stare at a wall, go to work”. (Interview 12)

Work at the unit was described as making high demands on nurses’ ability to prioritize and organize disparate tasks. Circumstances such as constantly having to check on alarms or lacking peace and quiet to focus on administrative tasks made it hard to concentrate on one thing at a time. Experienced nurses mentioned that they were expected to be more or less constantly available for advising less experienced coworkers; this was a significant addition to their workload.

Emotional intensity of work

Emotionally taxing situations that the participants had to deal with at work, in combination with their acute sense of responsibility for the patients and their families, could form significant emotional burdens although the patients at the unit were not critically ill. The extent to which participants felt emotionally affected by their work varied and was not seen as necessarily diminishing with experience.

While working with families was described as one of the most rewarding and meaningful aspects of nurses’ work, it also presented emotional challenges. The fact that parents were present most of the time accentuated the impact of their emotional state on nurses. In some cases, dealing with families’ transition from the level III NICU to the level II NICU and the expectations of staff that parents had formed at the level III NICU was an additional stress factor.

Certain families had a particularly marked emotional impact because of their exceptional distress or complicated psychosocial situation. At the same time, participants described the strain of having to control their own emotions in order to behave in a calm and professional manner in front of families. Some participants thought that nurses, especially less experienced ones, would have needed more support and guidance in how to deal with their own emotions in the face of families’ suffering.

A few participants expressed concern that patients’ safety might be at risk when nurses’ workload was at its most intense. More commonly, nurses were troubled by the feeling that patients’ families received less attention and support than they should have. Lacking time or ability to do as much for the families as they felt they ought to led, for some, to feelings of guilt and personal inadequacy. For some nurses this became a chronic source of frustration and ethical stress.

“It’s a word that unfortunately gets used quite a lot here when there’s been a lot to do, that you feel insufficient and that it’s … you haven’t been able to do all you wanted to. And that’s a dangerous feeling to go home with […] from what I’ve understood from the people who have quit since I started, it’s a pretty important part of [why they quit]”. (Interview 5)

Participants expressed a strong sense of the importance of their work and their responsibility for patients and patients’ families. For some, notably among less experienced nurses, this translated into stress and fear of what any negligence or error on their part could mean for the vulnerable infants and families. As a result, some nurses said they felt obliged, in practice, to exert themselves to the point of neglecting their own need of recovery.

Support from colleagues: a valuable resource to build upon

Generally, the participants perceived the climate among staff at the unit as caring and supportive. The nurses at the unit were described as interested in each other’s well-being and active in helping their col- leagues. In general, participants said they felt valued by their colleagues and received positive feedback from them.

Several factors were seen as hampering access to support from col- leagues. At busy times all nurses might be too occupied with their own work to support colleagues. The physical layout of the unit, with single- family rooms behind closed doors, made it difficult to locate colleagues. For this reason, even when the unit was adequately staffed with nurses, nurses could be impeded from asking colleagues for help when they needed it. Further, some participants regretted that there was little opportunity for non-work-related exchanges that might have developed cohesion among coworkers or provided respite in the work day. Another hindrance mentioned by a number of participants was the lack of a private office for nurses. Finally, the high proportion of inexperienced nurses in the group meant that the need for support could be greater than the supply of colleagues able to provide it.

 Support, including emotional support, from colleagues was viewed as an invaluable resource but one that was dependent on staff members’ individual initiative and good will, rather than an integral part of how work on the unit was organized.

“I think it saved me emotionally [as a new nurse] that I have colleagues who listen and show consideration […] It would have been much harder if there hadn’t been colleagues I could share things with, just briefly. I don’t think it’s really thought of as ‘support’ […] it’s more by good luck that the support is there”. (Interview 4)

Support from management: mixed perceptions

About half of the participants described their first-line nurse man- agers as supportive, accessible and willing to listen to their concerns.

Night shift nurses, however, commented that they seldom saw or communicated with their nurse manager.

Some participants felt that management tended to be too quick to impose changes in the way things were done on the unit, for example if families complained about something, rather than listen to what nurses had to say about the matter.

Some participants said they received sufficient feedback from their managers, whereas others said they received very little and would have liked more. One participant felt that managers too easily tended to brush off new nurses’ anxiety about making mistakes by referring to the or- ganization’s responsibility for adverse events.

“[they tell you] ‘well, if anything were to happen it’s not your fault, it’s the organization’s since it’s understaffed’. And I thought, yeah but that doesn’t help me, I’m still the one who’s responsible […] I would feel just as awful anyway”. (Interview 13)

Nurse managers were described as caring about nurses’ well-being and fairly willing to provide support, e.g. by referring staff members experiencing excessive stress to occupational health services for counseling. Some participants felt that managers should have done more to address individual nurses’ stress levels before their situation became dire. But participants also saw managers as having a limited ability to make adaptations that might help nurses at risk of burnout.

Recent rapid turnover among management was seen by some as negatively impacting nurses’ confidence in their supervisors and their ability to count on supervisors’ support.

Formal support: initiatives by the organization

Recently the introduction program for new nurses had been expanded in order to provide increased support for new nurses. After their initial orientation and trainee period was over they continued to have access to a nurse mentor who was there was to offer guidance and act as a professional role model. The mentor was seen as an important resource but was not present at the unit full-time. Over the first year, new nurses also had access to small-group professional supervision in nursing care. Some participants wished that nurses with more experience had also had access to similar forms of support.

The organization was seen as fairly generous with opportunities for further training and development, which the participants appreciated and saw as a strength of their workplace.

“[On this point] I have to say I’m extremely positive, almost surprised […] I came here and almost immediately I got to take this course in neonatology, and it’s a lot of fun. And that also makes you feel appreciated, that they want to invest in you”. (Interview 10)

However, fewer forms of support and opportunities for development were available for the most experienced nurses.

“They’ve invested in new nurses above all, with a lot of training and opportunities to discuss and reflect [on their work] and so on. But we older nurses get forgotten […] Some of us have been working for a really long time and we also need a bit of attention and support”. (Interview 1)

A group reflection session for nursing staff, taking place at the end of each day shift, had recently been introduced. The sessions allowed staff to compare notes on how the day had gone and discuss issues of concern, for example challenging situations they had been involved in. This was described as a valuable means of coping with emotional stressors at work.

Discussion

One of the most salient strengths of the work environment appreciated by the participants in our study was nurses’ positive attitude to- wards each other and their readiness to help and support colleagues.

Nevertheless, such collegial support was limited by a number of circumstances, including the single-family room layout of the unit. This layout offers parents in the NICU greater privacy and enables them to spend time with their infant, but it can also complicate nurses’ work. A novel finding in our study is the special impact of this layout on nurses just beginning independent work, who had few opportunities for learning by observation and felt it was daunting to work alone with families. Although some studies (Stevens et al., 2010) have shown enhanced workplace quality in a single-family room NICU layout, in our study the disadvantages of this environment were more evident, particularly for inexperienced nurses. More experienced nurses also regretted the obstacles to contact with colleagues. Similarly, in a previous study by Hogan et al. (2016), nurses in a single-family room level II NICU reported a sense of isolation. In view of our results, it would be important to organize nurses’ work in a way that facilitates communication and mutual support among nurses. The physical aspects of the workplace need to be taken into account, for example by providing ways to ensure nurses can find each other when needed and private office space for nurses. At the same time, informal collegial support cannot be a substitute for healthy organizational conditions such as an acceptable workload and adequate staffing.

We found that patients’ and families’ situation had a significant emotional impact on nurses although the infants cared for in a level II NICU are not normally critically ill. Participants mentioned the special impact of dramatic situations that were outside the normal routine at the unit and the need to be able to discuss these with colleagues. But they also spoke of the cumulative emotional impact of day-to-day work with patients and their families and a constant sense of responsibility that, for some nurses, shaded into a chronic feeling of inadequacy. Reflection sessions at the end of the day were an innovation that the nurses had found helpful as a way of coping with emotional stress. Opportunities for such sharing should be fostered, especially since a climate where staff can express their authentic feelings can protect health care staff from burnout caused by emotionally stressful encounters (Grandey et al., 2012). Our results also point to a need for training of nurses in dealing with emotionally taxing aspects of their work, something especially relevant within family-centered care where close communication with families is integral to nurses’ work.

The results of our study speak to the importance of adapting support to the needs of nurses at various stages of their career. Like previous studies (Labrague and McEnroe-Petitte, 2018), our results show new nurses’ particular vulnerability to stress. Apart from a general lack of experience, participants in our study provided information on specific difficulties for new nurses. For example, inexperienced nurses need to receive clear information on how their responsibilities will progress as they gain in competence. Not yet being well-versed in neonatal care is also liable to make prioritizing and organizing one’s own work harder, thus making work more stressful. This should be paid attention to in the training of new nurses. New nurses at the unit we studied appreciated having access to a nurse mentor whose job was specifically to support them. This type of mentorship seems worth investing in to provide assistance and security to new nurses.

At the same time, our results highlight the fact that nurses with extensive experience in neonatal care also have needs of support that should not be neglected, a little-studied area. Despite their competence, experienced neonatal nurses are also at risk for burnout, according to some studies even more so than less experienced colleagues (Tawfik et al., 2017b). In addition, they need professional stimulation and appreciation in order to feel that their work continues to be satisfying (Loft and Jensen, 2020). Because of their seniority and accumulated competence, their possible decision to leave can be especially disruptive for coworkers, including new nurses who rely on their teaching and support, as participants in our study noted. The value as well as the amount of the work that experienced nurses perform in teaching less experienced colleagues should receive recognition, and care should be taken that this task does not unduly increase their workload.

Limitations

Since this was a study of one unit, care needs to be taken in applying the results to other contexts that may differ in various ways. For example, the hierarchy among Swedish hospital staff (e.g. between nurses and doctors or between nurses with different levels of expertise) is less pronounced than in many other countries, which could potentially have both positive and negative effects on nurses’ stress, e.g. by increasing their sense of influence in the workplace or by increasing their burden of individual responsibility. Sweden’s generous parental leave policy means that parents are free to spend large amounts of time at the unit, a factor likely to affect nurses’ work environment. Further, the unit we studied is part of a large university hospital, and nurses’ circumstances may differ from those at a smaller hospital providing less advanced care.

Conclusions

Working in single-family rooms presents particular stressors for neonatal nurses, especially those who are new to the job, and work should be organized in ways that counteract its isolating effect. While continuing their efforts to support new nurses, organizations should also pay attention to the needs of the most experienced nurses. The question of what factors help nurses feel that their work continues to be rewarding after many years merits further research. Neonatal nursing, involving close collaboration with families in distress, has a significant emotional impact on nurses, and there is a need to develop interventions to support and educate nurses in this aspect of their work.

A year in review: Physician leaders look back on 2021 | Moving Medicine for Dec. 22, 2021

Dec 22, 2021        American Medical Association (AMA)

As we look back on 2021, it’s difficult to put into words all that our nation’s physicians have experienced this past year. AMA CXO Todd Unger shares a special end-of-year feature where physicians answer three questions and tell their own stories of 2021 … in their words.

We recognize our preterm birth community within the migrant /refugee populations around the world. You are a valuable part of our family! 

Unfortunately, we do not have the statistical information representing the actual percentage of preterm birth within this part of our community, but we know  preterm birth is likely on the higher end of probability.  Various field experts have suggested exposure to migration-related stress during pregnancy may lead to an increased risk of preterm birth. 

Stress is a consistent and powerful force within the life experiences of a refugee/migrant journey and also within the journey of preterm birth family.  We are hoping to promote research related to pre-verbal PTSD among our preterm birth community.  PTSD is also a condition that does effect preemie parents as well. There are effective treatment options available for consideration by preemie parents, and providers are increasingly aware of parental exposure to PTSD and may be a good resource for support.  Accessibility to these resources varies widely.

We are grateful for organizations such as the HERO2B Foundation that are raising awareness about PTSD among vulnerable and young populations. The impactful activities and valuable story-telling advocacy they are providing to youth and our global community is empowering. As highlighted in the HERO2B video above, our stories can inspire one our strength. 

Preemies and their family members  may benefit from hearing about their birth stories and the experiences and feelings their parents and family members endured and embraced along the path. Age appropriate sharing is encouraged. Storytelling in this capacity may be inspirational, educational and of benefit to all involved.

I Went Surfing In Morocco’s Hidden Magic Bay | Tastemade Travel

Jun 3, 2021      Tastemade Travel

Sierra takes us on a journey through Morocco and discovers a surfer’s paradise in Imsouane. Comment below what you want to see on our channel!

POLLUTION, SOLUTIONS, PREVERBAL PTSD

NIGERIA

PRETERM BIRTH RATES – Nigeria

Rank: 50  –Rate: 12.2   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Nigeria, officially the Federal Republic of Nigeria, is a country in West Africa. It is the most populous country in Africa; geographically situated between the Sahel to the north, and the Gulf of Guinea to the south in the Atlantic Ocean; covering an area of 923,769 square kilometres (356,669 sq mi), with a population of over 211 million. Nigeria is a federal republic comprising 36 states and the Federal Capital Territory, where the capital, Abuja, is located. The largest city in Nigeria is Lagos, one of the largest metropolitan areas in the world and the second-largest in Africa.

Nigeria is a multinational state inhabited by more than 250 ethnic groups speaking 500 distinct languages, all identifying with a wide variety of cultures. The three largest ethnic groups are the Hausa–Fulani in the northYoruba in the west, and Igbo in the east, together comprising over 60% of the total population. The official language is English, chosen to facilitate linguistic unity at the national level. Nigeria’s constitution ensures freedom of religion and it is home to some of the world’s largest Muslim and Christian populations, simultaneously. Nigeria is divided roughly in half between Muslims, who live mostly in the north, and Christians, who live mostly in the south; indigenous religions, such as those native to the Igbo and Yoruba ethnicities, are in the minority.

Health care delivery in Nigeria is a concurrent responsibility of the three tiers of government in the country, and the private sector. Nigeria has been reorganising its health system since the Bamako Initiative of 1987, which formally promoted community-based methods of increasing accessibility of drugs and health care services to the population, in part by implementing user fees. The new strategy dramatically increased accessibility through community-based health care reform, resulting in more efficient and equitable provision of services. A comprehensive approach strategy was extended to all areas of health care, with subsequent improvement in the health care indicators and improvement in health care efficiency and cost. The Nigerian health care system is continuously faced with a shortage of doctors known as ‘brain drain‘, because of emigration by skilled Nigerian doctors to North America and Europe. In 1995, an estimated 21,000 Nigerian doctors were practising in the United States alone, which is about the same as the number of doctors working in the Nigerian public service. Retaining these expensively trained professionals has been identified as one of the goals of the government.

https://en.wikipedia.org/wiki/Nigeria

The countries with the greatest numbers of preterm births are India – 3,519,100; China – 1,172,300; Nigeria – 773,600; Pakistan – 748,100; Indonesia – 675,700; United States – 517,400; Bangladesh – 424,100; Philippines – 348,900; Democratic Republic of the Congo – 341,400; and Brazil – 279,300.

Source:https://www.who.int/pmnch/knowledge/publications/preterm_birth_report/en/index3.html

COMMUNITY

We were very excited to discover the article below to share in our blog and with our Community to reference. It is heart-breaking to consider the pain a preterm birth baby may experience and worse yet, incomprehensible that we have denied our children recognition as deserving care towards healing their wounds related to their preterm birth experience. We have made gains towards reducing noise and light and interference/overstimulation in the NICU, we have made some progress in lessening preemie pain; pain that may be unavoidable if their lives are to be saved. We have figured out that separation of preemie babies from the parents/caregivers may not only create long term psychological damage to the preemie infants but may also reduce the  growth and development opportunities that loving touch provides.

Kat was born at 24 weeks gestation and at 3 ½ weeks old, weighing 1 lb. 3 ounces, she underwent open heart surgery without anesthesia under the care of a brilliant, brave, strong and guided surgeon. We are so blessed to have had this heroic female surgeon in our lives. Our Preterm Birth healthcare partner community is rich with skilled, heroic, gifted providers who also need our support.

Our Preterm Birth/Neonatal Womb Community must develop targeted treatment for preterm birth survivors to specifically address and treat preverbal trauma so that our children have access to therapy and therapists who are available and able to provide curative nonpharmaceutical treatments to support the healing, growth, and quality of life for our preemie population at large.  This will be difficult to accomplish, and we must not borrow a convenient but ineffective treatment designed to treat other conditions that did not generate in the way anxiety, depression, non-attachment, etc. develops in much of the preemie population.  The time to move forward in creating curative treatment to address preverbal stress for our Preterm Birth Survivors/Neonatal Womb Warriors is now. With 11 to 12 % of our global population born preterm the need is imminent, the availability to research the associated conditions and solutions is vast, and the potential to create therapies to address preverbal trauma is viable and necessary.

PHOTOGRAPH BY CRAIG CUTLER

Why it’s so hard to treat pain in infants

For decades physicians believed that premature babies didn’t experience pain. Here’s what doctors know now – and the innovative solutions being embraced by today’s caregivers.

By Sharon Guyup  Published November 11, 2021

Doctors once believed that infants—especially premature babies—did not feel pain, and if they did, they would not remember it.

This might sound like Medieval medicine. But as recently as the 1980s, babies undergoing surgery were given a muscle relaxant to paralyze them while in the operating room but were not given any pain medication, says Fiona Moultrie, a pediatrician and researcher at the University of Oxford who focuses on neonatal pain. “At the time, it was assumed that most of the behaviors that infants were exhibiting were just reflexes.”

Over the next decades, studies documented changes in infant behaviorstress hormones, and brain activity, proving that even the tiniest babies did indeed suffer pain. Research also revealed that continued pain could derail a child’s short- and long-term neurological, social, and motor development, especially in fragile, preterm babies born earlier than 37 weeks, says Björn Westrup, a neonatologist and researcher at the Karolinska Institute near Stockholm, Sweden.

