Malawi, Mothers, Medicine & Innovation

Malawi, officially the Republic of Malawi, is a landlocked country in Southeast Africa. It is bordered by Zambia to the west, Tanzania to the north and northeast, and Mozambique to the east, south, and southwest. Malawi spans over 118,484 km2 (45,747 sq mi) and has a population of 22,224,282 (as of July 2025). Lilongwe is its capital and largest city.

Malawi is one of the world’s least developed countries. Its economy is heavily based on agriculture, and it has a largely rural and growing population. The country has a low life expectancy and high infant mortality. HIV/AIDS is highly prevalent. The diverse population includes native peoples, Asians, and Europeans. The population is predominantly Christian, and the majority are Protestant.

Health services

Health services in Malawi are provided by the public, private for profit (PFP), and private not for profit (PNFP) sectors. The Ministry of Health (MOH) is responsible for overseeing healthcare in Malawi.

63% of health services are provided by the government, 37% are provided by the Christian Health Association of Malawi (CHAM), and a small fraction of the population receive health services through the private sector. Private doctors and non-governmental organizations (NGOs) offer services and medicines for a nominal fee.

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

STATS

COMMUNITY

The nonprofit organization founded by former President Franklin D. Roosevelt says 1 in 3 U.S. counties remains a maternity care desert, which is defined as an area without hospitals or birth centers that offer obstetric care, and lacks practicing obstetric clinicians like doctors or midwives.

“Maternity care deserts are not naturally occurring, nor are they inevitable. They are the result of policy decisions and longstanding underinvestment in maternity care infrastructure,” the report entitled “Nowhere to Go” says. 

“Individuals in these communities are increasingly required to navigate pregnancy and childbirth with fewer local resources and greater travel burdens,” it adds. 

Expecting moms in rural or underserved areas are more likely to face the consequences of maternity care deserts while conditions impact nearly 370,000 births annually, per the report.

The March of Dimes found that 35.9 percent of U.S. counties don’t have a practicing obstetrician clinician. 

More than half, or 57.9 percent, of rural counties don’t have access to an obstetrician clinician compared to 19.4 percent of urban counties. The report says workforce shortages are driving the disparity. 

“Recruiting and retaining clinicians in rural areas is further challenged by professional isolation, heavy workloads, frequent on-call demands, and family considerations including limited employment opportunities for spouses, housing availability, and long travel distances,” the report says. 

“Evidence suggests that medical students who complete rural training are more likely to practice in those settings, especially if they come from rural backgrounds. Strengthening rural training pipelines and recruitment is critical to addressing long-term workforce shortages. Additional strategies include expanding rural training programs, offering loan repayment incentives, and leveraging telehealth to support collaboration and complex care management,” it adds. 

Solving the lapse in care could help the U.S. rebound from its status as a country with the highest maternal and infant mortality rates — as well as the lowest overall life expectancy — among comparable high-income, developed peer nations.

The March of Dimes says expanding the workforce is key, noting that 16 states have already expanded midwifery practices, including independent practices, prescribing authority, admitting privileges and pay parity for certified nurse-midwives, or CNMs.

Comparatively, 26 states and Washington, D.C., now allow doulas to enroll as Medicaid providers and bill Medicaid independently.

The report says opening more birthing centers, ensuring expecting mothers are insured and access to reimbursement programs could solve the maternal care crisis in the U.S. 

“Traditionally, healthcare providers in the U.S. have been reimbursed through a fee-for-service (FFS) model, in which payment is tied to each individual service delivered. In contrast, value-based payment (VBP) models incentivize high-quality, coordinated, and cost-efficient care. Efforts to expand VBP in maternity care include pay-for-performance models, episode-based bundles, maternity care homes, population-based models, and total cost of care approaches,” the report says. 

“Strengthening and scaling value-based maternity care models may improve access, quality, and cost-efficiency. Some value-based models also create opportunities to better integrate midwives, doulas, care coordination, and postpartum support into maternity care systems,” it continues.

Source: https://thehill.com/policy/healthcare/6023785-march-dimes-maternity-deserts/

Key Points

Question  Does an integrated intervention delivered to mother-infant dyads during infancy improve growth among term small-for-gestational-age infants?

Findings  In this individually randomized clinical trial of 1300 term small-for-gestational-age infants in South Delhi, India, those receiving an integrated package of health, nutrition, and early stimulation support had significantly higher weight at 12 months (8.0 kg vs 7.8 kg) and weight-for-age z score (−1.3 vs −1.6) than those receiving usual care.

Meaning  An integrated intervention delivered during infancy improved growth among small-for-gestational-age infants born at term.

Abstract

Importance  Small-for-gestational-age (SGA) infants face elevated risk of undernutrition and developmental delays. Multidomain interventions may be needed to promote growth and neurodevelopment.

Objective  To evaluate the effect of an integrated intervention package on growth and neurodevelopment in term SGA infants.

Design, Setting, and Participants  Individually randomized clinical trial conducted in low-resource neighborhoods of South Delhi, India. Term SGA infants were enrolled within 14 days of birth; 1300 infants were randomized and followed up to 12 months of age. Recruitment occurred from January 14, 2023, until July 31, 2024, with follow-up completed on August 6, 2025. Outcome assessors were blinded to participant allocation.

Interventions  Infants were randomized in a 1:1 ratio to receive either an integrated intervention package including health, nutrition, early child stimulation, and psychosocial support (n = 647) or usual care through government programs (n = 653).

Main Outcomes and Measures  The primary outcomes were weight and weight-for-age z score at 12 months. Secondary outcomes included linear growth, neurodevelopment (assessed using the Bayley Scales of Infant and Toddler Development, Third Edition), anemia, and mortality.

Results  At 12 months, 1261 infants (97%) (mean age, 6 days; 48.1% male) had completed follow-up. The mean weight was 8.0 kg (SD, 0.9 kg) in the intervention group vs 7.8 kg (SD, 0.9 kg) in the usual care group (mean difference, 0.22 kg [95% CI, 0.11-0.32 kg]). The mean weight-for-age z score was −1.3 (SD, 0.9) vs −1.6 (SD, 1.0), respectively (mean difference, 0.24 [95% CI, 0.14-0.35]). The intervention group had a lower prevalence of underweight (23.9% vs 32.6%; risk difference, −8.75 [95% CI, −13.70 to −3.80] percentage points), stunting (20.1% vs 27.2%; risk difference, −7.17 [95% CI, −11.85 to −2.49] percentage points), wasting (13.9% vs 19.4%; risk difference, −5.52 [95% CI, −9.63 to −1.41] percentage points), and anemia (34.0% vs 72.5%; risk difference, −38.49 [95% CI, −44.36 to −32.61] percentage points) and higher cognitive scores (mean difference, 1.73 [95% CI, 0.32-3.14]), language scores (mean difference, 2.74 [95% CI, 1.51-3.98]), and motor composite scores (mean difference, 2.32 [95% CI, 1.25-3.38]). Nine children in the usual care group and 5 in the intervention group died.

Conclusions and Relevance  Among term SGA infants, an integrated intervention improved weight and weight-for-age z scores at 12 months.

Source: https://jamanetwork.com/journals/jama/article-abstract/2852130

The gap between health systems and women’s health needs is deep. PATH’s Chief Global Health Programs Officer Kammerle Schneider explains how our new strategy paves the way to better health for women and girls.

A few years ago, I visited a small clinic in rural Zambia early in the morning. The clinic had not opened yet, but there was already a long line of people waiting outside.

Women sitting quietly on wooden benches. Babies tied to their backs. Toddlers playing happily. Inside, one nurse was preparing for what was likely going to be a long day.

After standing there for a few minutes, I noticed something I have seen again and again in clinics and communities around the world.

Every single person in that line was a woman.

Some were pregnant and coming for prenatal care. Some were bringing children for vaccinations. Others were picking up medicine for parents, partners, or other family members.

This single moment captured what we already know from decades of data from communities around the world—that women are holding the health system together. And yet, too often, the health systems that depend on women are hard for women to use and they fail to address women’s unique needs.

First, more often than not, women are responsible for the whole family’s health care while also balancing childcare, eldercare, household management, and paid work. Around the world, women do 16 billion hours of unpaid care work every single day. Meanwhile, health systems often require patients to travel, wait for hours, return multiple times, and navigate separate health services on separate days.

Second, global health has long focused on women’s health primarily through the lens of pregnancy and childbirth. Maternal health is critically important. But girls and women live full lives, through adolescence, reproductive years, midlife, menopause, aging, and everything in between. Their health needs span decades, yet the evidence, financing, and care models too often remain too narrow.

That narrowness has consequences.

For too long, women have been underrepresented in research. Conditions that affect women uniquely, differently or disproportionately have received too little attention. In fact, women spend 25 percent more of their time— approximately 9 years—in poor health compared to men, and yet, only 4 percent of pharmaceutical research focuses on women’s health care needs.

By investing in women’s health and building systems that work for women, we can strengthen infectious disease prevention, primary care, research equity, and economic stability. We can improve childhood vaccination, families’ abilities to seek care early, and community resilience.

The good news is that the solutions are rarely abstract. They are often very practical—better evidence, simpler and more accessible quality health care delivery, and more control in the hands of women themselves.

That is one of the central challenges PATH’s new Strategy 2030 is built to address. Our strategy is about moving from innovation to impact, making sure breakthroughs do not just exist, but actually reach the people who need them most.

Putting women and girls at the center is an intentional strategy choice, because if a health strategy does not work for women and girls, it does not work.

That is where PATH can make a real difference.

Our new strategy focuses our work on three priorities: developing and introducing vaccines, diagnostics, and devices that reach everyone; protecting more people from infectious diseases; and strengthening and integrating health care for current and emerging needs.

Across all three, women and girls are the throughline.

For instance, when we advance HPV vaccination, we are not only preventing cervical cancer. We are correcting a longstanding failure to invest in girls’ health and futures. PATH-supported research showing that a single dose of the HPV vaccine can provide strong protection matters because it simplifies delivery, lowers costs, and expands access, especially in places where health systems are stretched.

When we support self-injectable contraception, we are not only introducing a product. We are shifting power. We are making it possible for women to decide when and where they access contraception, without depending on a clinic visit every few months.

And when we integrate prevention, screening, and treatment for multiple diseases into routine maternal care, we are not just improving efficiency. We are respecting women’s time and the reality of their lives. From the system’s perspective, HIV, malaria, and hepatitis B may fit in different categories, with different donors and reporting lines, but from a woman’s perspective, it is her health and her baby’s health. When she comes in for care, she should receive comprehensive care in one visit.

When women are healthy, everything else in the village works.

This is what it means to move from innovation to impact: After asking whether an intervention works in theory, we must also ask whether it works in women’s real lives.

So as we look toward 2030, we should be honest about what health equity requires.

That means asking better questions. Who was included in the evidence? Who can actually access the product? Whose time does the system require? Who carries the burden when care is fragmented? And does this solution help or complicate women’s lives?

These questions should sit at the center of how we define impact.

A community health worker once told me, “When women are healthy, everything else in the village works.”

That simple sentence captures what decades of global health work have shown. When women are healthy, children are more likely to thrive. Families are more economically stable. Prevention happens earlier. Health systems function better. Communities are more resilient.

Centering women and girls is not just the right thing to do. It is one of the smartest ways to build health systems that are more practical, more equitable, and more effective for everyone. Because the people holding health systems together should not have to fight so hard to be served by them.

Source: https://www.path.org/our-impact/articles/they-fail-everyone/

HEALTHCARE PARTNERS

Every neonatologist understands that the first days of life can shape a child’s entire future. We care for infants born too soon, too small, or critically ill, while guiding families through moments they never expected to face.

 Yet neonatal outcomes are not determined solely by medicine. They are influenced by whether a mother has access to prenatal care, whether an infant has health coverage after discharge, and whether families can obtain medications, preventive and specialty services, developmental support, and reliable follow-up care.

That is why the priorities of the American Academy of Pediatrics should matter deeply to neonatologists—and why neonatologists must have a stronger voice in determining the Academy’s future.

Medicaid and CHIP Are Essential to Neonatal Care:

Medicaid and the Children’s Health Insurance Program (CHIP) are sometimes discussed as broad insurance or public-policy programs.  For neonatologists, however, they are part of the clinical infrastructure supporting newborns and their families.

Medicaid finances about 40% of births in the United States and is especially important for infants born prematurely, infants with complex medical conditions, and those requiring prolonged hospitalization. CHIP provides coverage for children in families whose incomes may be too high for Medicaid but who may still be unable to afford comprehensive insurance.

Together, these programs support prenatal and maternity care, neonatal intensive care, and newborn screening, medications, specialty consultations, therapies, home health services, medical equipment, and essential follow-up after NICU discharge. They are also critical tools for reducing disparities. Families facing poverty, unstable housing, limited transportation, rural isolation, or inadequate access to specialists are more vulnerable to gaps in care. Strong Medicaid and CHIP programs can help narrow those gaps by connecting infants with the services they need before, during, and after delivery, hospitalization, and the transition home.

For a medically fragile infant, coverage cannot end at discharge from the NICU. Survival is only the beginning. A premature infant may require ophthalmology, cardiology, pulmonology, audiology, developmental pediatrics, nutrition services, physical therapy, occupational therapy, early intervention, durable medical equipment, or home nursing.

 When coverage is delayed, interrupted, or inadequate, the consequences become visible in our clinics and emergency departments. Appointments are missed. Prescriptions go unfilled. Developmental problems are identified later. Families already coping with the emotional and financial strain of a complicated birth are forced to navigate an increasingly fragmented system. Protecting Medicaid and CHIP is therefore not separate from neonatal advocacy. It is neonatal advocacy.

The Neonatology Pipeline Is at Risk:

 Recruitment into pediatric subspecialties is a growing challenge. In the most recent fellowship match, more than one in five pediatric fellowship positions went unfilled , and residents weighing debt, training length, and pay are increasingly choosing other paths. Neonatology is not immune. Rebuilding the pipeline requires stable graduate medical education funding, loan repayment that recognizes pediatric subspecialty service, and a profession that remains worth entering. Every unfilled fellowship position today is an uncovered call shift a few years from now. The Academy’s advocacy on workforce will help determine whether the next generation of neonatologists is there when our patients need them.

 Misinformation Is Reaching Families Before We Do:

 Neonatologists are also witnessing the erosion of preventive care for newborns. In a recent three-center study of more than 93,000 newborns, refusal of the hepatitis B birth dose roughly doubled between 2018 and 2025, and refusal of vitamin K prophylaxis doubled as well. Every neonatologist knows what follows: vitamin K deficiency bleeding and perinatal hepatitis B infection, harms we learned to prevent generations ago, returning one declined dose at a time. The Academy must lead with evidence families can trust, and it must equip the clinician standing at the bedside for that conversation.

My AAP Service Has Shaped My Leadership:

 My commitment to the AAP has grown through years of service in neonatal medicine, public health, military medicine, research, education, and pediatric policy. I have served in leadership roles within the AAP Section on Neonatal-Perinatal Medicine and as an Armed Services representative to the Uniformed Services Section. I have also worked closely with the Committee on Fetus and Newborn and served as a CDC liaison, connecting neonatal clinical expertise with public health evidence and national policy.

My research included leading a meta-analysis of 30 years of evidence examining outcomes among very preterm infants born outside hospitals with the highest levels of neonatal care. Published in JAMA, the study found higher mortality among very preterm infants born outside level III or higher facilities. The findings helped inform my work as lead author in AAP policy concerning levels of neonatal care, which now accompanies standards for delivering high-risk infants in appropriately resourced facilities. I also contributed to the seventh and eighth editions of Guidelines for Perinatal Care, the joint AAP and American College of Obstetricians and Gynecologists resource that helps establish standards for maternal, fetal, neonatal, and regionalized perinatal care.

 My AAP service has extended beyond the NICU. Through the Uniformed Services Section, I helped address the needs of children in military families and contributed to the 2013 Pediatrics clinical report on children affected by parental military deployment.

 These experiences taught me that AAP policy is not abstract. It influences where high-risk infants are delivered, how neonatal systems are organized, how clinicians practice, how families are supported, and whether children receive the services they need.

Neonatologists Must Lead Beyond the NICU:

Neonatologists routinely make complex decisions under extraordinary pressure. We lead multidisciplinary teams, interpret rapidly changing clinical information, communicate with anxious and grieving families, and coordinate care across multiple specialties. Those same leadership skills are needed within the AAP.

The Academy’s work directly affects maternal and infant health, insurance coverage, immunization, public health preparedness, injury prevention, safe sleep, substance use treatment, racial and geographic inequities, and the care of children with special health care needs. Each of these issues has important implications for neonatal outcomes and for the health of the infants and families we serve.

Two AAP resolutions considered in 2026 illustrate the connection between neonatology and broader pediatric policy. The first called for hospitals to model safe sleep practices for families before NICU discharge. The resolution was informed by evidence from the Pregnancy Risk Assessment Monitoring System (PRAMS), highlighted by neonatologists, showing that despite late preterm infants being at higher risk for sleep-associated death, they were less likely than term infants to be placed in safe sleep positions. Neonatologists in Massachusetts subsequently developed a quality improvement collaborative to integrate safe sleep practices into NICU care for all birthing hospitals across the state. The initiative’s success contributed to the introduction of a state bill that required Massachusetts hospitals to provide safe sleep education to families of newborns before discharge.

A second resolution supported paid family leave for parents of infants requiring intensive care. In Colorado, a state lawmaker whose family had experienced prolonged NICU hospitalization with the birth of their 29-week infant helped champion legislation that took effect in January 2026, providing an additional 12 weeks of paid family leave for eligible NICU families. (14) Although the safe sleep and paid family leave resolutions did not rank among the top 10 adopted resolutions, both resolutions drew support across the Academy, evidence that neonatal issues command attention within its broader policy agenda.

Our responsibility does not end when an infant leaves the NICU. We must bring our clinical experience and understanding of families into advocacy, policy, research, education, and organizational leadership. That is the perspective I hope to bring to the presidency of the American Academy of Pediatrics.

Representation and Participation Matter:

The Section on Neonatal-Perinatal Medicine is one of the Academy’s largest and most influential groups. Its members bring expertise in clinical care, quality improvement, ethics, research, education, family engagement, systems leadership, and public policy.

Despite that influence, participation in AAP elections is often low, both among pediatricians generally and among neonatologists specifically. Low turnout means that a small fraction of members determines who will help establish the Academy’s priorities, represent pediatricians publicly, and guide its response to the most consequential issues affecting children.

Voting is not merely an administrative responsibility. It is an act of professional leadership. If elected, I would become the first neonatologist to serve as president of the AAP. That milestone would not belong to one individual. It would recognize the contributions neonatologists make across the Academy and throughout the continuum of child health. A neonatal perspective offers AAP leadership an essential understanding: children’s health begins before birth, maternal and infant health are inseparable, and investments made early in life can yield benefits throughout an entire lifetime.

A Call to Vote:

 I am asking neonatologists to learn about the issues in this election, discuss them with colleagues and trainees, and participate. I am one of two candidates for AAP President-elect; information about both candidates, including our position statements and answers to the candidate questions, is available at the AAP National Election Center on AAP.org. Voting is open September 2-16

–VOTE because Medicaid and CHIP are essential to the infants and families we serve.

–VOTE because neonatal expertise should help shape national pediatric priorities.

–VOTE because one of the Academy’s largest sections should use its collective voice

–VOTE because our responsibility to children does not end when they leave the NICU.

The smallest patients require the strongest advocates. Neonatologists know this better than anyone. We must bring that same commitment to the future leadership of our professional home.

Source:https://neonatologytoday.net/newsletters/nt-aug26.pdf

PREEMIE FAMILY PARTNERS

A recently published qualitative study, Center and Care, examines the obstacles that Black families with preterm infants face after leaving the Newborn Intensive Care Unit (NICU). Funded partly by the California Preterm Birth Initiative (PTBi) in support systems and opportunities for meaningful change in healthcare and policy. 

Led by Principal Investigator, Dr. Kayla Karvonen, Assistant Professor of Pediatrics at UCSF, the study interviewed 20 Black caregivers with diverse educational, professional, and socioeconomic backgrounds. The study focused on having families prioritize the types of help and changes that would have improved their experiences raising a preemie the most.

Understanding the Journey

The short-term and long-term needs of families of premature infants (born before 37 weeks) are entirely different from those of babies born at term. Yet policies and systems don’t consider those needs, even though the average preterm birth rate is 10% nationally, and 14.7% for Black babies.

“Families in our study wanted more awareness and action, recognizing that having a baby in the NICU means you could use more financial support,” says Karvonen. “We also wanted to understand how families are screened for social needs during their hospital stay and primary care physician appointments to inform the practices in NICUs or primary care clinics in the Bay Area. How would families like to be screened, referred, and connected with community-based organizations that could help support them?”

Key Findings

These are the five areas that Black families with preterm infants identified as circumstances with the most significant challenges: 

  • Financial Security: Difficulty accessing basic needs, including housing, transportation to appointments, childcare, and food, was consistently identified by families. Respectful screening and referrals to connect families with organizations that can help were highlighted.
  • Provider Trust: A personal connection with a provider that could be confided in with sensitive information to address financial and social needs is necessary in medical settings. Creating a safe space for honest conversations was noted, especially around basic needs like food, housing, and financial insecurity.
  • NICU Transition Process: Graduating from the NICU creates a sudden loss of access to resources, going from an all-in-one support system to starting all over again with a whole new care team. The study participants recommended an ability to cluster in-person clinic visits together to limit the number of trips, continued lactation and mental health services, check-ins with home nursing, postpartum doula access, and peer support with other NICU parents.
  • Community Support: Black-centered community-based organizations (CBOs) that provide holistic postpartum support were noted as a vital source for basic needs, emotional support, childcare, and connectedness. Various CBOs were specifically named as champions for families in the study.
  • Policy Improvements: State and federal legislation, policies, and programs were identified as critical opportunities to address the unique needs of families with preterm babies. Some examples were improved parental leave policies for caregivers with preterm infants and infants with extended NICU stays, and financial help like a universal basic income and specific financial support for NICU grads.

“The most effective ways to support families begin by listening and hearing from them on what’s most important,” says Karvonen. “We’re so excited to get our work out there to highlight the family voices to changemakers, like policymakers, medical systems, and community-based organizations.”

Source: https://pretermbirthca.ucsf.edu/news/center-and-care-study-reveals-critical-needs-black-families-preterm-infants

Where you live should not determine whether you can access maternity care. Yet millions of families across the U.S. live in communities without enough obstetric clinicians, birthing facilities, or affordable options for care.

“Nowhere to Go: Maternity Care Deserts Across the U.S.” (2026 report) finds that 1 in 3 U.S. counties remains a maternity care desert. In total, 5.8 million women and 358,000 infants live in counties without full access to maternity care.

The report also documents an accelerating threat to local care: at least 96 hospital labor and delivery units closed across 35 states between 2024 and early 2026. In nearly 60% of affected counties, the closed unit was the community’s only birthing facility. These closures increased average travel time to maternity care by 25 minutes in affected communities.

Rural and under-resourced communities continue to face the greatest barriers. More than half of U.S. counties lack a hospital with labor and delivery services, and residents of maternity care deserts travel approximately three times longer to reach one than residents of full-access counties.

Do you live in a maternity care desert?

Maternity care deserts are counties with no obstetric clinicians or birthing facilities. Find your community on the map below to determine your level of access.

Sources: U.S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2024-2025 file; American Board of Family Medicine, 2021-2024; American Association of Birth Centers, 2024; Centers for Medicare and Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES), November 2024 file; National Center for Health Statistics, 2024 final natality data; U.S. Census Bureau, 2024 American Community Survey 5-Year Estimates; American Hospital Association, 2024; CMS Provider of Services File, 2024.

1 Introduction

As stated in the most widely ratified international human rights treaty in 1990, the Convention on the Rights of the Child (Articles 3, 4 and 5), infants have the right to be cared for by their parents (birthing person/caregiver(s)) and shall not be separated from their parents. The best interests of the child shall always be the primary consideration while also respecting the responsibilities, rights and duties of the parents. The devastating effects of parent–infant separation on infants’ and children’s emotional well‐being during routine hospital care were recognized and contested as early as the 1940s and 1950s. Although the child’s access to comforting parents’ presence has improved, there are still significant attitudes and beliefs among health care providers that continue to limit parental presence and involvement in neonatal care, with significant variation in practice globally.

Infants rely on their parents not only for survival and development, but also for comfort and protection. As recently as the 1980s, the mainstream view was that the infant brain was too immature to perceive or remember pain and, consequently, pain management was neither prioritized nor consistently integrated into standard care. Moreover, if pain care was offered, parental involvement was rarely emphasized, and procedures were often conducted in the absence of parents. Sadly, despite high‐quality evidence demonstrating the effectiveness of parent‐led pain care, global data indicate that many infants—both healthy and ill—continue to undergo painful needle‐related procedures without parental presence or involvement in procedural support. Urgent action is needed to protect infants’ rights to parental presence and the inclusion of parents as partners in neonatal care management.

As the saying goes, ‘It takes a village to raise a child’, but where is the support from the ‘village’ during the many painful procedures newborns endure as part of neonatal care? In reality, although neonatal care is often viewed as a shared responsibility, support for parent involvement during painful procedures remains limited and acceptance and implementation of parent‐led pain management remain suboptimal. A recent global survey of parent‐led pain management in neonatal care found that, although two‐thirds (67%) of the responding units (n = 303) had local neonatal pain guidelines, only 40% of those recommended parent‐led interventions or parental involvement in pain assessment.

Grounded within our ongoing multinational research project POP (Parent‐led pain management to Optimize neonatal Pain care, www.pearl.direct/home/pop), funded by Nyckelfonden Research Foundation at Örebro University Hospital, the main aim of this paper is to advocate for a call for action to improve infant pain management through the inclusion of parents during all stages of management including shared decision‐making regarding assessment, plan, provision and evaluation. Current evidence related to the efficacy, acceptability and feasibility of parent‐led neonatal pain care, as well as barriers and facilitators related to implementation, will be discussed.

2 Parents’ Perspective on Neonatal Pain

The POP Study was co‐designed by parents, researchers and clinicians in a common effort to improve neonatal pain management. The neonatal period is defined as care provided to any infant less than 44 weeks postnatal age and includes those healthy, sick or preterm. Parent partners within POP bring extensive first‐hand experience with the evolution of evidence‐based neonatal pain management guidelines. Moreover, as both parents and advocates, they have observed and have lived experience that these guidelines frequently fail to translate into consistent bedside clinical practice.

‘I felt so helpless because I felt I could not do anything to help my child when she was in the neonatal intensive care unit (NICU) for pain relief. I trusted doctors and nurses in everything. When I got the opportunity to have my child in kangaroo care I felt I could really do something for her well‐being’.

Mari, mother (Finland)

‘A routine vaccination during the NICU stay became a source of grief long after the event. Despite agreeing with the nurses that we would be there and wanted to be there, the vaccination was done out of convenience without us parents. It was devastating not being able to be there to comfort my child knowing that she was alone and knowing how negative pain is for brain development’.

Mikaela, mother (Sweden)

‘Not being involved in Gabriel’s pain management in the NICU still affects me today. He was poked every day—one day, 13 times—and I was not ‘allowed’ to be present to hold him or comfort him. I was once told that babies do not feel pain. We now know that preterm infants not only feel pain, but that repeated, unmanaged procedural pain can influence brain development and long‐term outcomes. As a parent, learning this after the fact is devastating. Had I understood the evidence then, I would have advocated to be present for every procedure, to provide skin‐to‐skin care, and to be an active partner in his pain management plan’. Fabiana, mother (Canada)

3 Latest Evidence on Parent‐Led Pain Management

Preventing pain by reducing the number of performed procedures and avoiding routine blood sampling are effective strategies for lowering infants’ cumulative pain exposure. Transferring agency and responsibility to the parents to assess pain and deliver pain management is a key component of pain prevention.

A substantial and growing body of evidence supports that parent‐led pain management—implemented in collaboration with healthcare providers and supported by shared decision‐making, including parental involvement in pain assessment—significantly reduces procedural pain associated with repeated early‐life interventions. Importantly, most parents report that they are willing to take on this responsibility if supported by clinicians. Culturally sensitive biopsychosocial strategies like the parent‐led interventions may reduce the need for additional pharmacological pain treatments, particularly those associated with a higher risk. These approaches can be safely extended to home and community settings, further reinforcing parental confidence and caregiving roles

.

Parent‐led pain interventions, such as skin‐to‐skin contact, breastfeeding and live singing, are humane, culturally informed and equitable, while also being effective, feasible and cost‐efficient. These interventions can be tailored to the needs of both the infant and parent. Moreover, parent‐led pain management aligns with family‐integrated care, a progressive philosophy and model of neonatal care that positions parents as primary caregivers and integral members of the care team.

Collaborative planning of procedures, along with shared roles in pain assessment and management, has been shown to reduce stress and pain in both infants and parents, while enhancing comfort and well‐being. Evidence further demonstrates that interprofessional collaboration that includes parents as active participants improves procedural pain outcomes in infants.

In conclusion, parent‐led interventions are effective, easy to use with little to no risk and implementable into everyday clinical practice in both low‐ and high‐resource settings.

4 Successes and Shortcomings in the Uptake of Parent‐Led Pain Management

In the Nordic countries, family‐friendly societal policies and strong commitments to gender equity in caregiving reinforce each infant’s right to parental presence during hospitalization. Across Sweden, Finland, Norway, Denmark and Iceland, awareness and implementation of family‐centred care are well established and continue to advance, with parents mostly welcomed and routinely included in their infant’s daily care.

Most Nordic neonatal units have been purpose‐built or redesigned to support continuous parental presence, featuring single‐family rooms, zero‐separation policies, bedside rounds and accommodations for siblings. Publicly funded healthcare and comprehensive social security systems are important factors in the sustainability of family‐centred care, where hospitalized children have a legal right to have at least one parent present during hospitalization.

In Nordic NICUs, parent‐led pain management, combining skin‐to‐skin contact, breastfeeding and parental live singing, is on the clinical agenda supported by innovative collaborative research initiatives involving parent‐staff‐researcher partnership. Evidence from these initiatives demonstrates that individualized preparation and education enable meaningful parent participation and promote infant–parent closeness during procedures, resulting in effective pain and stress reduction. Partnership and collaboration are central to successful implementation.

In Canada, in their pain and prevention clinical practice statement, the Canadian Paediatric Society has provided the first global paediatric declaration that provides clear prioritization of parent‐led strategies based on empiric evidence. It affirms that all health care providers caring for infants (healthy, small and/or sick) have a responsibility to provide effective pain management and emphasizes that parent‐led interventions—among the most effective approaches—should be prioritized.

Despite strong evidence supporting parent‐led pain management in NICUs, its integration into clinical practice remains limited due to slow implementation of evidence‐based practice. One key factor underlying both successes and shortcomings is the quality of parent–staff communication, which determines how well parents are informed about their important role, receive guidance and feel empowered to seize the opportunity. It is a growing process for parents to take their role in the interprofessional collaboration around the infant’s pain management. However, healthcare professionals often make assumptions about parental readiness without directly assessing it. Parents frequently report that information about pain management is insufficient, poorly timed or not aligned with their emotional readiness, while clinicians may act as gatekeepers due to concerns about parental anxiety or uncertainty about preparedness. These barriers limit parents’ active involvement, even in settings that endorse family‐integrated care. Strengthening communication through staff education, consistent and timely information‐sharing, and trust‐based, respectful interactions is essential to enhance parent‐led pain care.

Advancing effective and equitable implementation of parent‐led pain management requires diligent efforts to enhance communication, clarify parental roles and embed shared decision‐making within clinical culture.

5 Time to Move Forward

Facilitating parent‐led neonatal pain management is the central aim of the international research and dissemination initiative POP (www.pearl.direct/home/pop), built by parents, researchers and clinicians. This work challenges traditional hierarchies in neonatal care by addressing power imbalances and enabling those most affected—particularly parents—to shape decisions and solutions. By shifting the role of researchers from experts to collaborators, POP promotes shared authority in defining priorities and advancing care.

‘Parents are not passive observers in the NICU. We are protective regulators for our children, and our involvement in pain mitigation is both emotionally essential and scientifically supported. However, thirteen years later, on a recent hospital re‐admission with my son, I found myself navigating the same painful gap between what should happen and what actually happens. When pain prevention measures are missed, it is us parents who carry the emotional weight and, too often, the responsibility to speak up. Guidelines matter, but only when they are lived in practice’. Fabiana, mother (Canada)

In the best interest of the vulnerable infants and their parents, there is an urgent need for action to uphold infants’ and parents’ rights to optimal pain care, now. The POP research group calls for global implementation to ensure that every infant, regardless of birthplace, has access to parent‐led pain management during common painful procedures.

Source: https://onlinelibrary.wiley.com/doi/epub/10.1111/apa.70597?domain=p2p_domain&token=I29WGDQKVADQFZMDAM2C

INNOVATIONS

Abstract

The landscape of trauma‐focused interventions for young children has evolved significantly, though substantial gaps remain. Early childhood trauma exposure occurs during sensitive periods of brain development with potential lifelong consequences. However, these periods also present unique opportunities for intervention to redirect trajectories toward positive outcomes. Rapid neurodevelopmental changes across early childhood necessitate interventions specifically designed for evolving capacities rather than simply “scaled down” versions of adult treatments. A review focused exclusively on evidence‐based interventions for young children is needed. This review represents a synthesis of the literature informed by our clinical and research expertise. We review interventions that target trauma symptoms as primary outcomes,  were designed for children ages 0–8 years,  include substantive caregiver involvement, and  have empirical support from published randomized controlled trials or well‐designed quasi‐experimental studies. Our review revealed a tiered evidence base for young children, with the strongest support for interventions targeting specific age groups: Child–Parent Psychotherapy for infants and toddlers, Preschool PTSD Treatment for preschoolers, and Trauma‐Focused CBT for early elementary children. Critical gaps include limited interventions for children under age 3, sparse evidence for interventions targeting noninterpersonal trauma, assessment challenges, particularly with longitudinal measurement across developmental transitions, and insufficient implementation research on disseminating interventions in community settings. By continuing to refine effective trauma interventions for our youngest children, we can alleviate immediate suffering and potentially prevent decades of associated difficulties across the lifespan. Future research priorities should include expanding the evidence base for existing interventions through well‐powered trials with diverse samples, developing and testing preventive interventions delivered following potentially traumatic events, adapting established interventions for under‐studied trauma types, and implementation research to support widespread adoption in real‐world settings.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC13035056/

ABSTRACT

Background and Objectives: The widespread adoption of neonatal mortality risk assessment scores in triage of the ill newborn could greatly reduce the unacceptably high neonatal mortality in resource-limited countries especially those in sub-Saharan Africa. In spite of this potential, however, their use has not been established in the region due mainly to the invasive nature of some of the methods involved and the high cost of deployment of blood gas analyzers. We carried out this study to obviate these drawbacks by developing a simplified scoring system with minimally invasive methodologies. 

Method: We developed the Simplified Neonatal Acute Illness Severity Score (SNAISS) by adaptation of the Score of Neonatal Acute Physiology Perinatal Extension II (SNAP-PE II) through substitution of the arterial blood gas variables with hematocrit and peripheral oxygen saturation. We then evaluated the discriminant ability and calibration of SNAISS for adverse outcomes among 135 babies using receiver operator characteristic (ROC) curve and Hosmer-Lemeshow goodness of fit test.  We also assessed the relationship between outcome and SNAISS using Cramer’s V.

 Results: The area under ROC curve for the plot of outcome versus SNAISS was 0.926 and the Hosmer-Lemeshow goodness of fit  1.00 while the Cramer’s V for the relationship between SNAISS and neonatal outcome was 0.798. 

Conclusion: SNAISS has an excellent discrimination for adverse neonatal outcome, with a direct relationship between the scores and the risk of death. We recommend it as a readily available tool for use in clinical practice in resource-limited settings.

Source: https://www.jneonatal.com/abstract/adaptation-of-the-score-of-neonatal-acute-physiology-perinatal-extension-ii-snap-pe-ii-for-use-in-resource-limited-settings

Abstract

Introduction

Although ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organisation, it remains unavailable to many women in low-income countries where trained practitioners are scarce. This study aimed to evaluate a novel, context-specific education package to teach midwives basic obstetric ultrasound, including the determination of gestational age by measurement of fetal femur length.

Methods

The study was conducted across six sites in Malawi in January 2021. Following a virtual “training of the trainers”, local teams delivered a 10-day programme encompassing both didactic and “hands on” components. Matched pre and post course tests assessed participants’ knowledge of key concepts, with Objective Structured Clinical Examinations used to evaluate practical skills. To achieve a pass, trainees were required to establish the gestational age to within ±7 days of an experienced practitioner and achieve an overall score of >65% on five consecutive occasions. A matched pre and post course survey explored participants’ attitudes and confidence in performing ultrasound examinations.

Results

Of the 29 midwives who participated, 28 finished the programme and met the criteria specified to pass. 22 midwives completed the matched knowledge tests, with the mean (SD) score increasing from 10.2 (3.3) to 18 (2.5) after training (P <0.0001). Mean difference 7.9, 95% CI 6.5–9.2. Midwives passed 87% of the Observed Structured Clinical Examinations, establishing the gestational age to within ±7 days of an experienced practitioner in 89% of assessments. Beliefs regarding the importance of antenatal ultrasound increased post course (p = 0.02), as did confidence in performing ultrasound examinations (p <0.0001).

Conclusion

This study demonstrates not only that ultrasound-naive practitioners can be taught to perform basic obstetric ultrasound dating scans, confidently and competently, after 10 days of training, but also that local teams can be orientated to successfully deliver the programme virtually. Previous ultrasound training initiatives, while often more comprehensive in their syllabus, have been of considerably longer duration and this is likely to be a barrier to upscaling opportunities. We propose that this focused training increases the potential for widescale and sustainable implementation.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9017789/?utm

WARRIORS: A New School Year, A New Beginning — and a Future Worth Protecting

September is a season of new beginnings. Children and young adults are returning to classrooms, starting new grades, meeting new teachers, and imagining who they might become. For those of us who began life as preemies, that ordinary ritual can carry extraordinary meaning. Many of our first days were spent beneath the lights of a NICU, surrounded by incubators, monitors, clinicians, and families simply hoping we would have the chance to experience all the milestones that come next.

That is also why the health of the world these children inherit matters so deeply. Climate change is not only an environmental issue—it is increasingly a maternal, newborn, and child health issue. Extreme heat, wildfire smoke, severe storms, flooding, disrupted health systems, food insecurity, and displacement can place pregnant people, newborns, and medically vulnerable children at particular risk. Protecting babies should therefore mean thinking beyond the walls of the NICU. If we devote extraordinary science, resources, and compassion to giving premature and critically ill newborns a future, we should be equally committed to protecting the conditions in which that future will unfold.

Former preemies grow into students, artists, athletes, scientists, teachers, physicians, parents, advocates, and leaders. Their futures cannot be measured by the gestational age or birth weight recorded in a neonatal chart—and neither should those futures be limited by problems we already know how to confront. Climate action is, at its heart, an investment in children: cleaner air to breathe, safer communities to grow up in, resilient hospitals during disasters, and a healthier planet on which they can learn, play, work, and dream.

So as another school year begins, let us celebrate every preemie walking into preschool, elementary school, high school, college, or a new chapter of adulthood—and let us recognize our responsibility to protect the world they are walking into. Saving tiny lives and protecting their future belong to the same mission. Their first chapter may have begun earlier than expected, but the rest of the story is still being written. Go get ’em, Warriors. 💜🌎

Former NICU patient reunites with care team before heading to college

WVLT8 MEDIA-Published: Aug. 7, 2026 at 6:31 PM PDT

Born at just 23 weeks, weighing only 15 ounces, Drayton Brindisi was given little chance of survival and even less chance of living without major complications. (Source: WTIC)

Llama Llama Back To School 

Summer days are getting shorter and it’s almost time for the first day of school for Llama! But Llama Llama isn’t ready for summertime to end. It’s been full of backyard camping, family picnics, and ice cream with friends. All he wants is for summer to go on forever! He’s anxious about his first day back at school but maybe, with some help from his friends and Mama Llama, going back to school will be fun after all!

 ROADS, MENTORS, and the FORGOTTON

Cape Verde, also referred to in English by its Portuguese name Cabo Verde, and known officially as the Republic of Cabo Verde (Portuguese: República de Cabo Verde), is an archipelagic country in the central Atlantic Ocean off the coast of West Africa. It consists of ten volcanic islands with a combined land area of about 4,033 square kilometres (1,557 sq mi). These islands lie between 600 and 850 kilometres (370 and 530 miles) west of Cap-Vert (i.e., Dakar), the westernmost point of continental Africa, after which they are named. Cape Verde forms part of the Macaronesia ecoregion, along with the Azores, the Canary Islands, Madeira and the Savage Isles.

Cape Verde became independent in 1975. Since the early 1990s, it has been a stable representative democracy and has remained one of the most developed and democratic countries in Africa. Lacking natural resources, its developing economy is mostly service-oriented, with a growing focus on tourism and foreign investment. With a population of around 530,000 (as of 2026), Cape Verde is among the least populous countries in Africa. With a population of around 530,000 (as of 2026), Cape Verde is among the least populous countries in Africa. 

Healthcare in Cape Verde Starting from July 2012, a telemedicine program, funded by the Republic of Slovenia through ITF Enhancing Human Security and implemented by the US-based NGO, the International Virtual e-Hospital, is building a hospital-based telemedicine network for the whole country. As of January 2014, all the inhabited islands of the country are connected through an integrated telemedicine network representing the first case in Africa of such an approach to telemedicine.

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

STATS

It’s tempting to think of telemedicine as a pandemic-era invention,  something born out of necessity in 2020. In reality, the idea of treating patients across a distance is more than a century old, and its evolution says as much about politics, insurance systems, and geography as it does about technology.

The seeds were planted long before video calls existed. In the 18th century, Claude Chappe’s optical telegraph laid the groundwork for transmitting information across distance, and by the late 1800s the United Kingdom had become the first country to link communication technology to the actual practice of medicine, a relationship that deepened from 1864 through 1945. In 1905, physiologist Willem Einthoven inventor of the electrocardiograph  transmitted heart sounds by telephone from a hospital to his laboratory, and by 1910, American cardiologists in New York had published the first U.S. review describing electrocardiograms successfully sent by cable from hospital wards to the ECG room].

Radio Waves Over the Outback

If there’s a single moment that captures telemedicine’s founding spirit  using whatever technology exists to reach people who’d otherwise have no care at all,  it’s Australia in 1928. That year, Reverend John Flynn founded the Aerial Medical Service, combining telegraph, radio, and airplanes to bring diagnosis and treatment to some of the most remote communities on Earth. Doctors would consult by radio, then fly a health professional out to the patient. It’s widely regarded as the first organized effort anywhere to solve geographic isolation from healthcare using telecommunications.

Norway was moving in parallel. Haukeland Hospital began using two-way radio in 1920 to connect physicians with sailors at sea, and other countries soon followed with similar radio-based systems of their own.

Norway Turns Innovation Into Policy

Technology is one thing; making it a permanent part of a healthcare *system* is another. This is where Norway pulled ahead of the rest of the world. Through the 1980s and 1990s, Norway systematically built out telemedicine infrastructure starting with videoconferencing for medical purposes in 1986, followed by a national electronic patient record system for general practitioners in 1992, and a dedicated national telemedicine competence center in 1993 that handled everything from ultrasound transmission to teleradiology.

Then, on August 1, 1996, Norway became the first country in the world to implement a **nationwide telemedicine reimbursement schedule**,  a fixed, government-backed payment structure for specialist and radiology consultations delivered remotely. This is arguably the moment telemedicine stopped being an experiment and became infrastructure.

The Global Picture: What the World Health Organization Found

Because telemedicine adoption happens unevenly, country by country, specialty by specialty, the clearest snapshots come from the World Health Organization’s Global Observatory for eHealth, which has surveyed member states periodically since 2005.

 In its **2009 survey**, 114 countries (59% of WHO member states) completed the telemedicine module.

In its 2015 survey,  the most recent global survey of its kind, 125 member states responded, the highest participation to date. Teleradiology was the most widespread service, used in 77% of responding countries, while telepathology, remote patient monitoring, and teledermatology were each in use in nearly half. Yet despite that growth, only 22% of countries reported having an explicit *national* telemedicine policy meaning most countries using telemedicine were still doing so without a formal regulatory framework behind it .

No comparable global census exists specifically for 2019,  the WHO’s next major telehealth-focused work shifted to regional surveys, such as a 2022 European digital health survey. So while adoption clearly continued climbing through the late 2010s, there isn’t a single authoritative “X countries were using telemedicine in 2019” figure to point to.

The United States: Early Innovator, Late Policymaker

Here’s the twist in the story: the U.S. was never behind on the *science*. American researchers were transmitting ECGs by cable in 1910 , and NASA later pioneered remote physiological monitoring of astronauts during the Space Race. Where the U.S. genuinely lagged by decades  was in turning that technology into a “system” patients could actually access.

Milestone – Country -Year

*First nationwide telemedicine reimbursement policy – Norway – 1996 

*First (limited) Medicare telehealth reimbursement –  United States –  1997 

*Modest expansion, still geographically restricted – United States – 2001 

* Interstate licensure barriers finally waived – United States – 2020 

* Geographic/site restrictions lifted, payment parity achieved – United States – 2020 

The U.S. didn’t begin reimbursing telehealth through Medicare until the **Balanced Budget Act of 1997, ” one year after Norway’s nationwide policy,  and even then, coverage was narrowly restricted to rural areas, specific clinical settings, and a limited menu of services. The Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000, effective in 2001, expanded the list of covered services to include office visits, psychotherapy, and pharmacologic management, but coverage remained locked to rural health professional shortage areas and non-metropolitan counties.

