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.


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.



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.


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.”



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.


2Baba Ft. Syemca – Target You

 1,391,852 views     Premiered Nov 5, 2020


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


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


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.


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.


 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.


Global Health Education and Best Practices for Neonatal-Perinatal Medicine Trainees


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.


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.”


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



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.


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.


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.


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.



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.


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.


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.


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.



Rank: 170  –Rate: 6.4   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)


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


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


#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.


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.


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.


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.



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.


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.


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


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.”


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.


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.


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


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%)


These Female Doctors Are Changing the Lives of Fistula Survivors In Somaliland


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.”


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.


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…..

Dr Gabor Maté’s Life Advice Will Change Your Future (MUST WATCH)

                                    Jul 12, 2021  #GaborMaté #MotivationThrive

Dr Gabor Maté’s Life Advice Will Change Your Future (MUST WATCH). Who is Gabor Maté? A renowned speaker, and bestselling author, Dr. Gabor Maté is highly sought after for his expertise on a range of topics including addiction, stress and childhood development.


Videos | LIVE series | Preemie Chats

CPBF – Canadian Premature Babies Foundation

Below you can find our virtual educational sessions tailored to NICU parents and healthcare professionals. The sessions are interactive; you can join LIVE every Friday at 1pm EST either on our Facebook or YouTube pages. This is a great opportunity to chat with experts, researchers, and parents from all over the world. There is an abundant collection of interesting videos, and here are  a few examples:

Prematurity and Autism Spectrum Disorder -Vision Development from Infancy to Childhood -LGBTQ+ in the NICU -Preterm Birth and Adult Health


Below is a great example of a virtual session CPBF provides weekly to educate Preemie Parents and Healthcare Professionals.

An Adult Preemie Tells Her Story

February 2021

Pediatric and Fetal Surgeon, Dr. Timothy Crombleholme Explains Open Fetal Surgery

 Jun 25, 2018Fetal Care Center Dallas

Dr. Timothy M. Crombleholme is a pediatric and fetal surgeon recognized worldwide for his experience in fetoscopic surgery, open fetal surgery, image-guided fetal intervention and EXIT procedures. Dr. Crombleholme emphasizes educating his families about what to expect for the surgical procedure and throughout the pregnancy. “Our families are some of the most relaxed families in the newborn nursery because they have processed everything and have been prepared for the delivery and the challenges the baby faces, and nothing is intimidating to them.”

Fortifying Family Foundations

Assistant Professor Ashley Weber’s intervention empowers parents to care for their premature infants

By Evelyn Fleider –  July 20, 2021

Imagine you are a new mom or dad whose baby was recently born at fewer than 32 weeks old. Your infant needs weeks-long, round-the-clock support in the hospital, but you do not have the job flexibility that allows you to spend time there, a trusted sitter to care for your other child/children or reliable transportation to get you there. You are overwhelmed, emotional and missing out on critical moments at the hospital, when you could get to know your baby and learn to manage their complex care and needs.

Each year, about 100,000 U.S. women give birth to babies considered very or extremely premature who require long-term stays in a neonatal intensive care unit (NICU) and who are at a high risk of developing chronic conditions. But not all parents get the formal training they need to keep their child healthy, which can cause mental health issues for parents. To address the critical need for an effective, streamlined model of parent-driven care, Ashley Weber, PhD, RN, a practicing NICU nurse and assistant professor at the College, is piloting PREEMIE PROGRESS, a video-based intervention that helps parents understand, monitor and manage their infant’s care while in the NICU.

With the financial backing of a National Institutes of Health (NIH) grant, Weber and the College’s Center for Academic Technologies and Educational Resources (CATER) team designed and built the intervention to deliver education to overwhelmed, high-risk parents with low literacy and education through accessible, platformagnostic videos and optional worksheets. Parents can learn by watching the videos or completing worksheets
while doing laundry or caring for other family members at home. Specifically, PREEMIE PROGRESS provides family management skills including negotiated collaboration, care systems navigation, emotion control, outcome expectancy and more.

“Our mortality rates have significantly gone down over the decades, but long-term complications from prematurity have not changed,” Weber says. “We need to decrease the stress and sensory stimulation that babies experience throughout their NICU stay. Also, research shows that babies do best when they’re with their parents.”

Although parent education interventions exist, socioeconomic barriers, such as the lack of mandated paid family leave in the U.S., often prevent parents from participating in these opportunities and learning about their baby’s complex care during their NICU stay. The need to return to work shortly after birth or lack of transportation to the NICU are some of the various obstacles that prevent parents from being able to focus on their baby’s health and deliver the majority of care in the NICU.

“If you can spend large amounts of time in the NICU, you get to learn; nurses educate you on the plan of care and you participate in rounds, getting to know your baby,” Weber says.

“I wanted to build an intervention that could help disadvantaged families learn outside of the NICU, so that when they are able to be in the NICU, they maximize that time and spend it caring for their baby as opposed to playing catch-up.”

Currently, Weber and her team are refining PREEMIE PROGRESS through iterative usability and acceptability testing. In October, they will start testing feasibility and acceptability of the refined intervention and study procedures in a pilot randomized controlled trial with 60 families over the course of two years. They anticipate the intervention will decrease parent depression and anxiety, increase infant weight gain and receipt of mother’s milk and reduce neonatal health care utilization. Weber then plans to submit a competitive R01 for additional funding to conduct an even larger trial.

PREEEMIE PROGRESS has been years in the making for Weber, who in 2018 worked with the College of Nursing’s instructional designers, technology specialists, videographers and graphic designers to create the first prototype. She hopes the project will eventually evolve into a collaborative partnership among NICUs in Cincinnati, Columbus and Cleveland to conduct research trials centered on improving family care.

Weber’s long-term goal is to become a leader in designing, disseminating and implementing sustainable family management programs to improve health outcomes in the NICU. Regardless of her success, she recognizes that the best thing she can do for her patients is to advocate for universal paid family leave, better childcare and transportation infrastructures.

“We can come up with all sorts of interventions for reducing parent and infant stress and changing the way providers deliver care in the NICU, but if a mom doesn’t have the money to pay for a babysitter so she can get to the NICU or doesn’t have paid leave and has to go back to work a week or two after birth, the chances of parent engagement in care are extremely low,” Weber says. “I hope that PREEMIE PROGRESS empowers families who are at a disadvantage through no fault of their own. We want to give NICU families skills they can use for a lifetime, but these broader public health policies to support the social determinants of family success are really needed in order to move family research forward in the NICU.”


A Day in the Life of the NICU

Apr 25, 2017         Medtronic Minimally Invasive Therapies Group

Watch how staff at Rush University Medical Center combats neonatal stress. (14-RE-0016)


Gaps in Palliative Care Education among Neonatology Fellowship Trainees

Catherine Lydia Wraight   Jens C. Eickhoff   Ryan M. McAdams

Published Online:27 Jul 2021https://doi.org/10.1089/pmr.2021.0011


Background: To provide proper care for infants at risk for death, neonatologists need expertise in many areas of palliative care. Although neonatology training programs have implemented a wide variety of palliative care educational programs, the impact of these programs on trainees’ skills and effective communication regarding end-of-life issues remains unclear.

Objective: To determine whether neonatology fellowship programs are providing formal palliative care education and assess whether this education is effective at increasing fellows’ self-reported comfort with these important skills.

Methods: An anonymous survey was sent to program directors (PDs) and fellows of ACGME accredited neonatology fellowship programs in the United States. Using a 5-point Likert scale, participants were asked about the palliative care education they received, and their comfort level with several key aspects of palliative care.

Results: Twenty-four (26%) PDs and 66 (33%) fellows completed the survey. Fourteen PDs (58%) reported including palliative care education in their formal fellowship curriculum, whereas only 20 (30%) responding fellows reported receiving palliative care education. Of the responding fellows, most (80%) reported being uncomfortable or only somewhat comfortable with all assessed areas of palliative care. Fellows who received formal education were more comfortable than those without it in leading goals of care conversations (p = 0.001), breaking bad news (p = 0.048), discussing change in code status (p = 0.029), and grief and bereavement (p = 0.031).

Conclusions: Most fellows report being uncomfortable or only somewhat comfortable with essential areas of palliative care. Formal palliative care education improves fellows’ self-reported comfort with important aspects of end-of-life care. To promote a well-rounded neonatology fellowship curriculum, inclusion of formal palliative care education is recommended.



Stressful events – a byproduct of life for babies in the NICU – may increase their heart rate and blood pressure, while decreasing their oxygen levels.  Even sensory and environmental stimuli we take for granted, such as a simple touch and noise and bright lights, can affect physiologic responses such as heart rate, respiration, and oxygen saturation.

The additive impact of multiple stressors over time may have profound long-term consequences on the lives of NICU babies.  In the rapidly developing perinatal brain, repeated neonatal stress may have long-term effects on the central nervous system,  including effects on neural structure, function, and development.

Doctor and Two Nurses Drive 2 Miles In Texas Snowstorm To Deliver Premature Baby

Mar 4, 2021     Uplifting Stories in a Minute

Despite being only 24 weeks pregnant, Kimberley Arias went into labor in the middle of the Texas snowstorm. Thanks to the help of Dr. John Loyd and nurses Kelly Clause and Nicole Padden who traveled 2 hours in the blizzard, her baby was delivered safely.

The New Graduate Neonatal Nurse Practitioner’s Transition from Bedside to Head-of-the-Bed

By Chandler Williams, DNP NNP-BC

The Neonatal Nurse Practitioner (NNP) role in the neonatal intensive care unit (NICU) is about to mark its 50th birthday. 

According to the Accreditation Council for Graduate Medical Education, there has been an estimated 33% reduction in resident physician NICU rotations (Jnah & Robinson, 2015). This will only increase the need for NNPs in NICUs across the country. A 2020 survey reported that the average NNP is 51 years old, and there are 40 accredited NNP programs in the US with new NNPs entering the workforce every year (Snapp et al., 2021). One thing all these NNPs have in common is the journey of navigating the transition that is from the bedside RN role to the head-of-the-bed NNP role. New graduate NNPs have feelings of anxiety, insecurity, exhaustion, and lack of confidence in decision making.

The transition period can be looked at in terms of the first year of starting as a new graduate NNP; that’s because most NNPs report feelings of competence and viewing themselves as a member of the NICU team at the end of year 1 (Cusson & Strange, 2008). To ease this transition, novice NNPs should seek out mentors, be aware of areas of weakness or fears, seek out strategies to ease the transition, and consider the familiarity of the unit. NNPs are an important part of a neonate’s care team, and easing this transition is important for the future of NNPs’ careers.

There are many strengths and weaknesses of being a new graduate NNP, and it is important to be aware of these strengths to gain confidence through the transition process, as well as the weaknesses to know there is room for growth and to feel not alone. These strengths include strong assessment skills, hard-working, professionalism, previous neonatal nursing experience, compassion, calculations, and internal motivation to learn and excel. Perceived weaknesses include procedural experience, pharmacologic knowledge, limited experience, nervousness about role transition, doubting oneself, and emotional attachments to patients and families (Jnah & Robinson, 2015).

One way that novice NNPs can ease the transition to the workforce is through mentorship. There is an ease in the transition from RN to NNP in those who seek out mentors. A study on mentoring and self-efficacy in the NNP workforce revealed that mentorship facilitates positive self-efficacy for the novice NNP (Jnah & Robinson, 2015). Novice NNPs enter this new world with a passion for neonatal care and a desire to make a difference in the lives of neonates and their families; however, the fear of the unknown can be daunting. Mentorship is a collaborative relationship that is beneficial to both the mentor and the mentee by encouraging the development of long-term relationships between novice NNPs and experienced NNPs. During the orientation period, the novice NNP is generally placed under the guidance of a preceptor assigned to provide direct supervision and teach the novice NNP in their new clinical setting (Jnah & Robinson, 2015). A preceptor differs from a mentor in that a preceptor is time-limited; mentorship has no time limitations. Less experienced NNPs report longing for mentorship and support from other NNPs after their orientation is complete (Beal et al., 1997). Mentorship has reported increased job satisfaction, productivity, and quality of care (Jnah & Robinson, 2015). New graduate NNPs who seek out mentors and invest in these relationships can anticipate an ease in the role transition process.

There are a lot of opinions on whether it is a more difficult transition for a new graduate NNP in the facility or unit where they were an RN versus a new unit. An experienced NNP recruiter once described this phenomenon via a metaphor between ketchup and mustard bottles; stating that a novice NNP on the unit where that person was an RN is like a ketchup bottle that has been emptied and filled  with mustard. Even though this person is now filled with different substance (NNP knowledge), others will continue to look at them as ketchup (or their previous role).

However, there is evidence to suggest that RNs returning to their previous unit as an NNP has an easier transition and were benefited by their previous knowledge of the unit. It is also reported that those who accept jobs on units where they completed clinical practicum had a less difficult transition. These NNPs report a sense of familiarity with the hospital, unit, and staff. Challenges in these instances include initially being less accepted by nurses on the unit and, often, being questioned by staff nurses who expect them to prove themselves in their new role. There is evidence to suggest that NNPs who transition to their new role in a completely different unit from training or previous employment are more readily accepted by the staff but face a learning curve with regard to organizational culture and practice styles and routines (Cusson & Strange, 2008).

Strategies to enhance the role transition include developing good relationships with all staff, finding a mentor, becoming an active member of a professional nursing organization, sharing needs and accepting guidance, developing strategies to decrease stress, staying up-to-date in current evidence, and realizing that feelings of inadequacy are normal and will dissipate throughout the transition. Although each person develops in their identity of their new role, overall being open to support and guidance and being an active part of your new role as an NNP can increase confidence in the development of a role identity. A strong nursing identity is vital because it is associated with a successful NNP practice (Cusson & Viggiano, 2002).

The NNP is an important part of the neonatal care team. The average age of an NNP is decreasing as the NNP workload in the NICU is increasing across the country. New graduate NNPs will continue to transition in the role from bedside to head-of-the-bed, and can find support in this transition through mentors, self-evaluation, and careful examination of areas of strength and weakness. This transition period is just that, a transition, and there are ups and downs throughout this process. It is important to recognize that the progression of graduating from school, seeking employment, studying and obtaining licensure, and credentialling does not happen overnight. There are a lot of feelings of anxiety and worry, because it seems as if we have little control over the timeframe or outcome.

As the NNP progresses through orientation, and even in the first months of being “on their own,” they may feel anxious and inadequate and experience self-doubt, manifested primarily through questioning their knowledge and skills, wondering if they can handle a crisis or worse, and fearing making a fatal mistake or missing an important diagnoses (Cusson & Strange, 2008). As new graduate NNPs enter the workforce, it is important to provide support them throughout this process.



Developing eHealth in neonatal care to enhance parents’ self-management

Annica Sjöström Strand1Björn Johnsson2Momota Hena1Boris Magnusson2Inger Kristensson Hallström1


Background: Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for parents and thereby make the transition from hospital to home less stressful.

Aim: To develop an eHealth device supporting the transition from hospital to home for parents with a preterm-born child in Sweden using participatory design.

Method: Employing a framework of complex interventions in health care using participatory design. Parents of preterm-born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end-users – parents and professionals – were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis.

Results: Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home.

Conclusion: The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.


“In a Way We Took the Hospital Home”-A Descriptive Mixed-Methods Study of Parents’ Usage and Experiences of eHealth for Self-Management after Hospital Discharge Due to Pediatric Surgery or Preterm Birth

Rose-Marie Lindkvist1Annica Sjöström-Strand1Kajsa Landgren1Björn A Johnsson2Pernilla Stenström34Inger Kristensson Hallström1


The costly and complex needs for children with long-term illness are challenging. Safe eHealth communication is warranted to facilitate health improvement and care services. This mixed-methods study aimed to describe parents’ usage and experiences of communicating with professionals during hospital-to-home-transition after their child’s preterm birth or surgery for colorectal malformations, using an eHealth device, specifically designed for communication and support via nurses at the hospital. The eHealth devices included the possibility for daily reports, video calls, text messaging, and sending images. Interviews with 25 parents were analyzed with qualitative content analysis. Usage data from eHealth devices were compiled from database entries and analyzed statistically. Parents using the eHealth device expressed reduced worry and stress during the initial period at home through effective and safe communication. Benefits described included keeping track of their child’s progress and having easy access to support whenever needed. This was corroborated by usage data indicating that contact was made throughout the day, and more among families living far away from hospital. The eHealth device potentially replaced phone calls and prevented unnecessary visits. The eHealth technique can aid safe self-treatment within child- and family-centered care in neonatal and pediatric surgery treatment. Future research may consider organization perspectives and health economics.


Engaging Frontline Providers Prevents Hypothermia and Improves Communication in the Postoperative Neonate

Guidash, Judith C. BSN, RN, CPHQ; Berman, Loren MD, MHS; Panagos, Patoula G. MD; Sullivan, Kevin M. MD, MBA, FAAP

Advances in Neonatal Care: October 2021 – Volume 21 – Issue 5 – p 379-386 doi: 10.1097/ANC.0000000000000839



Neonates undergoing surgery are at high risk for perioperative hypothermia. Hypothermia has been associated with increased adverse events. Transfer of care from the operating room (OR) to the neonatal intensive care unit (NICU) adds another layer of risk for this population introducing the potential for miscommunication leading to preventable adverse events.


The aim of this quality improvement initiative is to decrease mean postoperative hypothermia rate and achieve compliance with use of a standardized postoperative hand-off in neonates transferred to the NICU from the OR.


An interdisciplinary team identified opportunities for heat loss during the perioperative period. The lack of standardized perioperative communication between the NICU and the OR and postoperative communication between neonatology, anesthesiology, surgery, and nursing were noted. Guidelines for maintaining euthermia in the perioperative period and a standardized interdisciplinary postoperative hand-off communication tool were created.


Mean rate for participation in the hand-off process increased from 78.8% to 98.4% during the study period. The mean hypothermia rate improved from 28.6% to 6.3% (P < .0001) and was sustained.

Implications for Practice: 

Creating a hypothermia guideline and standardizing temperature monitoring can significantly decrease the rate of postoperative hypothermia in neonates. Standardization of transfer of care from OR to NICU increases consistent communication between the services.

Implications for Research: 

Future research and improvement efforts are needed to optimize the management of surgical neonates through their transfers of care.


Nursing Students Create Wearable Night Light

Feb 11, 2021      CBS Pittsburgh

The founders of Lumify Care, Anthony Scarpone-Lambert and Jennifferre Mancillas, have more on the new tool for nurses.

Family-centered music therapy—Empowering premature infants and their primary caregivers through music: Results of a pilot study

Barbara M. Menke, Joachim Hass, Carsten Diener, Johannes Pöschl

Published: May 14, 2021   https://doi.org/10.1371/journal.pone.0250071



In Neonatal Intensive Care Units (NICUs) premature infants are exposed to various acoustic, environmental and emotional stressors which have a negative impact on their development and the mental health of their parents. Family-centred music therapy bears the potential to positively influence these stressors. The few existing studies indicate that interactive live-improvised music therapy interventions both reduce parental stress factors and support preterm infants’ development.


The present randomized controlled longitudinal study (RCT) with very low and extremely low birth weight infants (born <30+0 weeks of gestation) and their parents analyzed the influence of music therapy on both the physiological development of premature infants and parental stress factors. In addition, possible interrelations between infant development and parental stress were explored. 65 parent-infant-pairs were enrolled in the study. The treatment group received music therapy twice a week from the 21st day of life till discharge from hospital. The control group received treatment as usual.


Compared to the control group, infants in the treatment group showed a 11.1 days shortening of caffeine therapy, 12.1 days shortening of nasogastric/ orogastric tube feed and 15.5 days shortening of hospitalization, on average. While these differences were not statistically significant, a factor-analytical compound measure of all three therapy durations was. From pre-to-post-intervention, parents showed a significant reduction in stress factors. However, there were no differences between control and treatment group. A regression analysis showed links between parental stress factors and physiological development of the infants.


This pilot study suggests that a live-improvised interactive music therapy intervention for extremely and very preterm infants and their parents may have a beneficial effect on the therapy duration needed for premature infants before discharge from hospital is possible. The study identified components of the original physiological variables of the infants as appropriate endpoints and suggested a slight change in study design to capture possible effects of music therapy on infants’ development as well. Further studies should assess both short-term and long-term effects on premature infants as well as on maternal and paternal health outcomes, to determine whether a family-centered music therapy, actually experienced as an added value to developmental care, should be part of routine care at the NICU.


Keep Your Brain Young with Music


If you want to firm up your body, head to the gym. If you want to exercise your brain, listen to music.

“There are few things that stimulate the brain the way music does,” says one Johns Hopkins otolaryngologist. “If you want to keep your brain engaged throughout the aging process, listening to or playing music is a great tool. It provides a total brain workout.”

Research has shown that listening to music can reduce anxiety, blood pressure, and pain as well as improve sleep quality, mood, mental alertness, and memory.

The Brain-Music Connection

Experts are trying to understand how our brains can hear and play music. A stereo system puts out vibrations that travel through the air and somehow get inside the ear canal. These vibrations tickle the eardrum and are transmitted into an electrical signal that travels through the auditory nerve to the brain stem, where it is reassembled into something we perceive as music.

Johns Hopkins researchers have had dozens of jazz performers and rappers improvise music while lying down inside an fMRI (functional magnetic resonance imaging) machine to watch and see which areas of their brains light up.

“Music is structural, mathematical and architectural. It’s based on relationships between one note and the next. You may not be aware of it, but your brain has to do a lot of computing to make sense of it,” notes one otolaryngologist.

Everyday Brain Boosts from Music

The power of music isn’t limited to interesting research. Try these methods of bringing more music—and brain benefits—into your life.

Jump-start your creativity

Listen to what your kids or grandkids listen to, experts suggest. Often we continue to listen to the same songs and genre of music that we did during our teens and 20s, and we generally avoid hearing anything that’s not from that era.

New music challenges the brain in a way that old music doesn’t. It might not feel pleasurable at first, but that unfamiliarity forces the brain to struggle to understand the new sound.

Recall a memory from long ago

Reach for familiar music, especially if it stems from the same time period that you are trying to recall. Listening to the Beatles might bring you back to the first moment you laid eyes on your spouse, for instance.

Listen to your body

Pay attention to how you react to different forms of music and pick the kind that works for you. What helps one person concentrate might be distracting to someone else, and what helps one person unwind might make another person jumpy.


Wherever the Art of Medicine is Loved there is also Love of Humanity-Hippocrates

Reflecting on the impact of music therapy on preemie infant survivors and parents highlighted above brings me great joy both as a fellow survivor and a Zumba Instructor. For me music has been a vessel where I am able to tune into feeling emotions internally without the need to express them outwardly or verbally. Learning about the ways in which music therapy may influence the reduction of stressor and physiological development of the parents and preemies is an exciting development.  

The benefits of having therapies like music therapies that allow both the preemies and parents to engage in activities together is empowering. In the many years working as a Zumba fitness instructor, I have witnessed the impact music can have on others. I know for myself it has greatly contributed to my own development as a young child learning to play guitar, and as a teen and adult participating in and teaching Zumba where a variety of international beats is discovered in each class. Likewise, when I have felt uneasy in times of stress and anxiety music has helped me recenter and ground myself in my body. I am thrilled to learn researchers may now have the ability overtime to scientifically measure its tangible impact on the tiny members and parents in our community today.  

My go to music when I am working out and studying is EDM, and for emotional release I may listen to Latin vibes or Alternative pop. What type of music has helped you navigate the waves of your life? Are there songs that aided you along your neonatal community journey? If you are a preemie survivor, I encourage you to consider talking about music with your caregivers/parents. Some interesting stories may be yet to be discovered. 

No surfing in Somaliland but definitely the WAVES to do so.


11/3/2020 by RiyoTv

Hargeisa to berbera somaliland 2020!! beach vlog. 4k drone and GoPro


Peru is a country in western South America. It is bordered in the north by Ecuador and Colombia, in the east by Brazil, in the southeast by Bolivia, in the south by Chile, and in the south and west by the Pacific Ocean. Peru is a megadiverse country with habitats ranging from the arid plains of the Pacific coastal region in the west to the peaks of the Andes mountains extending from the north to the southeast of the country to the tropical Amazon Basin rainforest in the east with the Amazon river.[9] Peru has a population of 33 million, and its capital and largest city is Lima. At 1.28 million km2 (0.5 million mi2), Peru is the 19th largest country in the world, and the third largest in South America.