Rapid advances in medicine now allow very fragile, tiny, preterm babies to survive. But preemies may spend weeks or months in the hospital undergoing the constant, often painful procedures needed to save their lives. Strategies to make such procedures less traumatic are vital, as premature births are rising globally. In the United States alone, about 380,000 babies are born prematurely each year, or about one in 10 births. Worldwide, it’s about 15 million.

The medical profession tries to manage or prevent infant suffering with drugs such as ibuprofen (for mild to moderate pain) and fentanyl (used to alleviate extreme pain). For most analgesic drugs, though, the proper dosage, effectiveness, or effects on the brain remain unknown, so increasingly, hospitals are incorporating non-pharmaceutical interventions that center on techniques known as developmental care, which keep babies and their families together rather than isolating infants in incubators.

That’s critical, says Manuela Filippa, a researcher at the University of Geneva who studies prematurity because separating sick babies from their parents compounds pain with toxic stress that creates serious developmental problems. Inside a neonatal intensive care unit, or NICU, lights are bright and monitors blink. It’s loud, with machines beeping, alarms going off, people talking, and ventilators thumping and hissing.

“Brain maturation is based on sensory experience,” Filippa explains, “and the [traditional] neonatal intensive care unit is very stressful.”

How do babies express pain?

Babies born extremely early are whisked from the delivery room to the NICU. The youngest, those under 36 weeks, have underdeveloped lungs and may be intubated and hooked up to a ventilator. They are too weak to suckle and must be fed through tubes in the nose or mouth. Nurses need to lance their tiny heels for blood tests up to 10 times a day, and they are engulfed in IV lines, tubes, and wires.

In the early 1980s, Canadian newborn medicine researcher Celeste Johnston, an emeritus professor at McGill University in Montreal, was approached by nurses working in the NICU who wanted a way to measure pain in infants. In 1986, she was among the first to publish evidence that infants’ heart rates and oxygen levels changed when they were subjected to painful procedures. Their cries and facial expressions revealed what she calls “honest signaling,” behaviors that babies are born with that communicate distress.

“There is a particular grimace that was described by Darwin in the 1800s that is recognized universally as pain,” she says. That’s ironic, Moultrie notes, “as Darwin’s celebrated work on evolutionary theory and the expression of emotions in man promoted the concept of infants as primitive beings with under-developed senses and merely reflexive behaviors.”

Johnston was later horrified to learn that in intensive care, babies averaged about 14 painful procedures each day.

But understanding how these small, nonverbal beings experience pain is extremely difficult. “One of the biggest challenges in caring for preterm and sick infants is that they can’t tell us,” says Erin Keels, a nurse practitioner and director of advanced neonatal providers at Nationwide Children’s Hospital in Columbus, Ohio. “We can only infer by their behaviors and their vital signs.”

Forty different pain scores have been compiled over the last three decades, which can be used to evaluate pain levels. They each include various combinations of heart rate, oxygen saturation, facial expressions, or body movements. But since physiology can change for many reasons, and a baby may be too sick or too medicated to grimace, these are not always objective markers. There is an ongoing quest to better understand how infants perceive and experience painful stimuli.

“Although there has been great progress, we still don’t fully understand pain in neonates,” says the University of Oxford’s Moultrie. She and others have been trying to measure pain by observing bursts of electrical activity in the brain using electroencephalogram (EEG) testing. They identified a pain-related pattern of brain activity in infants, which is now being used in clinical trials to test the efficacy of medications. It could revolutionize pain treatment.

In a later studies, researchers at the University of Oxford used MRI scans to pinpoint brain activity. They found that 20 out of 22 brain regions activated in an adult’s brain in response to pain are also activated in a newborn baby’s brain. One area that did not register was the amygdala, which is associated with fear and anxiety, likely because days-old babies may not yet make these associations, Moultrie says.

But there’s still a lot researchers still don’t know about exactly what’s going on in the infant brain. “When you’re tiny and underdeveloped, differentiation between pain and stress is not clear,” says Johnston.

At the same time, researchers are uncovering the potential long-lasting physiological consequences of preemie pain, Filippa notes. The amount of pain-related stress predicts the thickness of the brain’s cortex, for instance. One study found that at school age, children who were born very preterm—at 24 to 32 weeks gestational age—had a thinner cortex in 21 of 66 cerebral regions, predominately in the frontal and parietal lobes. This has been linked to motor and cognitive impairments.

Preterm babies also face significant risk for lowered IQ, attention deficit disorder, memory issues, and difficulty with social interactions and emotional control. Heidelise Als, a pioneer in understanding physical and behavioral risks for both preterm and sick infants, attributes this at least partly to the vastly altered sensory experiences that can influence preterm babies’ immature nervous systems.

Alternatives to alleviate pain

Without an accurate way to measure pain, though, it’s tough to test how effective any given drug is. By the 1990s, doctors understood that using anesthesia during major surgeries improved outcomes. Babies that were intubated and on ventilators were—and still are—given morphine, though there’s ongoing controversy over whether it reduces their pain, says Moultrie. Meanwhile, the risks of pharmacological interventions include opioid addiction, withdrawal, difficulty breathing, and possible impacts on neurodevelopment.

The downside of painkillers has spurred the search for alternate treatments. One method gives babies sucrose before procedures because it can release endorphins and potentially ease pain. While it seems to soothe them and lower physical response to painful stimuli, the baby’s stress hormones and reactive brain signals remain high, says Nils Bergman, a researcher and pediatric specialist also at Karolinska Institute. Other work has found that breastfeeding during needle-related procedures provides more pain relief than interventions such as swaddling, being held, topical anesthetics, music therapy, or a pacifier.

The physical environment also matters in reducing a baby’s stress during painful procedures. In 2000, a trial in Sweden compared the progress of babies cared for in a traditional intensive care ward versus a darkened, quiet, more womb-like room with parents present. The latter group was discharged quicker and had grown slightly more by the end of their stay.

Today, many neonatal experts think this kind of family-centered care is the wave of the future. One of the most effective methods is Kangaroo Mother Care, which involves wrapping an infant skin-to-skin on its mother’s or father’s chest.

The method was developed in Colombia by pediatrician Edgar Rey, who began using it at Bogotá’s Maternal and Child Institute in 1978. At the time, some 70 percent of preemies died in their overcrowded neonatal ward. Rey had stumbled upon a report describing how a kangaroo raised its peanut-size underdeveloped joey to about a quarter of her own weight, raising it inside her pouch and keeping it warm through skin-to-skin contact.

Rey discovered that human babies also thrived in this way, and after implementing the technique, preemie death rates plummeted. The World Health Organization recently estimated that annually, kangaroo care could save 450,000 lives.

Years later in Canada, Johnston found that skin-to-skin contact provided a calming situation for conducting routine procedures in the NICU and babies both showed a milder pain response and recovered more quickly .

Filippa has studied the effects of other family-based interventions, including how the sound of a mother’s voice might mitigate her child’s pain. Her team monitored 20 premature babies at the Parini Hospital in Italy during their daily heel-prick blood tests, with mothers talking to them or singing to them. Hearing their mother’s voice during a medical procedure significantly improved the infant’s pain score. Singing also helped, but less so.

When the team examined hormonal changes triggered when a baby hears its mother speaking to them, they found that oxytocin levels rose substantially. Oxytocin, sometimes called the attachment hormone, is produced in the hippocampus and plays a crucial role in modulating pain, stress, and social behaviors. It also protects against inflammation in a preterm infant’s brain, Filippa explains.

With lower oxytocin levels, the emotional brain – the hypothalamus – is less developed. The result is that “you’re less able to face stressful events and have higher reactions to pain,” says Filippa. “Oxytocin is strong neuroprotection against the short- and long-term effects of pain.”

Toward zero separation

In 2010 Westrup revealed that even the smallest, sickest babies benefitted from having parents with them 24/7. Notably, there were fewer lung issues and much shorter hospital stays. Sweden has since incorporated this knowledge by redesigning many NICUs so parents can live with their baby, even in high intensive care situations. Pre-COVID-19, siblings could also visit.

This type of “zero separation” approach requires a holistic mindset that also cares for mothers: At least 50 percent of those who birth early have other health conditions and need obstetric care. In a number of countries, new NICUs are being built with individual rooms to house families. But government support is needed for most people to devote months to caring for their sick child.

In Sweden, nationalized medicine covers costs, and the government pays parental benefits up to 35 weeks; extended benefits can stretch to 61 weeks. In Canada, which also provides medical coverage, both mother and father are entitled to 240 days of paid leave.

The situation is far different in the U.S., where mothers are entitled to 12 weeks of unpaid leave if they work for a company with 50 or more employees. The U.S. is one of just six countries that has no national paid leave. Currently, Congress is considering four weeks of paid family leave as part of a $1.85 trillion domestic policy bill, which faces opposition. The U.S. also lacks nationalized health coverage – and has the world’s most expensive health care system.

Westrup and Bergman emphasize that we should not just wait until neonatal units are rebuilt or all the economic conditions are in place to act. Ultimately, there is substantial evidence that we need to change the system to embrace zero separation, they say. Teaching nurses and doctors how to provide this kind of developmental care will give children a healthier future.

Keels of Nationwide Children’s Hospital is optimistic about the evolution in preemie care and the research that will continue to inform best practices. “I’m hopeful that in the near future, we’ll have greater knowledge and better ways of evaluating pain so we can do really individualized medicine right at the bedside.”

Source:

https://www.nationalgeographic.com/science/article/why-its-so-hard-to-treat-pain-in-infants?cmpid=org=ngp::mc=social::src=facebook::cmp=editorial::add=fb20211111science-infantspain&sf251160525=1&fbclid=IwAR20SRqutz5HA5MkKjok3TFhPtpZZp5vU7JEAm5wYI9q_DhdKH8wPekjELo

Rural Midwives Fill Gap as Hospitals Cut Childbirth Services

Stateline Article -December 8, 2021 By: Aallyah Wright 

Editor’s Note: The story has been updated to clarify that Sharon Hospital will shut down its labor and delivery unit over the next year

For the past year or so, Toni Hill, a midwife in the lowlands of northern Mississippi, has received an influx of calls from women across the state who live in areas with no hospitals and only a smattering of health care providers.

As COVID-19 rates increased, some pregnant women did not feel safe receiving care in a hospital or were unable to contact their providers. Others, who lived in the Mississippi Delta, did not have transportation for the three-plus hour trip to Jackson, the state capital. Hill quickly found herself very overwhelmed, she said.

On most days, Hill is stretched thin: conducting home and clinic visits, which can be up to three hours away, while being a mother and running a nonprofit. Hill is one of at least 30 certified midwives and nurse midwives in Mississippi, a state where 84% of the areas with shortages of primary care health professionals are in rural counties, according to a health department report published this year.

Many rural hospitals across the country are struggling to stay afloat amid the coronavirus pandemic. Facing workforce shortages, financial challenges and more patients than beds, some have had to cut or suspend obstetric services.

Midwives, trained professionals who specialize in maternity care, are picking up the slack. In interviews with Stateline, midwives from rural areas say they’re overwhelmed and facing burnout because of an uptick in patients—even as they’re eager to help. Doulas, who assist parents during childbirth but don’t provide medical care, also are seeing an increase in demand.

Some states, recognizing a dire need for midwifery and doula support services, have passed laws to expand care, while members of Congress are considering federal investment. Rural health experts and leaders stress that policies should focus on the challenges of affordability, insurance coverage and lack of providers in rural areas.

This year, at least eight states—Arizona, Arkansas, California, Colorado, Connecticut, Louisiana, Nevada and Rhode Island—have passed laws that aim to improve birthing outcomes. Many of the laws have expanded Medicaid and other health insurance coverage for midwifery and doula services, required health facilities to allow doulas to attend births or increased pathways for students to become licensed midwives.

The Biden administration’s proposed Build Back Better Act would provide additional funding for postpartum Medicaid coverage as well as financial and programmatic support for doulas and nursing students.

The pandemic has revealed longstanding issues of “innate systemic racial basis” within health systems that have contributed to the maternal health crisis in the United States, said Louisiana state Rep. Matthew Willard, a Democrat. Willard sponsored a bill, signed into law by Democratic Gov. John Bel Edwards this summer, that created a state doula registry committee and required that all health insurance plans with maternity benefits cover midwifery services.

Nationwide, midwives attend less than 10% of hospital births, but in rural hospitals the figure is 30%, according to a 2019 brief by the federal Centers for Medicare and Medicaid Services.

In Nevada, legislators expanded Medicaid coverage for doula services along with pandemic-related health care bills. And in Arkansas, lawmakers passed legislation granting certified nurse midwives full practice authority without an agreement with a consulting physician.

The legislation can help, but it’s going to take more rural-centric, comprehensive policies to fix health infrastructure needs in rural America that have been exacerbated by the pandemic, said Katy Kozhimannil, health researcher and director of the Rural Health Research Center at the University of Minnesota.

Those needs include recruiting and retaining a skilled workforce and finding ways to keep labor and delivery units open despite relatively few births. Many rural hospitals have taken a financial hit, Kozhimannil said, and the pandemic has caused them to reduce services.

“In some cases, the hospital obstetric unit can’t remain open or won’t because not all communities can have a hospital that provides birth services,” she said. “And in those places, it’s very important not to turn a blind eye to the consequences that we know, [such as] more pre-term babies.”

Even before the pandemic, rural areas lacked maternal health services. In 2014, after a decade of steady decline, nearly 54% of rural U.S. counties had no hospital-based obstetric services, according to a 2020 study published in the Journal of the American Medical Association. Between 2014 and 2018, researchers found, the number of rural hospitals with obstetric services declined by another 3%.

The rural counties that were more likely to lose their hospital-based obstetric care services were less populated, more remote, had fewer doctors, had “less generous” Medicaid programs and had higher proportions of Black residents compared with White residents, said Kozhimannil, who co-authored the study.

Since January 2020, at least 21 hospitals in rural areas have closed, according to data from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

When hospitals close or shut down their obstetric services, the loss can lead women to deliver on their own or in ambulances on the way to a hospital, said Jennifer Cameron, a certified nurse midwife in rural Michigan.

“They go into labor. They call 911, and they get transported to the closest facility with a labor and delivery unit. For some people it may be 45 minutes away,” Cameron said. “If someone is having a heart attack, there’s no ambulance to take them.”

After the local hospital in Manistee, Michigan, where Cameron practices, stopped offering obstetric services, she conducted more out-of-hospital births at her freestanding birth center. She is usually on call every hour of the day because she has just one part-time office assistant. Prenatal visits, labor and delivery and up to six weeks of postpartum care can cost more than $4,000. Many of her patients don’t have insurance and can’t afford to pay out of pocket.

“It isn’t sustainable. Midwives burn out. There are a lot of midwives that only take cash-pay clients and if they can’t afford to pay, then they can’t get their care,” Cameron said. “I do take someone that can’t pay me a certain percentage. I do allow a couple births per month that I know I’m not going to get paid for, because it’s the right thing to do.”

Medicaid paid for a larger share of births in rural than urban areas and for people of color than White people in 2018. The program helps to alleviate rising mortality and morbidity rates and racial disparities in maternal health outcomes, according to a 2020 fact sheet by the Medicaid and CHIP Payment and Access Commission, a nonpartisan legislative agency that provides policy and data analysis to federal and state governments about Medicaid and the Children’s Health Insurance Program.

But the reimbursement Cameron gets from Medicaid isn’t enough to cover the cost of her services, she said.

Hill, the midwife in Mississippi, said even if she did receive Medicaid payments, she still wouldn’t be able to accept more patients with her small staff.

“They’d be covering maybe $1,300 for a birth. That’s less than half of what I get paid,” Hill said.

Hill said states and policymakers will need to take more action to address the economy and well-being of rural communities overall.

“We want people to come into care healthier. I’ve talked to pregnant women who don’t even have primary care physicians,” she said. “We need more midwives [in the hospitals and birth centers] in theory, but we have to look at the community health piece, too.”

Smaller hospitals have cited decreased births, financial woes and staffing issues as primary reasons for cutting back on services in the past year. Sharon Hospital in rural Connecticut is among those that this year made plans to halt labor and delivery services. Hospital officials plan to phase out the services over the next eight to 12 months pending regulatory approval.

Over the past few years, the hospital has seen an average of about 200 deliveries per year, said Dr. Mark Hirko, president of Sharon Hospital. He had hoped to see an influx of childbirths, but with an aging population, the “numbers remain essentially flat,” he said.

Instead of keeping the labor unit, the hospital will expand on other primary care services.

“Everything pointed us in the direction that we needed to refocus and redirect our efforts towards where the population is taking us,” Hirko told Stateline. Parents-to-be now will have to travel to other birthing centers and hospitals to receive care. 

Other rural health systems that cut services have lost employees as a result of the federal COVID-19 vaccine mandate for health care workers, which has been temporarily blocked by federal judges in Missouri and Louisiana.

Lewis County General Hospital in Lowville, New York, stopped delivering babies after losing at least six employees over the mandate. A similar instance occurred in rural Lamar, Colorado, which forced the Prowers Medical Center to suspend services at its maternity ward.

The staffing shortage in hospitals is placing an added burden on midwives. There were more than 12,000 certified nurse midwives and about 100 certified midwives in 2019, according to the American College of Nurse-Midwives.

The demand for midwives and other maternal care providers is higher than the supply, said Erin Ryan, a certified professional midwife and secretary for the National Association of Certified Professional Midwives. The need has increased with obstetric unit closures, she added.

According to the federal Centers for Medicare and Medicaid Services, the United States is expected to have a shortage of 22,000 obstetricians and gynecologists by 2050.

The worst shortages, the agency noted, are expected in rural areas.

Source:https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/12/08/rural-midwives-fill-gap-as-hospitals-cut-childbirth-services

2Baba Ft. Syemca – Target You

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Target You is an instant fan favourite from the Warriors album released in March 2020.