That framework barely changed for the next two decades. The Affordable Care Act in 2010 encouraged pilot programs and value-based care experiments, but didn’t overhaul telehealth reimbursement itself . Meanwhile, the single biggest practical barrier,  a requirement that providers hold a medical license in whatever state the patient physically sat in, meant that true interstate telemedicine was, for most purposes, not legally possible.

It took the declaration of the COVID-19 public health emergency in 2020 to finally break the logjam. Almost overnight, the federal government waived interstate licensure requirements, extended reimbursement to home-based visits, expanded which providers could bill for telehealth, and critically achieved payment parity between virtual and in-person visits.

**So how late was the U.S.?** Measured from Norway’s 1996 nationwide reimbursement policy to the point the U.S. removed its major structural barriers, the gap is roughly 24 years. And even now, the picture isn’t fully settled: many of the pandemic-era flexibilities were temporary, and Congress has had to repeatedly extend Medicare telehealth waivers piecemeal,  including a widely discussed “telehealth policy cliff” debate around October 2025, rather than making the changes permanent. Compared to countries with an established, stable national telemedicine framework, the U.S. arguably still hasn’t reached the same institutional footing that Norway achieved in the mid-1990s.

The Takeaway

Telemedicine’s story isn’t really about invention; the tools existed for over a century. It’s about the slower, harder work of building policy, reimbursement, and legal frameworks around technology that already worked. Norway got there first. The rest of the world, including the country that helped invent much of the underlying medical technology, is still catching up.

References

[1] National Library of Medicine. (n.d.). *The history of telemedicine* [Digital collection]. U.S. National Library of Medicine. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101520679-vid

[2] Curogram. (2022, February 8). *History of telemedicine*. Curogram Blog. https://curogram.com/blog/history-of-telemedicine

[3] Sigmund Software. (2023, July 28). *The history of telehealth: Telemedicine through the years*. Sigmund Software Blog. https://www.sigmundsoftware.com/blog/history-of-telehealth/

[4] UniNet. (n.d.). *History of telemedicine*. Conganat International Virtual Congress. https://www.uninet.edu/conganat/ICVHAP/conferencias/017/history.htm

[5] World Health Organization Global Observatory for eHealth. (2010). *Telemedicine: Opportunities and developments in Member States — Report on the second global survey on eHealth* (Global Observatory for eHealth Series, Vol. 2). World Health Organization. https://pmc.ncbi.nlm.nih.gov/articles/PMC3402558/

[6] World Health Organization. (2016, December). *WHO third global eHealth survey: Atlas of country profiles*. WHO Regional Office for the Eastern Mediterranean. https://www.emro.who.int/ehealth/ehealth-news/who-third-global-ehealth-survey-atlas-of-country-profiles.html

[7] World Health Organization. (2016). *Global diffusion of eHealth: Making universal health coverage achievable — Report of the third global survey on eHealth*. World Health Organization. https://www.who.int/publications/i/item/9789241511780

[8] Avanesova, A. A., & Shamliyan, T. A. (2019). Worldwide implementation of telemedicine programs in association with research performance and health policy. *Health Policy and Technology, 8*(2), 179–191. https://www.sciencedirect.com/science/article/abs/pii/S2211883718302636%5B9%5D Gullslett, M. K., Ronchi, E., Lundberg, L., Larbi, D., Lind, K. F., Tayefi, M., Ngo, P. D., Sy, T. R., Adib, K., & Hamilton, C. (2024).

 [9] Telehealth development in the WHO European region: Results from a quantitative survey and insights from Norway. *International Journal of Medical Informatics, 191*, 105558. https://www.sciencedirect.com/science/article/pii/S1386505624002211

[10] ChartRequest. (2024, November 26). *The origins of telehealth*. ChartRequest Blog. https://www.chartrequest.com/articles/telehealth-origins

[11] Accessible Telehealth. (2026, February 11). *The history of telehealth: A brief history of remote care in the United States*. Accessible Telehealth Blog. https://accessibletelehealth.com/2026/02/10/the-history-of-telehealth-a-brief-history-of-remote-care-in-the-united-states/

[12] Center for Connected Health Policy. (2024, April 8). *Federal telehealth laws*. CCHP. https://www.cchpca.org/federal/

[13] HGA. (2024, July 19). *The history of telehealth*. HGA. https://hga.com/the-history-of-telehealth/

[14] Ivanova, J., Cummins, M. R., Ong, T., Soni, H., Barrera, J., Wilczewski, H., Welch, B., & Bunnell, B. (2025). Regulation and compliance in telemedicine: Viewpoint. *Journal of Medical Internet Research, 27*, e53558. https://doi.org/10.2196/53558

[15] National Consortium of Telehealth Resource Centers. (2025, September 26). *The telehealth policy cliff: Preparing for October 1, 2025*. https://telehealthresourcecenter.org/resources/the-telehealth-policy-cliff-preparing-for-october-1-2025/

Anthropic. (2026). *Claude Sonnet 5* [Large language model]. https://claude.ai

HEALTHCARE PARTNERS

Abstract

Each year, nearly 15 million infants are born prematurely worldwide. These infants are exposed to pain, noise and separation during the first weeks of life. The high exposure to pediatric medical traumatic stress places infants and their caregivers at risk for mental health challenges that can persist into adulthood. To advance understanding, early stressors have been studied and linked to the development of later psychopathology. Recognizing these stressors creates a valuable opportunity for prevention through Trauma-Informed Developmental Care (TIDC) and Emotional Revival Therapy (ERT). These approaches equip Infant Mental Health Professionals with effective tools to support premature families and keeping hope up during the NICU journey. These early interventions at NICU help prevent manifest regulatory and attachment disorders in infants as well as perinatal psychiatric disorders in parents.

Abbreviations

ELS: Early-life stress

ERT: Emotional Revival Therapy

TIDC: Trauma-Informed Developmental Care

PMTS: Pediatric Medical Traumatic Stress

Introduction

Each year, close to 15 million infants are born prematurely worldwide, thrusting families into a world of uncertainty and intense medical intervention (World Health Organization, 2025). The physical and mental development of these vulnerable newborns has long been a central concern in neonatal care. Pioneering research in infant mental health shaped care strategies, emphasizing stress reduction and emotional regulation (Field, 1977; Als, 1982). The positive effects of these interventions have been extensively documented (Givrad et al., 2021). Despite these advances, preterm infants remain at heightened risk for psychiatric disorders from birth into adulthood (Johnson & Marlow, 2011). Johnson and Marlow (2011) describe the “preterm behavioral phenotype” which represents typical psychiatric manifestations of premature born adults characterized by inattention, anxiety, and social difficulties. Early-life stress (ELS), superimposed on immature neural pathways, deranges the developmental trajectory of prematurely born individuals contributing to the emergence of the preterm behavioral phenotype (Schmuecker et al., 2005).

Pediatric Medical Traumatic Stress (PMTS) is a term used to describe the responses of children and their families to trauma within a medical setting (Price, et al., 2016). The suffering during and after intensive care for both baby and parent underscores the importance of Trauma-Informed Developmental Care (TIDC) and Emotional Revival Therapy (ERT) throughout the hospital experience and beyond discharge to reduce the impact of PMTS. These interventions can mitigate the risks of mental health complications, to both baby and family that arise during the NICU stay and span the continuum from early childhood into adulthood. Ideally, these early interventions at NICU and beyond help prevent manifest regulatory disorders in infants, perinatal psychiatric disorders in parents, and disorders within the parent-infant relationship.

The NICU as a Dual Landscape of Healing and Trauma

The NICU is both a sanctuary of survival and a crucible of stress. For the infant, the soundscape of alarms and ventilators, the glare of fluorescent lights, and the invasive touch of medical procedures replace the gentle rhythms of the womb (Wolke, 1991). These sensory intrusions disrupt critical neural and emotion regulatory networks. In the womb, the baby’s sense of self is entirely relational, tied to the mother through a seamless co-regulatory bond that provides both physical and emotional sustenance. Suddenly, that bond is severed, leaving the baby exposed to bright lights and a cacophony of unfamiliar sounds, with so many hands touching, poking, and sticking needles into them. Tubes are inserted down their throat, often without any comforting reassurances or soothing touch. The babies, with no point of reference to understand the life-threatening situation, is left in a state of utter bewilderment and terror.

A state of shock is a natural response to birth that requires life-sustaining medical interventions for baby and mother, which begins when the two are torn apart. This separation is the first in a cascade of events that disrupts the intuitive bond between mother and child and often positions the caregiver(s) as visitors of their baby within the NICU. Imagine yourself as the parent; you are standing outside your baby’s room, separated by a door you cannot open. You must ring the bell and wait for permission to enter before you are then required to disinfect your hands and walk a long corridor before reaching your child. Even then, the natural response to gather your child into your arms and hold them in your loving embrace often depends upon the availability, and the permission of someone else to assist you. The power dynamic in these situations casts a long shadow over the caregiver’s experience. Parents often describe feeling like intruders in their child’s care, rather than being essential to their baby’s survival. Parents who are unable to participate in their child’s care often struggle with feelings of inadequacy and guilt, which can linger long after the NICU experience has ended.

TIDC seeks to mitigate these stressors, reframing the NICU as a place of healing (Coughlin, 2021). Within the context of earlier viability thresholds, TIDC faces new demands to address the heightened vulnerabilities of extremely preterm infants and their families. For parents, family-integrated care models, informed by trauma-informed paradigms, help to rebuild confidence and foster connection that is quintessential to healing. These person-centered paradigms transform the NICU from an alienating environment to one of shared caregiving. By integrating targeted developmental and relational strategies, TIDC aims to mitigate the compounded effects of early adversity.

Pediatric Medical Traumatic Stress: Defining the Experience

The experience of the infant in NICU typifies PMTS, with life threatening conditions, the suffocation associated with pulmonary immaturity, repeated painful procedures and prolonged caregiver separation. Unlike older children, newborns in the NICU lack established routines and memories, making it difficult to distinguish the infant’s baseline behavior profile from their lived experience of trauma. However, common key stressors associated with NICU hospitalization, that include respiratory distress, procedural pain, and separation from caregivers, are known risk factors for psychopathology (Pierrehumbert et al., 2013). Sleep fragmentation and noxious touch experiences, in conjunction with invasive procedures, further exacerbate the infant’s distress. Understanding how these stressors contribute to short and long-term developmental outcomes is essential for creating effective interventions.

Stressors in the NICU Environment

Pulmonary Immaturity: Respiratory distress syndrome is often a preterm infant’s first experience outside the womb, characterized by shallow breathing and grunting. It is a breathing pattern not exclusive to pulmonary immaturity but typical for a state of panic and a pretext to a traumatic development. To ensure the survival of the premature infant mechanical ventilation may follow the respiratory distress which alters physical recovery but also the neural pathways that regulate stress and basal affects. Often the infant experiences mechanical ventilation in a state of drug induced dissociation. Once the infant no longer needs external respiratory support, the pattern of dissociation may have become part of the infant’s neural networks and self-identity (Schore, 2012). Chronic lung conditions as well as early dissociation limits the individual’s quality of life, restricting their physical activities and potentially affecting their capacity for social participation (Lærum et al., 2019). The emotional cost of witnessing an infant’s struggle with respiratory distress weighs heavily on parents and caregivers, adding to their sense of helplessness and potentially influencing their capacity to provide attuned caregiving.

Pain and Procedural Trauma

NICU infants endure numerous painful procedures daily, often without sufficient analgesia (Carbajal et al., 2008). Premature infants respond visibly to this pain with crying, hypertonus and increase of the heart rate (Pokela & Koivisto, 1994). Despite the aversive reaction of the infant, the painful procedures will go on for days to months, often under-managed. The infant’s attempts to withdrawal from the pain results in an enduring state of dissociation. This traumatic state impairs the physiological stability and emotional development of the infant, increasing the risk for developmental disorders (Lammertink et al,. 2022). The long term consequences of early-life exposure to unmanaged pain is associated with altered gene expression linked to greater socio-emotional stress sensitivity and behavioral challenges at school-age (Chau et al., 2014). Pain is a major risk factor for dissociation and a traumatic developmental trajectory, and may pose a risk for disorganized attachment patterns (Wolke et al., 2014).

Separation from Caregivers

Separation exacerbates the infant’s stress, depriving them of co-regulation by and safety with their primary caregivers. For infants, the absence of consistent caregiver presence disrupts the natural rhythms of attachment formation, leaving them in a state of affect dysregulation (Schore, 2012). When this absence occurs under the conditions of life-threatening circumstances and constant medical stress, the opportunity for co-regulation is significantly restricted for the baby and their parent. Private rooms within the NICU setting remain rare and are not a guarantee for 24-hour parental presence and so, newborns and their parents may not be able to physically be together for days at a time. The singularly most traumatic experience for a newborn across all mammalian species is maternal separation.

Research confirms the benefits of immediate skin-to-skin contact between baby and the birthing parent, while separation increase the experience of toxic stress and risk of disorganized attachment (Mehler et al., 2023). Skin-to-skin contact during the NICU stay has proven to promote autonomic and neurobehavioral brain maturation in preterm infants positively impact neurodevelopmental profiles and infant mental health outcomes (Feldman & Eidelman, 2003). Ensuring parental presence and empowering parental involvement, especially during stressful medical procedures, buffers the adverse effects of the NICU experience. Parental presence and participation in medical, parenting and caregiving activities in the NICU are protective factors against PMTS and compromised neurodevelopmental outcomes (Pineda et al., 2017).

Developmental Consequences of PMTS

Although the prevalence of PMTS in premature infants has not been systematically studied, developmental disorders, physical, neurological and mental health outcomes in this population have been researched for about 50 years (Johnson & Marlow, 2011). Specifically, infants born premature are at risk for disorganized attachment, even when their parents are sensitive caregivers (Wolke et., 2014). For many infants who experience the NICU, the overwhelming stress and absence of a consistent caregiver teaches them that the world cannot be trusted. This lack of trust is often expressed as reduced facial responsiveness to their caregiver’s positive emotions over the first year of life (Schmuecker et al., 2015). This interferes with activities of daily living such as feeding experiences. Infants who have experienced ‘feeding protocols’ in the NICU may learn to not trust the ‘feeding experience’ because of their lived experience of fear and pain in the setting of non-responsive/non-attuned ‘feeding’ interactions. Consequently, these children are at an increased risk for post-traumatic feeding disorder and feeding tube dependency (Wilken & Bartmann, 2014). Prolonged exposure to toxic stress impairs affect regulation, executive functioning, memory, and learning, creating challenges that extend well beyond infancy (Grunau et al., 2009). Preterm born adults who exhibit characteristics consistent with the ‘preterm behavioral phenotype’ have an increased risk for psychiatric disorders like anxiety disorders and depression (Lærum, et al., 2019). Research has shown that NICU-related stress corresponds with neural patterns akin to those observed in early-life trauma victims, highlighting the long-term impact of unaddressed stressors (Lammertink et al., 2022).

Early Intervention: Emotional Revival and Healing

Addressing PMTS requires early interventions that prioritize relational repair. In the NICU, TIDC serves as a prevention model, leveraging our understanding of the long-term effects of chronic toxic stress. By equipping caregivers with the knowledge and skills to mitigate these experiences, TIDC transforms the NICU into a space of healing and recovery for infants and families alike. Within a TIDC approach, interventions are designed to minimize stress, support neurodevelopment, and nurture resilience. This approach also deepens clinicians’ awareness of the infant’s lived experience, fostering greater attunement and responsiveness. However, even with the most effective TIDC practices, pain and separation cannot be entirely eliminated, as the infant remains in a critical medical situation. Despite the prevention intervention some premature infants will suffer from PMTS after discharge. ERT is a new need-based trauma treatement for infants with PMTS. Available since 2021 in Germany infants and parents will be seen bi-weekly in a home-based environment. During ERT the therapist creates synchronized rhythm with the child to re-establish a sense of safety in four phases (Wilken et al., 2023).

1: Create Contact

To establish a therapeutic alliance with infants in a state of traumatic withdrawal the therapist needs to gain the infants’ trust. To build trust the empathic therapist will track affective states of the infant and regulate traumatic dysregulation. Non-verbal contact through body language, mimicry, gesticulations and intonation activate the sense of self enabling the baby to experience a sense of self-coherence.

2: Create Emotional Response

In the initial phase of the ERT treatment, inner withdrawal will not allow the infant to communicate using their emotions. The window of affect tolerance is closed. The infant will primarily express dysregulated traumatized affects. With adaptive affect mirroring the therapist will slowly help the infant to transfer dysregulated affects into emotions. The window of affect tolerance will gradually open. Over the course of the ERT process emotions become more and more part of the infant’s communication repertoire.

3: Create Intersubjectivity

The revival of emotions marks the beginning of an emerging subjectivity. This subjectivity opens a window of opportunity for the infant and caregivers to foster their developing attachment. Attachment is under development until 24 months. The ERT therapist supports parents in recognizing and responding to their infant’s emotional cues, deepening the parent-infant bond. Infants and caregivers will then be able to re-introduce emotions into their communication toolkit.

4: Create Meaningful Relationships

Rebuilding trust through nurturing, predictable, well attuned and emotionally supportive interactions is essential to help the infant transition from a state of survival to a state of growth and development. With a deepened process of bonding, the basis for a meaningful and trusting relationship is revealed with a securre attachment organization. As the infant develops new capacities, needs and desires, conflicts may come up. In this phase of evolution, the ERT therapist will guide the caregiver to recognize and respond to their infant’s emotional cues, strengethening the parent-infant bond. In this process the parents will be given room to reflect on their own trauma and hurt experienced during the NICU stay. When infants and caregivers can communicate in a balanced partnership, the treatment process can be terminated.

Conclusions

Research over the last fifty years has shown that the lived experience of NICU hospitalization is a stressful and traumatic life event and may represent a major mental health risk factor for infants. Research has shown that early-life stress and trauma in infancy build pathways of dysfunctional physiological, neurological and mental growth (Schore, 2012). This paper gives an overview of how Pediatric Medical Traumatic Stress may contribute to significant short-term and long-term psychopathology in premature infants and their families. Therefore, prevention and treatment of PMTS in the NICU is paramount.

TIDC represents a paradigm shift, reframing the NICU from a space solely focused on survival to one that fosters resilience and growth for infants and families alike. As a prevention model, TIDC seeks to mitigate the cumulative effects of chronic toxic stress by addressing its root causes and implementing evidence-based interventions that promote healthy development. One of the most transformative aspects of TIDC is its focus on empowering parents as essential members of the care team. This empowerment is critical for fostering a sense of hope and connection, which counteracts the pervasive helplessness often felt by parents navigating the NICU experience.

Transforming the NICU from a place exclusively focused on disease management and medical technology to an environment that acknowledges and responds to the multifaceted human and developmental needs of critically ill babies and their families is a long-term project. Sadly, pain, suffocation and separation will continue to impact babies and families experiencing NICU care around the globe. And Post-traumatic Stress Symptoms will likely be endured for generations to come. Therefore infants and caregivers should have access to early intervention like ERT or Psychoanalytic Parent-Infant Psychotherapy as preventive psychotherapy during NICU stay and in the following 1001 days. Research will show, if these interventions decrease the risk for feeding, sleeping or attachment disorders. With every incremental step toward more holistic care, we move closer to a future where the tiniest humans and their families are met with care that honors their humanity and potential. Together, we can create a world where no family feels alone, no infant’s needs to go unheard, and hope becomes the heart of every NICU journey.

Source: https://perspectives.waimh.org/2025/06/19/pediatric-medical-traumatic-stress-pmts-from-nicu-to-preschool

PREEMIE FAMILY PARTNERS

When I share my story with new NICU parents, they are often astonished that all three of my children were in the NICU and that I made it through those challenging times. They may think I’m stronger than I am. Honestly, each time I got pregnant, I didn’t believe my baby would end up in the NICU. Each time, I was surprised. I’ve always believed there is a silver lining, but when it came to the health of my babies, it was hard to see one.

My oldest daughter is now a teenager, but I still remember the day she was born like it was yesterday. My pregnancy was full-term and relatively normal. However, during labor, the umbilical cord was wrapped around her neck, affecting her breathing. She didn’t make a sound when she was born, and I couldn’t hold her. I was overwhelmed with fear and worry, unprepared for the NICU experience. She spent almost three weeks in the NICU. Leaving the hospital without her was devastating, but after several consultations, we were assured she wouldn’t have any long-term effects. The NICU stay changed our lives, but I never thought we would go through it again.

For a while, my husband and I didn’t plan on having more children due to a massive fibroid that required surgery. In 2019, I had a myomectomy, and the doctors assured me I could still have children, though it would require a c-section. During the pandemic, I became pregnant again at 40, which made me high-risk. The isolation of the pandemic made the experience even harder. Despite a smooth pregnancy, my second daughter had low glucose levels at birth and needed to stay in the NICU. We were distraught and unprepared, facing the NICU once again for a different reason.

Six months later, I became pregnant with our third daughter. At four months, an ultrasound revealed a cyst in her abdominal area, indicating she would need to stay in the NICU. After she was born, she had to be transported to another hospital for surgery.

Juggling a newborn in the hospital, a toddler at home, and a teenager was incredibly stressful, but now I am able to look back and know that I made it through all of that. My NICU journeys were tough, but my support system helped me through it.

Throughout these three NICU experiences, I’ve learned some valuable lessons:

  • Build a Support System Lean on family and friends when you can. Having people to talk to and share your worries with can make a significant difference. Hand to Hold’s support resources are built around the notion of talking to someone who’s been there. Find support groups, peer mentors, and more.
  • Focus on Progress No matter how small the progress, focus on it. Keeping a gratitude journal helped me maintain a hopeful outlook.
  • Advocate for Your Baby Don’t be afraid to ask questions and seek second opinions. Trust your instincts and ensure you understand your baby’s medical care.
  • Take Care of Yourself Your baby needs you to be strong. Prioritize self-care, rest when you can, and seek support for your mental health if needed.
  • Stay Informed: Educate yourself about the NICU process and your baby’s condition. Knowledge can empower you and reduce fear.

Being a NICU parent is a journey filled with unexpected challenges, but with support, hope, and advocacy, you can navigate through it. You are stronger than you think.

Source:      https://handtohold.org/my-journey-as-a-three-time-nicu-mom/

For decades, the conversation surrounding perinatal mental health has centered—appropriately—on mothers. The recognition of postpartum depression, anxiety disorders, and birth-related trauma has transformed obstetric and pediatric practice. Universal screening recommendations, increased public awareness, expanded access to mental health services, and growing legislative support have all reflected an important truth: the emotional well-being of mothers profoundly influences the health and development of their children. However, amid this progress, one parent has remained largely absent from both clinical practice and public policy

Last June 2025, Neonatology Today published an NCfIH Column examining paternal mental health and the often overlooked psychological challenges experienced by fathers during the transition to parenthood. (1) That article highlighted an uncomfortable reality: while medicine increasingly recognizes the importance of supporting mothers, fathers frequently receive little acknowledgment of their own emotional vulnerabilities. Despite a growing body of evidence demonstrating that paternal mental health significantly affects infant development, maternal wellbeing, family functioning, and long-term childhood outcomes, routine assessment and treatment of fathers remain uncommon throughout obstetric, neonatal, and pediatric care. (1-7) 

This omission represents more than a gap in clinical practice. It reflects a fundamental inconsistency in our commitment to family centered care. If family-centered care truly seeks to optimize outcomes for infants by supporting the entire family system, then paternal mental health can no longer remain an afterthought. 

The Expanding Science of Paternal Mental Health 

The traditional image of fatherhood has emphasized strength, emotional stability, and unwavering support for one’s family. While these qualities remain admirable, they have also contributed to a culture in which fathers often suppress emotional distress rather than acknowledge it. Modern neuroscience, psychology, and developmental medicine tell a far more complex story.

 The transition to fatherhood represents one of the most profound psychosocial adjustments in adult life. New fathers experience dramatic changes in identity, family dynamics, financial responsibilities, sleep patterns, interpersonal relationships, and daily routines. Increasingly, research demonstrates that measurable biological alterations accompany these psychosocial changes. Investigators have documented reductions in circulating testosterone, changes in cortisol regulation, fluctuations in prolactin, oxytocin, and vasopressin levels, and alterations in neural pathways associated with attachment and caregiving. These neuroendocrine adaptations appear to facilitate paternal bonding and promote nurturing behaviors. However, they may also increase susceptibility to mood disorders in vulnerable individuals. (2-4)

These biological findings reinforce an important concept: paternal depression is neither a personal weakness nor simply a stress reaction. Rather, it represents a multifactorial medical condition arising from the interaction of biological, psychological, and social factors.

 Current estimates suggest that approximately 8–10% of fathers experience postpartum depression during the first year following childbirth. The prevalence rises substantially when mothers are also experiencing postpartum depression and may exceed 20–25% among fathers whose infants require prolonged hospitalization in a neonatal intensive care unit (NICU). Fathers also demonstrate increased rates of generalized anxiety disorder, adjustment disorders, acute stress reactions, and post-traumatic stress disorder (PTSD), particularly following traumatic deliveries, neonatal surgery, congenital anomalies, or extreme prematurity. (2,3, 5-7) These numbers likely underestimate the true burden of disease because paternal mental health remains significantly underdiagnosed. 

Why Fathers Go Unrecognized

 One of the greatest barriers to addressing paternal mental health is that men often experience depression differently from women. Rather than expressing persistent sadness or tearfulness, fathers may present with irritability, emotional numbing, anger, increased conflict within relationships, substance misuse, compulsive work behaviors, social withdrawal, sleep disturbances, diminished concentration, or risk-taking behaviors. These manifestations are frequently interpreted as personality changes, occupational stress, or relationship difficulties rather than symptoms of an underlying depressive disorder. 

Cultural expectations further compound the problem. Traditional masculine norms encourage emotional self-reliance and discourage help-seeking behavior. Many fathers perceive acknowledgment of emotional distress as evidence of personal failure or inadequate parenting. Others believe that their own emotional needs are secondary to those of their partner and infant. 

Healthcare systems unintentionally reinforce these beliefs. Throughout pregnancy, childbirth, and postpartum care, fathers often occupy the role of supporter rather than recipient of care. Obstetric providers appropriately focus on maternal health, while pediatric providers concentrate on infant well-being. Consequently, fathers may accompany dozens of medical encounters without anyone directly asking about their own mental health. Ironically, they may be among the individuals most in need of support. 

The NICU: A Perfect Storm for Psychological Distress

 Although every transition to parenthood presents challenges, few experiences equal the psychological burden associated with neonatal intensive care hospitalization. Parents of critically ill newborns experience repeated exposure to uncertainty, invasive procedures, life-threatening complications, alarms, unfamiliar technology, and prolonged separation from the infant they anticipated bringing home shortly after birth.

While considerable research has documented maternal psychological distress during NICU hospitalization, fathers often shoulder multiple simultaneous responsibilities. They may balance full-time employment with daily hospital visits, care for siblings at home, provide emotional support to their partner, communicate with extended family, navigate insurance and financial concerns, and participate in complex medical decision-making. 

Many fathers describe feeling obligated to remain emotionally composed for everyone else, leaving little opportunity to process their own fears or grief. Not surprisingly, studies demonstrate significantly elevated rates of anxiety, depression, and PTSD among NICU fathers. These symptoms frequently persist long after hospital discharge, influencing parenting behaviors, family relationships, and future reproductive decisions.

Ignoring paternal mental health, therefore, represents a missed opportunity to improve both immediate and long-term family outcomes. 

The Impact on Infant Development 

The importance of paternal mental health extends well beyond the father himself. Contemporary developmental science increasingly recognizes fathers as critical contributors to early childhood development. Positive paternal engagement promotes language acquisition, executive functioning, emotional regulation, social competence, and cognitive development. 

Conversely, untreated paternal depression has been associated with reduced parent-infant bonding, diminished responsiveness to infant cues, decreased participation in reading and play, increased behavioral difficulties during childhood, and higher rates of anxiety and depression among offspring. The effects are often indirect but profound. 

A father experiencing depression may struggle to provide emotional support to his partner, increasing maternal stress and impairing co-parenting relationships. Household conflict may rise. Communication deteriorates. Family resilience diminishes precisely when it is needed most. From a systems perspective, paternal mental health should therefore be understood not as an isolated psychiatric concern but as an essential determinant of family health. 

Family-Centered Care Must Include Fathers 

Family-centered care has become a foundational principle within neonatal medicine. Its core philosophy recognizes parents as essential partners in their infant’s care and emphasizes collaboration, respect, education, and shared decision-making.

However, meaningful family-centered care requires more than inviting parents to participate in bedside rounds.

 If healthcare systems genuinely recognize families as integral members of the care team, they must also recognize that the psychological well-being of every caregiver directly influences infant outcomes. Supporting fathers should become an expected component of comprehensive neonatal and pediatric practice rather than an optional service available only at selected centers. This begins with acknowledgment. 

Simple screening instruments for paternal depression and anxiety already exist and can be incorporated into NICU follow-up clinics, pediatric well-child visits, and postpartum care with relatively little additional burden. Education on paternal mental health should be incorporated into prenatal counseling, childbirth education, NICU orientation, and discharge planning. 

Equally important is ensuring that screening leads to meaningful intervention through referral pathways that include behavioral health professionals, peer support groups, cognitive behavioral therapy, psychiatric evaluation when appropriate, and community resources designed specifically for fathers.

A Policy Imperative Clinical care alone cannot address paternal mental health. Public policy must evolve alongside scientific evidence. Paid parental leave remains inconsistent across the United States despite substantial evidence demonstrating benefits for parent-infant bonding, maternal recovery, breastfeeding success, and paternal involvement. Expanding paid paternity leave may also reduce psychological distress by allowing fathers a greater opportunity to adjust to new parenting responsibilities while participating actively in infant care.

Similarly, insurance coverage should facilitate access to behavioral health services for fathers during the perinatal period. Funding agencies should prioritize research examining paternal depression, anxiety, PTSD, and effective interventions, particularly among families experiencing NICU hospitalization or medically complex births. 

Professional organizations—including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the National Perinatal Association, the National Coalition for Infant Health, and neonatal nursing organizations— have an opportunity to develop evidence-based guidance to support routine paternal mental health assessment and referral. Such recommendations would acknowledge what decades of developmental science have already demonstrated: supporting fathers ultimately supports children. 

Changing the Narrative

 Perhaps the greatest challenge lies not within medicine but within society. We must replace the outdated expectation that fathers endure emotional suffering silently with a more accurate understanding of paternal resilience. Seeking help is not evidence of weakness. It is evidence of insight, responsibility, and commitment to one’s family.

The feature NCfIH published in Neonatology Today last June represented an important step toward bringing paternal mental health into mainstream neonatal discourse. (1) That conversation should not end with a single publication. Rather, it should catalyze sustained clinical innovation, multidisciplinary research, professional education, and policy reform. Medicine has successfully transformed maternal mental health from a neglected topic into a recognized public health priority. There is every reason to believe we can achieve the same progress for fathers.

 Doing so requires us to broaden our definition of perinatal care. Caring for infants means caring for parents. Caring for parents means caring for both mothers and fathers. Until paternal mental health receives the same attention, resources, and scientific rigor as maternal mental health, our vision of family-centered care will remain incomplete. (1) The health of fathers matters—not only because they deserve compassionate, evidence-based care, but because the well-being of fathers profoundly shapes the health, resilience, and future of the families they love.

Source: https://neonatologytoday.net/newsletters/nt-jul26.pdf

INNOVATIONS

Bringing a child into the world can feel overwhelming for most new parents, but these feelings are heightened when the new baby must be admitted to the Neonatal Intensive Care Unit, or NICU, due to prematurity, a genetic condition or critical illness that requires around-the-clock care. About 10% of all newborns need this specialty treatment. 

For Esther Kangethe, those feelings began in June 2024, when she was rushed to Oregon Health & Science University due to significant cramping and bleeding while 20 weeks pregnant with twins.

Tragically, Kangethe lost one of her twins that day. But she held onto hope as “Twin B” remained stable for the next few weeks. She gave birth to her son at 23 weeks; he weighed just over a pound. He was named Myles — a profound tribute to his health journey, representing the miles traveled between the different hospital units during their stay.

Although overjoyed that Myles was born safely, Kangethe understood there was a long road ahead to ensure he grew strong and healthy. 

“Now the reality hit me that I had a baby in the NICU, and I was so scared,” she said. “It was something new I’d never experienced before.”

But Kangethe wasn’t alone for what would be five months in the NICU. Recognizing the need for both mental health and resource support through the traumatic experience of a NICU stay — particularly for families from racial and ethnic minority groups — OHSU Doernbecher health care teams have established culturally specific support groups designed specifically for Black and Latino families. The groups are open not only to OHSU patient families like Kangethe but all families who have had a child in a Portland NICU.

“It’s hard to explain what’s going on with your baby to someone who hasn’t had that experience. A lot of families are spending days and nights in the hospital, which can lead to a feeling of extreme isolation,” said Devlynne Sasha Ondusko, M.D., assistant professor of pediatrics in the OHSU School of Medicine who helped establish the support groups.

“Peer support groups provide the opportunity for families with similar lived experiences to come together, learn from and mentor one another, and find hope from those families who have come out the other side.”

Personalized support

Navigating a NICU stay is a challenging experience for any family, but can be especially so for racial and ethnic minority groups. An OHSU-led study published recently in the journal Pediatrics found that Black families continue to experience differential treatment in the NICU, including discrimination and poor communication, which reinforces the untrustworthiness of the health care system.

Improving care and the patient family experience requires more transparent communication, advocacy and mental health support, increasing engagement in patient families’ parental roles, and decreasing biased treatment and provision of resources, said Ondusko, corresponding author of the study.

“One thing that is apparent is that there is not nearly enough mental health support for parents who are going through the traumatic experience of a NICU stay,” she said. “Finding resources and staying connected to resources is very hard, especially during and after the transition of taking your baby home. We started to think about how we could better support families of color, who have told us they experience additional isolation in this setting.”

The OHSU support groups seek to address that issue. They are a safe, supportive space where families can come together, share a meal, learn about resources and, most importantly, find connection with others sharing a similar experience. The discussions are participant-led but guided by facilitators, who are qualified mental health professionals, and community organization leaders, including Healthy Birth Initiatives and Healthy Families.

Ondusko introduced Kangethe to the support group for Black families. Kangethe said the group is not only a safe place to speak about her emotional experiences, but also provides the opportunity to ask questions and better understand her baby’s care.

“I’ve been going to the meetings every month and have connected with the parents there who had similar situations to mine, and that has really given me hope,” she said. “These groups make you stronger and remind you that you’re not alone in this.”

Feeling supported by the care team was a crucial part of her overall experience, Kangethe said.

“The doctors in the OHSU NICU were really the best,” she said. “They understood the parents, were very good at explaining things, had empathy and were able to listen. They even offered regular one-on-one time with my doctor where I could ask any questions and write things down.”

Expanding access to support

Ondusko and colleagues are now conducting ongoing research, including in-depth interviews with patient families, to understand what is beneficial about the support groups and what could be improved, as well as how to expand access throughout the community and adapt the format to other groups.

“I’d love to see us make this more inclusive between all of the NICUs, and even alternate between sites to ensure all families can access this resource,” Ondusko said.

Ondusko also hopes to leverage lessons from these groups for the development of a program that could be shared and applied in other NICUs around the country.

For Kangethe, after five long months in the NICU and meeting with her support group, she received the ultimate holiday gift: Baby Myles was discharged just before Thanksgiving. At 8 months old, he’s now happy, healthy and thriving at home with his family.

Source: https://news.ohsu.edu/2025/02/21/ohsu-led-groups-provide-culturally-specific-support-for-nicu-families-across-portland

Background

Telemedicine uses videoconferencing technology to enable real-time audio and visual communication, linking on-site healthcare providers with specialists at remote locations. Over the past decade, telemedicine has grown significantly within the field of neonatology. This study seeks to deepen the understanding of telemedicine applications for newborns and neonatal intensive care units (NICUs) through a detailed bibliometric analysis.

Methods

Publications on telemedicine in newborns and NICUs from January 1, 2004, to October 22, 2024, were retrieved from the Web of Science Core Collection. Using Microsoft Excel, CiteSpace, the R package “bibliometrix,” and VOSviewer, we analyzed the data to examine the number of publications, contributing countries/regions, institutions, authors, journals, references, and keywords.

Results

Since 2004, 1177 publications have been included, reflecting a rapid increase in research on telemedicine in newborns and NICUs over the past decade. These studies originated from 55 countries/regions and 139 institutions. The United States, the United Kingdom, and India were the primary contributors in terms of publication volume. Among the 405 authors analyzed, Jennifer L. Fang had the highest number of publications, while James P. Marcin received the most co-citations. BMC Pregnancy and Childbirth published the most articles, and Pediatrics had the highest citation count. The most frequently used keywords included “accuracy,” “depression,” “digital health,” “mobile health,” and “parents,” highlighting key research areas. Emerging research frontiers such as “palliative care,” “low-income populations,” “artificial intelligence,” and “parents with high-risk infants” indicate rapidly advancing topics in this field.

Conclusions

This study is the first to perform a comprehensive bibliometric analysis of publications on telemedicine in newborns and NICUs. In the previous 20 years, global interest in teleneonatology research has significantly increased. Our bibliometric findings offer valuable insights for researchers, helping them understand essential information, recognize current research hotspots, identify potential collaborators, and explore future research frontiers in this field.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC12035156/

Background: Caregiver-child interactions, and specifically child-directed speech, play a central role in early language acquisition by scaffolding children’s attentional and lexical development. The features and developmental effects of child-directed speech may vary depending on the child’s developmental status and communicative needs, especially in clinical risk conditions such as preterm birth.

Aims: This study examined maternal child-directed speech in a semi-structured context, focusing on prosodic cues (mean pitch, pitch range, and speech rate) and structural features (lexical diversity, verbosity, and syntactic complexity) in preterm (PT) and full-term (FT) 18-month-old toddlers interacting with their mothers. We explored (a) differences in child-directed speech between PT and FT groups, (b) the modulation of prosody based on word familiarity, and (c) associations between child-directed speech characteristics, children’s attentional engagement (visual exploration of familiar/unfamiliar objects), and vocabulary skills.

Methods and procedures: Forty-three mother-child dyads (20 PT, 23 FT) participated in the study. Maternal speech was transcribed and analysed for linguistic features, while target word tokens were acoustically analysed with PRAAT for prosodic measures. Child visual exploration of objects was coded from video recordings, and vocabulary skills were assessed using validated measures.

Outcomes and results: All mothers modulated prosody to highlight novel words, using higher pitch, wider pitch range, and slower speech rate for unfamiliar versus familiar referents. Mothers of FT children produced more frequent and lexically diverse speech compared to PT counterparts, though verbosity did not differ between groups. In the FT group, slower maternal speech rate was associated with reduced visual exploration of objects, suggesting dynamic adaptations to children’s attention. No such association was found in PT dyads. In the PT group, receptive vocabulary index was positively correlated with maternal verbosity, lexical diversity and syntactic complexity.

Conclusions and implications: Findings highlight both shared and group-specific patterns in maternal child-directed speech effects. While prosodic adjustments to word familiarity are preserved in PT dyads, structural aspects of maternal input appear more closely linked to receptive vocabulary in PT children, possibly reflecting adaptive scaffolding strategies. These results underscore the importance of considering both prosodic and structural features of child-directed speech and child conditions in informing targeted early interventions.

What this paper adds: What is already known on this subject CDS is essential for early language acquisition by enhancing attention and vocabulary. However, CDS characteristics may vary with child developmental status, and little is known about differences in maternal speech between preterm and full-term toddlers in relation to word learning. What this paper adds to existing knowledge Both preterm and full-term mothers modulate prosody to mark unfamiliar words, yet full-term mothers use more frequent and lexically diverse speech. Structural aspects of maternal input correlate more strongly with receptive vocabulary in preterm children, indicating possible adaptive strategies. What are the potential or actual clinical implications of this work? These results support the need for early interventions tailored to preterm children that target both prosodic and structural features of maternal speech to optimise language development.  

2025 Royal College of Speech and Language Therapists.: https://pubmed.ncbi.nlm.nih.gov/41456959/

The Music That Carries Our Preemie Community

For many of us, music has been part of our journey since the NICU. Our earliest soundscape may have included monitors, ventilators, alarms, and the quiet voices of parents and caregivers beside an incubator. Within that unfamiliar environment, a softly sung lullaby, gentle humming, or the familiar rhythm of a parent’s voice could create a moment of comfort and connection. Music therapy in the NICU can also offer families a meaningful way to participate in their baby’s care, nurture bonding, and bring warmth into a highly medicalized space.

As preemie survivors, NICU parents, siblings, caregivers, and advocates, we know that healing and development do not end when a baby leaves the hospital. Music can continue to support us throughout childhood and adulthood—as a source of expression, emotional release, confidence, memory, and joy. A familiar song may remind us of how far we have come, help us through difficult moments, or give us a way to celebrate the strength that has always existed within our community.

Music also connects our preemie community across cities, countries, cultures, languages, and generations. We may have different birth stories, medical experiences, traditions, and favorite styles of music, but we recognize many of the same emotions: uncertainty, hope, fear, gratitude, resilience, and love. Through lullabies, cultural songs, community performances, shared playlists, and family traditions, music reminds us that none of us is walking this journey alone.

Summer offers a beautiful opportunity for our community to enjoy that connection together. Music surrounds us at cookouts, picnics, neighborhood festivals, outdoor concerts, family reunions, city/town events, and relaxed evenings with the people we love. This season, we can create playlists that celebrate our journeys, share songs that helped our families through the NICU, dance with our children, attend accessible community concerts, or simply enjoy music together at home. Every beat can become a celebration of our survival, our families, our cultures, and the powerful community we continue to build.

Playdate With Stacy

Cabo Verde Song for Kids 🇨🇻 | Learn About Cabo Verde (Cape Verde) | Africa Island Geography Song

Learn about Cabo Verde (Cape Verde) with this fun and educational song for kids!Kids explore this African island nation, its geography, and culture through real-life footage and catchy music designed for young learners.


Zayn Malik Reads ‘Music Is In Everything’ | CBeebies Bedtime Stories

Zayn Malik joins us for a Bedtime Story. Listen as he reads ‘Music Is In Everything”, written by Ziggy Marley and illustrated by Ag Jatkowska. This story is a picture book celebrating the joy of music all around us. From the sound of sea waves to laughter and dancing in the family kitchen, music really is in everything!

Our Little Miracle – A Heartfelt Song from Parents to Their Newborn Baby

Our Little Miracle is a heartwarming song from parents to their newborn child — a tender celebration of life, love, and the first moments of parenthood. 💕

This song captures the magic of holding your baby for the first time — the warmth, the tears, and the unspoken promise of unconditional love. Whether you’re a new parent, expecting, or reminiscing about your baby’s first days, this lullaby will melt your heart.

KiteSurf | Waves, Wind & Good Vibes | Kite Verde | Cape Verde | PalmeraFilm

In Santa Maria, a group of people from different corners of the world share what brings them together: a love for the ocean and a passion for learning.

This video, filmed in collaboration with Kite Verde, captures the essence of that energy: laughter, wind, learning, and the feeling of being exactly where you’re meant to be.

Laos, NICU & Sustainability 

Laos, officially the Lao People’s Democratic Republic (LPDR), is a country in Mainland Southeast Asia, and the only landlocked country in Southeast Asia. It is bordered by Myanmar and China to the northwest, Vietnam to the east, Cambodia to the southeast, and Thailand to the west and southwest. Laos has a population of more than 6 million, and its capital and most populous city is Vientiane.

Health in Laos refers to the health of the population of Laos. Life expectancy in Laos was estimated at 67.78 years in 2021. Malnutrition, especially in children, is most prevalent in rural areas and among ethnic minorities. Poor sanitation, and tropical diseases including malaria are strains on the population’s health.

Lao health has improved in the period since Laos joined the World Health Organization in 1950: in addition to life expectancy increases, malaria deaths and tuberculosis prevalence have decreased and the maternal mortality ratio (MMR) has declined by 75%.

Healthcare in Laos is provided by both the private and public sectors.

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

COMMUNITY

Public hospitals in Laos are working to achieve autonomy in a bid to improve service standards, reduce the number of people paying for medical services in other countries, and encourage VIP and private patients to make use of state-run facilities.

Minister of Health Ms Baikham Khattiya chaired a high-level meeting on February 13 with directors general from the ministry, directors of five central hospitals, and leading health officials from 10 provinces taking part in a pilot programme.

Mrs Baikham gave guidance on the reform process and spelled out three key goals: improving services for all patients, using resources more efficiently, and winning back VIP and private patients who typically seek treatment at private hospitals or overseas clinics.

Hospital autonomy allows management teams to make faster decisions on day-to-day operations and to allocate resources more effectively for diagnosis and treatment, so that hospitals can respond better to patient needs.

Starting in 2022, Mahosot, Mittaphab and Setthathirath hospitals have piloted the use of autonomy, while the Mother and Newborn Hospital, the Children’s Hospital and 10 provincial hospitals joined the programme last year.

The provincial hospitals taking part are in Bokeo, Oudomxay, Xayabouly, Xiengkhouang, Luang Prabang, Vientiane, Bolikhamxay, Khammuan, Savannakhet and Champasak.

The health minister urged hospital heads to lead staff in a patient-centred and quality-focused way, and to build trust among medical staff and patients.

Those in charge must be accountable role models and motivate their teams so that staff are inspired to improve services, she said.

Director General of the Department of Healthcare and Rehabilitation, Dr Khampasong Theppanya, reported on progress to date and outlined plans to further develop the legal framework around hospital autonomy.