The sovereign state of Peru is a representative democratic republic divided into 25 regions. Peru is a developing country, ranking 82nd on the Human Development Index, with a high level of human development with an upper middle income level and a poverty rate around 19 percent. It is one of the region’s most prosperous economies with an average growth rate of 5.9% and it has one of the world’s fastest industrial growth rates at an average of 9.6%. Its main economic activities include mining, manufacturing, agriculture and fishing; along with other growing sectors such as telecommunications and biotechnology. Peru ranks high in social freedom; it is an active member of the Asia-Pacific Economic Cooperation, the Pacific Alliance, the Trans-Pacific Partnership and the World Trade Organization; and is considered as a middle power.

Peru has a decentralized healthcare system that consists of a combination of governmental and non-governmental coverage. Five sectors administer healthcare in Peru today: the Ministry of Health (60% of population), EsSalud (30% of population), and the Armed Forces (FFAA), National Police (PNP), and the private sector (10% of population).

In 2009, the Peruvian Ministry of Health (MINSA) passed a Universal Health Insurance Law in an effort to achieve universal health coverage. The law introduces a mandatory health insurance system as well, automatically registering everyone, regardless of age, who living in extreme poverty under Integral Health Insurance (Seguro Integral de Salud, SIS). As a result, coverage has increased to over 80% of the Peruvian population having some form of health insurance. Health workers and access to healthcare continue to be concentrated in cities and coastal regions, with many areas of the country having few to no medical resources. However, the country has seen success in distributing and keeping health workers in more rural and remote regions through a decentralized human resources for health (HRH) retention plan. This plan, also known as SERUMS, involves having every Peruvian medical graduate spend a year as a primary care physician in a region or pueblo lacking medical providers, after which they go on to specialize in their own profession.



Rank: 148 –Rate: 7.3%  Estimated # of preterm births per 100 live births 

  (USA – 12 %, Global Average: 11.1%)


Newborn babies, whose mothers are infected with coronavirus, at the National Perinatal and Maternal Institute. Photograph: Rodrigo Abd/AP

Hidden pandemic’: Peruvian children in crisis as carers die

Mon 16 Aug 2021

With 93,000 children in Peru losing a parent to Covid, many face depression, anxiety and poverty.

When Covid-19 began shutting down Nilda López’s vital organs, doctors decided that the best chance of saving her and her unborn baby was to put her into a coma.

Six months pregnant, López feared she would not wake up, or that if she did, her baby would not be there.

Her partner had already died of the virus, and doctors predicted that López would too.

But whether due to the expertise of the intensive-care unit’s medical team, López’s will to cling to life for her children – or, as she sees it, divine intervention – doctors were able to save the mother and the baby, María Belén, who was three months premature, with an emergency caesarean.

“It really is a miracle of God,” says López, who lives in a settlement of ramshackle wooden and concrete-block houses in the dusty mountains skirting the northern edge of Lima. “Maybe he didn’t want me to die for my kids, so I could continue fighting for them. They are the ones that really need me.”

Mental health in the life of this population is likely to be marked by various breakdowns

The scars remain for López. She has not yet processed the loss of her partner and has to provide for her three children – including 12-year-old twins from a previous marriage – while Covid-19 has impaired her ability to walk.

María Belén, now six months old, is one of an estimated 99,000 children in Peru and 1.6 million globally who have lost a caregiver to Covid-19, according to a study published in the Lancet in July.

Covid-19 orphanhood is a “hidden pandemic”, say researchers. Obscured by the more visible tumult of the pandemic, it is damaging the mental and physical health and economic future of the next generation.

Peru faces a particularly severe crisis. High levels of informal labour, intergenerational housing and poverty have made it fertile ground for the coronavirus. It has recorded 197,000 Covid-19 deaths – the highest number in the world per capita.

By the end of April this year, almost 93,000 Peruvian children – more than one in 100 – had lost a parent, according to the Lancet study.

Experts believe the impact of the pandemic on children has been overlooked as they are usually less badly affected than adults by the illness itself, even though more than 1,000 Peruvian children have died from Covid-19.

Yuri Cutipé, executive director of mental health at Peru’s ministry of health, says: “If we add the loss of a parent or caregiver to the mental health impact of the pandemic in the context of weakening family and community networks and economic shortcomings, mental health throughout the life of this population is likely to be marked by various breakdowns and some complex difficulties.”

Lengthy lockdowns have caused a sharp increase in domestic violence as well as anxiety and depression in children. A third of children in Lima “show a high burden of mental health risk”, according to a study by Peru’s health ministry and Unicef.

Roxana Pingo, coordinator of Save the Children Peru’s (SCP) Covid response programme, says: “Even before you take into account that more than 1,000 children have died from Covid-19 in Peru, they have been extremely affected by depression and anxiety.”

Latin America and the Caribbean had the largest number of children missing school in the world, according to Unicef’s estimates in March. The educational hiatus is accentuating existing chasms in inequality and setting back life prospects for a generation, the UN agency says.

Children try to get a mobile signal during virtual classes in the Puente Piedra shantytown outside Lima. Latin America and the Caribbean have the world’s highest number of children missing lessons. Photograph: Martín Mejía/AP

The pandemic has plunged families who have lost a breadwinner into deeper poverty. López’s partner, a taxi driver, brought in the main wage and she cannot continue her job cleaning at a local college due to her difficulties walking. “We don’t know what to do,” she says. “I don’t see any economic opportunities.”

So many Peruvian families have lost a caregiver that the government approved an “orphan pension” in March. It pays caregivers of children who have lost one or both parents 200 Peruvian soles (£35) a month until the child is 18 years old. “It’s a lifeline,” says López.

But the delivery of pension payments has been slow. For now, López is relying solely on the goodwill of strangers and donations from SCP for food, milk and nappies.

It could take up to six months for a child who has lost a parent to start receiving payments and longer for those who have lost both parents, says Pingo. There are also insufficient funds to cover the programme, so children under five are prioritised.

The sluggish, fragmented response is typical of Peru, says Nelly Claux, SCP’s director of programme impact. The country became a model for child rights in Latin America during the 1990s, thanks to its progressive legislation. But the government often struggles to bring ideas conceived in Lima into reality in the sprawling slums on its periphery or the towns and villages dotted across the Andes.

“We have no lack of legal framework. It’s world-leading,” Claux says. “What we don’t have is cooperation, officials who know what they are doing, and funds.”

An official at a Child Defence Centre (Defensoría Municipal del Niño y el Adolescente or Demuna) told López that many parents and caregivers did not know that they were entitled to the pension. Demuna, a state-funded office that supports children’s rights at a local level, has been distributing flyers at its centres, posting notices on Facebook and going from door to door to raise awareness.

By the end of July, more than 11,000 families were receiving the payment, according to Peru’s ministry for women.

The government estimates that 35,000 children are eligible, which is below the Lancet study’s findings of 99,000. Terre des Hommes, a child development agency, puts that number at 70,000.

Children who lose a caregiver are more likely to be institutionalised in an orphanage or care home, and experience broader short- and long-term adverse effects on their health, safety and wellbeing, say experts.

Girls become more vulnerable to sexual exploitation and boys to illegal mine work. “The Peruvian response must be comprehensive, protecting against damage to mental health, education, exploitation and crime,” says Pingo.

“We know that they are out there and that the quicker we get to them, the more we can help. But we just don’t know where they are. We’ve got to find them.”

Early intervention minimises the impact. But first, they have to find the children. All the while, the list keeps growing. In the week to 10 August, more than 500 Covid deaths were recorded, meaning hundreds more children have likely lost a parent or caregiver.


Respectful Maternity Care and Maternal Mental Health are Inextricably Linked

September 15, 2021 By Sara Matthews

A positive birth experience is not a luxury, but a necessity, said Hedieh Mehrtash, consultant for the Department of Sexual and Reproductive Health and Research at the World Health Organization (WHO), at a panel during the Maternal Mental Health Technical Consultation hosted by the United States Agency for International Development’s (USAID) MOMENTUM Country and Global Leadership, in collaboration with WHO and the United Nations Population Fund

Much is still unknown about the connections between respectful maternity care and maternal mental health outcomes, said Patience Afulani, Assistant Professor at the University of California, San Francisco. Nevertheless, existing research indicates that women who have negative birth experiences are at higher risk of developing post-traumatic stress disorder, postpartum depression, and other perinatal mental health issues. “When women are treated in a way that is responsive to their needs, their preferences, and values; when providers are compassionate and respectful and supportive, a woman feels engaged in their care,” she said. “They feel satisfied. They feel valued. They feel empowered, which promotes positive emotional health.”

There is a complex “cyclic relationship” between respectful maternity care and maternal mental health, said Afulani. For example, due to provider discrimination, women with pre-existing mental health issues may be more likely to have negative birth experiences. Negative birth experiences may also deter women from seeking care in the future, making it less likely that mental health issues will be properly identified and addressed, she said.

Although supporting mothers and parents is incredibly important, “caring for the carers” is also essential, said Mary Ellen Stanton, Senior Maternal Newborn Health Advisor at USAID. Partially due to provider burnout, health care workers often lack the role models, skills, and resources needed to provide the highest standard of respectful care, said Charity Ndwiga, Program Officer III in the Reproductive and Maternal Health Program at the Population Council. When providers are burnt out, they are less able to communicate with and listen to patients. This damages the patient-provider relationship and can worsen health outcomes. In light of this reality, interventions need to target both mothers and providers, said Ndwiga. 

Although supporting mothers and parents is incredibly important, “caring for the carers” is also essential.

Developing measurement tools is a crucial next step, said the panelists. Concerns about the impact of respectful maternity care on maternal mental health outcomes are widespread but evidence remains fairly anecdotal, said Dr. Mary Sando, Chief Executive Officer of the Africa Academy of Public Health. More research will help stakeholders “name and frame” the problem and determine its extent. This knowledge can then be used to develop solutions and inform implementation strategies, she said. For this to happen, research tools need to be consolidated, validated, and standardized, said Mehrtash. Tools must also be critically examined based on the context in which they are being employed, especially given that most mental health instruments were developed in high-income countries and are now being imported to low- and middle-income settings, said Afulani.

Nevertheless, this pursuit of further evidence does not preclude present action, said Afulani. We cannot wait until we have perfect measurement tools in place before beginning to think about the mechanisms driving provider stress and poor maternal outcomes, she said. Instead, stakeholders must recognize the ways in which research and advocacy can support each other and pursue the two in tandem, said Stanton. “Women will tell their stories, while the research provides a growing body of evidence about what works in different environments. That will encourage policymakers and healthcare providers and society at large to tackle these problems with skill, compassion, and respect.”

Learn more about perinatal mental health at the Wilson Center’s Maternal Health Initiative’s upcoming event: Maternal Mental Health: Providing Care and Support in the Perinatal Period


Gravens By Design: Standards, Competencies and Best Practices for Infant and Family Developmental Care in Intensive Care: The Time Has Come

Joy Browne, Ph.D., PCNS, IMH-E(IV)

As evidence mounts to ensure the quality of care for hospitalized infants, and as families become more central to their baby’s caregiving, the time has come for assuring that such data are identified, examined, and standards set for family integration into all aspects of care. Neurodevelopmental and family-centered care now have a scientific base, practical application, and, most importantly, humane caregiving approaches that provide a basis for the development and implementation of neuroprotective standards to intensive care.

Excellence in neonatal care has produced remarkable outcomes in both mortality and morbidity, but optimal neurodevelopmental and social and emotional outcomes for the most vulnerable babies remain elusive. We have learned from basic and developmental science that early nurturing and caregiving impact neurophysiologic and epigenetic outcomes; however, these important findings are only beginning to be fully understood by medical professionals and applied to fragile newborns.

Recent advances in neuroprotection and developmental caregiving have provided significant opportunities to enhance early brain development and subsequent neurodevelopmental outcomes, yet applying those findings in intensive care is inconsistent and spotty at best. Without recognizing the available evidence, application to clinical care, and integration into all aspects of medical and nursing policies and procedures, the potential benefits will be lost. Global recognition of the need for guidelines and standards for developmental care has resulted in the publication of the European Foundation for the Care of Newborn Infants (EFCNI) Standards of Care for Newborn Health

(https://www.efcni.org/health-topics/ in-hospital/developmental-care/) and the Canadian Guidelines for Developmental Care (https://extranet.ahsnet.ca/teams/policydocuments/1/clp-neonatology-devcare-developmental-care-hcs-203-01.pdf). Until recently, the United States has not established standards or guidelines for developmental, family-centered care. Instead, various disciplines and organizations have developed their own expectancies and competencies for intensive care developmental care and family-centered care practices (for example, from NIDCAP, OT, PT, Speech and Parent groups).

In recognizing the need for evidence-based standards, competencies, and practice guidelines for infant and family-centered developmental care, an interprofessional group including representatives from all intensive care practice leading organizations and parents came together in 2015 to begin to determine if evidence for a variety of aspects of developmental care, neuroprotection, and family-centered care warranted identification, development, and publication of standards of care. After review of over 1000 publications, classification of quality of studies, and review by national and international professionals, the Standards, Competencies and Best Practice Guidelines for Infant and Family-Centered Developmental Care (IFCDC) process and articulation were published (1) and made readily available on the web (https://nicudesign.nd.edu/nicu-care-standards/).

Development of the Standards was based on the scientific principles that 1. Baby is an active participant and the primary focus of caregiving, 2. Family as integral and inseparable from the baby, 3. Neuroprotection of the developing brain; 4. Environmental impact, 5. Infant mental health; and 6. Individualized care. These principles can be demonstrated in intensive care only with appreciation for the change process and application to the system in which it is integrated.

The panel additionally identified six content areas that exemplified the aforementioned principles and for which IFCDC is well represented in the literature. The six areas that have ample evidence for the development of standards and competencies for practice include:

• Systems Thinking; • Positioning and Touch; • Sleep and Arousal; • Skin-to-Skin Contact with Intimate Family Members; • Reducing and Managing Pain and Stress in Newborns and Families; and • Feeding, Eating, and Nutrition Delivery.

IFCDC Standards in each content area include measurable competencies, appropriate references, and instruments by which an intensive care professional, administrator, or manager can assess current practice. Additionally, it includes reflective opportunities for improvement of practices, including policy change toward integration into all aspects of intensive caregiving. The evidence is now beyond hearsay and is based on stringent scientific review, so it cannot be relegated to an “add-on practice when the situation is right.”

The panel of professionals agrees that the time has come to become serious about the opportunities that IFCDC affords for optimizing the outcomes of babies and families who experience intensive care at birth, so they not only will survive but thrive. The evidence is based on stringent scientific review, so it cannot be considered “nice but not essential” or an “add-on practice when the situation is right.” The IFCDC standards and competencies are readily accessible and should raise a call to action for intensive care professionals, managers, quality assurance administrators, and families alike.

More information and resources can be found at the website: (https://nicudesign.nd.edu/nicu-care-standards/).

 Reference 1. Browne JV, Jaeger CB, Kenner C. Executive summary: standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit. Journal of perinatology : official journal of the California Perinatal Association. 2020;40(Suppl 1):5-10.


Arriba Perú – Daniela Darcourt, Eva Ayllón, Renata Flores, Tony Succar

Premiered Jul 26, 2021   Daniela Darcourt

I really wanted to make a union song, and with that idea in mind, “Arriba Peru” was born. Music is the best language of union. Proof of this is that to my admired Eva Ayllón, as soon as I commented on the idea of ​​the song, she agreed to accompany me on this path and when Renata Flores is added, the sweetness of Quechua and Renata’s enormous interpretive capacity, round off a song of the nos we are all very proud. With the musical direction of Tony Succar, Oscar Cavero and Mudo Venegas, we believe that Arriba Peru manages to express itself in a way that is very exciting for us. A special recognition to the maestro Oscar Cavero, for teaching us so much about our rhythms from the coast and giving this song his unique stamp. I love you dani

Reverting five years of progress: Impact of COVID-19 on maternal mortality in Peru

Camila Gianella, Jorge Ruiz-Cabrejos, Pamela Villacorta, Andrea Castro, Gabriel Carrasco-Escobar (2021)

Bergen: Chr. Michelsen Institute (CMI Brief no. 2021:1) 4 p.

Peru has moved back at least five years on its road to reducing maternal mortality, due to the profound impact COVID-19 has had on the capacity of health services. Our research shows that the health system needs urgent reengineering. Among other things, we recommend including pregnant woman in the COVID-19 risk groups.

Since the early 1990s, Peru has seen a major decline in the maternal mortality ratio. In fact, the country was well on its way to achieving Sustainable Development Goal 3 (SDG3) target 3.1, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. But the COVID-19 pandemic has led to dramatic setbacks. Peru swiftly implemented strict measures to control the spread of the virus, such as closing borders, restricting freedom of movement nationwide, banning crowds, and closing schools, universities, and churches. It also restricted all non-essential activities or services, including non-emergency primary health services. Despite these actions, it is among the countries with the highest COVID-19 incidence and mortality rates in Latin America and the Caribbean, as well as globally (Johns Hopkins University Coronavirus Resource Center 2020, The Economist 2020). This Brief aims to show the impact that the COVID-19 pandemic has had on the maternal mortality trajectory in Peru.

Maternal health not considered core in COVID response

This analysis contributes to the COVID-19 debate by analysing the pandemic’s direct and indirect impact on maternal mortality in Peru. There are a number of reasons why we focus on maternal mortality. First, in an emergency context where health systems have been put under pressure, it is important to understand what has been prioritised, as well as the different ways in which shutting down essential health services affect different population groups disproportionally. There is an emerging body of literature describing the impact on emergency services, including antenatal and neonatal services (Garrafa, Levaggi et al. 2020, Reinders, Alva et al. 2020). The effect that this has had on health outcomes needs to be understood more thoroughly. Second, the literature describes how maternal mortality indicators are sensitive to the health system’s capacity to provide quality health services, at the primary level, as well as its capacity to refer to complex care. What is more, maternal mortality is sensitive to social inequity and socioeconomic marginalisation. 

Maternal mortality focuses on a group in the population, women, of reproductive age, that in the context of the pandemic has not been identified as a high-risk group by most health authorities, in Peru or worldwide. At the beginning of the pandemic, the main concern around pregnant women was to prevent the exposure of the foetus to the disease. Health agencies did not consider maternal health or mortality risk to be a core issue. Early evidence showed a lower risk for women (grouping all of them and neglecting particular vulnerable groups). Meanwhile, the data collected, mainly from China, and Europe, did not indicate that pregnant women were at higher risk to develop severe symptoms due to SARS-CoV-2. There were almost no reported maternal deaths (Takemoto et al. 2020). Importantly, researchers excluded pregnant women from COVID-19 treatment trials, even when the treatment being evaluated had no or low safety concerns during pregnancy (Taylor, Kobeissi et al. 2020).

Increased risk of maternal deaths

By the end of 2020, evidence was showing that pregnant women were potentially more likely to need intensive care treatment for COVID-19 (Allotey et al. 2020). In addition, conditions related to high-risk pregnancies (such as pre-existing comorbidities, high maternal age, and high body mass index) now seemed to be risk factors for severe COVID-19 (Allotey, Stallings et al. 2020, Zambrano, Ellington et al. 2020). Evidence from low- and middle-income countries that are highly affected by the pandemic, like Iran or Brazil, indicates that there is a possibility of increased risk of maternal deaths due to COVID-19 (Takemoto, Menezes et al. 2020). However, there is still limited information on the effect of the pandemic response on maternal services and maternal health. This is within a context where across the globe, many countries, including middle- and low-income countries, are facing second waves of COVID-19 outbreaks. Therefore, it is important that studies generate evidence to correct COVID-19 responses and protect vulnerable groups of the population. 

As with other health conditions, including COVID-19, maternal mortality is unevenly distributed across Peru. Reports from 2019 show that the Amazon regions of Ucayali, Amazonas, Madre de Dios, and Loreto reported maternal mortality ratios (MMR) that are far above the national indicators (Gil 2018).

The main causes of maternal deaths in Peru are haemorrhage, hypertension (related to eclampsia and pre-eclampsia), and abortion complications. In the case of pregnancy-related death, the causes are suicide, cancer, and respiratory tract infections (Gil 2018, Centro Nacional de Epidemiología Prevención y Control de Enfermedades 2020). In Peru, three out of five maternal deaths occur in the puerperium period (42 days after delivery) (UNFPA 2020). 

Restrictions on preventive and emergency services

Formally, all pregnant women residing in the country have the right to access to antenatal and postnatal health care. In April 2020, Peru’s Ministry of Health (MoH), issued an order to guarantee access to antenatal, perinatal, and postpartum care during the COVID-19 emergency. Yet preventive services, as part of primary health care, were suspended for around two and a half months(Mesa de Consertación de Lucha Contra la Pobreza 2020). Despite the MoH plans, across the country obstetric outpatient services also remained restricted up until the end of 2020(Reinders, Alva et al. 2020, UNFPA 2020). Within the context of COVID-19 second wave, it is still uncertain when the services will be reopened. At the same time, access to emergency health care was also limited for many months due to the absence of health personnel. It has been reported that intensive care units for pregnant women have been reallocated to COVID-19 patients (UNFPA 2020). 

The Ministry of Health has reported an increase in maternal deaths (see Figure 1). However, it is not yet clear how many of these were directly linked to COVID-19 infection and/or as a consequence of lack of timely access to health care. 

Study method and findings

We used the data from the national death registry information system (SINADEF is the Spanish acronym) from 2017 to the 28 November 2020. SINADEF contains individual data on gender, age, district of residence, civil status, insurance, and education at the moment of death, along with the causes of death (direct, underlying, or associated) in ICD-10 codes (World Health Organization 2019). However, 22.72% of registered deaths did not have any cause of death reported. For our analysis, the inclusion criteria for a record to be classified as a ‘maternal death’ was any woman, between the age of 12 and 57 (the oldest reported maternal age by the MoH)(Ministerio de Salud and Centro Nacional de Epidemiología Prevención y Control de Enfermedades 2020), that had at least one cause of death labelled as ‘pregnancy, childbirth and postnatal’, which includes all ICD-10 codes in the range O00–O99. Additionally, a registered death was categorised as a ‘COVID-19 related death’ if at least one of the six causes of death was coded under chapter U07 (ICD-10 code for SARS-CoV-2). After including those that fulfilled these criteria, we selected a total of 442 registered deaths for further analysis. 

Our analysis shows an increase in maternal deaths, from 83 deaths in 2019, up to 146 during 2020 (to November). This is a 75% increase. When adjusted for live births, the increase in maternal mortality ratio (MMR) goes from 17 maternal deaths per 100,000 live births in 2019 to 34 maternal deaths per 100,000 live births. This shows a 102% increase in the data collected by SINADEF. The MMR increased from 62 to 92 when calculated from the MoH totals. This increase represents a major disruption given that maternal mortality in the country had previously reduced two years in a row. 

COVID not the main cause of increase in maternal deaths

Out of the 146 maternal deaths reported in the period included in this analysis, 35 (23.97%) were categorised as COVID-19 cases. The mean age for both groups at the moment of death was similar, with a mean of 31 for COVID-19 cases and a mean of 30 for those for whom COVID-19 was not recorded. The age ranges went form 15 – 45 for COVID cases and 16 – 48 for non COVID cases. 

The data on cause of death indicate that COVID-19 infection was not the main reason behind the increase in maternal deaths. Without the COVID-19 cases, there was an increase of 33% in the number of maternal deaths between 2019 and 2020. Our analysis of causes of death shows that women lacked timely health care. Figure 3 (graph A corresponds to the years 2017–19 while graph B corresponds to 2020), shows an increase on the proportion of cases where preeclampsia/eclampsia appeared as the main, or principal, underlying cause of deaths in 2020. It should be noted that the principal risk factors for death in women with preeclampsia/eclampsia are a lack of prenatal care, associated with chronic hypertension (Amorim, Santos et al. 2001). Lack of antenatal care does not allow timely diagnosis of high-risk pregnancies due to for example preeclampsia. The rise in childbirth complications (including preterm delivery, intrauterine growth restriction, abnormal placenta, detection of congenital malformations, and haemorrhage, among others) also indicates lack of antenatal control for timely diagnosis of some conditions, as well as a lack of access to emergency obstetric care. During the COVID-19 pandemic, health services have been saturated and intensive care units for pregnant women have decreased (UNFPA 2020).

Conclusion and policy recommendations

COVID-19, as a health condition, contributes to maternal mortality. Peru has moved back at least five years on its path to reducing maternal mortality (see Figure 1). Although pre-pandemic trajectories could be recovered once extensive vaccinations have been undertaken, this Brief highlights the weakness of a health system that needs urgent re-engineering to guarantee access to health services to those that require care. 