Indoor Air Pollution Is a Major Culprit in Preterm Births

Tara Haelle – October 26, 2021

Scientists have long known that exposure to air pollution during pregnancy increases risks for preterm birth or low birth weight. New findings suggest that pollution exposures are higher in low- and middle-income countries and especially from indoor sources.

In 2019, for example, about half the world’s population breathed household air pollution from cooking fires. In addition, 92% of the global population lived in areas in which the air quality did not meet World Health Organization recommendations.

For this latest report, published in PLOS Medicine, researchers analyzed data from 124 studies on air pollution, birth weight, and preterm birth. They wanted to be sure distinguish exposures to indoor air pollution, which often is overlooked. (A preterm birth is defined as before 37 weeks of pregnancy; low birth weight is about 5.5 pounds, or less than 2,500 grams).

Most of the studies they assessed came from the United States, Europe, and Australia, with a scattering of findings from India, China, South America, and sub-Saharan Africa. The researchers specifically included reports from Africa and Asia because indoor fire cooking is more common in these regions.

About a third of the air pollution causing preterm birth came from the outside air, so that most of it was from indoor air pollution, largely in low-income countries.

The results showed that air pollution accounted for 16% of all babies born with a low birth weight and 36% of preterm births. The findings imply that one out of every three preterm births could be prevented if air pollution exposure during pregnancy could be eliminated. The study authors estimate that about 5.9 million preterm births worldwide in 2019 could instead have been delivered at term if air pollution were kept to levels associated with minimum risk.

In sub-Saharan African countries, for example, more than half of all preterm births (52.5%) were attributable to air pollution exposure. Keeping air pollution at the minimum risk level could reduce both preterm births and incidence of low birth weight by 78% in this region, the study authors estimate.

Low birth weight and preterm birth increase the risk of death before age 1 and can have additional lifelong consequences. These infants have a greater likelihood of intellectual and developmental disabilities and of other disabilities, such as vision, lung, or hearing problems. Asthma, digestion difficulties, and infections are also more common in those born preterm.

Source  PLOS Medicine: “Ambient and household PM2.5 pollution and adverse perinatal outcomes: A meta-regression and analysis of attributable global burden for 204 countries and territories.” https://www.medscape.com/viewarticle/961571

PREEMIE FAMILY PARTNERS

Day in the life of a DOCTOR: Shadowing NICU NURSE PRACTITIONER (ft. premature babies)


Violin MD
    Nov 27, 2021

Babies born at 22 weeks (5.5 months) can survive!! Join me in the largest NICU in Canada and learn about the lifesaving treatments for premature babies! I’ll be shadowing Nikki, a nurse practitioner who works in the neonatal ICU. Plus you’ll meet baby Kalani who was born at 23 weeks and her mother, Paola. **note: at the time this video was filmed, Nikki was a nurse practitioner candidate. She will be fully licensed after passing her final exam. For simplicity, I have referred to her as a nurse practitioner.

Increasing Early Skin-to-Skin in Extremely Low Birthweight Infants

POSTED ON 09 NOVEMBER 2021

Although the benefits of skin-to-skin care (SSC) for preterm and low birthweight infants are known to the neonatal community, some health centres still struggle with implementation. To increase SSC within the first 72 hours of life among extremely low birthweight (ELBW) infants, a multidimensional approach was chosen at a Level IV university-based regional intensive care nursery (ICN).

SSC has many benefits for mothers and infants, especially those born preterm. Previous studies showed that in extremely low birthweight (ELBW) babies, early and frequent infant-parent SSC increases life expectancy and improves short- and long-term health outcomes. Unfortunately, many health centers still do not regularly implement this practice as early or as frequently as evidence supports.

As an example, in a 58-bed, Level IV ICN at a children’s teaching hospital, the implementation of SSC during the first 72 hours of ELBW infants’ lives has only been achieved 7% of the time. Motivated to increase this rate to 80% within one year, a multidisciplinary team of neonatal providers conducted an intervention to encourage SSC from July 2018 to December 2019, using the Institute of Healthcare Improvement quality improvement methodology.

Following this approach, unit policies and guidelines were updated to facilitate early skin-to-skin. A readiness checklist was developed, and the education of parents, staff and providers on SSC was prioritised. The balancing measure was the rate of severe intraventricular haemorrhage (IVH), a risk commonly associated with SSC. Data collected from monthly chart reviews were used to analyse the changes in SSC rate during the intervention.

Ultimately, 52 infants born under 28 weeks’ gestation or weighing less than 1,000g were included in the project. After the intervention, there was a significant improvement in the rate of early SSC from 7% to 84%. Furthermore, the analysis showed no difference in the balancing measure of severe IVH, encouraging the practice of early SSC among the staff.

The initiative was successful, and the team calls for future efforts to measure long-term health and neurodevelopmental outcomes from the practice of early SSC on extremely low birth weight babies.

Source:https://www.efcni.org/news/increasing-early-skin-to-skin-in-extremely-low-birthweight-infants/

This Dad Spends Every Christmas With Babies In The NICU | Dads Got This! | TODAY Original

Dec 18, 2019         TODAY

On this episode of “Dads Got This!” TODAY’s Craig Melvin spotlights a dad who dresses up as Santa Claus to give back to the same NICU where his son was a patient.

BRAIN BLEEDS IN PREMATURE BABIES

 March of Dimes – November 9, 2021

Preterm birth can lead to many different health complications. Brain bleed, also called an intraventricular hemorrhage (IVH), is one type of serious problem that can happen in babies who are born too early, smaller and sicker.  If you or someone you know has a baby with a brain bleed, it can be a very scary and upsetting experience.

Bleeding in the brain is most common in preterm babies who weigh less than 3 pounds, 5 ounces). A baby born before 32 weeks of pregnancy is at the highest risk of developing a brain bleed. This is because the tiny blood vessels in a baby’s brain are very fragile and can be injured easily. The bleeds usually happen in the first few days of life.

How are brain bleeds diagnosed?

In IVH, bleeding occurs near the fluid-filled spaces (ventricles) in the center of the brain. An ultrasound test can show if a baby has a brain bleed and how severe it is. All babies born before 30 weeks should have an ultrasound of the head to screen for IVH, according to MedlinePlus.gov. The test is typically done between 7 and 14 days of age. Babies born between 30 weeks and 34 weeks also may be screened if they have symptoms of IVH.

Are all brain bleeds the same?

Brain bleeds usually are given a number grade (1 to 4) based on where in the brain it’s happening in and how big the brain bleed is. The right and left sides of the brain are graded separately. Most brain bleeds are mild (grades 1 and 2) and resolve themselves with few lasting problems. More severe bleeds (grades 3 and 4) can cause difficulties for your baby during hospitalization as well as possible problems in the future.

What happens after your baby leaves the hospital?

Every child is unique. How well your baby will do depends on several factors. Many babies with IVH will need to be seen by a pediatric neurologist or another specialist (such as a developmental-behavioral pediatrician) during infancy and early childhood. Some children may have seizures or problems with speech, movement or learning.

If your baby is delayed in meeting their developmental milestones, they may benefit from early intervention services. Early intervention services such as speech, occupational and physical therapy may help your child catch up.

Where can parents find support?

Having a baby with a brain bleed can be overwhelming. The March of Dimes online community, Share Your Story, is where parents can find comfort and support from other parents who have (or had) a baby in the NICU with a brain bleed. Just log on and post a comment, and you will be welcomed.

Source: https://newsmomsneed.marchofdimes.org/baby/brain-bleeds-in-babies/

Tour the NICU at Sharp Mary Birch with Dr. Anup Katheria

Dec 4, 2019      Sharp HealthCare

Join Dr. Anup Katheria, Director of the Neonatal Research Institute at Sharp Mary Birch Hospital for Women & Newborns, on a tour of the hospital’s 84-bed NICU and see a few of the many technologies and therapies used to help give preterm infants the best start in life.

HEALTH CARE PARTNERS

Global Health Education and Best Practices for Neonatal-Perinatal Medicine Trainees

PERSPECTIVE| DECEMBER 01 2021

Sharla Rent, MD; Krysten North, MD; Ellen Diego, MD; Carl Bose, MD

Neoreviews (2021) 22 (12): e795–e804.https://doi.org/10.1542/neo.22-12-e795

Neonatal-perinatal medicine (NPM) trainees are expressing an increased interest in global health. NPM fellowship programs are tasked with ensuring that interested fellows receive appropriate training and mentorship to participate in the global health arena. Global health engagement during fellowship varies based on a trainee’s experience level, career goals, and academic interests. Some trainees may seek active learning opportunities through clinical rotations abroad whereas others may desire engagement through research or quality improvement partnerships. To accommodate these varying interests, NPM fellows and training programs may choose to explore institutional partnerships, opportunities through national organizations with global collaborators, or domestic opportunities with high-risk populations. During any global health project, the NPM trainee needs robust mentorship from professionals at both their home institution and their partner international site. Trainees intending to use their global health project to fulfill the American Board of Pediatrics (ABP) scholarly activity requirement must also pay particular attention to selecting a project that is feasible during fellowship and also meets ABP criteria for board eligibility. Above all, NPM fellows and training programs should strive to ensure equitable, sustainable, and mutually beneficial collaborations.

Source:https://publications.aap.org/neoreviews/article-abstract/22/12/e795/183466/Global-Health-Education-and-Best-Practices-for?redirectedFrom=fulltext

Study Finds Healthcare Lacks Female Leadership, Opportunities

Aine Cryts   November 29, 2021

 A new study on diversity, equity, and inclusion in the healthcare leadership structure of organizations in the United States has found that women are underrepresented, despite making up a majority of the overall healthcare workforce. Fifteen percent of health system and health insurer CEOs are women, according to the study, which was published online today in JAMA Network Open. Representation by women as chairpersons of the board of directors at health systems and health insurers was just slightly better: 17.5% of chairpersons at health systems are women, and 21.3% of boards of directors have chairpersons who are women.

The study also found that having a woman as a health system CEO was associated with a higher proportion of women on the board of directors or in roles as senior executives. Having more women in senior leadership roles at health insurance companies was also associated with increased representation of women as CEOs, per the study.

Researchers also learned that more than half (58.1%) of the leadership positions in the US Department of Health and Human Services (HHS) are held by women.

Bismarck Odei, MD, lead author of the study, told Medscape Medical News that he was most surprised that “the healthcare system in one of the largest populated countries in the world, where women form a slight majority, has so few women leaders influencing the day-to-day healthcare realities of women.”

Still, he points to the gender diversity of healthcare organizations’ boards of directors as “not a trivial statistic.”

“It may be one of the more important parameters that can increase the representation of women in the CEO position across healthcare organizations,” said Odei, a radiation oncology resident at the Ohio State University Comprehensive Cancer Center.

Healthcare Organizations Are More Diverse Than Fortune 500

As a benchmark, women are more likely to serve as CEO at healthcare organizations than at Fortune 500 companies. Fortune reported in June that only 8.1% of these companies are led by women CEOs. Barron’s reported in July that 29% of US board directors were women in 2020, which is up from 19% in 2014.

In addition, a 2019 analysis by consulting firm McKinsey revealed that organizations in the top quartile in terms of gender diversity on executive teams were 25% more likely to deliver above-average profitability than companies in the fourth quartile.

The JAMA study authors wrote that the underrepresentation of women on leadership teams, especially since women make up slightly more than half (50.8%) of the US population, “likely diminishes their role in policy decisions that affect population and women’s health.”

Putting the study in the larger context of research in this area, Odei observes that increased diversity improves organizational performance. “The US healthcare system has been valiantly trying to reach its full potential for some time now, and strengthening its leadership ranks with diverse and innovative voices will be key to achieving its goals.”

Source:https://www.medscape.com/viewarticle/963741

Please enter full article below to access excellent resource information to reference regarding pregnancy loss and ED staff empowerment.

Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department with Pregnancy Loss

Abstract: Members of the National Perinatal Association and other organizations have collaborated to identify principles to guide the care of women, their families, and the staff, in the event of the loss of a pregnancy at any gestational age in the Emergency Department (ED). Recommendations for ED health care providers are included. Administrative support for policies in the ED is essential to ensure the delivery of family-centered, culturally sensitive practices when a pregnancy ends.

Full Resource access       

Sleep-Disordered Breathing In High-Risk Pregnancies Is Associated With Elevated Arterial Stiffness And Increased Risk For Preemcampsia

Published:December 01, 2021    DOI:https://doi.org/10.1016/j.ajog.2021.11.1366

ABSTRACT

Background

Impaired vascular function is a central feature of pathologic processes preceding the onset of preeclampsia. To this end, arterial stiffness, a composite indicator of vascular health and an important vascular biomarker, has been found to be increased throughout pregnancy in those destined to develop preeclampsia and at the time of preeclampsia diagnosis. While sleep-disordered breathing in pregnancy has been associated with increased risk for preeclampsia, it is unknown if sleep-disordered breathing is associated with elevated arterial stiffness in pregnancy.

Objectives

This prospective observational cohort study aimed to evaluate arterial stiffness in pregnant women with and without sleep-disordered breathing and assess the interaction between arterial stiffness, sleep-disordered breathing, and preeclampsia risk.

Study Design

Women with high-risk singleton pregnancies were enrolled at 10-13 weeks’ gestation and completed the Epworth Sleepiness Score, Pittsburgh Sleep Quality Index, and Restless Legs Syndrome questionnaires each trimester. Sleep-disordered breathing was defined as loud snoring or witnessed apneas (≥3 times/week). Central arterial stiffness (carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness), peripheral arterial stiffness (carotid-radial pulse wave velocity), wave reflection (augmentation index, time to wave reflection), and hemodynamics (central blood pressures, pulse pressure amplification) were assessed non-invasively using applanation tonometry at recruitment and every four weeks from recruitment until delivery.

Results

High-risk pregnant women (n=181) were included in the study. Women with sleep-disordered breathing (n=41; 23%) had increased carotid-femoral pulse wave velocity across gestation independent of blood pressure, and body mass index (p=0.042). Differences observed in other vascular measures were not maintained after adjustment for confounders. Excessive daytime sleepiness, defined by Epworth Sleepiness Score >10, was associated with increased carotid-femoral pulse wave velocity only in women with sleep-disordered breathing (pinteraction=0.001). Mid-gestation (first or second trimester) sleep-disordered breathing was associated with a 3.4 odds ratio (0.9-12.9) for preeclampsia, which increased to 5.7 (1.1-26.0) in women with sleep-disordered breathing and hypersomnolence, while late (third trimester) sleep-disordered breathing was associated with a 8.2 odds ratio (1.5-39.5) for preeclampsia.

Conclusions

High-risk pregnant women with mid-gestational sleep-disordered breathing had greater arterial stiffness throughout gestation compared with those without. Sleep-disordered breathing at any time during pregnancy was also associated with increased preeclampsia risk, and this effect was amplified by hypersomnolence.

Source:https://www.ajog.org/article/S0002-9378(21)02626-0/fulltext

INNOVATIONS

Study Links Air Pollution to Nearly 6 Million Preterm Births Around the World

Data on Indoor and Outdoor Pollution Comes from All Inhabited Continents

September 28, 2021

Air pollution likely contributed to almost 6 million premature births and almost 3 million underweight babies in 2019, according to a UC San Francisco and University of Washington global burden of disease study and meta-analysis that quantifies the effects of indoor and outdoor pollution around the world.  

The analysis, published Sept. 28, 2021, in PLOS Medicine, is the most in-depth look yet at how air pollution affects several key indicators of pregnancy, including gestational age at birth, reduction in birth weight, low birth weight, and preterm birth. And it is the first global burden of disease study of these indicators to include the effects of indoor air pollution, mostly from cook stoves, which accounted for two-thirds of the measured effects.

A growing body of evidence points to air pollution as a major cause of preterm birth and low birthweight. Preterm birth is the leading cause of neonatal mortality worldwide, affecting more than 15 million infants every year. Children with low birthweight or who are born premature have higher rates of major illness throughout their lives.  

The World Health Organization estimates that more than 90 percent of the world’s population lives with polluted outdoor air, and half the global population is also exposed to indoor air pollution from burning coal, dung and wood inside the home.  

“The air pollution-attributable burden is enormous, yet with sufficient effort, it could be largely mitigated,” said lead author Rakesh Ghosh, PhD, a prevention and public health specialist at the Institute for Global Health Sciences at UCSF.

The analysis, which was conducted with researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, quantified preterm birth and low birthweight risks based on total indoor and outdoor pollution exposure, while also accounting for the likelihood that the negative effects taper off at higher levels.

The study concluded that the global incidence of preterm birth and low birthweight could be reduced by almost 78 percent if air pollution were minimized in Southeast Asia and sub-Saharan Africa, where indoor pollution is common and preterm birth rates are the highest in the world.  

But it also found significant risks from ambient air pollution in more developed parts of the world. In the United States, for example, outdoor air pollution is estimated to have contributed to almost 12,000 preterm births in 2019.

Previously, the same research team quantified the effects of air pollution on early life mortality, concluding that it contributed to the deaths of 500,000 newborns in 2019.

“With this new, global and more rigorously generated evidence, air pollution should now be considered a major driver of infant morbidity and mortality, not just of chronic adult diseases,” Ghosh said. “Our study suggests that taking measures to mitigate climate change and reduce air pollution levels will have significant health co-benefit for newborns.”

Authors of the study include Kate Causey, Katrin Burkart, Sara Wozniak, Aaron Cohen and Michael Brauer, of the Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Source:https://www.ucsf.edu/news/2021/09/421471/study-links-air-pollution-nearly-6-million-preterm-births-around-world

Studio 24 launches Purple Baby Project to reduce spate of premature mortality

Health By Chukwuma Muanya 25 November 2021

STUDIO 24, a digital photography company, has launched Purple Baby Project in a bid to reduce premature births and the rising mortality of preterm babies in Nigeria.

The project was launched at the Lagos University Teaching Hospital (LUTH) to commemorate this year’s World Prematurity Day, with the theme: “Zero Separation, Act now! Keep parents and babies born too soon together.”