Director General of the Department of Organisation and Personnel, Dr Bounserth Keopraseuth, said motivated personnel are essential and that hospital culture must shift towards greater self-responsibility.

Director General of the Department of Planning and Finance, Dr Viengmany Bounkham, highlighted the need for professional financial management and strong accountability and transparency.

A management expert with the Swiss Lao Hospital Project, Dr Alphons Schnyder, said public hospitals in Laos need to improve service standards so they are better placed to compete with private hospitals.

Skills in leadership, management, marketing, financial management, human resources management and change management must be strengthened to improve patient care, he added.

The Swiss Lao Hospital Project has supported the design and development of hospital autonomy since 2019, providing leadership and management training for hospital directors and key staff, and helping hospitals develop action plans.

Source:https://www.swisslaos.ch/en/hospital-autonomy-increases-service-qualityfor-patients-of-public-hospitals-in-laos/

Introduction: The design of Neonatal Intensive Care Units (NICUs) has significant implications for infant outcomes, parental well-being, and the delivery of family-centered care. Increasing evidence demonstrates that the physical environment of the NICU influences parental presence, participation in care, stress levels, and the development of parent–infant bonding (1-3). As such, NICU design should be understood not merely as an architectural or operational endeavor, but as a critical component of equitable, family-centered healthcare delivery. Centering family voices throughout the design process is essential to ensuring that NICU environments align with the lived realities, needs, and values of the families they serve.

Family Partnership Councils as Decision-Making Bodies: The formation of a NICU-specific Family Partnership Council (FPC) provides a structured mechanism for embedding family perspectives into NICU quality improvement and processes, including design governance. Such councils should include parents and family members who have experienced a NICU stay and who represent diverse backgrounds and lived experiences. They should reflect variation in race, ethnicity, language, socioeconomic status, family structure, and infant diagnoses and outcomes.

Importantly, Family Partners should participate directly in design meetings and decision-making processes, rather than serving solely in advisory or consultative roles. Equitable participation requires intentional preparation, inclusive meeting practices, and recognition of family expertise as complementary to clinical and technical knowledge. When families are positioned as equal stakeholders, design outcomes are more likely to reflect authentic family needs and promote shared ownership of the resulting space. This looks like adopting a framework like the NEC Society’s All In Meeting Guidelines, which aims to dismantle the hierarchy in healthcare and empower everyone to stakeholders, design outcomes are more likely to reflect authentic family needs and promote shared ownership of the resulting space. This looks like adopting a framework like the NEC Society’s All In Meeting Guidelines, which aims to dismantle the hierarchy in healthcare and empower everyone to contribute, by providing meeting materials in advance so Family Partners can adequately prepare and decode acronyms and other medical jargon contribute, by providing meeting materials in advance so Family Partners can adequately prepare and decode acronyms and other medical jargon.

Early and Continuous Family Engagement: Family engagement in NICU design should occur early and be sustained throughout the planning and implementation phases. Traditionally, families are consulted during late-stage feedback or evaluation periods, limiting their meaningful influence on core design decisions. Early involvement enables families to contribute to the establishment of guiding principles, identify priorities, and highlight unmet needs that may not be apparent to clinicians, administrators, or design professionals.

Ongoing engagement throughout the design process allows for iterative refinement and ensures that family perspectives remain integrated as budgets, timelines, and priorities evolve. This continuous approach positions families as partners rather than passive stakeholders, thereby strengthening alignment between design intent and real-world use.

Accessibility, Inclusivity, and Equity Considerations: Centering family voices in NICU design necessitates intentional inclusion of families from historically marginalized or underrepresented groups, including non-English language preference (NELP) families and parents with disabilities. Without deliberate outreach and accommodation, design processes risk privileging a narrow subset of experiences. Inclusive NICU environments should incorporate multilingual communication tools, universally accessible layouts, and design features that accommodate a range of physical, sensory, and cognitive needs. Soliciting feedback from parents navigating linguistic or cultural barriers and those with disabilities ensures that design decisions promote equity and reduce structural obstacles to participation in care.

Co-Design Through Participatory Methods:

Participatory co-design methods offer a practical way to translate family input into actionable design solutions. Focus groups, mock room walkthroughs, and simulated environments allow Family Partners to interact with proposed layouts and provide experiential feedback prior to construction.

These methods enable assessment of factors such as room configuration, lighting quality, acoustic conditions, ventilation, and the clarity of wayfinding and signage. Families often identify usability challenges that may not be evident in architectural plans, particularly under conditions of stress or fatigue. They may also identify accessibility challenges as it relates to recovery from childbirth, including considerations for parents recovering from traumatic births and/or cesarean sections. Incorporating iterative feedback through co-design processes enhances usability, reduces the likelihood of costly post-construction modifications, and promotes environments that better support family well-being.

Designing for the Daily Realities of NICU Families:

Family-centered NICU design must be grounded in an understanding of families’ daily lived experiences during prolonged hospitalizations. Parents in the NICU frequently assume caregiving responsibilities while managing physical exhaustion, emotional stress, and logistical challenges. Design strategies should therefore prioritize functionality, comfort, and proximity. Key design considerations include the availability of spaces that support parental rest, layouts that facilitate continuous proximity to the infant, and infrastructure that enables sustained participation in feeding and pumping. Attention to these elements acknowledges parents as integral members of the care team and supports their capacity to remain present and engaged.

Pumping spaces, in particular, should be intentionally designed to support frequent, sustained milk expression by locating them in proximity to the infant’s bedside whenever feasible. Proximity reduces physical and psychological barriers to pumping, minimizes time away from the infant, and supports parental presence and engagement in care. These spaces should provide visual and acoustic privacy, adequate and secure storage for personal belongings and expressed human milk, and immediate access to hygienic cleaning and handwashing facilities. Integrating pumping infrastructure inside patient rooms acknowledges lactation as a core component of neonatal care rather than an ancillary activity, and reinforces the role of parents as active participants in their infant’s treatment and development.

Transparency and Accountability in the Design Process: Transparent communication is essential to sustaining trust and meaningful engagement with Family Partners. Families who contribute to NICU design efforts should receive regular updates regarding design decisions and clear explanations of how their feedback has influenced outcomes.

When constraints limit the feasibility of certain recommendations, openly communicating the rationale for these decisions reinforces accountability and respect. Transparency transforms family engagement from a symbolic exercise into a substantive partnership and supports long-term collaboration beyond the design phase.

Northern European Approaches to Family-Centered NICU Design: Exploring design and care models implemented in other countries, particularly in Northern Europe, can further expand the possibilities for family-centered NICU environments. Many Northern European NICUs have long prioritized continuous parental presence, integrated caregiving roles, and physical designs that support parents as primary caregivers rather than visitors.

Examining these international approaches can help illuminate alternative spatial configurations, workflows, and cultural norms that may not be readily apparent within U.S.-based systems. Limitations are often assumed to be fixed when, in fact, they are products of historical design choices and institutional culture. Without intentional efforts to look beyond familiar models, stakeholders may envision only incremental improvements rather than transformative change. Incorporating international case studies and comparative learning into the design process encourages stakeholders to question entrenched assumptions, broaden their conceptual frameworks, and reimagine NICU environments from principles grounded in family needs rather than legacy constraints.

Conclusion: Centering family voices in NICU design represents a critical strategy for advancing family-centered, equitable neonatal care. Through early and continuous engagement, the establishment of Family Partnership Councils, participatory co-design methods, attention to daily lived realities, inclusive practices, transparent communication, and examination of international approaches, NICU environments can be intentionally aligned with the needs of families. Ultimately, NICU design that is informed by family expertise contributes not only to improved physical spaces but also to a broader culture of partnership, respect, and shared responsibility in neonatal care.

Source: https://neonatologytoday.net/newsletters/nt-may26.pdf

HEALTHCARE PARTNERS

Innovation in neonatal care often stalls in the “Valley of Death,” the treacherous gap between laboratory discovery and clinical application. Dr. Bernard Thébaud explains that while amphibians possess a “blastema” to regrow limbs, humans rely on mesenchymal stromal cells (MSCs) to orchestrate healing. Research indicates that umbilical cord derived MSCs and their extracellular vesicles (EVs) offer significant lung and neuroprotective benefits in animal models. To overcome the 30 year drought of new neonatal medications, Thébaud introduced “The Incubator,” a clinical accelerator strategy that integrates parent perspectives and animated educational tools to improve trial enrollment. Using single cell RNA sequencing, his team can now barcode individual cells to distinguish between therapeutic progenitors and ineffective fibroblasts, aiming to transform cell therapy into a precise, high tech biotechnology.

PREEMIE FAMILY PARTNERS

INNOVATIONS

Japan has long set the global standard for neonatal survival: between 80–90% of infants born at 22–24 weeks’ gestation survive to discharge, with an overall NEC rate below 2% in very low birth weight (VLBW) infants. (1) Yet survival is only the beginning. Japanese clinicians recognized that, even with this impressive clinical success, neurodevelopmental outcomes could be improved with better early growth. Achieving that required solving a nutritional dilemma in Japan.

Prior to a recent landmark regulatory decision, human milk-based fortifiers (HMBF) were not approved for use in Japan; only cow milk-based fortifiers (CMBF) were available. Concerns over the risks of CMBF in the smallest and most vulnerable infants led clinicians to routinely delay or avoid fortification, leaving those infants without adequate nutritional support during the most critical window of brain development.  Now, for the first time anywhere in the world, HMBF has been designated as a prescription drug with Japan’s Ministry of Health, Labour and Welfare approving Prolacta Bioscience’s fortifiers for use in VLBW and post-surgical infants. It is a decision that has the potential to transform not just Japanese neonatal care but the global standard.

The Neurodevelopmental Stakes: The third trimester is the most dynamic period of neurological development in the entire human lifespan, one in which brain mass increases measurably week by week and approximately 250,000 neurons are formed every minute.  For the very preterm infant, this extraordinary period of growth is happening outside the womb in the neonatal intensive care unit (NICU) with care teams managing the nutritional support that fuels it.

The consequences of nutritional deficits during this window extend far beyond the NICU. Inadequate early nutrition reduces brain cells, myelin production, and synaptic connections, and has been associated with lasting cognitive impairment. What we feed these infants in their first days and weeks of life can shape their long-term neurodevelopmental trajectory in ways that no intervention later in childhood can fully reverse.

Why Japan’s Fortification Practice Needed to Change:

Despite its exceptional survival rates, Japan’s standard nutritional approach carried a critical limitation. The prevailing practice often relied on withholding or delaying CMBF and formulas, known to carry risks of complications in premature infants. The recently published study on the Japan-led JASMINE trial describes the clinical reality plainly:

Notably, Japan is a world leader in survival rates of extremely preterm infants, with 80–90% of infants 22–24 weeks surviving to discharge in 2022, and an overall NEC rate of 2% in VLBW infants. Despite these excellent outcomes, there is not yet wide availability of human donor milk (DM) and a great hesitancy to feed and fortify infants with cow milk-based products early, often leading to poor growth outcomes in Japanese infants. The result was inadequate nutrition and growth during the precise developmental window when the brain needs it the most. Japanese neonatologists were, in effect, winning on one metric while potentially compromising on another.

The JASMINE Trial: A Phase III Answer:

The JASMINE trial, Growth and Safety Evaluation in Very Low Birth Weight Infants Receiving an Exclusive Human Milk Diet: A Phase III Randomized Control Trial in Japan, was conducted across 11 Japanese NICUs and randomized very low birth weight infants to either an exclusive human milk diet (EHMD) with human milk-based fortifiers added to mother’s own milk or donor milk, or the Standard Diet where CMBF or formula was delayed or avoided completely. Baseline characteristics were similar between groups, with a mean birth weight of 908.1 g in the EHMD group and 947.6 g in the standard diet group, and a mean gestational age of 27.05 weeks and 27.63 weeks, respectively. For clarity, findings are summarized from the per-protocol set (PPS; n=135), which included infants who remained on protocol through 34 weeks’ gestational age (EHMD n=66; standard diet n=69) without a major protocol violation.

The EHMD comprised three Prolacta products in the trial: Prolact+6 and Prolact+8, human milk-based fortifiers, and Prolact CR, a human milk-derived fat module added to mother’s own milk or donor human milk. Prolact CR played a central role in the protocol; approximately 95% of infants in the EHMD arm received it, providing concentrated nutrition without substantially increasing feeding volumes.

The JASMINE results were compelling. In the per-protocol set (PPS), the EHMD group demonstrated significantly greater weight gain velocity than infants in the Standard Diet group (14.30 vs. 11.96 g/kg/day, p <0.001). Standard Diet (0.85 vs. 0.66 cm/week, p≤0.0016), and infants in the EHMD group achieved full feeding volumes faster. Notably, the EHMD group spent fewer days on antibiotics compared to the Standard Diet group, a meaningful indicator of infection resilience in a context where sepsis remains the leading acquired cause of neonatal death in Japan.  Although not statistically significant, head circumference growth was numerically improved in the human milk arm. Critically, these growth gains came without compromising safety. There was a single NEC case in the EHMD group, consistent with Japan’s low baseline NEC rates. Although randomized, the EHMD group included a higher proportion of infants born at 22–23 weeks’ gestation than the Standard Diet group, making the superior growth outcomes even more meaningful.

Human Milk Fat and the Developing Brain: For the preterm infant, fat is not simply a source of calories. The fat in human milk is uniquely structured to nourish the developing brain in ways that cow milk-based products cannot match. Human milk fat globules (MFGs) comprise approximately 98% of the fat in human milk and deliver 191 bioactive proteins, as well as long-chain polyunsaturated fatty acids, including DHA, which is critical for brain development. Premature infants miss approximately 80% of the DHA that would normally accumulate in the brain and tissues during the third trimester. (15) Prolact CR is composed of approximately 25% human milk fat and has been shown to increase weight and length velocity in VLBW infants significantly. A randomized trial of infants 750–1,250 g showed that infants who received human milk-derived cream had superior weight gain (14.0 vs. 12.4 g/kg/day, p=0.03) and superior length gain (1.03 vs. 0.83 cm/week, p=0.02) compared to those who did not receive it.  Cow milk-based products cannot replicate this bioactive profile, as intact MFGs are largely absent from CMBF. Prolacta’s vat pasteurization process preserves MFG integrity, maintaining the structural and functional properties of these bioactive components in their native state.  By contrast, processing methods such as homogenization and ultra-high-temperature (UHT) sterilization disrupt MFG membranes and additionally degrade key bioactive proteins. Immunoglobulins are reduced to nearly undetectable levels under UHT, and vascular/endothelial growth factor (VEGF), critical to gut and vascular development, is reduced by more than 60%. The human milk-based products also preserve a wide spectrum of human milk oligosaccharides (HMOs), the third-most-abundant component in human milk, which guide the development of beneficial gut bacteria and, emerging research suggests, may directly influence neurodevelopmental processes in early brain development.

The Long View: Neurodevelopmental Outcomes Beyond the NICU: The JASMINE trial had a clear goal: to optimize early growth in the most vulnerable preterm infants to support better neurodevelopmental outcomes potentially. Evidence from EHMD use in other settings underscores the long-term benefits.

A 2025 multicenter study by Chou and colleagues across 13 Kaiser Permanente Southern California NICUs involving more than 1,000 infants found that an EHMD was associated with 26% lower odds of motor skill delays at age 3, compared with infants fed cow milk-based products, despite EHMD infants being born approximately three weeks earlier and weighing more than 300 g less at birth.  Hair and colleagues reported that infants fed an EHMD had significantly higher cognitive scores and a trend toward improved language scores at 18–22 months corrected age compared to those fed cow milk-based diets.

A Landmark Decision with Global Implications:

Japan’s prescription drug designation for Prolacta’s human milk-based fortifiers is not simply a regulatory milestone; it is a clinical statement grounded in rigorous Phase III evidence that early fortification with an EHMD is achievable, beneficial, and safe for VLBW infants. For NICUs globally, this approval sets a powerful precedent that the evidence is strong enough and the safety profile clear enough that all NICUs should be using human milk-based products to fortify the enteral feeds of very preterm infants, not just to help premature infants survive but to help them thrive in the long term.

Source: https://neonatologytoday.net/newsletters/nt-jun26.pdf

Very Preterm birth (vPTB) and extreme Preterm birth (xPTB) are the major concerns in maternal and child healthcare and are associated with increased morbidity and mortality. Machine learning methods have traditionally been used to predict preterm births (vPTB and xPTB). However, most medical datasets, including preterm births, are imbalanced in class distribution. Although data-balancing techniques can be employed, complications due to the limited sample size of the minority class are frequently encountered, leading to inconsistent results. This study adopted a novel approach by employing one-class classification (OCC) in conjunction with several strategies to predict instances of vPTB and xPTB within an Emirati pregnant population. We used a well-curated dataset acquired during the first trimester of pregnancy. We employed multiple OCC algorithms and their ensembles involving multiple aggregation strategies to predict vPTB and xPTB in both parous and nulliparous populations. Our approach effectively incorporated only majority class information during training. Our detailed experimental setup demonstrated that the proposed methodology achieved promising performance with a maximum AUC-ROC of 0.823 for the parous population without any explicit modeling of the minority class. Our approach demonstrated robustness and efficacy in identifying at-risk pregnancies within the Emirati population. Our results suggest that one-class classification framework which requires only normal data points for training can be used for early prediction of very preterm and extreme preterm births with reasonable accuracy. In this paper, we applied one-class classification framework only on the Emirati population. Generalizing the proposed approach in this domain requires experimentation on similar datasets from other countries.

Source:https://www.nature.com/articles/s41598-025-29219-4

Abstract

Background

In the neonatal intensive care unit (NICU), premature neonates frequently endure painful procedures that can lead to long-lasting sequelae, underscoring the critical need for safe and effective pain management strategies. Auricular massage has demonstrated significant benefits for children, including anxiety and stress relief. Investigating its effectiveness in alleviating pain in neonates could introduce a valuable nonpharmacological approach to pain management, enhancing the overall care and comfort of these vulnerable infants.

Objective

This research is aimed at studying the effectiveness of a 3-min session of auricular massage in reducing pain caused by nasal and oral suctioning among premature neonates in the NICU in Jordan.

Methods

A randomized controlled trial employing a single-blind crossover design was conducted in a single hospital. Preterm neonates were randomly assigned to one of two conditions. In Condition I, neonates initially received auricular massage treatment after suctioning, followed, after 2 days, by no massage after suctioning. Conversely, in Condition II, neonates had the reversed sequence, starting with no massage and then receiving auricular massage treatment after 2 days. Pain levels in the neonates were assessed using the Premature Infant Pain Profile-Revised (PIPP-R) scale.

Results

Data from 60 preterm neonates were analyzed using the SPSS Version 28. Chi-square and independent t-tests revealed no significant differences between neonates in the study conditions based on gender (p = 0.43), gestational age (p = 0.41), and body weight (p = 0.35). Paired t-test results indicated a significant difference in pain scores when comparing periods of auricular massage to periods without massage. The mean pain score following auricular massage was 3.63 (SD = 2.36), whereas it was 10.23 (SD = 2.40) in the absence of massage.

Conclusion

Auricular massage for a 3-min duration is an effective nursing intervention that warrants consideration as a nonpharmacological method of pain relief for premature neonates during admission to the NICU.

Source:https://pmc.ncbi.nlm.nih.gov/articles/PMC12520807

Neonatal Womb Warriors for a Healthier World

To everyone reading this who started life early: this one is for you. For many of us, the beginning of our story was not only a medical event, but an environmental one. Research increasingly links extreme heat, wildfire smoke, and fine particulate air pollution with higher rates of preterm birth. For some families in this community, the air outside the hospital window may have helped shape what happened inside it. That truth is heavy, but it also gives neonatal womb warriors a powerful place in the fight for cleaner air, safer pregnancies, and healthier futures.

The NICU that saved so many of us is one of the greatest examples of human skill, science, technology, and love working together. Monitors, isolettes, tubing, ventilators, medications, and specialized teams ran day and night to give fragile, early life a chance. Because we know what that care means, we also know why the future of neonatal care matters. Green NICU initiatives are beginning to show how hospitals can reduce waste, conserve energy, and limit unnecessary plastic while protecting the lifesaving care that babies and families depend on.

The science keeps getting clearer: heat waves, air pollution, fine particulate matter, and ozone are associated with increased risks of early delivery, low birth weight, and other complications. Families living near heavy traffic, industry, wildfire smoke, or poor air quality often carry the highest burden. Climate and air quality are not side issues for the neonatal community. They shape pregnancy, birth, survival, and long-term health.

That is why neonatal womb warriors have such an important voice. Supporting clean air policy is preemie advocacy. Pushing for climate-resilient hospitals is preemie advocacy. Reducing unnecessary healthcare waste is preemie advocacy. Protecting pregnant people and newborns from environmental harm is preemie advocacy. This is the same fight, carried further upstream, toward a world where fewer babies have to begin life fighting so hard.

So let this be a small flag planted for every preemie survivor, NICU graduate, parent at the bedside, clinician in the unit, and tiny warrior who did not make it home. The world that shaped our beginning is worth protecting. Bring your reusable water bottle, support policies that clean the air, ask your hospital about sustainability, and talk about this connection with people who may never have considered it before. You were a warrior before you ever drew an unassisted breath, and now that strength can help build cleaner air, stronger hospitals, safer births, and a healthier world for the next generation of tiny fighters.

Coalitions, Intergenerational Associations, Drones

Botswana, officially the Republic of Botswana, is a landlocked country in Southern Africa. Botswana is topographically flat, with approximately 70% of its territory being a part of the Kalahari Desert. It is bordered by South Africa to the south and southeast, Namibia to the west and north, Zambia to the north, and Zimbabwe to the northeast. With a population of slightly over 2.4 million people and a comparable land area to France, Botswana is one of the most sparsely populated countries in the world. While it is not enshrined by statutory law, Botswana is de facto the nation state of the Batswana people, who constitute nearly 80% of the population while legally undistinguished Kalanga people, who account for another 11%, are the single largest ethnic minority.

Botswana is a parliamentary republic governed by the Constitution of Botswana. It is the longest uninterrupted democracy in Africa. Its seat of government is in Gaborone. Botswana’s governing institutions were established after it became an independent nation in 1966. Botswana’s governmental structure is based on both the United Kingdom’s Westminster system and the Tswana people’s tribal governments. Botswana has a centralised government in which national law supersedes local law. Local laws are developed by local councils and district councils. They are heavily influenced by tribal governments, which are led by the tribe’s chief.

Botswana provides universal healthcare to all citizens through a public healthcare system, but privately run healthcare is also available. The government operates 98% of all medical facilities. Healthcare in Botswana is delivered through a decentralised model with primary healthcare being the pillar of the delivery system. Botswana has an extensive network of health facilities (hospitals, clinics, health posts, mobile stops) in the 27 health districts. In addition to an extensive network of 104 clinics with beds, 195 clinics without beds, 338 health posts and 844 mobile stops primary health care (PHC) services in Botswana are integrated within overall hospital services, being provided in the outpatient sections of all levels of hospitals. It is through these structures that a complement of preventive, promotive and rehabilitative health services as well as treatment and care of common problems are provided.

For a general check-up, citizens are charged 5 pula, unless they are under five or over 65, in which case check-ups are free. The network of public hospitals is organized between primary hospitals, which function as general hospitals and equipped to deal with most diseases and immediate threats to health, district hospitals, which have more beds and are equipped to deal with more serious medical issues, and referral hospitals, which are highly advanced facilities equipped to deal with specialized problems. There are also two private hospitals in the country. The government pays for the treatment of patients referred abroad for medical procedures.

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

COMMUNITY

Each year, nearly 300,000 women die during childbirth. The vast majority of these deaths are preventable – yet maternal survival is still determined by where a woman lives, her access to care and the strength of the health system around her.

The leading cause of maternal death is postpartum hemorrhage (PPH)—a condition that, with appropriate quality care, is almost entirely preventable. Yet, due notably to limited access to the full range of recommended lifesaving, quality-assured medicines and devices, 86,000 women die of PPH each year. Most of these deaths occur in sub-Saharan Africa, where a woman is 130 times more likely to die in childbirth than a woman in Europe or North America.

These preventable deaths of women and adolescent girls have an enormous impact on families and communities. Data shows that infants who lose their mothers are 35 times more likely to die within the first six months of life.

We know the causes, and we know the solutions. With proven interventions, access to quality assured life-saving commodities and sustainable investment, we can eliminate preventable maternal deaths and save millions of lives.

SafeBirth Africa is a collaborative initiative addressing barriers to effective postpartum hemorrhage care in Africa.

Funded by the European Union in the framework of the Team Europe Initiative on Sexual and Reproductive Health and Rights in Africa and a Flagship project of the Global Gateway strategy, co-led by Unitaid and the United Nations Population Fund (UNFPA) and in partnership with African authorities, SafeBirth Africa aims to accelerate the access to World Health Organization (WHO)-recommended lifesaving tools for prevention, detection and treatment of PPH that are not yet widely used in Africa, while implementing innovative delivery solutions.

Unitaid and UNFPA are working with health authorities in five African countries as well as partners and communities to overcome barriers that limit access to these tools, ensure their routine quantification, procurement and supply, strengthen health systems’ readiness to use them appropriately, and disseminate the latest WHO recommendations on the management of PPH.

SafeBirth Africa is working with health authorities five African countries to address the leading cause of death of women in childbirth.

As part of this project, Unitaid leads the efforts to tackle market barriers related to demand, cost, quality, supply and the optimal use of lifesaving medicines and diagnostic tools, including support for regional production. This initiative builds on Unitaid’s existing US$45 million investment to increase access to lifesaving health products that prevent and treat PPH aiming to drive scalable, evidence-based solutions.

UNFPA brings its technical expertise in emergency obstetric and newborn care and midwifery models of care. By training providers in evidence-based practices and supporting the quantification and procurement of quality-assured PPH commodities through its Supplies Partnership, UNFPA contributes to strengthening health supply chains and building the readiness of health systems to uptake the full range of recommended products.

This initiative complements UNFPA’s Maternal and Newborn Health Fund, which provides catalytic support to strengthen public health systems in countries with high maternal mortality and morbidity, focusing on providing quality maternal and newborn care and integrated SRH services in line with the UNFPA Start with Her Strategy.

Source: https://unitaid.org/uploads/SafeBirth-Africa-Reducing-preventable-deaths-in-childbirth.pdf

Botswana has taken a major step toward modernizing its healthcare system with the launch of a national medical delivery drone programme. President Duma Boko unveiled the initiative in Chanoga, describing it as a transformative move to improve access to life-saving medicines across the country.

The drone programme is designed to strengthen the medical supply chain by ensuring faster and more reliable delivery of essential medicines, particularly to remote and underserved communities. President Boko emphasized that the innovation aligns with the government’s commitment to equitable healthcare, stating that no citizen should be denied timely access to critical treatment.

The deployment of medical drones marks a significant advancement in Botswana’s efforts to build a modern, inclusive and resilient healthcare system. The technology is expected to enhance emergency response, reduce delivery times and support healthcare workers in rural areas.

Officials say the programme reflects Botswana’s broader strategy to leverage technology in improving public services and safeguarding the well-being of all citizens.

Source: https://techreviewafrica.com/public/news/3232/botswana-launches-medical-delivery-drones-to-boost-healthcare-access#0

In remote areas across Tanzania, nurses and midwives like Saraphina and Janeth are dedicating their lives to making childbirth and motherhood safer. And their hard work is paying off. The country has witnessed remarkable progress in reducing maternal mortality, roughly 80% in just seven years (2016-2022). With this momentum, the country stands on track to achieve the global target of the Sustainable Development Goals (SDGs) of less than 70 deaths per 100,000 live births by 2030, and advance the commitments set in the country’s Health Sector Strategic Plan V (2021–2026) to reduce maternal and newborn mortality.

The drive guiding Saraphina – a midwife working in a labor ward – is clear: “My vision is to ensure that every woman in the community knows the importance of going to a health facility as soon as they become pregnant. They should follow the advice offered by healthcare providers because the baby she is carrying is the nation of tomorrow.”

She utilizes new skills and tools like labor care guides to monitor all stages of labor and delivery, reducing risks even in remote and low-resource settings, so women can safely give birth.

That care and dedication is making a lasting impact on some of the most vulnerable moments of a mother’s life: “What made me come here [the health center] is to get good service, and give birth safely,” explains Herena, a mother to twins. “I am grateful to the nurse who helped me during delivery…giving me words of encouragement, and even making me laugh.”

Herena’s decision to deliver in a health facility also reflects current national trends, with 85 per cent of births assisted by skilled providers (TDHS2022).

For some healthcare workers, it is often their personal experience that motivates the work that they do: “I’ve volunteered my life to help pregnant women,” highlights midwife Janeth. “From a young age, I have always loved [this work] because I saw what challenges my mother went through in motherhood that she would then tell me.”

To maintain this momentum, midwives like Janeth and Saraphina are being supported through 2gether 4 SRHR, a joint United Nations regional programme, funded by Sweden, that aims to advance sexual and reproductive health and rights in Tanzania, and across the region.

The programme is helping increase access to sexual and reproductive health and rights, HIV, and GBV prevention and response information and services in some of the most needed areas. One key component of this work has focused on improving maternal health outcomes for women like Herena, by enhancing service delivery, rolling out guidelines on improved, evidence-based healthcare, and training healthcare workers on issues like intrapartum care, postpartum family planning, and comprehensive post-abortion care.

Source:https://www.2gether4srhr.org/news/the-nation-of-tomorrow-meet-the-midwives-redefining-maternal-care-one-birth-at-a-time

HEALTHCARE PARTNERS

In this powerful episode of FEM, MD, Dr. Lauren Umstattd sits down with ENT surgeon-turned-author Frances Mei Hardin to discuss her debut memoir and the hidden emotional cost of surgical training. Frances Mei speaks candidly about the anger she carried out of residency and how writing became the vehicle that transformed it. From resident-on-resident hostility and weaponized reporting systems to the psychological toll of perfectionism, sleep deprivation, and hierarchy in the OR, this conversation pulls back the curtain on what many physicians experience but rarely say out loud. They explore: • The cultural legacy of The House of God — and why its themes still ring true • How narrative nonfiction differs from anonymous venting and why accountability matters • Neurodivergence as both vulnerability and superpower in medicine • The role of hypnosis therapy in healing trauma and reclaiming focus • Perfectionism, emotional intelligence, and the cost of brittle excellence • Psychological safety in the operating room and how hierarchy without respect harms patient care • Resident-on-resident toxicity and the bystander effect in surgical culture Frances Mei shares what it means to “write through the anger.” What began as revenge writing evolved into a reckoning with her own blind spots, emotional immaturity, and survival mechanisms. The result is a memoir that examines burnout, identity, agency, and reinvention inside academic medicine. This is an honest, nuanced conversation about: surgical residency culture, physician mental health, neurodivergence in medicine, emotional intelligence, trauma recovery, mentorship, and what happens when the system beats the love of the work out of someone. If you are a medical student, resident, attending physician, or simply someone navigating ambition in a high-pressure field — this episode will resonate.

While Certified Child Life Specialists (CCLS) have been actively involved in most children’s hospitals for years, the role and function of CCLS are relatively new in most neonatal intensive care units (NICUs). Because of this, most staff in NICU settings are unaware of the many ways a CCLS can participate in creating a family-centered care culture and environment. Annie Jacobson provides FCC Taskforce members with insights into the role of CCLS and describes ways CCLS can enhance the NICU team, help implement family-centered care principles, and maximize the health outcomes of both babies and families in the NICU setting.

What is a Certified Child Life Specialist (CCLS)?

Many people may be under the impression that a Child Life Specialist is a volunteer brought into a hospital setting to provide activities for children during their hospitalization. In fact, that perception could not be further from the truth. Child Life Specialists are certified professionals who are experts at the intersection of a child’s social, emotional, and cognitive development and the effect of stress and trauma on that development. They are extensively trained in both child development and the impact of trauma on children and their families. CCLSs are required to maintain credentialing and minimum standards of care, and professional organizations such as the American Academy of Pediatrics have issued policy statements stating that CCLSs should be included as essential team members in hospital-based pediatric care.

What is the Role of a Certified Child Life Specialist?

CCLSs specialize in developing individualized plans of care for hospitalized children of all ages. These care plans focus on promoting optimal development, positive coping, and support for the entire family, including siblings. Among the many services provided are developmental support for children, education for families to better understand treatment plans, preparing both patients and families for surgery and other procedures, and assistance in aligning family and medical goals of care. Their role is especially important in helping siblings understand why their brother or sister is hospitalized.

CCLSs also serve a vital role in bereavement and end-of-life discussions. In that role, they can facilitate difficult conversations, support siblings, and create keepsakes and memories.

 Certified Child Life Specialists in the NICU

The services of a CCLS can greatly help develop a family-centered care environment in the NICU. Specific to NICU babies, their training and input can help create developmentally supportive policies and pain management plans. However, the role of a CCLS can go much further, empowering parents to recognize the important role they play in their baby’s care and helping them better understand treatment plans. Examples of ways in which CCLSs can help integrate parents into their child’s care include reading programs, parent orientation classes, and assistance with discharge planning. In addition, CCLS are especially well trained to recognize siblings’ needs and to identify and address the concerns and fears siblings may not openly express. This intervention can expand a policy of sibling visitation into a comprehensive support program to minimize the trauma experienced by older brothers and sisters. CCLSs are uniquely trained to address these needs.

Source:https://neonatologytoday.net/newsletters/nt-mar26.pdf

Somewhere between the kid who wanted to be a doctor and the physician you are now, something broke. A third of clinicians cannot even remember why they chose medicine, and the gap between the dream and the daily practice is where burnout settles in. Brian Sayers, a rheumatologist who has run an anonymous counseling program for almost 4,000 physician visits, argues that the way back starts with a 10-minute exercise most doctors have never done.

PREEMIE FAMILY PARTNERS

ABSTRACT

Background

Around half of preterm births lack identifiable causes, indicating the need for further investigation to understand preterm birth risk factors. Existing studies on the intergenerational association of preterm birth showed inconsistency in effect size and direction.

Objective

This systematic review and meta-analysis aimed to review existing studies and provide comprehensive evidence on the intergenerational association of preterm births.

Search Strategy

We searched MEDLINE, Embase and Maternity and Infant Care databases, from the inception of each database to 04 April 2024.

Selection Criteria

Eligibility criteria included studies that reported on women who had given birth and had recorded information about a family history of preterm birth in one or both of the child’s biological parents.

Data Collection and Analysis

Data were extracted by two independent reviewers. A random-effects model was used to compute pooled estimates using odds ratios.

Main Results

Sixteen eligible studies with a total of 2 271 612 mothers were included. The findings indicated a 1.44 (OR = 1.44, 95% CI: 1.34, 1.54) fold increase in odds of giving preterm births among women who were born preterm. Additionally, having a sibling born preterm (OR = 1.53, 95% CI: 1.24, 1.87) and having a partner born preterm (OR = 1.12, 95% CI: 1.01, 1.25) were associated with increased likelihood of giving preterm births among women.

Conclusion

The study revealed that women with a family history of preterm birth face an increased risk of giving preterm births. Screening pregnant women for a family history of preterm birth is essential, with those having a positive family history requiring closer follow-up. *** A video is embedded in article!!!

Source: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.17924

Key Points

Your baby’s NICU stay may also impact your family and friends, making them feel sad and worried. 

It’s important to ask for help from family and friends when your baby is in the NICU.

Talking openly with your child’s grandparents may reduce your stress during your baby’s NICU stay and help them understand more about your needs during this time.

Your older children may have a hard time coping when their baby sibling is in the NICU. If possible, try to include them in your baby’s care and prepare them for what to expect in the NICU.

What emotions are common for family and friends in the neonatal intensive care unit (NICU)?

Your baby’s NICU stay may impact members of your family, like your older children, parents, and friends. They may be sad, worried, and show these emotions in many ways. Share your feelings with your family or friends so you can support each other. Here are some things to keep in mind about you, your partner, and your families:

  • People cope with grief in different ways. Some partners may not express their emotions openly, which can sometimes be misunderstood as not caring. Open communication can help both people feel seen and supported.
  • You may have similar feelings but not always at the same time. You may not always be on the “same page.”
  • You may react differently to a situation. Talk about your feelings. Listen to each other and try to understand others’ feelings.
  • You and your partner may not always feel the same about what to tell others. Some people don’t want to share many medical details, especially if they feel stressed or blame themselves for the baby’s condition. Try to listen to each other and agree on what you both feel okay sharing.

How can friends and family members help when your baby’s in the NICU? 

Because this may be a very stressful time in your life, it’s important to get help from others. It may not be easy for you to ask but many people want to help. They just don’t always know how. Here are some ideas of how friends and family can help you. They can:  

  • Bring a meal to you and your family  
  • Do your grocery shopping, laundry, or clean your home  
  • Help with your older children  
  • With your OK, share updates about your baby through blogs, email, or social media  
  • Drive you to and from the hospital  
  • Go with you to meetings at the hospital and take notes. These meetings can be with your baby’s healthcare team, the NICU social worker, or hospital financial staff. 
  • Sit with your baby in the NICU so that you can take a break, if the NICU allows visitors to be with your baby without you there.  

What emotions are common for grandparents in the NICU?

Your baby’s grandparents have their own unique experience in the NICU. They may feel joy over the arrival of a grandchild, but also may worry about the health of the baby. They also may be worried about how you and your partner are coping with the baby’s stay in the NICU. As a parent and a grandparent, they have a very important role during this time.

Grandparents may have mixed feelings after their grandchild is born. They may feel:

  • Concerned about your baby’s medical condition
  • Angry about the difficulties you and your baby are facing
  • Worried about how everyone in the family is coping
  • Frustrated by not being able to help or ease your family’s distress
  • Pride and joy over the latest addition to your family

How can you help your baby’s grandparents understand what you need when your baby’s in the NICU?

Talking openly with your child’s grandparents may reduce your stress during your baby’s NICU stay. It may also help your child’s grandparents understand more about what you need during this time. Here are some things you can talk about:

  • Tell them that you and your partner need time alone with your baby. But let them know when there is a good time for them to come to the NICU to spend time with their grandchild. You may feel more comfortable leaving the NICU if a trusted family member stays with your baby. Check with the NICU staff to make sure grandparents can be with your baby while you’re not there.
  • Share your feelings and be patient with each other. Share how you’re coping with your baby’s NICU stay and talk with them about their feelings too. All members of the family are under stress and may sometimes be overwhelmed and short-tempered.
  • Give them ideas of how they can help you. Grandparents may want to help, but may not know how. Their support outside of the NICU is just as important as inside the NICU. Whether they live nearby or far away, grandparents can do lots of things to help your family while your baby’s in the NICU.

How can you help your older children cope when your baby’s in the NICU?

You may wonder how you’re going to help your children cope when you’re having trouble coping yourself. And how will you find time for your other children when your baby needs you, too? There are a lot of things you can do to help your older children. These things can help reassure your children that you love them. Here are some ways you can help your children:

  • Be honest with them. Your children may have a lot of questions but may not know how to ask them. Tell them what’s going on with you and with their baby brother or sister in words they can understand.
  • Try not to change your children’s daily routine. This can help make the situation less stressful for them. When you can’t be at home, ask a relative or other caregiver to take your children to the playground or do other things your children enjoy.
  • Try to create some quality time with your children. This will help reassure them that they are important to you too. For example, you can take them to the park to get fresh air for them and for yourself. If you can’t be home, you can call to check in on their school day or read a bedtime story.
  • Let other caregivers know about your baby’s NICU stay. Talk to your children’s caregivers, such as day care providers and school teachers, about your baby’s NICU stay. They can give your child additional support and let you know about any problems or behavior changes.

How can you include your older children in your baby’s care in the NICU?

It’s important for your children to become involved with their newborn sibling from the start. The birth of a baby is a big event for the whole family, and you don’t want your older children to feel left out. Here are activities your children can do at home to help care for the baby while they’re in the NICU:

  • Color pictures to put up near the baby’s bed
  • Pick a favorite photo of themselves or the family to have near the baby’s bed
  • Put together a photo album of pictures of the baby
  • Create a story book about the birth of their baby brother or sister
  • Help get the nursery ready for when the baby comes home
  • Record their voice reading a book to the baby

How can you prepare your older children for the NICU?

Many children can’t wait to meet the new baby. Each NICU has its own guidelines about children visiting. Some NICUs only allow siblings who are over a certain age or allow visits during certain hours. Find out what the rules are in your NICU, then talk to your children before they go to the NICU about what they may see and hear. Here’s how you can prepare for their visits to the NICU:

  • Plan to keep visits short (less than 30 minutes)
  • Describe what they may see or hear
  • Explain what equipment in the NICU does
  • Tell your children what they can do and how to behave in the NICU

Talk to your children after they spend time in the NICU. Ask if they have any questions about the baby or the equipment. Answer their questions simply but honestly.

Source: https://www.marchofdimes.org/find-support/topics/neonatal-intensive-care-unit-nicu/familys-role-nicu?utm_source=chatgpt.com

(Section of Back to Basics, Bonding and Attachment In The Neonatal Unit Irish Neonatal Health Alliance)

You might worry that you won’t be able to bond with your premature baby in the NICU. It’s true that you are separated from your baby because he needs to be cared for in the hospital. You might not be able to see and hold him early on, or even visit him as much as you’d like because of distance or older children. The worry about your baby’s health might also get you down. But there is a lot you can do in the NICU to feel close to your baby and develop a bond.

Even though your baby was born early, your baby ‘knows’ you – your voice and your smell. Your presence will give your baby a sense of familiarity and comfort. This is a great starting point for bonding. Here are some ideas to help you and your baby bond while he/she is in the NICU.

 Watch your baby.

Premature baby body language is different from that of full-term babies but over time, you’ll learn how to tune into your baby and know whether he wants closeness, or whether he has had enough stimulation. The medical staff can help you start reading your baby’s signs.

The underlying principle involved in learning to read your baby’s body language is to observe and understand your baby’s developing ability to achieve balance i.e homeostasis. This means that your baby can have the neurological capacity under the right circumstances to move from an unbalanced (disorganized ie. fussy or crying) state to achieve a more balanced state (organised state i.e calm, alert). Sometimes your baby will require the help of a carer to move from a disorganized to an organised state. Under certain circumstances your baby can achieve this change from disorganised to organised themselves. This developing ability in premature infants is called self-soothing or self-regulation.

When observing your baby’s behaviour you should observe the sequence of events more than individual behaviours. There are 5 interconnected levels of baby behaviour and observations at one level will have an effect on one or more of the other levels.

Five Levels Of Infant Behaviour

1. The physiological level.

 2. Muscle tone and quality of physical movements.

3. The level of state and alertness.

 4. The level of interactive behaviour.

 5. The stress level.

Physiological Signs

These are signs which can be observed directly by watching your baby closely.

Breathing and Pattern of Breathing

 Note the skin colour around your baby’s mouth, eyes, hand and feet. Is your baby experiencing repeated hiccuping or excessive yawning?

Motor Tone and Motor Control

 Motor tone consists of passive and active muscle tone. Passive muscle tone refers to how your baby resists stretching his limbs during caregiving. Passive muscle tone can by hypertonic (high), normal tone or hypotonic (low or floppy).

Active muscle tone refers to your baby’s tendency to keep or bring his limbs flexed or extended when he is alone. Your baby’s active muscle tone can be observed in the arms, legs, neck and body. As your baby develops he can more actively flex and extend his limbs with improved neuro-motor control.

 Motor control can also be observed in terms of smooth or jittery, tremor like movements. Good motor control is seen as fluent and elegant movements with little or no tension/tremors/startles whereas poor motor control may appear as having little or no smooth movement and moderate levels of tremors or jitteriness.

 3. Sleeping and Waking Behavioural States

Babies have six characteristic levels of arousal but it is not always easy to tell which is which in a premature baby as these states are immature and often fleeting.

Deep Sleep– Also referred to as “Quiet Sleep” because your baby does not move apart from occasional small startles and has higher overall muscle tone. Breathing is slower and more regular than other times. This state becomes more noticeable after 32 weeks gestation.

Light Sleep– Also referred to as “Active Sleep” because your baby moves about more. Rapid Eye Movements (REM) may be observed: breathing tends to be faster and more irregular than in quiet sleep with lower overall muscle tone.

Drowsy- This is an important part of the sleep cycle and your baby may appear “half awake” as if in transition from sleep to awake or awake to sleep. Some babies may require your assistance to go to sleep (comforting hold) or to wake up (see if your baby opens his eyes in response to your greeting).

Quietly Alert– It may be some time before you see your baby with his eyes open and in the early days the facial expression may appear strained or glazed. During periods of quiet wakefulness you can watch how your baby responds to you does he turn his head towards you when you speak? When he needs some time out does he turn away from your voice? It is important to read your baby’s cues in particular during moments of stress or when he needs a break and to respond appropriately. Some babies will close their eyes and go to sleep when they are feeling overwhelmed and others get hiccups, yawn or sneeze.

Actively Awake-Premature babies are often quite active with their eyes closed and it can be difficult to know they are awake or not. Fussy behaviour indicates that your baby requires something to change or stop. Over time you will discover methods of settling your own baby.

Crying-Premature babies seldom cry but demonstrate that they are upset with agitated movements, grimaces and a crying facial expression.

4. Interactive Behaviour

Your baby’s ability to achieve and maintain an alert state is an important developmental step. Babies can begin to process and learn from interaction when in a quiet alert state When your baby is able to stay awake or alert for a short time you can begin to observe his interaction with you or objects. If your baby is experiencing discomfort or over-stimulation from the environment he is less able to interact. It is advisable to ascertain if your baby is “available” or “not available” to interact by observing his behaviour.

Opportunities to observe interaction

– Note your baby’s reaction when you place your face close to your baby’s face and speak softly.