Following on from this study, the authors make the following recommendations:

  • The need to re-examine COVID-19 risk groups to include pregnant women, and to call governments to develop and implement measures to protect this group of the population from COVID-19 infections. This is especially given that there are valid safety concerns to include pregnant women as priority group for COVID-19 vaccines.
  • That truly comprehensive approaches to pregnant women should be developed. Diseases, such as malaria, have already show the risks that pregnancy creates for women. The health of pregnant women should receive the same level of interest as vertical transmission from the medical community. 
  • In the context of calls for new lockdown measures as a means to control second waves of COVID-19, there is a need to guarantee the provision of essential services such as antenatal care. 
  • It is also important that open data sources inform decisions. SINADEF is a positive example; however, the superposition of different records of death limits the capacity to perform comprehensive analyses. National registers such as SINADEF must include all deaths, including maternal deaths. Some of the weakness of this analysis – for example, the differences between the gross data reported on maternal deaths by the MoH and the data from SINADEF – are rooted in the lack of clarity or omission in the initial reports, and the presence of different overlapping systems. Accurate information on maternal deaths is registered as part of the Surveillance System of the National Center for Epidemiology and Disease Control (CDC-Peru). This information is not open access and is under control of Peru’s Ministry of Health (the team in charge of this study formally asked for access to the information, but the request was not answered). However, as mentioned above, when compared annually, both sources follow a consistent trend. 
  • It is important to assess the impact of COVID-19 pandemic, beyond the number of COVID related deaths. The devastating effects of COVID-19 on health systems are contributing to excess mortality. It is important to understand how this is distributed among the population, which groups are more vulnerable. 



This positive support resource for Preterm Birth Families provides a variety of NICU and Bereavement resources and services. Check them out!

Welcome to Project Sweet Peas


About Us

Project Sweet Peas is a 501(c)3 national non-profit organization coordinated by volunteers, who through personal experience have become passionate about providing support to families of premature or sick infants and to those who have been affected by pregnancy and infant loss.

Project Sweet Peas acknowledges the importance of parental involvement in caregiving and decision-making in the neonatal intensive care unit (NICU), and seeks to promote family-centered care (FCC) competencies in hospitals nationwide. Care packages, hospital events, peer-to-peer support, financial aid, educational materials, and other Project Sweet Peas services, support the cultural, spiritual, emotional, and financial needs of families as they endure life in the NICU.

Project Sweet Peas makes a lifelong commitment to support families experiencing pregnancy and infant loss. In a baby’s last moments, families are encouraged to make cherished memories with custom Project Sweet Peas keepsake items. Healing and remembrance continue to be fostered through programming such as peer-to-peer support, and our annual candlelight vigil.

Through our services, we give from our hearts, to inspire families with the hope of tomorrow.

Source: https://www.projectsweetpeas.com/

Mom’s pandemic pivot helps babies in the NICU

Good Morning America – Jan 13, 2021

After her child underwent heart surgery at 4 months old, Kate Bowen decided to create a line of comfortable clothes for struggling newborns.

Benefits of healthy lifestyle interventions in improving maternal and infant health outcomes


The review reports evidence from meta-analyses on smoking cessation, alcohol reduction, diet and physical activity at reducing the risk of adverse health outcomes. The outcomes vary, yet diet and physical activity appear to be the variables with the most significant impact on maternal and infant health.

Fetal and infant health is related to maternal behaviours during pregnancy. Some adverse pregnancy outcomes such as maternal and perinatal mortality, low birthweight, and preterm birth share common risk factors associated with an unhealthy lifestyle. International guidelines for pregnancy behaviour recommendations exist but need some clarification in some cases like alcohol consumption.

Furthermore, there is a lack of data on recognising similarities or differences between interventions for specific behaviours, which motivated a systematic review of 602 English language meta-analyses published since 2011. The review was set to examine the effectiveness of interventions on improving health-related outcomes for women and infants and explore shared behavioural techniques of those interventions. Pregnant women were the target population for the reviewed papers’ inclusion criteria. As for the intervention, the included papers needed to relate to maternal smoking, alcohol, diet or physical activity behaviours.

At the end of the selection, 332 meta-analyses of maternal health outcomes related to maternal weight, gestational diabetes (GDM), hypertensive disorders, mode of delivery and “others” were analysed. The other 270 meta-analyses presented the infant health outcomes and included fetal growth, gestational age at delivery, mortality and admission to the neonatal intensive care unit (NICU). Moreover, most of the evidence identified with this review was related to diet and physical activity intervention. Unfortunately, there were only two systematic reviews on evidence for smoking interventions and health outcomes, and no reviews on health outcomes from alcohol interventions.

Regarding the outcome itself, physical-activity-only interventions had the most effective impact on maternal health outcomes, reducing GDM. Within the infants’ outcomes, fetal growth and gestational age at delivery were highly impacted. By comparing the behaviours and population subgroups, evidence suggests particular effectiveness of smoking cessation for increasing birthweight. In contrast, diet-only interventions appear most effective at reducing weekly gestational weight gain (GWG). Concerning preterm deliveries, meta-analyses of the effectiveness of diet and physical activity interventions showed a significantly reduced risk of preterm delivery. Other interventions like counselling, feedback, or incentives had no significant effect. Interventions on women with a Body Mass Index (BMI) in the overweight or obese categories had the most considerable GWG and GDM reductions.

Previous reports have shown promising effects of smoking and alcohol interventions at changing maternal health outcomes. This systematic review reports the opposite trend and sets physical activity and diet to be the docking point for improvement. Explanations for the conflicting findings in the meta-analyses might be related to unmeasured factors. It is also worth mentioning that the review’s data gap from lower-middle-income and low-income countries compromises the validity and effectiveness of the interventions strategies globally.

One of the aims of a systematic review of systematic reviews is to describe the current evidence’s extent and gaps to inform future research. There is a clear necessity to conduct further analyses on the benefits of a healthy lifestyle for maternal and infant health outcomes.

Paper available at: MDPI, Journal Nutrients

Full list of authors: Louise Hayes, Catherine McParlin, Liane B Azevedo, Dan Jones, James Newham, Joan Olajide, Louise McCleman and Nicola Heslehurst

DIO: 10.3390/nu13031036

Mom, baby doing great after giving birth on Delta flight to Honolulu with help of doctor, three NICU

May 3, 2021   KHON2 News

It could’ve been a worse case scenario: a woman giving birth to a baby, who arrived early, on an airplane. But a physician and three nurses trained to care for premature babies were on board that same flight — and they did an amazing job to keep mom and baby safe.


COVID-19 Gave Birth to Changes in Neonatal Intensive Care Units

August 20, 2021

Jenny Hayes, MSN, RN, CICMichelle Ferrant, DNP, CNS, RN, RNC-NIC

Testing of the infant of the COVID-19–positive mother requires 2 negative COVID-19 tests 2 days apart. This time delay adds to the challenge of ensuring available isolation beds.

The emergence of the SARS-CoV-2 virus swiftly effected change in every facet of society, with health care delivery being the frontline to the COVID-19 pandemic. This agent of change spared no population. Rapid process changes infiltrated neonatal intensive care units (NICUs) to protect the most vulnerable newborn babies who made their entry into the world during a global pandemic. Just as the virus has adapted to its global host with variant strains, health care delivery in the NICU has adapted with evolving and sustainable practices.

The NICU at the Hospital of the University of Pennsylvania provides care to a level 3 NICU patient population. The American Academy of Pediatrics defines a level 3 NICU as a hospital setting that offers expertise of care providers and specialized equipment needed to provide “comprehensive care for infants born <32 weeks gestation and weighing <1500 g and infants born at all gestational ages and birth weights with critical illness.” Four open bays comprise the 38-bed unit with only 2 negative pressure capable isolation rooms located in 1 of the bays. The NICU includes a separate resuscitation space adjacent to the labor and delivery (L&D) unit with 3 available bed spaces. To adapt to potential census fluctuations, many bed spaces are capable of accommodating overflow and multiple gestation infants in a single-bed space footprint.

Crisis Operations

Operational challenges in the NICU were quickly unveiled with the emergence of COVID-19. Staff illness or exposures to COVID-19 from community and workplace venues resulted in prolonged furlough periods.Severe supply chain shortages in personal protective equipment (PPE) and disinfectant products compounded these operational challenges, prompting conservation and reuse. The NICU was thrust into a crisis capacity mode from a baseline of conventional capacity operations. Unlike other areas of the hospital, the NICU could not reduce admissions or defer scheduled procedures. This prompted emergent planning for contingency operations.

Contingency Operations

To continue safe delivery of care, immediate process changes were developed by a collaborative multidisciplinary team. Expert guidance was enlisted from the NICU and L&D nursing leadership and physician provider teams along with hospital partners from infection prevention and control, lab and pathology services, perioperative services, environmental services (EVS), facilities, and materials management (MM). Internal and external supply chain shortages of disinfectant products prompted EVS and MM to forge a plan to make and distribute disinfectant wipes.

Infection prevention in the NICU begins in the L&D setting. Prior to the availability of universal COVID-19 testing for the antepartum population upon admission, the patient history and physical (H&P) included screening for community exposure to COVID-19 and presence of signs or symptoms of COVID-19 infection. Any positive findings on the H&P resulted in a person under investigation (PUI) for COVID-19 status with laboratory testing to confirm diagnosis.6

Three negative pressure L&D rooms were designated for PUIs or COVID-19–positive patients. An operating room (OR) for cesarean-section deliveries was also designated for this patient population, with terminal cleaning commencing at the end of the case or upon discharge of the patient from the L&D room. A hospital nursing team of subject-matter experts (SMEs) was deployed to enhance PPE training with donning and doffing procedures as well as safe handling of N95 masks that were reused.

An infant who was born to a mother who was a PUI required airborne and contact isolation pending the maternal COVID-19 result. This challenged the limitation of 2 NICU isolation rooms, prompting the conversion of the adjacent open bay to a negative pressure airflow to accommodate a third infant who would require isolation. Precipitous deliveries leave little time for the NICU to prepare for an admission, requiring airborne isolation resources to be in a state of readiness.

The admission of a third patient to the negative pressure bay requires imminent transfer of up to 4 other patients to other locations in the NICU. For this reason, the goal is to preserve this open bay for the most stable patients. Testing of the infant of the COVID-19–positive mother requires 2 negative COVID-19 tests 2 days apart. This time delay adds to the challenge of ensuring available isolation beds.

How to COPE

Because of the highly specialized nature of the neonatal population, the NICU adapted the hospital nursing SME model and implemented a unit specific team of SMEs. This core group of RNs served as trained observers for appropriate donning and doffing of PPE in the delivery room and during the admission and stabilization of the infant in the isolation bed space. This role quickly evolved into a dedicated resource for the interprofessional staff of the NICU. The acronym COPE was coined by a team member,Jennifer Roman, BSN, RN, CBC, to describe the team of COVID-19 operations and patient-care experts. In this role, nurses served as communication liaisons for unit leadership to disseminate the rapid evolution of guidance in the initial wave of the pandemic, which led to rapid process changes.

The COPE team was tasked with remaining knowledgeable on current processes, readily guiding the interprofessional team to unit resources and protocols and providing direct and indirect support to staff. In order to sustain preparedness, the COPE team created specific checklists and supply par levels that are utilized by all staff members to ensure isolation admission spaces are always at the ready. Identifying appropriate supply par levels and paring down admission supplies to the necessities also aided preserving supplies and minimizing waste during the terminal cleaning process of isolation spaces.

This population based SME team allowed for streamlined and systematic information communication to the unit staff members. The COPE team members were able to filter out the overwhelming volume of information being shared hospital-wide, much of which did not pertain to the specialized neonatal patient population, and provide concise, timely, and pertinent information to the neonatal team.

Ongoing assessments of patient and staff safety prevailed as more information about the transmission of SARS-CoV-2 virus and supply chain challenges became available.The interdepartmental collaboration and frequent virtual communications sustained the contingency plans and required resources through the peak of the pandemic, providing a pathway to a new conventional capacity operations model. Increased testing capacity and widespread vaccination for the SARS-Cov-2 virus has alleviated the contingency capacity operations with improved supply chain and decreased staffing burdens.

New Model

Sustained changes in the delivery of care in the NICU have forged new conventional capacity operations in the setting of the COVID-19 pandemic. Negative pressure in L&D rooms is no longer a requirement because updated information became available. A designated OR remains in use for COVID-19 positive patients as intubation may take place. Terminal cleaning procedures follow use of the L&D room or designated OR used for a COVID-19–positive patient. Infant resuscitation continues to be performed in the delivery room or in the OR. Delivery teams for COVID-19–positive patients continue to be limited to essential personnel with N95 masks used in aerosolizing procedures. The responding neonatal team has expanded to include pre-pandemic staff level participation.

Due to the increased potential for a neonate to require an aerosolizing procedure including initial resuscitation steps, neonatal responders continue to utilize N95 masks and viral filters for all neonatal respiratory equipment in L&D. Clean supply carts are maintained outside the room with a “clean” team member to hand off the supplies as needed to the delivery team.A daily checklist for supplies in each NICU isolation room is utilized to ensure capacity for airborne and contact isolation. Universal testing for hospital admissions continues. Visitors and employees are screened for symptoms of COVID-19 infection or exposure to sick contacts upon entry to the facility.

COPE team members continue to provide the necessary emotional support for the interprofessional staff during times of extraordinary stress and anxiety.The team serves as a sounding board for the other staff members and were able to bring forth staff concerns to unit based leadership for discussion and potential solution creation. Having dedicated “experts” who were specific to the unique population and space constrains of the NICU alleviated much of the staff worry, anxiety, and concern related to providing safe patient care. The COPE team continues to support the NICU interprofessional staff and has helped sustain unit readiness throughout several waves of COVID-19.

Other Successes

Surveillance for all hospital acquired infections as required by the state of Pennsylvania continued throughout the pandemic. No central line associated bloodstream infections (CLABSIs) were identified in over 400 days, nor were any other device-associated infections identified. There was no increase in non-device–associated infections. Recent hand hygiene observations conducted by college co-op/volunteer students on all shifts revealed 95% compliance in 175 observations for 1 month.

This infection surveillance data indicates proven success in both contingency and new capacity models, with COVID-19 serving as an agent of change to facilitate improvement in infection prevention.A recently published study demonstrates the increased risk of maternal complications and preterm birth when Covid-19 infection occurs in pregnancy. This is a critical reminder that contingency planning and sustained operations are essential to the needs of our maternal and NICU population. 


Intro to abdominal ultrasound for necrotizing enterocolitis

Video Author: Belinda Chan
Published on: 09.06.2021
Associated with: Advances in Neonatal Care. 21(5):365-370, October 2021

Necrotizing enterocolitis (NEC) can be life threatening and x-ray may miss up to 50% of the early signs of NEC. The use of ultrasound can expedite diagnosis and improve clinical management. This video abstract provides a brief introduction to the use of ultrasound for diagnosis and management of necrotizing enterocolitis.


Being a gift- Multilingual healthcare professionals in neonatal care

Journal of Neonatal Nursing

23 April 2021     KatarinaPatrikssonabStefanNilssondHelenaWigertce



Parents said that they sometimes wished they had a multilingual physician as an interpreter, because the physician would understand the child’s care and treatment and share a language with the parents.


To understand and describe the lived experience of multilingual neonatal healthcare professionals dealing with interpreting in their workplace, performing as interpreters in addition to their regular work.


Interviews with multilingual neonatal healthcare professionals and analysed using a phenomenological reflective lifeworld approach.


Multilingual healthcare professionals understood the interpreting experience as being a gift, comprising three themes: feeling satisfaction – happiness from helping workplace colleagues; identifying with families – empathy from having been in the same situation; and expected to be available – colleagues expected them to provide interpreting services.


This study found that it is common in neonatal care to use multilingual healthcare professionals to interpret communication with parents when language barriers exist.


Stressed Healthcare Workers Face Another Threat: Harassment

by Sophie Putka, Enterprise & Investigative Writer, MedPage Today

September 15, 2021

Healthcare workers across the country, already strained by the demands of caring for COVID-19 patients, face another threat in the workplace: medical conspiracy theorists harassing them with phone calls, and even showing up at their hospitals.

Last week, a Chicago hospital treating known anti-vaxxer and QAnon supporter Veronica Wolski for COVID became the target of such threats.

AMITA Health Resurrection Medical Center reportedly received hundreds of phone calls from Wolski’s followers, demanding she receive alternative medical care, including the antiparasitic ivermectin.

The hospital declined to comment to MedPage Today, but in a statement released to Chicago TV station NBC5, AMITA said it’s following CDC and FDA guidelines in the treatment of COVID-19, and also confirmed earlier this month that it wasn’t administering ivermectin for COVID-19.

Wolski died Monday morning from pneumonia from “novel corona (COVID-19) viral infection” with hypothyroidism, according to a report from the Cook County Medical Examiner’s office.

Fueling the flood of calls to the hospital was a right-wing lawyer, Lin Wood, who harnessed his more than 800,000 Telegram followers with a call to “go to war” against what he called “medical tyranny in our country and around the world,” although he said on his Telegram channel he did not mention ivermectin in connection to Wolski’s treatment. Wood’s message called her death a “medical murder.”

Wolski’s supporters began calling the hospital to complain about her medical care, according to the NBC5 report and Wolski’s Telegram channel.

According to a Freedom of Information officer for Chicago’s Office of Emergency Management and Communications (OEMC), at least nine 911 calls were made related to the incident.

At least one of those calls was from hospital staff on Sunday, who were concerned about an “irate” person who wouldn’t leave the hospital, the officer said.

“Security’s trying to remove them from the location, the person was screaming, people are showing up to the hospital,” the officer said, reading from the call report. “There was a lot going on that day, I guess.”

According to one Telegram user, 20 to 30 cars showed up at Resurrection Hospital.

Other calls, the officer said, were from people calling on Wolski’s behalf, telling dispatchers that the patient was “being held against her will” and that they “wanted to make sure she’s being treated fairly. … There were a bunch of calls about her.”

Though a reporter for the Daily Beast tweeted about police being called “amid bomb threats,” the officer said she didn’t see a record of bomb threats related to the incident. No police reports were filed, according to a representative from the Chicago Police Department.

One of Wolski’s supporters on Telegram wrote in her channel, “The receptionist hung up on me … as soon as I said Veronica Wolski’s name. How freakin rude. We need to start a campaign THAT NO ONE . IF THEY CAN at all HELP it BE ADMITTED TO THAT HOSPITAL.”

Another wrote on September 12, “Resurrection has horrible reception, likely on purpose. Cannot understand menu. CALL POLICE INSTEAD!!!!!!”

Other commenters shared the physical address of the hospital.

With healthcare workers increasingly targeted as misinformation about treatments for COVID-19 swirls, incidents like this one are a cause for concern, experts said.

“We did see a rise in cases of violence and harassment when the COVID-19 pandemic broke out, and such cases continue to this day,” Jason Straziuso, a media representative for the International Committee of the Red Cross, which collected data on violent incidents against healthcare workers related to COVID-19 last year, wrote in an email. “This puts healthcare workers in harm’s way and under increased stress at a time when they are sorely needed, in particular in COVID-19 hotspots.”



Can EEG accurately predict 2-year neurodevelopmental outcome for preterm infants?

Rhodri O Lloyd1,2, John M O’Toole1,2, Vicki Livingstone1,2, Peter M Filan1,2,3, Geraldine B Boylan1,2

Correspondence to Professor Geraldine B Boylan, Department of Paediatrics and Child Health, INFANT Research Centre, University College Cork, Cork T12 DFK4, Ireland; g.boylan@ucc.ie



Establish if serial, multichannel video electroencephalography (EEG) in preterm infants can accurately predict 2-year neurodevelopmental outcome.

Design and patients 

EEGs were recorded at three time points over the neonatal course for infants <32 weeks’ gestational age (GA). Monitoring commenced soon after birth and continued over the first 3 days. EEGs were repeated at approximately 32 and 35 weeks’ postmenstrual age (PMA). EEG scores were based on an age-specific grading scheme. Clinical score of neonatal morbidity risk and cranial ultrasound imaging were completed.


 Neonatal intensive care unit at Cork University Maternity Hospital, Ireland.

Main outcome measures

 Bayley Scales of Infant Development III at 2 years’ corrected age.


Sixty-seven infants were prospectively enrolled in the study and 57 had follow-up available (median GA 28.9 weeks (IQR 26.5–30.4)). Forty had normal outcome, 17 had abnormal outcome/died. All EEG time points were individually predictive of abnormal outcome; however, the 35-week EEG performed best. The area under the receiver operating characteristic curve (AUC) for this time point was 0.91 (95% CI 0.83 to 1), p<0.001. Comparatively, the clinical course AUC was 0.68 (95% CI 0.54 to 0.80, p=0.015), while abnormal cranial ultrasound was 0.58 (95% CI 0.41 to 0.75, p=0.342).


 Multichannel EEG is a strong predictor of 2-year outcome in preterm infants particularly when recorded around 35 weeks’ PMA. Infants at high risk of brain injury may benefit from early postnatal EEG recording which, if normal, is reassuring. Postnatal clinical complications can contribute to poor outcome; therefore, we state that a later EEG around 35 weeks has a role to play in prognostication.


Association of Blood Donor Sex and Age With Outcomes in Very Low-Birth-Weight Infants Receiving Blood Transfusion

Ravi M. Patel, MD, MSc1Joshua Lukemire, PhD2Neeta Shenvi, MS2; et alConnie Arthur, PhD3,4Sean R. Stowell, MD, PhD3,4,5Martha Sola-Visner, MD6Kirk Easley, MApStat2John D. Roback, MD, PhD3,4Ying Guo, PhD2Cassandra D. Josephson, MD3,4

Original Investigation  Pediatrics  September 3, 2021

JAMA Netw Open. 2021;4(9):e2123942. doi:10.1001/jamanetworkopen.2021.23942

Key Points


 Is the sex or age of a blood donor associated with morbidity or mortality in very low-birth-weight infants receiving blood transfusion?


In this cohort study of 181 very low-birth-weight infants at 3 centers, infants receiving red blood cell transfusion from female donors had a lower risk of death or serious morbidity compared with those who received transfusion from male donors. The protective association between female donor and adverse outcomes increased with increasing donor age, but diminished with increasing number of blood transfusions.


These findings suggest that characteristics of blood donors, such as sex and age, may be associated with recipient outcomes in very-low-birth weight infants receiving blood transfusions.



  There are conflicting data on the association between blood donor characteristics and outcomes among patients receiving transfusions.


 To evaluate the association of blood donor sex and age with mortality or serious morbidity in very low-birth-weight (VLBW) infants receiving blood transfusions.

Design, Setting, and Participants  

This is a cohort study using data collected from 3 hospitals in Atlanta, Georgia. VLBW infants (≤1500 g) who received red blood cell (RBC) transfusion from exclusively male or female donors were enrolled from January 2010 to February 2014. Infants received follow-up until 90 days, hospital discharge, transfer to a non–study-affiliated hospital, or death. Data analysis was performed from July 2019 to December 2020.


Donor sex and mean donor age.

Main Outcomes and Measures 

 The primary outcome was a composite outcome of death, necrotizing enterocolitis (Bell stage II or higher), retinopathy of prematurity (stage III or higher), or moderate-to-severe bronchopulmonary dysplasia. Modified Poisson regression, with consideration of covariate interactions, was used to estimate the association between donor sex and age with the primary outcome, with adjustment for the total number of transfusions and birth weight.


In total, 181 infants were evaluated, with a mean (SD) birth weight of 919 (253) g and mean (SD) gestational age of 27.0 (2.2) weeks; 56 infants (31%) received RBC transfusion from exclusively female donors. The mean (SD) donor age was 46.6 (13.7) years. The primary outcome incidence was 21% (12 of 56 infants) among infants receiving RBCs from exclusively female donors, compared with 45% (56 of 125 infants) among those receiving RBCs from exclusively male donors. Significant interactions were detected between female donor and donor age (P for interaction = .005) and between female donor and number of transfusions (P for interaction < .001). For the typical infant, who received a median (interquartile range) of 2 (1-3) transfusions, RBC transfusion from exclusively female donors, compared with male donors, was associated with a lower risk of the primary outcome (relative risk, 0.29; 95% CI, 0.16-0.54). The protective association between RBC transfusions from female donors, compared with male donors, and the primary outcome increased as the donor age increased, but decreased as the number of transfusions increased.

Conclusions and Relevance

 These findings suggest that RBC transfusion from female donors, particularly older female donors, is associated with a lower risk of death or serious morbidity in VLBW infants receiving transfusion. Larger studies confirming these findings and examining potential mechanisms are warranted.