Speaking on the project, the Chief Executive Officer of Studio 24, Christopher Ifeanyi Oputa, said the company is embarking on a journey to save lives and raise awareness for a cause it strongly believes is grossly neglected in Nigeria.

He said over the years, Nigeria has witnessed the dire rise of mortality in babies caused by lack of awareness, insufficient equipment, lack of maintenance programme for equipment in use, and knowledge on how to handle premature babies before transferring them to the hospital.

He said despite inventions and adoption of new technologies by countries across the world to reduce the mortality rates globally, Nigeria is still lagging behind, with statistics placing the country as the second highest in premature deaths.

Oputa also pointed at the lack of knowledge on the part of healthcare givers in knowing the right care to give to premature babies at the point of birth, adding that Studio 24 will equip the health providers in rural areas with new technologies and new safe practices of managing premature babies.

The Studio 24 boss explained that the focal points of the project include, to convert educational materials into a step-by-step audio and visual training resource for health professionals in caring/teaching expectant and newborn mothers, adding that this is also in line with the vision of training neonatal nurses.

Others are to facilitate the Purple Baby Equipment Maintenance Program in the Neonatal Intensive Care Units (NICU) across selected hospitals, starting with Lagos State, and spanning across Nigeria, as well as arresting public attention by promoting content that inspires public awareness, engagement and goodwill for the Preterm New-Born and Vulnerable Baby Care in hospitals.

The Head, Neonatal Unit, Lagos University Teaching Hospital, Prof Chinyere Ezeaka, lamented that Nigeria carries a disproportionate burden, as it records the highest numbers of newborn deaths in Africa and the second highest in the world.

She said while prematurity is the leading cause of deaths in all children less than five years old, three-quarters of these deaths could be prevented with current, cost-effective interventions.

Ezeaka said with early and good antenatal care, some of these conditions could be identified and managed appropriately to prevent preterm delivery.

She stressed that while the economic burden and the physical demand on the parents are often unquantifiable, the healthcare system is often overburdened, as their care is usually very intensive and requiring more staff than older children and adults.

Ezeaka said to prevent preterm births there is need to strengthen the healthcare systems and provide essential drugs and equipment.

She said all stakeholders must come together to promote low cost, effective, innovative medical equipment, adding that due to the immediate challenges to the survival of preterm babies, they require assistance to maintain temperature, breathe and in the area of nutrition.

This equipment, she said, include radiant warmer, oxygen concentrators, respiratory support breathing machines-bubble to aid their breathing; and more invasive mechanical ventilation for tertiary centres, phototherapy machines, pulse oximeters to monitor oxygen levels, glucose meter checks, infusion units, suction machines.

Source:https://guardian.ng/features/studio-24-launches-purple-baby-project-to-reduce-spate-of-premature-mortality/

Temporal Trends in Neurodevelopmental Outcomes to 2 Years After Extremely Preterm Birth

Cheong JLY, Olsen JE, Lee KJ, Spittle AJ, Opie GF, Clark M, Boland RA, Roberts G, Josev EK, Davis N, Hickey LM, Anderson PJ, Doyle LW; Victorian Infant Collaborative Study Group. Temporal Trends in Neurodevelopmental Outcomes to 2 Years After Extremely Preterm Birth. JAMA Pediatr. 2021 Oct 1;175(10):1035-1042. doi: 10.1001/jamapediatrics.2021.2052. PMID: 34279561; PMCID: PMC8290336.

Abstract

Importance: Survival of infants born extremely preterm (EP) (<28 weeks’ gestation) has increased since the early 1990s. It is necessary to know whether increased survival is accompanied by increased neurodevelopmental disability.

Objective: To examine changes in major (ie, moderate or severe) neurodevelopmental disability and survival free of major neurodevelopmental disability at 2 years in infants born EP.

Design, setting, and participants: Four prospective longitudinal cohort studies comprising all EP live births at 22 to 27 weeks’ gestation from April 1, 2016, to March 31, 2017, and earlier eras (1991-1992, 1997, and 2005), and contemporaneous term-born controls in the state of Victoria, Australia. Among 1208 live births during the periods studied, data were available for analysis of 2-year outcomes in 1152 children: 422 (1991-1992), 215 (1997), 263 (2005), and 252 (2016-2017). Data analysis was performed from September 17, 2020, to April 15, 2021.

Exposures: Extreme preterm live birth.

Main outcomes and measures: Survival, blindness, deafness, cerebral palsy, developmental delay, and neurodevelopmental disability at 2 years’ corrected age. Developmental delay comprised a developmental quotient less than -1 SD relative to the control group means on the Bayley Scales for each era. Major neurodevelopmental disability comprised blindness, deafness, moderate to severe cerebral palsy, or a developmental quotient less than -2 SDs. Individual neurodevelopmental outcomes in each era were contrasted relative to the 2016-2017 cohort using logistic regression adjusted for gestational age, sex, birth weight z score, and sociodemographic variables. Changes in survival free of major neurodevelopmental disability over time were also assessed using logistic regression.

Results: Survival to 2 years was highest in 2016-2017 (73% [215 of 293]) compared with earlier eras (1991-1992: 53% [225 of 428]; 1997: 70% [151 of 217]; 2005: 63% [170 of 270]). Blindness and deafness were uncommon (<3%). Cerebral palsy was less common in 2016-2017 (6%) than in earlier eras (1991-1992: 11%; 1997: 12%; 2005: 10%). There were no obvious changes in the rates of developmental quotient less than -2 SDs across eras (1991-1992: 18%; 1997: 22%; 2005: 7%; 2016-2017: 15%) or in rates of major neurodevelopmental disability (1991-1992: 20%; 1997: 26%; 2005: 15%; 2016-2017: 15%). Rates of survival free of major neurodevelopmental disability increased steadily over time: 42% (1991-1992), 51% (1997), 53% (2005), and 62% (2016-2017) (odds ratio, 1.30; 95% CI, 1.15-1.48 per decade; P < .001).

Conclusions and relevance: These findings suggest that survival free of major disability at age 2 years in children born EP has increased by an absolute 20% since the early 1990s. Increased survival has not been associated with increased neurodevelopmental disability.

Source:https://pubmed<a href=”http://Abstract Importance: Survival of infants born extremely preterm (EP) (<28 weeks’ gestation) has increased since the early 1990s. It is necessary to know whether increased survival is accompanied by increased neurodevelopmental disability. Objective: To examine changes in major (ie, moderate or severe) neurodevelopmental disability and survival free of major neurodevelopmental disability at 2 years in infants born EP. Design, setting, and participants: Four prospective longitudinal cohort studies comprising all EP live births at 22 to 27 weeks’ gestation from April 1, 2016, to March 31, 2017, and earlier eras (1991-1992, 1997, and 2005), and contemporaneous term-born controls in the state of Victoria, Australia. Among 1208 live births during the periods studied, data were available for analysis of 2-year outcomes in 1152 children: 422 (1991-1992), 215 (1997), 263 (2005), and 252 (2016-2017). Data analysis was performed from September 17, 2020, to April 15, 2021. Exposures: Extreme preterm live birth. Main outcomes and measures: Survival, blindness, deafness, cerebral palsy, developmental delay, and neurodevelopmental disability at 2 years’ corrected age. Developmental delay comprised a developmental quotient less than -1 SD relative to the control group means on the Bayley Scales for each era. Major neurodevelopmental disability comprised blindness, deafness, moderate to severe cerebral palsy, or a developmental quotient less than -2 SDs. Individual neurodevelopmental outcomes in each era were contrasted relative to the 2016-2017 cohort using logistic regression adjusted for gestational age, sex, birth weight z score, and sociodemographic variables. Changes in survival free of major neurodevelopmental disability over time were also assessed using logistic regression. Results: Survival to 2 years was highest in 2016-2017 (73% [215 of 293]) compared with earlier eras (1991-1992: 53% [225 of 428]; 1997: 70% [151 of 217]; 2005: 63% [170 of 270]). Blindness and deafness were uncommon (<3%). Cerebral palsy was less common in 2016-2017 (6%) than in earlier eras (1991-1992: 11%; 1997: 12%; 2005: 10%). There were no obvious changes in the rates of developmental quotient less than -2 SDs across eras (1991-1992: 18%; 1997: 22%; 2005: 7%; 2016-2017: 15%) or in rates of major neurodevelopmental disability (1991-1992: 20%; 1997: 26%; 2005: 15%; 2016-2017: 15%). Rates of survival free of major neurodevelopmental disability increased steadily over time: 42% (1991-1992), 51% (1997), 53% (2005), and 62% (2016-2017) (odds ratio, 1.30; 95% CI, 1.15-1.48 per decade; P .ncbi.nlm.nih.gov/34279561/

“Movement is my medicine, my meditation, my metaphor and my method, a living language we can rely upon to tell us the truth about who we are, who we are with, and where we are going. There is no dogma in the dance.”
— Gabrielle Roth

COME join me on my  daily walk to seminar classes in Denmark Hill, London and we will witness a kaleidoscope of inspiring sounds, colors, and movement of children and teachers as we pass London’s  primary school playgrounds.

Are you as shocked and excited as I was to hear music blasting from loudspeakers while children (and some teachers) danced and sang during recess? Brilliant! Education in action, and collaborative activity that feeds the mind, body and spirit. 

Watching the weekly recess dance battles at the various schools I pass has brought  small moments of joy into my daily life.  I love witnessing this promise of a healthy and evolved humanity as I walk through this dynamic and beautiful city and observe an impressive educational system in action.  I had a great laugh on one occasion as a child, singing his favorite song loudly, was reminded to sing the “clean” version. As a Zumba instructor, this particular requirement really resonated with me.

My hope is that now and into the New Year, we remember to cherish the small moments that draw us into pure presence and fuel the true meanings of our existence. 

My  New Year resolution this coming year is to grow my heart through attentive immersion in and reflection on the moments in my life that bring me comfort, ignite my vitality, engage my soul.

What actions did you take or witness that brought joy into your day? What small steps can you imagine that may inspire you to cultivate more happiness in your daily life?  

The innocent, noisy, exuberant and chaotic joy of children playing at recess in London reminds me that when we just let go and choose to be authentically present we experience our wholeness, if only for a moment.  Thank you, children and teachers of the magnificent city of London.

We heartily wish you All a Healthy, Safe and Joyful 2022!

Bishops Down Primary School

6,689,340 views    Stephen Brewin

In May 2017, the children and staff at Bishops Down Primary School made a school video – we are very proud of everyone involved – we hope you enjoy watching it as much as we enjoyed making it! – Clare Owen, Headteacher

Left in Lagos – A Nigerian Surf Film

Sep 9, 2017    Calvin Thompson

Professional surfer’s Luke Davis and William Allioti embark on the most unlikely of surf adventures, missioning through Africa’s largest city in search of a wedging left-hander.

Algorithms, GP Grief, Workforce Crisis

Ireland is an island in the North Atlantic. It is separated from Great Britain to its east by the North Channel, the Irish Sea, and St George’s Channel. Ireland is the second-largest island of the British Isles, the third-largest in Europe, and the twentieth-largest on Earth.

Geopolitically, Ireland is divided between the Republic of Ireland (officially named Ireland), which covers five-sixths of the island, and Northern Ireland, which is part of the United Kingdom. In 2011, the population of Ireland was about 6.6 million, ranking it the second-most populous island in Europe after Great Britain. As of 2016, 4.8 million lived in the Republic of Ireland, and 1.8 million in Northern Ireland.

Health care in Ireland is delivered through public and private healthcare. The public health care system is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.

Source:https://en.wikipedia.org/wiki/Ireland

PRETERM BIRTH RATES – Ireland

Rank: 170  –Rate: 6.4   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

COMMUNITY

We applaud the collaborative work INHA shares with our global preterm birth community. Numerous resources of significant value are provided through the INHA website. An important example we are sharing below targets the journey of loss of a preemie infant/infants.

The INHA is Ireland’s first collaborative platform and network to represent the interests of preterm infants, ill infants in the Neonatal Intensive Care Units (NICU) and their families. It comprises of families affected by a preterm birth, multi-disciplinary healthcare experts, educators, researchers, political decision makers and industry partners who share the common goal of reducing the incidence of preterm birth in Ireland, supporting families with infants in the NICU and  improving the long-term health of preterm infants by ensuring the optimum prevention, treatment, care and support.

Our vision is to support and empower families affected by prematurity by advocating increased awareness, improved pre-conceptual, ante-natal and post natal education, equitable and standardized neonatal care and improved long-term care for both the premature baby and the family.

Resources for Bereaved Parents

If your baby has died, this is a devastating loss for you and your family. We are working hard to develop bereavement supports and resources for families whose baby has died some of which are outlined below.

We have produced a suite of information booklets on baby loss. Two of these booklets aim to offer support and guidance to you as bereaved parents who have experienced loss of your baby (babies). You can download them below:

We have also developed two booklets which contain a collection of 20 short stories written by bereaved parents about life after loss of their baby or babies.

In addition, we have developed a guide for bereaved parents, which offers guidance about parenting your surviving twin or triplet (s).

Recommended books

Books for children about loss of a baby brother or sister

Source:https://www.inha.ie/resources-bereaved-parents/

Prof John Murphy: ‘The modern intensive care unit is a quiet place.’ Photograph: Dara Mac Dónaill

‘A lot of people don’t know neonatology exists – until they get a small baby who is sick’

Over the decades, Prof John Murphy has seen many advances in the care of newborns

Tue, Oct 26, 2021 – Sheila Wayman

On the pavement outside the front door of the National Maternity Hospital on Holles Street, a neonatal nurse and neonatal doctor are preparing to clamber into a waiting ambulance that is adapted for the transport of critically ill newborn babies.

As consultant neonatologist Prof John Murphy walks by, he stops to have a quick word about what has been a busy week for this transport team, which can be mobilised within 20 minutes of a call. The three Dublin maternity hospitals take turns to supply specialist staff for the National Neonatal Transport Programme and this is the NMH’s week on, with the crew about to depart for Cork, having been to Sligo the day before.

It’s now a 24/7 transport service, in no small part thanks to Murphy who, as clinical lead for the National Clinical Programme for Paediatrics and Neonatology, oversaw its expansion from a 9am-5pm operation. This speedy, specialised transfer of infants to the Republic’s four tertiary neonatal intensive care units (NICUs) – three in Dublin, one in Cork – is one of many innovations in the care of newborns over recent decades that have all played a part in the saving of thousands of fragile lives.

Back in 1970, for every 1,000 live births in Ireland, 13 babies would die within the first month. By 2019, that rate had dropped to two per 1,000 live births.

“For every 1,000 births, an additional 11 babies now go home alive,” says Murphy, whose 35 years as a neonatologist in the NMH and Temple Street hospital have spanned many advances in the care of newborns. For instance, he can still remember, in 1992, giving the first dose of surfactant, which “looks like skim milk” and helps babies with immature lungs to breathe.

“I couldn’t believe it. A baby that was very blue and unwell suddenly going very pink; the change was so dramatic. That was a key, life-saving event, one of the keys that unlocked the door to survival of small babies. You could put a tube into their windpipe and give it to them and that made their lungs very flexible and that had a huge impact on mortality.”

Tiny babies of just 23 weeks’ gestation now have a fighting chance of life, while the survival rate for those who reach 26 weeks before birth is close on 80 per cent.

Murphy was “surprised and flattered” to be this year’s recipient of the Kathleen Lynn Medal, awarded by the Royal College of Physicians of Ireland (RCPI) for “exceptional service on behalf of children.” Nevertheless, in this interview to mark the occasion, he is quick to deflect any reflection of personal achievement and instead welcomes it as “very good recognition of neonatology, which is not necessarily the most widely known speciality. I think a lot of people don’t know it exists – until they get a small baby who is sick,” he says, sitting in a boardroom at the top of NMH offices on Mount Street.

Neonatology is a speciality in medical and nursing care that only began to emerge in the 1960s. Other professionals, including dietitians, pharmacists, psychologists and clinical engineers who maintain NICUs’ complex equipment, now have vital roles in the field too.

Covering the care of all babies from birth until one month of age, he describes neonatology as “the ‘human turnstile’ through which everyone passes,” as we adapt to life outside the womb. About 10 per cent of babies require admission to a special care baby unit, although the time spent there may range from hours to several months.

The death of baby Patrick Bouvier Kennedy in August 1963, just three months before his father, US president John F Kennedy, was assassinated, kickstarted huge investment into research around prematurity. Jacqueline Kennedy, who missed her husband’s trip to Ireland earlier that summer due to the pregnancy, had to have a Caesarean section to deliver their infant son 5½ weeks early. Suffering from respiratory distress syndrome, he lived only 39 hours, despite access to the best medical care the US could offer at the time.

Today, he would be a very routine case in any neonatal unit. Although 7 per cent of babies born in Ireland are premature, defined as less than 37 weeks’ gestation, “only about 1-2 per cent of those are really immature and going to cause all the problems”, says Murphy. Initially, neonatology was all about saving lives but its focus has broadened to trying to minimise lifelong effects of a baby’s early departure from its mothership. The brain is the new frontier in the constant quest for improved neonatal care.

“Once you meet a level of survival and your specialty matures, you begin to look at the quality of survival, that is what you are really after.”

Low birthweight, sometimes no more than half a standard bag of sugar, is not the principal problem in itself. Rather, it is the immaturity of their organs. Also, their skin is thin, resulting in a “lobster red” appearance and making them liable to rapid loss of heat and water, as well as open to infections.

Murphy, described as “a true prince of neonatology and paediatrics in Ireland” in the award citation delivered by Royal College of Surgeons in Ireland -Bahrain vice-president and fellow paediatrician Prof Alf Nicholson, traces his choice of career back to childhood. At home in Cork city he used to watch Dr Finlay’s Casebook, a 1960s TV series about a doctor working in the fictional Scottish town of Tannochbrae. “I saw him one day going into a house and seeing a child who was sick and making a diagnosis of meningitis. Then doing a lumbar puncture and the child got better; I thought, ‘I’m going to do that’.” He successfully applied to study medicine at University College Cork.