– How does your baby respond to sounds and voices in the surrounding environment?

– How does your baby respond to touch, handling and soothing?

Cues that your baby is ready to interact:

Babbling

– Soft smooth movement with arms and legs.

– Soft slow chewing. l Relaxed, open facial expression/movements.

– General muscle tone is average or lower.

– Little or no physical movements. l His breathing is regular and relaxed.

– His limbs are /relaxed/tucked/flexed close to his body.

– His mouth is relaxed and slightly open.

– His eyes are open or open in response to your voice.

– He calms upon hearing your voice

5. The Stress Level:  Cues that your baby requires time to rest:

– He closes his eyes or turns away.

– His breathing becomes irregular.

– He may stretch or wriggle or arch his back.

– His body becomes limp or stiffens or the arms and legs straighten.

– He places his hand over his face (palm outward with fingers splayed).

– He frowns, grimaces, yawns*, grunts of hiccups.

– He falls asleep.

– His skin appears mottled or pale.

– Paroxysmal (at the extremities), circumoral (around the mouth) or periocular (around the eyes) cyanosis (blue colour) is visible.

– He displays roving eye movements or tight blinking.

When your baby is trying to achieve homeostasis (balance or a more organised calm state) he may display the following coping/self-soothing behaviours:

– Brings his hand to his mouth or his touches face. l Covers his eyes and ears.

– Clasps his hands or press one foot over the other. l Moves his body, lift or turn his head to get  comfortable.

– Sucks his hand.

– Presses his feet against the bedding or cot. Grabs or hold onto the bedding, tubes or clothing.

– Brings his hands to the center line of his body.

– Turns away from strong stimuli.

Source: https://inha.ie/wp-content/uploads/2024/11/Back-To-Basics-Booklet.pdf

INNOVATIONS

Abstract

International collaborations between investigators in low-and-middle-income countries (LMICs) and high-income countries (HICs) in neonatal and fetal medicine have expanded over the past decade. This narrative review documents a rise in HIC–LMIC publications since 2014, with a plateau and transient dip during the COVID-19 pandemic. It analyses leadership, patient recruitment, and how HIC-based technologies and laboratory platforms shape research agendas. Many influential trials are conceived and sponsored by HIC institutions, with recruitment concentrated in LMICs because of higher disease burden, larger eligible populations and lower costs. Meanwhile, LMIC centers report growing readiness to support randomized controlled trials, and LMIC-conceived, led and completed multicentre studies are increasingly reported. Ongoing concerns include misalignment between donor priorities and national agendas, inequities in authorship and leadership, and ethical challenges related to standards of care, post-trial access, consent and compensation. The review compares regulatory, consent and insurance processes in India and the United States, and highlights enabling factors such as harmonised guidelines, global registries, political goodwill and professional networks. It anticipates a doubling of HIC–LMIC collaborative studies over the next decade, rapid growth of South–South partnerships, and gradual, though incomplete, correction of authorship and leadership imbalances in global neonatal and fetal medicine.

Source: https://www.sciencedirect.com/science/article/abs/pii/S1744165X26000399

A new era for Botswana’s healthcare system has begun. President Duma Boko has officially partnered with the Susan Thompson Buffett Foundation to transform maternal and reproductive health services in Botswana. At the heart of this groundbreaking move? A bold, tech-forward plan to digitize healthcare, save lives, and build long-term resilience in the system. With support from global health leader Dr. Senait Fisseha, this partnership brings serious funding and innovation to: ✅ Expand maternal health services ✅ Digitize Botswana’s healthcare delivery ✅ Address non-communicable diseases ✅ Strengthen national surgical and gynecological strategy 📊 “Data is power,” says Dr. Fisseha — and Botswana plans to use it wisely. 🌍 Could Botswana’s model lead the way for the rest of Africa? Tune in to find out — only on Snap Flash, where African progress meets real reporting. Botswana & Buffett Foundation Unite to Revolutionize Healthcare | President Boko’s Bold Vision.

Tiny Tech: Innovations Reshaping Neonatal Care

By Juliane Crafton, MSN RNC-NIC

Imagine—on a bright summer day in 1901, you walk into the Pan-American Exposition, a world’s fair in Buffalo, New York. Struck by the foreign architecture and bold colors, you explore. From fine art to horticulture to a Native American village, all the western hemisphere’s best advancements are on display. Soon, you find yourself in a room lined with unfamiliar machines and nurses, showcasing the tiniest babies you have ever seen.

The incubator was a landmark innovation, marking the beginning of a technological revolution in neonatal care (“Baby incubators at the Pan-American Exhibition,” 1901; Reedy, 2003). Over the 20th century, the incubator was joined by a wave of other life-saving technologies, such as pulse oximetry, phototherapy, and transcutaneous carbon dioxide monitors (Brennan et al., 2019; Hay, 2005; Parga & Garg, 2017).

Today, the pace of innovation is accelerating, demanding that neonatal nurses continuously adapt to improve safety and efficiency in caring for these tiny patients. This rapid evolution not only introduces new tools for care but also fundamentally reshapes the neonatal nurse’s role, demanding new skills in data interpretation and raising complex ethical considerations.

What’s New and What’s Coming

The technological boom of the late 20th century ushered in a new era for neonatal care. While innovations like transcutaneous carbon dioxide monitors and ECMO are now widely used, their adoption is relatively recent, becoming standard only in the past few decades. Now, even more sophisticated technologies are emerging.

Krbec et al. (2024) describe emerging innovations, including remote sensing technologies that could rid the NICU of wired monitoring of vital signs. Developments in camera technology and improved affordability have led to an increase in the study of their use in health care. The focus has been on adult applications with pilot studies exploring the use of visible light, infrared light, and radar-based technologies to monitor vital signs (Chung et al., 2020; Krbec et al., 2024). Chung et al. (2019) describes a wireless epidermal system with in-sensor analytics studied for neonatal use. Go to https://www.science.org/doi/10.1126/science.aau0780 to see images of the system on a neonate. Preliminary study has shown advanced capabilities in monitoring, along with a skinlike profile that reduces skin breakdown and reduces barriers for skin-to-skin contact.

Beyond passively monitoring vital signs, the next frontier involves artificial intelligence (AI) actively interpreting this data. Though there are many challenges and limitations, AI deep learning models have shown promising capability to detect features like subtle changes in movements or skin color and correlate them with vital sign changes and various pathologies (Krbec et al., 2024). Kwok et al. (2022) describes the use of deep learning models for prediction of neonatal mortality and morbidity, identifying patterns within data, interpreting data in relation to neuroimaging, performing image recognition, and predicting responses to neonatal treatment. Many NICUs already use some combination of early warning systems and scoring models to determine risk and predict adverse outcomes. Adding the additional layer of AI to deepen the ability to predict has great implications for providers and caretakers of this patient population.

Telehealth is emerging as a powerful tool to democratize neonatal expertise, bridging the critical gaps of distance and resources that can impact care. Through applications like remote specialist consultations and virtual grand rounds, these systems connect providers across different levels of NICUs, fostering collaboration that leads to improved outcomes. For instance, a tele-NICU program in Arkansas gives patients in rural hospitals unprecedented access to leading specialists through bidirectional information sharing (Arkansas Children’s, 2025). This model is not unique; similar pilot programs are being implemented in NICUs worldwide, demonstrating a global shift toward leveraging technology to overcome geographical barriers to care (Arkansas Children’s, 2025; Wagenaar, 2025).

On the cutting edge of regenerative medicine, three-dimensional (3D) bioprinting holds profound potential for neonatal care. Tottoli et al. (2020) describe a technique to create custom hydrogel scaffolds by “printing” a combination of biomaterials and a patient’s own cell cultures directly onto a wound. See Figure 5 in Tottoli et al.’s 2020 article. The resulting structure acts as a bioactive dressing—a living bandage that actively supports and accelerates skin regeneration, integrating concepts from cell therapy and tissue engineering. Although clinical applications for infants have not been thoroughly explored, the implications are significant (Tottoli et al., 2020). For premature infants with extremely fragile skin prone to injury, 3D bioprinting could one day offer a revolutionary approach to healing, minimizing scarring and the risk of infection. For premature infants with extremely fragile skin prone to injury, 3D bioprinting could one day offer a revolutionary approach to healing, minimizing scarring and the risk of infection.

Evolving Tools, Evolving Roles

The integration of these emerging tools does more than change workflows: it fundamentally redefines the identity and responsibilities of the neonatal professional. Already hands-on caretakers, nurses are evolving to add new responsibilities as critical data interpreters and technology managers who must validate predictions and facilitate care alongside sometimes-remote specialists. This evolution brings many important ethical considerations. The use of AI shows promise for predicting adverse outcomes but raises questions about algorithmic bias, data privacy, and accountability when a predictive model is wrong. Similarly, while telehealth can give low-access regions access to specialists, it introduces challenges in maintaining the human connection essential to care and ensuring equitable access for families with technological or resource barriers.

The emerging role of the neonatal caregiver is not just to be technologically proficient but to be a vigilant, ethical advocate, ensuring that these new, powerful tools are applied in a way that is safe and equitable and enhances compassionate, patient- and family-centered care.

Conclusion

From the simple, life-sustaining warmth of the first incubators to the complex predictive power of AI learning models, the evolution of neonatal care is a story of technological advancement. Innovations like remote sensing, telehealth, and 3D bioprinting are the tangible future, promising to further improve survival and long-term outcomes for the most fragile infants.

As these tools are integrated into practice, they demand an evolution in the role of the neonatal nurse: from a hands-on caregiver to a sophisticated clinical data analyst, technology facilitator, and ethical guardian. The ultimate challenge and opportunity lie not just in adopting the new technology but also in thoughtfully combining it with compassionate, human-centered care to ensure that every innovation serves the ultimate goal: helping the tiniest humans thrive.

Source: https://nann.org/publication/feature-35/

Step into the heart of Botswana’s Okavango Delta, where water gives life to everything it touches. In this short travel documentary, I explore the sacred relationship between nature, wildlife, and the waters that define this incredible region. From vast floodplains to close encounters with elephants, this film is a reflection of how deeply water shapes every step we take in the African wilderness.

Caring for the World That Helped Us Survive: A Summer Reflection from the Neonatal Womb Warriors Community

As summer approaches, many of us begin spending more time outdoors — walking along waterfronts, visiting parks, gathering with family, and reconnecting with nature after long winters and busy seasons of life. For the Neonatal Womb Warriors community, this season also offers something deeper: an opportunity to reflect on the world we are helping shape for future generations of children and families.

Climate change and environmental health are no longer distant issues. They are directly connected to the health and wellbeing of communities around the world — especially vulnerable populations such as premature infants, medically complex children, and families navigating fragile health journeys.

Air quality, extreme heat, pollution, natural disasters, access to clean water, and environmental instability all influence maternal and neonatal health outcomes. Research continues to show that environmental stressors can increase risks during pregnancy and impact neonatal and pediatric health. For families who have experienced NICU stays, neonatal complications, or the lifelong journey of prematurity, these realities feel especially personal.

But alongside these challenges comes hope — because communities everywhere are stepping forward to make a difference.

Summer often brings local opportunities for environmental conservation and neighborhood engagement: park cleanups, waterfront restoration projects, recycling initiatives, community gardens, tree planting events, and volunteer-driven beautification efforts. These moments may seem small, but collectively they reflect something powerful: people choosing to care for the environments that sustain all of us.

This summer, I will personally be participating in the Charles River Esplanade Cleanup in Boston — helping clean and preserve one of the city’s most treasured public spaces. For me, this is about more than environmental stewardship. It is about giving back to the communities and environments that support health, healing, resilience, and connection.

As preemie survivors, NICU families, healthcare workers, advocates, and supporters, we understand survival in a deeply human way. Many within our community began life fighting for every breath, every ounce of strength, and every milestone forward. That perspective often creates a unique appreciation for life, compassion, and community responsibility.

Environmental conservation is another form of protecting life.

  • It is protecting cleaner air for children with chronic lung disease or asthma.
  • It is preserving safe public spaces for families and children to gather.
  • It is helping create healthier futures for the next generation of babies entering the world.
  • And it is reminding ourselves that even small acts of service matter.

The Neonatal Womb Warriors community has always been rooted in resilience, advocacy, and hope. This summer, we encourage our community members to consider participating in local environmental or community service efforts in whatever way feels meaningful and accessible to them — whether that means joining a cleanup event, planting flowers, reducing waste, supporting conservation organizations, or simply spending intentional time caring for the spaces around us.

Every effort counts.

Together, we are not only survivors.

We are builders of healthier, kinder, and more compassionate communities.

And that includes caring for the world future womb warriors will inherit.

Jul 21, 2025

Ubongo Kids is an animated educational TV series produced in Tanzania and viewed across 40 countries in Africa. It targets children between the age of 7-14 and covers Science, Technology, Engineering and Mathematics (STEM) subjects and social emotional learning (SEL). Join Kibena, Kiduchu, Koba and Baraka as they go on adventures and use their brains to solve problems in Kokotoa Village, with the help of the animals of Kokotoa Forest!

CHALLENGES, WINDOWS, and SUPERPOWERS!

Estonia, officially the Republic of Estonia, is a country in the Baltic region of Northern Europe. It is bordered to the north by the Gulf of Finland across from Finland, to the west by the Baltic Sea across from Sweden, to the south by Latvia, and to the east by Russia. The territory of Estonia consists of the mainland, the larger islands of Saaremaa and Hiiumaa, and over 2,300 other islands and islets on the east coast of the Baltic Sea. Its capital city of Tallinn, along with the city of Tartu, are the country’s two largest urban areas. The Estonian language, of the Finnic family, is the official language and the first language of the majority of nearly 1.4 million people. Estonia is one of the least populous member states of the European Union.

Present-day Estonia has been inhabited since at least 9,000 BC. The medieval indigenous population of Estonia was one of the last pagan civilisations in Europe to adopt Christianity following the Northern Crusades in the 13th century. After centuries of foreign rule by the Teutonic Order, Denmark, Poland, Sweden, and the Russian Empire, a distinct Estonian national identity gained new momentum with the Age of Awakening in the mid-19th century. This culminated in the 1918 Estonian Declaration of Independence. Democratic throughout most of the interwar period, Estonia declared neutrality at the outbreak of World War II, but the country was repeatedly invaded and occupied, and ultimately annexed into the USSR. Throughout the de facto Soviet occupation, from World War II until 1991,] Estonia’s de jure state continuity was preserved by diplomatic representatives and the government-in-exile. Following the 1988–1990 “Singing Revolution” against Soviet rule, full independence was restored on 20 August 1991, and the country joined NATO and the European Union in 2004.

Estonia is a developed country with a high-income, advanced economy, and Eurozone membership. It is a democratic unitary parliamentary republic, with a single-tier local government system consisting of 79 municipalities. Estonia is among the least corrupt countries in the world and ranks very high in international rankings for education, human development, press freedom, online public services, and the prevalence of technology companies.

Healthcare in Estonia is supervised by the Ministry of Social Affairs and funded by general taxation through the National Health Service.

The service is administered by the Estonian Health Insurance Fund (EHIF). An insured person must be either a permanent resident or a legal resident who pays the social tax. All health care providers in Estonia are required to submit the health information of their patients to the digital health information system.

Estonia’s health care system is based on compulsory insurance based on solidarity funding and on universal access to services provided by private service providers. All providers of health services are autonomous businesses governed by private law. The single buyer and payment method is the Estonian Health Insurance Fund (Eesti Haigekassa), which pays all contracted providers. The majority of general practitioners work for themselves, privately owned businesses, or local governments. In Estonia, the majority of hospitals are either foundations created by the government, municipalities, or other public organizations, or limited businesses owned by the local government. If the hospital has a contract with the Fund, the Estonian Health Insurance Fund will also pay for necessary treatments received in a private hospital. If no agreement is reached, private medical care is not reimbursed.

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

https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2025.1565897/full

Children born with single‑ventricle heart disease, a rare and serious heart defect, often undergo multiple surgeries in their first years of life. A new study shows the challenges for these children can last well into adolescence and sometimes throughout their lives.

Researchers from Duke Health and the Pediatric Heart Network followed 549 children with single ventricle heart disease for 16 years and found that 87% either died or developed a major health problem over time. Only 12% reached adolescence without a significant complication.

These findings, published in the Journal of the American College of Cardiology March 11, give families a clearer picture of what to expect and offer the medical community new direction for improving care.

“Now that we understand these trajectories and the risk factors for suboptimal outcomes, we can counsel families more clearly and tailor therapies to each child.”

Kevin D. Hill, M.D., corresponding author, chief of division of pediatric cardiology and professor, Department of Pediatrics, Duke University School of Medicine

The study introduces a new way of evaluating long term health called a global rank score. It’s a measure developed with input from families that captures what matters most to them, including daily functioning, quality of life, and heart performance.

One of the most important findings for families is that most children will continue to need specialized care long after surgery. The study found high rates of adaptive behavior delays, quality of life challenges, and reduced heart function in many patients, often emerging gradually as they grow.

Researchers also found that premature babies faced the steepest uphill climb. More than 60% of premature infants in the study died, and only 3% reached adolescence without major problems. The data suggests that supporting healthy pregnancies and preventing preterm birth could make a meaningful difference.

For clinicians, the study provides new clues that may help tailor early surgical decisions. Although the two main shunt types used in infancy showed similar long-term outcomes overall, babies who had moderate or severe tricuspid valve leakage before surgery did worse with the right ventricle shunt, a finding that could guide future decision making.

Just as importantly, the study revealed substantial differences among hospitals. Some centers had lower early mortality, while others excelled in long term follow up and rehabilitation. This variation highlights opportunities to share best practices and improve care no matter where a child is treated.

“These children need lifelong comprehensive care, including medical, developmental, and school support,” Hill said. “It’s not like they get surgery and are ‘fixed.’ Ongoing, coordinated services are essential to help them thrive.”

The study emphasizes that children with single ventricle heart disease often face challenges in multiple areas of life. The research team hopes these findings will help families feel better prepared, while giving healthcare teams a roadmap for improving outcomes through physical therapy, mental health support, school accommodations, exercise programs, and strong long-term monitoring.

In addition to Hill, study authors include, Lillian Kang, Qiao Wang, Jane W Newburger, J. William Gaynor, Kristin M. Burns, Richard Williams, Felicia Trachtenberg, Brian W. McCrindle, Eric M. Graham, Christian Pizarro, Awais Ashfaq, Andrew Souza, James A. Kuo, Dawn Ilardi, Kurt R. Schumacher, Hwanhee Hong, and Caren S. Goldberg.

https://www.news-medical.net/news/20260311/Long-term-study-reveals-lifelong-challenges-for-children-with-single-ventricle-heart-disease.aspx

Abstract: Premature birth shifts late fetal organ maturation into the extrauterine environment, creating overlapping biologic windows during which organs remain structurally immature yet actively developing and highly sensitive to neonatal exposures. Because organ systems mature in parallel, vulnerability evolves across postmenstrual age (PMA) rather than discrete gestational stages. Prematurity unfolds as a developmental continuum in which the dominant focus of neonatal care shifts with maturation. This review integrates developmental physiology with evolving care priorities across four maturational phases: early transition (lung– cardiovascular, brain, kidney), interface (skin, gut–immune, retina), growth–accretion (bone–mineral, hematologic, somatic growth), and near-term neurointegrative maturation. Interpreting prematurity through these sequential biologic windows clarifies the timing of prematurity-related disorders and provides a physiologic rationale for neonatal monitoring and management across the course of prematurity.

Introduction: Late gestation is characterized by coordinated maturation across organ systems, including structural growth, angiogenesis, epithelial barrier formation, mineral accretion, and physiologic integration. Preterm birth interrupts this synchronized developmental program and exposes organs to extra-uterine oxygen tension, fluctuating perfusion, artificial nutrition, microbial colonization, and environmental stress while maturation remains incomplete. The neonatal course of prematurity, therefore, reflects shifting biologic windows during which specific systems are actively developing and particularly vulnerable to perturbation.

Because fetal organ maturation proceeds in parallel rather than sequence, vulnerability windows overlap broadly across PMA. For clinical interpretation, prematurity can be conceptualized as progression across phases in which particular organ systems dominate vulnerability while earlier susceptibilities recede.

Importantly, this maturation also corresponds to a developmental shift in neonatal care priorities that parallels changes in organ vulnerability across PMA. This progression of biologic windows across prematurity is outlined below.

Developmental Progression of Care Focus Across Prematurity:

Prematurity unfolds as a continuum in which the dominant determinants of physiologic stability shift with maturation. Immediately after birth, survival depends on fragile organs still constructing the internal physiologic environment. As cardiopulmonary stability improves, organs mediating interaction with the extra-uterine world become the principal sites of vulnerability. With the maturation of these interfaces, development becomes dominated by nutrient-dependent tissue accretion. Although nutrient provision is required throughout prematurity, this stage reflects the period when accretion demand becomes the principal determinant of vulnerability. Near-term equivalent age: maturation culminates in the integration of previously developing systems into coordinated whole-organism function.

Accordingly, neonatal care priorities evolve in parallel with these biologic transitions:

internal stabilization → environmental interface → growth accretion → neurointegrative function

This sequence reflects the organs most actively developing at each PMA and most susceptible to environmental disruption. As maturation proceeds, earlier vulnerabilities recede while new developmental demands emerge, producing the characteristic temporal pattern of prematurity-related disorders and the need for clinical monitoring across the neonatal course.

PHASE 1—EARLY TRANSITION:

Vulnerable Organ Stabilization (Birth to ~30 wk PMA):

Dominant systems: Lung–Cardiovascular, Brain, Kidney:

Immediately after a very preterm birth, survival depends on organs still undergoing fundamental structural and regulatory assembly. The immature lung–cardiovascular system determines oxygenation and systemic perfusion; the developing brainstem governs respiratory rhythm, autonomic tone, thermoregulation, and postural organization; and the immature kidney regulates electrolyte and metabolic homeostasis. Instability within these systems propagates system-wide physiologic variability affecting all organs. Care during this phase focuses on stabilizing these vulnerable transitional organs that establish the internal environment for subsequent development

Lung and Cardiovascular System:

Between approximately 22–28 weeks of gestation, the lung transitions from canalicular to early saccular architecture, with active formation of distal airspaces and pulmonary capillary networks. Pulmonary vascular resistance remains elevated, and the circulatory transition remains incomplete. Exposure to mechanical ventilation, oxygen variability, and inflammation during this stage disrupts septation and capillary alignment. Because rapid alveolarization occurs later (32–36 wk PMA), structural injury sustained during early transition manifests weeks later as evolving bronchopulmonary dysplasia.

Pulmonary immaturity produces intermittent hypoxemia and carbon-dioxide variability that propagate systemic perfusion instability affecting cerebral, renal, and intestinal circulation. Immature ductal smooth muscle contributes to the persistence of the ductus arteriosus. As pulmonary vascular resistance falls toward term PMA, oxygenation stabilizes and hemodynamic variability declines.

Noninvasive distending pressure is commonly continued into late prematurity to support alveolar stability during the transition from saccular to early alveolar development. Although oxygen requirements and work of breathing may improve before term equivalent age, the preterm lung remains prone to derecruitment due to a compliant chest wall, limited surfactant reserve, and an evolving distal airspace-capillary architecture. Many infants remain on nasal CPAP until approximately 34 weeks PMA to preserve functional residual capacity and reduce cyclic atelectasis while pulmonary mechanics and distal airspace maturation continue.

Brain and Neuroregulatory Maturation:

Between approximately 24–32 weeks of gestation, brainstem and hypothalamic networks regulating respiratory rhythm, arousal, autonomic tone, thermoregulation, and postural control remain structurally and functionally immature. Limited central respiratory drive, impaired chemoreceptor responsiveness, and weak upper airway motor control produce unstable breathing with periodic apnea, while immature hypothalamic and sympathetic pathways limit vasomotor tone and brown-fat thermogenesis, necessitating external thermal support. Immature central motor organization and reduced flexor tone also impair spontaneous midline posture and physiologic self-regulation.

The preterm brain simultaneously exhibits vascular and white matter vulnerability during this interval. Fragile germinal matrix vasculature predisposes to intraventricular hemorrhage, while pre-oligodendrocytes predominant between approximately 24–32 weeks of gestation are highly susceptible to hypoxia–ischemia and inflammation, creating a developmental window for periventricular leukomalacia. Fluctuating cerebral perfusion and oxygenation associated with respiratory and hemodynamic instability, therefore, affect both vascular integrity and white matter maturation.

These vulnerabilities define recommended neuroimaging and developmental care practices. Cranial ultrasonography during the first postnatal week and again at 7–14 days targets hemorrhage and early white matter injury. Developmental positioning— nesting, boundary support, and facilitated flexion—provides external containment that supports postural tone development and behavioral state regulation during immature central neuroregulatory function.

 At approximately 33–35 weeks PMA, maturation of brainstem respiratory generators and autonomic pathways permits a stable respiratory rhythm, improved arousal responses, effective thermoregulation, and sustained flexed posture. Resolution of apnea and discontinuation of caffeine therapy around 34 weeks PMA reflect maturation of central respiratory control within this neuroregulatory window.

Kidney:

Nephrogenesis and tubular differentiation continue until approximately 34–36 weeks of gestation, rendering the preterm kidney structurally and functionally immature during early transition. Limited sodium reabsorption and relative chloride retention lower the plasma sodium–chloride difference, producing the mild hyperchloremic metabolic acidosis characteristic of prematurity. Immature filtration and autoregulation increase susceptibility to acute kidney injury during systemic instability.

These features define renal-directed monitoring and pharmacologic adjustment. Reduced glomerular filtration during the first postnatal week necessitates prolonged dosing intervals for renally cleared medications; intervals shorten as clearance matures. Electrolyte monitoring and sodium supplementation reflect maturation of tubular transport within this renal biologic window.

PHASE 2—INTERFACE:

Environmental Interaction and Barrier Maturation (~28–34 wk PMA):

Dominant systems: Skin, Gut–Immune, Retina:

As lung–cardiovascular stability improves, the infant’s physiologic interaction with the external environment expands. Organs mediating exchange with that environment—skin, intestine, immune system, and retina—become the principal sites of vulnerability. Care focus shifts toward the regulation of the environmental interface and barrier function.

Skin:

The epidermal barrier develops during the third trimester through keratinization and intercellular lipid deposition. Extremely preterm infants have minimal stratum corneum and high permeability, producing substantial insensible water and heat loss. Because environmental exposure begins immediately at birth while structural immaturity is maximal, cutaneous vulnerability peaks earliest among interface organs. Barrier formation accelerates between approximately 30–34 wk PMA, reducing permeability and stabilizing fluid and thermal balance.

Gut and Neurointestinal Maturation:

Intestinal epithelial integrity, mucosal immune regulation, enteric nervous system function, smooth-muscle motility, and neurogastrointestinal coordination mature progressively through approximately 28–34 weeks PMA. Preterm birth exposes the intestine to enteral nutrients and microbial colonization while neuromuscular coordination and barrier function remain incomplete, defining the intestinal biologic window.

Neurointestinal motility is most immature in extremely preterm infants (<28 weeks PMA) with weak peristalsis, delayed gastric emptying, and poor coordination of swallowing and breathing. During this stage, feeds are typically minimal and trophic. As feeding volumes advance between approximately 28 and 32 weeks PMA, while coordination remains incomplete, delayed gastric emptying and ineffective peristalsis become clinically evident as gastric residuals, abdominal distension, and feeding intolerance. Continued maturation after approximately 32–34 weeks PMA permits progressive improvement in gastric emptying and tolerance.

Intestinal epithelial and immune barrier maturation during approximately 28–34 weeks of gestation permits increased interaction with the luminal microbiota. Immature tight-junction integrity and dysregulated inflammatory responses predispose to necrotizing enterocolitis, which typically emerges after several weeks of feeding and colonization and therefore peaks within this biologic window.

 Oral feeding readiness emerges as neurogastrointestinal and neurorespiratory coordination mature during late prematurity. Coordinated sucking, swallowing, and breathing develop primarily between approximately 32 and 34 weeks PMA, with progressive improvement after approximately 34–36 weeks PMA. Supportive feeding therapy practices optimize bolus control while coordination remains incomplete.

Retina:

Retinal vascularization progresses during 28–40 weeks of gestation under oxygen-regulated signaling. Premature hyperoxia suppresses physiologic angiogenesis early, leaving the peripheral retina avascular. As metabolic demand rises later (~30–34 wk PMA), hypoxia drives pathological neovascularization characteristic of retinopathy of prematurity, peaking at 34–38 wk PMA. An initial retinal examination at approximately 31 wk PMA (4weeks postnatal age) targets the onset of this proliferative phase.

PHASE 3—GROWTH ACCRETION:

 Nutrient-dependent Construction (~30–36 wk PMA): Dominant systems: Bone–Mineral, Hematologic, Somatic Growth: With systemic stability largely achieved and environmental interfaces maturing, development becomes dominated by sustained tissue growth. Organs requiring high substrate supply— bone, hematopoietic system, and somatic tissues—now define vulnerability, and care priorities shift toward ensuring that nutrient supply matches growth demand.

Bone–Mineral:

Fetal skeletal mineralization accelerates after 28 weeks of gestation. Preterm birth interrupts placental mineral transfer while skeletal growth continues. As growth accelerates after approximately 30– 32 wk PMA, mineral requirement exceeds supply and metabolic bone disease emerges. Biochemical screening beginning around 4–6 weeks postnatal age corresponds to the onset of mineral accretion demand within this window.

Erythropoiesis transitions to marrow dominance during late gestation. After preterm birth, low erythropoietin production and rapid growth produce anemia of prematurity, with hemoglobin nadir near 32–34 wk PMA. Periodic hemoglobin monitoring during the first 6–8 weeks aligns with this erythroid accretion window.

Somatic Growth:

Rapid tissue accretion, normally occurring in late gestation, must occur postnatally in preterm infants. Immature anabolic regulation limits early growth; improving nutrition and endocrine maturation toward term PMA increases growth velocity.

PHASE 4 — NEAR-TERM NEUROINTEGRATIVE MATURATION:

 Functional Synchronization (~34–40 wk PMA):

Dominant systems: Brainstem–Autonomic–GI Integration:

 Near-term equivalent age: organ systems are largely structurally complete, and the dominant developmental task becomes integration. Brainstem respiratory rhythm, autonomic regulation, thermoregulation, postural stability, and neurogastrointestinal coordination converge toward mature function. Vulnerability now reflects incomplete coordination rather than structural immaturity.

Preterm infants approaching discharge may appear stable supine but may desaturate when positioned semi-upright. Car-seat tolerance testing evaluates this final stage of neurorespiratory integration. Gastroesophageal reflux and feeding discoordination likewise decline during this phase as coordination matures.

CLINICAL MEANING:   

The biologic windows framework provides a developmental basis for anticipatory neonatal care. Because organ vulnerability follows maturation rather than chronological age alone, monitoring and management priorities should align with the dominant developmental processes at each PMA. Early transition care emphasizes stabilization of oxygenation, perfusion, and metabolic homeostasis to protect the immature lung, brain, and kidney. As cardiopulmonary stability improves, care shifts toward regulation of environmental interfaces, including thermal balance, feeding progression, microbial exposure, and oxygen stability. With advancing maturation, sustained growth and substrate delivery become central to preventing deficits in mineralization, erythropoiesis, and somatic accretion. Near-term equivalent age, assessment focuses on integrated physiologic competence, including respiratory control, feeding coordination, and autonomic stability before discharge.

Recognizing these maturation-linked priorities enables anticipatory monitoring, phase-appropriate interventions, and physiologically timed screening across the course of prematurity.

SUMMARY:

Biologic windows of prematurity arise because organ maturation proceeds in parallel during late gestation. Vulnerability shifts with PMA—from systemic stabilization (lung–brain–kidney), to environmental interface (skin–gut–retina), to growth-dependent accretion (bone–hematologic–somatic growth), and finally to neurointegrative maturation near term age. Interpreting prematurity through these sequential biologic windows provides a unified developmental framework linking maturation, disease timing, and neonatal management across the course of prematurity.

Click to access nt-mar26.pdf

Abstract

Importance: Contradictory differences regarding fertility among adults born very preterm (VP; <32 weeks’ gestation) or with very low birth weight (VLBW; <1500 g) have been reported at different ages. Longitudinal investigations of fertility beyond ages 20 to 29 years are lacking.

Objective: To assess whether VP and VLBW are associated with lower fertility up to age 35 years.

Design, setting, and participants: This prospective population-based cohort study was conducted in Bavaria, Germany, with participants born between January 1985 and March 1986 who required admission to a children’s hospital within the first 10 days after birth. Healthy infants born at term (ie, at least 37 weeks’ gestation) in the same hospital and children alive at 6 years were selected as controls. Follow-up occurred repeatedly up to 34 to 35 years. Data were analyzed from July to December 2024.

Exposures: Gestational age and birth weight.

Main outcomes and measures: Cumulative incidence of having the first alive child (ie, fertility) was calculated using Kaplan-Meier estimation and the difference between participants born VP or with VLBW and term-born participants was compared with log-rank tests. Univariable and hierarchical multivariable Cox proportional hazards regressions were performed to estimate hazard ratios (HRs) for fertility associated with VP and VLBW adjusting for individual factors. Estimations were compared between early (<30 years) and late (≥30 years) reproductive windows.

Results: A total of 414 participants (212 born VP or with VLBW and 202 term-born) were included (mean [SD] age, 34.67 [0.53] years; 216 [52.2%] female). Cumulative incidence of having the first alive child was lower in participants born VP or with VLBW throughout the follow-up. The association of VP and VLBW with lower fertility was significant during the late (HR, 0.46; 95% CI, 0.31-0.68) but not early (HR, 0.73; 95% CI, 0.47-1.14) reproductive window; this association attenuated after adjusting for neonatal factors (sex and family socioeconomic status) and childhood neurosensory impairment at step 2 (HR, 0.59; 95% CI 0.40-0.88), childhood family factors (eg, parenting) at step 3 (HR, 0.61; 95% CI, 0.40-0.92), and there was no longer an association after adjusting for sociodemographic factors (eg, partnering) at step 4 (HR, 0.78; 95% CI, 0.50-1.20). Partnering (ie, being married or cohabitating with a partner) had the largest magnitude association with fertility across both the early (HR, 7.87; 95% CI, 3.44-18.00) and late (HR, 3.95; 95% CI, 2.47-6.31) reproductive windows.

Conclusions and relevance: In this cohort study of participants born VP or with VLBW and term-born adults, VP and VLBW were associated with overall lower fertility. A major reason was an association of less partnering with lower fertility, suggesting that partnering is key to reproductive success.

https://pubmed.ncbi.nlm.nih.gov/40105837/

Podcast: https://nanncast.podbean.com/e/building-psychological-safety-in-the-nicu-preventing-burnout-and-compassion-fatigue/

https://www.frontiersin.org/journals/education/articles/10.3389/feduc.2026.1758593/full

by Neonatal Womb Warriors (2026) using AI-assisted design tools (Informal infographic/educational resource). Content informed by global research on preterm birth and education. This infographic is intended for educational purposes and does not replace professional medical or educational advice.

https://pubmed.ncbi.nlm.nih.gov/40816932/

In 2021, Université de Montréal graduate student Adèle Saives asked to fast-track into the doctoral program in nursing specifically to work on an ambitious project: a device to support the development of prematurely newborn babies.

This was a major undertaking, probably a first for a doctorate in nursing, according to her supervisors, Faculty of Nursing professor Marjolaine Héon and Marilyn Aita, a professor and researcher at the Azrieli Research Centre of the UdeM-affiliated CHU Sainte-Justine.

Saives had come across a study of a handmade neonatal hammock used in Brazil. After some research, she concluded that nothing similar existed in North America or Europe, and there was no standardized model on the market.

She called her project Prémac — and the hammock has come a long way since. It underwent initial testing in the neonatal unit at CHU Sainte-Justine and then received funding under a pilot program there to clinically validate new healthcare technologies in a real-world environment.

The project is jointly supported by the CHU Sainte-Justine Research Centre, Quebec’s Ministry of Economy, Innovation and Energy, and Axelys, a non-profit that supports the transfer of innovations produced by research to promote sustainable prosperity for Quebec.

Developed by a research team led by Adèle Saives who is supported by a CIHR doctoral training scholarship, and used in the neonatal unit at CHU Sainte-Justine, the hammock is already generating significant interest. Since a patent application for it is still under review, however, images of it are not being circulated.

Reproducing intrauterine movement

After delivery, a premature baby is flung into a blindingly different environment.

“In neonatal units, we want to optimize neurological development,” said Saives, who has also worked as a neonatal nurse at CHU Sainte-Justine since 2020. “So we try to provide the same sensory stimulation as during pregnancy.”

In the womb, it’s darker and quieter than outside, but the foetus is also free to move. “That provides important stimuli for brain development, promoting everything from coordination to sleep,” Saives said.

In an incubator, however, premature babies have little opportunity to move in ways that engage their vestibular system. Saives wanted to create a hammock that would allow more movement, activated simply by the baby’s breathing, while at the same time enveloping the baby.

“This is the closest we can get to in utero movement,” she said. “We think it could have positive effects on the stability of physiological parameters and also on sleep, which is very important for the development of premature newborns.”

Input from many quarters

Saives drew extensively on her experience and practical knowledge as a nurse.

“Adèle did it all,” said Aita and Héon. “She didn’t just come up with the idea, she created the design using software, chose the materials, sewed the prototype and recruited the hospital’s seamstresses to produce the final models.”

Saives was also concerned with getting her idea accepted. “It was important to make my project compatible with the care routine in a clinical setting,” she said. The response at the hospital was enthusiastic from day one, she added.

Saives consulted people from a variety of disciplines: neonatologists, physiotherapists, occupational therapists, respiratory therapists. She then worked on the first sketches with Sophie Labat, then a doctoral student in biomedical engineering at Polytechnique Montréal.

Then she sewed the prototype. To design a fastener that would work on the new-model incubator used in the neonatal unit at CHU Sainte-Justine, she sought the expertise of Julie Lévesque, an engineer at the Centre de métallurgie du Québec.

While the project spans several disciplines, Saives’ experience gave her a holistic vision. “Her university training in nursing equipped her to consider many aspects of the device in terms of developmental care,” said Aita.

Every detail was carefully analyzed, from the choice of the material that gently envelops the babies to the seams, which must not damage their fragile skin. The hammock can also be quickly laid flat for an emergency intervention and can be easily disinfected.

The real test

After confirming the safety of the technology, Saives is now conducting a randomized clinical trial involving premature babies in the neonatal unit at CHU Sainte-Justine who were born at between 26 and 35 weeks.

“I want to evaluate the effects of the hammock compared with babies lying on their backs in an incubator,” she explained.

In addition to the funding agencies and Axelys, Saives has received assistance from other organizations including the Canadian Institutes of Health Research, UdeM’s Bureau Recherche-Développement-Valorisation (BRDV) and the CHU Sainte-Justine’s Bureau de l’innovation.

“This was a new process for us,” said Saives. “We really appreciated the step-by-step support.”

If the results of the clinical trial are positive, Saives hopes to patent the Prémac and see widespread use of the device. But whatever the results, the project has been formative and rich in both intellectual and human discoveries, she said.

https://nouvelles.umontreal.ca/en/article/2025/09/15/udem-nursing-student-develops-hammock-for-preemies

Roles, Relational Trauma, A Poem

El Salvador, officially the Republic of El Salvador, is a country in Central America. It is bordered on the northeast by Honduras, on the northwest by Guatemala, and on the south by the Pacific Ocean. El Salvador’s capital and largest city is San Salvador. El Salvador’s population in 2024 was estimated to be 6 million.

The economy of El Salvador has historically been dominated by agriculture, beginning with the Spanish taking control of the indigenous cacao crop in the 16th century, with production centred in Izalco, along with balsam from the ranges of La Libertad and Ahuachapán. This was followed by a boom in use of the indigo plant in the 19th century, mainly for its use as a dye. Thereafter the focus shifted to coffee, which by the early 20th century accounted for 90% of export earnings. El Salvador has since reduced its dependence on coffee and embarked on diversifying its economy by opening up trade and financial links and expanding the manufacturing sector. The colón, the currency of El Salvador since 1892, was replaced by the United States dollar in 2001. As of 2019, Salvadoran economics gifted them the lowest level of income inequality out of nearby countries. Among 77 countries included in a 2021 study, El Salvador had one of the least complex economies for doing business.

The Human Rights Measurement Initiativefinds that El Salvador is fulfilling 89.6% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, El Salvador achieves 98.3% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 82.9% of what is expected based on the nation’s level of income.  El Salvador falls into the “fair” category when evaluating the right to reproductive health because the nation is fulfilling 87.6% of what the nation is expected to achieve based on the resources (income) it has available.

There are now 30 public hospitals in El Salvador, plus various primary care facilities and 27 basic health care systems. Before 2009 a “voluntary” donation was demanded to access a public hospital or clinic. Clinics staffed by Community Health Teams have been established in the rural areas. Although services are supposed to be a free, a shortage of funds means that people may have to pay for supplies Emergency services are very basic. The private health sector offers care in medical facilities concentrated in urban areas.

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

COMMUNITY

Source: https://www.unicef.org/innovation/newborn-health-innovations#:~:text=UNICEF%20is%20working%20to%20improve%20access%20to,management%20*%20**ASTRONAUT**%20Point%20of%20care%20ultrasound

Source:https://doi.org/10.63682/jns.v14i31S.8739

Source: https://www.caf.com/en/currently/news/el-salvador-launches-doctorsv-a-digital-health-system-pioneer-in-the-world/

HEALTHCARE PARTNERS

Overview

 Leadership by the head nurse/unit manager in facilitating the implementation of Infant and Family Centered Care (IFCDC) is often unrecognized. The key role of the head nurse/unit manager in promoting IFCDC and creating a NIDCAP Training Center within the neonatal intensive care unit at the University Hospital of Ghent, Belgium, serves as an example of significant practice change. Instead of taking a theoretical model of change as a starting point, concrete personal experiences and roles that are incorporated into daily practice are described. The aim is to provide insight into how leadership, entrepreneurship, and connection significantly contribute to successful implementation, and to inspire managers facing similar processes.

 A description of the evolution of the role of the head nurse from clinical expert to an inspiring, facilitating, and strategic manager includes grounding in clinical skills that lead to an understanding of the necessity of implementing IFCDC. Expansion of the leadership role includes believing in one’s own team, actively giving employees opportunities to build and share expertise, and developing a culture of shared leadership and evidence-based working. The use of care consultants, working groups, and internal study days strengthened both expertise and team solidarity.

 A focus on the importance of the head nurse’s entrepreneurial leadership complements clinical expertise and team leadership. Despite budgetary pressure, gaining insight into financial flows, using workload measurement tools, and developing an appropriate financing model enabled continued investment in training and innovation. Strategic alignment with the hospital’s mission, vision, and quality models increased support among senior management.

The head nurse’s role in connecting and communicating is highlighted as crucial for sustainable change management. Transparent communication, multidisciplinary involvement, and attention to pitfalls and concerns proved essential to embed IFCDC and NIDCAP principles into daily healthcare practice and create a shared sense of ownership and pride.

Background When preparing and developing a large project, such as a startup, any practice change involving developmentally supportive, family-centered care can be framed with objectives, project plans drawn, and theoretical frameworks developed from the literature. However, the role of the head nurse/unit manager does not include managing theoretical change processes; rather, it involves using concrete examples to demonstrate how implementation can work in a particular NICU. The theory can be used, often post hoc, to get insight into why a project is or is not implemented in practice.

The intent of the description of the head nurse’s/unit manager’s development and resulting role is to provide a narrative of what worked. The descriptions and strategies included are intended as inspiration for those facing similar implementation projects.

Knowledge background of the nurse manager

 In the past, the ‘better nurses’ often rose to managerial positions. The person who was the most handy and who had the most clinical knowledge was often appointed as head nurse. However, it has become increasingly clear that the role has expanded to include many other competencies.

Inspirational role of a nurse manager

As a head nurse, it is first and foremost important to believe in the strength of your own team. Your own employees should be given maximum opportunities to develop their expertise, and in turn, they should share it within the team. A manager primarily facilitates nurses’ growth, embraces the knowledge they develop, and ensures it is shared with colleagues.

In the Ghent NICU, work is conducted across many domains (ventilation, breastfeeding, pain, transport, skin and wound care, resuscitation, developmental care, vascular topics, etc.). The head nurse/unit manager, recognizing the importance of work groups that address clinical care, grants a part-time exemption for a nursing consultant in each care domain. Their role is to follow and document the work group processes and provide training to colleagues, intra- and extramural. The resulting work on the specific care domains is supported not only by the nursing consultant but also by several team ambassadors. In this way, multiple contact persons for various topics are created, and opportunities are offered to different team members. Recognition of evidence-based, high-performance care then spreads within the broader organization.

Every two years, a symposium for nurses and midwives is developed and offered with significant support from the head nurse/unit manager. These educational programs provide a connection and collaboration towards a common goal within the various care domains of neonatal care. It is a moment to ‘shine’ as a team and to share the evidence we have acquired with others. This ‘study day’ can be seen as an example of the department’s dynamic culture, which pursues clinical excellence.

As a unit manager, inspiring is essential to education. For example, looking for relevant topics together and cross-pollinating ideas with each work group is an example of how to provide inspiration. Additionally, providing inspiration is essential for stimulating employee growth on your team. It is an opportunity both to optimize care quality and for nurses individually to grow and rise above themselves. If a manager is not afraid to step outside of their comfort zone, it can lower the threshold for employees to do the same.