New research on preventing infant deaths due to neonatal sepsis

  Aug 10, 2021

Information about the most effective antibiotics to use in low and middle income countries (LMICs) for neonatal sepsis has been discovered uniquely combining epidemiological, genomic and pharmacodynamic data. The research could be applied to potentially save many lives globally by increasing the effective treatment – currently neonatal sepsis causes an estimated 2.5 million infant deaths annually. This research also highlights economic issues, specifically regarding treatment costs and other barriers to treatment.

The research published today in The Lancet Infectious Diseases, combined microbiology, genomic, epidemiological, pharmacodynamic and economic data for the first time to study the efficacy of various antibiotic treatments for neonatal sepsis in seven Low- and Middle- Income Countries (LMICs) across Africa and South Asia. This research was done by an international network led by the microbiologists at the Division of Infection and Immunity, Cardiff, in collaboration with researchers at the University of Oxford, the paper proposes alternative antibiotics for septic neonates which could drastically decrease new-born mortality. 

This research, funded by the Bill and Melinda Gates Foundation, studied over 36,000 infants over seven countries, making it the largest study of its kind. Data was procured by Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS), a project run by Professor Tim Walsh, which collected data across seven countries between April 2015 and March 2018. Prof. Walsh joined the University of Oxford in 2021 to help established the Ineos Oxford Institute of Antimicrobial Research. BARNARDS collected data from Nigeria, Pakistan, Bangladesh, Rwanda, South Africa, Ethiopia, and India, allowing researchers to have a vast amount of data to analyse. 

Neonatal sepsis causes an estimated 2.5 million infant deaths annually, with LMICs in sub-Saharan Africa and Asia having the highest mortality rates. These countries often have reduced access to resources such as laboratory facilities to assess what sepsis-causing pathogens are present, and to discover more about associated antimicrobial resistance. 

The World Health Organisation recommends the use of ampicillin and gentamicin for the empirical treatment of neonatal sepsis. Whilst these may be effective in Higher Income Countries (HICs), there has long been speculation that they were less effective in LMICs due to different levels of antibiotic resistance and variation in common pathogens. 

Researchers discovered that some sites are already using different antibiotics to those endorsed by the WHO, due to high resistance against these antibiotics. Those prescribed the recommended combination of ampicillin and gentamicin had a survival rate of 75% over 60 days. Conversely, where those prescribed ceftazidime and amikacin had a survival rate of over 90% over the same time period.

Previous research found that globally an estimated 214,000 neonatal sepsis deaths are attributable to resistant pathogens each year, so changing the recommendations to ceftazidime and amikacin could drastically reduce this number.

These findings will lead to additional follow-up studies; not least, intervention studies related to treatment and ensure that sepsis is treated with appropriate antibiotics and Infection Prevention and Control practices. 

The study also investigated the frequency of resistance to various antibiotics, which shows how frequently resistance may arise in susceptible bacteria against different antibiotics. Whilst varied antibiotics have been suggested for neonatal sepsis, this is the first study that has incorporated frequency of resistance data, allowing insight into how quickly a certain antibiotic could become redundant following extensive use, if selected as an alternative, allowing for more accurate recommendations on which antibiotics to be used.

Lead author Kathryn Thomson says, ‘Extremely high resistance (>97%) was found against ampicillin in Gram-negative sepsis causing isolates analysed from BARNARDS sites. Furthermore, only 28.5% of Gram-negative isolates were susceptible to at least one of the combined antibiotic therapy of ampicillin and gentamicin. While this may be a suitable empirical treatment for neonatal sepsis in high income countries, this data showcases that it is not an effective option for LMICs, who have different common pathogens and vastly increased resistance against these antibiotics. Many LMIC sites depend on recommended therapies, due to a lack of microbiology facilities to detect common species or resistance profiles. Therefore, further work is urgently needed to improve the sparsity of data in LMICs regarding prevalence and AMR in neonatal sepsis, a major contributor to neonatal mortality and to determine more effective alternative empirical treatments, taking affordability into account.’

The other factor investigated in this study is economic impact on antibiotic use. The study examined the average earnings of people in LMICs. This was used to contextualise the impact of antibiotic costs on the average person, by comparing average wages with the vast discrepancies in costs of certain antibiotics in different countries. For example, piperacillin-tazobactam costs $2.60 per day in India, which is a massive 76% of the average daily wage. By contrast, it costs $20 a day in Nigeria, representing between 219% and 741% of the average daily wage depending on the area of the country.

The economic data raises questions about who should be responsible for costs of antibiotic treatment, given that more effective alternative antibiotic treatments are often inaccessible in LMICs due to lack of universal healthcare. When asked, six of the seven countries studied stated that the cost of antibiotics influenced which are prescribed. This is shown by the continued wide use of ampicillin and gentamicin, as they are consistently the most affordable antibiotics, despite being considered less effective than other antibiotic regimes for some time now. 

Professor Tim Walsh says, ‘Whilst this study uniquely combined sets of data to help address critical issues around the treatment of neonatal sepsis in LMICs, this study also highlighted gaps and the need for further critical data; not least, how the accessibility and cost of antibiotics impacts on therapeutic treatments and outcomes. The newly established IOI is committed to undertake such studies and establish new and dynamic international networks to provide the rigor of data that will hopefully further our understanding and address one of the most pressing issues in a critical patient population across LMICs.’ 

This raises the ethical dilemma of how to maximise the number of lives saved whilst minimising the economic burden on both the patient and the state.

Follow-up studies will be undertaken by the newly formed Ineos Oxford Institute at the University of Oxford, which will focus on new drug development for both human health and replacement of clinically relevant antibiotic use in agriculture, in addition to studying antibiotic resistance and ways of promoting more responsible and effective uses of antibiotics. 


This month’s recommended resource for personal awareness (a look inside):

Guided Sleep Meditation, Manifest In Your Sleep Spoken Meditation with Sleep Music and Affirmations

Aug 22, 2021                Jason Stephenson – Sleep Meditation Music

A guided sleep meditation to help you manifest your dreams in your sleep. Includes affirmations and sleep music. For a comforting sleep, download your FREE guided sleep meditation!

Trucking Through 2021 – Hello Heroes! 

As nature moves into the Fall season, I am reminded of the importance of finding balance within the transitions life brings our way.   

Immersed in a world experiencing long, ongoing, and unpredictable pandemic challenges I seek to increase my engagement in learning ways to better support the health and wellness of myself and others.   

Many preemies, I included, have a history of being taken care of.  We may feel challenged at times to trust our own intuition, experience, and education to secure our individual and unique self-care capacities and confidence. Awareness and effort are required in order to build and sustain a dynamic foundation of self-care. In other words, let’s take it on!  

My challenges towards managing my own health and well-being include my tendencies to detach from how I am feeling, and “freezing” when I feel I am over-stimulated. This makes sense considering the types of touching and often a lack of positive touch a preterm baby may experience. We had/have no control over our environment and were/are not able to “defend” ourselves from painful physical encounters. The stress/anxiety reactions of detachment and “freeze” are developmental. In order to transition these reactions, we have the responsibility and opportunity to choose to do the work required to gain conscious control. Because there are not strong protocols or treatment resources developed specifically for our community at this time, we need to and can explore, identify,  and engage in positive behavioral and personal development activities.   Be your own sleuth in this regard.

The sun rising over London at 6 AM  beckons  a new day. My morning sanctuary, the Thames River, is a runner’s paradise. Here, I experience my strength and fragilities, the beauty and wonder of an everchanging horizon, and the complexities, creativities, and unpredictable characteristics of mankind.   When I run, I experience me.  As I meditate, I see deeper aspects of  myself and create broader capacities for change. When do you most feel present with yourself?

The Hero within us lies in the small actions we take each day to be authentically present within ourselves and the world around us. We are Warriors.

Surfing Ancient-Style Surfboards In Peru w/Red Bull team

Red Bull Surfing
– Jun 1, 2010

Originally used by fishermen, the caballitos de Totora original surfboards are a versatile tool to navigate the waters of Peru. Sofia Mulanovich together with world-class surfer Sally Fitzgobbons and junior Nadja de Col exchanged their boards for the ancient type to test the surfing quality of these Peruvian boats that have thousands of years of history.

Preterm Birth: A Marathon Community

Croatia, officially the Republic of Croatia, is a country at the crossroads of Central and Southeast Europe on the Adriatic Sea. It borders Slovenia to the northwest, Hungary to the northeast, Serbia to the east, Bosnia and Herzegovina and Montenegro to the southeast, and shares a maritime border with Italy to the west and southwest. Its capital and largest city, Zagreb, forms one of the country’s primary subdivisions, with twenty counties. Croatia has 56,594 square kilometres (21,851 square miles) and a population of 4.07 million.

sovereign state, Croatia is a republic governed under a parliamentary system. It is a member of the European Union, the United Nations, the Council of EuropeNATO, the World Trade Organization, and a founding member of the Union for the Mediterranean. An active participant in United Nations peacekeeping, Croatia has contributed troops to the International Security Assistance Force and took a nonpermanent seat on the United Nations Security Council for the 2008–2009 term. Since 2000, the Croatian government has invested in infrastructure, especially transport routes and facilities along the Pan-European corridors.

Croatia is classified by the World Bank as a high-income economy and ranks very high on the Human Development IndexServiceindustrial sectors, and agriculture dominate the economy, respectively. Tourism is a significant source of revenue, with Croatia ranked among the 20 most popular tourist destinations. The state controls a part of the economy, with substantial government expenditure. The European Union is Croatia’s most important trading partner. Croatia provides social securityuniversal health care, and tuition-free primary and secondary education while supporting culture through public institutions and corporate investments in media and publishing.



Rank:180 –Rate: 5.5% Estimated # of preterm births per 100 live births 

  (USA – 12 %, Global Average: 11.1%)


Marathon Swimmer Dina Levačić Planning Humanitarian Swim for KBC Department of Neonatolog

By Daniela Rogulj  –  6 August 2021

While the COVID-19 situation has made things a bit more difficult, marathon swimmer Dina Levačić has not taken time to rest. In ten days, on August 13 or 14, Dina will swim a humanitarian marathon from the island of Vir to Ist – a 27-kilometer stretch. In cooperation with the Split Fire Brigade, the action ‘Heart for Little Heroes’ was launched to help the Split Clinical Hospital Center’s Department of Neonatology purchase a special device, reports Dalmatinski Portal

“For me, this season is marked by the coronavirus, just like it is for most athletes. Poljud has always been open to me. I trained without major problems. I had planned to swim across the Strait of Gibraltar, but Spain and Morocco are not in the best situation. I hope that the possibility for that will open by October,” said Levačić, and then revealed her latest goal.

“Next weekend I will swim from Vir to Ist. My late grandfather Stipe is from the island of Ist. It is a place where I learned to swim, fell in love with the sea, jumped into the depths for the first time without fear. It is an island that deserves to swim in the world’s oceans without fear.”

She also revealed plans for the future.

“I hope to swim Gibraltar, even if they let me know two days before. New Zealand, one of the big seven, is also planned. I’ve been waiting for years for my turn. I don’t know what it will be because New Zealand is closed to everyone except Australia, and it won’t open until the New Year. So I should be swimming in February or March of next year when it is summer there. I hope that their authorities will give in and that I will be able to get there.”

She follows the Olympic Games in great detail.

“It’s the only opportunity to see some sports that I don’t have a chance to watch. I know Tonči Stipanović personally. I know how humble he is and how much he lives for sailing. I am thrilled for him, but also all the other athletes. When I watch videos on Facebook, I cry. When you are an athlete, you know how much effort has been put in and how heavy that medal is. Sandra Perković was fourth. Many ‘couch experts’ will say it is a failure, but many would give a hand for such a result. I am glad to see the success of any Croatian athlete.”

On behalf of the Split Fire Brigade, Mateo Štrljić revealed how the idea for this humanitarian action was born.

“We came up with the idea to organize a humanitarian action at the fire station. A lot of us went through that department with our kids, and so the idea came to life. We got in touch with Dr. Marija Bucat and found that they need a device for nitric oxide therapy, which makes breathing easier for newborns. Such a device exists in pediatrics, but it is needed immediately after childbirth. The device costs 250,000, and we achieved two-thirds of that amount through various donations. We are grateful that Dina also got involved in the action. We hope to collect the requested amount.”

Source: https://www.total-croatia-news.com/lifestyle/55109-marathon-swimmer-dina-levacic

The beauty and emotion of music does not require verbal translation…….


Jul 26, 2021 Tonika Records

Lorena – Tvoja i gotovo (Splitski festival 2021, Srebrni val – druga nagrada žiri

The effect of parity on obstetric and perinatal outcomes in pregnancies at the age of 40 and above: a retrospective study

Croat Med J. 2021;62:130-6 https://doi.org/10.3325/cmj.2021.62.130

University of Health Science, Okmeydani Training and Research Hospital, Obstetrics and Gynecology Department, Istanbul, Turkey


 To examine the characteristics of pregnancies at a very advanced maternal age and the effect of parity on adverse obstetric outcomes.


We retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydanı Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%).


Significantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher


Since primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.


PTSD in the NICU and Psychological Distress in Parents of Premature Infants/APA Publishing

Mar 10, 2021

Treatment of Psychological Distress in Parents of Premature Infants: PTSD in the NICU Edited by Richard J. Shaw, M.D., and Sarah Horwitz, Ph.D. At the outset of pregnancy, most parents expect a roughly 40-week journey punctuated by the birth of a healthy baby. When a preterm birth upends these expectations, the effects extend beyond the infant; there are real psychological consequences for the parents themselves. Treatment of Psychological Distress in Parents of Premature Infants tackles these issues, shedding light on the high prevalence of symptoms of posttraumatic stress disorder (PTSD) in parents following a premature birth. More than a dozen experts lend their expertise as they examine not only the medical and neurological consequences of premature birth on infants but also recent findings on the psychological effects of premature birth on parents—including the particular issues that fathers experience, which receive their own chapter.                             

BOOK:  https://www.appi.org/PTSD-in-NICU

Neonatal care during the COVID-19 pandemic – a global survey of parents’ experiences regarding infant and family-centred developmental care

Johanna KostenzerJulia HoffmannCharlotte von Rosenstiel-PulverAisling WalshLuc J.I. Zimmermann – Silke Mader et al.



The COVID-19 pandemic restrictions affect provision and quality of neonatal care. This global study explores parents’ experiences regarding the impact of the restrictions on key characteristics of infant and family-centred developmental care (IFCDC) during the first year of the pandemic.


For this cross-sectional study, a pre-tested online survey with 52 questions and translated into 23 languages was used to collect data between August and November 2020. Parents of sick or preterm infants born during the pandemic and receiving special/intensive care were eligible for participation. Data analysis included descriptive statistics and statistical testing based on different levels of restrictive measures.


In total, 2103 participants from 56 countries provided interpretable data. Fifty-two percent of respondents were not allowed to have another person present during birth. Percentages increased with the extent of restrictions in the respondents’ country of residence (p = 0·002). Twenty-one percent of total respondents indicated that no-one was allowed to be present with the infant receiving special/intensive care. The frequency (p < 0·001) and duration (p = 0·001) of permitted presence largely depended on the extent of restrictions. The more restrictive the policy measures were, the more the respondents worried about the pandemic situation during pregnancy and after birth.


COVID-19 related restrictions severely challenged evidence-based cornerstones of IFCDC, such as separating parents/ legal guardians and their newborns. Our findings must therefore be considered by public health experts and policy makers alike to reduce unnecessary suffering, calling for a zero separation policy.


EFCNI received an earmarked donation by Novartis Pharma AG in support of this study.

<a href=”http://Abstract Background The COVID-19 pandemic restrictions affect provision and quality of neonatal care. This global study explores parents’ experiences regarding the impact of the restrictions on key characteristics of infant and family-centred developmental care (IFCDC) during the first year of the pandemic. Methods For this cross-sectional study, a pre-tested online survey with 52 questions and translated into 23 languages was used to collect data between August and November 2020. Parents of sick or preterm infants born during the pandemic and receiving special/intensive care were eligible for participation. Data analysis included descriptive statistics and statistical testing based on different levels of restrictive measures. Findings In total, 2103 participants from 56 countries provided interpretable data. Fifty-two percent of respondents were not allowed to have another person present during birth. Percentages increased with the extent of restrictions in the respondents’ country of residence (p = 0·002). Twenty-one percent of total respondents indicated that no-one was allowed to be present with the infant receiving special/intensive care. The frequency (p Source: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00336-9/fulltext


Mental Health Care is Important

If you are struggling right now, we want you to know that this is normal. It is temporary. And you can feel better.

Having a baby in the NICU can be a profoundly traumatic experience for both your baby and YOU.  It may leave you feeling sad, guilty, overwhelmed, irritable, or unable to relax and enjoy your developing relationship with your new baby.  You may feel more tired than usual yet unable to get a good night’s sleep, you may be uninterested in eating, or you may have trouble thinking clearly and making decisions. You may even experience flashbacks or nightmares about some of the more unsettling experiences you had, or find your heart racing with anxiety for reasons you don’t completely understand.

We have partnered with Mental Health America to bring you their useful, quick and easy screening tools, which are short, confidential questionnaires, to determine whether you are might be experiencing a mental health condition like depression, anxiety disorder, or post-traumatic stress disorder (PTSD).  A positive score on a screening questionnaire does not mean you have a specific diagnosis.  It just gives an idea of whether you have any of the feelings associated with the various conditions.

Having a baby in the NICU can be a profoundly traumatic experience for both your baby and YOU.  It may leave you feeling sad, guilty, overwhelmed, irritable, or unable to relax and enjoy your developing relationship with your new baby.  You may feel more tired than usual yet unable to get a good night’s sleep, you may be uninterested in eating, or you may have trouble thinking clearly and making decisions. You may even experience flashbacks or nightmares about some of the more unsettling experiences you had, or find your heart racing with anxiety for reasons you don’t completely understand.

We have partnered with Mental Health America to bring you their useful, quick and easy screening tools, which are short, confidential questionnaires, to determine whether you are might be experiencing a mental health condition like depression, anxiety disorder, or post-traumatic stress disorder (PTSD).  A positive score on a screening questionnaire does not mean you have a specific diagnosis.  It just gives an idea of whether you have any of the feelings associated with the various conditions.

Once you have taken the screening, return here for more resources.


  • If your baby is still in the NICU, we recommend discussing results of your screening test with the NICU social worker or psychologist, or even the neonatologist or chaplain. Any of these professionals should be able to help you and direct you to further resources in your baby’s hospital or in your community.
  • If your baby is already at home, you can contact your OB/Gyn provider, your family doctor, or your child’s pediatrician. Again, they can refer you to local resources.
  • Return to our page on Mental Health resources on this site for handouts you can read and download about depression and PTSD, and other links to helpful organizations.


Social Security Benefits for Your Premature Baby

By Cheryl Bird, RN, BSN      Medically reviewed by Lyndsey Garbi, MD     Updated on May 07, 2021

If your baby was born premature, they might be eligible to receive social security benefits. Though it’s usually modest, this monthly stipend may help defray the added costs of having a preemie, including your baby’s hospital stay, other medical bills, and child care once home.

The type of social security benefits that premature babies can receive is called supplemental security income, or SSI. The Social Security Administration provides SSI benefits for any disabled child, and some preemies with low birth weight or developmental delays are eligible.

SSI Eligibility for Preemies

Simply being born prematurely doesn’t qualify your child for social security benefits. To be eligible for SSI, a baby must have one of the following conditions:

  • Low weight at birth: Any baby who weighs less than 2 pounds, 10 ounces at birth qualifies for SSI.
  • Low birth weight for their gestational age: Babies who are very small for their gestational age—what age they are from conception, not birth—can qualify for SSI. For example, a full-term baby, born between 37 and 40 weeks, still qualifies for SSI if they weigh less than 4 pounds, 6 ounces at birth.
 Gestational AgeBirth Weight for SSI Eligibility
37–40 weeks< 4 pounds, 6 ounces
36 weeks< 4 pounds, 2 ounces
35 weeks< 3 pounds, 11 ounces
34 weeks< 3 pounds, 4 ounces
33 weeks< 2 pounds, 14 ounces
32 weeks< 2 pounds 12 ounces
Any age< 2 pounds, 10 ounces
  • Growth failure combined with a developmental delay between birth and age 3: Some preemies exhibit a “failure to thrive,” meaning they are not gaining as much weight as expected during the newborn period and infancy. If your baby’s weight or body mass index (BMI) is below the third percentile for other babies at the same height between birth and age 3, they may be able to receive SSI.

Benefit Amount for Preemies

Payments for SSI are sent monthly. While your baby is in the hospital, the maximum social security SSI benefit you can receive is $30 per month. The benefit amount may change when your baby is healthy enough to go home.

After your baby is discharged, the amount of benefit you receive will depend on your family income and how many other children you have. It will also vary by state as some states supplement SSI with additional payments. Recent data show that the average SSI monthly payment that the federal government provides to families of children with any disability is around $690.

It’s important to know that your baby is not likely to be eligible for SSI if your family earns a substantial combined income. Children receiving SSI are usually from families with a total income below or near the poverty level.

How to Apply for Social Security Benefits

If you think your baby may qualify for SSI benefits, you should apply as soon as you are able. Although it can take up to three to five months for the Social Security Administration to decide eligibility for most children with disabilities, it will grant SSI immediately to families of babies who weigh less than 2 lbs 10 oz at birth.4 However, other preemies with low birth weight or babies with growth failure after birth won’t receive SSI payments until the application and review processes are complete.

Your infant’s birth weight must be documented by an original or certified copy of the birth certificate or in a medical record signed by a physician. If your child fails to grow as expected and has developmental delays, it’s important to collect and submit regular doctor’s records with your application.

To apply for SSI benefits, you can visit your local social security office or call the Social Security Administration at 1-800-772-1213. Also, don’t hesitate to check if the hospital where you delivered your baby can help; many neonatal intensive care units (NICUs) have representatives who are pros at guiding parents through the SSI application process.

If you have applied for and received immediate SSI relief for your baby with low birth weight and it’s determined that your baby doesn’t meet all the requirements for disability benefits, after all, you won’t have to pay back any payments you received to that point.

Expiration of SSI Benefits for Preemies

Parents should know that SSI payments are intended to expire when a child is on an age-appropriate weight and development track. As welcome as a little monthly financial boost is when you’re caring for a baby with medical issues, the Social Security Administration’s decision to discontinue payments is likely recognition of something positive: Your child’s attainment of or return to good health.

If your baby receives SSI for low weight at birth, the government will review their health status and eligibility again around their first birthday. If your child isn’t gaining weight or developing as expected, benefits will continue until the next review cycle.

For children who qualify for SSI later due to growth failure and associated developmental delays, benefits personnel will review their health progress and medical records at least every three years to determine eligibility.

If your child receives SSI, you are required to report to the Social Security Administration if you or your co-parent has a change in income. If you start earning more money, your child’s benefit payments could be reduced or end altogether.5

Be sure to keep track of how you spend your child’s SSI payments since the Social Security Administration requires you to submit a form detailing these expenses every year. You must spend the SSI money in ways that specifically benefit your child, such as:5

  • Food, shelter, and safety needs (including child care)
  • Medical and dental care not covered by insurance
  • Personal needs, like clothing and enrichment programs.

Other Financial Assistance Programs

If you have a preemie or baby with weight and growth problems and lack private insurance, there are other ways to get some financial relief to help curb costs for their care. These programs include:

  • Medicaid: Depending on the state, a family who qualifies for SSI on behalf of a child may also qualify for Medicaid, a healthcare program for low-income people. Even if your child doesn’t qualify for SSI, they might be eligible for Medicaid and other state and local programs. Check with your state Medicaid office and your state or county social services.
  • CHIP: The Children’s Health Insurance Program (CHIP) covers medical and dental costs for millions of kids whose families aren’t insured otherwise. You can apply for coverage and find participating doctors on the federal Insure Kids Now website.
  • WIC: Managed by the United States Department of Agriculture (USDA), the Supplemental Nutrition Program for Women, Infants, and Children (WIC) is designed to promote the health of expecting parents along with children up to age 5. To meet WIC eligibility for these monthly food vouchers, families must have an income at or below the poverty line and have demonstrated nutritional needs or deficiencies.
  • Reference:
  • https://www.ssa.gov/disability/professionals/bluebook/100.00-GrowthImpairment-Childhood.htm


A Sunny Day Reveals the Dirty Windows | Everyday Health

There is value in this father’s sharing related to the loss of his child and how he was able to share this loss and grow his relationship with his wife through and following the loss. So often the experience of losing a child, and even the impact of having a child with significant medical needs, tends to divide families. Building relationships while moving through the loss of a loved one can be a difficult yet rewarding endeavor.