During medical training, the sight of a baby with apnoea breathing irregularly, made a big impression on him. There was no treatment for it at the time and it made him think if only there was something that could be done. That was before the administration of caffeine was discovered to be really effective for treating this condition, by improving the contracting of the diaphragm.

After several years of further training in the UK, Murphy was the first consultant neonatologist appointed in Wales, before returning to Ireland in 1986 to become one of three at the NMH. Since then, big changes he has worked through include the handling of sensory issues in neonatal care. “There was a time when people were probably less aware of pain in babies. My rule of thumb is that if I find something painful, the baby is jolly well going to find it painful too.”

Loud noises can be very upsetting for these babies who cannot yet filter stimuli. “The modern intensive care unit is a quiet place. No hoovers are allowed in, the floor must be brushed; phones are put on a light system so less noisy.

“Then we have these quiet hours where all the lights go out in the unit and everybody speaks in a whisper and activity goes right down so the babies can rest.” Things that have to be done for a baby, such as taking a blood sample, a swab, changing a nappy, are planned, to reduce the number of disturbances.

“It’s all an attempt to replicate what goes on in the womb, which is really protective, but also to recognise that over-stimulation of these babies may have consequences on their development.”

Another simple intervention has been the placement of preterm babies in a plastic bag immediately after birth to keep them warm before transfer to an incubator. They can lose up to 1 degree Celsius a minute and when once, he recalls, theatre and corridor windows were hastily closed in an effort to alleviate heat loss, this “phenomenal technique” now does a very effective job.

He’s also seen the introduction of nitric oxide gas for the treatment of respiratory distress syndrome and improvements in minimising brain injuries in preterms through the giving of steroids to mothers at risk of premature delivery.

Tracking how these babies fare after they are discharged is vital. At the NMH, the neonatal department’s clinical development psychologist Marie Slevin sees all premature babies back at two years of age for what is known as the Bayley assessment, looking at cognitive skills and speech and language development.

Prof John Murphy is this year’s recipient of the Kathleen Lynn Medal, awarded by the Royal College of Physicians of Ireland for ‘exceptional service on behalf of children.’

“It is very helpful to be constantly getting the feedback,” says Murphy, who sees upcoming World Prematurity Day on November 17th as a way to mark the impact prematurity has on society. “There are very few families, either parents or grandparents, uncles or aunts, who won’t have come across, or had, a baby that was preterm.”

Incidence of prematurity has gone up, mainly because multiple births are a big factor and the rate of twinning has increased significantly, due to more widespread use of assisted reproduction. The Economic and Social Research Institute reported a twinning rate of 18.8 per 1,000 maternities for 2016, an increase of 22.1 per cent over the previous decade.

At the NMH on November 17th, as at other maternity hospitals, some “preemies” and their parents are invited in to celebrate what is achieved within the walls of their NICU. But these are not the only cohort of former patients that Murphy is always delighted to see come bouncing back.

There are also full-term babies for whom the treatment of therapeutic hypothermia (TH), introduced in Ireland in 2009, has proven to be “one of the most amazing changes” in the prevention of disability resulting from oxygen deprivation during birth. Such babies are at high risk of cerebral palsy.

With TH, a cooling jacket is used to lower a baby’s body temperature to 33.5 degrees Celsius, about four degrees lower than normal, within six hours of birth and until it’s 72 hours old. Nobody yet knows precisely how it works, he explains, “but if we learn more about that, we may be able to use some pharmacological methods as well as this physical method of cooling. It seems to act by slowing down, or cooling, the brain activity – and that way the brain cells get a chance to recover.”

About 70 babies are cooled in Ireland every year, giving good results in the term of outcomes. For every case, antenatal, labour and neonatal data is collected and analysed to help increase knowledge in maternity hospitals about oxygen deprivation and see if and where it might have been preventable.

“It has been very rewarding to me to see children who obviously have got a problem at birth and then they have been cooled – and then see them running into you at a clinic, when I would have seen the opposite. As the cooling has gone on, it’s got better and the equipment has got better. And we have got better at managing it.”

Murphy acknowledges the “dichotomy” in keeping preterm babies warm to save life and then cooling some full-term babies to do likewise. “A lot of medicine is counter-intuitive – it doesn’t work out the way you think it’s going to work out,” he says.

Hundreds of trainee paediatricians have benefited from his experience and inspiring passion for the care of the youngest possible members of our population. The training programme set up by the RCPI’s faculty of paediatrics, established in 1992, is, he asserts, “second to none”. About 40 doctors come into it annually after completing their intern year and do an initial two years. They can progress to higher specialist training, which takes another five years.

“They come out at the end of that with their certificate of full training, which is recognised very well internationally. All our young consultants who have been appointed in recent years have all come through our training system, which is very flattering in a way that all these bright young doctors have chosen to stay in Ireland.”

He believes the clinical nature of paediatrics appeals to student doctors. “You have to work out what’s wrong with the child from observation. It’s not as much about tests, as it is with an adult; tests are painful and difficult to do, so you have to go a lot on your clinical skills.”

As for himself, it’s the opportunity to be working with long-term survivors of medical care that he relishes. With a sick, premature baby, there is the satisfaction of setting them up for a lifetime of maybe 80 or 90 years.

He has always found writing up individual cases very stimulating. His father, who used to do a lot of writing advised him that “writing gives an existence to what you do, gives us some meaning.” In his “spare” time, Murphy has, since 1989, edited the Irish Medical Journal, now published only online, and plays golf. He’s married to a doctor and two of their three adult children have followed in their footsteps, while the third is a solicitor.

It’s said that the age of viability for preterm babies is lowered by a week for about every decade of improved neonatal care. Last December, the RCPI recommended 23 weeks’ gestation as the threshold for viability, the previous bar of 24 weeks having been set in 2006. “Anecdotally, we were beginning to resuscitate 23 weeks’ gestation babies so we decided we would lower the limit in recognition of that.”

How much lower does Murphy think it can go? “We haven’t had survivors of 22 weeks, we don’t see that,” he says, while acknowledging that they do in Japan. He reckons it would need another fairly significant innovation before the threshold drops again.

Active management of extremely premature babies is ethically complex and when a baby is born at 23 weeks, important conversations have to be held with the parents about the merits and demerits of intensive care. “You may institute intensive care and then a few days into the intensive care sequence, you find the baby has a major complication, say a brain bleed, and then you reconsider.” There are frank discussions when complications arise, in some “very challenging human scenarios.” Maybe a couple has been through three or four rounds of IVF before achieving a pregnancy that has resulted in an extremely premature delivery.

Constant interaction with colleagues and a sense of camaraderie is what he finds “destressing” in the job. “With our team, the junior hospital doctors are teaching every morning and we all go for tea. You’re meeting every day and discussing things every morning, that takes the stress out of situations because you discuss and unburden your concerns and get the best opinions on how to do X, Y and Z. The hospital has that tradition of being a good place to work.”

Will he ever retire?
“I will eventually,” he smiles.

But he’s certainly showing no sign of it yet.

Source: https://www.irishtimes.com/life-and-style/health-family/parenting/a-lot-of-people-don-t-know-neonatology-exists-until-they-get-a-small-baby-who-is-sick-1.4706642

Westlife perform Starlight in the Ballroom ✨ BBC Strictly 2021

Oct 17, 2021            BBC Strictly Come Dancing

PREEMIE FAMILY PARTNERS

#3 James Boardman: Growing up following premature birth

July 24, 2018

Professor James Boardman, Professor of Neonatal Medicine at the University of Edinburgh, describes his work on the brain development of premature babies, as part of Their world Edinburgh Birth cohort (http://www.tebc.ed.ac.uk/). This presentation was part of a public engagement event called ‘Celebrating your contribution to Scottish Cohort Studies’, which took place in The Assembly Hall on the Mound, on 10th June 2018.

Pregnant Women Urged to Get COVID-19 Vaccine

Michelle Winokur, DrPH, and the AfPA Governmental Affairs Team, Alliance for Patient Access (AfPA)

Public health officials are urging pregnant and breastfeeding moms to get the COVID-19 vaccine – and soon. A federal health advisory from the Centers for Disease Control and Prevention follows the release of new data showing a 70% increased risk of death from COVID-19 during pregnancy. Unvaccinated pregnant women also have a higher risk of early delivery or stillbirth.

Pregnancy and Vaccine Safety

As part of their campaign to encourage pregnant women to get inoculated, Federal health officials are highlighting the safety and efficacy of the vaccine. As the health advisory notes, the vaccine does not increase the risk of miscarriage or birth defects or affect fertility. The COVID-19 vaccine is recommended for pregnant women, recently pregnant, breastfeeding, or trying to get pregnant. Professional medical organizations have endorsed these recommendations, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. COVID-19 Among Pregnant Women Despite the benefits to mothers and their unborn babies, only 31% of pregnant women are vaccinated against COVID-19. Being unvaccinated leaves expectant moms vulnerable to contracting COVID-19, while pregnancy makes them more likely to experience severe symptoms and require intensive-level care.

As part of their campaign to encourage pregnant women to get inoculated, Federal health officials are highlighting the safety and efficacy of the vaccine. As the health advisory notes, the vaccine does not increase the risk of miscarriage or birth defects or affect fertility. The COVID-19 vaccine is recommended for pregnant women, recently pregnant, breastfeeding, or trying to get pregnant. Professional medical organizations have endorsed these recommendations, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

COVID-19 Among Pregnant Women

Despite the benefits to mothers and their unborn babies, only 31% of pregnant women are vaccinated against COVID-19. Being unvaccinated leaves expectant moms vulnerable to contracting COVID-19, while pregnancy makes them more likely to experience severe symptoms and require intensive-level care.

Thus far, approximately 97% of pregnant women hospitalized with COVID-19 were unvaccinated. Moreover, in August, 22 pregnant women died of COVID-19, making it the single highest month for COVID-related pregnancy deaths since the pandemic began. In contrast, getting vaccinated protects both expectant moms and her baby. Getting vaccinated is the single most effective way to prevent serious illnesses, death, and adverse pregnancy outcomes from the coronavirus.

A Precaution Not to be Overlooked

Women who are planning to get pregnant take many steps to prepare. Likewise, expectant moms pay extra attention to their health and safety for the sake of their babies. Getting vaccinated against COVID-19 is one precaution they should not overlook. The sooner, the better, say the experts.

References: https://emergency.cdc.gov/han/2021/han00453.asphttp://neonatologytoday.net/newsletters/nt-nov21.pdf

Pregnancy and infancy loss – Grandparents grief

Nov 9, 2020    Pascale Vermont

Pascale Vermont, PhD – Grief counselor Author of Surviving the Unimaginable -Grandparents’ grief after a baby loss Most grandparents feel devastated and very lonely when their son or daughter loses a baby during pregnancy or infancy. In this video I share some suggestions other grandparents have found to be very helpful.

INNOVATIONS

What Happened With Preterm Birth During the Pandemic?

Some mothers — and their babies — may have fared better than others

by Amanda D’Ambrosio, Enterprise & Investigative Writer, MedPage Today – April 8, 2021

While pregnant women have been warned about their potential for more severe COVID-19 illness, a few early reports have suggested one positive finding for this population — that pandemic lockdown restrictions may have coincided with a decrease in preterm births.

Early studies have observed a decline in preterm birth rates during the lockdowns, highlighting a potential “silver lining” of the pandemic. But while these findings are encouraging, experts say there is still not enough data to know whether the reduction in preterm births was widespread, or what factors may have caused this outcome to drop in the first place.

“The jury is out, in terms of what’s the overall impact [of the pandemic] on preterm birth,” said Rahul Gupta, MD, MPH, chief medical and health officer at March of Dimes. While early data may provide some insight into lifestyle changes such as working from home and remote access to healthcare, Gupta said more information is needed before drawing conclusions about preterm birth reductions — and which populations were most affected.

Globally, preterm birth is the leading cause of death in children under 5 years old, according to the WHO. In the U.S., the preterm birth rate has been on a consistent upward trajectory, with 2019 being the fifth straight year in a row that the rate increased. Between 2018 and 2019, the preterm birth rate rose by 2%, according to the CDC.

Clinicians from Denmark and Ireland first began to notice a decline in preterm births last spring — specifically, those that were earliest and most critical. A preprint study from Denmark, which included more than 31,000 infants born between 2015 and 2020, showed around a 90% decrease in extremely preterm births (those born before 32 weeks’ gestation) during the lockdown period. In Ireland, another study published in BMJ Global Health observed a 73% reduction in extremely low birthweight deliveries, from January to April of last year.

Other studies have found that rates decrease for specific populations. A recent systematic review and meta-analysis in The Lancet Global Health found that while the overall preterm birth rate was not significantly different before and during the pandemic, the rate in high-income countries declined by 9%. Spontaneous preterm births in high-income countries saw an even greater reduction, falling by almost 20%.

“Interestingly, there are happy numbers mainly from high-income countries,” said the study’s lead author, Asma Khalil, MD, of St. George’s University Hospitals NHS Foundation Trust in London.

Some reports from the U.S. also reflected a decline, albeit a smaller one. Last April, Stephen Patrick, MD, MPH, of Vanderbilt University, wrote on Twitter that he noticed a lower number of infants in the neonatal intensive care unit (NICU) at his institution.

Last month, Patrick and colleagues published a study in JAMA Pediatrics showing the relationship between preterm birth and stay-at-home orders in Tennessee. Patrick’s team found that the risk of preterm birth fell nearly 15% during the lockdown period, after controlling for maternal age, race, education level, hypertension, and diabetes.

Naima Joseph, MD, MPH, a maternal-fetal medicine fellow at Emory University School of Medicine, said it could be that the decline is related to the environmental and lifestyle changes that occurred during the early months of the pandemic.

Alison Gemmill, PhD, of Johns Hopkins University, said that a number of changes during lockdown may have been associated with drops in the preterm birth rate. When most cars were off the roads, there may have been a decline in the number of preterm births associated with air pollution. Additionally, as pregnant people shifted to remote work and found themselves at home and off their feet, Gemmill said there may have been a decline in physical stress.

Another hypothesis, Gemmill added, is that the decrease in preterm births may have occurred simultaneously with an increase in stillbirths. Some reports have shown an increase in stillbirths during the pandemic (including Khalil’s analysis), but U.S. data has yet to confirm this increase.

Gemmill and colleagues published a study last week (which has not yet been peer-reviewed) showing that the preterm birth rate in the U.S. was one of several birth outcomes that was lower than expected in March and April of last year. But the group also observed that the rate dipped significantly again in November and December — coinciding with the months when infection rates climbed.

“Something is definitely going on,” Gemmill said in an interview. She added that the rates her group observed are crude, and do not describe how different demographic groups in the U.S. were affected. However, she said her research is “detecting a really important signal that doesn’t occur in birth outcomes research.”

Not all U.S. data confirm this pattern. A JAMA study of nearly 9,000 infants at the University of Pennsylvania showed that mothers in 2020 were at the same risk of preterm birth than they had been in years prior.

Gupta, of March of Dimes, stated that the U.S. is not a homogenous society, and preterm birth rates will look different across different populations. Black parents, for example, have a 50% higher chance of having a premature infant than white or Hispanic parents. And while preterm births may have coincided with remote work, that would not apply for the essential workers who continued their employment throughout lockdowns.

Regarding preterm birth outcomes during the pandemic, Gupta said that once scientists break down data by demographics, social determinants of health, and medical comorbidities, he expects there will be a “variety of outcomes.” There is no real-time, national birth surveillance data in the U.S. — so it will take time to understand these outcomes fully.

As far as the theories about which factors may have impacted preterm birth, Joseph said that “mostly, these data have led to more hypothesis generation than anything else more conclusive.”

Gupta agreed, adding that there is more research to be done about both the impacts of COVID-19 infection, as well as the indirect effects of the pandemic.

“I think we really have to better understand what factors during COVID — including lockdowns, unemployment, social interactions, mental health, adherence to medications, job loss — all played a role,” he said. “I think we should not take any of these one factors for granted.”

Source: https://www.medpagetoday.com/special-reports/exclusives/92000

INFANT Led European Network to Advance Development of Algorithms that Detect Brain Injuries in Infants

By Alan Drumm|October 27th, 2021

Working alongside a team of scientists, clinicians and technical experts from 14 different European countries, Dr John O’Toole aims to build capacity and strengthen cooperation among international research groups, with the goal of developing algorithms that will minimise the risk of babies developing catastrophic life-long neonatal brain injuries.

Insufficient oxygen around the time of birth can cause brain injury. For babies born prematurely, the heart and lungs may struggle to adapt to the new environment which can lead to brain injury too. Brain monitoring of a tiny infant in an intensive care unit is challenging.

It can be difficult and slow to interpret the complex brain-wave patterns.  AI systems are a perfect fit to this problem, as they can be designed to automatically recognise signs of brain injury.

Funded by the European Cooperation in Science and Technology, the researchers involved in the AI-4-NICU project plan to build on existing cot-side technologies, such as devices that measure brain waves, by including AI algorithms to detect markers of brain injury.

This, Dr O’Toole anticipates, will lead to the development of decision-support tools that will help clinicians in neonatal intensive care units to quickly identify potential brain injuries that can result in death, cerebral palsy, or delayed development.

Reading and interpreting the brain-wave signals is a notoriously difficult task which requires highly specialised expertise. AI systems can be designed to mimic the human expert, by shifting through enormous amounts of data to automatically find signs of brain injury.

These AI systems, unlike the human expert, can then run around the clock for all at-risk infants to provide a continuous assessment of brain health.

To develop the device, Dr O’Toole and his team will first develop the tools necessary to acquire, pool, share, and manage neuro-physiological data sets.

They will then create a framework to develop, test, and compare algorithms that they hope will act as decision-support tools in neonatal intensive care units.