 Entrepreneurial and innovative role of the nurse manager

 Inspiring and facilitating staff are important, but achieving financial freedom and earning the trust of senior management are necessary. In a context where resources are increasingly scarce and priorities are increasingly focused on direct business results, the role of a head nurse/unit manager as an entrepreneur and innovator is not an obvious choice. However, it is essential to the success of any initiative.

 Financing as an entrepreneurial skill.

Financial autonomy to generate and control income is a key component of the entrepreneurial role of the head nurse/unit manager. To realize this new cultural shift in how a head nurse/unit manager’s role is perceived, an individualized, well-thought-out financial plan that generates income (e.g., by organizing symposia and offering training to external partners) is essential. In turn, generating income makes it possible, for example, to send colleagues to international conferences and training courses. It is therefore also the task of a head nurse, as the department’s budget holder, to identify, see, and take advantage of financial opportunities.

It is important to have insight into the NICU’s financial flows relative to the entire organization. Very often, people complain about deficiencies, which is nothing new and is probably a sore point in every organization. A head nurse/unit manager should try to get a handle on the income and expenses of their department. Demonstrating financial control often ensures that senior management has the confidence to start working with the NICU entrepreneurially. For example, the Ghent NICU, together with the other Flemish NICUs, successfully validated a neonatal measurement instrument and used it to document nurses’ workload on a daily basis (WANNNT). The outcome data, along with income from fees and historical hospitalization data for our service, enabled us to predict our unit’s budget. Working solely with post-factum data means the head nurse/unit manager is less able to respond quickly to a rapidly evolving context.

Innovation as an entrepreneurial skill.

An important aspect of the entrepreneurial role is innovation. Head nurses are expected to actively explore innovative solutions and consider opportunities to optimize patient care. Undoubtedly, these opportunities present themselves in every organization.

Neonatal care has undergone many developments in recent decades. NIDCAP and IFCDC are receiving increasing attention. It leads, among other things, to better neonatal outcomes, shorter length of stay, fewer complications, and less stress for parents. Sharing the most recent literature on this subject with the hospital’s management and higher management while also emphasizing the financial benefits to the hospital can help free up budgets more easily.

 Implementing NIDCAP and IFCDC comes with a significant price tag. When hospitals are under financial pressure, they often quickly reduce non-primary assignments, including training. It is important to demonstrate that the investment in developmental care is profitable in the long term, not only through patient and family outcomes but also by showing the sustainability of quality of care and staff retention. In addition to having self-acquired resources to continue investing in your team’s education and training, it ensures a successful start to greater innovation in implementing NIDCAP training and IFCDC standards of care.

Policy implementation role of the nurse manager

Within the hospital, the mission and vision are periodically adjusted. The individual units and services are asked to align their departmental objectives with the hospital’s policy. Keywords of the Ghent University Hospital policy are excellent—daring, people oriented, and efficient. It does not take much imagination to see that the core IFCDC and NIDCAP values are reflected in these key words in hospital policies. The head nurse/unit manager of the NICU must translate the link between the hospital and the developmental care values using concrete examples from clinical practice and present it to the hospital’s higher management.

Each hospital also works around and with an international quality model. The NICU at University Hospital Ghent also strives to meet, as far as possible, the highest standards set by the European Standards of Neonatal Care. Working with 2 different models is not always efficient. As a service, embedding the Neonatal Standards of Care is done as much as possible within the various care domains with the hospital’s quality model as the goal. On the one hand, this ensures working on quality in a broad sense, as expected by the hospital, and avoiding ‘quality fatigue’ by working with parallel models. It is also an opportunity to demonstrate in practice how to translate the hospital’s keywords and the organization’s central vision into our daily policies.

Connecting the role of the nurse manager

The head nurse serves as a connector within change management, linking vision and practice. In a care context that is constantly evolving, the head nurse helps translate changes into reality for the nursing team. This translation is best made in collaboration with stakeholders from the developmental care team, in concrete terms. The multidisciplinary working group on development-oriented care includes NIDCAP professionals who serve as guides. In this way, a bottom-up culture of co-ownership for important projects is cultivated.

Clear and empathetic communication is essential here. A space for dialogue is created; active listening to questions and concerns is employed; and assurance is provided that employees feel heard and involved.

In this way, a team-oriented culture, in which cooperation and interprofessional respect are central, is promoted. In the past, NIDCAP and a developmental care emphasis were often seen as the work of a small number of passionate nurses. A multidisciplinary approach, in which doctors, psychologists and, for example, care consultants are closely involved, provides much more support for this process and increases the likelihood of success.

Finally, the head nurse/unit manager acts as a role model in the change process. By showing a willingness to change, flexibility, and a constructive attitude, you give the team direction and trust. In this way, the head nurse not only becomes an initiator of change but also a catalyst that connects and strengthens people to achieve these sustainable improvements together.

Communicative role of the nurse manager

 The head nurse also plays a central role in communicating key changes. This role goes beyond merely passing on information; it includes actively connecting people, their expectations, and their goals. A head nurse is at the crossroads between the nursing team, the medical staff, and senior management, ensuring that those three worlds are anchored together.

Within the team, creating clarity and trust is a priority, and open communication is crucial. In addition, a culture of dialogue is emphasized in which team members, together, are encouraged to help shape the policy on developmental care. Congruence in thinking and acting is essential here. The manager must ensure that the team’s vision translates into daily operations in direct patient care: in other words, “make sure that you DO what you SAY”.

At the same time, the head nurse is an important communication partner with senior management. Frequent, open, and honest feedback to management about the current state of the change process creates a long-term atmosphere of trust between management and the team. In doing so, the possibility of identifying any additional needs (e.g., additional staff needs) is embedded. SAYING what you DO is therefore not an empty illusion here.

 To achieve this, it is also an undeniable asset if senior management wants to delve into the content of the developmental and family centered care project to a certain extent. The presence of a board member during a feedback session with the Ghent NICU staff made it easier to continue the discussion. In this way, co-ownership of the change project is supported at the higher management level.

 As in any organization, organizational change sometimes occurs at the senior management level. Every change and new situation should be proactively used to invite new board members to share the unit’s vision and to explain projects within the long-term vision of both the organization and the unit. This approach can ensure that a lot of additional context information is less necessary for specific and/or new questions related to the project.

Pitfalls

Does everything always go perfectly? Not at all. Not everyone is immediately open to change: why would anyone suddenly change something that they have been doing in a certain way for 20 years? Familiar questions are  • “Is there sufficient evidence for changes to this protocol?” • “Do all those adjustments cost too much money?” • “Is that profitable?” communication is crucial. In addition, a culture of dialogue is emphasized in which team members, together, are encouraged to help shape the policy on developmental care. Congruence in thinking and acting is essential here. The manager must ensure that the team’s vision translates into daily operations in direct patient care: in other words, “make sure that you DO what you SAY”. At the same time, the head nurse is an important communication partner with senior management. Frequent, open, and honest feedback to management about the current state of the change process creates a long-term atmosphere of trust between management and the team. In doing so, the possibility of identifying any additional needs (e.g., additional staff needs) is embedded. SAYING what you DO is therefore not an empty illusion here. To achieve this, it is also an undeniable asset if senior management wants to delve into the content of the developmental and family centered care project to a certain extent. The presence of a board member during a feedback session with the Ghent NICU staff made it easier to continue the discussion. In this way, co-ownership of the change project is supported at the higher management level. As in any organization, organizational change sometimes occurs at the senior management level. Every change and new situation should be proactively used to invite new board members to share the unit’s vision and to explain projects within the long-term vision of both the organization and the unit. This approach can ensure that a lot of additional context information is less necessary for specific and/or new questions related to the project. Pitfalls Does everything always go perfectly? Not at all. Not everyone is immediately open to change: why would anyone suddenly change something that they have been doing in a certain way for 20 years? Familiar questions are • “Is there sufficient evidence for changes to this protocol?” • “Do all those adjustments cost too much money?” • “Is that profitable?” • “Is that really a priority now?” • “Are we not shifting the focus too much to education and training, to project work, which jeopardizes our clinical work in direct patient care?” • “As a care provider, will I still be able to take my holidays with all those different assignments?”

Thus, we can continue with similar questions for a while.

These are all recognizable concerns in departmental change processes—concerns that can and will come from both the team and senior management and concerns to which head nurses cannot always give an immediate, satisfactory answer. Nevertheless, it is important to stick to basic ideas and evidence, asking the question: “Why and for whom are we doing all this?” which will often help with forward movement. It will be important to stay transparent with the team—even during personal uncertainties— show vulnerability, and, above all, continue to ensure a safe climate in which employees can share their concerns. Working step by step so that the effort remains manageable for everyone and not forgetting to celebrate the team’s successes when reaching milestones are essential to avoiding missteps. In this way, it creates a joint sense of pride with the developmental and family-centered care implementation story, in which even the care for each other as care providers within the team must continue to receive necessary attention.

Summary

 Successful implementation of a complex and intensive change process, such as the start-up of a NICU-wide infant- and family centered developmental care program and a NIDCAP Training Center, is not merely the result of a theoretically based project plan but above all of thoughtful and committed leadership in practice.  The role of a head nurse/unit manager in this effort is multifaceted: entrepreneurial, innovative, inspiring, facilitating, strategic, connecting, and communicative.

 By starting with trust in the team’s expertise and growth opportunities, a culture is created that centralizes shared leadership, multidisciplinary collaboration, and evidence-based care. Consciously investing in training, stimulating internal nursing consultancy, and making expertise visible within and outside the department not only strengthens the quality of care but also increases employee involvement and pride. Entrepreneurial leadership within a healthcare context that is increasingly under financial pressure appears to work. Insight into budgets, the use of financial opportunities, and the substantiation of investments with both clinical and economic arguments have proven necessary to make such a change process possible.

 Sustainable change can only succeed if it is strategically embedded in the broader mission, vision, and quality structures of the organization. Alignment with hospital-wide policy objectives increased support and prevented fragmentation or ‘quality fatigue.’ Crucial here is the head nurse’s role as a link between the unit and the hospital’s management, where transparent communication strengthens trust on both sides.

Finally, the change process is inevitably accompanied by uncertainties, resistance, and pitfalls. By leaving room for concerns, working step by step, and celebrating successes, a safe learning climate can be created in which change is not experienced as a threat but, hopefully, as joint growth. In this way, the head nurse not only becomes a manager of change but also a driving force behind sustainable, people-oriented care.

Source:https://neonatologytoday.net/newsletters/nt-feb26.pdf

PREEMIE FAMILY PARTNERS

New parents Nicole and Joe welcomed identical twins Ava and  Amelie, who were born premature at just 26 weeks at Birmingham Women’s Hospital, and were cared for on the Neonatal Intensive Care Unit (NICU) for over 11 weeks before they were well enough to go home.

Nicole, who lived in Lichfield at the time, was seen at the hospital’s Fetal Medicine Department when they noticed at her 16-week scan one of the twins was growing significantly smaller than the other.

She recalled: “It was my first pregnancy, and we found out we were having twins at six weeks and the pregnancy was going smoothly.

“They noticed at a scan one of the twins was growing significantly smaller, so we were referred to the Fetal Medicine team.”

The Fetal Medicine department discovered the twins had Selective Intrauterine Growth Restriction ( sIUGR ), a condition that can occur in identical twin pregnancies where one twin is growth restricted due to an absent or reversed flow from the umbilical cord.

Nicole added: “We’d never heard of the condition before, and it was really scary knowing something was potentially wrong.

“It was all due to where they’d ended up connecting to the placenta. The bigger twin was plugged in at a larger part so was getting plenty of nutrition, but the smaller twin was plugged into the tail end of the placenta, meaning she wasn’t getting enough nutrition and was so much smaller.

“We didn’t know what this would mean for them, but everyone was so kind and reassuring and explained things in a way we could understand.”

Nicole was scanned twice a week to closely monitor the smaller twin’s growth, until Nicole was 26 weeks pregnant and was admitted overnight for daily monitoring.

She said: “Her heart rate kept dropping low on the monitor, and we were starting to get concerned and thinking about having to deliver them early.

“It kept dropping and taking longer to come back up, and one of the consultants who looked after us said that it was time for them to come out now.

Ava and Amelie arrived prematurely at 26 weeks and 4 days, weighing just 2.2 and 1.9 pounds.

Nicole said: “I was able to see both girls after they were born before they went straight down to the NICU, where they were both intubated for 24 hours before progressing onto oxygen.

“Joe went down with them, and once I’d recovered, they took me to see them, and they looked so tiny and fragile.

“Amelie, the smaller twin, kept getting blood in her feeding tube, so had to be nil by mouth due to the risk of infection. She had a much harder ride to start with, but she kept fighting.”

Both twins started to get stronger with the help of oxygen and feeding tubes, however, when Ava was six weeks old, she developed Necrotising Enterocolitis (NEC) which, an infection which can affect premature babies and is a condition where the bowel becomes inflamed and damaged.

Nicole recalled: “Something hadn’t been quite right with her tummy the day before, but then we got a phone call at home to say she’d taken a turn for the worse.

“It was horrible hearing the phone ring in the middle of the night knowing it was probably about the girls, but knowing we weren’t with them.

“They were both so strong and were real fighters all the way throughout.”

During their stay at the NICU, Nicole and Joe visited every day, arriving first thing in the morning and staying until last thing at night. They also received counselling on the unit and were part of the family group that had been set up for parents to share their journey.

Nicole commented: “Nothing can prepare you for a stay on the NICU.

“While we were there, we lived in our own little bubble and we didn’t talk to family or friends much because it was hard to explain how it feels, and you don’t know what’s going to happen next.

“The team were really supportive, and they helped us be as hands-on as possible with their care, and the family group was really helpful too. It was nice to be able to talk to other parents who knew how it felt and were going through the exact same thing too.

 “Walking away from your babies every night was just horrible, so to finally leave with them was a huge relief.

“When we went home, they both still had a feeding tube, but the team were brilliant in giving us training so we could do it ourselves at home. Both tubes ended up being removed the next day as they were doing so well breastfeeding.”

The twins are now over two years old and are thriving at home after their difficult start to life.

Nicole added: “They’ve got such different personalities now, but they’re both very cheeky little girls.

“Ava especially loves animals and trips to the farm, and they both love singing and dancing around the house.

“They both absolutely adore their younger sister and they’re so gentle and kind with her.

“We’re so thankful for everyone at the Women’s Hospital for looking after our girls, they’re both so strong and such fighters and we couldn’t be prouder of how far they’ve come already.

“Shireen Meher looked after us from our time in fetal medicine all the way to the delivery, and she was had such a positive impact on our journey.”

Source:https://bwc.nhs.uk/news/identical-twins-now-thriving-after-being-born-premature-at-26-weeks-14305/

INNOVATIONS

Background: 

The neonatal intensive care unit (NICU) relies on a multidisciplinary team of advanced practice providers (APPs), including neonatal nurse practitioners (NNPs) and physician assistants. With the Accreditation Council for Graduate Medical Education residency rotation reductions taking effect in July 2025, the demand for NNPs to fill clinical coverage gaps will increase. Anticipated changes in federal reimbursement and Medicaid services and National Institutes of Health pose financial challenges for Children’s Hospitals.

Evidence Acquisition: 

This review examines the current state of the NICU APP workforce with special emphasis on NNPs, including historical trends, educational requirements, and the impact of regulatory changes. Data were gathered from surveys completed by national professional organizations, published literature in PubMed, and expert communication.

Results: 

Despite their critical role and increased demand, APPs including NNPs face challenges, such as burnout, staffing deficits, reimbursement, and a decline in the number of NNP graduates by 20% since 2022. Neonatal nurse practitioner recruitment is hindered by the lengthy onboarding process and high costs. The integration of physician assistants, hospitalists, and non-NNPs as possible solutions to fill the NNP shortage gap presents challenges, such as lack of training opportunities and managing patients outside their scope of practice.

Implications for Practice and Research: 

Addressing workforce shortage requires strategies, including tuition-supported programs, recruiting registered nurses to become NNPs, developing mentorship programs, and increasing NNP preceptors. Further research is needed to evaluate the effectiveness of these strategies and to explore additional solutions for sustaining the NNP workforce.

Source:https://journals.lww.com/advancesinneonatalcare/abstract/2026/02000/new_workforce_challenges_for_neonatal_nurse.9.aspx?context=featuredarticles&collectionid=3

Introducing Preemies Hub: A New Global Resource for Preemie Families, Built with You in Mind

For every preemie warrior and every parent who has stood beside an incubator, the journey into the NICU often begins without warning. It can feel overwhelming—filled with medical language, uncertainty, and the urgent need to make sense of what is happening to your baby. In those moments, access to clear, trustworthy, and relatable information is not just helpful—it is essential. That is why we are so excited to introduce Preemies Hub, an innovative new platform developed in partnership with Our Kids Health, designed to support families navigating the realities of premature birth.

Preemies Hub was created with a deep understanding that not all families experience the NICU in the same way. For many, challenges are compounded by language barriers, cultural differences, and limited access to reliable, evidence-based information. This platform addresses those gaps by providing translated, adapted, and culturally responsive health information specifically designed for parents across equity-deserving communities. Every piece of content has been developed with respect for different values, beliefs, and ways of communicating—ensuring that families can not only access information, but truly connect with it.

So why does this matter? Because caring for a premature baby is already one of the most emotionally and physically demanding experiences a family can face. Misconceptions about prematurity, lack of preparation for an unexpected early delivery, and difficulty navigating medical information can make that journey even harder. Preemies Hub helps change that. It empowers parents with knowledge they can trust, presented in a way that is clear, compassionate, and accessible—so families can feel more confident, informed, and supported in advocating for their child.

The platform offers a wide range of topics relevant to the NICU journey and beyond, along with resources available in multiple languages including Punjabi, Ukrainian, Tamil, Spanish, Mandarin, Inuktitut, Cantonese, Filipino, Arabic, and more. It also intentionally centers diverse communities, including Black families, ensuring that representation and inclusivity are not afterthoughts—but foundational to the resource itself. For providers, this means having a trusted tool to share with families. For parents, it means finally seeing information that reflects your language, your culture, and your experience.

At Neonatal Womb Warriors, we believe that every family deserves access to information that meets them where they are. Preemies Hub is more than just a resource—it is a step toward equity in neonatal care, a bridge between knowledge and community, and a reminder that no preemie journey should be navigated alone. 💙

Preemies Hub: https://www.cpbf-fbpc.org/preemie-hub

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Dads, Signaling Behaviors, Fortification

Cambodia, officially the Kingdom of Cambodia,is a country in Mainland Southeast Asia. It is bordered by Thailand to the northwest, Laos to the north, and Vietnam to the east, and has a coastline along the Gulf of Thailand in the southwest. It spans an area of 181,035 square kilometres (69,898 square miles), dominated by a low-lying plain and the confluence of the Mekong river and Tonlé Sap, Southeast Asia‘s largest lake. It is dominated by a tropical climate. Cambodia has a population of about 17 million people, the majority of which are ethnically Khmer. Its capital and most populous city is Phnom Penh, followed by Siem Reap and Battambang.

The quality of health in Cambodia is rising along with its growing economy. The public health care system has a high priority from the Cambodian government and with international help and assistance, Cambodia has seen some major and continuous improvements in the health profile of its population since the 1980s, with a steadily rising life expectancy.

A health reform of Cambodia in the 1990s, successfully improved the health of the population in Cambodia, placing Cambodia on a track to achieve the Millennium Development Goal targets set forth by the United Nations. One such example is the Cambodian Health Equity Fund, largely financed by the country itself, created in 2000 to increase access to free health care to around 3 million poor people. The Fund, which pays for traveling expense and even daily allowance for anyone accompanying a patient, has resulted in increasing health care seeking among Cambodians who otherwise could not afford any kind of medical care. As a result of the reform, mortality rates significantly dropped. Similarly, life expectancy at birth in 2010 was 62.5 years, a 1.6 folds increase from 1980.

COMMUNITY

Cambodia’s sustained progress in improving maternal, newborn and child health

20 February 2025

At the beginning of the 2000’s, Cambodia faced alarming maternal, newborn and child health indicators. The maternal mortality ratio stood at 437 per 100 000 live births, while newborn and child mortality rate accounted for 37 and 124 per 1000 live births respectively. Limited infrastructure, a shortage of skilled birth attendants and financial constraints hindered progress. To tackle these challenges, the Cambodian government, with support from WHO and key partners, embarked on a transformative journey to strengthen maternal and newborn health services and ensure equitable access to quality care. 

Today, skilled birth attendance is near universal, with 98.7% of births attended by trained health professionals and 97.5% of women giving birth in a health facility. Between 2014 and 2021-2022, neonatal and under-five mortality rates declined by 54%, from 18 to 8 and from 35 to 16 per 1000 live births respectively, far exceeding the global average reduction of 14% during 2015-2022. Cambodia achieved its Sustainable Development Goal targets for reducing neonatal and under-five mortality eight years ahead of schedule. 

Strengthening health systems 

Cambodia’s investments in health systems and workforce capacity have been instrumental in driving progress. Midwifery training programmes have equipped health workers with essential skills to provide safe, high-quality care, including routine antenatal care, essential intrapartum care, postnatal care, and management of childbirth complications. Deployment strategies have ensured that even remote health centres are staffed with skilled birth attendants. 

To incentivize facility-based deliveries, the government introduced a delivery incentive programme for health teams in 2007 and launched cash transfer programmes for pregnant women and infants from poor families in 2019, targeting the critical first 1000 days of life. These initiatives encourage families to seek comprehensive antenatal and postnatal care, ensuring access to a full package of essential health services. Financial mechanisms such as health equity funds, cash transfers and fee exemptions have alleviated economic barriers, making institutional care more accessible to vulnerable populations. 

Improvements in water, sanitation and hygiene infrastructure have also contributed significantly to better health outcomes. An integrated routine primary health care delivery system has been established across provinces and districts, ensuring that essential services effectively reach communities. Health promotion and behaviour change campaigns have played a vital role in encouraging exclusive breastfeeding and antenatal care-seeking behaviours.

Strong leadership and strategic framework 

A key milestone in Cambodia’s progress has been the strong leadership of the Ministry of Health, which has provided clear strategies for advancing maternal and newborn health. Two main coordination platforms — the Sub-Technical Working Group for Maternal and Child Health and the Early Essential Newborn Care (EENC) Coordination Committee — were established and have convened regularly to align efforts within the Ministry and with health partners.  

With technical support from WHO and funding from the Korea Foundation for International Healthcare (KOFIH), the EENC Coordination Committee plays a crucial role in harmonizing national and sub-national efforts, monitoring progress through regular reviews, mobilizing resources to scale up EENC practices, and ensuring consistency in care delivery while addressing service gaps. 

Recognizing the need for a strategic and systematic approach to newborn care, the committee led the development and adoption of the Five-Year Action Plan for Newborn Care (2016–2020). The plan emphasizes scaling up EENC and institutionalizing evidence-based practices, integrating key life-saving and cost-effective interventions — such as routine immediate care for all newborns under “The First Embrace” approach, as well as measures to prevent and care for small or sick newborns. 

By 2023, EENC coaching was implemented in 89.4% of health facilities (1187 out of 1328), surpassing the 80% target. Kangaroo Mother Care for preterm and low birthweight infants has been scaled up to two national hospitals and ten provincial and district referral hospitals, while a national protocol for EENC in Caesarean sections, introduced in 2019, has standardized care nationwide. 

“Maternal, newborn and child health are essential components of investing in human capital. Providing quality care for mothers and newborns brings immense benefits — not just for families, but for entire communities and economies. Cambodia’s coordinated approach to maternal and child health serves as an inspiring model for the region and globally. It demonstrates what can be achieved with strong national leadership, dedicated health workers and sustained partnerships,”stated Dr Marianna Trias, WHO Representative to Cambodia.

Remaining challenges  

Despite significant achievements and high coverage of antenatal care and facility-based deliveries by trained health personnel, challenges persist. While maternal mortality has declined, it remains high at 154 deaths per 100 000 live births, primarily due to haemorrhage and pregnancy-induced hypertension — both preventable causes. Greater efforts are needed to get on track to achieve the 2030 target of 70 deaths per 100 000 live births. Similarly, child malnutrition continues to impact long-term productivity, with 22% of children under five stunted and 10% wasted for over a decade. 

Disparities between urban and rural areas and gaps in facility capacity to provide quality essential services require targeted attention. Addressing unmet family planning needs and expanding adolescent-friendly services are crucial, particularly as rural adolescent girls aged 15–19 experience significantly higher birth rates than their urban peers.


The way forward 

Moving forward, further reducing maternal and neonatal mortality requires a stronger focus on enhancing the quality of care. Building on significant improvements in coverage, efforts should prioritize improving the quality of basic routine care during antenatal and intrapartum periods, including emergency obstetric care, alongside establishing robust referral systems for cases requiring higher-level care. Achieving this will require both the strengthening of quality improvement mechanisms with enhanced monitoring and the implementation of targeted improvement actions. 

The Fast-Track Initiative Roadmap for the Reduction of Maternal and Newborn Mortality (2025–2030) aims to accelerate progress by scaling up interventions, sustaining quality care and addressing service delivery gaps. To support its implementation, WHO will assist in developing a comprehensive country action plan and support the Coordination Committee for Strengthening Quality of Care and Wellbeing of Women, Maternal, Newborn and Child Health to ensure effective coordination and execution.

Source: https://www.who.int/westernpacific/newsroom/feature-stories/item/cambodia-s-sustained-progress-in-improving-maternal–newborn-and-child-health

Bringing clean water to where life begins: a neonatologist’s story from Ukraine

12 June 2025

These are the words of Galina Dmytrova, a neonatologist at Chuhuiv Central Hospital in the Kharkiv region of Ukraine. To her patients, the support Galina and her colleagues provide make a difference between life and death.

“They are already under enormous stress because of the war and now we are facing water shortages again. Before the war, you’d turn on the tap and not think twice. But now, under daily shelling, the electricity goes out, and with it, the water too,” says Galina.

5 water stations set up across Kharkiv city and the wider region in Ukraine continue to allow hospitals to provide essential care despite the war. Among them is Chuhuiv Central Hospital. The stations were installed in 2025 by WHO with funding from the European Union and in partnership with Ukraine’s Ministry of Health.

For communities regularly affected by attacks that disrupt electricity and water supply, this support ensures access to clean, safe water for both patients and health workers, which is critical in maternity wards, where hygiene and continuity of care are vital.

“In our hospital, thanks to WHO and the European Commission, we now have a water treatment system. I’m deeply grateful. It’s hard to explain the importance – especially for mothers and their babies. Many people actually can’t believe women are still giving birth under such harsh conditions. But they are, and I truly admire them,” Galina adds.

Those are our babies

In 2024, some 179 children were born in the Chuhuiv Central Hospital in the Kharkiv region. This year, the birth rate is similar; in the first 3 months of 2025, hospital staff oversaw more than 45 births.

“That’s our maternity ward, our babies, around 15 every month – even while the war goes on,” Galina tells us.

The certainty and assurance that care is available, that there is a hospital nearby, gives people hope. A functioning hospital is a reminder that life goes on. The opposite is also true; when health facilities are damaged or attacked in conflict, it not only deprives communities of access to health care. It also deprives them of hope.

“When the war started, I was new to Chuhuiv. I didn’t know the area that well. One night, a woman in labour came very late and explained they’d been looking for a boat. The bridge to her village had been destroyed – so, to get here, they had to cross the river. But they did it, because they knew here was a hospital that could help,” says Galina.

Source: https://www.who.int/europe/news-room/feature-stories/item/bringing-clean-water-to-where-life-begins–a-neonatologist-s-story-from-ukraine

Fortifying our commitment to pediatric academic medicine during turbulent times

Academic Medicine, with its tripartite mission to advance medical science, cultivate the next generation of healthcare professionals, and provide exceptional clinical care, offers unparalleled opportunities to shape the future of evidence-based healthcare delivery and inform health policy. Biomedical innovation developed through collaboration between academic medicine and public health can improve health at the individual and population health levels including mapping disease trends and improving treatment outcomes. According to the Association of American Medical Colleges (AAMC) economic impact report published in 2022, every one dollar spent by the AAMC member medical schools and teaching hospitals contributes $1.62 to the United States economy. Unfortunately, medical schools and teaching hospitals continue to face reductions in government funding for research and education support and have faced decades of under-reimbursement for publicly insured care, often delivered in these systems which also serve as safety net health care systems across the country.

The National Institutes of Health (NIH) revealed that the nation’s supply of physicians engaging in research continues to decline, with increased competition for decreasing available federal funding. Pediatric research is disproportionately impacted by gaps in funding, directly impacting the scientific innovation aimed at improving child health outcomes. As advanced technology such as artificial intelligence (AI) balanced with rapidly evolving scientific discoveries offer novel and dynamic clinical approaches to care, these persistent funding gaps often lead to pediatric care falling behind adult care delivery. With an estimated 646,000 researchers supported by federal grants, 48% of whom are students and trainees, the cross-cutting dependence and impact of federal funding on research and education is undeniable. Therefore, to mitigate further impact in pediatric academic medicine, continued promotion of NIH-funded pediatric research must leverage the understanding that return on the investment continues over the lifespan of the growing child to adult.

In the article by Arnaez and colleagues, Dr. Garcia-Alix is celebrated for his longitudinal contributions and global reach in academic medicine, specifically in field of Neonatal Neurology. By understanding that at least 30% of neonates admitted to Neonatal Intensive Care Units (NICUs) present with neurological pathology or other conditions impacting brain development, he recognized the importance of studying neuroprotective factors that impact these children’s morbidity. For Dr. Garcia-Alix, this area of interest sparked a career long passion. His dedication was evident, while advancing and supporting academic education and mentorship of his learners, generously investing time and role modeling for further generations. With the appreciation of the life-course model for his neuro-neonatal patients, Dr. Garcia-Alix, translated the overarching goal of improvement of functional outcomes by creating Brain-Aware Care, a family-centered, multidisciplinary approach targeting protecting an infant’s developing brain at the earliest stages. He recognized and appreciated that neuro-neonatal care delivery differs requires a comprehensive, multidisciplinary, family-centered approach tracking continuity of care as a baby grows, as is the continued research to understand how to develop appropriate care guidelines and protocols for developing, growing and thriving children. Dr. Garcia-Alix dedication and contributions as a physician scientist and educator with global impact on generations of patients in the field Neonatal Neurology is a testament of the longitudinal investment and support required to achieve the return on investment in child health outcomes in pediatric academic medicine.

Fiscal pressure on the future of pediatric academic medicine

The goal of pediatric academic medicine is to continue to develop and support clinician scientists like Dr. Garcia-Alix throughout their careers, who are committed to innovation, clinical care, and education. However, the fiscal pressure on pediatric academic medicine for the past several years, balancing under-reimbursed Medicaid clinical activity, rising labor costs, inadequate availability of pediatric extramural funding, and insufficient graduate medical education funding, is leaving teaching hospitals and partnered medical schools to find novel ways to advance this pediatric academic mission. Institutional-level investment in clinician scientists (e.g., 3 year contracts where early career faculty have time to successfully compete for a career development grant) are less feasible as financial pressure mount from funds flow models in Children’s Hospitals. Similarly, competition for institutional (e.g., KL2) and external (e.g., K23) grants are increasing as paylines are decreasing. With recent changes in administration policy, opportunities for first-generation scientists and those underrepresented in biomedical research (e.g., diversity supplements, MOSAIC award) are now unavailable. Protecting NIH funding, particularly money appropriated to child health research, is essential to promote the mission of pediatric academic medicine. Moreover, given diminishing availability of federal extramural funding, reviewing alternative, non-traditional academic sources of funding mechanisms for research including private industry, venture capital or foundation funding will be necessary to explore to uphold the tripartite mission of our pediatric academic mission.

In addition to research challenges, pediatric residency training programs are in jeopardy. Since the annual budget for graduate medical education is supported through the Congressional appropriations processes, strategic consideration of alternative platforms of support for retention, learner mentorship, and workforce pipelines are critical to ensure continued access to care for our pediatric population. Mentors can be instrumental at different stages of learners, from guiding students in explicit academic knowledge, to implicit knowledge of professionalism, ethics and the art of medicine.9 Retention of faculty is critical during times of economic stressors in academic medicine and leaning on mentorship and sponsorship as a key strategy, especially given pay inequity between pediatric and adult academic clinicians. Finally, evaluation of the economics of health professions education (HPE), is critical with ongoing cost-constrained academic medicine environments, especially with graduate medical education funding at risk.

Call to action for the health of our nation’s children

We need to reinforce and double-down on our commitment to the pediatric academic medicine mission-centered goal in improving the health and well-being our children and youth through investments in advancing science, cultivating our next generation of pediatric learners and improving clinical care for our pediatric patients. With several decades of Medicaid under-reimbursement, challenging degradation of federal pediatric extramural funding compared with adult funding, and even greater disparities in pediatric workforce shortages, families are facing a stark reality in worsening access to pediatric healthcare which will only grow in the upcoming years due to Medicaid cuts. We must continue to educate legislators and government officials that children require the same level of extramural funding (if not greater), in efforts to evolve even greater investment on return investment over the life-course trajectory. We must advocate for reimbursement parity greater than Medicare, especially understanding the discrepancy between Medicaid enrollment and Medicaid expenditure on children, being roughly 50% and 20%, respectively. Finally, we must educate that pediatric academic medicine, with its medical schools and teaching hospitals, contribute to the economy and health of the United States.

Call to action

  • Support the Bipartisan Legislation H.R. 3890 (Sewell, Fitpatrick)- Resident Physician Shortage Reduction Act of 2025- Educate your local legislators on the importance of Pediatric Education workforce pipeline and its’ impact on access to care, especially in rural communities
  • Continuing to unequivocally advocate for Children’s Hospitals Graduate Medical Education (CHGME), and budget appropriation within the annual Labor Health and Human Services Appropriations Process for the House and Senate Committees
  • Support NIH funding increases for Pediatric Research funding, which will increase and parity (and increase) for pediatric extramural funding for research to improve the evidence-based decision-making, and uphold trust with patients, families and society
  • Continue to educate our legislators about the life-course model in child health, and the return on investment, with the reality that for every $1 investing in early intervention, there is a return on investment from $1.26 to $17.07 for every child invested in the United States.
  • Finally, ensure that with the rapid advancing in technology, including artificial intelligence (AI), gaps do not arise regarding access to therapeutic tools between pediatric and adult populations in healthcare.

Source: https://www.nature.com/articles/s41390-025-04621-w

Abstract

Background: Perinatal loss is a profoundly complex form of grief, often linked to heightened risk of prolonged bereavement and adverse mental health outcomes. Perinatal grief rooms-private, supportive spaces within healthcare settings-aim to help families process their loss, spend time with their baby, and create meaningful memories in a respectful environment. While bereavement care has received growing attention, the role of the physical environment in supporting grief remains underexplored.

Objective: To synthesize current evidence on how dedicated physical spaces can support individuals and families after perinatal loss, and to identify priorities for research, design standards, and interdisciplinary collaboration.

Methods: A narrative review was conducted in accordance with PRISMA-ScR guidelines. Literature searches were performed across PubMed, PsycINFO, Medline (OVID), Embase, ScienceDirect, SCOPUS, SciELO, and Google Scholar using terms, such as “perinatal grief rooms”, “bereavement rooms”, “angel suites”, “butterfly suites”, “snowdrop suites”, “cloud rooms”, “designated units for perinatal loss”, and “birthing + bereavement suites”. The review examined (1) the current role of physical spaces in the perinatal loss experience, and (2) how their availability and design may influence grief outcomes.

Results: Of the 17 articles meeting inclusion criteria, only 4 (24%) referenced bereavement rooms, and just 3 (18%) noted the need for formal protocols-without offering concrete examples. No studies evaluated implementation, design standards, or measurable impact on grief, mental health, or family well-being. This lack of empirical evidence and standardized guidance underscores a critical gap that limits integration of therapeutic environments into perinatal bereavement care.

Conclusion: Despite increasing recognition of the importance of bereavement care, dedicated grief rooms remain under-researched and inconsistently implemented. Advancing this field will require rigorously designed studies, development of design standards, and collaborative partnerships among healthcare providers, researchers, policymakers, and design experts to ensure equitable access to therapeutic spaces for grieving families.

Source: https://pubmed.ncbi.nlm.nih.gov/40986076/

HEALTHCARE PARTNERS

Why it matters: 

Harnessing the power of a multidisciplinary team carries vast potential for effectiveness and problem-solving—while achieving high-performance with diversely skilled stakeholders requires adroit management.

The Center for Innovative Leadership (CIL) exists to support and accelerate the production of new research on leadership in today’s dynamic, complex organizations and bring research to life through engaging student experiences and powerful industry partnerships.

Summary: In healthcare it is common practice for multidisciplinary teams to be involved in efforts to improve the quality and safety of patient care. The perioperative period, which encompasses the time before, during, and after a surgical operation, is a prime target  for multidisciplinary improvement efforts because of the diversity of professional roles and care delivery settings involved. Failure to achieve improvement targets in this context is often attributed to lack of resources or resistance to change. 

A recent study counters this view, suggesting failure is more likely to be due to the way the multidisciplinary improvement team is led and how well it collaborates. Successful improvement projects depend on effective leadership—from designing the team, communicating a shared vision, planning the project, through to creating a collaborative approach to getting work done, and a structured training and feedback process.

A new study distils existing literature and gathers expert opinions on leadership and high-performing teams to offer practical guidance on those factors and behaviors relevant to the delivery of perioperative improvement projects, but also to leading multidisciplinary teams outside of healthcare.

High-performing healthcare services continually seek to improve patient experience and outcomes. One key area of focus for improved performance has been the perioperative period—the time leading up to, during, and after surgery. Unfortunately, perioperative improvement teams often fail to achieve their goals and when this happens the blame is often ascribed to resistance to change or lack of resources.

A recent study highlights that another important – yet overlooked – reason why t improvement projects fail is because of  the way multidisciplinary improvement teams are designed, how they are led, and how the multidisciplinary teamwork is managed. 

The study, from Christina Yuan and Michael Rosen, Faculty Affiliates at the Center for Innovative Leadership at Johns Hopkins Carey Business School, in collaboration with Tasnuva Liu, Benjamin Eidman, Della M. Lin, and Elizabeth Wick, contends that taking time to pre-plan and continually reflect on how team leadership behaviors are enacted is the best way to ensure team success—yet this is often overlooked. 

The researchers surveyed a range of thought leaders and team leaders with deep-rooted experience in perioperative work to discover the leadership behaviors and practices considered to be most relevant to planning and implementing perioperative improvement initiatives. 

Based on their findings the researchers recommend the following six key areas leaders should consider when designing and leading teams to deliver perioperative improvement projects—recommendations that carry implications for the management of multidisciplinary and cross-functional teams in a wider context too:

Design and Define

It is important to clearly define the aims of the mission, and to choose a team that includes all stakeholders and the right mix of skills and roles—allowing flexibility and ensuring that roles are not too rigidly defined. It is also wise to include those who are skeptical about improvements, as well as those who are more receptive, so as to understand the scope of the challenge ahead and ideally to bring skeptics on board. 

Manage

Leaders should create an environment where collaboration is prioritized and fine-tuned. Through discussion, establish effective processes for getting work done and delegating tasks. With agreement leaders should identify challenging but realistic goals for the team. They should monitor and report on progress and help the team recover from any small set-backs.

Sustain

An environment of psychological safety should be created, where team members feel they have a voice and their opinions are acknowledged. Leaders should communicate regularly to everyone to show how the project is progressing and to build a collective understanding of what is being achieved and what more might be done. This should be framed as a positive way to learn from successes and failures as opposed to seeking compliance.

Train and Feedback

Listening, asking good questions, and soliciting feedback are essential leadership behaviors. In a multidisciplinary team it is important everyone participates and is heard, including less vocal team members. This interaction can be the basis for providing skills training and promoting continuous learning—appreciating that failures can be opportunities for learning.

Manage Team Boundaries

It is a leader’s role to clarify the boundaries between the core project team and other groups and departments, as well as to be a liaison with these entities. It is vital to obtain senior leadership buy-in at the outset of the project and to maintain this throughout with regular reporting on progress, successes, and any potential barriers. Messages should be brief and individualized to address each senior leader’s particular concerns. 

Manage Organizational Context

Aligning the team’s efforts with organizational needs is key. Here an important factor is for senior leaders to ensure access to data the team needs to make decisions and do their work. Removing barriers to data sources and providing the team with opportunities to ask senior leaders questions and get information as needed is also the leader’s responsibility.

In a busy healthcare setting, where the delivery of a perioperative improvement project will be one of many priorities for the members of the assigned multidisciplinary team, above all team leadership must be clear and precise. It must ensure all members of the team understand their roles, feel free to participate fully, and are empowered to achieve to the best of their abilities. There are innumerable management theories and practices that might be suggested to accomplish this.

The value of Yuan and Rosen’s study is that it helps to distil the essence of what is really required for effective team leadership in this context.

Source: https://carey.jhu.edu/articles/leadership-lessons-multidisciplinary-teams-healthcare

PREEMIE FAMILY PARTNERS

New insights into brain and behavior development:

Recent research provides new insights into significant brain and behavioral changes in the baby’s first six months after birth, laying a foundation for later physical, cognitive, and social development. Preparation in utero leads to infant behavioral responses that ensure survival, and the caregiving environment provides safety and protection during these early months.  Brain development accelerates, and regulation of biophysiology is demonstrated in respiratory, cardiovascular, and gastrointestinal systems, as well as in behavior.

Newborns and young infants often exhibit behaviors that signal caregivers to provide protective and nurturing responses.  Caregivers, usually the baby’s parents, typically respond to the baby’s signaling. Mutual reinforcement of behavior leads to the dyad becoming adapted and regulated in early infancy. Mismatches in the baby’s explicit behavioral signaling and/or challenges in the caregiver’s reading and/or responding to the baby’s behavior in these early formative months can affect later social, emotional, and cognitive development.

Signaling behavior:

Signaling behaviors such as crying, vocalizations, alertness, and face scanning prompt interaction with others. Crying signals distress and is likely to promote immediate caregiver response. Facial expressions, such as smiling, brow knitting, and pouting, often elicit an emotional response from the baby’s caregiver. The resulting dyadic exchanges promote ongoing social interaction. As brain development proceeds at a rapid pace, the transition from reflexive to volitional behaviors typically occurs around 2-4 months. These more intentional behaviors lead to more sophisticated behavioral repertoires and social bids.

The responsive caregiving environment and mutual interaction between caregivers and their baby during this time contribute to the development of increasingly regulated behavior. Caregivers of newborn and very young infants need support to understand babies’ available signaling behaviors, as these behaviors have a significant impact not only on early caregiving relationships but also on brain development.

Signaling behavior of hospitalized babies:

Early-born or sick newborns are at a disadvantage in the development of signaling behavior. Their experience as a fetus and during delivery can interfere with the development of or overwhelm effective behavioral communication. Early-born babies have not had experiences during the last weeks of their fetal life that contribute to more organized behavioral responses. Their reflexes may be weak or hard to elicit, arousal and visual regard may be limited, and physiologic instability may affect responsiveness. Necessary medical support may also overwhelm their meager energy and/or fail to recognize their efforts to signal.

In addition to early birth and/or medical concerns, the caregiving environment in intensive care is vastly different from the “expected” one for a more typically developing baby and can thus affect foundational brain and behavioral development.  It is well known that long-term effects on brain development, social/emotional, and cognitive development in babies hospitalized at birth are recognized as less than optimal. Early birth, medical issues, and hospitalization can interfere not only with a baby’s ability to provide clear signals but also with caregivers’ ability to interpret them.

 Intensive care professionals are typically trained in medical assessment and intervention, which until recently have not included behavioral assessment. Berry Brazelton was a pediatrician who took the lead in understanding the behavioral repertoire of newborn babies. Heidelise Als, one of his protégés, extended that understanding to babies born early. She developed the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) and emphasized observing and interpreting babies’ behavior. Based on those assessments, caregiving recommendations are developed to help the baby achieve regulated behavior and thus achieve their own developmental goals. Since her early work, most NICUs now incorporate identification of at least some behavioral signals and implement strategies to support babies’ development.

IFCDC standards provide a foundation for supporting signaling behavior:

At the center of the IFCDC standards concept model is an emphasis on the baby as an interactor in their relationship with their primary caregiver, typically the mother. Woven into each of the other principles is the understanding that the baby influences how they are cared for both by family members and by intensive care professionals. The model implies that the baby’s individualized interaction with the environment of care influences their physical, social, emotional, and cognitive development.

Each of the six evidence-based areas of developmental care emphasizes the importance of understanding the baby’s behavioral communication to fashion an individualized approach to their caregiving experience. Additionally, each of the six areas includes an emphasis on supporting the baby’s primary caregivers, typically the parents, to observe, interpret, and respond to the baby’s behavioral signals. Early-born and medically fragile babies’ signals can be challenging to interpret. Professional staff must have a thorough understanding of the baby’s signaling behavior to provide individualized caregiving and support parents in knowing how best to care for their baby.

The continuum after discharge:

The continuum after discharge: Leaving intensive care marks a transition into early infancy and involves a multitude of brain and behavioral changes. During these foundational months, rapid brain development is reflected in significant behavioral changes. As noted above, reflexes become modified into volitional events, and signaling behaviors become dependent on the baby’s environment of care. As the medically fragile or early-born baby becomes more physiologically and behaviorally regulated, their signaling becomes more socially responsive.

The primary caregiver, on the other hand, may still be affected by the intensive care experience and be hesitant to interact with their previously fragile baby vigorously. It is postulated that as the baby becomes clearer in their communication, more intentional, and ready to interact, the parent can be less responsive to their bids.

Although targeted interventions for caregivers in their early relationships with their baby begin in the NICU, they must be continued after discharge, as behavioral changes in the first months are rapid, and it is often difficult to understand how best to respond.