Father Gives Tips On How To Survive Child Loss

Parents for Window Blind Safety

It is hard to find videos of a father’s perspective on child loss. We felt it was important to film a father’s loss and give the public tips on how he coped, what helped him, what he went through the first year and what thoughts and actions helped him move through the grieving process. We hope you find this video helpful to you whether you are on your own road of grief or you’re trying to relate to a friend in need.


Journal of Gynecology and Womens Health

Incidence of Cervical Cerclage and Preterm Birth Rates: A Retrospective Analysis of Data from Two Centers in Croatia

Planinic Rados G, Haller H, Zegarac Z, Duic Z, Stasenko S. Incidence of Cervical Cerclage and Preterm Birth Rates: A Retrospective Analysis of Data from Two Centers in Croatia. J Gynecol Women’s Health. 2020: 19(2): 556009. DOI: 10.19080/JGWH.2020.19.556009


Aim of the study: In recent period significant changes in the indications for cerclage procedure have emerged. Published trials caused shift in clinical practice with the reduction in the number of procedures worldwide. Analysis was undertaken to evaluate how did the more selective approach to patients who were candidates for cervical cerclage affect the preterm birth rates.

Methods: We conducted a retrospective analysis of women who underwent cerclage for prevention of preterm birth in two Croatia’s hospitals, University hospital Merkur (Zagreb) and University hospital Rijeka (Rijeka) over a 16-year period, from 1994 to 2009. Data from medical records were used to determine the total number of cervical cerclage procedures performed on singleton pregnancies and to calculate incidence rates. Annual hospital reports were used to calculate preterm birth rates in the same period.

Results: From 1994 to 2009 in both centers there were 81800 singleton deliveries including 3847 preterm births (4.7%). Of all deliveries 977 women (1.19%) received cerclage and were included in the analysis. A significant linear decrease of cervical cerclage rate across the whole time from 1994 to 2009 was observed. Over the 16 year period there was no statistically significant change in the percentage of preterm births.

Conclusion: More appropriate selection of patients who are candidates for cervical cerclage reduced the number of unnecessary procedures from 2.71% in 1994 to 0.69% in 2009 without significant increase in preterm birth rates.

FULL STUDY:   https://juniperpublishers.com/jgwh/JGWH.MS.ID.556009.php

Burnout, Exhaustion, and … It Is Not Just COVID

Kelly Welton, RRT-NPS

I’d been waiting for the Email for days…. And there it was: The subject line, “ IT would like your feedback on your recent interaction with tech support.” My chance to be heard! There better not be any character limits on this one! My IT guy was a dream. [He} had me back in the system in no time. It’s just that….. every other day I came to work, I had to call IT to sort out some new befuddlement with my access. Whether access to log on to the computer, the blood gas machine, or access to a patient’s chart so I could document or Pyxis, this was taking time away from patient care every time I had to sit on hold while IT was experiencing higher-than-normal-call-volume. In the comments section, I wrote:

“Once, just once, I would like to come to work, log in to my computer, and get on with my day. As it is, I spend my first one to 2 hours each shift on the phone with someone to get me logged in. I find this an insane waste of time”. I sent a copy to administration with a gentle explainer that I am still expected to perform patient care whether on hold with or interacting with IT those first 2 hours.

CoVid has done a number on all of us in healthcare, no matter what our specialty. But the insidious increase in time stolen by our computers in the name of patient care has been going on for years. And we are not equipped to fight it. Or are we? As bedside patient care clinicians, can we fight back or otherwise revolt against this system and put things back the way they ought to be: Patients come first, with thorough documentation of only pertinent information. What is the correct protocol for the rebellion?

 For example, if I make a ventilator change, I should also know what other parameters need to be accounted for as a professional. If I change the PIP, I should also document returned tidal volume, any change in O2 saturations or ETCO2 , and chest rise or breath sounds. The system often requires that I document the entire ventilator check and allows a very dangerous practice of copying and pasting the last entry. Can we band together and let Clinical Informatics know this is not working for us? Several articles have shown that even ‘mature’ EHR’s require that we spend approximately 1.5-time units documenting for every 1.0 time unit in actual patient care. But no one is factoring this into our workloads.

I read accounts by my fellow CoVid RT’s in adult capacities of crazy workloads, constant codes being called, non-stop intubations, and HFNC and BiPap setups. When do they chart all of this? Did someone perhaps ingeniously develop a minimum documentation protocol for when things get crazy? Think 24-week triplets, and you are the only MD or RT on the unit. Or, a baby crumps requiring an oscillator, which needs to be found, set up, calibrated, and vents moved around. Then we must titrate to optimal settings and wait 20 min to draw the ABG. If I get called to a crash C-section in the middle of this, that will surely take priority over finishing documenting every change we made on the “crumping” baby.

Patient care always comes first, but staying late every shift to complete documentation on every last detail of every baby in the unit does not allow us the time off we need to reset and regroup.

I am reminded of my last hospital, where a critical result on a CBG required 65 ( yes, that is sixty-five) clicks of the mouse to enter a result per The Joint Commission (TJC) and College of American Pathologist (CAP) standards. I could have run to the MD and showed him the slip of paper and run back ten times by the time I met the requirement — Not to mention the delay in care. This delay was not TJC or CAP’s fault; this situation occurred because the modern ABG machine could not make a way to interface with our old, pieced-together, and patched-up EHR. How can we get back to patient care truly being our focus? Can we talk IT into giving us a SOAP button for those days when we need to focus on what the baby is doing or not doing and lose extraneous charting parameters that, although they may be related, are not affected by the changes we made?

Many healthcare personnel left the field in the Spring when the pandemic calmed down, understandably so. Nevertheless, the undercurrent of a different pandemic – the need for more information and to cover us and our health systems in case of lawsuits presents a different level of exhaustion and burnout. Instead of just allowing MDs, RNs, and RTs to leave in droves, why not start a conversation about building a better (more straightforward) system. We built it; we can un-build it. Moreover, we MUST convince administration, IT, and insurance carriers that clicking boxes is not patient care.

Source: http://neonatologytoday.net/newsletters/nt-aug21.pdf

Diversity, Inclusion and Cultural Competency in Pediatric Hospital Medicine Fellowship Programs

Gabrina Dixon, Fatuma Barqadle, Edward Gill, Whitney Okoroafor, Barrett Fromme and Jorge Ganem

Hospital Pediatrics August 2021, 11 (8) 779-785;  https://doi.org/10.1542/hpeds.2020-004515



The objectives with this study were to describe the current state of Pediatric Hospital Medicine (PHM) fellowship programs with regards to (1) diversity of fellows and programs’ leadership, (2) current diversity and inclusion (D&I) programs and measures of their success, and (3) the state of cultural competency training.


 In 2018, fellowship directors of the 35 active PHM fellowship programs were invited to participate in a survey of diversity, inclusion, and cultural competency at PHM fellowship programs. Participants were invited via in-person invitations at the annual PHM fellowship directors meeting and through e-mail invitations from July to September to complete an online survey.


There was an 89% response rate of the survey. Most fellows, faculty, and program directors in PHM were female (74%, 70%, and 70%, respectively) and white (53%, 67%, and 60%, respectively). There were no African American, American Indian or Alaskan Native, or Native Hawaiian or other Pacific Islander program directors. Forty-five percent of programs reported that neither the fellowship program nor their hospital had a strategic plan that addresses D&I. Approximately 61% of programs had cultural competency training for fellows.


This is the first survey to report on the state of D&I in PHM fellowship programs. There is lack of racial and ethnic diversity in programs fellows, faculty, and directors. Although most programs have cultural competency training, strategic planning to promote D&I is not widely implemented among PHM fellowship programs.

Source: https://hosppeds.aappublications.org/content/11/8/779

Optimal Crash Cart Configuration for a Surgical NICU Utilizing Human Factors Principles



Neonates admitted to cardiac and surgical neonatal intensive care units (NICUs) are at an increased risk of requiring emergency lifesaving interventions that require the use of both Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) algorithms. Clinicians working within the surgical NICU must be able to access emergency equipment and medications quickly in order to respond to critical situations. A crash cart that integrates human factors principles and supports both the NRP and PALS algorithms is necessary to promote patient safety for this high-risk population.


A multidisciplinary quality improvement project constructed an optimal crash cart configuration that embedded human factors principles and supported clinical workflow by reflecting both the NRP and the PALS algorithms in an NICU that cares for cardiac and surgical patients.


A crash cart working group including frontline NICU staff, simulation experts, and a human factors specialist was formed within a surgical NICU. Human factors principles were utilized to align the organization of the cart with the NRP and PALS algorithms to increase the efficiency and intuitiveness of the cart. The new crash cart configuration was usability tested through simulation, revised on the basis of clinical feedback, and then implemented in a clinical setting. Data were collected following implementation of the new crash cart to validate that the new configuration was viewed as a significant improvement. The Plan-Do-Study-Act cycle was used to make improvements and capture outcome indicators.


Evaluation data collected both during usability simulation testing and in situ within the NICU clinical environment indicated that the revised crash cart scored higher on Likert scale response questions than the previous crash cart.

Implications for Practice: 

Human factors science, in combination with frontline user engagement, should be utilized to create intuitive crash cart configurations, which are then tested in a simulation environment and evaluated in situ in the NICU.

Implications for Research: 

Further research around crash cart design within NICUs that use multiple lifesaving algorithms would add to the paucity of research around the impact of human factors theory in the utilization of lifesaving equipment and medications within this specific population.


Changes in thresholds for treatment of extremely preterm infants – a study among neonatal experts in the UK


Through an online survey among UK neonatal staff, the thresholds and viability for treatment of extremely preterm infants (EPIs) were evaluated. Respondents reported a median grey zone for neonatal resuscitation between 22 and 24 weeks’ gestation. Compared with previous studies, the survey showed a shift in the threshold for resuscitation, with greater acceptance of active treatment for infants also below 23 weeks’ gestation.

Infants born before 28 weeks of pregnancy are considered EPIs, and earlier gestations are associated with worse health outcomes. However, advances in perinatal care and other circumstantial factors could impact the preterm’s prognosis. An ethical dilemma is presented in some cases, where the EPI has a very high risk of longer-term neuro-disability. An active stabilisation attempt and survival-focused care (active treatment) may not always be appropriate. New technologies and statistical improvements in EPI outcomes challenge the survival grey zone boundaries and influence decision making.

Through an anonymous online survey, researchers captured views of UK-based neonatal clinicians (consultants, neonatal registrars or fellows, and advanced neonatal nurse practitioners) on decision-making around active treatment/palliative care for EPIs. The 336 participants were asked to select the lowest gestation at which they would offer active treatment at parental request and to answer questions about the conceptual understanding of the term ‘viability’.

The majority of respondents (60%) stated a lower limit between 22 weeks and 22 weeks plus six days for engaging in active treatment. Physicians and NICU personnel chose the lowest end of the threshold, at 22 weeks. The results of the upper threshold show that more than half of those surveyed would set a limit at 24 weeks to offer palliative care at parental request, deciding to actively treat the infant past this mark. The pattern of upper limits was similar regardless of the professional group. Almost two-thirds of respondents understood the concept of “viability” to reflect possibility of survival after birth and indicated that the risk of disability was irrelevant to viability. However, the remaining 34% suggested viability should reflect survival without severe disability.

Interestingly, the vast majority of respondents (91%) agreed that the gestation at which an infant is considered viable has changed in the last decade. Before this survey, in 2008 and 2016, only the minority of UK neonatologists would resuscitate prior to 23 weeks. Participants attribute their shifted views regarding resuscitation to improvements in neonatal intensive care. Furthermore, international guidelines might have influenced their opinion as well. Changed opinions create new ethical discussions. Nevertheless, further research would help establish standards and understand the optimal way perinatal clinicians could incorporate risk factors and parental views into difficult decisions such as treatment for EPIs.

Full list of authors: Lydia Mietta Di Stefano, Katherine Wood, Helen Mactier, Sarah Elizabeth Bates, Dominic Wilkinson

Paper available at: BMJ Archives of Disease in Childhood – Fetal and Neonatal Edition


Emerging biosensing technologies could revolutionize the diagnosis of neonatal sepsis

Reviewed by Emily Henderson, B.Sc – August 11, 2021

Source: Shoolini University

Sepsis in newborn infants can be fatal. Early diagnosis is thus key to effectively manage the infection. Conventional diagnostic methods are, however, time-consuming. Now researchers from Shoolini University, in collaboration with IIT Hyderabad and Amity University, Rajasthan, describe the current point-of-care methods for improved diagnosis of neonatal sepsis and their limitations. Their review sheds light on emerging biosensing technologies that can revolutionize diagnostics in the future and help decrease mortality associated with neonatal sepsis.

Sepsis refers to a systemic (body-wide) infection accompanied by inflammation. Newborn infants are particularly susceptible to developing sepsis, given their naïve and under-developed immune system. Their immune system reacts to the acquired pathogen by releasing inflammatory factors such as cytokines and free radicals. The heightened immune response mounted against the pathogen, if uncontrolled, can cause severe damage to other organs, which can be fatal for the newborn. The prevalence of neonatal sepsis and associated mortality rates are especially high in developing countries, owing to poor sanitation and the dearth of healthcare resources.

Early diagnosis is thus cardinal for effective management of the infection and decreasing neonatal mortality. Current point-of-care (POC) methods rely on conventional blood culture and molecular techniques that may be time-consuming and often detect a single parameter or biomarker. Hence, development of rapid, sensitive, and integrated diagnostic strategies is crucial to enhance detection and improve the standard of care.

In a new Clinica Chimica Acta article, researchers from Shoolini University, in collaboration with researchers from IIT Hyderabad and Amity University, Rajasthan, India, have reviewed the latest advancements in analytical devices that enable multi-analyte detection with high sensitivity and accuracy. They also describe the limitations of currently used methods and why a combinatorial approach may be better. Speaking of why this caught their attention, lead author of the study, Dr. Anupam Jyoti, says, “Developing countries like India report an increased incidence of neonatal sepsis (50–70/1000 live births) as compared to developed countries (1–5/1000 live births), with a substantial mortality rate of 11-19%. We were thus motivated to review the field of neonatal sepsis detection and propose new directions towards effective diagnosis.”

Routinely used blood culture techniques often require two to five days to yield results. Meanwhile, the infection escalates, and the newborn is often pumped with unnecessary antibiotics that can lead to anti-microbial resistance. Techniques such as the polymerase chain reaction, which detects the genetic material of the pathogen, and mass spectrometry, which detects pathogen specific proteins, are more sensitive and require less time. However, they can yield false positive results and do not differentiate between viable and non-viable pathogens in the sample. While tests that detect serum biomarkers and immune factors, expressed in response to infection, may give a broad idea about the presence of sepsis, they cannot differentiate between specific pathogens. Together, the methods may however complement each other for robust diagnosis of sepsis.

Biosensing analytical technologies have emerged as a powerful tool in biomedical devices. Advanced biosensors that promise multi-analyte detection in a single platform are now being increasingly developed for rapid and sensitive diagnosis. Electrochemical sensors can detect various electrolytes and biomarkers based on their specific electrical properties. “Aptamers” or single stranded nucleic acid probes, given their minute size, stability, and high binding affinity, are useful for detecting bacterial traces in the blood. Next, sensors based on the surface plasmon resonance technique can detect changes in the optical properties of the sample. They are highly sensitive with low limits of detection, thus enabling the detection of small concentrations of pathogens. Finally, microfluidic devices and chip-based sensors analyze samples based on their flow or size and can thus detect bacterial and blood cells in the samples of patients with sepsis.

In addition to the above methods, integrated approaches that combine the principles of multiple techniques on a single platform are gaining popularity. Such hybrid biosensors will be capable of detecting multiple parameters in a short time from considerably small samples; all this at the bedside of the patient! Moreover, their wide applicability, cost-effectiveness, small size, and need for limited resources make them a practical and valuable tool for the diagnosis of neonatal sepsis.

Overall, the review sheds light on modern technologies that can help strengthen, and possibly replace conventional POC approaches in the future.

This is indeed a ray of hope for protecting neonatal health.


Plastic Drapes Reduce Hypothermia in Premature Babies

Study: Plastic Better Than Cloth for Low Birth-Weight Newborns

By Laurie Fickman  July 1, 2021

Most babies born prematurely or with health problems are quickly whisked away to the Neonatal Intensive Care Unit (NICU) where they might require assisted heating devices to regulate their temperature. A University of Houston College of Nursing researcher is reporting that the traditional use of cloth blankets and towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia. In Advances in Neonatal Care, Huong (Kelle) Phan, clinical assistant professor, reports that a plastic drape lowers the incidence of hypothermia.  

“The use of the plastic drape is a quality improvement to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement,” said Phan. “A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement.” 

When a premature baby’s body temperature drops below 36.5°C, the baby may experience cold stress, which is a cause for concern. The recommended temperature range for postnatal stabilization is between 36.5° and 37.5°C. 

Phan’s research project included implementing plastic drapes over three months, during 58 PICC procedures in a Level-3 NICU. A pre-/posttest was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort.  

“After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively). Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort,” said Phan.  

This evidence demonstrated plastic drapes reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blankets or towels.  

“Phan’s innovative nursing intervention of using the plastic drape during a PICC insertion helps some of our most vulnerable patients, those infants that must be treated in neonatal intensive care units,” said Kathryn Tart, founding dean and Humana Endowed Dean’s Chair in Nursing, UH College of Nursing. 

Phan recommends further research to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures. 

Teresa M. McIntyre, UH College of Nursing research professor, was co-author on the paper.


Parental Stress and Mental Health Symptoms in the NICU: Recognition and Interventions

Janine Bernardo, Sharla Rent, AnnaMarie Arias-Shah, Margaret K. Hoge and Richard J. Shaw

NeoReviews August 2021, 22 (8) e496-e505;DOI: https://doi.org/10.1542/neo.22-8-e496


Parental experiences in the NICU are often characterized by psychological stress and anxiety following the birth of a critically ill or premature infant. Such stress can have a negative impact on parents and their vulnerable infants during NICU hospitalization as well as after discharge. These infants are also at increased risk for adverse developmental, cognitive, academic, and mental health outcomes. Identifying parents at risk for psychological distress is important and feasible with the use of well-validated screening instruments. Screening for psychological distress is essential for identifying families in need of referral for psychological support and resources. Numerous interventions have been implemented in the NICU to support parents. These include staff-based support such as wellness rounds and education in developmental care as well as parental-based support that includes cognitive behavioral therapy and home visitation programs. Comprehensive interventions should use a multidisciplinary approach that involves not only NICU staff but also key stakeholders such as social workers, spiritual/religious representatives, specialists in developmental care, and psychiatrists/psychologists to help support families and facilitate the transition to the home. Future efforts should include raising awareness of the psychological stresses of NICU parents and encouraging the development of programs to provide parents with psychological support.

Source: https://neoreviews.aappublications.org/content/22/8/e496

ADC Fetal and Neonatal’s Fantoms. Highlights from the May 2021 issue – ADC Podcast

ADC Fetal and Neonatal’s Associate Editor, Jonathan Davis, and the Edition Editor of the journal, Ben Stenson, discuss the highlights from the May issue.
Read the Fantoms here: fn.bmj.com/content/106/3/229 – release date: 9 June 2021

ADC Fetal and Neonatal’s Fantoms. Highlights from the May 2021 issue By BMJ talk medicine is licensed under a  Creative Commons License.

Birthweight and patterns of postnatal weight gain in very and extremely preterm babies in England and Wales 2008-2019: A cohort study

2-year outcomes of Prof Neil Marlow, DM  Prof Andreas Stahl, MD Prof Domenico Lepore, MD Prof Alistair Fielder, FRCP Prof James D Reynolds, MD Qi Zhu, PhD l.Show all authors ,:https://doi.org/10.1016/S2352-4642(21)00195-4



Intrauterine and postnatal weight are widely regarded as biomarkers of fetal and neonatal wellbeing, but optimal weight gain following preterm birth is unknown. We aimed to describe changes over time in birthweight and postnatal weight gain in very and extremely preterm babies, in relation to major morbidity and healthy survival.


In this cohort study, we used whole-population data from the UK National Neonatal Research Database for infants below 32 weeks gestation admitted to neonatal units in England and Wales between Jan 1, 2008, and Dec 31, 2019. We used non-linear Gaussian process to estimate monthly trends, and Bayesian multilevel regression to estimate unadjusted and adjusted coefficients. We evaluated birthweight; weight change from birth to 14 days; weight at 36 weeks postmenstrual age; associated Z scores; and longitudinal weights for babies surviving to 36 weeks postmenstrual age with and without major morbidities. We adjusted birthweight for antenatal, perinatal, and demographic variables. We additionally adjusted change in weight at 14 days and weight at 36 weeks postmenstrual age, and their Z scores, for postnatal variables.


The cohort comprised 90 817 infants. Over the 12-year period, mean differences adjusted for antenatal, perinatal, demographic, and postnatal variables were 0 g (95% compatibility interval −7 to 7) for birthweight (−0·01 [–0·05 to 0·03] for change in associated Z score); 39 g (26 to 51) for change in weight from birth to 14 days (0·14 [0·08 to 0·19] for change in associated Z score); and 105 g (81 to 128) for weight at 36 weeks postmenstrual age (0·27 [0·21 to 0·33] for change in associated Z score). Greater weight at 36 weeks postmenstrual age was robust to additional adjustment for enteral nutritional intake. In babies surviving without major morbidity, weight velocity in all gestational age groups stabilised at around 34 weeks postmenstrual age at 16–25 g per day along parallel percentile lines.


The birthweight of very and extremely preterm babies has remained stable over 12 years. Early postnatal weight loss has decreased, and subsequent weight gain has increased, but weight at 36 weeks postmenstrual age is consistently below birth percentile. In babies without major morbidity, weight velocity follows a consistent trajectory, offering opportunity to construct novel preterm growth curves despite lack of knowledge of optimal postnatal weight gain.


UK Medical Research Council.


Eleanor Roosevelt Wisdom…


In a few weeks I will be stepping off the plane in London. As I immerse myself in a new country across the “pond”, I am reminded that 10-12% of those I may come across may be fellow preemie survivors like myself.  

As medical research and innovation within the field of neonatology progresses, I believe that it is important that we are seen and embraced as the unique population we are; a global community deserving of targeted research and treatment solutions based not only on symptoms, but on preterm birth specific dynamics that focus  on symptom etiologies, and preemie development (cognitive, mental health, emotional, physical, behavioral, social development). We need and warrant evolving health care assessment and understanding, and deserve preterm birth specific treatments, and  solutions to address our neonatal needs. Representing more than 10% of the Global population we require recognition, investment, support of, and empowered awareness and response that includes progressive research, technologies, medical and educational specialty development. 

I encourage those of us born premature, preemie parents, family members,  healthcare professionals, health related industries, associated educators and technologists, logistics/supply chain related workforce partners, and all of our community members to engage in advocacy towards advancements in neonatal research and the promotion of new research activities in order to address our healthcare needs and wellbeing.  Big and small, all efforts to create awareness and action will make a difference.  

SUP-y z Padlle Surf Croatia na Baćinskich Jeziorach
Aug 20, 2019   Wakestok Wasilków

Od teraz zwiedzanie rzeki Supraśl może być jeszcze bardziej interesujące, a to wszystko za sprawą SUP-ów, które dostępne są do wypożyczenia w naszej bazie

From now on, visiting the Supraśl river can be even more interesting, thanks to SUPs that are available for rent in our database.


Zambia,which is officially the Republic of Zambia , is a landlocked country at the crossroads of CentralSouthern and East Africa. Its neighbors are the Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the east, Mozambique to the Southeast, Zimbabwe and Botswana to the south, Namibia to the southwest, and Angola to the west. The capital city of Zambia is Lusaka, located in the south-central part of Zambia. The population is concentrated mainly around Lusaka in the south and the Copperbelt Province to the north, the core

Zambia contains abundant natural resources, including minerals, wildlife, forestry, freshwater and arable land.[13] In 2010, the World Bank named Zambia one of the world’s fastest economically reformed countries.[14] The Common Market for Eastern and Southern Africa (COMESA) is headquartered in Lusaka.

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

Healthcare: Zambia’s healthcare system is decentralized, therefore it is broken up into three different levels: hospitals, health centers and health posts. Hospitals are separated into primary (district), secondary (provincial) and tertiary (central). It offers universal healthcare for its citizens, yet the health care system in Zambia remains one of the most inadequate in the world.