Source:https://www.infantcentre.ie/2021/10/27/infant-led-european-network-to-advance-development-of-algorithms-that-detect-brain-injuries-in-infants/

In prematurity, twins can have developmental advantages over singletons

November 2, 2021   Marian FreedmanJon Matthew Farber, MD

A recent study indicates that when born prematurely, twins may have some gains over singleton babies.

A milestone-related assessment of early psychomotor development of preterm (PT) twins compared with PT singletons found that twins born between 32 and 33 weeks’ gestational age (GA) have an early neuro- development advantage over their singleton peers. Italian investigators conducted developmental assessments in 73 PT twins and 207 PT singletons throughout the first 18 months of life. Assessments, using standardized tests and parental observation, included primary gross motor milestones, beginning of babbling, early visual fixation, and being able to follow a moving object. Investigators divided participants into 3 groups according to GA: 17 born at less than 31 weeks (group 1), 30 born between 32 and 33 weeks (group 2), and 26 born between 34 and 36 weeks (group 3). Twins in group 1 not only spoke their first single word significantly earlier than singletons in the group did but also demonstrated persistent superior language skill achievement at long-term follow-up together with better oculomanual abilities. Compared with singletons, group 2 twins also spoke their first single words at a younger age and achieved standing, walking, and pointing earlier. No significant differences emerged between group 3 twins and singletons except that twins demonstrated worse personal and social skills than singletons at long-term follow-up. Overall, investigators concluded that the differences in twins compared with singletons in the 3 groups were independently related to their gemellarity (“twinness”).

Thoughts from Dr. Farber

This is an interesting finding. An earlier study showed that firstborn twins above 28 weeks’ gestation were less likely to have respiratory distress syndrome than singletons. I wonder whether better lungs account for some of the difference. Unfortunately, many of the children, twins or not, had developmental delays at 25 to 36 months of corrected age.

Source:https://www.contemporarypediatrics.com/view/in-prematurity-twins-can-have-developmental-advantages-over-singletons

Child Development: How to Improve Educational Outcomes of Children Born Preterm

Education and Training Foundation

Posted on January 4th, 2021 – In a guest blog, Dr Joanna Goodman, an independent education consultant and expert panel member for developing T Levels, writes why the new Education and Childcare T Level must signpost to evidence-based educational resources for children born prematurely.

In the UK, in an average sized classroom, two to three children are likely to have been born preterm (before 37 weeks of pregnancy). Whilst the numbers of children born preterm are rising, there has been very little training available to education professionals – teachers, educational psychologists, nursery nurses or teaching assistants– with regard to the potential learning difficulties that these children can encounter in early years settings or schools.

It is, therefore, particularly important that the new ‘gold standard’ T Level qualification in Education and Childcare signposts to the evidence-based educational resources for children born prematurely: PRISM resources. These free resources, aimed at education professionals, not only raise the awareness of the impact of prematurity on learning, but also highlight a range of strategies that can be used to improve the educational experiences of these children, ultimately leading to improving their life chances. 

As part of the panel of experts who worked on developing the curriculum for the Education and Childcare T Level, I am now keen to raise awareness and understanding of the potential needs of these children – to bridge the gap between healthcare and education.  Additionally, learning from my experience developing NICE guidelines for the follow-up of children born preterm and subsequently making a contribution to the development of PRISM resources, I feel that I am well placed to raise awareness among education professionals of the potential risk factors and learning needs of this cohort. Moreover, it is critical that any new quality training for education professionals – for example the T Level Professional Development (TLPD) offer – should include evidence-based information that is relevant to particular workplaces. This is particularly imperative when information applies to 8% of the school population, and when education professionals have received very little training in this area to date.

Research asserts that:

…education professionals receive very little training about the impact of preterm birth on children’s development and learning and have poor knowledge of how to support preterm-born children in the classroom. In a recent national survey, only 16% of teachers had received any training about preterm birth and over 90% expressed the need for training. As teachers have primary responsibility for supporting the learning and development of preterm born children in the long term, this represents a significant public health concern. (Johnson, S. et al., 2019).

To address this gap in knowledge and training, it is crucial that any new training or qualification for professionals working with children in education or early years settings, includes high quality evidence-based resources on how to improve the outcomes of children born preterm. 

For those undertaking training within the TLPD offer, the Education and Childcare courses will signpost practitioners to the PRISM resources, which serve to raise awareness and understanding of the different learning techniques when teaching preterm children.

Furthermore, as “preterm birth places children at an increased risk for a range of developmental problems and disorders later in life” and “this disadvantage persists throughout the lifespan with fewer preterm-born adults having completed high school and undertaken higher education” (Johnson, S. et al., 2019), this issue is not only of concern to professionals working in primary school or early years settings. Clearly, awareness of prematurity and potential learning difficulties is applicable to all educational settings, so appropriate teaching and learning strategies can be used for improved outcomes. 

As an experienced educator and an expert on learning, I cannot emphasise enough how fundamental it is for all staff working with children to have the right level of knowledge with regard to child development, including the impact of birth problems on subsequent cognitive, sensory or physical development. Free access PRISM e-resources provide valuable information for adults working with children on risk factors for child development and expected milestones. Despite significant improvements in neonatal care, to date there is no evidence of improved long-term outcomes for these young people. The experts highlight that:

The continued increase in preterm birth rates for extremely preterm babies [born <27 weeks gestation] means that there are increasing numbers of preterm survivors entering societies year on year. This results in greater demands being placed on education systems and their professionals to identify difficulties and provide support for these children in the long term.(Johnson, S. et al., 2019).

According to evidence, these particular areas may require additional support:

  • difficulties with mathematics
  • inattention
  • working memory difficulties
  • slow processing speed
  • poor hand-eye co-ordination
  • social and emotional problems
  • sensory impairments
  • poor fine and gross motor skills.

However, as these children’s development is different to children born full term, it is important to understand that preterm children have different developmental mechanisms behind their difficulties than term-born children. For example, inattention can be linked to poor working memory or visual impairment, rather than attention-deficit-hyperactivity disorder, as known in term-born children. It is also worth noting that the attainment of these children is often lower by comparison with peers and some may never attain at the same level as their peers born at term.

For these reasons, and to minimise external interventions, it is important for any professionals working with children to engage with these interactive free e-learning resources, which are the only kind of resources available worldwide. An early evaluation of these resources indicates they have “substantially improved teachers’ knowledge of preterm birth and their confidence in supporting preterm children in the classroom.” (Johnson, S. et al., 2019). This is why the access to these resources provides another important dimension to the study of child development as part of T Level training in Education and Childcare, through the TLPD offer.

Source:https://www.et-foundation.co.uk/t-level-professional-development-tlpd/child-development-how-to-improve-educational-outcomes-of-children-born-preterm/

HEALTH CARE PARTNERS

The U.S. needs more nurses, but nursing schools don’t have enough slots

October 25, 20215:00 AM ET YUKI NOGUCHI  HEALTH INC

Struggle is nothing new to Foxx Whitford.

He grew up desperately poor in Fairfield, Calif., losing a beloved brother to epilepsy and getting evicted from his home as a child. As a teenager, he joined the Marines to help put himself through college and he completed a harrowing tour in Afghanistan. All of that hardship, he says, prepared him for one of his biggest life challenges: getting into and through nursing school during a pandemic.

“Every time things get hard, I always think about all those losses and hard times,” says Whitford, a nursing student at California State University, East Bay.

And everything about his nurse training has been hard. Whitford, a C-average student in high school, says he spent sleepless nights in community college, studying and teaching himself to learn. After nearly failing an anatomy course, he eventually made the dean’s list and won student-athlete awards. Still, when he tried to transfer to a four-year bachelor of science in nursing program, he lost out. There were some 800 others applying for 64 slots.

He waited a year to reapply and finally got in. Then the pandemic hit — making it even more difficult to get the clinical experience he needs to graduate.

Across the country, hospitals desperate for nurses — especially in acute care —are trying to address intense burnout among health care workers and accelerated nurse retirements by hiring new graduates. They’re offering jobs to students even before they graduate, and in many cases offering bonuses and loan repayment as financial incentives. And the interest is there; enrollments and applications in baccalaureate and advanced nursing degree programs increased last year. Leaders in nursing say the trends — which predate the pandemic — are the same for certificate programs in licensed practical nursing, licensed vocational nursing and certified nursing assistants programs.

Yet — paradoxically — becoming a nurse has become more difficult, narrowing the pipeline for new nurses coming through the system.

A lack of instructors is part of the problem

One of the biggest bottlenecks in the system is long-standing: There are not enough people who teach nursing. Educators in the field are required to have advanced degrees yet typically earn about half that of a nurse working the floor of a hospital.

Health workers know what good care is. Pandemic burnout is getting in the way

The pandemic worsened those financial strains, forcing many educators to look for more lucrative work, says Sharon Goldfarb, who has advanced degrees in nursing care, has worked as an RN and family nurse practitioner and teaches nursing at several schools near San Francisco. Her spouse lost his job during the pandemic and that is one of the most common reasons educators are leaving, she says. She surveyed 91 community colleges in California and found nursing faculty declined 30% since the pandemic began.

“To lose an additional 30% has been devastating,” she says. “There is not a school I know of that isn’t desperately looking for nursing faculty.”

That desperation is compounded by an aging demographic. With so many in their late 50s and 60s, the country’s nursing faculty is continuing to decline, to about two-thirds what it was in 2015.

Taken together, those factors are severely limiting the number of students that schools can accept, and in some cases it disrupts classes themselves.

“Some schools went on hiatus; some schools reduced their enrollment, so they took even fewer students; some schools … scrambled so much, they actually have to extend semesters,” Goldfarb says.

The pandemic curtailed training programs

In addition, since the beginning of the pandemic, nursing students have had a harder time getting the clinical or hands-on training required to graduate, because hospitals curtailed their training programs to control the risk of infection.

“Faculties and schools have found ways to innovate, to educate students by the use of the internet, distance learning, and simulation labs,” says Peter Buerhaus, a professor and health economist at Montana State University’s College of Nursing who studies the nursing workforce. Those innovations have helped mitigate the impact of the pandemic on education, he says, but schools aren’t like factories that can ramp up their production.

The nursing shortage, he says, was more acute in the 1990s, when hospitals drastically cut back on staff to cut costs. But with the retirement of baby boomers, the influx of new nurses needs to keep up.

Last year, enrollment in baccalaureate and higher-level nursing degree programs increased, but colleges and universities (not including community college nursing programs) still turned away more than 80,000 qualified applicants due to shortages of faculty, clinical sites and other resources, according to the American Association of Colleges of Nursing.

How one applicant persevered

Whitford, the nursing student aiming to become an RN, is getting even more specialized training as an ER nurse. He says many people ask him how he has persevered through the gantlet of nursing school. “Everything I have, I’ve always had to work extremely hard for,” he tells them.

At age 10, shortly after his brother — whom he describes as his “best friend” and idol — died of epilepsy, Whitford started working at a bowling alley to supplement his father’s truck-driving income. “We had to struggle a lot when I was growing up, in terms of getting food on the table.”

His early childhood tested him, he says, and ultimately deepened his resolve.

“Pursuing nursing,” he says, “was my ticket to doing everything that I wanted.” And that meant getting out of poverty and into meaningful work he loved.

His childhood experiences also made him feel comfortable in chaos. So when the pandemic hit, Whitford became even more eager to join the front lines: “I like being in tents outside in [expletive] conditions — terrible stuff that people don’t want to do,” he says. “I’m not always the strongest in those conditions, but I like working through them, so that way I can learn how to be strong in those situations. Because I feel like, a lot of times when things go wrong, people would look to me for answers.”

For many others, though, the path to nursing is too steep.

Financial strain often gets in the way

Over the past 15 years, Nathan Ballenger, 46, has tried three separate times to enroll in nursing school. He’s harbored lifelong dreams of a career in medicine, which the Colorado native considers heroic work. During the pandemic, he even got certified as an emergency medical technician, hoping that would give him a foot in the door and an advantage over his fellow nursing school applicants.

But the cost and difficulties of a nursing degree program and training — and the pay cut he would have had to take compared to what he earns his current salesman’s job — meant he simply couldn’t afford to go in that direction.

“It’s hard for me to say that I see a path toward that,” he says, “regardless of the fact that I hold it in my mind and in my heart as something that I sure wish I could have done in this lifetime.”

Hospitals recognize the need to lower some of the barriers to becoming a nurse, while maintaining high standards of education, training and patient care.

Hospitals are not only offering full scholarships and loan repayment to recruit registered nurses these days, many are also offering to put new graduates through intensive training to acquire special skills, says Robin Begley, CEO of the American Organization for Nursing Leadership and chief nursing officer and senior vice president of workforce for the American Hospital Association. Many hospitals are also partnering with nursing schools to do what they can to widen the pipeline by allowing hospital nurses to take time off to teach, for example.

“We really have to put a real emphasis on the pipeline and making sure that everybody who wants to become a nurse has the opportunity to be able to secure a position in a nursing program,” Begley says.

Source:https://www.npr.org/sections/health-shots/2021/10/25/1047290034/the-u-s-needs-more-nurses-but-nursing-schools-have-too-few-slots

Losing Touch

Perspective -Ken Wu, M.B., B.S.

We called it the “cold light.” It looked like a small blue button with a power cord attached to the end of it. At its center was a single round eye that emitted a light, crimson in color and piercing in power. In the neonatal intensive care unit (NICU), we used the cold light to find our patients’ veins, but in the baby in front of us, we found nothing.

My attending physician switched off the cold light. I looked at my patient, pondering this tiny embodiment of life writhing inside an incubator. She had been born at 24 weeks of gestation, weighing just over one pound. She was so small that I could see all of her in a single gaze. Her body was smaller than my hand, her hand smaller than my finger. I had looked after her for 3 weeks, but I’d never seen her face — it was always obscured by equipment that was helping her breathe. Yet her vigor far exceeded her size; she had already survived two different infections and now needed a blood transfusion. To give her the transfusion, we needed access to her veins.

We switched the light on again and placed it under one of her arms for another look. The anemic limb transformed into a translucent pearl surrounded by a red halo. Inside the pearl were black lines, some of which were veins. We moved the light up and down the limb, tracking each black line to see if it might be a vein long and straight enough to accommodate an intravenous cannula.

For a moment, I looked at my own arm, its veins bulging from the heat of the incubator. Fortunate to have veins that can easily be seen and felt, I often use my own limbs as an anatomy reference when inserting an intravenous line. I sometimes feel guilty for relying on this guide, especially when I notice a parent’s envious gaze at my arm as I make my nth attempt to find a vein in their child. “I am sorry this is difficult. I hated needles as a child,” I always say, adding, “I still hate getting my flu vaccine every year.”

Although in the NICU most procedures are not done under the watchful eye of worried parents, I still felt the guilt and shared the parents’ pain. My patient’s limbs were dotted with puncture marks and bruises. Practically, I used them as a record of previous attempts and a road map for potential entry points. Viscerally, I could not help but feel the twitch of a limb withdrawing from pain every time a needle went through the baby’s skin. “I’m sorry, baby,” I murmured. But who I was talking to — the still-nameless baby, who lacked the awareness to accept apologies? The parents, absent in body but present in mind?

Or was I really apologizing to myself for physicians’ facile recourse to medical necessity as justification for inflicting physical pain? From the moment this baby was born, we had intubated her, fed her using an orogastric tube, and repeatedly inserted intravenous lines to give her medications. Although I knew these invasions of her organs were necessary in order to replace the lifeline from which she’d been prematurely separated, their importance did not diminish their noxiousness. In my mind, I could still see the imprint of a laryngoscope blade in the baby’s neck as she was intubated and feel the silent gags of a voiceless newborn as the orogastric tube passed through her mouth. The knowledge that these procedures were lifesaving dampened but did not eliminate my empathetic discomfort.

After every blood test I’d had as a child, I’d run into the arms of my parents. But here in the NICU, there were no comforting hugs, no whispers of “It’s OK, it’s all over,” no rewards of lollipops or bravery stickers. When we finished inserting the cannula, I cleaned the area, checked the insertion site for bleeding and leaks, and closed the doors of the incubator. The sterility was as necessary as it was jarring. I glanced back as I walked away and saw one tiny arm outstretched, while the other was weighed down by the cannula. Although we’d obtained the access we needed, the baby seemed to be reaching out for the parental touch she missed.

But the only people she could touch worked in the NICU, living and thriving in an intimidating environment defined by a hawkish hygiene policy, the complex fragility of the newborns, and the minutiae of the care we provided. When new parents first enter the NICU, I can always see the subdued heartache reflected in their crestfallen faces. For them, the NICU is a place of hope, of patience, but also of submission. For the first weeks or months of their child’s life, it is up to the NICU team to feed and diaper their baby. Procedures are carried out, investigations done, and treatments started with emergency consent only, in the absence of parents. The complexities of neonatal medicine, the difficulties of neonatal procedures, and the absurdities of minute size all overwhelm parents who are newly flooded with the emotions of parenthood and protection. The parents’ role is reduced to receiving daily updates from a team that has usurped their position as the protectors and nurturers of their baby. Every time I see parents looking at their baby in an incubator, I imagine them struggling to reconcile the joyful anticipation of pregnancy with the frustrating reality of a baby whose skin they cannot touch, whose cries they cannot hear, but whose pain they always feel.

I am conscious that in providing surrogate incubators for babies who were born too soon, we in the NICU place painful restrictions on the most basic of human relationships, the one between parents and their child. Although the team always tries to involve parents in as much of the care and decisions as possible, part of the NICU experience requires parents and baby to lose touch with one another. The touch that is lost by parents is gained by physicians, and we know that our touch can hurt as well as heal.

Taking on some of parents’ responsibilities also means adopting their instinctive burdens. Though I fully grasp the medical necessity of our interventions, I sometimes find carrying them out and justifying them as difficult as parental bystanders find caring for their newborn from afar, especially when it involves so much discomfort for someone so small. Not only am I the one doing the procedures, I am also the one who can and must touch, viscerally connected and thus feeling the immediate effects of causing pain.