Caregivers’ understanding of their baby’s signaling behavior as it changes over time must be supported and reinforced by knowledgeable professionals for at least the first six months of the baby’s corrected age, and sometimes longer, depending on the baby’s adaptation during this period. As brain and behavior, as well as parenting skills, are still developing, individualized dyadic care should be provided early and frequently after discharge and should continue for at least six months.

Conclusion:

The continuum of brain and behavior development from the fetal to the newborn to the early infancy period evolves in the context of the baby’s environment of care. The behavior the baby uses to signal their need for caregiving changes dramatically over the first six months, and caregiving responses that regulate the baby’s behavior lay the foundation for later physical, cognitive, and social emotional development. Babies born preterm or medically fragile are typically less effective in their signaling behavior. Due to the altered environment in which they develop and the myriad factors that influence their parents’ responsiveness to their behavior, they and their parents need supportive measures to assess, interpret, and provide support for early development. The current IFCDC standards incorporate supportive strategies into both the concept model and the evidence-based practice areas. Because brain and behavior are particularly vulnerable during the first six months, there is a need not only to understand and respond to their behavior in intensive care but also to continue this understanding and response after discharge for at least the first six months.

Source: https://neonatologytoday.net/newsletters/nt-jan26.pdf

Breastfeeding a premature baby requires special care, patience, and close monitoring—especially during the transition from tube or bottle feeding to the breast. In this hospital-based guide, a healthcare professional demonstrates how to safely breastfeed a growing preterm infant while ensuring adequate milk intake.

This video explains how pre- and post-feeding weight checks are used to accurately measure how much milk a premature baby consumes. You’ll learn correct breastfeeding positions, how to maintain proper body alignment, and how to achieve a deep, effective latch. The guide also helps parents distinguish between nutritive sucking and comfort sucking, recognize early signs of fatigue or stress, and follow essential safety protocols such as monitoring breathing patterns and proper burping techniques.

Ideal for parents of premature babies and NICU families, this video supports confident, safe breastfeeding during a critical stage of infant development.

INNOVATIONS

“In the 1960s, when the first NICUs opened, premature infants had a 95% chance of dying. Today, they have a 95% chance of survival” – Dr. Rahul K. Parikh, a pediatrician from California, published in August 2012 in the New York Times . This incredible shift in survival can be considered a great example of the conquest of modern neonatal medicine. Among many technological advancements, the ability to continuously monitor vital signs such as heart rate and respiratory rate, was followed by closed loop body temperature (T) control, blood pressure assessment, and finally by continuous and non-invasive monitoring of oxygen saturation. Monitoring of these vital signs was paramount for the assessment of well-being and detection of pathophysiological states in tiny patients, allowing for adjustments or initiation of treatments or interventions that are lifesaving.

There is no question that neonatal technology has advanced tremendously over the last 60 years and parents have become very approving of this. In the book From Surviving to Thriving, Fabiana Bacchini, the mother of a twin baby boy born at 27 weeks, wrote: “I was able to watch in happiness and gratitude, all the technology that exists to keep these tiny beings alive.” Later, it also became clear that, despite the important role of technology, it can also cause fear and anxiety for parents. Fabiana mentioned that the first time she entered the NICU “I did not see a baby, I saw wires, monitors and a breathing machine” .

Indeed, current technology for vital signs monitoring uses several skin sensors connected to the bedside monitors by wires and cables. In most patients, raw signals, average values and trends of heart rate, respiratory rate, temperature, and oxygen saturation are continuously displayed. However, this system carries some challenges for patients, parents, and healthcare professionals (HCP) as the multiple wires can tangle around the infant body, restrict the patient’s movement, and cause discomfort or pressure sore. Hence, regular care involves frequent removal, reapplication, and readjustments of the sensors, which may harm the fragile neonatal skin, cause pain, and/or interrupt resting or sleeping. For parents, not much information is available on what are their perspectives on these vital signs monitoring systems. Some small surveys have reported that the presence of multiple wires and cables can cause intimidation and additional stress, acting as a barrier to skin-to-skin contact for fear of disconnecting the sensors or wires, or interfering with regular monitoring . This technology may also increase HCP’s workload as wires and cables may touch contaminated surfaces or become soiled with urine, blood or stools, increasing the risks of nosocomial infections. Consequently, nurses must constantly inspect, sanitize, reposition, or replace components of the system.

Is a Wireless NICU Possible?

Neonatal intensive care units manage a diversity of health problems with variable degrees of severity and patient maturation. To develop a wireless system that can be used during the first days of life in a 400 g extremely preterm infant born at 22–23 weeks of gestation and a 4-kilo term infant born with perinatal asphyxia is a real challenge. Furthermore, there are some more stable infants that are just feeding and growing, or infants with chronic problems that require prolonged hospitalizations. Noticeably, the needs of these populations are different, creating challenges for the development of new vital signs monitoring systems. As an example, an extremely preterm infant in the first days of life spends most of the time quiet, sleeping inside the incubator, and has very sensitive skin that can easily be damaged by skin adhesives and sensors. In these cases, non-contact technologies may play a very important role, at least for the monitoring of heart rate and respiratory rate. This is not the case with more stable and mature infants that are active, and where parents can constantly hold and promote kangaroo care (KC). Therefore, the adoption of new monitoring technologies needs to consider those different needs, be very familiar with the technology advantages and limitations, and develop protocols and proper training for all healthcare providers involved.

Is a Wireless NICU Desirable?

Although wired vital sign monitors are the standard, they are frequently cited as obstacles to key aspects of family-integrated care and routine clinical practice. Wireless vital sign monitoring technologies are increasingly being explored as a potential solution to these issues. However, there is limited research available which quantitatively or qualitatively examines how key NICU stakeholders such as parents and HCPs, perceive the current monitoring system and these wireless innovations.

The small number of existing studies have highlighted that the wires and sensors used in current systems interfere with skin-to-skin contact and KC, limit parents’ ability to hold or touch their infants, and contribute to a highly technical environment that many find overwhelming. Survey and interview studies consistently show that parents perceive the wires as intimidating and as contributing to their anxiety . HCPs also express widespread concerns with the current systems, especially regarding the physical clutter created by wires, challenges with positioning and handling of infants, risk of pressure sores from adhesives, and the frequency of false alarms .

These concerns have led to growing interest in wireless monitoring as a possible solution. While research on parent and HCP in this area is very limited, all existing studies show optimism toward the adoption of wireless technology. Parents have generally responded positively, citing benefits such as reduced anxiety, possible easier interaction with their infant, improved KC, and enhanced infant comfort. However, there are some apprehensions related to signal reliability, sensor size and appearance, battery duration, and potential risks such as radiation exposure . Similarly, HCPs have voiced strong support for wireless monitoring, highlighting its potential to reduce handling difficulties, decrease false alarms, and improve comfort for both infants and families . Importantly, they also emphasize areas of concern, including reliability, safety related to radiation, and costs . In particular, the absence of economic feasibility studies is a significant gap in the current literature.

Overall, the available evidence indicates that wireless monitoring is a promising advancement, with support from key stakeholder groups in the NICU. The shift away from wired systems could improve key aspects of neonatal care, particularly KC and parental engagement, while also addressing some of the frustrations voiced by HCPs. However, to address these challenges, and ensure new technologies will be adopted by NICU staff and parents, concerns around reliability, safety, and cost must be addressed through careful user-centered design, and rigorous research including clinical evaluation. Future research should prioritize that wireless systems not only meet regulatory and clinical standards but are also feasible and acceptable for daily use in the NICU.

What Wireless Technology for Neonatal Vital Signs Monitoring Is Available or Emerging?

Non-Contact

A large number of small studies have investigated the use of non-contact vital sign monitoring in the NICU. Most studies used a single-device system and monitored respiratory or heart rate using offline analysis. The following technologies have been tested: red, green, blue cameras, infrared cameras, monochrome cameras, depth cameras, and radar, primarily for respiratory rate and heart rate monitoring . Non-contact sensors are typically placed at the head or foot of the infant’s incubator or crib. In some cases, the sensor cannot collect data through the plexiglass and may require either an open incubator or a small opening to maintain a clear line of sight. Depending on the technology and algorithms used, a defined Region of Interest within the sensor’s visual field may be designated for vital sign extraction.

These studies generally featured small sample sizes and short recording durations of <1 h . Nearly all exclusively focused on accuracy by comparing novel non-contact methods to a reference measurement using the Bland-Altman method. Analyses of heart rate and respiratory rate using this method revealed low bias and moderately acceptable 95% limits of agreement. Feasibility outcomes were rarely explored and measured using metrics such as the amount of usable data or processing times. No studies explored outcomes related to safety, although this can be expected as these monitoring methods pose no threat to the fragile neonatal skin.

While these technologies show promising preliminary results, several concerns remain. First, feasibility concerns remain as most devices rely on an uninterrupted clear view of the infant. How it would perform in situations where the infant is moving, clothed, or receiving care needs to be better clarified. Additionally, a systematic review of non-contact technologies applied the QUADAS-2 assessment and revealed several areas of concerns regarding risk of bias and applicability due to lack of clear inclusion and exclusion criteria and small sample sizes . Furthermore, many studies lacked key basic descriptors of the population, such as age and weight, making it difficult to ensure a representative range of NICU patients such as those requiring respiratory support or in incubators were included in the research. Additionally, some studies provided incomplete descriptions of reference measurements, only naming them as “standard” or “routine” monitoring, limiting the ability to determine the risk of bias. Unfortunately, most non-contact studies lack a conflict-of interest statement.

Ultimately, non-contact technologies may represent an appealing monitoring solution for some of the most vulnerable infants in the NICU, such as extremely premature infants with extremely fragile skin. This research area is rapidly growing as non-contact studies often utilize commercially available cameras and present low research risks for patients. However, concerns regarding the ability to perform reliably for prolonged periods in a real NICU environment and across a range of patients require further exploration and validation.

Wireless Wearables

Studies focusing on wearable devices provide slightly more detailed information regarding participant selection criteria and larger sample sizes. Emerging classes of wireless sensors in the form of soft, flexible, skin-like (“epidermal”) platforms have the potential to redefine practices for monitoring in the NICU, with additional possibilities for use in the home. Recent work at Northwestern University shows that a pair of devices of this type, each of which gently and non-invasively adheres to the fragile skin of a premature neonate, is capable of capturing complete, clinical grade vital signs information without any wires or cables . These devices include distributed flexible electronic components with stretchable interconnects; all embedded in strategic layouts within medical-grade silicone encapsulating structures. The designs optimize for conformal interfaces to the skin at relevant anatomical locations. In pilot studies on patients in NICU settings, these technologies achieved high accuracy and fidelity similar to those of traditional wired monitors. Extensions enabled by additional sensors allow for precise measurements of body sounds, relevant to cardiac and respiratory monitoring, with additional capabilities in tracking gastrointestinal activity . Specifically, high-bandwidth microphones and accelerometers yield seismocardiograms, lung sounds, bowel motility, and even the spectral and temporal features of crying and other forms of vocalization. In this way, these advanced technologies can not only capture vital signs and physiological signals but also an array of important biophysical metrics of health status, beyond those addressed with conventional NICU hardware.

Commercial translation is also gaining momentum. As an example, Sibel Health (Sibel Health, USA) has secured successive FDA 510(k) clearances since 2021 for its ANNE® One sensor platform, a pair of chest and foot patches to continuously monitor heart rate, respiratory rate, skin and core temperatures, oxygen saturation and biomarkers. It is also noteworthy that ANNE One® is currently under investigation in NICU at Montreal Children’s Hospital with the aim of create a wireless NICU. Meanwhile, other emerging technologies, focusing on more specific modalities, include Bambi Belt (Bambi Medical, the Netherlands) and Boppli® (PyrAmes, USA) for monitoring ECG/EMG and blood pressure, respectively.

Collectively, efforts with wireless technologies signal a paradigm shift to transform neonatal care with fewer risks and burdens, and to improve clinical workflow and patient safety. With continued refinement and real-world validation, wireless multimodal sensors are poised to enhance monitoring precision, promote a patient-centric environment, and ultimately give our most vulnerable patients a gentler start to life . With that, a wireless NICU became a much closer to reality than just fiction.

Source: https://karger.com/neo/article/122/5/635/931098/A-Wireless-Neonatal-Intensive-Care-Unit-Fiction-or

Abstract

Background

Vaginal cervical cerclage and progesterone are established treatments for prevention of pregnancy loss and prematurity. There is limited data to assess the effect of these treatments in combination. The objective of this study was to investigate the association between progesterone and no progesterone treatment on pregnancy outcomes in women at high risk of preterm birth who had received a vaginal cervical cerclage.

Methods and findings

This is a secondary post-hoc analysis of women recruited to the C-STICH randomised controlled trial, which recruited in 75 obstetric units in the UK between 2015 and 2021. In the C-STICH trial, women with a singleton pregnancy, receiving a vaginal cervical cerclage due to a history of pregnancy loss or premature birth, or if indicated by ultrasound, were randomised to cerclage with braided or monofilament suture, with a primary outcome of pregnancy loss, defined as miscarriage, stillbirth, or neonatal death in the first week of life. In this secondary analysis, the primary outcome was pregnancy loss, defined as miscarriage and perinatal mortality, including any stillbirth or neonatal death in the first week of life. Secondary maternal outcomes included miscarriage and previable neonatal death; stillbirth; gestational age at delivery; preterm pre labour rupture of membranes, and sepsis. Secondary neonatal outcomes included early/late neonatal death and sepsis. For each outcome, regression models were fitted adjusting for prespecified prognostic variables.

From the 2,048 women recruited to C-STICH, 1943 (95%) women had a vaginal cerclage placed and available progesterone data. Of these, 834 (43%) women received progesterone and 1,109 (57%) did not receive progesterone. In women with primary outcome data available, in our predefined analysis pregnancy loss occurred in 49 (5.9%) of 832 women who received progesterone and 91 (8.3%) of 1,103 women who did not receive progesterone (adjusted* risk ratio 0.70 (95% confidence interval (CI) [0.50, 0.99]); adjusted risk difference −0.02 (95% CI [−0.04, −0.001], *adjusted for indication, obstetric history, surgical technique, and maternal age). Further exploratory analysis excluding women who had termination of pregnancy for foetal anomaly demonstrated a nonsignificant reduction in the risk of pregnancy loss. Key limitations of this study include a non-randomized trial design and unknown confounding relating to variation in progesterone use.

Conclusion

In women with a vaginal cervical cerclage and concomitant progesterone there appears to be an association with a reduced risk of pregnancy loss. This combination therapy may be an important opportunity to further reduce the risk of pregnancy loss in this high-risk cohort.

Source:https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004513

First Responders

Stronger Together: Building Friendship, Community, and Courage as Neonatal Womb Warriors

Building friendships is one of the most powerful ways we grow as Neonatal Womb Warriors. As preemie survivors, we begin life in a world of uncertainty, strength, and resilience that most people never experience. That journey can sometimes feel isolating—but it doesn’t have to be. When we build friendships with peers, colleagues, and our broader community, we create spaces where our stories are understood, our challenges are validated, and our victories are celebrated. These connections remind us that we are not alone—we are part of a network of survivors, supporters, and advocates who stand together.

Friendship also teaches us how to trust again—trust in others, and trust in ourselves. Many preemie survivors grow up navigating medical complexities, transitions, and moments of vulnerability. Through friendships, we learn how to communicate our needs, listen to others, and build mutual support systems. Whether it’s a colleague who understands the importance of flexibility, a friend who encourages us during a difficult moment, or a mentor who helps us see our potential, these relationships become pillars of strength. They help transform survival into thriving.

Stepping outside of our comfort zone is often where the most meaningful connections begin. It can feel intimidating to introduce yourself, to join a new group, or to share your story—but courage lives in those small steps. For Neonatal Womb Warriors, getting out of our comfort zone is not just about social growth; it’s about reclaiming our voice and our place in the world. Each time we reach out, collaborate, or say yes to a new opportunity, we expand what is possible for ourselves and for others who may be watching and learning from our example.

At its heart, friendship is teamwork. It is showing up for one another, lifting each other up, and building something stronger together than we could alone. As a community of preemie survivors, families, clinicians, and advocates, we are all part of a shared mission: to help every warrior survive, grow, and thrive. When we lean into friendship and community, we build not only support systems, but movements of compassion, advocacy, and hope. And that is the true strength of a Neonatal Womb Warrior.

Enlighten  Presence  mHealth

Uruguay, officially the Oriental Republic of Uruguay, is a country in South America. It shares borders with Argentina to its west and southwest and Brazil to its north and northeast, while bordering the Río de la Plata to the south and the Atlantic Ocean to the southeast. It is part of the Southern Cone region of South America. Uruguay covers an area of approximately 176,215 square kilometers (68,037 sq mi). It has a population of almost 3.5 million people, of whom nearly 2 million live in the metropolitan area of its capital and largest city, Montevideo.

Uruguay is highly ranked in international measurements of democracy, government transparency, economic freedom, social progress, income equality, per capita income, innovation, and infrastructure.  It is classified as a high-income economy and has fully legalized cannabis—the first country in the world to do so—as well as same-sex  marriage, abortion and euthanasia. Uruguay is also a founding member of the United Nations, the OAS, and Mercosur.

The current Uruguayan healthcare system is the State Health Services Administration (ASSE) created in 1987. The National Healthcare Fund (FONASA) is the financial entity responsible for collecting, managing and distributing the money that the state has destined for health in the country. It was created in 2007 to entitle all employees and pensioners to health care outside of the public health system. Latest government figures state that there are 2.5 million people registered with Fonasa – out of a total population of just over 3 million. This would mean that 500,000 Uruguayans are left choosing between the public system or having to pay the full amount for private health care.

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

COMMUNITY

Much has been written about medical errors that reach patients.  Almost without exception, these accounts focus on tragic outcomes, cases in which patients suffer harm or die as a result of mistakes in diagnosis, treatment, or communication. Entire fields of research, safety initiatives, reporting systems, and regulatory frameworks have been developed in response. By framing medical error as a systems problem rather than an individual failing, health care has sought to encourage transparency, promote reporting, and ultimately reduce preventable harm. This approach is necessary, ethical, and long overdue.

Nevertheless, another category of medical error receives little attention in the literature or in public discourse. It is an uncomfortable and largely unspoken phenomenon: errors that reach patients and, paradoxically, improve their clinical course.

These events are rarely documented, formally reported, or analyzed. They tend to live in the realm of anecdote, shared quietly in hallways or over coffee, often accompanied by discomfort or nervous humor. A test ordered on the wrong patient reveals a life-threatening condition that would otherwise have gone undetected. An unintended medication change exposes a diagnosis sooner than expected. A deviation from standard practice uncovers a better therapeutic pathway. There is no research into these “random” improvements. These occurrences are typically dismissed as luck, coincidence, or, for some, providence.

Occasionally, they are more than that. Medical history itself is replete with discoveries born of accident. Penicillin was not discovered through a carefully designed protocol but through contamination. Countless diagnostic insights have emerged from unexpected findings. While these events do not excuse error, they complicate the narrative that all deviations from protocol are uniformly harmful.

This raises an unsettling question: Is all medical error inherently detrimental to patient care?

From the standpoint of risk management and patient safety, the answer must be yes. No health care institution would, or should, endorse error as a tool for discovery. Indeed, no clinician has ever been sued for failing to make a mistake, although many have been sued for making one. The legal, ethical, and professional imperatives are clear. Errors must be minimized, reported, and prevented.

However, the practice of medicine is not merely the execution of flawless protocols. It is a human endeavor, characterized by uncertainty, variation, and judgment, which some would call the “practice” of medicine. If medical care were delivered without any deviation, without experimentation, adaptation, or learning from the unexpected, would we consider that the “perfection” of medicine, or its stagnation?

Consider the randomized clinical trial, the “gold” standard of medical evidence. By design, half of the participants receive a therapy that ultimately proves inferior. When the superior arm emerges, we do not label the inferior treatment a medical error, nor do we report it to risk management. Instead, we publish the findings, celebrate the advance, and change practice accordingly. Progress is achieved precisely because uncertainty was permitted within ethical boundaries.

Honestly, though, the best path may not be through completing the trial but through interim analysis or using alternative research strategies such as “play the winner.” In seeking strategies that optimize good science rather than patient outcomes, we may find ourselves stuck promulgating only treatment modalities that have been completed and accepted for publication. Moreover, negative studies are usually not accepted for publication. In this context, error and expertise begin to blur. What is considered a mistake today may, in retrospect, be recognized as the first step toward tomorrow’s innovation. This does not absolve clinicians or systems of responsibility, nor does it diminish the real harm caused by preventable errors. (1, 2) Instead, it challenges us to acknowledge that medicine advances not only through precision but also through humility, recognizing that our current standards are provisional and that learning often emerges from imperfection.

The task, then, is not to romanticize error, but to understand it more honestly. Error, like medical expertise, may ultimately lie in the eye of the beholder. What is labeled a mistake in one era may later be understood as the necessary precursor to discovery, refinement, or progress. This reality does not weaken the moral obligation to protect patients from harm, nor does it excuse preventable failures in care. Instead, it underscores the complexity of practicing medicine in a world of uncertainty, evolving evidence, and imperfect knowledge.

The challenge for modern medicine is to uphold the highest standards of safety and accountability while preserving the intellectual flexibility that allows clinicians and scientists to question assumptions, recognize unexpected patterns, and learn from outcomes that diverge from expectations. Only by balancing vigilance with curiosity can the field continue to evolve in ways that serve both current patients and future generations.

Source: https://www.neonatologytoday.net/newsletters/nt-dec25.pdf

Abstract

Objective

To assess the effectiveness of an mHealth neonatal intensive care unit (NICU) parent support smartphone application to improve psychosocial well-being, specifically reduced stress and anxiety, increased parenting competence, and improved social support among a diverse group of parents with infants born preterm in 3 Chicago-area NICUs.

Study design

A time-lapsed, quasiexperimental design in which control participants were enrolled and then intervention participants enrolled. Data collection occurred at 3 timepoints: NICU admission (AD), discharge (DC), and 30 days post-DC (DC+30). Validated outcome measures included parenting sense of competence, stress, anxiety, and social support.

Results

Intention-to-treat analyses included 400 participants (156 intervention; 244 control). After covariate adjustment, a significant increase in parenting sense of competence (AD–DC, DC+30), decrease in stress (AD–DC+30), decrease in anxiety (AD–DC, DC+30), and increase in social support (AD–DC) were noted but did not differ by study arm. However, secondary analysis of parents with infants born at <32 weeks of gestational age (156 participants) showed decrease in stress (AD–DC+30) that was greater in intervention vs control group (P = .03). Among intervention participants who were Black, a significant increase in social support (AD–DC) total score (P = .01), and 2 subscales of emotional/informational support (P = .02) and positive social interaction (P = .02) were found.

Conclusions

This novel mHealth intervention shows evidence of reduced stress and anxiety while increasing social support among some subsets of parents at high risk of negative psychosocial experiences in the NICU, potentially enhancing outcomes for infants born preterm by ensuring that parents are less stressed and better supported.

Source:https://pubmed.ncbi.nlm.nih.gov/39880156/

Background: The need for paternal support is rarely addressed in neonatal intensive care units (NICUs). Neonatal nurses often primarily focus on the needs of the mother and infant and may not be trained in support of fathers.

Purpose: To investigate nurses’ self-efficacy (SE) in guiding and supporting fathers after implementing a father-friendly NICU.

Methods: Nurses from the intervention NICU and 13 control NICUs were included in a before-and-after intervention study. Questionnaires measuring nurses’ SE regarding support of fathers and mothers were obtained when starting the development process, before and 18 months after the implementation. The primary outcome was the difference between nurses’ SE scores for father and mother questions in the intervention group compared with the control group.

Results: In total, 294, 330, and 288 nurses responded to the first, second, and third questionnaires, respectively. From the first to third questionnaires, the intervention group showed a significantly higher increase in SE scores for father questions compared with the control group (0.53 vs 0.20, P = .005) and a nonsignificantly higher increase for mother questions (0.30 vs 0.09, P = .13). In the third questionnaire, the intervention group showed a higher SE score for father questions compared with the control group (9.02 vs 8.45, P = .002) and the first questionnaire (9.02 vs 8.49, P = .02).

Implications for practice and research: By implementing a father-friendly NICU, nurses’ SE for providing support to fathers increased significantly. Training in a father-friendly approach increases nurses’ ability to support both parents. Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the National Association of Neonatal Nurses.

Source: https://pubmed.ncbi.nlm.nih.gov/37463518/

Every situation is different, every mother and every family are different, and what ‘works’ for some parents may not work for others. Don’t pre-judge or assume. No one can be prescriptive about what to say or do, but here were some phrases and behaviors we heard about that were typically either helpful or not helpful.

Phrases that were un-helpful

  • At least you still have one
  • You can try again (for another pregnancy)
  • It wasn’t meant to be
  • Maybe you weren’t ready; maybe [twin’s name] wasn’t ready
  • Why don’t you stop thinking about or forget about [twin’s name] and just focus on the other twin?
  • You’ll get over it
  • You’ll soon get over it
  • I know what you going through (unless of course, you have been in a very similar situation)
  • You need to talk about it (this is very different to saying ‘would you like to talk about it’ or ‘do you want to tell me when it would help to talk’)

Behaviors that weren’t helpful

  • Not talking about the twin because you are worried about upsetting the parents
  • Not calling the twin by their name (if they had one) or forgetting their name
  • Not recognizing the twin identity (trying to behave as if it was a singleton pregnancy)
  • Staying away, not ringing or messaging, because you felt uncomfortable (any discomfort you feel is insignificant compared to the parents’ grief)
  • Trying to focus on, or just talk about, the surviving baby or babies
  • Where a triplet dies, suggesting that the two surviving babies are ‘only twins’ (although some parents told us they wanted to think of the surviving babies as twins, typically where the triplet loss was quite early in pregnancy). If you are not sure, ask the parents.
  • Not saying anything because you don’t know what to say (sometimes saying ‘I am really sorry, I don’t know what to say’ is enough)
  • Discarding any mementos from the baby who died – photos, cot cards, name tags, blankets & clothes (however dirty, do NOT wash them without asking parents), items bought for the baby before they were born e.g. clothes

Phrases that were often helpful

  • I’m really sorry, do you want to talk about it?
  • I’m sorry
  • Do you want to tell me when it would help you to talk about her or him? (even better to use the baby’s name)
  • Is there anything I can do to help?

Behaviors that were often helpful

  • Talking about the twin by name
  • Asking if you can say hello and goodbye to the baby who died
  • Helping make memories, collect mementos
  • Taking and keeping photos (with parents permission)
  • Offering to help with ‘household’ chores – parents of babies on NICU struggle to do routine tasks – walk the dog, go shopping etc. However, be careful not to ‘smother’ families or remove their family identity/role
  • Offering to help with other siblings
  • Offering to tell other family members or friends what has happened. However, always ask parents first what they would like.

The grief and sadness that parents feel will stay with them for months and years, often their whole life. Offering to talk months or years later about their grief, or talking about the baby who died by name is appreciated by most parents. If they are a close friend, or family, and you do not know what they would like, ask them!

Source: https://www.neonatalbutterflyproject.org/resources/

HEALTHCARE PARTNERS

My name is Marília Rêgo, and I’m an occupational therapist working in the neonatal intensive care unit (NICU) of a public hospital in Recife, Brazil. Every day, I have the privilege—and the responsibility—of accompanying premature babies and their families through some of the most fragile and formative moments of their lives.

Among all the babies I’ve cared for, there is one who left a lasting mark on me. She was born with a rare syndrome, incredibly delicate, and spent two months in the NICU. During that time, our bond was built not through dramatic interventions, but through the quiet power of presence. I would often go to her bedside just to change her diaper slowly, calmly—so that she could have a positive experience of touch and human connection, even in the middle of so many wires and monitors.

There were days when there was no specific therapeutic plan for her. And still, I showed up. Because sometimes the most powerful thing we can offer is our presence, our gentleness, our intention.

And then, one day, she passed away.

Even though she had received every professional care possible—medical support, therapies, loving attention—that loss hurt deeply. But it also revealed something profound to me: that our work in neonatal care is not only about helping babies recover or thrive. It’s also about loving them fully, even when there are no guarantees. It’s about being a bridge, even when the road is short.

Her story changed me. It reminded me that care isn’t measured only in days of life, but in the love and intention that fill those days. That sometimes, a baby’s mission is brief—but never meaningless. And that if there is love, there is purpose.

I’m sharing this not to romanticize pain, but to honor the truth that sometimes, it teaches us the most. If you are a parent, a caregiver, or a healthcare professional reading this—what you do matters. Even when it feels small. Even when it ends sooner than you hoped.

Your presence matters. And that, in itself, is a form of healing.–Marília Rêgo

Source: https://nidcap.org/

THE BASICS

Key points

  • Brief interactions in the NICU can have an impact on caregivers’ self-efficacy and bonding with their newborn.
  • It’s important to train healthcare professionals to actively listen, use nonverbal gestures, and empathize.
  • Comforting and compassionate patient-provider interactions may be the most healing interventions for family.

For parents and family caregivers, navigating a child’s medical condition can be the most stressful of life experiences. When a child begins their life in the Neonatal Intensive Care Unit (NICU), caregivers are often catapulted into feelings of uncertainty, fear, and powerlessness. No one anticipates that having a new baby will involve being in a hospital indefinitely relying on physicians and nurses for lifesaving care. Sensitive and compassionate parent-provider interactions are critical for parents to develop feelings of safety, trust, and hope during this overwhelming period.

Even brief interactions at the NICU bedside may make or break a caregiver’s sense of self-efficacy and confidence in caring for their babies (Labrie et al., 2021). A 2021 meta-analysis by Labrie and colleagues revealed that these frequent moments with providers have far-reaching impacts on parents’ coping ability, their understanding of their baby’s condition, their participation and satisfaction with care, and their ability to attach to and bond with their newborn. Most importantly, these effects were often related to routine bedside interactions – not solely to structured conversations at family conferences.

Personal experiences

The authors are both psychologists who have worked in medically complex settings with patients across the lifespan. The perspectives and tips are based on working with patients experiencing unexpected medical adversity as well as personal experience.

Joanna: Six years ago, my son spent the first month of his life in the NICU following an unexpected birth trauma, leading to a sudden loss of blood and oxygen. Waiting for medical updates felt unbearable. It was as though the MRI machine and medical team held the key to our family’s future. Emotions fluctuated like a rollercoaster from shock and numbness, to anxiety, anger, grief, and – eventually – hope.

Occasionally, in an effort to manage our expectations, health care team members reminded my husband and me of how “medically fragile” our son was at birth. These “warnings” tended to overshadow positive news and made me question my gut sense that our baby would get well. I preferred updates on even the smallest steps our son made: hearing that he moved his tongue slightly when given a drop of breastmilk felt uplifting.

Simple, previously taken-for-granted events were deeply felt on a visceral level. When the elevator was out of order and the physician walked me up the stairs from the NICU to my own hospital floor, his support and kindness deepened the level of trust in the entire treatment team. My obstetrician standing patiently and quietly beside me at our son’s NICU crib provided immense comfort. Oftentimes, silence, presence, and accompaniment are the most healing interventions.

No matter how much time has passed, these patient-provider verbal and nonverbal communications remain imprinted in the memories of NICU parents and caregivers.

Bedside manner

“Bedside manner” has long been held as an important virtue of effective medical care. Ancient Greek writing urged providers to be “sober, not a winebibber” and to act “not with head thrown back (arrogantly).”

Teachings have evolved over time and have been incorporated into medical school education. Despite this development, issues of time, financial pressures, and the complexity and urgency of medical needs due to advances in technology may interfere with effective patient-provider communication.

Current healthcare education highlights the importance of listening to the entire message or question from the patient or family caregiver without interruption, showing genuine interest through nonverbal gestures including tone of voice, using understandable, non-jargon language, providing comfort, and putting oneself in the patient’s shoes to cultivate empathy (Deepak, 2024).

Examples of unhelpful vs. helpful communication

Unhelpful

  • Opening with, “I have some bad news,” which can lead to catastrophic thinking
  • Using jargon such as “We need to do a needle stick,” which can evoke an upsetting image
  • Describing the situation as “very severe,” even if true

Helpful

If appropriate, starting with, “Your baby is okay, but I wanted to share that…”

Using accurate language such as “We need to draw some blood.”

Using specifics like, “The blood transfusion is helping your baby with the blood loss,” provides a degree of hope, even in dire times

Tips for fostering effective communication in the NICU

These tips apply to communication with mothers, fathers, other caregivers, and integral supports. Including all caregivers in communications can help ensure the whole family feels seen and acknowledged as important to the baby’s care.

Medical professionals can optimize communication and bedside manner by:

  • Validating that what caregivers are experiencing is scary and difficult.
  • Using comforting nonverbal communication: sitting down, giving full attention and listening deeply to the family’s concerns and questions, and using a calming, reassuring touch when appropriate.
  • Letting family members know that providers are available and how to reach them.
  • Acknowledging that uncertainty exists while also expressing specific efforts to make things better.

Family and friends can further enhance a sense of support by:

  • Listening without offering advice. It is natural to want to lighten the mood or “fix” a problem. However, active listening and acknowledging how things are may be what the caregiver needs.
  • Checking in after the baby leaves the hospital. Support may be strong at the beginning but tends to taper. However, parents may struggle with the adjustment to life after the NICU.

Psychology providers working with caregivers in the NICU can help by:

  • Collaborating to make a list of questions or script in advance of medical appointments to ensure that concerns are addressed.

In navigating these challenging encounters with the medical team, caregivers can utilize the following communication strategies:

  • Taking initiative in asking specific questions to convey self-efficacy and active hope.
  • Making time to interact with their partner or other supports outside the hospital setting. Separation from the NICU and having conversations about other topics is a healthy way to cope.
  •  

Lessons learned

Just as parents/caregivers need to be highly attuned to subtle cues to develop secure attachments to their babies, the suggested communication tips highlight the importance of nonverbal communication. Voice tone, posture, eye contact, deep listening, and presence foster feelings of security and agency in the receiver.

As a psychologist who ended up on the receiving end of care, my own patients’ stories now resonate more deeply. Beyond what I could possibly learn in graduate school, the personal experience has informed the clinical wisdom of sitting calmly, presently, holding space for patients to discover their unformulated feelings, and being human to whatever emerges. I choose my words carefully – for they may never be forgotten.

Source: https://www.psychologytoday.com/us/blog/psychological-trauma-coping-and-resilience/202409/creating-effective-parent-provider

Abstract:

The environment in the neonatal intensive care unit (NICU) is often unpredictable and loud, leading to overstimulation and stress. A variety of negative auditory input, including alarms, respiratory support machines, speech, and other environmental sounds, occurs daily. When sound policies are implemented, they may help mitigate infants’ negative auditory experiences. The purpose of this paper is to provide an overview of the auditory development of the fetus and NICU infant and the role that music might play in ameliorating the adverse effects of life outside of the protective womb. Of particular importance is the family’s role in using music to provide developmental care that supports auditory development while still meeting the infant’s medical needs, such as physiological parameters, weight gain, and reduced hospitalization length. Utilizing the mother’s singing has positive ramifications as an ideal source of auditory input, given the continuity and predictability of music’s acoustic properties, along with careful consideration of the infant’s auditory development across gestational age and the medical and developmental needs at that moment. In addition, when mothers sing to their infants in the NICU, it can have a significant impact on maternal mental health. Music therapy researchers have examined the use of the maternal voice for preterm and term infants; music therapists taught mothers to sing and use their voices to support their infants, resulting in increased singing at home and improved mother-infant bonding. This paper will discuss recommendations for auditory stimulation, based on years of music therapy research in the neonatal intensive care unit, to promote healthy neurologic development.

Introduction to Music Therapy:

Before discussing fetal and infant auditory development and the role of music and sound for preterm infants in the neonatal intensive care unit (NICU), we would like to provide an overview of music therapy. While it might be considered a new field, the profession has existed as an organized entity in the United States since the 1950s. Music therapy is a healthcare profession in which evidence-based music interventions are used to address non-musical goals within a therapeutic relationship. Entry into the profession requires a Bachelor’s degree or completion of an Equivalency Program in music therapy. Eligibility to sit for the board exam depends on completing academic coursework and 1200 clinical training hours. Credentialed professionals use the term music therapist-board certified, “MT-BC,” which is provided through the Certification Board for Music Therapists (www.cbmt. org); music therapists must recertify every 5 years, and some states have licensure. The current professional organization is the American Music Therapy Association (www.musictherapy. org), which oversees student training .

Music therapists are trained to use music to address sensory, physical, cognitive, communication, social, emotional, and spiritual needs. We address these needs through evidence based interventions, often involving live, client-preferred music across multiple settings. Music therapists commonly work within the following settings:

• Medical hospitals/outpatient clinics

 • Neurorehabilitation facilities

• Hospice/palliative care

 • Psychiatric hospitals/community mental health centers

*Early intervention and day care treatment centers

• Public school systems

• Correctional facilities

• Private practice

This paper is based on the approach of the Institute for Infant & Child Medical Music Therapy. created by Dr. Jayne Standley at Florida State University in 2003. Standley established this approach by drawing on medical and developmental models, endorsing and teaching music therapy based on empirical evidence. There are other models of music therapy in the NICU, such as psychodynamic approaches, but we prefer to use this model since it closely aligns with the medical profession and developmental care of the preterm infant.

Auditory Development of the Fetus/Infant and Impact on Neurological Development

 The NICU environment can increase preterm infants’ risk of long-term hearing impairment; however, it is essential first to understand how auditory development occurs in the womb. This is a highly intricate process that begins early within fetal development. At 23–25 gestational weeks, all major structures of the ear, including the cochlea, are in place, allowing the fetus to hear and process sounds in utero, with a consistent response to sound by 29 weeks of gestation. Beginning at 25 weeks, thousands of fine hair cells known as sensory receptors in the cochlea begin to respond to specific frequencies of sound.  These hair cells are arranged tonotopically throughout the cochlea. As the fetus develops, it becomes finely tuned to various sound frequencies transmitted through amniotic fluid and skull bone vibrations. Starting at 28 weeks and throughout the third trimester of pregnancy, the auditory system is maturing as myelination of the auditory nerve enables auditory responses and processing between the cochlea and the brainstem . As the walls of the uterus thin towards the end of pregnancy, sounds of higher frequency (>500 Hz) gradually pass through the womb (13), preparing the fetus for language development after birth. During fetal development, the womb acts as a low-pass filter, promoting the healthy development of the cochlea by limiting exposure to higher-frequency sounds . Fetuses can safely process low-frequency sounds (250–500 Hz) between 25–27 weeks and high-frequency sounds (1000–3000 Hz) by 29–31 weeks . However, most sounds in the NICU environment exceed 3000 Hz or exceed the recommended maximum sound level of 45 decibels (dB) set by the American Academy of Pediatrics, making it difficult for proper cochlear development to occur and creating an acoustic gap between the NICU and the womb. Exposure to high-frequency sounds in the NICU can not only cause stress but also lead to apnea, hypoxemia, and inadequate oxygen saturation levels that can affect growth, neurodevelopment, and hearing impairment . To better support auditory and overall sensory development, there is currently a need to identify developmental care interventions, based on gestational age and medical status, that are embedded in a family-centered care model and support optimal neural network development. The clinical use of music in the NICU can reflect the predictable, rhythmic, and organized environment of the womb, supporting positive auditory development while yielding consistent, positive outcomes such as stabilization of physiologic parameters, increased weight gain, and shortened length of stay as well as a decrease in maternal stress, making it an optimal developmental intervention throughout an infant’s stay until discharge.

Clinical Use of Music by Gestational Age:

25–28 Weeks: The cochlea and auditory cortex begin to process sound at 25 weeks and are critical to the development of the auditory system; however, they are easily affected by sounds and care practices in the NICU environment . Starting at 26 weeks, the process of tonotopic tuning begins, in which hair cells in the cochlea are finetuned to specific frequencies of sound, which are then processed into electrical signals sent to the brainstem and auditory cortex . As stated earlier, infants between 25–27 weeks can efficiently process sounds between 250–500 Hz ; however, frequencies above 1000 Hz can adversely affect autonomic functions. A stimulus considered critical, especially for infants in the NICU, is the maternal voice, which typically resonates between 200– 300 Hz, making it optimal for auditory processing and early language development.

According to the literature, the maternal voice is the strongest acoustical signal for the developing fetus and has yielded positive effects not only on auditory system development but also on autonomic functioning and behavioral responses. Similar results have been reported for preterm infants born between 25 and 32 weeks of gestation: the maternal voice significantly decreased heart rate, suggesting possible improvements in autonomic stability and neurobehavioral development  In addition, mothers of preterm infants often use “baby talk” when speaking to their infants, which has a regulatory effect on their behavior and lays the foundation for early language development.

The presence of meaningful sounds, such as the mother’s voice, is pertinent to the appropriate development of the auditory system, and music has been considered an impactful stimulus for infant development in the NICU when provided in a meaningful way. Lullabies have long been considered the most effective type of music for mitigating overstimulation in preterm infants, due to their simple, repetitive, and predictable structure. When using music for infants 25–28 gestation weeks, it is recommended to use live lullaby singing that includes a single female voice without additional instruments, slow tempo, little to no dynamic changes with limited pitch range, and repetitive play of each lullaby with a high degree of continuity among the lullaby music that is used. The recommended duration of music at this age is no more than 30 minutes based on infant response. Since the mother’s voice is preferred, live lullaby singing by the mother or caregiver is best to promote family-centered care. Maternal singing during kangaroo care is highly recommended and has a significant impact on both the infant and the mother, reducing infant distress and maternal anxiety. If recorded music is to be used, it is recommended to present it binaurally, following the same parameters as previously mentioned, while closely observing the infant to adjust the music/turning it off based on infant responses. If possible, a recording of the maternal voice is recommended. Classical music, nature sounds, musical toys, and white noise machines are not recommended, as they could be overstimulating due to their unpredictable or unorganized structure and do not provide the meaningful auditory input needed to support auditory development at this gestational age.

29–32 Weeks:

During this time period, tonotopic tuning of hair cells in the cochlea continues, and it is recommended that sounds/music remain between 250–500 Hz until 33 weeks, when the auditory system can safely process sounds at higher frequencies of 1000–3000 Hz . Lullaby music remains preferred for auditory development, and the aforementioned protocol should be used when providing either live lullaby singing or recorded lullaby music. The maternal voice is highly recommended at this time as it supports the auditory skills needed to process basic human speech sounds.

Preterm infants are considered to be at a high risk for developing language delays and impairments due to the lack of exposure to the maternal voice while in the NICU. Lullabies share characteristics with “baby talk” provided by the mother, such as simple prosodic contours, higher pitches, and short lyrical phrases that convey emotions necessary for promoting early language development and communication in preterm infants. Infants at this age can also discriminate between different phonemes, indicating the beginnings of language and speech development. Regarding music processing, it has been found that preterm infants at this age can detect differences in simple and complex beats/meters in auditory recordings, indicating early neural auditory discrimination .

33–36 Weeks: From 33 to 37 weeks, the fetus changes to process complex sounds, with differences apparent in the older fetus: a gradual increase in heart rate that did not change with sound levels. The authors stated that the older fetus might attend to the music. In contrast, the younger fetus might respond to the acoustic properties of the sound, such as pitch, loudness/intensity, and timbre. At this time, infants process higher frequencies of 1000– 3000 Hz.

Based on this information, it is crucial to continue to provide positive auditory input to infants in the NICU, including singing, reading, and speaking. If the infant is medically stable and responds positively to simple songs over several days, it is appropriate to progress to more complex songs. Thus, shifting from songs that have a simple melody, such as “Mary Had a Little Lamb,” which consists of 4 notes within a narrow range of a perfect fifth and contains two chords if an accompaniment is provided, to more complex songs, such as “Twinkle, Twinkle Little Star. Twinkle, Twinkle Little Star” consists of 6 notes within a range of a major sixth interval and has three chords if an accompaniment is provided. After an infant shows positive responses to music, such as cooing, smiling, turning towards the sound source, and maintaining heart rate and oxygen saturation within baseline levels before music listening, it may be appropriate to gradually introduce more complex and new songs into the routine.

Eventually, more complex songs might be beneficial, including songs with three chords and eventually four chords, longer song duration, and a chorus and verse. The overall goal is to provide auditory input to the infant systematically to prepare them for the home environment, including the car ride home from the NICU, during which the radio might be playing. It is important to start with simple, repetitive songs first to determine how the infant is handling sensory input, since what is appropriate one day might not be another due to new experiences (a first bath) or medical procedures (an eye exam). Also, infants who were born extremely low birthweight (ELBW) and/or have experienced significant amounts of respiratory assistance across time as well as those with major complex medical needs might not be ready for complex presentation of music at 36 weeks postmenstrual age (PMA), while an infant born at 32 weeks might be ready for more complex songs at 35 weeks PMA. The presentation of music must be carefully considered by the families and medical team. The IRainbow

 provides guidelines for the use of music and auditory input based on the infant’s medical stability and physiological maturity.

By 35 weeks, the fetus’s learning includes memory formation  Thus, caretakers will want to continue to utilize songs and rhythmic books that have already been presented to the infant at an earlier age, but it is important to integrate new information through new songs. Infants habituate to repeated presentations of the same information, and auditory stimuli become less relevant; hence, musical mobiles and sound devices that loop the same song are still not advised for the NICU or even the home environment. Parents need to be involved in their infant’s care, including providing auditory input.  Having lists of songs appropriate to musical complexity and medical and developmental needs (abilities) might be one way to involve parents in providing their infant with appropriate auditory experiences. Providing song lyrics will also help parents to remember and recall songs.

Parents need to be involved in their infant’s care, including providing auditory input . Having lists of songs appropriate to musical complexity and medical and developmental needs (abilities) might be one way to involve parents in providing their infant with appropriate auditory experiences. Providing song lyrics will also help parents to remember and recall songs.