Universal Health Care

Zambia is working on implementing universal health care coverage for its citizens to diminish the burden of accessing life-saving treatments. At the moment, Zambia’s government-run health facilities offer basic healthcare packages at the primary (district)level free-of-charge. Their services are under the National Health Care Package (NHCP). With this being said, due to “capacity constraints” and limited funding, the services sometimes do not reach those who need it most. Luckily, the Ministry of Health (MoH) of Zambia and Japan International Cooperation Agency (JICA) have come together in order to help restore the health care system in Zambia. They are investigating ways to effectively set priorities so that processes in health facilities can run faster and smoother.

Source: https://borgenproject.org/health-care-system-in-zambia/


Rank:37 –Rate: 12.9% Estimated # of preterm births per 100 live births   (USA – 12 %, Global Average: 11.1%)


Determinants of Preterm Births at a National Hospital in Zambia: Application of Partial Proportional Odds Model

Received: 27 March 2021; Accepted: 06 April 2021; Published: 11 June 2021 Obstet Gynecol Res 2021; 4 (2): 117-130 Citation: Moses Mukosha, Choolwe Jacobs, Patrick Musonda, John Mathias Zulu, Sheila Masaku, Chipo Nkwemu, Bellington Vwalika, Kunda Mutesu Kapembwa, Patrick Kaonga. Determinants of Preterm Births at a National Hospital in Zambia: Application of Partial Proportional Odds Model. Obstetrics and Gynecology Research 4 (2021)


Background: Preterm birth (PTB), the delivery of a baby before 37 completed weeks of gestation, is responsible for increased childhood morbidity and mortality globally. However, in most developing countries, the determinats of PTB are usually underestimated and content-specific. Therefore, we assessed the determinants of ordered preterm birth levels at the Women and Newborn Teaching Hospital, Lusaka, Zambia.

Results: The study included a total of 3243 case records of women with a median age of 26 years (IQR, 22-33), of whom 399 (12.3%) delivered very preterm infants, 914 (28.18%) delivered moderate-term infants, 957 (29.51%) delivered late-term infants and 973 (30%) delivered term infants. There were disparities across infants born to HIV uninfected and HIV infected women, with the latter being more likely to be on the lower levels of preterm birth. However, attending antenatal clinic and a unit increase in maternal age were more likely to be on the higher levels of preterm birth. Pre-eclampsia’s effect was not constant across the binary logistic regression models but generally showed a reduced odds of being in higher preterm birth levels for women with the condition.

Conclusion: HIV infection and pre-eclampsia predict lower preterm birth levels while attending antenatal care (ANC), and increased maternal age is protective. Pregnant women presenting with pre-eclampsia and HIV infection should receive special considerations. Our findings support interventions aimed at increasing ANC uptake in the Zambian and other sub-Saharan Africa settings.         

Source:  https://www.fortunejournals.com/articles/determinants-of-preterm-births-at-a-national-hospital-in-zambia-application-of-partial-proportional-odds-model.pdf

Charmaine Sipatonyana a nurse midwife at Kaoma District Hospital in Western Province attending to a client during COVID-19 pandemic Photo credit ©UNFPA Zambia 2020

How midwives are contributing to averting maternal and newborn deaths amid COVID-19

23 June 2021

As the COVID-19 pandemic continues to rage, the role of skilled midwives towards averting maternal and newborn deaths continues to be key. Unfortunately, in most underserved communities with high maternal and neonatal deaths, significant gaps in availability of well-trained health care workers remains.

Charmaine Sipatonyana is a midwife placed at Kaoma District Hospital in the Western Zambia, with support from UNFPA and funding from the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO). Prior to her arrival, the hospital was experiencing significant gaps in providing quality maternal health services due to limited availability of skilled staff.

“From the time I arrived, we have not recorded any maternal deaths, and we only had a few neonatal deaths for which we are working hard to close that gap as a matter of urgency. The Hospital is engaging with the community to continuously sensitize expectant mothers on the importance of antenatal visits and close monitoring during pregnancy and postpartum period.” says Charmaine because of the training and support she has received as part of UNFPA support to the Province, Charmaine further narrates how this has given her confidence to execute her very sensitive role of facilitating safe deliveries and saving lives.

In 2020, through the Government of Zambia/FCDO/UN Joint Programme on Health Systems Strengthening, a total of 69 midwives were mobilised and deployed to primary healthcare facilities in Western, Luapula and Central Provinces to help reduce key gaps in health workforce shortages and ensure continuity of essential service during COVID-19 pandemic. This contributed to 14,900 health facility deliveries between October and December 2020.

The role of a midwife goes beyond facilitating safe deliveries. When adequately skilled, midwives also play a critical role in delivering all other essential sexual, reproductive, maternal, and new-born health services including providing family planning and counselling services.

UNFPA Zambia | How midwives are contributing to averting maternal and newborn deaths amid COVID-19

Judy Yo – Always On My Mind

Premiered Apr 24, 2021

Judy Yo performing Always On My Mind produced by Shenky Sugah For Kalandanya Music promotions Official Video Shot By Bang Bang Media Download Always on my mind

Focus on Fathers for Promoting Safe Sleep and Breastfeeding

Alison Jacobson, Corresponding Author

In 2020 First Candle hosted a series of focus groups in Georgia, Michigan, and Connecticut to understand the impact of implicit bias, cultural norms, and socio-economic issues on individuals’ access to information about the American Academy of Pediatrics’ infant safe sleep guidelines and the choice to adopt them. We had five groups in each state: moms, breastfeeding moms, dads, grandparents, and in-home care providers.

 It was among the dads where we discovered the greatest opportunities to increase behavior change regarding safe sleep. Here are some highlights of the insights we gleaned from our focus groups:

Dads are more engaged than ever. Each of the dads spoke passionately about caring for his baby and equally sharing responsibility with mom. They shared stories with each other about how they care for their baby and want to be involved in parenting.

Dads feel marginalized by health care providers. Many dads spoke about how they felt ignored by in-home care providers and medical staff both during the birth and at the pediatrician’s office. Because of COVID-19 restrictions, most dads could not even attend prenatal and well-baby visits, but when they did, they felt the conversation and questions were directed towards mom. There was very little acknowledgment of their presence.

Dads do not have enough information. Whether it was due to COVID-19 or the inability to be present during in-home or office visits, dads do not feel they receive much information about safe sleep and breastfeeding. What they learn about safe sleep usually is what they hear from mom second-hand. Because of this, they are unsure about how to support mom in breastfeeding and how to create a safe sleep environment. One dad, an emergency medical technician who had been present at a Sudden Unexplained Infant Death (SUID) event, felt that the safe sleep guidelines are “mere opinions,” not facts, and therefore do not necessarily need to be adopted.

Dads always defer to mom. Dads have strong opinions, especially around bed-sharing, but they generally do not share this with mom. Many dads expressed that they “freak out” having a baby in bed with them, and it makes them nervous. But, they believe that “mom knows best” and that their opinions will always be second to mom. Dads want to receive information in different ways. Dads are less likely to read brochures about safe sleep or breastfeeding, as they feel the information is directed towards mom. It is generally images of mom and baby on brochures, and there is no specific information geared towards dad. They do not see themselves reflected in the materials. Dads also prefer to learn information from other dads. They are less inclined to read materials or listen to a care provider but would be open to listening to recommendations in a group setting of other men in places they frequent, such as gyms, barbershops, and men’s organizations.

PLEASE ALSO References: 1. https://firstcandle.org/straight-talk-for-infant-safe-sleep/ 2.https://neonatologytoday.net/newsletters/nt-jul21.pdf


Nov 18, 2020 ZNBC Today

At least 60 percent of babies admitted to the Neonatal Unit at the University Teaching Hospital -UTH- are premature.


Neonatal Airway Monitoring System

Jun 10, 2021   Purdue Engineering

After 30 years of development, a medical device designed to continuously monitor the airways of the tiniest ventilated patients could become the standard of care for babies worldwide. Since 2016, five neonatal intensive care units in the U.S. have been using what George Wodicka and his students later invented as a solution: the first and only FDA-approved medical device that alerts nurses when a baby’s breathing tube is in the wrong position or obstructed. To make the device available to babies in every NICU, one of the world’s largest medical technology companies, Medtronic, recently added the Purdue invention to its product line as the SonarMedTM Airway Monitoring System. The company adopted the technology through its acquisition of SonarMed Inc. in December 2020, a startup Wodicka co-founded to bring the device to market.

NANN has provided a comprehensive Medication Position Statement addressing medication safety in the NICU. We strongly recommend this article for review by our esteemed healthcare provider community serving our preterm birth babies.

Medication Safety in the NICU Position Statement #3073 NANN Board of Directors June 2021 As the professional voice of neonatal nurses, the National Association of Neonatal Nurses (NANN) recommends a comprehensive approach to medication safety in the NICU that integrates available technology, focused healthcare provider medication safety education, standardized medication processes, and robust medication error reporting and prevention efforts. NICU patients are uniquely vulnerable to medication errors and require additional safeguards embedded within the medication-use process to reduce medication errors and mitigate harm. NICU healthcare providers should be proactive in evaluation and implementation of safe medication practices.

Please review full statement


Transition to a Safe Home Sleep Environment for the NICU Patient

Michael H. Goodstein, Dan L. Stewart, Erin L. Keels and Rachel Y. Moon; COMMITTEE ON FETUS AND NEWBORN, TASK FORCE ON SUDDEN INFANT DEATH SYNDROME Pediatrics July 2021, 148 (1) e2021052045; DOI: https://doi.org/10.1542/peds.2021-052045


Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (ie, weight <2500 g) and 10% were born preterm (ie, gestational age of <37 weeks). Ten to fifteen percent of infants (approximately 500 000 annually), including low birth weight and preterm infants and others with congenital anomalies, perinatally acquired infections, and other diseases, require admission to a NICU. Every year, approximately 3600 infants in the United States die of sudden unexpected infant death (SUID), including sudden infant death syndrome (SIDS), unknown and undetermined causes, and accidental suffocation and strangulation in an unsafe sleep environment. Preterm and low birth weight infants are 2 to 3 times more likely than healthy term infants to die suddenly and unexpectedly. Thus, it is important that health care professionals prepare families to maintain their infant in a safe home sleep environment as per recommendations of the American Academy of Pediatrics. Medical needs of the NICU infant often require practices such as nonsupine positioning, which should be transitioned as soon as medically possible and well before hospital discharge to sleep practices that are safe and appropriate for the home environment. This clinical report outlines the establishment of appropriate NICU protocols for the timely transition of these infants to a safe home sleep environment. The rationale for these recommendations is discussed in the accompanying technical report “Transition to a Safe Home Sleep Environment for the NICU Patient,” included in this issue of Pediatrics.


Source: https://pediatrics.aappublications.org/content/148/1/e2021052045

Hero Nurse Who Saved Preemie Babies After Beirut Blast Speaks Out | TODAY

TODAY Aug 13, 2020

More than a week after a deadly explosion shook Beirut, Pamela Zaynoun, a NICU nurse, describes how she saved three babies from the rubble of a hospital and ran three miles with them in her arms. Her heroic act was captured in images that have gone viral. NBC’s Molly Hunter reports for TODAY.


Love is not Enough

Jun 1, 2013   Child Health BC

Your Own Happiness is a Gift to Your Child. Parents may need to put their life goals on hold and look after their own emotional needs so that they can create an environment where their child is connected and secure. Babies are not blank slates but rather, born with tremendous potential for self-realization. Or self-negation. Parents may need to deal with their own stress and seek support as needed. Attachment Patterns have a Multigenerational Aspect When parents focus on the comfort, security and happiness of their young child, the child benefits and so do future generations. The human brain develops, not only according to genetics, but largely in response to input from the environment. In other words, a baby’s capacity for intimate relationships, connection, self-regulation, attention and stress regulation are directly shaped by the emotional availability of the parents. During the critical first three months the right conditions need to be met for healthy brain development. Babies need caregivers who are non-stressed, non-depressed, emotionally available and consistently available. Babies and toddlers need a safe and low-stress environment. Featuring: Dr. Gabor Maté

When Extreme Preemies Get to School, Check Their Screen Time

Study suggests extra cognitive and behavioral risk for those with heavy device use by John Gever, Contributing Writer, MedPage Today July 12, 2021

Young schoolchildren who had been born very early and who logged “screen time” in excess of 2 hours daily were more likely also to show neurobehavioral problems than similar children spending less time with electronic devices, researchers found.

In a follow-up study conducted with a cohort of extremely premature infants, those with high screen time showed significant deficits in IQ, executive function, inhibition, and attention relative to the low screen-time children, according to Betty R. Vohr, MD, of Women & Infants Hospital of Rhode Island in Providence, and colleagues.

Having a television or computer in the bedroom was also associated with certain problems, the researchers reported in JAMA Pediatrics.

The 414 children in the study were about 6 to 7 years old at evaluation; all were born at less than 28 weeks gestation with a mean of 26 weeks. Just under 240 of the children logged screen time of at least 2 hours daily, and 266 had a TV or computer in the bedroom. Some 55% of the cohort were boys.

Overall, according to Vohr and colleagues, the results add to the already substantial literature connecting electronic device use to a variety of adverse outcomes. How a history of prematurity might play into this, however, is less clear. The researchers cited another study published in 2019 that linked high levels of screen time to abnormal “microstructural integrity” in white matter in preschool-age children.

Vohr and colleagues noted that several other groups have found a variety of structural brain defects in children born at extreme prematurity, and these in turn are “associated with cognitive, behavior, and language outcomes.” Thus, it’s not a great stretch to see a causal chain between birth prior to 28 weeks and neurobehavioral deficits associated with screen time, such that the risk with device use is “amplified,” the researchers suggested.

Study Details

Participants had been enrolled from 2005 to 2009 in an NIH study called SUPPORT NEURO, itself a secondary analysis of another cohort study called NEURO designed to evaluate short-term management strategies for extreme preemies. In the NEURO substudy, participants underwent cranial ultrasonography up to first or second grade, with clinical parameters evaluated as well.

Numerically, deficits in the high screen time group reached 3.92 points for full-scale IQ (SE 1.64, P=0.02) and 0.79 points for inhibition as assessed with the Developmental Neuropsychological Assessment (SE 0.38, P=0.03). Scores for inattention on the Conners 3rd Edition Parent Short Form were 3.32 points greater (SE 1.67, P<0.05).

Executive function was measured for different domains with the Behavior Rating Inventory of Executive Function. Scores for metacognition and global executive function were significantly lower among children with more than 2 hours/day of screen time, at 8.81 and 7.49 points, respectively (both P=0.01).

These figures included adjustments for a host of covariates, including sex, gestational age, and social determinants of health. Among the latter were maternal age and education, race, and public insurance; kids who were Black, on Medicare or Medicaid, or with mothers younger than age 20 when delivering — all were more likely to have high screen time and to have a TV or computer in the bedroom. Children whose mothers hadn’t completed high school were also more likely to have these devices in the bedroom, but not to have more screen time than those with more educated mothers.

Postpartum Depression… in Dads! – PediaCast 493

Posted by Dr. Mike on June 16, 2021

Parents have questions. PediaCast has answers.

Each episode of our award-winning audio program provides trustworthy, detailed and up-to-date answers to your questions. How do we do it? We start by searching the latest peer-reviewed journals. We find current evidence-based answers. Then we work a little translation magic, turning scientist-talk into parent-talk. The result is an entertaining listen that’s not elementary.

Of course, your child’s doctor is the best source of information for specific questions regarding your child’s health. We believe in keeping the practice of medicine in the examination room. But we also know parents have many questions that don’t get answered. Why do kids get so many ear infections? Is a fever dangerous? When should tonsils come out? Many parents think about these questions AFTER leaving the doctor’s office. Others remember to ask, but get the short answer instead of details.

Enter PediaCast–a supplemental source of educational information you can trust. We also provide a healthy dose of news parents can use and lively interviews with pediatric and parenting experts.

Please enjoy the example podcast below and note the abundance of Pod Casts available for your review and for future interactive participation.

Topic: Depression and Anxiety in Fathers after the Birth of a Baby Guest: Dr David Levin Pediatrician, Atlantic Medical Group Director of Professional Outreach Postpartum Support International Links to Empowering Resources are listed on website

Please enjoy the example podcast below and note the abundance of Pod Casts available for your review and for future interactive participation.



Preemies’ Blood Type Tied to Risk for Serious Intestinal Infections

AB blood group associated with risk of necrotizing enterocolitis and focal intestinal perforation-by Zaina Hamza, Staff Writer, MedPage Today July 7, 2021

AB blood type was associated with a higher risk for necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in preterm infants, as compared with other blood types, a German population-based study found.

Among very low birth weight infants enrolled in a prospective study, surgery for NEC/FIP was more likely to be performed in those with blood group AB versus all other blood groups in both univariate (OR 1.51, 95% CI 1.07-2.13, P=0.017) and multivariate analyses (OR 1.58, 95% CI 1.10-2.26, P=0.013), reported Illya Martynov, MD, of the University of Leipzig in Germany, and colleagues.

AB blood type was associated with a higher risk for necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in preterm infants, as compared with other blood types, a German population-based study found.

Among very low birth weight infants enrolled in a prospective study, surgery for NEC/FIP was more likely to be performed in those with blood group AB versus all other blood groups in both univariate (OR 1.51, 95% CI 1.07-2.13, P=0.017) and multivariate analyses (OR 1.58, 95% CI 1.10-2.26, P=0.013), reported Illya Martynov, MD, of the University of Leipzig in Germany, and colleagues.

“Blood group AB may be considered as a novel risk factor for developing NEC/FIP in very low birth weight infants besides the well-known factors including gestational age, hemodynamically relevant PDA [patent ductus arteriosus], and male gender,” wrote Martynov and co-authors in Nature Scientific Reports.

Factors that proved protective against NEC/FIP needing surgery included greater gestational age (OR 0.73, 95% CI 0.68-0.78), female sex (OR 0.68, 95% CI 0.55-0.83), and higher birth weight (OR 0.89, 95% CI 0.83-0.94; P<0.0001 for all), according to their findings. While use of ibuprofen or indomethacin for PDA showed a higher risk for NEC/FIP requiring surgery (OR 1.50, 95% CI 1.21-1.85, P<0.0001).

For their study, the researchers aimed to identify the associated risk factors of NEC/FIP in preterm infants with birth weights less than 1,500 grams (3.3 lb), where early diagnosis and intervention could be initiated. The two conditions typically affect infants born at 22 to 28 weeks of gestation and present within the first few weeks after birth. NEC/FIP can cause necrosis in the intestinal mucosa, leading to bowel perforation.

“Although FIP and NEC have been recognized as distinct entities, the clinical features and timing of presentation are frequently overlapping, making both diseases clinically indistinguishable in many cases,” the authors wrote.

In cases requiring surgery, neonatal mortality is higher in premature infants with NEC compared to those with FIP (35% vs 21%, respectively). A prior retrospective study had found a higher mortality risk for premature infants with NEC and type AB blood.

NEC risk factors can include formula feeding (after exposure to cow’s milk), immune system dysregulation, or any change to the microbiota.

“Blood group antigens are not only on the surface of red blood cells but also occur in other tissues, including the intestinal surface,” explained Martynov and coauthors, adding that these antigens are released into the lumen of the intestines and can serve as receptors for toxins or bacteria.

In the current study, data on the premature infants came from the German Neonatal Network, and included 10,257 infants with very low birth weight, 441 of whom required surgery for NEC/FIP. Most infants had type A blood (46.5%), followed by type O (34.5%), type B (13%), and type AB (6%). In regards to birth weight, mode of delivery, gestational age, gender, and corticosteroid exposure, no differences were reported according to blood type.

Most infants had an average gestational age of 28.5 weeks, and the average birth weight was 1,051 grams (2.3 lb) for the AB blood group and 1,037 grams (2.3 lb) for the non-AB group (P=0.26).

NEC/FIP requiring surgery was observed in 6.2% of infants with AB blood versus 4.2% of those with non-AB blood and 4.4% of those with type O blood. Mortality from NEC/FIP was 7.7% for the AB blood type group and 6.8% for the non-AB blood groups (P=0.385).

Multivariate analyses included gestational age, multiple birth, sex, and PDA medical/surgical treatments as covariates.

Limitations of the study included the small number of patients in the cohort who required surgery for FIP/NEC, as well as the low prevalence of AB blood type in infants with NEC/FIP (5.9%). Variability also may have existed among unrecognized confounders, such as donor milk availability and center protocols for feeding advancement.


Gestational Weight Gain and Its Effects on Maternal and Neonatal Outcome in Women With Twin Pregnancies: A Systematic Review and Meta-Analysis

Front. Pediatr. | https://doi.org/10.3389/fped.2021.674414

Wei Zhong1†, Xiaojiao Fan2†, Fang Hu1, Meiqin Chen1 and Fanshu Zeng3*

Background: The incidence of twin pregnancies has risen recently. Such pregnancies are associated with an increased risk for poor maternal and infant outcomes. Gestational weight gain, particularly in singleton pregnancies, has been well-linked with maternal and infant outcomes. The aim of the current meta-analysis was to evaluate the effects of gestational weight gain on maternal and fetal outcomes in women with twin pregnancies.

Methods: A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies, either retrospective or prospective in design, evaluating the effects of gestational weight gain (defined using Institute of Medicine (IOM) guidelines) maternal and/or fetal/neonatal outcomes in women with twin pregnancies were included. Statistical analysis was performed using STATA software.

Results: Eleven studies were included in the meta-analysis. Mothers with inadequate weight gain had increased risk for gestational diabetes mellitus (OR 1.19; 95% CI: 1.01, 1.40) and decreased risk for gestational hypertension (OR 0.58; 95% CI: 0.49, 0.68) and cesarean section (OR 0.94; 95% CI: 0.93, 0.96). Neonates born to mothers with inadequate weight gain were susceptible to increased risk for preterm delivery (OR 1.17; 95% CI: 1.03, 1.34), very preterm delivery (gestational age <32 weeks) (OR 1.84; 95% CI: 1.36, 2.48), small for gestational age status (OR 1.41; 95% CI: 1.15, 1.72), low birth weight status (<2,500 g) (OR 1.27; 95% CI: 1.17, 1.38), and neonatal intensive care unit (NICU) admission (OR 1.16; 95% CI: 1.08, 1.24). The pooled findings indicate an increased risk for gestational hypertension (OR 1.82; 95% CI: 1.60, 2.06) and cesarean section (OR 1.07; 95% CI: 1.05, 1.08) among mothers with excessive weight gain. Neonates born to mothers with excessive weight gain were susceptible to increased risk for preterm delivery and very preterm delivery but were associated with a decreased risk for low birth weight status and small for gestational age status.

Conclusions: Gestational weight gain in twin pregnancy, either lower or higher than IOM recommended guidelines, is associated with poor maternal and neonatal outcomes. Our findings call for incorporating counseling on optimal weight gain during pregnancy as part of routine antenatal visits.


Clinical Pearl: Age is just a number: Evidence of Accelerated Biological Aging in Adults Born Extremely Low Birthweight (ELBW)

Melanie Wielicka, MD, PhD, Joseph R Hageman, MD

With the increasing rates of preterm birth and survival worldwide, a number of studies have started to focus not only on the immediate consequences of prematurity seen in the neonatal intensive care units but also on its long-term effects on adult health. There is now evidence that individuals with a history of preterm birth are at a greater risk of developing hypertension, strokes as well as type 1 and type 2 diabetes (1, 2). These chronic medical conditions have been classically associated with increasing age, raising whether ex-preemies are at risk for accelerated aging.

The extent of DNA methylation increases with chronological age. Various “epigenetic clocks” are available to quantify the relationship between methylation and chronological age to determine an individual’s “epigenetic” or “biological” age. Increased biological age has been linked to a greater risk of age-related morbidities (3). In their study, Van Lieshout and colleagues collected buccal cells from 45 extremely low birth weight (ELBW) survivors and 49 normal birthweight controls at 30-35 years of age. Epigenetic age was calculated from the weighted average of DNA methylation at 353 cytosine-phosphate-guanine sequences within the DNA methylation sites. The technique used is called the Illumina Infinium Human Methylation EPIC 850k BeadChip array devised by Horvath. They found that men born at ELBW demonstrated accelerated biological aging when compared to age-matched adults born at normal birth weight. The authors suggest that these findings could potentially be related to the increased psychological and physiologic stress premature infants endure (4, 5).