As I prepare to insert an intravenous cannula in my next patient, his mother stands up and leaves. “I can’t watch,” she says. “It’s just too much.” Sometimes I wish the parents could stay, or the baby could understand me when I apologize before inflicting more suffering in the name of healing. I stay, the baby’s foot in one hand, cannula in the other, bracing myself for the reflexive kick as the needle pierces the skin.

Source:https://www.nejm.org/doi/full/10.1056/NEJMp2033590

Implementation and Outcomes of a Telehealth Neonatology Program in a Single Healthcare System

Front. Pediatr., 23 April 2021 | https://doi.org/10.3389/fped.2021.648536Lory J. MaddoxJordan Albritton, Janice Morse, Gwen Latendresse, Paula Meek and Stephen Minton

Background: Intermountain Healthcare, an early adopter and champion for newborn video-assisted resuscitation (VAR), identified a reduction in facility-level transfers and an estimated savings of $1. 2 million in potentially avoided transfers in a 2018 study. This study was conducted to increase understanding of VAR at the individual, newborn level.

Study Aim: To compare transfers to a newborn intensive care unit (NICU), length of stay (LOS), and days of life on oxygen between newborns managed by neonatal VAR and those receiving standard care (SC).

Methods: This retrospective, nonequivalent group study includes infants born in an Intermountain hospital between 2013 and 2017, 34 weeks gestation or greater, and requiring oxygen support in the first 15 minutes of life. Data came from billing and clinical records from Intermountain’s enterprise data warehouse and chart reviews. We used logistic regression to estimate neonatal VAR’s impact on transfers. Negative binomial regression estimated the impact on LOS and days of life on supplemental oxygen.

Results: The VAR intervention was used in 46.2 percent of post-implementation cases and is associated with (1) a 12 percentage points reduction in the transfer rate, p = 0.02, (2) a reduction in spoke hospital (SH) LOS of 8.33 h (p < 0.01) for all transfers; (3) a reduction in SH LOS of 2.21 h (p < 0.01) for newborns transferred within 24 h; (4) a reduction in SH LOS of 17.85 h (p = 0.06) among non-transferred newborns; (5) a reduction in days of life on supplemental oxygen of 1.4 days (p = 0.08) among all transferred newborns, and (6) a reduction in days of life on supplemental oxygen of 0.41 days (p = 0.04) among non-transferred newborns.

Conclusion: This study provides evidence that neonatal VAR improves care quality and increases local hospitals’ capabilities to keep patients close to home. There is an ongoing demand for support to rural and community hospitals for urgent newborn resuscitations, and complex, mandatory NICU transfers. Efforts may be necessary to encourage neonatal VAR since the intervention was only used in 46.2 percent of this study’s potential cases. Additional work is needed to understand the short- and long-term impacts of Neonatal VAR on health outcomes.

Full Article: https://www.frontiersin.org/articles/10.3389/fped.2021.648536/full

WHY HEALTH-CARE WORKERS ARE QUITTING IN DROVES

About one in five health-care workers has left their job since the pandemic started. This is their story—and the story of those left behind.

By Ed Yong   NOVEMBER 16, 2021

The moment that broke Cassie Alexander came nine months into the pandemic. As an intensive-care-unit nurse of 14 years, Alexander had seen plenty of “Hellraiser stuff,” she told me. But when COVID-19 hit her Bay Area hospital, she witnessed “death on a scale I had never seen before.”

Last December, at the height of the winter surge, she cared for a patient who had caught the coronavirus after being pressured into a Thanksgiving dinner. Their lungs were so ruined that only a hand-pumped ventilation bag could supply enough oxygen. Alexander squeezed the bag every two seconds for 40 minutes straight to give the family time to say goodbye. Her hands cramped and blistered as the family screamed and prayed. When one of them said that a miracle might happen, Alexander found herself thinking, I am the miracleI’m the only person keeping your loved one alive. (Cassie Alexander is a pseudonym that she has used when writing a book about these experiences. I agreed to use that pseudonym here.)

The senselessness of the death, and her guilt over her own resentment, messed her up. Weeks later, when the same family called to ask if the staff had really done everything they could, “it was like being punched in the gut,” she told me. She had given everything—to that patient, and to the stream of others who had died in the same room. She felt like a stranger to herself, a commodity to her hospital, and an outsider to her own relatives, who downplayed the pandemic despite everything she told them. In April, she texted her friends: “Nothing like feeling strongly suicidal at a job where you’re supposed to be keeping people alive.” Shortly after, she was diagnosed with post-traumatic stress disorder, and she left her job.

Since COVID-19 first pummeled the U.S., Americans have been told to flatten the curve lest hospitals be overwhelmed. But hospitals have been overwhelmed. The nation has avoided the most apocalyptic scenarios, such as ventilators running out by the thousands, but it’s still sleepwalked into repeated surges that have overrun the capacity of many hospitals, killed more than 762,000 people, and traumatized countless health-care workers. “It’s like it takes a piece of you every time you walk in,” says Ashley Harlow, a Virginia-based nurse practitioner who left her ICU after watching her grandmother Nellie die there in December. She and others have gotten through the surges on adrenaline and camaraderie, only to realize, once the ICUs are empty, that so too are they.

Some health-care workers have lost their jobs during the pandemic, while others have been forced to leave because they’ve contracted long COVID and can no longer work. But many choose to leave, including “people whom I thought would nurse patients until the day they died,” Amanda Bettencourt, the president-elect of the American Association of Critical-Care Nurses, told me. The U.S. Bureau of Labor Statistics estimates that the health-care sector has lost nearly half a million workers since February 2020. Morning Consult, a survey research company, says that 18 percent of health-care workers have quit since the pandemic began, while 12 percent have been laid off.

Stories about these departures have been trickling out, but they might portend a bigger exodus. Morning Consult, in the same survey, found that 31 percent of the remaining health-care workers have considered leaving their employer, while the American Association of Critical-Care Nurses found that 66 percent of acute and critical-care nurses have thought about quitting nursing entirely.

“We’ve never seen numbers like that before,” Bettencourt told me. Normally, she said, only 20 percent would even consider leaving their institution, let alone the entire profession. Esther Choo, an emergency physician at Oregon Health and Science University, told me that she now cringes when a colleague approaches her at the end of a shift, because she fears that they’ll quietly announce their resignation too. Vineet Arora, who is dean for medical education at University of Chicago Medicine, says that “in meetings with other health-care leaders, when we go around the room, everyone says, ‘We’re struggling to retain our workforce.’ Nobody says, ‘We’re fine.’”

When national COVID hospitalizations fell in September and October, it was possible to hope that the health-care system had already endured the worst of the pandemic. But that decline is now starting to plateau, and in 17 states hospitalizations are rising. And even if the country dodges another surge over the winter, the health-care system is hemorrhaging from the untreated wounds of the past two years. “In my experience, physicians are some of the most resilient people out there,” Sheetal Rao, a primary-care physician who left her job last October, told me. “When this group of people starts leaving en masse, something is very wrong.”


Health-care workers, under any circumstances, live in the thick of death, stress, and trauma. “You go in knowing those are the things you’ll see,” Cassandra Werry, an ICU nurse currently working in Idaho, told me. “Not everyone pulls through, but at the end of the day, the point is to get people better. You strive for those wins.” COVID-19 has upset that balance, confronting even experienced people with the worst conditions they have ever faced and turning difficult jobs into unbearable ones.

In the spring of 2020, “I’d walk past an ice truck of dead bodies, and pictures on the wall of cleaning staff and nurses who’d died, into a room with more dead bodies,” Lindsay Fox, a former emergency-medicine doctor from Newark, New Jersey, told me. At the same time, Artec Durham, an ICU nurse from Flagstaff, Arizona, was watching his hospital fill with patients from the Navajo Nation. “Nearly every one of them died, and there was nothing we could do,” he said. “We ran out of body bags.”

Most drugs for COVID-19 are either useless, incrementally beneficial, or—as with the new, promising antivirals—mostly effective in the disease’s early stages. And because people who are hospitalized with COVID-19 tend to be much sicker than average patients, they are also very hard to save—especially when hospitals overflow. Many health-care workers imagined that such traumas were behind them once the vaccines arrived. But plateauing vaccination rates, premature lifts on masking, and the ascendant Delta variant undid those hopes. This summer, many hospitals clogged up again. As patients waited to be admitted into ICUs, they filled emergency rooms, and then waiting rooms and hallways. That unrealized promise of “some sort of normalcy has made the feelings of exhaustion and frustration worse,” Bettencourt told me.

Health-care workers want to help their patients, and their inability to do so properly is hollowing them out. “Especially now, with Delta, not many people get better and go home,” Werry told me. People have asked her if she would have gone to nursing school had she known the circumstances she would encounter, and for her, “it’s a resounding no,” she said. (Werry quit her job in an Arizona hospital last December and plans on leaving medicine once she pays off her student debts.)

COVID patients are also becoming harder to deal with. Most now are unvaccinated, and while some didn’t have a choice in the matter, those who did are often belligerent and vocal. Even after they’re hospitalized, some resist basic medical procedures like proning or oxygenation, thinking themselves to be fighters, only to become delirious, anxious, and impulsive when their lungs struggle for oxygen. Others have assaulted nurses, thrown trash around their rooms, and yelled for hydroxychloroquine or ivermectin, neither of which has any proven benefit for COVID-19. Once, Americans clapped for health-care heroes; now “we’re at war with a virus and its hosts are at war with us,” Werry told me.

Beyond making workdays wretched, these experiences are inflicting deep psychological scars. “We want to be rooting for our patients,” Durham told me, “but anyone I know who’s working in COVID has zero compassion remaining, especially for people who chose not to get the vaccine.” That’s why he has opted to do travel-nursing stints, which are time-limited and more lucrative than staff jobs: “It just isn’t worth it to do the job for less than the most I can get paid,” he said. He’s still providing care, but he finds himself emotionally detached, and unsettled by his own numbness. For a health-care worker, being shaken by a patient’s death comes with the job. Finding yourself unmoved is almost worse.

Many have told me that they’re bone-weary, depressed, irritable, and (unusually for them) unable to hide any of that. Nurses excel at “feeling their feelings in a supply closet or bathroom, and then putting their game face back on and jumping into the ring,” Werry said. But she and others are now constantly on the verge of tears, or prone to snapping at colleagues and patients. Some call this burnout, but Gerard Brogan, the director of nursing practice at National Nurses United, dislikes the term because “it implies a lack of character,” he told me. He prefers moral distress—the anguish of being unable to take the course of action that you know is right.

Health-care workers aren’t quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs. Even before COVID-19, many of them struggled to bridge the gap between the noble ideals of their profession and the realities of its business. The pandemic simply pushed them past the limits of that compromise.

The United States uses the rod of Asclepius—a snake entwined around a staff—as a symbol of medicine. But the pandemic suggests that the more fitting symbol might be the Ouroboros, a snake devouring its own tail.

Several health-care workers told me that, amid the most grueling working conditions of their careers, their hospitals cut salaries, reduced benefits, and canceled raises; forced staff to work more shifts with longer hours; offered trite wellness tips, such as keeping gratitude journals, while denying paid time off or reduced hours; failed to provide adequate personal protective equipment; and downplayed the severity of their experiences.

The American Hospital Association, which represents hospital administrators, turned down my interview request; instead, it sent me links to a letter that criticized anticompetitive pricing from travel-nursing agencies and to a report showing that staff shortages have cost hospitals $24 billion over the course of the pandemic. But from the perspective of health-care workers, those financial problems look at least partly self-inflicted: Many workers left because they were poorly treated or compensated, forcing hospitals to hire travel nurses at greater cost. Those nurses then stoke resentment among full-time staff who are paid substantially less but are often asked to care for the sickest patients. And in some farcical situations, “hospitals hired their own staff back as travel nurses and paid them higher rates,” Bettencourt said.

Whatever the intentions behind these decisions, they were the final straw for the many health-care workers who told me that they left medicine less because of COVID-19 itself and more because of how their institutions acted. “I’ve been a nurse 45 years and I’ve never seen this level of disaffection between clinicians and their employers,” Brogan told me. The same is true across almost every sector of the U.S. Record-breaking numbers of Americans left their jobs this April—and then again in July and August. This “Great Resignation,” as my colleague Derek Thompson wrote, “is really an expression of optimism that says, We can do better.”

The culture of medicine makes it hard for health-care workers to realize that. Most enter medicine “as a calling,” Vineet Arora told me, which can push them to sacrifice ever more of their time, energy, and self. But that attitude, combined with taboos around complaining or seeking mental-health help, can make them vulnerable to exploitation, blurring the line between service and servitude. Between 35 and 54 percent of American nurses and physicians were already feeling burned out before the pandemic. During it, many have taken stock of their difficult working conditions and inadequate pay and decided that, instead of being resigned, they will simply resign.

Molly Phelps, an emergency doctor of 18 years, considered herself a lifer. Her medical career had cost her time with her family, wrecked her circadian rhythms, and taxed her mental health, but it offered so much meaning that “I was willing to stay and be miserable,” she told me. But after the horrific winter surge, Phelps was shocked that her hospital’s administrators “never acknowledged what we went through,” while many of her patients “seemed to forget their humanity.” Medicine’s personal cost seemed greater than ever, but the fulfillment that had previously tempered it was missing. On July 21, during an uneventful evening spent scrolling through news of the Delta surge, Phelps had a sudden epiphany. “Oh my God, I think I’m done,” she realized. “And I think it’s okay to walk away and be happy.”

America’s medical exodus is especially tragic because of how little it might have taken to stop it. Phelps told me that if her workplace “had thrown a little more of a bone, that would have been enough to keep me miserable for 13 more years.” Some health systems are starting to offer retention bonuses, long-overdue raises, or hazard pay. And the next generation of health-care workers doesn’t seem to be deterred. Applications to medical and nursing schools have risen during the pandemic. “That workforce is apparently seeing the best of us, and maybe their vision and energy is what we need to make us whole again,” Esther Choo told me.

But today’s students will take years to graduate, and the onus is on the current establishment to reshape an environment that won’t immediately break them, Choo said. “We need to say, ‘We got this wrong, and despite that, you’re willing to invest your lives in this career? What an incredible gift. We can’t look at that and change nothing.’”

The health-care workers who have stayed in their jobs now face a “crushing downward spiral,” Choo told me. Each resignation saddles the remaining staff with more work, increasing the odds that they too might quit. They don’t resent their former colleagues, but some feel that medicine’s social contract, wherein health-care workers show up for one another through tragedy, is fraying. Before the pandemic, “I knew exactly who I would be working with in every single role,” Choo said.

“There was a lot of unspoken communication, and my shifts were so smooth.” But with so many people having left, the momentum that comes from trust and familiarity is gone.

Expertise is also hemorrhaging. Many older nurses and doctors have retired early—people who “know that one thing that happened 10 years ago that saved someone’s life in a clutch situation,” Cassie Alexander said. And because of their missing experience, “things are being missed,” Artec Durham added. “The care feels frantic and sloppy even though we’re not overrun with COVID right now.” Future patients may also suffer because the next generation of health-care workers won’t inherit the knowledge and wisdom of their predecessors. “I foresee at least three or four years post-COVID where health-care outcomes are dismal,” Cassandra Werry told me. That problem might be especially stark for rural hospitals, which are struggling more with staff shortages and unvaccinated populations.

This decline in the quality of health care will likely occur as demand increases. Even in the unlikely event that no further COVID-19 infections occur, the past months have left millions with long COVID and other severe, chronic problems. “I’m seeing a lot of younger people with end-stage cardiac or neurological disease—people in their 30s and 40s who look like they’re in their 60s and 70s,” Vineet Arora told me. “I don’t think people understand the disability wave that’s coming.”

Hospitals are also being flooded by people who don’t have COVID but who delayed care for other conditions and are now in terrible shape. “People are coming in with liver failure, renal failure, and heart attacks they sat on for weeks,” Durham told me. “Even if you take COVID out of the equation, the place is a mess with sick patients.” This pattern has persisted throughout the pandemic, trapping health-care workers in a continuous, nearly two-year-long peak of either COVID or catch-up care. “It doesn’t feel great between surges,” Choo told me. “Something always replaces COVID.”

Throughout the pandemic, commentators have looked to COVID-hospitalization numbers as an indicator of the health-care system’s state. But those numbers say nothing about the dwindling workforce, the mounting exhaustion of those left behind, the expertise now missing from hospitals, or the waves of post-COVID or non-COVID patients. Focusing on COVID numbers belies how much harder getting good medical care for anything is now—and how long that trend could potentially continue. Several health-care workers told me that they are now more concerned about their own loved ones being admitted to the hospital. “I’m worried about the future of medicine,” Sheetal Rao said. “And I think we all should be.”

A life outside medicine can be hard for people who have built their identities within it. For some, it’s like returning from war and mingling with civilians who don’t understand what you went through. “I met up with some friends who are really bright people but who said, ‘Wait, the winter was traumatizing?’” Molly Phelps told me. She thinks that “health-care workers are either preparing for work, at work, or recovering from work,” which leaves little time for talking about their experiences. And those who do talk can hit a brick wall of pandemic denial.

Cassie Alexander also struggled with the fact that she was struggling. “I built my whole identity around being the toughest person I knew, and it was shattering to admit that I was broken and needed help,” she said. She returned to work last week, partly for financial reasons and partly to prove to herself that she can still do it. Others have peeled off to less intense medical roles. And some have no plans to return at all—but feel guilty about abandoning their colleagues and patients. “People going into medicine want to be of service in moments of crisis, so it was hard to watch [further surges] and feel like I was on the sidelines,” Lindsay Fox told me.

Some former health-care workers have found new purpose in tackling health problems at a different scale. Sheetal Rao has helped launch an environmental nonprofit that plants trees in Chicago, especially in poorer neighborhoods that lack them. “In primary care, we focus on prevention, but that’s also about advocating for cleaner air so I’m not just sending my patients home with an inhaler,” she told me.