When parents cannot visit the NICU, it would be beneficial to record the mother’s voice reading and singing to her infant to be played at the bedside. If recorded music is used, only music that has a single accompanying instrument, such as a guitar or piano, should be used. Researchers have found positive effects of singing combined with guitar accompaniment on both male and female infants’ physiological outcomes and length of hospitalization . Regarding the duration of musical and auditory stimulation, a longer duration would yield greater benefits, but there is potential harm when providing auditory input without research supporting the protocol. Eight hours of music per day, 4 hours during the day shift and 4 hours during the night shift, resulted in infants being hospitalized longer than the control group; hence, recorded music or other auditory stimulation should not be played continuously. Protected sleep, especially REM sleep, is pertinent and necessary for learning . Meaningful auditory input is necessary for infant development; thus, providing live singing or recorded music might be best during clustered care when infants are awake or in quiet sleep. For example, when infants are awakened for diaper changes and vitals prior to feeding, the time frame before feeding might help the infant achieve an alert, awake state. Similarly, singing soothing lullabies after feeding might help infants fall asleep. Of particular importance is providing auditory stimulation in a quiet environment, as preterm and term infants cannot discern meaningful auditory input if the noise exceeds 60 decibels.

36 Weeks and Older:

Auditory processing skills continue to develop and refine from 36 weeks PMA through term. By term, the fetus adjusts to specific elements of music, such as sound intensity (loudness) and frequency (high versus low notes), among others. In an fMRI study, infants were aware of previously heard musical elements, such as tempo, which led to positive connections in the auditory cortex . Consequently, families should continue using past songs and books, and introduce new stimuli if the infant shows positive responses to auditory stimulation to decrease habituation. Mothers should use their voice  and be encouraged to sing. Medical staff should continue to control the amount and quality of auditory stimulation in the NICU environment to reduce adverse developmental outcomes.

As infants evince positive responses to music and are medically stable and thriving, they might be ready for movement to music that involves midline orientation and hand-to-hand play (such as a modified “Patty Cake” or “Itsy Bitsy Spider”) (53). Since newborns discriminate between speech and other sounds, indicating a sensitivity to the frequencies and timbres of speech (49, 53), infants should be encouraged to engage in cooing and babbling. Songs such as “Little Green Frog” and “If All the Raindrops” involve distinct lip and tongue movements that might help prompt infants to respond with vocalizations or facial movements.

Summary:

Using music to support auditory development can be highly effective, particularly given the infant’s gestational age and medical stability. The above recommendations are based on evidence-based research and should be followed to reduce the risk of harm. Music can also be used in the NICU to encourage parent involvement in their infant’s care and development. Many neurosensory programs, such as SENSE and iRainbow©, advise parents to sing and/or talk to their infants to enhance auditory development. The above recommendations provide clear guidance on how best to use music within these programs and may increase parent involvement, as music is an easy way to bond with and care for an infant in the NICU. Clinical and developmental care staff should adhere to the above guidelines to best support auditory development while promoting family-centered care for preterm infants and their families.

Source:https://www.neonatologytoday.net/newsletters/nt-dec25.pdf

PREEMIE FAMILY PARTNERS

Spilling the Tea is an educational series for new preemie moms and dads brought to you by TEACUP Preemie Program®. These brief but in-depth videos will explore aspects of prematurity including emotional and mental effects, the NICU environment, breastfeeding & pumping, reclaiming attachment & bonding, and others. Preemie parents share their experiences through intimate video journals, and experts in infant development and prematurity offer guidance and information. In this second episode of Spilling the Tea, two preemie moms share about the effects of the premature birth on their own mental health. Licensed Mental Health Counselor Jenny Estrada offers insights and information about PPD, Anxiety, and PTSD to help preemie moms know when and how to find help.

INNOVATIONS

This review explores methodological considerations in estimating racial disparities in mortality among very preterm infants (VPIs). Significant methodological variations are evident across studies, potentially affecting the estimated mortality rates of VPIs across

racial groups and influencing the perceived direction and magnitude of racial disparities. Key methodological approaches include the birth-based approach versus the fetuses-at-risk approach, with each offering distinct insights depending on the specific research questions posed. Cohort selection and the decision for crude versus adjusted comparison are also critical elements that

shape the outcomes and interpretations of these studies. This review underscores the importance of careful methodological planning and highlights that no single approach is definitively superior; rather, each has its strengths and limitations depending on the research objectives. The findings suggest that adjusting the methodological approach to align with specific research questions

and contexts is essential for accurately assessing and addressing racial disparities in neonatal mortality

IMPACT:

● Elucidates the impact of methodological choices on perceived racial disparities in neonatal mortality.

● Offers a comprehensive comparison of birth-based vs. fetuses-at-risk approaches in the context of racial disparity research.

● Provides guidance on the cohort selection and adjustment criteria critical for interpreting studies on racial disparities in very preterm infant mortality.

Source: https://www.nature.com/articles/s41390-024-03485-w

ABSTRACT

Aim

Extremely preterm infants (born before 28 weeks of gestation) face substantial risks of mortality and severe morbidity. This study aimed to identify early clinical predictors of survival and major complications in this vulnerable population in order to guide individualized neonatal care strategies.

Materials and Methods

A retrospective cohort analysis was conducted on 102 infants born between 22+0 and 27+6 weeks of gestation and admitted to a tertiary neonatal intensive care unit from 2017 to 2020. Demographic, perinatal, and clinical variables were extracted from their medical records. Survival and morbidity outcomes were compared across gestational subgroups. Statistical analyses included chi-square, t-tests, and receiver operating characteristic (ROC) curve analysis.

Results

The overall survival rate was significantly influenced by gestational age, birth weight, and the type of respiratory support received. Infants born at 22-25 weeks exhibited lower survival rates and higher incidences of respiratory distress syndrome, invasive ventilation, and patent ductus arteriosus (PDA). Mortality was independently associated with lower birth weight (p<0.0001), invasive ventilation (p=0.0014), and the presence of hemodynamically significant PDA (p=0.0243). In contrast, longer durations of non-invasive ventilation correlated with improved survival (p<0.0001). ROC analysis demonstrated high predictive performance for birth weight [area under the curve (AUC)=0.82] and non-invasive ventilation duration (AUC=0.96).

Conclusion

Early postnatal respiratory parameters, birth weight, and cardiovascular status are critical determinants of survival in extremely preterm infants. Optimizing non-invasive ventilation strategies and timely PDA management may enhance outcomes. Notably, the rate of antenatal corticosteroid administration was markedly low in our cohort, which may have contributed to adverse respiratory and survival outcomes, underscoring the need for improved perinatal care strategies in extremely preterm births.

Source: https://jpedres.org/articles/survival-predictors-and-morbidity-risk-factors-in-extremely-preterm-infants-a-clinical-cohort-study/doi/jpr.galenos.2025.33427

Babies born prematurely can have a number of complications at birth, simply because they are brought into the world before their organs are fully developed. One complication is called patent ductus arteriosus (PDA).

PDA occurs when a small fetal blood vessel in the heart remains open after birth. Much like trying to drink through a straw with a hole in it, the condition can cause unnecessary stress on the heart and lungs, as they have to work harder to push blood throughout the body.

However, treatment for the condition remains controversial among neonatologists, cardiologists, and pediatricians alike. Results from a clinical trial published in the Journal of the American Medical Association, or JAMA, brings physicians one step closer to an answer.

Led by neonatologist Matthew Laughon, MD, MPH, the study found that using medication to treat patent ductus arteriosus was associated with higher mortality compared with an expectant, or “watchful waiting,” approach.

“There is wide variation in treatment of PDA in preterm infants,” said Laughon, who is a professor of perinatal-neonatal medicine at the UNC School of Medicine and lead author on the paper. “Some clinicians always treat, and some clinicians never treat. We need to know which one is better for babies”

A total of 482 extremely pre-term infants (born between 22 weeks and 28 weeks of gestation) with PDAs were enrolled in the clinical trial. All of the infants were born within affiliated hospitals of the NICHD Neonatal Research Network, a collaborative network of neonatal intensive care units across the United States.

Participants were randomized into two treatment groups: those to receive pharmacologic treatments (either acetaminophen, indomethacin, or ibuprofen) and those to receive expectant management, or a “wait and see” approach.

Researchers wanted to know which intervention would decrease the risk of death or bronchopulmonary dysplasia (BPD), a serious lung condition caused by life-saving efforts to ventilate and oxygenate into the lungs, by the time the infants reach 36 weeks adjusted age.

Through statistical analysis, researchers found that infants given expectant management had treatment had nearly double the chance of survival before 36 weeks.

“This trial showed no benefit of active treatment of the PDA in extremely preterm infants,” wrote Laughon. “In fact, it identified a higher chance of survival for expectant management, consistent with

emerging data on the effects of early (i.e., prior to one or two weeks after birth) pharmacologic PDA treatment.”

The medications themselves, which are all commonly used to treat the PDA, can also alter the immune system, reduce blood flow to the intestine, or cause gastrointestinal mucosal injury. These effects may lead to serious conditions like sepsis or the death of intestinal tissue, called necrotizing enterocolitis.

Results from this trial will help inform new treatment strategies for preterm infants with patent ductus arteriosus, saving more lives and putting families on a path towards growth and healing.

This work was supported by The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Source: https://news.unchealthcare.org/2025/12/unc-study-confirms-early-use-of-medications-may-lead-to-life-threatening-conditions-in-preterm-infants-with-heart-defect/

The three Betos of Zumba—creator Alberto Perez and partners Alberto Aghion and Alberto Perlman—are not often fully recognized for the powerful global impact their vision has inspired. Zumba has become one of the most effective, joyful, and widely embraced exercise programs in the world, blending cardiovascular training, strength-building, and flexibility through energetic, Latin- and globally inspired music and dance. Workouts feel less like exercise and more like a celebration, leaving participants feeling uplifted, embraced, confident, and connected. Today, more than 15 million people take part in Zumba classes each week across roughly 200,000 locations in about 180 countries, a testament to its extraordinary reach and influence on global physical activity, community health,  and engagement. This sense of unity comes alive each year at the international Zumba Convention, where instructors from around the world gather and the shared humanity of the global community is visible—our oneness acknowledged, individuality celebrated, and human creativity welcomed with open arms. Every Zumba class has the power to create a space of acceptance, belonging, and shared joy. A great Zumba class reminds us to celebrate the uniqueness and precious presence of ourselves and others. Zumba is, at its core, a love dance—and there is no power greater than love.

GHOSTS, HORIZONS, EMERITUS

Belize is a country on the north-eastern coast of Central America. It is bordered by Mexico to the north, the Caribbean Sea to the east, and Guatemala to the west and south. It also shares a maritime boundary with Honduras to the southeast. Despite being in central America, Belize identifies with the Caribbean region, and is a member of the Caribbean Community (CARICOM) and the Commonwealth Caribbean, the historical British West Indies.

The Maya civilization spread into the area of Belize between 1500 BCE and 300 CE and flourished until about 1200. European contact began in 1502–04 when Christopher Columbus sailed along the Gulf of Honduras. European exploration was begun by English settlers in 1638. Spain and Britain both laid claim to the land until Britain defeated the Spanish in the Battle of St. George’s Caye (1798). It became a British colony in 1840, and a Crown colony in 1862. Belize achieved its independence from the United Kingdom on 21 September 1981.[  It is the only mainland Central American country which is a Commonwealth realm, with King Charles III as its monarch and head of state, represented by a governor-general.

Belize’s abundance of terrestrial and marine plants and animals and its diversity of ecosystems, including extensive coral reefs, give it a key place in the globally significant Mesoamerican Biological Corridor. It is considered a Central American and Caribbean nation with strong ties to both the American and Caribbean regions.

It has an area of 22,970 square kilometres (8,867 sq mi) and a population of 397,483 (2022). Its mainland is about 290 km (180 mi) long and 110 km (68 mi) wide. It is the least populated and least densely populated country in Central America. Its population growth rate of 1.87% per year (2018 estimate) is the second-highest in the region and one of the highest in the Western Hemisphere. Its capital is Belmopan, and its largest city is the namesake city of Belize City. The country has a diverse society composed of various cultures and languages. It is the only Central American country where English is the official language. Belizean Creole and Spanish are widely spoken, followed by the Mayan languages and Garifuna. Over half the population is multilingual due to the diverse linguistic backgrounds of the population. It is known for its September Celebrations and punta music.

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

Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.

In contrast to the public health sector, the private health sector provides care to a smaller portion of the population. However, similar to the public sector, private health services are offered at a relatively low cost with a shared emphasis on quality of care and quality improvement.

The Human Rights Measurement Initiative[3] finds that Belize is fulfilling 83.0% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Belize achieves 99.1% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 86.6% of what is expected based on the nation’s level of income. Belize falls into the “very bad” category when evaluating the right to reproductive health because the nation is fulfilling only 63.2% of what the nation is expected to achieve based on the resources (income) it has available.

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

COMMUNITY

Longest continuously running study on preterm birth that has followed research participants for more than 35 years published in JAMAURI College of Nursing Professor Amy D’Agata’s study shows that the effects of preterm birth can linger throughout an individual’s lifetime, necessitating the inclusion of birth history in adult health records.

KINGSTON, R.I. — August 4, 2025 — The stress preterm infants experience at birth can carry on throughout a lifetime and cause negative health impacts later in life, necessitating the routine inclusion of birth history in medical records and the development of clinical guidelines for adults born preterm, the longest continuously running study of individuals born preterm in the United States has shown.

University of Rhode Island College of Nursing Professor Amy D’Agata is continuing the work that began in the 1980s with a group of babies born preterm at Women & Infants Hospital. Involving 215 people born 35 years ago—including a control group of full-term babies, and preterm babies born at 22 to 36 weeks—the study tracks the successes and difficulties preterm babies continue to face into adulthood, and compares them to the group of participants born full term. The project has so far garnered more than $10 million in research grant funding.

D’Agata, who took over as principal researcher after the retirement of Professor Emeritus Mary Sullivan, has published the most recent results in the Journal of the American Medical Association. The published paper focuses physiological and psychological health outcomes that D’Agata and her team of researchers have identified as the study participants approach 40 years old. Those born preterm have shown a higher risk of high blood pressure, high cholesterol, increased abdominal fat, and low bone density. Psychologically, the group tends to internalize problems, often resulting in increased levels of depression and anxiety.

“Preterm birth is not just a neonatal issue. It, in fact, is a lifelong condition,” D’Agata said the study shows. “For individuals who have medical complications early in life, we are now seeing an increased risk of different chronic health issues later in life. We are now realizing that there is a very strong link between what happens to you early in life and later health outcomes.”

The study offers important takeaways for health-care clinicians, who are not always aware a patient was born preterm because birth history is not commonly included in adult medical records. D’Agata’s study is showing the need to include the information, and to develop adult screening guidelines for individuals who have a history of preterm birth. The work is also helping people who have been impacted by preterm birth understand that their birth history should be included in their medical records and should be considered in the context of their overall health.

“In this country, millions of people born preterm have grown into adulthood and are now seeing clinicians across primary care and various specialties, yet providers rarely ask about birth history,” D’Agata said. “We are urging that birth history be included as a standard question on every adult intake form. Health cannot be fully optimized if we overlook such a critical assessment piece.

Understanding an individual’s birth history, alongside growing research identifying increased health risks for those born preterm and the development of targeted clinical guidelines, will advance health equity for survivors of early birth. We believe a paradigm shift is needed in health care that recognizes preterm birth as a chronic condition requiring lifelong monitoring and support.”

While the study’s most recent results were just published in JAMA Network Open in July, D’Agata is already looking toward the next set of findings. Continuing to work with fellow URI professor Justin Parent, D’Agata is examining epigenetic age acceleration among individuals born preterm. Understanding any differences in epigenetic aging that may exist between preterm and full-term born adults may be another approach to understanding long-term health.

Source:https://www.uri.edu/news/2025/08/preterm-birth-can-cause-health-problems-later-in-life-should-be-considered-in-adult-health-records-uri-study-shows/

In the heart of the Cuban capital, the Dr. Cosme Ordoñez Carceller Teaching Polyclinic stands as a testament to the nation’s unique approach to healthcare: universal, free of charge, accessible, regionalized, community-centered, and deeply rooted in preventive medicine. Unlike the profit-driven models that dominate much of the world, Cuba’s system prioritizes equitable access, public health education, and early intervention.

At the core of this approach is a commitment to health promotion through education, disease prevention through habit management, and the integration of medical care and rehabilitation. By emphasizing proactive healthcare rather than reactive treatment, the system ensures that communities receive continuous, comprehensive support to maintain overall well-being.

During a recent visit to the Dr. Cosme Ordoñez Carceller Teaching Polyclinic in Havana, the staff detailed how the system was developed and how it ensures that no Cuban, regardless of income, is left without medical care.

The structure of Cuba’s healthcare system

Cuba’s National Health System operates as a hierarchical, state-run model designed to ensure seamless coordination of care. At the top, the National Assembly oversees the Ministry of Public Health, which sets national policies and directs specialized health institutes that tackle broader public health concerns.

Below the Ministry, provincial governments, answering directly to the Assembly, oversee provincial health departments, which manage larger hospitals and specialized medical facilities. These provincial bodies, in turn, delegate responsibilities to municipal governments, which run the municipal health departments and smaller hospitals that serve local populations. At the community level, municipal health departments manage Cuba’s extensive polyclinic network, the cornerstone of the country’s healthcare system. These polyclinics not only provide specialized care, diagnostics, and emergency services, but they also coordinate closely with family doctor-and-nurse teams, who serve as the first point of contact for Cuban citizens.

These frontline providers play a crucial role beyond immediate treatment, emphasizing preventive care, home visits, and alternative therapies such as nutrition counseling, acupuncture, and plant-based medicine. Despite supply shortages exacerbated by US sanctions, this integrated, top-down approach ensures that resources are distributed efficiently, maintaining consistent healthcare access nationwide.

Founded in 1974, the Dr. Ordoñez Carceller Polyclinic serves approximately 13,000 residents, offering care in medical specialties such as cardiology, orthopedics, fertility consultations, and genetic testing. The clinic is named after Dr. Cosme Ordoñez Carceller (1927–2019), an epidemiologist and pioneer of Community Medicine, who championed the polyclinic model that emerged in the 1960s and 1970s. He played a key role in training young physicians in comprehensive general medicine and launched innovative programs like the Grandparents’ Circles, a senior care initiative so effective that it was replicated nationwide.

Cuba’s system prioritizes equitable access, public health education, and early intervention. The country’s healthcare approach is rooted in promoting health through education, preventing disease by managing habits, and ensuring comprehensive medical care and rehabilitation. Unlike the fragmented, for-profit US healthcare model, Cuba’s integrated, community-based approach ensures better health outcomes and higher patient satisfaction. At polyclinics like Ordoñez Carceller, primary care is not just about treating illness but about education, prevention, and holistic well-being. This commitment to accessible, people-centered medicine reflects Cuba’s broader philosophy: that healthcare is not a privilege, but a fundamental human right.

Cuba’s healthcare achievements: A global leader in public health

Despite enduring over six decades of economic embargo, Cuba has achieved remarkable public health milestones. The following list highlights key accomplishments of both the Ordoñez Carceller Polyclinic and the Cuban healthcare system as a whole:

  • AIDS: Cuba identified HIV in 1983 and quickly set up a system to track and treat it. By 2014, it eliminated mother-to-child transmission of HIV and syphilis, a milestone the US has yet to reach.
  • COVID: Cuba developed two COVID vaccines, kept infections low, and even sent vaccines abroad.
  • Diabetes: The nation has developed an effective medication that treats diabetic ulcers (skin wounds that result from poor blood sugar control)
  • Alzheimer’s research: Cuba developed a drug that may help reverse Alzheimer’s effects
  • Maternal-fetal medicine: 99% of Cuban children are vaccinated, and the country has a lower infant mortality rate than the US
  • Nutrition: While obesity is not an issue in Cuba, malnutrition is an increasing concern due to shortages caused by the US embargo
  • Home health Doctors make house calls to care for the elderly and new mothers.

Profit vs. public health: How medical education and healthcare delivery differ in Cuba and the US

The paths to becoming a doctor in Cuba and the United States could not be more different. In the US, medical students take on crippling debt, often exceeding USD 200,000, before ever treating a patient. The pressure to repay loans steers many toward high-paying specialties, leaving primary care and rural communities underserved. The system is structured around financial incentives rather than public need, reinforcing the idea that medicine is a business first, a service second.

Cuba takes the opposite approach. Medical education is fully state-funded, allowing students to focus on patient care instead of profit. Training begins immediately after secondary school, with students placed in community clinics early in their careers. By the time they specialize, they have already served in primary care settings, ensuring that the system produces physicians committed to public health, not private wealth.

A focus on prevention, not just treatment

Cuba’s prevention-first model stands in stark contrast to the reactive nature of US healthcare. While American medicine often prioritizes treatment over lifestyle interventions, Cuban doctors routinely incorporate nutrition, exercise, and disease prevention strategies into care plans. The country’s polyclinic system ensures patients receive consistent, community-based healthcare rather than navigating a fragmented, for-profit system that often leaves them behind.

The US blockade: An unjust barrier to health

The US embargo continues to hinder Cuba’s healthcare system by restricting access to essential medicines, medical equipment, and scientific research. Pharmaceutical and shipping companies, fearing US penalties, avoid business with Cuba—leading to severe shortages of everything from aspirin to cancer treatments.

Even medical journals and online resources are blocked due to US restrictions, forcing Cuban researchers to work under constraints that most Western physicians never encounter.

Yet, rather than succumbing to these barriers, Cuba has turned to self-sufficiency, investing in biotechnology, vaccine development, and herbal medicine research to compensate for limited imports. If freed from economic sanctions, Cuba’s contributions to global healthcare innovation could expand exponentially.

For decades, Cuba has exported medical expertise worldwide, sending doctors to disaster-stricken and underserved regions. These global medical brigades have provided care to millions, particularly in Latin America, Africa, and the Caribbean. Yet, rather than supporting these humanitarian efforts, Washington has sought to dismantle them. In February 2025, the US expanded sanctions on Cuba’s international medical program, further restricting its ability to send doctors abroad. The move reflects a deeper failure to understand Cuba’s model of solidarity-driven healthcare, a stark contrast to the US system, where medicine is often dictated by profit rather than public service.

It is within this profit-driven framework that Cuba’s medical missions are misunderstood, labeled as “forced labor” by those who cannot imagine doctors choosing service over salary. The very idea of healthcare as a human right, rather than a commodity, challenges the US worldview, leading to efforts to discredit and sanction those who practice it differently.

What could be if the embargo were lifted

Cuba’s healthcare system is a model of resilience and innovation, but its full potential remains hindered by decades of US sanctions. If given access to global resources and technology, Cuban researchers could expand medical advancements in infectious diseases, chronic illness treatment, and disaster response. For now, Cuban doctors continue their work—undaunted by external pressures, committed to the principle that healthcare is a right, not a privilege.

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch.  Renée L. Quarterman, MD, FACS, is a surgical breast specialist. She is the director of Delaware Breast Care, a part of US Oncology.

Source: https://peoplesdispatch.org/2025/03/18/healthcare-in-cuba-how-a-tiny-island-defies-us-sanctions-to-lead-in-healthcare/

HEALTHCARE PARTNERS

Quality improvement (QI) initiatives have become essential to advancing patient outcomes in the neonatal intensive care unit (NICU), where high acuity and complex care are the norms. NICU nurses are uniquely positioned to find inefficiencies, propose practical solutions, and drive meaningful change. However, despite the growing emphasis on QI in nursing practice, well-intentioned projects fall short due to avoidable missteps in the planning and execution phases.

The following guide can be utilized by NICU nurses to navigate through common pitfalls in QI research and offers evidence-based strategies to overcome them. By focusing on foundational principles and real-world examples, this guide supports nurses in conducting impactful, sustainable QI work that enhances neonatal outcomes and team collaboration.

Common Pitfalls in QI Research

Lack of Clear Problem Definition

A common pitfall in QI efforts is the failure to define the problem thoroughly. Without a precise understanding of the issue, teams may invest critical time and resources into solutions that do not address the root cause.

For instance, a unit may notice an uptick in central line-associated bloodstream infections (CLABSIs) and immediately implement new sterile techniques without investigating the underlying variables. Was the increase related to staffing changes, procedural drift, or equipment issues? Without a clear problem definition, interventions risk being misaligned or ineffective.

Strategy: Use structured problem-identification tools—such as root cause analysis (like the Five Whys) or fishbone diagrams—to uncover deeper system issues. Frame the problem in a way that is specific, data-informed, and agreed upon by stakeholders. A clearly defined problem becomes the foundation for targeted and measurable interventions.

Neglecting Stakeholder Involvement

Successful QI initiatives require input and collaboration across disciplines. A common misstep occurs when projects are developed in isolation, often without input from those who will implement or be affected by the change. This can lead to resistance, logistical challenges, or unintended consequences.

For example, consider a QI team aiming to improve feeding initiation times by adjusting nursing workflows. If respiratory therapists or neonatal physicians are not consulted, the new protocol might inadvertently clash with intubation or stabilization practices, resulting in delays rather than improvements.

Strategy: Identify all stakeholders early in the project, including nurses, physicians, respiratory therapists, pharmacists, and families, when appropriate. Conduct stakeholder analyses and engage representatives in project design and testing phases. Inclusive collaboration fosters ownership, smoother implementation, and more sustainable outcomes (Institute for Healthcare Improvement, n.d.).

Poorly Defined Metrics

Without clearly defined, relevant, and measurable outcomes, a QI initiative’s impact is difficult to assess. Broad or vague goals such as “improve thermoregulation” fail to provide direction or an evaluation method.

Strategy: Use SMART goals—Specific, Measurable, Achievable, Relevant, and Time-bound—to guide metric development. For instance, instead of aiming to “reduce hypothermia,” a SMART goal might be: “Increase the percentage of newborns with normothermic admission temperatures (36.5°C–37.5°C) from 65% to 90% over six months.” Tools and resources are available to learn how to develop clear metrics, help track progress, guide adjustments, and communicate results to the team and leadership (Agency for Healthcare Research and Quality, 2020).

Inadequate Data Collection Planning

Even well-designed projects can falter without a strong plan for data collection. Inconsistent, incomplete, or biased data limit the ability to draw valid conclusions and make informed decisions.

Strategy: Design a standardized data collection process before the intervention begins. Identify what data are needed, who will collect data, how often, and how data will be stored and analyzed. Use validated tools where possible and use the electronic health record (EHR) system to reduce manual workload and increase reliability. Pilot test the data collection process to identify issues before scaling up.

Failure to Pilot Interventions

Another frequent misstep is implementing large-scale changes without first evaluating them in a controlled way. Skipping the pilot phase can lead to disruptions in care, staff confusion, or overlooked safety concerns.

Strategy: Use Plan-Do-Study-Act (PDSA) cycles to test changes on a small scale. For instance, a new bedside handoff tool can be trialed with one team for over a week before expanding unit wide. Piloting helps refine interventions, identify barriers early, and build staff confidence.

Lack of Sustainability Planning

Often, improvement is easier to achieve than sustain. QI initiatives can experience initial success but not maintain gains over time due to a lack of follow-up, ownership, or integration into routine practice.

Strategy: Plan for sustainability from the outset. Embed new practices into policies, electronic systems, and training programs. Assign champions to monitor compliance, provide feedback, and adapt as needed. Ongoing measurement and leadership support are critical to prevent regression.

Not Sharing or Publishing Results

When results are not shared beyond the unit, valuable insights and lessons are lost. This limits the potential for broader impact and professional growth.

Strategy: Disseminate findings through presentations, newsletters, or professional journals. Even small projects can inspire similar efforts elsewhere and contribute to the collective advancement of neonatal care. Sharing also strengthens the culture of learning and improvement.

Better QI Creates Lasting Change

Quality improvement is a powerful tool NICU nurses use to enhance care and outcomes. By avoiding common pitfalls—such as unclear problem definitions, poor metric planning, and lack of sustainability—nurses can lead effective and lasting change. Through structured planning, collaborative engagement, and thoughtful execution, every QI effort becomes an opportunity for growth and better care for our most vulnerable patients. (Institute for Healthcare Improvement, n.d.).

Source: https://nann.org/publication/feature-34/

Ghosting is one of those terms that seem out of place in medicine, borrowed from social media and dating culture. However, the phenomenon itself is alive and well in our clinical ecosystems. In fact, medicine may be one of the most fertile environments for it. How else can someone remain deeply involved, wholly committed, ever-present in the work, yet increasingly pushed to the side, rendered peripheral to decisions they once shaped?

In the professional world, ghosting is less dramatic and more insidious. It is not someone vanishing; it is colleagues stepping around them. It is conversations that slip behind closed doors. It is the rise of intermediaries and buffers. It is the subtle but unmistakable shift from direct speech to third-person references. It is the choice to go around rather than through.

It is ostracizing, but with a veneer of civility. It is quiet exclusion disguised as efficiency.

 And yes, it does not feel very good. For many, the experience intensifies with seniority. The more seasoned someone becomes, the more they know, the more institutional memory they carry, the more perspective they bring; the easier it becomes for others to rationalize keeping them out of the loop. People frame it as respect, as courtesy, as a desire not to “burden” them. Nevertheless, the line between courtesy and dismissal is thin and often crossed.

Technology, ironically, amplifies the problem. Zoom, Teams, and the creeping normalization of AI presence create new pathways for invisibility. What once required the discomfort of face-to-face avoidance now happens silently. Disengagement becomes frictionless. They can be physically present on a screen and still be utterly alone in the room. When they realize they are the only one who showed up in person, while everyone else has delegated their attendance to an AI proxy, they feel the ghostliness in full.

Ghosting rarely begins with an attack. It begins with a narrative.

“They’re too busy for this.”

 “They have so much on their plate already.”

“They’re so senior; we shouldn’t bother them with this.”

“They don’t need feedback—they’re above the evaluators.”

What begins as deference quietly morphs into distance. And distance, unchecked, hardens into exclusion. Soon, the storyline shifts:

“They’re not involved.”

“They didn’t attend the last meeting.”

 “They never weigh in anymore.”

What remains unsaid and often unnoticed is that no one invited them, no one asked for their opinion, and no one created space for them to be part of the process.

Decisions move forward. Processes evolve. Incentives and priorities shift. Meanwhile, the ghosted clinician continues to do their work, unaware that the landscape is changing around them in ways that diminish their role, complicate their tasks, or diminish their influence. When they finally recognize that something fundamental has shifted, it is often too late to re-enter the conversation.

What does this feel like? It feels exactly like being a ghost.

The film The Sixth Sense offers a powerful metaphor. (Spoiler Alert) Bruce Willis’s character, after suffering a fatal gunshot wound, continues living as though nothing has changed. He goes to work, he engages in therapy, and he attempts to connect with his wife. However, something is off. People drift away. His wife is distant. Rooms feel colder. It is only through his sessions with a child who can “see dead people” that he finally confronts the truth: he is no longer part of the living world, no longer part of the relationships he believes himself to be nurturing.

 Professionally, the comparison is not perfect, but it is evocative. In medicine, the “ghosts” have not died. They walk our halls. They mentor trainees. They contribute to scholarship. They carry decades of clinical experience. They built the foundations upon which our teams now stand.

Nevertheless, they are treated as if they no longer inhabit the same professional world as everyone else.

Ghosting in medicine is not just a social slight; it is a cultural wound. It erodes respect. It weakens teams. It destroys continuity. It discards institutional memory. It creates unnecessary rifts between generations of clinicians. It deprives trainees of mentorship. It can turn accomplished physicians into isolated figures who continue to serve, but without the acknowledgment or inclusion that sustains service.

 Most dangerously, ghosting perpetuates the illusion that this is normal. That it is natural. That it is simply the denouement of a career.

But it does not have to be.

In an era where burnout is widespread, where talent is scarce, and where the wisdom of experience is more valuable than ever, ghosting is a luxury medicine cannot afford. Inclusion is not just good manners: it is good practice. It strengthens teams, enhances decision-making, and honors the very people who paved the way.

So the next time you see a colleague who seems peripheral, someone once central, now slowly fading from the edges of the conversation—pause before stepping around them. Invite them in. Ask their opinion. Keep them part of the fabric of the work. The difference between belonging and ghosthood may hinge on the smallest acts of acknowledgment, the simplest acts of inclusion. Because the ghost you see before you today is not a relic to be ignored; they are a reflection, a warning, of what any one of us might become.

Source: https://neonatologytoday.net/newsletters/nt-nov25.pdf

PREEMIE FAMILY PARTNERS

Key Points

At well-baby visits, your baby’s provider checks your baby’s health and development and gives your baby vaccinations to protect them from diseases.

If your baby has a medical condition, they may need ongoing care from different healthcare providers.

If you think your baby is sick, call their provider. If you think it’s an emergency, call 911.

If your baby needs medicine or medical equipment at home, learn how to give or use it correctly before your baby leaves the NICU.

When does your baby need to see their healthcare provider?

Your baby will get several checkups (well-baby visits) with their provider during their first year. At each visit, talk to their provider to make sure your baby’s developing in a healthy way. Are they rolling over, sitting up, crawling, and walking when they should? These skills are called developmental milestones. You may need to remind the provider that your baby spent time in the neonatal intensive care unit (NICU), because this may affect when they reach the milestones.

Take your baby’s medical file to your first visit with your baby’s provider. This file includes their discharge summary and other information from the hospital. The provider needs to know what happened during and after your baby’s birth. Hospital staff may send the summary directly to the provider.

If your baby has a medical condition, such as a birth defect, they may need ongoing care from different  healthcare providers. Find a way to keep track of your baby’s medical appointments. This may be on a calendar in your kitchen or on your phone with an alert to remind you. Decide if it’s easier to schedule a few appointments on the same day or spread them out over different days.

Ask your providers to keep your baby’s main provider up to date about all visits and treatments. This helps make sure that all members of your baby’s healthcare team have the same information.

Keep your own record of any checkups, tests, and treatments your baby has had. When your doctor makes a change to your baby’s care or medication, make sure this is also shared with your baby’s in-home nursing care agency and equipment company if you use these services.

What should you do if your baby gets sick?

All babies get sick from time to time. But babies who were in the NICU are more likely than other babies to get infections. Watch for signs that your baby may be sick so you can get medical help right away. You should call your baby’s healthcare provider if your baby:  

  • Looks blue around the nose, lips, or on the skin, or is paler than usual
  • Refuses to eat or doesn’t eat enough
  • Throws up (which is more serious than spitting up or reflux)
  • Has less than five wet diapers in a 24-hour period, or has diarrhea for more than a day
  • Has a large or hard belly that they have not had before
  • Has a temperature higher than 100.4 F or lower than 97 F (using a rectal thermometer)
  • Has apnea or trouble breathing. Apnea is when the baby stops breathing for 15 seconds or more.

You know your baby best. If you think something is wrong, call their provider, call 911, or take your baby to the emergency room.

How do vaccinations help protect your baby?

All babies, including those who spend time in the NICU, need vaccinations to help protect them from serious diseases. Some babies start getting these shots while they’re in the NICU. Check with your baby’s provider about when they need their vaccinations. Keep a record of your baby’s vaccinations in your medical file for them.

If you have other children, they need their vaccinations, too. This helps keep them from passing infections to the baby. During flu season, everyone in the family, including parents, should get a flu shot. Any adult who may have contact with your baby also needs a Tdap vaccination. This vaccination helps protect against tetanus, diphtheria, and pertussis (whooping cough). If you didn’t receive your Tdap vaccine during pregnancy, you can get it after you’ve given birth. To create a safe space for your baby, it is important for everyone who will be in contact with your baby to receive their vaccinations.

How can you protect your baby from respiratory syncytial virus (RSV)?

RSV is a common virus. It affects almost all children before they reach age 2. Most of the time, it causes a slight cold. But for preterm babies (born before 37 weeks of pregnancy), this virus can be more serious. Babies born preterm or who have heart or lung problems may benefit from a medicine to keep them from getting RSV. Ask your baby’s healthcare provider if your baby got this medicine in the NICU or if they should get it now that they’re at home.

What do you need to know about giving your baby medicine?

Some babies go home from the NICU still taking medicines. Learn how to give your baby their medicine before they leave the hospital. Write down all the directions. If you have questions or are worried about giving your baby medicine, tell the nurse or other NICU staff. They can show you exactly what to do so you feel comfortable and confident about giving your baby medicine.

When giving your baby medicine, make sure you know:

  • Where you can get the prescription filled (at a grocery store, drug store, or pharmacy). A prescription is an order for medicine given by a healthcare provider.
  • How much medicine to give, how often to give it, and when to stop giving it
  • If you can give it before, during, or after feedings
  • If the medicine needs to be refrigerated, prepared, or mixed
  • What to do if you miss a dose
  • If your baby needs more than one medicine, if you can give them together at the same time
  •  

You also need to know:

  • What position your baby should be in to take the medicine
  • What to do if your baby spits up or vomits the medicine
  • If there are side effects from the medicine and what to do if your baby has them

To track your baby’s different medicines and when to give them, use a chart. Ask the nurse to help you make the chart.

How can you manage your baby’s medical equipment at home?

If your baby has medical equipment at home, this can feel like a lot to manage. Staying organized and planning ahead can help. Keep a list of your baby’s equipment and medical supplies, including order numbers, size, and quantity. The equipment company can give you a checklist. Be sure to re-order supplies with enough time, as shipments can sometimes be delayed. Always be prepared when you leave the house, make sure you have your baby’s supplies even when you’re just going to the park.

If the equipment uses electricity:

  • Share information about your baby’s medical condition with your local fire department and emergency or first responders so they know what to expect in case they’re called to your home for an emergency. Invite them to come to your home to meet you and your baby.
  • Contact your utility companies to let them know your baby’s healthcare needs. They may have a priority list for repairing power outages or plowing snow.
  • Make a plan for if the power goes out. Have back-up batteries and know how long they will last.

Last reviewed April 2025: https://www.marchofdimes.org/find-support/topics/neonatal-intensive-care-unit-nicu/continuing-medical-care-after-nicu

Anxiety is another word for feeling worried or scared. It’s normal for children and teens to feel anxious sometimes, like before a big test at school or talking in front of a group of people. But if your child’s anxiety gets in the way of normal activities, such as sleeping alone at night, playing outside or going to school, they may need extra support.

The good news is that there are things you can do to help prevent your child from feeling anxious and help them handle worries when they happen. Talk with your pediatrician to discuss strategies and tips that can help.

What are some common signs of anxiety in children?

If your child is feeling anxious, they may not be able to tell you. Your child may feel bad or sick without knowing why, or you may notice they seem restless or tired.

  • Feeling as if their heart is racing
  • Sweating or blushing
  • Shaking or feeling sick to their stomach
  • Feeling very cold or hot
  • Trouble paying attention or sitting still
  • Touching the crotch area (for young boys)

How can I help my child manage anxiety at home?

These tips are helpful for all children, but they can be especially helpful for children with anxiety. Parenting is a busy job, so use your judgment about which tips make the most sense for your family.

Connect with your child

  • Set aside one-on-one time every day without TV or other media. Even just 10 minutes each day can make a big difference. Try gardening or taking care of houseplants, drawing or going for a bike ride.
  • Praise your child and make them feel good about themselves. For example, “You did a great job on that homework assignment!” or “Thank you for helping me with the laundry. I’m so lucky to have your help.”
  • Find out what’s worrying your child, because stress can make them feel anxious. Things such as being bullied at school, divorce, or a death in the family can make a child feel anxious. Your child may need extra help to handle issues such as these.

Help your child learn to manage fears

When your child is calm, start a conversation about things they can do to manage fears and worries when they happen. For example, let them know that they can

  • Practice deep breathing and muscle relaxation.
  • Use positive self-talk (for example, “I can try this” instead of “I can’t do this”).
  • Think of a safe place, such as their bedroom or favorite place outdoors.
  • Gradually facing fears. Consider gradually exposing your child to feared objects or activities.
  • Praise and reward brave behavior: the goal is to cope, not avoid.

Build healthy habits to support mood

Healthy lifestyle habits can help reduce stress and support a positive mood.

  • Get active! Encourage your child to be active for at least an hour every day. This activity can include playing outside, joining a sports team or an activity at the YMCA, biking or walking to school, or dancing at home to favorite music.
  • Eat healthy. Eat healthy meals every day, including fruits and vegetables, whole grains, and protein foods. Remember to eat breakfast!
  • Get plenty of sleep. School-aged children need 9 to 12 hours of sleep every night, and teens need 8 to 10 hours.
  • Build a family media plan to set healthy guidelines around entertainment screen time. Avoid scary or violent TV shows, video games, and movies.
  • Set up family routines. Follow a regular schedule for playtime, mealtime, and bedtime. Knowing what to expect can help your child feel safe and secure.
  •  

How can I help my child manage school anxiety?

Children may find it hard to focus on or even go to school when they’re feeling worried. If your child is having trouble in school, try these ways to help.

  • Gently but firmly tell your child why it’s important to go to school.
  • Talk with your child’s teachers and the guidance counselor about what to do if your child asks to go home from school early.
  • If you think your child may be upset by family stress or pressure to do well in school, let them know they are doing a good job and you’re proud of them.
  • Help your child set realistic goals for school. If they set goals that are too hard to meet, they may feel worse about themselves.
  • Remind your child that they can take steps to control their worries. For example, they can think about what to do ahead of time to handle a stressful situation.
  • Reward your child’s brave behaviors at school. Spending time doing fun activities with a parent is a very powerful reward.

Remember, you know your child best.

Whether it’s at school or the doctor’s office, you are your child’s biggest advocate. Don’t hesitate to speak up on behalf of your child.

When do I need to go back to the doctor?

If your child’s anxiety doesn’t go away or gets worse, get back in touch with the doctor. You and the doctor can make a plan to try new approaches or strategies with your child.

It’s especially important to talk with your child’s doctor if:

  • Your child starts to experience other behavior problems, such as shyness.
  • Something scary happens in your child’s life that may make their anxiety worse, such as an injury or death in the family.
  • You suspect your child’s anxiety is affecting another medical condition (for example, if your child’s asthma gets worse with anxiety).

The doctor can also help you decide whether visiting a specialist may help. For example, a type of therapy called cognitive behavioral therapy can be helpful for children with anxiety.

Make time to care for yourself, too.

Parenting can be stressful. If you’re feeling overwhelmed, don’t be afraid to ask for support from family, close friends, social services, or your faith community. Children pick up on the stress and worries of adults, so getting support for yourself can help your child too.

Last Updated – 09/24/2024 –https://www.healthychildren.org/English/family-life/family-dynamics/Pages/help-your-child-manage-fears-and-anxieties.aspx

The neonatal intensive care unit (NICU) is a special unit in the hospital for babies born preterm, very early, or who have some other serious medical condition. Most babies born very early will need special care after birth. This is done by or under the supervision of a neonatologist, a doctor with special training in the care and problems of newborns.

This article discusses the consultants and support staff who may be involved in the care of your infant depending on your infant’s specific medical needs.

Information

AUDIOLOGIST

An audiologist is trained to test a baby’s hearing and provide follow-up care to those with hearing problems. Most newborns have their hearing screened before leaving the hospital. Your health care providers will determine which hearing test is best. Hearing tests may also be done after leaving the hospital.

CARDIOLOGIST

A cardiologist is a doctor that has special training in the diagnosis and treatment of heart and blood vessel disease. Pediatric cardiologists are trained to deal with newborn heart problems. The cardiologist may examine the baby, order tests, and read test results. Tests to diagnose heart conditions may include:

If the structure of the heart is not normal due to a birth defect, a cardiologist might work with a cardiovascular surgeon to perform surgery on the heart.

CARDIOVASCULAR SURGEON

A cardiovascular (heart) surgeon is a doctor who has special training in doing surgery to correct or treat defects of the heart. Pediatric cardiovascular surgeons are trained to deal with newborn heart problems.

Sometimes, surgery can correct a heart problem. Other times, complete correction is not possible and surgery is done just to make the heart work as well as possible. The surgeon will work closely with the cardiologist to care for the baby before and after surgery.

DERMATOLOGIST

A dermatologist is a doctor who has special training in diseases and conditions of the skin, hair, and nails. Such a doctor might be asked to look at a rash or skin lesion on a baby in the hospital. In some cases, the dermatologist might take a sample of the skin, called a biopsy. The dermatologist might also work with the pathologist to read the biopsy results.

DEVELOPMENTAL PEDIATRICIAN

A developmental pediatrician is a doctor who has been specially trained to diagnose and care for infants who have trouble doing what other children of their age can do. This type of doctor often evaluates babies who have already gone home from the NICU and will order or perform developmental tests. The doctor can also help you find resources near your home that provide therapies to help infants and children in meeting development milestones. Developmental pediatricians work closely with nurse practitioners, occupational therapists, physical therapists, and sometimes neurologists.

DIETITIAN

A dietitian has special training in nutritional support (feeding). This type of provider may also specialize in pediatric (children’s) nutritional care. Dietitians help determine if your baby is getting enough nutrients, and may recommend some choices of nutrition that can be given through the blood or a feeding tube.

ENDOCRINOLOGIST

A pediatric endocrinologist is a doctor with special training in the diagnosis and treatment of infants with hormone problems. Endocrinologists might be asked to see babies who have problems with the level of salt or sugar in the body, or who have problems with the development of certain glands and sexual organs.

GASTROENTEROLOGIST

A pediatric gastroenterologist is a doctor with special training in the diagnosis and treatment of infants with problems of the digestive system (stomach and intestines) and liver. This type of doctor might be asked to see a baby who has digestive or liver problems. Tests, such as x-rays, liver function tests, or abdominal ultrasounds, might be done.