At this time, further studies are still needed to establish the link between accelerated cellular aging in individuals with a history of prematurity and specific outcomes, as well as to identify which subgroups are at the highest risk. Van Lieshout and colleagues point out that male preterm infants are susceptible to worse outcomes, and thus, are at risk for increased stress, which could potentially explain why the differences were only found in males (4, 5). Their findings appear to be supported by Parkinson et al., who used a different molecular marker, telomere length, to study cellular aging in patients with a history of prematurity. They have demonstrated a greater proportion of shorter telomeres in preterm men when compared to term men but were unable to find similar differences in women (6). Interestingly, in a recent study by Raffington et al., the authors analyzed DNA methylation to determine a methylation-based “pace of aging” in children. They have found that a greater socioeconomic disadvantage among white and Hispanic children was associated with a significantly faster pace of aging. This topic should be explored further. It would be imperative to determine if racial and socioeconomic disparities enhance the risk of accelerated aging in individuals with a history of prematurity (7).

All the emerging evidence has important implications for clinicians, researchers, and policymakers. At the policy level, more data is still needed to establish appropriate screening and preventative guidelines. However, when caring for children, adolescents, and adults with a history of prematurity, physicians should closely monitor blood pressure and weight and encourage appropriate nutrition and physical activity. They should also be reminded of the importance of inquiring about preterm birth when obtaining routine medical history, even when encountering patients later in life. Lastly, family members of children born preterm should be counseled on the risk for accelerated aging and increased risk of cardiovascular and metabolic disorders.


Have neurodevelopmental outcomes improved in extremely preterm children?

July 21, 2021 Miranda Hester

As more extremely preterm infants survive delivery, a study examines whether the advances that allowed for that survival also improve neurodevelopmental outcomes.

Medical advancements in perinatal and neonatal care have led to greater survival for extremely preterm infants. A report in JAMA Pediatrics examined whether these advances had also led improvements in the neurodevelopmental outcomes in children who were born <28 weeks’ gestation.1

The investigators used 4 prospective longitudinal cohort studies that included all live extremely preterm births 22 to 27 weeks’ gestation in the state of Victoria, Australia in 1991-1992, 1997, 2005, and 2016-2017. The main outcomes looked at were survival, blindness, cerebral palsy, developmental delay, deafness, and neurodevelopmental disability at 2 years’ corrected age. Delays in development included a developmental quotient that was less than -1 SD relative to the control group averages on the Bayley Scales. A major neurodevelopmental disability involved moderate to severe cerebral palsy, blindness, deafness, or a developmental quotient less than −2 SDs.

Data were available for 1152 children across the 4 studies. The investigators found that survival to 2 years of age was highest in the 2016-2017 cohort (73% [215 of 293]) in comparison with the other cohorts: 1991-1992: 53% (225 of 428); 1997: 70% (151 of 217); 2005: 63% (170 of 270). Additionally, cerebral palsy was not as common in 2016-2017 (6%) than the other 3 time periods (1991-1992: 11%; 1997: 12%; 2005: 10%). No notable changes in the rates of developmental quotient less than -2 SDs (1991-1992: 18%; 1997: 22%; 2005: 7%; 2016-2017: 15%) or rates of major neurodevelopmental disability (1991-1992: 20%; 1997: 26%; 2005: 15%; 2016-2017: 15%) were found across the eras. Across all 4 cohorts, both blindness and deafness were not common. Furthermore, the rate of survival that was also free from major neurodevelopmental disability went up 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).

The investigators concluded that children who are born extremely preterm are increasingly surviving to age 2 years without a major disability. Furthermore, this increased rate of survival was not linked to an increase in neurodevelopmental disability.


  1. Cheong J, Olsen J, Lee K, et al. Temporal trends in neurodevelopmental outcomes to 2 years after extremely preterm birth. JAMA Pediatr. July 19, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.2052

Source: https://www.contemporarypediatrics.com/view/have-neurodevelopmental-outcomes-improved-in-extremely-preterm-children

Rates of Neuropsychiatric Disorders and Gestational Age at Birth in a Danish Population

Yuntian Xia, MPH1Jingyuan Xiao, MPH1,2Yongfu Yu, PhD3,4; et alWan-Ling Tseng, PhD5Eli Lebowitz, PhD5Andrew Thomas DeWan, PhD1,6Lars Henning Pedersen, MD, PhD7,8,9Jørn Olsen, MD, PhD3Jiong Li, MD, PhD3Zeyan Liew, PhD, MPH1,2 Obstetrics and Gynecology-June 29, 2021: JAMA Netw Open. 2021;4(6):e2114913. doi:10.1001/jamanetworkopen.2021.14913

Key Points

Question  Are there associations between gestational age, analyzed in 6 subgroups covering the full range of gestational duration, and the rate of neuropsychiatric diagnoses?

Findings  In this Danish, nationwide, registry-based cohort study, shortened gestational duration was associated with the rate of both child-onset and adult-onset neuropsychiatric diseases. Beyond the traditional threshold of fetal maturity (≥37 weeks), the early term group (37-38 weeks) had a slightly elevated rate of multiple neuropsychiatric disorders compared with the full-term group, whereas the late-term and postterm groups had the lowest rates for most disorders except pervasive developmental disorders.

Meaning  These findings suggest that neuropsychiatric disorders might be associated with factors related to early development and that interventions focusing on perinatal risk factors and obstetric practices might lower the risk for neuropsychiatric disorders in the population.


Importance  Nonoptimal gestational durations could be associated with neurodevelopmental disabilities, yet evidence regarding finer classification of gestational age and rates of multiple major neuropsychiatric disorders beyond childhood is limited.

Objective  To comprehensively evaluate associations between 6 gestational age groups and rates of 9 major types and 8 subtypes of childhood and adult-onset neuropsychiatric disorders.

Design, Setting, and Participants  This cohort study evaluated data from a nationwide register of singleton births in Denmark from January 1, 1978, to December 31, 2016. Data analyses were conducted from October 1, 2019, through November 15, 2020.

Exposures  Gestational age subgroups were classified according to data from the Danish Medical Birth Register: very preterm (20-31 completed weeks), moderately preterm (32-33 completed weeks), late preterm (34-36 completed weeks), early term (37-38 completed weeks), term (39-40 completed weeks, reference), and late or postterm (41-45 completed weeks).

Main Outcomes and Measures  Neuropsychiatric diagnostic records (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F00-F99) were ascertained from the Danish Psychiatric Central Register up to August 10, 2017. Poisson regression was used to estimate the incidence rate ratio (IRR) and 95% CI for neuropsychiatric disorders, adjusting for selected sociodemographic factors.

Results  Of all 2 327 639 singleton births studied (1 194 925 male newborns [51.3%]), 22 647 (1.0%) were born very preterm, 19 801 (0.9%) were born moderately preterm, 99 488 (4.3%) were born late preterm, 388 416 (16.7%) were born early term, 1 198 605 (51.5%) were born at term, and 598 682 (25.7%) were born late or postterm. A gradient of decreasing IRRs was found from very preterm to late preterm for having any or each of the 9 neuropsychiatric disorders (eg, very preterm: IRR, 1.49 [95% CI, 1.43-1.55]; moderately preterm: IRR, 1.23 [95% CI, 1.18-1.28]; late preterm: IRR, 1.17 [95% CI, 1.14-1.19] for any disorders) compared with term births. Individuals born early term had 7% higher rates (IRR, 1.07 [95% CI, 1.06-1.08]) for any neuropsychiatric diagnosis and a 31% higher rate for intellectual disability (IRR, 1.31 [95% CI, 1.25-1.37]) compared with those born at term. The late or postterm group had lower IRRs for most disorders, except pervasive developmental disorders, for which the rate was higher for postterm births compared with term births (IRR, 1.06 [95% CI, 1.03-1.09]).

Conclusions and Relevance  Higher incidences of all major neuropsychiatric disorders were observed across the spectrum of preterm births. Early term and late or postterm births might not share a homogeneous low risk with individuals born at term. These findings suggest that interventions that address perinatal factors associated with nonoptimal gestation might reduce long-term neuropsychiatric risks in the population.


“From fear and freezing to trust and letting go”– an interview with Ingeborg Anna Martens on preterm birth and the consequences of separation policies

Ingeborg Anna Martens was born in gestational week 30/31 in the 1970s. As was the common practice back then, she was separated from her parents who could only “visit” their daughter at the ward and look at her from a distance, for about two months. Over the years, Ingeborg has reflected a lot on the long-term influence her preterm birth had had on herself and on her relationship with herself and to those close to her. With GLANCE, she shared how she emerged stronger from the past and looks into the future with courage and self-acceptance.

Since the outbreak of the pandemic, many hospitals and neonatal intensive care units
(NICUs) have introduced the practice of separating preterm babies and otherwise sick
newborns from their parents, allowing only very limited contact or none at all.
When you as an adult who was born preterm and separated from your parents, hear or read about this practice, does it trigger anything in you?

Absolutely this triggers something in me. I understand that in a pandemic choices have to be made and safety comes before anything else. But separating parents from their child also results in insecurity, in the sense of feeling unsafe. In a child, this can leave lifelong marks.
Knowing this fills me with sadness, heartache.

G: You were separated from your parents for 2 months after your birth. Looking back, do you have the impression that this had lasting consequences? For example, on your (emotional) development or on interpersonal relationships like the one you had with your parents?


In life, we all take our own journey, with our own desires, needs and ideals.
A common thread in my life is my health. As young as I was, I often expressed ‘ how wonderful it would be if my body could be baked over again’. From an early age on, I have had a strong drive to get things done, a hard worker, wanting to do well, to prove to myself that I can do it. The urge to prove? I think so. But also the need to feel to be seen heard and understood. To know that I am loved, although I do not always believe it myself deep inside.

I found out pretty quickly that body and mind are connected. My willpower is enormous I am blessed with a strong positive mindset. And yet? Why has my body overpowered my mind several times in the past? After all these years I realise that my premature birth and my time in the incubator had a lot of impact on my life. For a long time, I didn’t want to face that.
Emotional connection and unconditional love are at the core of our basic trust and right to exist.

During the incubator period, my parents were allowed to admire me only from a distance and so they did. There was no touch, let alone skin-to-skin contact. (Except the physical contact during medical procedures, of course). So emotional nourishment was out of the question basically. Fortunately, this was later rectified and some holes in my (attachment) web were repaired.

Despite a safe home, I think that, in retrospect, I have ‘survived’ most of my life; full in my survival mode.

In the meantime, I have taken a lot of steps in this and gathered knowledge to get out of this survival mode. By immersing myself in the workings of our stress system, I have become aware of several things and have set to work. Mostly by myself, but I also called for help. After all, we don’t have to do everything on our own. I have mapped out my birth and unmet needs, tapped into my body memory, felt things through and had several conversations. Thankfully.

I became aware of various triggers, which still occasionally set my survival mechanism into motion. I then go into a kind of ‘rigidity’, in my head. With bodywork and meditation, I manage to find the connection with my heart, soul and body again and how to relax. That is very nice.

From fear and freezing to trust and letting go. Because of this, I am also able to guard my own boundaries better and I don’t let others cross them so quickly anymore. I have learned to take up my own space, without feeling guilty. I do matter as a person and I am safe because, in the end, it is all about feeling safe and comfortable with and within yourself. The result is that I feel the love in myself again, the love of others, and I feel welcome. Sometimes not yet, but every day we learn, by trial and error. For a lifetime.

G: You were born preterm in the 70s when it was very common to restrict the parents’ access to their baby. Now we observe that in many hospitals practices like this are still or again in use as they were 40 years ago. What lessons do you think neonatal units and hospitals should learn from the pandemic?


I think it’s important to think in terms of possibilities and solutions. Even in these times, full of challenges. The first 1000 days of a child’s life are decisive for the rest of their lives. A good attachment, feeling seen, heard, loved and understood. These are incredibly important building blocks for a strong bond between an infant and parent.

No matter how small you are, all the early experiences and impressions are saved in your brain. You can’t put words to it yet, but the body saves all this information. This creates stress and has an influence on your emotional and physical development.

I always say: ‘You always take yourself with you’. As a child, a parent, but also for example in your role as a professional. Be aware of your own emotions and stress.

Individual developmental care should really be key in the care of the sick and/or premature baby. It takes into account the needs of each individual baby and the relationship with his parents. (So, no separation!)

With an optimal start, you can prevent much suffering later. Not only in the period in the hospital, but also in the period when the baby comes home. Give everyone a ‘soft landing’ in this respect.

Connected, no matter what or how your start has been.

“From fear and freezing to trust and letting go” – An interview with Ingeborg Anna Martens – GLANCE (glance-network.org)


Reflecting on the article interviewing Ingeborg Anna Martens, I felt a significant connection to the insight she shared. As a fellow preemie survivor I too have experienced challenges in interpersonal relationships in setting my boundaries, getting in touch with my emotions, and feeling safe. Always keeping myself at arm’s length to maintain control has become second nature. This is a response I am working to change as an adult empowered with access to information, an informed community, and a sense of curiosity like that of which Ingeborg has courageously shared.  

Preemie’s are impacted by the circumstances we face in our fight to survive. Survival mode as expressed by Ingeborg at such a visceral, sub-conscious level was validating for me, and empowering towards my journey.

I, too, feel a sense of sadness knowing worldwide many preemies born today and their families are experiencing an increased period of separation. While much of the knowledge Ingeborg has shared in my opinion has traditionally been met with hesitation from the medical and research community, my hope is that increased engagement with fellow preemie survivors and NICU community members may advance discussion, research, and outlets of information sharing. I hope such dialogue will support parents and families of young preemies in their awareness and ability  to positively impact their child’s long-term health and wellness. Healthcare providers and facilities have the opportunity to make this information accessible and attractive to our preemie parents, families, and survivors.

Microlight flight over Victoria Falls (Livingstone, Zambia)

Jan 11, 2018

Flying over the 7th Natural Wonder of the World : Victoria Falls (Zambia & Zimbabwe, Africa) !

Follow, Get Physical, NTs

Turkey, officially the Republic of Turkey, is a country straddling Western Asia and Southeast Europe. It shares borders with Greece and Bulgaria to the northwest; the Black Sea to the north; Georgia to the northeast; ArmeniaAzerbaijan, and Iran to the east; Iraq to the southeast; Syria and the Mediterranean Sea to the south; and the Aegean Sea to the west. Istanbul, the largest city, is the financial centre, and Ankara is the capital. Turks form the vast majority of the nation’s population, and Kurds are the largest minority.

Turkey is a regional power and a newly industrialized country, with a geopolitically strategic location. Its economy, which is classified among the emerging and growth-leading economies, is the twentieth-largest in the world by nominal GDP, and the eleventh-largest by PPP. It is a charter member of the United Nations, an early member of NATO, the IMF, and the World Bank, and a founding member of the OECDOSCEBSECOIC, and G20. After becoming one of the early members of the Council of Europe in 1950, Turkey became an associate member of the EEC in 1963, joined the EU Customs Union in 1995, and started accession negotiations with the European Union in 2005.

Healthcare in Turkey consists of a mix of public and private health services. Turkey introduced universal health care in 2003. Known as Universal Health Insurance Genel Sağlık Sigortası, it is funded by a tax surcharge on employers, currently at 5%. Public-sector funding covers approximately 75.2% of health expenditures. Despite the universal health care, total expenditure on health as a share of GDP is the lowest among OECD countries at 6.3% of GDP, much lower than the OECD average of 9.3%. Average life expectancy is 78.6 years, compared with the EU average of 81 years. Turkey has one of the highest rates of obesity in the world, with nearly one third (29.5%) of its adult population obese.

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


Rank: 56 –Rate: 12% Estimated # of preterm births per 100 live births  (USA – 12 %, Global Average: 11.1%)


Effects of a home follow-up program in Turkey for urban mothers of premature babies

Nebahat Bora Güneş MSc, PhDHicran Çavuşoğlu MSc, PhD

First published: 23 October 2019https://doi.org/10.1111/phn.12671



To examine the effects of a home follow-up program in Turkey on care problems, anxiety, and depression levels of mothers after the birth of a premature baby.


A semi-experimental study with a pretest–posttest control group design. Eighty premature newborns and their mothers were included in the study. Nursing care was given to mothers and babies in the study group through a total of four home visits on weeks 1, 2, 3, and days 40–42 in Kırıkkale, Turkey guided by the Nursing Diagnosis System and Nursing Interventions Classification (NIC) system of the North American Nursing Diagnosis Association (NANDA). Data were collected from a sociodemographics form, home care needs evaluation form, Edinburgh Postpartum Depression Scale, and State Anxiety Inventory.


There were no significant differences between groups for nursing diagnoses at baseline, while the study group resulted in significantly fewer problems on days 40–42, compared to the control group. Mothers had a comparatively lower depression and state anxiety risk in the study group compared to the control group.


Providing home-based nursing care for preterm mothers and babies during the first 40–42 days has the potential to decrease postnatal care problems, including maternal depression and state anxiety levels.

FULL TEXT –> https://onlinelibrary.wiley.com/doi/abs/10.1111/phn.12671

We appreciate both the simplicity and comprehensive picture of a neonatal therapist scope of practice this article provides for parents/families and healthcare providers/organizations. Please review the full article (links below) for access to the complete study, valuable charts and reference information.

Risk-adjusted/neuroprotective care services in the NICU: the elemental role of the neonatal therapist (OT, PT, SLP)

Jenene W. Craig & Catherine R. Smith Journal of Perinatology volume 40, pages549–559 (2020)


Infants admitted to neonatal intensive care units (NICU) require carefully designed risk-adjusted management encompassing a broad spectrum of neonatal subgroups. Key components of an optimal neuroprotective healing NICU environment are presented to support consistent quality of care delivery across NICU settings and levels of care. This article presents a perspective on the role of neonatal therapists—occupational therapists, physical therapists, and speech–language pathologists—in the provision of elemental risk-adjusted neuroprotective care services. In alignment with professional organization competency recommendations from these disciplines, a broad overview of neonatal therapy services is described. Recognizing the staffing budget as one of the more difficult challenges hospital department leaders face, the authors present a formula-based approach to address staff allocations for neonatal therapists working in NICU settings. The article has been reviewed and endorsed by the National Association of Neonatal Therapists, National Association of Neonatal Nurses, and the National Perinatal Association.


Infants requiring neonatal intensive care are a particularly vulnerable population secondary to prematurity and/or significant medical conditions. Risk-adjusted care considers the broad spectrum of medical, neurologic, developmental, and psychosocial outcomes experienced by neonatal subgroups [1]. The effectiveness of providing the highest level of care to support family-centered, holistic developmental care services to improve short- and long-term outcomes for preterm and medically fragile neonates is well documented in the literature [2,3,4,5,6,7,8,9]. This has resulted in a standard of care for implementation of developmental care procedures in patient management practices in many neonatal intensive care units (NICUs) in the United States and around the world. However, the elemental components needed to create an optimal neuroprotective healing environment for infants in the NICU lack the requisite standardization recommendations to ensure consistent quality of care delivery across NICU settings and NICU levels of care. A 2017 joint position statement from the Canadian Association of Neonatal Nurses, Canadian Association of Perinatal and Women’s Health Nurses, National Association of Neonatal Nurses (NANN), and Council of International Neonatal Nurses addressed this concern by detailing guidelines for the institutional implementation of developmental neuroprotective care in the NICU [1011]. Inclusion of neonatal therapists (NTs) as essential components of a comprehensive preventive model of developmental care in the joint position statement acknowledged the critical contribution of the therapy disciplines to developmental care service design and delivery in the NICU [11, p. 65]. Relatedly, the current article presents a perspective on the role of NTs—occupational therapists (OT), physical therapists (PT), and speech–language pathologists (SLP)—in the provision of elemental risk-adjusted, neuroprotective care services in the NICU.


Neonatal therapy encompasses the art and science of integrating typical development of the infant and family into the environment of the NICU [12,13,14,15,16]. Incorporating theories and scopes of practice from the respective disciplines of occupational therapy, physical therapy, and speech-language pathology, neonatal therapy requires advanced knowledge of the diagnoses and medical interventions inherent to the NICU setting in order to provide safe and effective assessment, planning, and treatment [17]. While the provision of developmental neuroprotective care is a fundamental neonatal nursing responsibility, the five core measures included in the 2011 NANN guidelines serve as imperatives that an optimal neuroprotective environment requires the coordination of care with disciplines of medicine and nursing, including the scope of practice of NTs [18,19,20,21,22,23]. Skilled neonatal therapy competencies support preventative intervention from birth to enhance physiologic function and neurostructural development of the infant with benefits extending to all stakeholders including the infant, family, healthcare community, and provider networks [1124,25,26,27,28,29,30,31,32,33,34,35,36].

The Universe of Developmental Care (UDC) Model provides a useful framework to underscore the value of including neonatal therapy as an elemental component of quality service delivery in the NICU [37]. Recognizing the foundational interdependence of a shared surface interface when defining developmental care, the UDC model represents the impact of all body systems and the environment on brain development. Serving as an extension of the Synactive Theory proposed originally by Dr Heidelise Als, UDC purports that “all interactions begin at the organism–environment interface,” with the interface between the infant’s body and the environment serving as the tangible link between the person and all elements of the micro- and macroenvironment [3839, p. 146]. Accurate identification of both antecedents and consequences of consistent neuroprotective care formulates the basis to better understand the impact of the organism–environment interface as crucial to the delivery of quality care in the NICU. NTs are integral to the creation of a sensitive transactional interface through their understanding of sensory and environmental factors impacting critical elements of development.

Elemental roles of the neonatal therapist

Defining the necessary components required to provide risk-adjusted age-appropriate neonatal care for complex and critically ill infants will facilitate implementation of standardized care practices consistent with the central tenets of developmental care philosophy and the demonstrable effect on perinatal outcomes. The American Occupational Therapy Association (AOTA), American Physical Therapy Association (APTA), American Speech–Language–Hearing Association (ASHA) define the NICU as a specialized practice setting due to the medical and developmental fragility of the infants, the vulnerable emotional status of the families, and the intricacy of medical, cultural, and social factors that impact the family-infant unit [20,21,22,2340]. NTs apply knowledge of neonatal medical conditions, intensive care equipment, preterm infant development and necessary handling precautions, and family system dynamics to contribute to the development of a collaborative management plan that promotes age-appropriate infant neurobehavioral organization and interactions. Interventions provided by NTs optimize long-term development, prevent adverse sequelae, nurture the infant-family dyad, and support education needs of the family and NICU team [12].


A rapidly expanding body of evidence supports the improved scope of outcomes for all involved stakeholders when a comprehensive neuroprotective developmental care model is applied in the NICU setting. Recommendations include neonatal therapy expertize as essential for optimal delivery of an integrated family-centered neuroprotective care model. Provision of therapy services in the NICU is an advanced area of practice for OT, PT, and SLP that requires specialized knowledge and experience to function independently as an expert NT in the NICU. Recommended preparation resources are available to assist licensed professionals to acquire the discipline-specific expertize needed to meet practice standards in this acute medical practice setting. It is incumbent on the individual therapist to work collaboratively within a transdisciplinary service delivery model to maximize the effectiveness of services of all care providers while simultaneously working to gain the requisite discipline-specific advanced training needed to fulfill the unique contributions the respective disciplines offer in this complex acute care setting.




Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight

May 27, 2021WHO Immediate KMC Study Group

N Engl J Med 2021; 384:2028-2038
DOI: 10.1056/NEJMoa2026486


“Kangaroo mother care,” a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (<2.0 kg) when initiated after stabilization, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among infants with low birth weight are uncertain.


We conducted a randomized, controlled trial in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania involving infants with a birth weight between 1.0 and 1.799 kg who were assigned to receive immediate kangaroo mother care (intervention) or conventional care in an incubator or a radiant warmer until their condition stabilized and kangaroo mother care thereafter (control). The primary outcomes were death in the neonatal period (the first 28 days of life) and in the first 72 hours of life.


A total of 3211 infants and their mothers were randomly assigned to the intervention group (1609 infants with their mothers) or the control group (1602 infants with their mothers). The median daily duration of skin-to-skin contact in the neonatal intensive care unit was 16.9 hours (interquartile range, 13.0 to 19.7) in the intervention group and 1.5 hours (interquartile range, 0.3 to 3.3) in the control group. Neonatal death occurred in the first 28 days in 191 infants in the intervention group (12.0%) and in 249 infants in the control group (15.7%) (relative risk of death, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P=0.001); neonatal death in the first 72 hours of life occurred in 74 infants in the intervention group (4.6%) and in 92 infants in the control group (5.8%) (relative risk of death, 0.77; 95% CI, 0.58 to 1.04; P=0.09). The trial was stopped early on the recommendation of the data and safety monitoring board owing to the finding of reduced mortality among infants receiving immediate kangaroo mother care.


Among infants with a birth weight between 1.0 and 1.799 kg, those who received immediate kangaroo mother care had lower mortality at 28 days than those who received conventional care with kangaroo mother care initiated after stabilization; the between-group difference favoring immediate kangaroo mother care at 72 hours was not significant. 