Dona Kim Murphey, a former physician who now has long COVID, started a political action committee to get doctors into office as part of a plan to reform medicine. “I was growing increasingly concerned about how inhumane our profession is,” she told me. “There’s no culture of physicians organizing and fighting for their rights, but that’s something we should think about to leverage the outrage and frustration that people have.” For the same reason, Nerissa Black, a nurse in Valencia, California, is staying in medicine. She was so disillusioned by her hospital’s handling of the pandemic that she almost left nursing entirely. But she changed her mind to continue being part of the National Nurses United union and advocating for better working conditions. For example, California is the only state that caps the ratio of patients to nurses, and she wants to see similar limits nationwide. “I feel more resolute,” she told me.

Phelps, meanwhile, found the last thing she expected—a sense of peace. She used to scoff when she heard people say that you’re more than your job. “I thought, That may be true for all you nonmedical laypeople, but I am a doctor and it’s who I am,” she told me. And yet, she has experienced no identity crisis. After her last shift this September, she was on a random weekend trip with her children when, in the middle of a pumpkin patch, she started sobbing. “I realized that I was happy, and I hadn’t experienced that in almost two years,” she told me. “I’m not sure I can ever see myself going into an ER again.”

Source:https://www.theatlantic.com/health/archive/2021/11/the-mass-exodus-of-americas-health-care-workers/620713/

Nov 19, 2021      nightyniteswithneli
 
Hi Friends! Welcome back to my channel! I’ve missed you guys so much! November is Prematurity Awareness Month so all month long we will be reading books by Preemie Authors, Parents, Siblings, and Healthcare workers who work with Preemies!

As we transition from a month-long celebration of Premature Awareness in November, I encourage our community to continue the momentum of raising advocacy for our global healthcare/medical community.    

It is troubling that our pre-term birth/Neonatal Womb Warrior community is losing some of its most essential members and that a severely reduced access to trained providers lies ahead. There is a critical shortage globally of access to healthcare providers who are more challenged now than ever to keep all of our hearts beating.   

In the specialty of neonatology clinicians are essential to saving lives and to guiding/empowering parents/caregivers and families in some of their most life-changing and challenging life chapters.   

Throughout the past almost 5 years within this blog we have shared articles calling attention to the critical global Healthcare Workforce shortages. Recently, the loss of many members of our vital global healthcare/medical community has been and is becoming better understood, more clearly documented, and shared to some extent with the Public at large. It is a quickly evolving and sometimes complex situation that demands intelligent and expedited attention in order to mitigate the damaged caused so far. Solutions for developing and rebuilding/expanding the healthcare/medical workforce require the collaborative efforts of actual healthcare/medical provider-directed solutions and a clear patient population needs assessment generated by the patient population itself.   

The loss of clinicians has a staggering impact on the overall functionality and progress of positive health outcomes in every community. Just as we are all touched by preterm birth and preterm birth loss, we are all directly and indirectly impacted by the loss of our clinical workforce at large.    

I encourage us all to do what we can to promote awareness and support for our local and global medical/healthcare community at this time. We all need safe, equitable, timely and sustainable access to preterm birth care, maternal care, general medical and surgical healthcare and ancillary services. We require more than pharmaceuticals thrown our way; we need trained providers to provide us with optimal care that is curative when possible and personalized to meet our unique individual needs.   

With great appreciation and love for our preterm birth/Neonatal Womb Warrior Community, we Thank You. 

Kat, Kathy, and Gannon (our beloved cat). 

These Are The Burly Souls Who Brave Ireland’s Biggest Waves

Nov 7, 2020Red Bull Surfing

The start of the 2020–21 big wave season has been nothing if not historic. Especially in Ireland, where Conor Maguire nabbed what many are calling the biggest wave ever surfed at Ireland’s premiere – and most terrifying – wave, Mullaghmore. Here’s a look back at filmmaker Mikey Corker’s award-winning 2018 docu-series Made In Ireland, which traces surfing’s roots in what was once considered the unlikeliest of surf destinations.

E HEATH, GAPS & BABY BRAIN

Somaliland, officially the Republic of is an unrecognised sovereign state in the Horn of Africa, internationally considered to be part of Somalia. Somaliland lies in the Horn of Africa, on the southern coast of the Gulf of Aden. It is bordered by Djibouti to the northwest, Ethiopia to the south and west, and Somalia to the east. Its claimed territory has an area of 176,120 square kilometres (68,000 sq mi), with approximately 5.7 million residents as of 2021. The capital and largest city is Hargeisa. The government of Somaliland regards itself as the successor state to British Somaliland, which, as the briefly independent State of Somaliland, united in 1960 with the Trust Territory of Somaliland (the former Italian Somaliland) to form the Somali Republic.

Since 1991, the territory has been governed by democratically elected governments that seek international recognition as the government of the Republic of Somaliland. The central government maintains informal ties with some foreign governments, who have sent delegations to Hargeisa. Ethiopia also maintains a trade office in the region. However, Somaliland’s self-proclaimed independence has not been officially recognised by any country or international organisation. It is a member of the Unrepresented Nations and Peoples Organization, an advocacy group whose members consist of indigenous peoples, minorities and unrecognised or occupied territories.

Source:https://en.wikipedia.org/wiki/Somaliland

Healthcare in Somaliland, as with other Somalia ‘zones’, is largely in the private sector, regulated by the Ministry of Health of the Federal Government of Somalia. The system is largely staffed by undertrained, under-supervised and -paid staff, dependent upon donations from international agencies.

Source: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-5049-2

PRETERM BIRTH RATES – Somaliland

The self-declared country of Somaliland remains largely unrecognized by the rest of the world. We were not able to gain preterm birth rates for Somaliland.  

We “recognize” Somaliland as a respected member of our global Neonatal Womb Warrior/preterm birth community.

Rank: unknown –Rate: unknown  Estimated # of preterm births per 100 live births 

  (USA – 12 %, Global Average: 11.1%)

COMMUNITY

These Female Doctors Are Changing the Lives of Fistula Survivors In Somaliland

MEGAN IACOBINI DE FAZIO   3 May 2018

On one day in March dozens of people gathered in a hospital in Hargeisa, Somaliland. The bright room was decorated with flowers and banners in red, green and white, the colours of Somaliland’s flag. Doctors –foreign and Somali – ministers, medical students, former patients and journalists filed in, greeting each other, standing in little groups and talking animatedly. A man walked to the front, bowed his head, and intoned a prayer over the crackly microphone, and the murmur turned to silence as people took to their seats.

Minutes later, a woman dressed in an elegant blue gown took to the podium. Edna Adan, the face of Somaliland’s healthcare and founder of the hospital where this event took place, is in her 80s, but the passion in her voice and her strong demeanour make her seem decades younger.

We were all gathered to celebrate the 16th anniversary of the Edna Adan Hospital, which has been a shining example of healthcare and education since its inception.

“I always felt there was a need to provide Somalilanders with better healthcare,” says Edna, whose doctor father she credits with inspiring her to pursue medicine. “And that’s why, as a child, I decided I would build a hospital.”

Before she retired in 2002, Edna — who worked with the World Health Organization in the region after a working as a nurse — founded the hospital with the view of drastically reducing child and maternal mortality in the country.

“Women in Somaliland have the world’s highest mortality rates because there are no health facilities and few health professionals,” she says. “Seeing the magnitude of the problem and knowing the limited resources, I decided to put everything I could into reproductive health, and it’s the most rewarding thing that we’ve done.”

Since opening its doors, the hospital has delivered thousands of healthy babies, and its maternal mortality rate is a tiny fraction of the national average. The hospital has also become a centre for the treatment of obstetric fistula, one of the most devastating conditions faced by women in developing countries.

“Fistula can happen when women go through a long labour, and especially when they deliver at home, far from hospitals, in rural areas with no facilities or doctors,” explains 32-year-old Dr. Shukri Mohamed Dahir, Somaliland’s first female fistula surgeon.

“Pressure between the pelvic bone and fetal head kills the tissue of the bladder and rectum, and a small hole develops,” says Dr. Dahir. This hole – the fistula – can cause the woman to uncontrollably leak bodily waste, with shattering health and social consequences.

Shukri studied midwifery and nursing at Edna Adan Hospital, which later sponsored her through medical school. After she graduated in 2011, Dr. Dahir returned to Edna Adan’s hospital to learn about surgery.

“I always wanted to solve women’s problems myself, rather than hand them off to a male doctor to solve,” says Dr. Dahir. “And I also realized how important it was to have woman surgeons so women can feel free.”

Unfortunately, getting her degree wasn’t always enough to convince patients of her expertise: “People were not used to seeing women doctors, and wouldn’t trust us to do the operations. Once, during a consultation with a woman suffering with fistula, I had to pretend to be a student, while my male student posed as the surgeon. After the surgery, I told her I was the one who had cured her, so she let me take over.”

Because of the hospital’s great results, patients are now used to seeing female surgeons, and many of those suffering from obstetric fistula even request to be seen by other women. And, thanks to the Edna Adan University, which was formally established in 2009, it is not only women in the capital who are now receiving world-class healthcare. Graduate doctors from all Somaliland are coming here for training, and returning to their rural clinics with newfound life-saving skills.

“I am glad we are turning 16,” says Dr. Dahir of the hospital. “We have made a huge change in this country.”

Source:https://www.mhtf.org/geography/somaliland/

Learn how to boost your baby’s brain from a Harvard Professor

Feb 25, 2019    From an international health authority  Learn how experts define health sources in a journal of the National Academy of Medicine 

Dr. Jack Shonkoff, Professor of Child Health and Development at Harvard University, shares his important play tips to boost your child’s brain. In the first 1,000 days of life, a baby’s brain forms 1,000 new connections every second. Just 15 minutes of play can spark thousands of brain connections. Learn more: https://uni.cf/2Sk1yEn

Preterm births cost Australian Government $1.4 billion Annually

Monday, 19 July 2021

A new study has shown that the annual cost of preterm birth to the Australian Government is approximately $1.4 billion with one quarter of this arising from the need for educational assistance for those born too soon.

Conducted by the Women & Infants Research Foundation (WIRF) and the Australian Preterm Birth Prevention Alliance, the study was developed to estimate the costs of preterm birth in the first 18 years of life for a hypothetical cohort of 314,814 children – the number of live births in 2016.

Being born too early is the single greatest cause of death in young children in Australia and all similar societies. It is also one of the major causes of disability, both in childhood and adulthood. These disabilities include cerebral palsy, deafness, blindness and learning and behavioural problems.

Recently published in the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG), the study revealed two thirds of the costs were borne by health care services with costs of preterm birth inversely related to gestational age at birth. Extremely preterm births were most expensive at $236,036 each, very preterm birth at $89,709, and late preterm birth at $25,417.

Chair of the Australian Preterm Birth Prevention Alliance and WIRF’s Chief Scientific Director, Professor John Newnham AM said assessments of economic costs were critical to inform evaluations of interventions aimed at the prevention or treatment of preterm birth.

“Discovering how to safely lower the rate of preterm birth and then evaluating the impact of that effectiveness needs to be one of our highest priorities in contemporary healthcare,” Professor Newnham said.

“The consequences of preterm birth for individuals, families and societies are considerable, both in terms of human suffering and economic consequences.”

Whilst previous international studies had quantified direct medical expenditure, this latest analysis also sought to measure the significant costs to educational services.

“The benefits of preterm birth prevention include fewer children with behavioural and learning problems, including the need for special education assistance,” Professor Newnham said.

 “In our study, additional costs at school were calculated to contribute 25% of the cost of preterm birth. Promotion of programs to safely prevent preterm birth needs to include the educational advantages at school, as well as the profound benefits for families that arise from avoidance of behavioural problems.”

Professor Newnham, the 2020 Senior Australian of the Year, explained that it should no longer be assumed that the high costs of preterm birth are an inevitable consequence of our reproduction.

 “The rate of preterm birth has been rising dramatically in Australia and elsewhere over the last two decades. There are many pathways to untimely early birth, each requiring a different clinical approach, and we have discovered some are now amenable to prevention.” Media Release

In 2014, WIRF launched the WA Preterm Birth Prevention Initiative was launched – the world’s first whole-of-state and whole-of-population program to prevent preterm birth.

Results from the first year of this program revealed a reduction in the rate of preterm birth across WA by 8% and by 20 per cent at the major tertiary level centre – King Edward Memorial Hospital.

The success of the WA program, which has also extended to the ACT as part of their reported 10% reduction of preterm birth rates in 2020, have been underpinned by the development of key interventions to safely lower the rate of early birth.

“When we apply these interventions as part of a multifaceted program across an entire population the rate of preterm birth can be reduced, at least by about 8%. Further advances in potential interventions can be expected to make prevention even more effective,” Professor Newnham said.

“Investing in the prevention of preterm birth is a social and economic investment in our community’s future.”

As accurate data is only available to estimate the costs to 18 years of age, it is reasonable to conclude that the costs to government estimated in the current study represent only a fraction of the eventual overall burden to individuals, families and the nation.

In May 2021, the Australian Government announced $13.7 million in federal funding to bolster the Alliance’s ongoing efforts to lower the rate of preterm birth across Australia.

The funding will support the expansion of a national education and outreach program to safely lower rates of preterm birth in each Australian state and territory.

The study, ‘The health and educational costs of preterm birth to 18 years of age in Australia’, has been published online in the Australian and New Zealand Journal of Obstetrics and Gynaecology.

Authors for the original ANZJOG article are: John Newnham, Chris Schilling, Stavros Petrou, Jonathan Morris, Euan Wallace, Kiarna Brown, Lindsay Edwards, Monika Skubisz, Scott White, Brendan Rynne, Catherine Arrese, and Dorota

Joyful voices to savor from our Somaliland family

Xidigana Geeska Wadani Dhaba Maaha Hargeeisa Book Fair Music Video 2021Jul 29, 2021

Xidigaha Geeska,Najax Nalka,Mubarak October,Suldaan Seeraar, Xariir Axmed, Mursal Muuse, Hodan Abdirahman, Kiin Jamac, Waqal Studio

Breastfeeding status and duration significantly impact postpartum depression risk

Study first to explore current breastfeeding status in association with postpartum depression risk in large national dataset

Date:  September 30, 2021   Source: Florida Atlantic University

According to the United States Centers for Disease Control and Prevention, between 11 and 20 percent of women who give birth each year in the U.S. have postpartum depression symptoms, which is the greatest risk factor for maternal suicide and infanticide. Given that there are 4 million births annually, this equates to almost 800,000 women with postpartum depression each year.

Current biological and psychosocial models of breastfeeding suggest that breastfeeding could possibly reduce a woman’s risk for postpartum depression. However, prior studies only have looked at the initiation of breastfeeding and breastfeeding length. In addition, small and often homogenous samples have yielded ungeneralizable results lacking in statistical power with biased results due to higher levels of education, income, and proportions of white participants compared to the general population of the sampled country.

Researchers from Florida Atlantic University’s Christine E. Lynn College of Nursing and collaborators are the first to examine current breastfeeding status in association with postpartum depression risk using a large, national population-based dataset of 29,685 women living in 26 states

Results of the study, published in the journal Public Health Nursing, demonstrate that postpartum depression is a significant health issue among American women with nearly 13 percent of the sample being at risk. Findings showed that women who were currently breastfeeding at the time of data collection had statistically significant lower risk of postpartum depression than women who were not breastfeeding. In addition, there is a statistically significant inverse relationship between breastfeeding length and risk of postpartum depression. As the number of weeks that women breastfed increased, their postpartum depression decreased. An unexpected finding was that there was no significant difference in postpartum depression risk among women with varying breastfeeding intent (yes, no, unsure).

“Women suffering from postpartum depression, which occurs within four weeks and up to 12 months after childbirth, endure feelings of sadness, anxiety and extreme fatigue that makes it difficult for them to function,” said Christine Toledo, Ph.D., senior author and an assistant professor in FAU’s Christine E. Lynn College of Nursing. “Women with postpartum depression who are not treated also may have negative outcomes, including difficulty bonding with and caring for their children, thoughts of harming themselves or their infant, and also are at an increased risk of substance misuse.”

Woman who have experienced postpartum depression have a 50 percent increased risk of suffering further episodes of postpartum depression in subsequent deliveries. In addition, they have a 25 percent increased risk of suffering further depressive disorders unrelated to childbirth up to 11 years later. Postpartum depression increases maternal morbidity and is associated with increased risks for cardiovascular disease, stroke and type-2 diabetes.

For the study, Toledo and collaborators from the University of Miami School of Nursing and Health Studies, University of North Carolina School of Nursing, Chapel Hill, Seattle University of Nursing, and The University of British Columbia School of Nursing, analyzed dataset from the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire to investigate the association of breastfeeding practices taking into consideration significant covariates such as age, race, marital status, education, abuse before and during pregnancy, cigarette smoking, among others.

“Findings from this important study suggest that breastfeeding is a cost efficient and healthy behavior that can decrease a woman’s risk for postpartum depression,” said Safiya George, Ph.D., dean, FAU Christine E. Lynn College of Nursing. “Nurses in particular play an important role in educating and promoting both the maternal health benefits of breastfeeding and infant benefits such as providing necessary nutrients and protecting them against allergies, diseases and infections.”

Florida Atlantic University. “Breastfeeding status and duration significantly impact postpartum depression risk: Study first to explore current breastfeeding status in association with postpartum depression risk in large national dataset.” ScienceDaily. ScienceDaily, 30 September 2021.

Source:https://www.sciencedaily.com/releases/2021/09/210930101408.htm

Dr. Gabor Mate, philosopher, doctor and  powerful resource, is accessible to those who seek to explore our inner selves, identify avenues to healing,  and gain  a broader perspective of emotional support and healing pathways.  Not always an easy “listen” and therefore a thought provoking experience, Gabor, as he also travels through his life, shares his insights and  perspectives. Dr. Mate invites contemplation as he suggests that a key component of understanding the effects of trauma is not how it affects what we do so much as how it impacts what we do not do. Definitely food for thought…..