<a href=”http://BACKGROUND “Kangaroo mother care,” a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (Source:https://www.nejm.org/doi/full/10.1056/NEJMoa2026486

AAMC estimates 124K more physicians will be needed by 2034, with the largest gap among specialists

by Jacqueline Renfrow – Jun 15, 2021

The U.S. is going to have a massive shortage of physicians in primary and specialty care by 2034, according to new estimates.

The Association of American Medical Colleges (AAMC) projects a shortage between 37,800 and 124,000 physicians, with the largest disparities being in the area of specialty doctors.

The seventh annual study by the life science division of IHS Markit was conducted in 2019, prior to the start of the COVID-19 pandemic, and looked at data such as physician work hours, retirement and other trends in the healthcare workforce.

“The COVID-19 pandemic has highlighted many of the deepest disparities in health and access to health care services and exposed vulnerabilities in the health care system,” AAMC President and CEO David Skorton, M.D., said in a statement. “The pandemic also has underscored the vital role that physicians and other healthcare providers play in our nation’s healthcare infrastructure and the need to ensure we have enough physicians to meet America’s needs.” One of the biggest concerns for the future of physicians is the rise in clinician burnout, which—intensified by the pandemic—has led workers to cut hours or accelerate retirement. Before the pandemic, in 2019, 40% of U.S. physicians felt burned out at least once a week. And according to the survey, more than two out of every five active physicians in the U.S. will reach the age of 65 or older within 10 years.

“We are taking a closer look at the well-being of healthcare workers,” Janis Orlowski, M.D., chief healthcare officer for the AAMC, told Fierce Healthcare. “We had a summit right before COVID with CEOs to discuss what we could do nationally to standardize metrics for credentials and licensing to take the burden of paperwork and overhead from physicians.”

Simultaneously, she said the industry needs to make sure teams are working together locally to improve well-being for all healthcare staff, and ultimately, patients.

Shortage or not, factors within the U.S. population are speeding up the need for more healthcare workers. For example, from 2019 to 2031, the population is projected to grow by 10.6%, with an increase of 42.4% of those aged 65 and above.

Looking at the data specifically, primary care shortages will range between 17,800 and 48,000 physicians. And within specialties, surgical shortages will be one of the highest, between 15,800 and 30,200 physicians.

Orlowski notes the number of medical schools and medical education enrollment are up, which is a positive step toward increasing the number of physicians in the U.S.

And at the end of 2020, Congress added 1,000 new Medicare-supported graduate medical education positions—200 per year for five years—targeted at underserved rural and urban communities. New bipartisan legislation called The Doctors of Community (DOC) Act, introduced in the House of Representatives Tuesday and expected to be released in the Senate next week, would permanently authorize the Teaching Health Center Graduate Medical Education program that aims to train primary care medical and dental doctors. The legislation would increase annual funding by more than $500 million per year from 2024 through 2033.

Finally, the pandemic has put a spotlight on disparities in health and access to care among underserved populations in the U.S. The estimates in the survey do not include the additional 180,400 physicians AAMC believes the country would need if there were fewer barriers to access for minority populations as well as if people living in rural communities and people without health insurance were included.

“The issue that I’m probably most worried about is equity,” said Orlowski. “As we take a look at equity throughout the U.S. and how different populations are affected by COVID, it strikingly points out the differences of access and utilization. If everyone had the same access to physicians as those who are living in an urban center, white, not low-income, we would still need more than 180,000 physicians to build equity. And that’s not 15 years from now, that’s today.”



Neonatal Intensive Care Unit Admission Temperatures of Infants 1500 g or More -The Cold Truth

ORIGINAL RESEARCH: Apanovitch, Audrey R. BS, RN; McGrath, Jacqueline M. PhD, RN, FNAP, FAAN; McGlothen-Bell, Kelly PhD, RN, IBCLC; Briere, Carrie-Ellen PhD, RN, CLC     Advances in Neonatal Care: June 2021 – Volume 21 – Issue 3 – p 214-221 doi: 10.1097/ANC.0000000000000787



Smaller preterm infants often receive extra attention with implementation of additional thermoregulation interventions in the delivery room. Yet, these bundles of interventions have largely remained understudied in larger infants.


The purpose of this study was to evaluate initial (or admission) temperatures of infants born weighing 1500 g or more with diagnoses requiring admission to the neonatal intensive care unit (NICU).


Retrospective medical record review of 388 infants weighing 1500 g or more admitted to the NICU between January 2016 and June 2017.


In total, 42.5% of infants weighing 1500 g or more were admitted hypothermic (<36.5°C), 54.4% with a normothermic temperature, and 2.8% were hyperthermic. Of those infants admitted hypothermic, 30.4% had an admission temperature ranging from 36°C to 36.4°C and 12.1% had an admission temperature of less than 36°C. When compared with infants weighing less than 1500 g, who were born at the same institution and received extra thermal support interventions, there was a statistically significant difference (P < .001) between admission temperatures where infants less than 1500 g were slightly warmer (36.8°C vs 36.5°C).

Implications for Practice: 

Ongoing admission temperature monitoring of all infants requiring NICU admission regardless of birth weight or admission diagnosis is important if we are going to provide the best support to decrease mortality and morbidity for this high-risk population.

Implications for Research: 

While this study examined short-term outcomes, effects on long-term outcomes were not addressed. Findings could be used to design targeted interventions to support thermal regulation for all high-risk infants.


Neonates admitted to the NICU weighing 1500 g or more are at high risk for developing hypothermia, similar to smaller preterm infants.


What Did Pre-COVID PTSD Look Like for Interns?

— Life-related risk factors played a key role, study found by Kara Grant, Enterprise & Investigative Writer, MedPage Today June 8, 2021

Symptoms of work-related post-traumatic stress disorder (PTSD) were three times higher for interns than the general population, according to a 2018 study.

There were 10.8% of intern physicians who screened positive for PTSD at the end of their first internship year compared with a 12-month prevalence of 3.6% in the general population, reported Mary Vance, MD, of the Uniformed Services University’s Center for the Study of Traumatic Stress in Bethesda, Maryland, and colleagues.

Among 1,134 resident physicians surveyed, 56.4% reported exposure to trauma in the workplace, and 19% of that group screened positive for PTSD by the end of their residency, the authors wrote in JAMA Network Open.

“Doctors with PTSD … in addition to being unwell, don’t necessarily function at the top of their ability,” commented Albert Wu, MD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, who was not involved with the study. “This can diminish their ability to deliver the best quality care, and may increase incidents of medical errors,” he told MedPage Today.

Wu coined the term “second victim” over 2 decades ago to highlight the need for mental health services for doctors who were involved in a medical error. He explained that physicians-in-training are particularly susceptible to trauma exposure, as they are just beginning to adjust to the onslaught of new stressors from residency.

For the study, Vance and colleagues contacted interns from participating institutions across a wide array of specialties 2 months before the start of participants’ training. After this baseline assessment, there were four follow-up surveys sent via email at months 3, 6, and 12 of internship. The authors used the Primary Care PTSD Screen for DSM-5 to assess trauma exposure and PTSD symptoms.

The mean age of those surveyed was about 28; 58.6% were women and 61.6% were non-Hispanic white.

Multivariable logistic regression analyses found, not surprisingly, that those who reported working longer hours experienced higher rates of exposure to work-related trauma (OR 1.01, 95% CI 1.00-1.03, P=o.03). Early family environment and the presence of stressful life events at baseline were also significant risk factors (OR 1.03, 95% CI 1.01-1.05, P<0.001; OR 1.46, 95% CI 1.06-2.0, P=0.02, respectively) for trauma exposure, the researchers found.

There were associations between screening positive for PTSD and certain risk factors, such as being unmarried (OR 2.00, 95% CI 1.07-3.73, P=0.03) or experiencing stressful life events during internship (OR 1.43, 95% CI 1.14-1.81, P=0.002).

While there was no association between specialty and trauma exposure overall, the authors found surgery and psychiatry were “less associated” with PTSD following work exposure (OR 0.26, 95% CI 0.09-0.81, OR 0.15, 95% CI 0.03-0.77, respectively), but Vance’s group urged caution when interpreting these findings as they were only compared to internal medicine.

For interns and residents who reported depression during their last month of training, there was a significant association between depression and PTSD (OR 2.52, 95% CI 1.36-4.65, P=0.003). PTSD and reports of anxiety during the last month of residency were also significant (OR 2.14, 95% CI 1.13-4.04, P=0.02), the team reported.

Study limitations included the relatively low response rate to the survey (26% overall).

“More research is needed to determine the prevalence of trauma exposure and PTSD at different stages of a physician’s career,” the researchers concluded.

Wu agreed, noting that the interns who made it through the survey process may have wanted a platform to air out frustrations and grievances; he suggested that, as a result, the study’s rates of PTSD symptoms might be an overestimation.

He said that considering the physicians who started their journey into residency during a pandemic, COVID-19, and the high rates of work-related trauma that emerging doctors have experienced this year have made medicine more receptive to conversations around PTSD and funding future research.

“Interns experience tremendous stress during training,” he said. “I’d like to see every training program … take steps to make sure they have adequate support systems in place for … their most valuable asset — their health workers.”

JAMA Network Open

Source Reference: Vance MC, et al “Exposure to workplace trauma and posttraumatic stress disorder among intern physicians” JAMA Netw Open 2021; DOI: 10.1001/jamanetworkopen.2021.12837.

Source: https://www.medpagetoday.com/psychiatry/anxietystress/92994?vpass=1

Barriers to Kangaroo Care in the NICU A Qualitative Study Analyzing Parent Survey Responses

Saltzmann, April M. RN, MSN, NNP-BC; Sigurdson, Krista PhD; Scala, Melissa MD Editor(s): Dowling, Donna PhD, RN; ; Schierholz, Elizabeth PhD, MSN, NNP-BC; ; Parker, Leslie PhD, APRN, FAAN; Advances in Neonatal Care: May 27, 2021 – Volume Publish Ahead of Print – Issue – doi: 10.1097/ANC.0000000000000907



Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored.


To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC.


This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services.


Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance.

Implications for Practice and Research: 

The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.

© 2021 by The National Association of Neonatal Nurses



Gravens by Design: Should Nurturing Stimuli be Limited to Times When a Preterm Baby is Awake?

For many years, the NICU was an undesirable place for a baby’s brain to develop. Lights were bright, the noise was pervasive, painful procedures plentiful, sleep disturbed frequently, and parental access severely restricted. There has been a gradual awakening to the adverse effects this can have on a premature infant who is in the “synaptic explosion” stage of brain growth and development, which, coupled with technological changes that allow us to monitor babies better and less invasively, has enabled us to minimize these noxious stimuli. The importance of infant sleep to brain development has also gained greater recognition so that timing necessary interventions to protect sleep is happening more often.

Concurrently, there has also been a move to introduce nurturing stimuli into the baby’s experience. Skin-to-skin care (1), music (2), reading (3,4), and circadian lighting (5) are examples of such stimuli that are much more commonly offered today than they were in the earlier days of NICU care.

Unfortunately, in many NICUs, the effort to reduce overstimulation and protect infant sleep has come into conflict with the desire to provide nurturing stimuli. It is hypothesized by some practitioners that there is danger in providing these stimuli when an infant is asleep on the grounds that it may cause overstimulation or interfere with the important sleep cycle itself. Thus, nurses and parents are often admonished to stop reading and providing music once their baby falls asleep and to keep the lights dim. Some also prescribe a maximum amount of time these stimuli should be provided in the course of a day, suggesting again that there is a risk of overstimulation. In fact, there is no data to support these beliefs; it is more likely an overly enthusiastic acceptance of the desire to protect babies that has led to this practice – good intentions can have unintended consequences. William Fifer demonstrated that newborns, unlike any other age group, learn while they are asleep (6,7). In utero, we know that infants learn to recognize their mother’s voice (8) and smell; we also know that the fetus sleeps most of the time, so these stimuli are likely presented and learned for many hours every day, much of that time while the fetus is asleep.

Unless new data demonstrate that presenting these nurturing stimuli to babies is harmful or that limits are necessary, then we should no longer proscribe their use once an infant falls asleep. Babies are likely to benefit and, in all likelihood, will not be harmed by continuing to provide them with auditory, vestibular, and circadian stimuli throughout the sleep cycle. Of course, these stimuli should be removed if the baby appears to react adversely, but it is much more common to see that babies continue to sleep peacefully even when the nurturing stimuli are continued. Incubators and private rooms are important tools for protecting babies from overstimulation, but they can also become isolation chambers if parents are absent and we do not enrich their sensory environment or do so only in small doses. The best environment for neurosensory development in the NICU is in the arms of a caregiver or when that is not feasible in the presence of nurturing stimuli. Certainly, we need more data to determine what that should look like exactly, but our default should not limit sensory input altogether in a well-meaning effort to protect infant sleep.


Fetal Surgery Boosts Survival for Babies With Severe Birth Defect

— Randomized trial confirms benefit of complex fetal procedure

by Amanda D’Ambrosio, Enterprise & Investigative Writer, MedPage Today June 8, 2021

Fetoscopic endoluminal tracheal occlusion (FETO) resulted in higher survival rates among babies with severe diaphragmatic hernia on the left side, according to a randomized trial.

Fetuses with severe left diaphragmatic hernia, a condition that disrupts normal airway and pulmonary vascular development, had more than double the chances of surviving to discharge from the NICU after they underwent FETO between 27 and 29 weeks’ gestation, compared to fetuses that received expectant care (RR 2.67, 95% CI 1.22-6.11), reported Jan Deprest, MD, PhD, of University Hospitals Leuven in Belgium, and colleagues.

Fetoscopic endoluminal tracheal occlusion (FETO) resulted in higher survival rates among babies with severe diaphragmatic hernia on the left side, according to a randomized trial.

Fetuses with severe left diaphragmatic hernia, a condition that disrupts normal airway and pulmonary vascular development, had more than double the chances of surviving to discharge from the NICU after they underwent FETO between 27 and 29 weeks’ gestation, compared to fetuses that received expectant care (RR 2.67, 95% CI 1.22-6.11), reported Jan Deprest, MD, PhD, of University Hospitals Leuven in Belgium, and colleagues.

Infant survival rates in the FETO group were identical up to 6 months after the procedure, the researchers wrote in an early edition of the New England Journal of Medicine.

The prevalence of severe diaphragmatic hernia is 1 in 4,000 infants, with around 85% of the defects occurring on the left side. Deprest and colleagues stated that the condition is associated with high rates of neonatal death from respiratory failure or pulmonary hypertension, as the hernia blocks a fetus’s airway and can disrupt lung growth.

Fetal lung growth can be stimulated by tracheal obstruction, the researchers noted. During FETO, clinicians prenatally insert a small, inflatable balloon into a fetus’s trachea, which can be done while the mother is under local anesthesia. A few weeks after insertion, the balloon is removed.

Deprest said that observational data previously indicated that FETO may increase survival rates among fetuses with congenital diaphragmatic hernia, but this randomized trial was able to confirm that benefit. Now, he said, researchers are looking into ways to optimize timing of diagnosis.

“To have choices, parents need to have a prenatal diagnosis, and it is better to have that by end of the second or beginning of the third trimester,” he told MedPage Today.

Deprest’s group did find some adverse effects. FETO was associated with a higher risk of preterm, pre-labor rupture of membranes (RR 4.51, 95% CI 1.83-11.9), and preterm birth (RR 2.59, 95% CI 1.59-4.52).

Additionally, the researchers conducted another study published in the New England Journal of Medicine evaluating the effect of the procedure on fetuses with moderate congenital diaphragmatic hernia on the left side. The group found no benefit of FETO when performed between 30 and 32 weeks (RR 1.27, 95% CI 0.99-1.63, P=0.06).

“To me, it was surprising that there was a difference in the effect,” Deprest said. “But in retrospect, this probably has to do with the fact that we did the operation later,” he added, noting that in fetuses with a severe condition, the procedure was likely to be performed at least a week earlier than those with moderate illness.

In an accompanying editorial, Francis Sessions Cole, MD, of the Washington University School of Medicine in St. Louis, said that the data from this trial increase our understanding of FETO and may help inform counseling for parents. However, Cole stated that this trial is limited in that it only followed infants 6 months after the procedure, and did not perform prospective genetic screening.

Cole added that the trial raises technical questions about the procedure, including the frequency of spontaneous balloon deflation prior to removal, as well as the increased risk of pre-labor rupture of membranes and preterm birth.

“The current reports serve as a critical basis for future studies to improve outcomes in pregnancies complicated by fetal congenital diaphragmatic hernia and in infants,” Cole wrote.

Study Details

Deprest and colleagues designed the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trial, to assess postnatal survival rates after FETO in infants with severe pulmonary hypoplasia from a diaphragmatic hernia on the left side. They conducted the open-label, randomized trial in 10 FETO centers and 26 neonatal care centers in several countries, including Belgium, Japan, the U.S., and others.

Women were included in the study if they were older than age 18, had a singleton pregnancy, were at a gestational age less than 30 weeks, had congenital diaphragmatic hernia on the left side and severe pulmonary hypoplasia. Mothers were excluded if they had conditions that would make fetal surgery risky or an elevated risk of preterm birth.

Starting in February 2011, researchers conducted preliminary assessments on more than 1,300 mothers carrying fetuses with congenital diaphragmatic hernia. The trial was stopped in March 2020 for efficacy at the third interim analysis, and 80 women were ultimately included. Of these, 40 were randomized to FETO surgery and 40 to expectant care. There were no differences in baseline characteristics between groups.

A total of 40% of infants in the FETO group and 15% in the expectant care group survived to discharge from the NICU. Survival at 6 months was identical to survival at discharge from the NICU.

In 38% of patients, delivery occurred within 24 hours after balloon removal. Preterm, pre-labor rupture of membranes occurred in 47% of mothers in the FETO group, while it occurred in only 11% in the expectant care group. Preterm birth was observed in 75% of women in the FETO cohort, compared to 29% in the expectant care group.

Among the FETO procedures, there were five spontaneous balloon deflations. Additionally, there was one case of placental laceration from fetoscopic balloon removal that led to neonatal death, and another neonatal death from failed balloon removal.

Deprest and colleagues noted that their results were limited by the long duration of the trial, as protocols for postnatal care of congenital diaphragmatic hernia may have changed. The group also acknowledged that this study only provides information on short-term outcomes, and that future studies are needed to assess the long-term effects of FETO. Finally, as the trial involved experienced fetal surgery units, the researchers said that results should not be generalized to centers that do not have experience in fetoscopy or FETO.

Deprest stated that future research will evaluate optimal timing of diagnosis, and medications that could improve the success of the procedure. “But there is hope now, for these patients,” he said.


This subject is very close to my heart and intellect. I also want to shout out to Bruce Lipton PhD, a global leader in the science of epigenetics, whose work I have followed for decades. Treatment for preverbal PTSD, which many preemies may experience, is critically lacking.  Expertise towards developing therapies to treat preterm birth survivors who experience preverbal PTSD is not developed or available. A key component in the neonate development to consider beyond unique NICU stimulus is the lack of human touch. I believe that an essential component in developing treatment for the effects (physical, cognitive, neurological, psychological, developmental) of preterm birth experience is to avoid assuming that symptom-similar psychological/cognitive behaviors imply similar interventions are effective and adequate. It is critical to look at the preterm birth development process as a unique human developmental experience that justifies focused research and specifically related medical, physical, behavioral, educational, cognitive and psychological treatment options.

Epigenetics Explains the Imperative for Extended, Intimate Human Contact in Every Newborn, Especially Those at the Highest Risk

“Developmental Care,” a term often used to encompass both sensory protection and targeted sensory stimulation in high-risk newborns, has faced two serious challenges since its inception:

• It has been difficult to prove its value.

• It has not been easy to incorporate into a NICU culture.

The primary tenets of developmental care – that newborns should be protected from noxious stimuli and provided with age-appropriate nurturing stimuli by their parents whenever possible – were established in extensive studies decades ago. In the 1950s, John Bowlby (in humans) and Harry Harlow (in monkeys) showed that separating newborns from their mothers led to immediate and lasting psychological changes. Even so, this separation continued to be practiced in newborn nurseries until it was successfully challenged by Marshall Klaus and John Kennell in the 1970s. Their work led to a radical change in maternity services in the newborn nursery but a much lesser degree in the NICU.

As parents continued to be excluded from the NICU or, at best, allowed to “visit” their infants, efforts to enrich the sensory environment in the absence of parental caregiving were introduced, of which the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is the most notable example. A highly structured, labor-intensive, specialist-based program, NIDCAP became well-established in some NICUs, supported by several trials that suggested efficacy (1), but has not been adopted by a large majority of NICUs because of its cost, complexity, and absence of evidence of a compelling benefit(2). However, several other developmental care-based programs have been introduced, some of which, such as the SENSE program, are actively being studied (3).

Concurrent with these efforts, families have been granted increased access to their infants as both structural and operational barriers are removed. The importance of family participation is emphasized in NIDCAP, SENSE, and similar programs, but the value of simple skin-to-skin care, even without a structured developmental care program, has also been demonstrated. While numerous trials suggest efficacy, meta-analysis has yet to confirm the benefit of skin-to-skin care in high-risk premature infants except in resource-limited settings (4).

Perhaps the chief challenge with these efforts has been that neuronal development in the premature infant is still largely a “black box.” The impact of a ventilator change, a dose of surfactant, or most other NICU interventions can be easily demonstrated – if not immediately, then at least within a short time and almost always by the time an infant is discharged. However, there is no such obvious positive response to developmental care that a clinician can appreciate by making rounds. A NIDCAP therapist can detect responses to interventions, as can a nurse when an infant is being held skin-to-skin, but these do not show up on the datasheets or outcome measures that drive decision-making in the NICU. It may well be that more long-term brain deficits are secondary to inadequate developmental care in the NICU than to intraventricular hemorrhage, but we have no real-time markers available to us to study this.

Developmental Care Has Not Been Easy to Incorporate into a NICU’s Culture:

Providing the optimal sensory environment for high-risk newborns throughout their NICU stay is challenging for multiple reasons:

• Parental interaction is often restricted by operational rules or by parental absence.

• Nursing provision of developmental support is seen as secondary and optional in many NICUs. Nurses obtain vital signs, provide feedings, and change diapers in even the most stable infants; they understand there will be consequences if they do not do this. But all these tasks can be accomplished without providing any nurturing stimuli and neglecting this aspect of care rarely brings any consequences to the provider.

• Developmental specialists are costly in that their services generally do not generate revenue

If developmental care provided immediate evidence of its value or generated revenue, it would be much easier to incorporate into the fabric of NICU care.

Is There a Way Forward?

It is unlikely that strong data to support developmental care or skin-to-skin care in high-risk infants will appear in the near future, given that large, multi-center trials are not currently in progress and are unlikely to be launched due to their cost and complexity.

Fortunately, in an ironic twist that Harry Harlow would best appreciate, we have been able to return to studies in primates to find compelling evidence of the lifelong impact of sensory deprivation caused by the separation of babies from their mothers at birth, expressed in a language that modern-day scientists understand: DNA methylation. In a fascinating TED talk (5), Moshe Szyf describes how early life experience, especially maternal-infant interaction, influences the long-term expression of many genes. Monkey newborns who are separated from their mothers appear healthy, but an examination of DNA methylation of their genome reveals dramatic differences from siblings who remained with the mother. As in Harlow’s studies, the monkeys who provided surrogate care suffered long-term psychological and physical differences that could not be explained by genetic differences or health in infancy. Instead, the lack of normal sensory input early in life led to a permanent change in gene expression that persisted into adulthood. These trials provide evidence that cannot ethically be obtained in humans but is certainly relevant to the NICU environment of care. It requires little imagination to draw a line connecting these findings to the continued high burden of neuropsychological disability seen in NICU graduates.

Epigenetics, then, explains how early life experiences influence the expression of the genetic code, even for neurons yet to form. Changes in DNA methylation that occur early in infancy can have a lifelong impact on health and behavior. Neuronal growth, synaptic formation, and DNA methylation are not put “on hold” while the infant is in the NICU; therefore, developmentally supportive care, centered around parents whenever possible, is an essential component of state-of-the-art NICU care.


How  Early Life Experience is Written into DNA

Moshe Szyf is a pioneer in the field of epigenetics, the study of how living things reprogram their genome in response to social factors like stress and lack of food. His research suggests that biochemical signals passed from mothers to offspring tell the child what kind of world they’re going to live in, changing the expression of genes. “DNA isn’t just a sequence of letters; it’s not just a script.” Szyf says. “DNA is a dynamic movie in which our experiences are bein