GENETICIST

A geneticist is a doctor with special training in the diagnosis and treatment of infants with congenital (inherited) conditions, including chromosomal issues or syndromes. Tests, such as chromosome analysis, metabolic studies, and ultrasounds, may be done.

HEMATOLOGIST-ONCOLOGIST

A pediatric hematologist-oncologist is a doctor with special training in the diagnosis and treatment of children with blood disorders and types of cancer. This type of doctor might be asked to see a baby for bleeding problems due to low platelets or other clotting factors. Tests, such as a complete blood count (CBC) or clotting studies, might be ordered.

INFECTIOUS DISEASE SPECIALIST

An infectious disease specialist is a doctor with special training in the diagnosis and treatment of infections. They might be asked to see a baby that develops unusual or serious infections. Infections in babies can include blood infections or infections of the brain and spinal cord.

MATERNAL-FETAL MEDICINE SPECIALIST

A maternal-fetal medicine doctor (perinatologist) is an obstetrician with special training in the care of high-risk pregnant women. High-risk means there is an increased chance for problems. This type of doctor can care for women who have premature labor, multiple gestations (twins or more), high blood pressure, or diabetes.

NEONATAL NURSE PRACTITIONER (NNP)

Neonatal nurse practitioners (NNP) are advanced practice nurses with extra experience in the care of newborn infants in addition to completing master’s or doctoral level educational programs. The NNP works along with a neonatologist to diagnose and treat health problems in babies in the NICU. The NNP also performs procedures to help diagnose and manage certain conditions.

NEPHROLOGIST

A pediatric nephrologist is a doctor with special training in diagnosing and treating children who have problems with the kidneys and urinary system. This type of doctor might be asked to see a baby who has problems in the development of the kidneys or to help care for a baby whose kidneys do not work properly. If a baby needs kidney surgery, the nephrologist will work with a surgeon or urologist

.NEUROLOGIST

A pediatric neurologist is a doctor with special training in the diagnosis and treatment of children with disorders of the brain, nerves, and muscles. This type of doctor might be asked to see a baby who has seizures or bleeding in the brain. If the infant needs surgery for a problem in the brain or spinal cord, the neurologist might work with a neurosurgeon.

NEUROSURGEON

A pediatric neurosurgeon is a doctor trained as a surgeon who operates on children’s brains and spinal cords. This type of doctor might be asked to see a baby who has problems, such as spina bifida, skull fracture, or hydrocephalus.

OBSTETRICIAN

An obstetrician is a doctor with special training in taking care of pregnant women. This type of doctor might also assist women who are trying to get pregnant and follow women with medical conditions, such as diabetes or decreased fetal growth.

OPHTHALMOLOGIST

A pediatric ophthalmologist is a doctor with special training in diagnosing and treating eye problems in children. This type of doctor might be asked to see a baby who has birth defects of the eye.

An ophthalmologist will look at the inside of the baby’s eye to diagnose retinopathy of prematurity. In some cases, this type of doctor might perform laser or other corrective surgery on the eyes.

ORTHOPEDIC SURGEON

A pediatric orthopedic surgeon is a doctor with special training in the diagnosis and treatment of children who have conditions involving their bones. This type of doctor might be asked to see a baby who has birth defects of the arms or legs, hip dislocation (dysplasia), or fractures of the bones. To see the bones, orthopedic surgeons might order ultrasounds or x-rays. If needed, they can perform surgery or place casts.

OSTOMY NURSE

An ostomy nurse is a nurse with special training in the care of skin wounds and openings in the belly area through which the end of the intestine or the collecting system of the kidney stick out. Such an opening is called an ostomy. Ostomies are the result of surgery needed to treat many intestinal problems, such as necrotizing enterocolitis. In some cases, ostomy nurses are consulted to help care for complicated wounds.

OTOLARYNGOLOGIST/EAR NOSE THROAT (ENT) SPECIALIST

A pediatric otolaryngologist is also called a pediatric ear, nose, and throat (ENT) specialist. This is a doctor with special training in the diagnosis and treatment of children with problems with the ear, nose, throat, and airways. This type of doctor might be asked to see a baby who has problems with breathing or a blockage of the nose.

OCCUPATIONAL/PHYSICAL/SPEECH THERAPISTS (OT/PT/ST)

Occupational and physical therapists (OT/PT) are professionals with advanced training in working with infants with developmental needs. This work includes neurobehavioral assessments (postural tone, reflexes, movement patterns, and responses to handling). In addition, the OT/PT professionals will help determine a baby’s nipple-feeding readiness and oral-motor skills. Speech therapists will also help with feeding skills in some centers. These types of providers might also be asked to provide family education and support.

PATHOLOGIST

A pathologist is a doctor with special training in lab testing and examination of body tissues. They supervise the lab where many medical tests are performed. They also examine tissues under the microscope that are obtained during a surgery or an autopsy.

PEDIATRICIAN

A pediatrician is a doctor with special training in the care of infants and children. This type of doctor might be asked to see a baby in the NICU, but is usually the primary care provider for a healthy newborn. A pediatrician also provides primary care for most babies after they leave the NICU.

PHLEBOTOMIST

A phlebotomist is a specially trained professional who takes your blood. This type of provider may take the blood from a vein or a baby’s heel.

PULMONOLOGIST

A pediatric pulmonologist is a doctor with special training in diagnosing and treating children with respiratory (breathing) conditions. Even though the neonatologist cares for many infants with respiratory problems, the pulmonologist might be asked to see or to help care for babies who have unusual conditions of the lung.

RADIOLOGIST

A radiologist is a doctor with special training in obtaining and reading x-rays and other imaging tests, such as barium enemas and ultrasounds. Pediatric radiologists have extra training in imaging for children.

RESPIRATORY THERAPIST (RT)

Respiratory therapists (RTs) are trained to deliver multiple treatments to the heart and lungs. RTs are actively involved with babies having breathing problems, such as respiratory distress syndrome or bronchopulmonary dysplasia. An RT might become an extracorporeal membrane oxygenation (ECMO) specialist with further training.

SOCIAL WORKERS

Social workers are professionals with special education and training to determine the psychosocial, emotional, and financial needs of families. They help families find and coordinate resources in the hospital and community that will help to meet their needs. Social workers also help with discharge planning.

UROLOGIST

A pediatric urologist is a doctor with special training in diagnosing and treating conditions involving the urinary system in children. This type of doctor might be asked to see a baby with conditions such as hydronephrosis or hypospadias. With some conditions, they will work closely with a nephrologist.

X-RAY TECHNICIAN

An x-ray technician is trained in taking x-rays. X-rays can be of the chest, stomach, or pelvis. Sometimes, solutions are used to make body parts easier to see, as with barium enemas. X-rays of bones are also commonly performed on babies for a variety of reasons.

Source: https://medlineplus.gov/ency/article/007249.htm

INNOVATIONS

OBJECTIVE

Pediatric surgical conditions are a significant source of morbidity and mortality in low- and middle-income countries (LMICs), where children with surgically treatable conditions lack access to care owing to an insufficient number of pediatric surgeons, poor and limited training, and financial barriers. There is a growing shift from charitable missions to capacity-strengthening projects, which strengthen the skills and resources of communities. The objective of this study was to synthesize the literature to identify capacity-strengthening projects, their methods and outcomes, and their limitations and barriers.

METHODS

MEDLINE, EMBASE, Cochrane, and Web of Science were searched until May 5, 2023. Eligibility criteria were as follows: (1) inclusion of pediatric surgery patients; (2) designation as capacity-strengthening interventions; (3) outcomes of improved access defined through Lancet Commission on Global Surgery Indicators; and (4) designation as an LMIC defined by the World Bank. Two independent reviewers conducted screening and extraction.

RESULTS

A total of 80 studies met inclusion criteria. Interventions were implemented in 69 LMICs and used 19 different methods of capacity strengthening. Common capacity-strengthening methods included the following: international surgical visits, training programs, partnerships, mobile clinics and camps, infrastructure enhancements, and telemedicine. Common methods used included the following: training of local providers, continuous contact between both countries after the visit was completed, improved access for rural families, and economic support for low-income families. A total of 1 357 077 pediatric surgeries were performed through these interventions. Limitations included the fact that only peer-reviewed studies were included. Included studies were mainly case series or small observational studies with qualitative data.

CONCLUSIONS

This review identifies methods to implement capacity-strengthening interventions in LMICs, including their successes and barriers. Future research should report ethical concerns and quantitative outcomes to determine effectiveness.

Source: https://publications.aap.org/pediatrics/article-abstract/156/6/e2025072119/205410/Improving-Access-to-Pediatric-Surgery-in-LMICs?redirectedFrom=fulltext

Introduction

Neonates and infants are commonly referred to as “therapeutic orphans” due to the overall scarcity of therapeutic interventions that have been developed and tailored to their needs and specific characteristics. This is well known by care providers and researchers active in this field, but is perhaps less on the radar of authorities, funding bodies or the broader public. There is significant health inequity when comparing newborns to other age populations in terms of specific drug and device development and therapeutics. In addition there are health inequities in the provision of neonatal care globally which require special attention in terms of improvement.

Bronchopulmonary dysplasia, neonatal seizures, poor growth, necrotizing enterocolitis (NEC) and short bowel, hypoxic-ischemic encephalopathy, retinopathy of prematurity (ROP), neonatal infections and sepsis hereby serve as a non-exhaustive list of “orphan conditions” in need of more equity, through adequately and urgently funded research and improvement.

The good news is that there have been increased efforts, in recent years, by researchers and regulatory bodies to focus on the provision of drugs, devices, and treatment modalities tailored for neonatal use, while further advocacy remains an obvious need . This brings perspective and explains the initiative taken to organize a focused research topic on what is on the horizon as well as recent advances.

Overview of the topics covered

We targeted emerging or new aspects related to monitoring, diagnostics and therapeutics in neonatal care for the current research topic. Fortunately, this research topic was perceived as very relevant by the research community, as 135 authors expressed their interest as contributors, resulting in 20 accepted papers. This serves as a signal of the importance to continue to work on this topic.

Post-hoc, and in a somewhat arbitrary way (because of overlap in these subcategories) these papers were subdivided by the editors into different subcategories, with focus on (1, 5 papers) perinatal biomarkers in blood and urine and how these relate to or predict outcomes, (2, 6 papers) adaptations of existing and newly emerging equipment in neonatal units, (3, 3 papers) needed advances in pharmacotherapy, (4, 3 papers) machine learning or deep learning applications in neonatal care, and finally, (5, 3 papers) underreported aspects of contemporary NICU care, with a focus on the holistic nature of care for the infant and the family.

Perinatal biomarkers in blood and urine and how these relate to or predict outcomes

Two papers focused on biomarkers related to gestational diabetes, with reflections and data on maternal and neonatal outcomes. Postnatal maternal levels of glycated albumin and hemoglobin A1c in mothers of large-for-gestational-age (LGA) informed us of the relevance of accurate diagnosis during pregnancy. This is because postpartum women without diagnosis during pregnancy had higher glycated albumin values, associated with LGA and associated complications (Železnik et al.). Interestingly and related to this paper, Yin et al. reported on a untargeted metabolomics study in women with gestational diabetes, with the recommendation of a maternal serum metabolite panel to forecast neonatal adverse outcomes (hypoglycemia and macrosomia) (Yin et al.).

Other papers focused on the use of vitamin D, acid-base and biomarkers associated with fetal growth restriction with impaired neurodevelopmental outcome. In a cohort of 217 preterm neonates, a multivariate regression analysis identified antenatal steroids as protective, and lower birth weight, duration of ventilation, sepsis and the serum 25-(OH)D vitamin as risk factors to develop ROP (Yin et al.). Musco et al. reported on a systematic review on blood biomarkers indicating risks of adverse neurodevelopmental outcome in fetal growth restricted infants (Musco et al.). While the authors retrieved some data on neuron specific enolase and S100B, the overall conclusions reflect a call for further research. Finally, an association between lactate levels in umbilical cord blood and cerebral oxygenation in preterm neonates was studied as a secondary outcome analysis (Dusleag et al.). In non-asphyxiated preterm neonates with respiratory support, lactate levels were negatively associated with cerebral and arterial oxygenation. In term neonates without respiratory support, no associations were observed.

Adaptations of existing and newly emerging equipment in our units

In a review on emerging innovations in neonatal monitoring, Krbec et al. concluded that there is an urgent, still unmet need to develop wireless, non- or minimal-contact, non-adhesive technology, capable to integrate multiple signals in a single platform, tailored to neonates (Krbec et al.). Related to this call of action, Svoboda et al. reported on their pilot experience with contactless assessment of heart rate, applying imaging photoplethysmography (Svoboda et al.). Rectal and axillary temperature monitoring on admission were compared in a cohort of preterm (n = 80, <32 weeks gestational age) by Halabi et al., reporting that rectal measurement was likely more reliable in the event of hypothermia (Halabi et al.). Ultrasound-guided measurement of anterior cerebral artery resistive index in the first week of life in 739 preterm neonates (<35 weeks) was not associated with subsequent co-morbidities on admission or during neonatal stay (asphyxia, sepsis, NEC) (Singh Gill et al.). A case series of neurally adjusted ventilatory assist to rescue pulmonary interstitial emphysema in 5 extremely low birth weight infants illustrated the potential value of this ventilatory equipment and strategy and need for further study (Chen et al.). Finally, van Rens et al. compared a conventional to a modified Seldinger technique (a dedicated micro-insertion kit) for peripherally inserted central catheter (PICC) placement, illustrating the relevance of developing “low risk, high benefit” type of medical devices, adapted to the specific needs of neonates (van Rens et al.).

Advances needed in pharmacotherapy

The currently available medicines and dosing regimens in neonatal care are limited and there is an urgent need for improvement in this domain. This was illustrated by articles on sepsis, septic shock and steroids. Inequity in provision of neonatal care across the globe ought to be a major focus of improvement. Gezahegn et al. described the outcome in neonates admitted with sepsis in Harar (Ethiopia). Low white blood cell count, desaturation, preterm birth, absence of prenatal maternal care, and chorioamnionitis were important risk factors for sepsis-related mortality (Gezahegn et al.). Addressing these prognostic factors hold the promise to act as levelers to improve outcomes. A pilot study compared noradrenaline and adrenaline as first line vasopressor for fluid-refractory sepsis shock (Garegrat et al.). Both interventions were comparable to resolve the septic shock, while the overall mortality (13/42, 30%) remained significant, highlighting the need for better diagnostic and therapeutic options. Finally, in a systematic review, outcome of postnatal systemic corticosteroids (hydrocortisone to dexamethasone) were compared as reported in randomized controlled trials (Boscarino et al.). The authors concluded that dexamethasone appeared to be somewhat more effective than hydrocortisone in improving respiratory outcomes, but with inconclusive but relevant concerns on the uncertainties on long-term neurodevelopmental outcome, again highlighting the need for better therapies for prevention and management of chronic lung disease of prematurity.

Machine learning or deep learning applications in neonatal care

Artificial intelligence is a rapidly advancing area with fast evolving clinical applications in healthcare, including in the NICU (6). It is no surprise that the current research topic also contains papers illustrating its relevance to improve our practices and outcomes. Two papers hereby focused on NEC, and a 3rd paper on prediction of significant patent ductus arteriosus (PDA). In a mini-review, Cuna et al. reports on the various pathophysiological processes underlying NEC endotypes, and how artificial intelligence holds the promise to influence further understanding and management (Cuna et al.). An approach to enhance surgical decision making in NEC is illustrated by Wu et al. Based on x-rays from 263 neonates diagnosed with NEC (94 surgical cases), a binary diagnostic tool was trained and validated, with Resnet18 as approach applied (Wu et al.). For PDA, an ultrasound-based assessment of ductus arteriosus intimal thickness in the first 24 h after birth was applied in 105 preterm neonates. A prediction model for closure on day 7 included birth weight, mechanical ventilation, left ventricular end-diastolic diameter, and PDA intimal thickness (Hu et al.). Such models can be considered to better target future study, integrated in a precision medicine approach. Use of AI and big data have the potential to significantly improve our understanding of neonatal conditions and also support neonatal researchers in asking better research questions.

Underreported aspects of contemporary NICU care, holistic care

As part of this research topic, we also accepted papers reporting on the use of music on pain management, on multisensory stimulation to improve maternal milk volume production, and parents’ experiences related to congenital cardiac surgery. All these 3 papers reflect the need for holistic care and to further integrate the perspectives of (former) patients and parents into neonatal practice.

In a systematic review, Ou et al. demonstrated that music is an effective intervention to relief procedural pain (e.g., Premature Infant Pain Profile score) in preterm neonates, as it reduced some markers of stress, and improved blood oxygen saturation (Ou et al.). Multisensory stimulation (audiovisual, or audiovisual + olfactory) compared to a control setting improved maternal milk volume production, with evidence of positive effects of both interventions, even more pronounced if both interventions are combined (Cuya et al.). Finally, a quantitative analysis of parent’s experiences with neonates admitted to NICU with a congenital heart disease reinformed us on the importance of actively focusing on parental experiences of care (Catapano et al.).

From advances in neonatal care to implementation In our opinion, this research topic nicely illustrates the diversity in ongoing clinical research activities, that all hold the promise to improve our clinical management practices, with the overarching aim to improve neonatal outcomes. There is an urgent need to focus on the current health inequities in the provision of care to neonates (3). The trend towards a “neuro” dedicated NICU care is an illustration on how relevant progress may occur. This progress is based on improved neuromonitoring techniques (7), improved management and precision medicine in the field of anti-epileptic drugs (8), and integrating families as partners in neonatal neuro-critical care and similar improvement programs (9). The good news is that we are already experiencing a shift in the right direction. The neonatal community and all other relevant stakeholders need to work better together to improve the pace and scale of this improvement.

Source:https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2025.1552262/full

Despite the widespread use of pain rating scales in neonatal care worldwide, a new Cochrane review shows that current tools for assessing pain in newborns are based on very low quality evidence. According to the review, none of the pain rating scales in use today are methodologically reliable enough to measure pain.

The Cochrane analysis, which included 79 studies involving over 7,000 infants across 26 countries, evaluated 27 different clinical rating scales. The findings reveal significant limitations in the reliability and clinical usefulness of all currently available tools, raising concerns about whether healthcare professionals can accurately measure pain in this extremely vulnerable population.

“We were truly hoping that one pain scale would be stronger than another, but instead we found that all of them are poorly developed. This is an issue that also affects Swedish clinical practice and research. For example, a recent publication out of KI found that 25 percent of Swedish infants were assessed without using a rating scale at all, which was already shocking, and now we can confirm that the remaining 75 percent of the infants were assessed with rating scales that are now known to not be methodologically sound enough to measure pain. So, this unfortunately means that medical professionals cannot be sure whether they are measuring pain at all.” says Emma Persad, Phd student at the Department of Women’s and Children’s Health, Karolinska Institutet.

Yet, from this uncertainty comes a call to action. The researchers hope these findings will spark a global collaborative effort, led by Swedish experts, to develop a new, robust, and evidence-based pain assessment scale for newborns. Such a tool could greatly improve neonatal care worldwide and further establish Sweden as a leader in the field of neonatology.

According to the article “this involves developing better rating scales or physiological techniques to measure pain”.

““This is precisely what we are hoping to do. Through convening the global community we hope these findings and the outcome become a global collaborative effort, driven by Swedish researchers, to finally develop a pain rating scale that is robust and evidence-informed (and will hopefully be properly adapted and translated for use worldwide). We hope that Sweden’s role in neonatology can further be solidified through this work,” says Emma Persad.

Source: https://news.ki.se/swedish-led-initiative-aims-to-revolutionise-pain-assessment-in-newborns

Dr. Michael Copass, M.D.—a Harborview Emergency Medicine physician instrumental in the early development and later leadership of the Medic One paramedic training program, helping expand it beyond cardiac care—worked alongside Dr. Leonard Cobb and Seattle Fire Chief Gordon Vickery to shape what would become one of the world’s most respected emergency medical systems. When the original grant funding for the Medic One program ended unexpectedly, the community rallied in extraordinary ways: bake sales, marathons, neighborhood drives, even children donating their birthday money. Their efforts raised nearly $200,000, inspiring the creation of the Medic One Foundation in 1974 to ensure this lifesaving work would never fade. Since that time, more than $35 million has been invested in Medica One’s training, equipment, and research, contributing to lifesaving outcomes on a daily basis.

Years later, that legacy still lives and breathes inside the halls of Harborview Medical Center. As a student assistant with the University of Washington School of Medicine and the UW surgical residency program, I had the privilege of witnessing something quite extraordinary. Each week, an Emeritus physician would return to the hospital—not for recognition or ceremony, but simply to sit down for lunch and vibrant conversation.

Those gatherings were never formal lectures. They were living, breathing exchanges of wisdom — stories from the early days of emergency medicine, thoughtful clinical reflections, and gentle reminders that compassion matters just as much as technical skill. Students, interns, residents, fellows, and senior attendings all pulled up chairs. Hierarchies faded. Curiosity filled the room. Medicine, in its truest form, felt like a shared calling.

It was in those moments that I truly understood the impact Emeritus physicians have on the medical community. They often carry history, perspective, humility — and they give it away freely. Their mentorship strengthens not just clinical practice, but the heart of healthcare itself. The legacy of Medic One isn’t only found in ambulances and survival rates — it is also found in conversations around cafeteria tables, where knowledge is passed from one generation to the next.

And as we continue to advocate for fragile newborns and medically complex children, that lesson stays with me: when compassion, community, courage, and teaching come together, the ripple effect is immeasurable — and hope continues forward.

–Kathryn Campos & Kathy Papac

Voices, Targeting Healthcare, Breaking Bread

Lebanon, officially the Republic of Lebanon, is a country in the Levant region of West Asia. Situated at the crossroads of the Mediterranean Basin and the Arabian Peninsula, it is bordered by Syria to the north and east, Israel to the south, and the Mediterranean Sea to the west; Cyprus lies a short distance from the coastline. Lebanon has a population of more than five million and an area of 10,452 square kilometres (4,036 sq mi). Beirut is the country’s capital and largest city.

Lebanon is a parliamentary democracy that includes confessionalism. The National Pact, erected in 1943, laid out a governing arrangement intended to harmonize the interests of the country’s major religious groups. The President has to be a Maronite Christian, the Prime Minister a Sunni Muslim, the Speaker of the Parliament a Shi’a Muslim, the Deputy Prime Minister and the Deputy Speaker of Parliament Eastern Orthodox. This system is intended to deter sectarian conflict and to represent fairly the demographic distribution of the 18 recognized religious groups in government.

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

COMMUNITY

Background

Most of the Infant and Family Centered Developmental Care (IFCDC) Standards focus on evidence-based approaches to care of the baby and family while in intensive care. An ever expanding literature provides rationale for promoting the best care environments for the baby’s developing brain, as well as for parents’ physical and emotional adjustment as they transition to parenthood. As babies may spend days, weeks, and sometimes months during a critical time for brain and behavioral organization, an emphasis has been placed on neuroprotective caregiving strategies and environmental protection to enhance medical, developmental, and psychosocial outcomes.

Both neurodevelopmental and physiological research focus primarily on the age range of babies from birth to discharge, typically ending at 40 weeks post-conceptional age, or when the baby goes home. As babies may be discharged at earlier ages than in previous years—when medically stable, but before many neurodevelopmental tasks have been firmly established (e.g., coordinated eating, sleeping, and regulation)– it is important to extend the focus to the weeks and months after discharge when the baby is still in a developmental fast track.

Babies deemed medically stable enough to transition home need appropriate supports for discharge and preparation for life after hospitalization. A growing literature documents best practices for that preparation, assuring a smooth and uncomplicated transition to community services.

Post-discharge visits to the baby’s pediatrician typically focus on medical stability, as is appropriate. However, most follow-up clinic visits, which include developmental assessment and monitoring, may not occur until the baby is 3-6 months of age. Early intervention services in the United States provide developmental assessment and intervention, if appropriate, for those babies who are “categorically eligible” through Part C of the Individuals with Disabilities Education Act (IDEA). https://www.ed.gov/laws-andpolicy/individuals-disabilities/idea.

Each state determines the qualifications for eligibility, often including diagnoses of established conditions that demonstrate evidence of significant developmental delay (e.g., Down syndrome, chromosomal abnormalities, deafblind conditions, etc.). Often, low birthweight is either not included or restricted to birthweight under 1200 grams, which excludes those babies who have been identified as likely to have lingering developmental deficits (e.g., late preterm babies 34-36 weeks post-conceptual age). Part C assessment and follow-up are mandated to occur within a 45-day timeframe. However, many babies are not identified while they are in the hospital and may not be deemed eligible until obvious developmental concerns surface.

Rationale for assuring continuity of developmental and psychosocial supports from hospital to home.

Support for early brain organization during the neonatal period and throughout the first years of a baby’s life is critical for later development. The literature is replete with evidence regarding neurophysiological and behavioral development, as well as an emphasis on the need for appropriate relationship environments to promote optimal outcomes. Emerging evidence of specific brain development during the first few months of a baby’s life (often referred to as “the fourth trimester”) lends emphasis to the importance of not only understanding the enormity of brain development during this period, but also the potential opportunities for creating appropriate environments and caregiving.

The impact of early birth, medical complexities, and associated hospitalizations on brain development and organization indicates that short and long-term neurophysiologic, behavioral, and mental health outcomes are affected. These and many other outcome studies emphasize the need for early, appropriate environmental and developmental protections, as well as individualized care. Given the recent findings regarding the significant brain development and organization during the first three to six months (in addition to development during the last trimester), it becomes apparent that a significant focus should be on effective interventions both before and after discharge.

Brain and behavior development in parents

Brain changes also occur as parents are transitioning to becoming primary caregivers of their new baby. Emerging evidence of neuroendocrine, neurophysiologic, and behavioral changes during pregnancy, delivery, and postpartum indicates that the experience of becoming parents—for both mothers and fathers — has significant implications for later physical and mental health. Fewer studies indicative of brain changes in parents of early born and medically fragile babies are available; however, there are clear associations with parental mental and physical health challenges.

 Punctuated events and recalibration

As babies transition from being fetuses to newborns, there is a significant impact on their brain and behavioral organization. The environment is significantly different, necessitating adaptation from uterine to a maternal caregiving environment. This dramatic change has been referred to as a “punctuated event,” which signifies a significant change in both physiology and behavior, resulting in a period of adaptation and recalibration of behavior.

As previously proposed, a similar punctuated event occurs when the baby transitions from the familiar hospital caregiving environment to the novel home/community environment. (39, 40) It is no wonder that the babies who transition home experience changes in physiology and behavior as a result. Often, medical issues arise, sleep states are disorganized, feeding challenges occur, and previously effective calming strategies seem to be ineffective.  If the parent and baby have not had a chance to experience intimate and consistent caregiving in the hospital, which provides the continuity of a trusting relationship, there can be challenges in the process of recalibration.

Parents also experience significant life-changing events to which they must adapt and recalibrate. Pregnancy to delivery and delivery to parenting represent significant punctuated events that may cause other physiologic and/or mental health concerns to emerge. Most parents of term and medically stable babies have had opportunities to adapt to this change cognitively and psychologically. For parents who have a challenging pregnancy, a difficult delivery, and/or a baby at risk for medical challenges, these punctuated events can raise physiological and psychological challenges to which recalibration is complicated.

As with the transition home for babies, the transition home for parents can be disorganizing and difficult. Parents may not only be dealing with their own physical and/or mental health issues as a result of pregnancy, delivery, and hospitalization of their baby, but with the full-time care and adjustment to care in their own home environment. (48-50) Often, the demands of baby care and selfcare are discrepant, resulting in poor sleeping and eating, lack of exercise and social interactions, and other mental health concerns becoming issues that need to be addressed. Unfortunately, these issues may not be addressed quickly and may persist for the first 3-6 months of the family’s life together at home.

Relationship environments are essential for optimal development.

 One of the most significant influences on babies’ outcomes is the relationship environment with their primary caregiver. Given the significant neurophysiological and behavioral changes that occur in both newborns and their parents during the first few months after delivery, the development of robust and mutually supportive interactions is fraught with a variety of challenges and successes. These are particularly challenging for parents who come to parenting with significant mental health issues, economic and/or cognitive challenges, few social supports, and/or limited educational backgrounds.  Effective interventions have been developed to enhance the parent/baby relationships applied in community settings.

Although effective interventions in communities to promote relationships between parents and their babies have been developed, the application of these programs for parents of medically fragile or early born babies and related research is limited.  Having a hospitalized baby presents challenges to early relationship development. A multitude of medical, psychosocial, environmental, cultural, and systems events can challenge early relationship development. Early separation of baby and parent, postpartum medical issues in the postpartum period, family and job responsibilities, grief reactions and fear, poor communication with professionals, as well as restrictive policies and procedures, are but a few of the interfering variables that can affect robust relationship development. 

The Infant and Family Centered Developmental Care (IFCDC) Standards address continuity from the hospital to the community.

The IFCDC standards emphasize the importance of collaboration with parents to ensure they are well-prepared to support their baby’s development both in the hospital and after discharge. Each NICU system should engage in collaborative efforts among team members, including parents and caregivers.

The focus should promote and ensure parents’ preparation for transition to community resources, which can be accomplished by providing competent and relevant physical, developmental, and psychosocial services throughout the hospital stay and into the community.

The IFCDC standards also emphasize the need for collaboration with follow-up and community providers who will support their families in the weeks and months after hospitalization.

Conclusion:

Continuity during the transition from intensive care to the family’s home and community presents neurophysiological, psychosocial, and behavioral challenges for both babies and their parents. These occur during a particularly vulnerable time, as the last trimester and the first 3-6 months represent a sensitive period of brain, behavior, and relationship development. Interventions in the hospital should focus not only on neurodevelopmental support and environmental protection but should also emphasize parental involvement in preparation for supporting their baby’s development after discharge. As delineated in the IFCDC standards, it is essential for the intensive care community to not only engage parents as team members and prepare them during hospitalization for post-discharge care, but also to ensure continuity of well-prepared community support and medical follow-up. Currently, the kind of intervention that addresses the specific needs of babies and their parents — early and often, during the first 3-6 months —is not consistently practiced in the United States. There is a need for appropriately trained providers who can sensitively and knowledgably address health, development, relationship, and mental health, development, relationship, and mental health issues for vulnerable families during this vulnerable period.                    

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Source: https://www.marchofdimes.org/ways-to-give/donate?utm_campaign=2021advocacy&utm_content=footer&utm_medium=email&utm_source=advocacy

Since 7 October 2023, 47% of attacks on health care – 65 out of 137 – have proven fatal to at least one health worker or patient in Lebanon, as of 21 November 2024.

This is a higher percentage than in any active conflict today across the globe – with nearly half of all attacks on health causing the death of a health worker.

In comparison, the global average is 13.3%, based on the SSA’s figures from 13 countries or territories that reported attacks in the same period, 7 October 2023–18 November 2024 – among them Ukraine, Sudan and the occupied Palestinian territory (oPt). In the case of oPt, 9.6% of the total number of incidents has resulted in the death of at least one medical professional or patient.

According to the SSA, 226 health workers and patients were killed in Lebanon and 199 injured between 7 October 2023 and 18 November 2024.

In the same period, the SSA registered a combined total of 1401 attacks on health in oPt, Lebanon and Israel – 1196 in oPt, 137 in Lebanon and 68 in Israel.

Civilian health care has special protection

“These figures reveal yet again an extremely worrying pattern. It’s unequivocal – depriving civilians of access to lifesaving care and targeting health providers is a breach of international humanitarian law. The law prohibits the use of health facilities for military purposes – and even if that is the case, stringent conditions to taking action against them apply, including a duty to warn and to wait after warning,” said WHO Representative in Lebanon Dr Abdinasir Abubakar.

International humanitarian law states that health workers and facilities should always be protected in armed conflicts and never attacked. Health facilities must not be used for military purposes, and there should be accountability for the misuse of health facilities.

“There need to be consequences for not abiding by international law, and the principles of precaution, distinction and proportionality should always be adhered to. It’s been said before, indiscriminate attacks on health care are a violation of human rights and international law that cannot become the new normal, not in Gaza, not in Lebanon, nowhere,” said WHO Regional Director for the Eastern Mediterranean Dr Hanan Balkhy.

The majority of incidents in Lebanon impact health workers

The majority (68%) of incidents in Lebanon registered by the SSA impacted health personnel, a pattern seen repeatedly in the last few years, including in Gaza in the past year. In Lebanon, roughly 63% affected health transport and 26% affected health facilities.

Attacks on health care hit twice. First, when health workers lose their lives or when a health centre is obliterated, and again in the following weeks and months when the injured can’t be treated, those who are dependent on regular care don’t receive it and when children can’t be immunized. 

“Casualty numbers among health workers of this scope would debilitate any country, not just Lebanon. But what the numbers alone cannot convey is the long-term impact, the treatments for health conditions missed, women and girls prevented from accessing maternal, sexual and reproductive health services, undiagnosed treatable diseases and, ultimately, the lives lost because of the absence of health care. That is the impact that’s hard to quantify,” said Dr Abubakar.

1 in 10 hospitals in Lebanon directly impacted

The greater the blow to the health workforce, the weaker the longer-term ability of a country to recover from a crisis and deliver health care in a post-conflict setting.

Lebanon is a lower middle-income country with a fairly advanced health system that’s been hit hard by multiple crises in recent years. After hostilities in Lebanon escalated in September 2024, the growing number of attacks on health have caused further strain on an already over-burdened system.

Today, the country’s health system is under extreme duress, with 15 out of 153 hospitals having ceased to operate, or only partially functioning. Nabatieh, as an example, one of Lebanon’s 8 governorates, has lost 40% of its hospital bed capacity.

“Attacks on health care of this scale cripple a health system when those whose lives depend on it need it the most. Beyond the loss of life, the death of health workers is a loss of years of investment and a crucial resource to a fragile country going forward,” Dr Balkhy concluded.

So far this year, between 1 January 2024 and 18 November 2024, a total of 1246 attacks on health care were registered globally, in 13 countries or territories, killing 730 health workers and patients and injuring 1255.

Note to editors

The Surveillance System for Attacks on Health Care (SSA), established in 2017 by the World Health Organization, is an independent global monitoring mechanism whose goal is to collect reliable data on attacks on health care and to then identify patterns of violence that inform risk reduction and resilience measures so that health care is protected. The SSA also provides an evidence base for advocacy against attacks on health care.

Source: https://www.who.int/news/item/22-11-2024-lebanon–a-conflict-particularly-destructive-to-health-care

HEALTHCARE PARTNERS

Skin-to-skin care helps newborn babies in many ways – brain development, regulating heart rate and body temperature, and bonding with their caregivers.

When a baby needs to be in the NICU, skin-to-skin care is especially important, but there can be challenges.

The team at Regional One Health’s Sheldon B. Korones Newborn Center is helping address that through an innovative use of existing equipment that helps facilitate skin-to-skin care.

After a baby is born, skin-to-skin contact is a powerful tool to bond with your baby, improve their brain development, and help them regulate their heart rate and body temperature. But when a baby needs to be in the NICU, skin-to-skin care can be more challenging.

“After a routine delivery, moms are encouraged to have skin-to-skin care right away,” said Ajay Talati, MD, medical director at Regional One Health’s Sheldon B. Korones Newborn Center. “If the baby has to go straight to the NICU for treatment, that can’t happen.”

Challenges can remain once a baby is in the NICU, said Kelley Smith, NICU Nursing Manager. If a baby is on an oscillator, a mechanical ventilation device used to help premature or ill infants breathe, they are connected to tubing that has to stay at the same level as their incubator.

“With an oscillator, the tubing is very stiff – it can’t be bent,” Smith explained. “That makes it hard to move the baby into the parents’ arms for skin-to-skin care.”

The NICU team started looking for a solution and found it in an innovative new use for a piece of equipment that is commonly found in other parts of the hospital.

Cardiac chairs are typically used to help cardiac and stroke patients rest in an optimal position. Because the chairs can go up and down, recline, and even lay flat, Smith and Assistant Nursing Manager Heather Burgess saw an opening to use them in the NICU for skin-to-skin care.

“With this chair, we can have the mom or dad sit in the chair and raise the chair to the level of the oscillator’s tubing,” Smith said. “It makes it easier to get the baby out of the incubator.”

Skin-to-skin care helps babies in a number of ways. “After a routine delivery, moms are encouraged to have skin-to-skin care right away,” said Ajay Talati, MD, medical director at Regional One Health’s Sheldon B. Korones Newborn Center. 

A generous Regional One Health Foundation supporter stepped up to donate a cardiac chair to the NICU, and the nursing team is now educating patients about its use and making it available to all families that can benefit. Along with families whose baby is on an oscillator, moms who have had a C-section are finding the chair useful.

“Many moms can’t sit upright for 12 to 24 hours after a C-section, and it can be uncomfortable trying to get in and out of a chair,” Dr. Talati said. “We use it whenever a mom or baby needs it. It’s great for when a baby is too sick to be lowered or when a mom has pain after a C-section.”

Burgess said finding a solution was important to the NICU team because skin-to-skin care has many proven medical benefits for babies and moms.

For the baby, skin-to-skin care helps regulate body temperature, breathing and heart rate and improves brain development, Burgess said. For moms, skin-to-skin can help improve breastmilk production, regulate postpartum hormone balance, and reduce anxiety and stress.

There’s also the matter of bonding, which applies not only to new moms, but to all caregivers.

“We encourage parents to do skin-to-skin care in the first week of their baby’s life, especially for very small, very sick babies,” Smith said. “When you have a baby in the NICU, you’re anxious and afraid, so sometimes parents wait until they go home. That can be a missed opportunity for bonding. The sooner we start skin-to-skin, the better off the family unit will be.”

Dr. Talati, Smith and Burgess have seen the value of skin-to-skin care on multiple occasions.

Moms, dads and other caregivers can all take part in skin-to-skin care. “We encourage parents to do skin-to-skin care in the first week of their baby’s life, especially for very small, very sick babies,” NICU Nursing Manager Kelley Smith said. 

The first mom to use the chair had impressive results. “Her baby came off the oscillator the next day!” Smith said. “It’s amazing to see. We’ll have babies on an oscillator with an oxygen saturation in the low 90s…then they do skin-to-skin and it shoots up to 100!”

Burgess said another mom provided skin-to-skin care in the NICU every day, and it contributed to her baby getting healthy enough to go home much sooner than originally expected.

Dr. Talati said there is plenty of evidence behind those individual experiences. Factors like better milk production and better feeding, the ability to regulate body temperature and heart rate, and increased oxygen saturation can all help a baby get stronger.

“It’s a lot of little things that can add up to the baby making faster progress toward going home,” he said. “We hope it can speed that up and we can help more babies go home sooner.”

Source: https://www.regionalonehealth.org/blog/2025/01/22/nicu-finds-innovative-way-to-facilitate-skin-to-skin-care-helping-families-improve-their-babys-health-and-get-home-sooner/

Have you ever wondered how the Neonatal Resuscitation Program (NRP) guidelines are created—and more importantly, who decides what changes and why? In this episode, we take you behind the scenes of the science and collaboration that shape NRP. From the rigorous evidence review conducted by the International Liaison Committee on Resuscitation (ILCOR) to how these findings are translated into bedside practice, you will learn exactly how research becomes reality. 

Together, Dr. Gary Weiner and Amanda Williams break down the multi-layered process of evidence evaluation, guideline development, and educational translation, while highlighting the critical role nurses play in shaping the NRP used daily. Whether you are new to NRP or a seasoned instructor, this episode will inspire you to see the program through a whole new lens and recognize the power of your voice in shaping neonatal care. 

Discover why NRP is more than a textbook—it is a living, breathing, global collaboration grounded in science and strengthened by the people who use it. 

For the past 10 years, I have worked as a pediatrician and neonatal hospitalist in multiple Level 2 NICUs across Georgia and other states. Over time, I have come to a realization that I cannot ignore: there is a significant public health imperative—and a gap in equitable access—when it comes to developmental and family support services in Level 2 NICUs.

Level 3 and 4 NICUs often have consistent access to lactation consultation, feeding therapy, physical and occupational therapy, and even music therapy. In Level 2 settings, those services are less consistently available—sometimes absent altogether. This discrepancy has a lasting impact on infants and families.

The common perception is that if a baby is born at or after 32 weeks and weighs ≥ 1500 grams—the typical admission criteria for Level 2—that they have “made it.” But research tells a different story. Moderately and late-preterm infants, even those who meet Level 2 thresholds, remain at high risk for readmission, feeding difficulties, developmental delays, and long-term neurodevelopmental challenges (1-4). Prematurity in any form is not a short-term hurdle—it is a lifelong risk factor that requires intentional support from the start.

So, why are we not introducing key developmental concepts, early intervention techniques, and consistent family education into Level 2 NICUs? Why are we not equipping nurses and families with the same foundational knowledge and access to services that higher-level NICUs utilize?

The NICU is not only a place for acute medical stabilization—it is a unique window of opportunity to shape lifelong outcomes. Families in Level 2 units should see themselves as vital participants in their baby’s success and be empowered with the tools to support feeding, bonding, sensory development, and early learning before discharge. Nurses should have access to training that enables them to integrate trauma-informed, developmental care principles into their daily practice, even when an entire therapy team is not available on the unit.

I believe it is time to establish a Task Force on Level 2NICU Care, bringing together neonatologists, neonatal hospitalists, nurses, therapists, public health professionals, and parents, to examine the current state of developmental and family support services in these units, identify barriers, and develop scalable strategies for improvement.

Potential strategies include: • Standardized education for nursing staff on early-intervention techniques, family engagement, and trauma-informed developmental care.

 • Telehealth access to lactation consultants, feeding/ occupational/physical therapists, and other specialists when on-site resources are limited.

• Parent-education toolkits that cover feeding, developmental milestones, safe sleep, and the importance of follow-up and early-intervention services.

• Structured discharge planning that includes referrals to early-intervention programs and developmental follow-up clinics for all eligible infants.

The public-health impact of closing these gaps is profound. If we can equip Level 2 NICUs with consistent developmental care education and tools, we can reduce readmissions, improve neurodevelopmental outcomes, and strengthen families’ ability to support their child’s growth and resilience.

The babies in Level 2 NICUs deserve the same intentional approach to developmental care as those in higher-level units. They may have “made it” past the highest-risk thresholds, but they have not yet crossed the finish line. We can—and must—do better.

Now is the time to act. Clinicians, hospital leaders, and policymakers must collaborate to prioritize Level 2 NICUs in state and national maternal-child health agendas. By identifying service gaps, piloting telehealth and staff-training models, and measuring family-centered outcomes, we can transform Level 2 NICUs from sites of short-term stabilization into launchpads for lifelong development, resilience, and equity.

Source: https://neonatologytoday.net/newsletters/nt-oct25.pdf

INNOVATIONS

Introduction: The huge prevalence of neurodevelopmental disorders underscores the necessity for novel, comprehensive prevention strategies for neuroprotective intervention, particularly in preterm infants. The COVID-19 pandemic has accelerated the transformation of healthcare services, emphasizing the use of digital resources. Given the rapid brain development in infants in the first 1,000 days of life and the demonstrated impact of adaptive neuroplasticity, the implementation of early and ecological interventions are essential for supporting optimal neurodevelopment in this vulnerable population. Aim of this project is to develop a digital tool for parent-led parent-based intervention and assess its feasibility and accessibility.

Materials and methods: We collected evidence on early intervention strategies for preterm infants through a non-systematic review of current literature to develop the platform and created an ad-hoc questionnaire to evaluate the tool’s feasibility and acceptability in our neurological follow-up.

Results: “NE@R” is a digital platform designed to support neurodevelopment through parents-delivered play. The platform offers evidence-based information, videos, and practical activities to enhance motor, cognitive, social, and language development at each developmental phase. We introduce the resource in our clinical setting and collect 100 preterm infants’ families feedback. The majority of parents reported finding the resource beneficial, with many expressing increased confidence in supporting their child’s development.

Discussion: Preterm babies families’ support represents a precious field of intervention both for parents and infants at risk. “NE@R” has proven to be an effective, low-cost tool within our follow-up program, aligning with the principles of family-centered care.

Patricia Odero is an innovation facilitator extraordinaire based in Nairobi, Kenya, working for The Duke Global Health Institute. Patricia is trained in Medicine, Business and Social innovation and uses her skills and experience to help entrepreneurs in West Africa and beyond with funding and growth. She talks about the importance of networks, particularly in health entrepreneurship – long-term relationships and support programmes for organisations of different sizes and stages. Patricia has great advice for entrepreneurs and really interesting stories from the field. You can follow Patricia on Twitter @TrishOdero, BMJ Innovations @bmjinnovations and podcast host Helen Surana @hjsurana.

BMJ innovations is grateful to the World Innovation Summit for Health WISH for making this podcast series possible.

Takeaways

  • Children born preterm were significantly less likely to complete high school or university compared with full-term peers, according to a large Quebec-based study.
  • Non-graduation rates were highest among those born extremely preterm (40.2%) and lowest among full-term births (27.1%).
  • Low maternal education, male sex, unmarried parents, and low neighborhood socioeconomic status were major predictors of poorer academic performance.
  •  The odds of completing high school are reduced among children born preterm vs full-term, according to a recent study published in JAMA Network Open.

Approximately 10% of infants are born preterm, which may cause early exposure to noxious factors and influence brain development, challenging neurodevelopment and mental well-being. Additionally, socioeconomic factors often prevent children from accessing support systems that can mitigate disabilities.

“Few researchers have conducted studies on long-term educational outcomes across the full spectrum of preterm birth using large population-based cohorts that account for other health-related determinants and socioeconomic factors,” wrote investigators.

Assessing preterm birth and education

The birth cohort case-control study was conducted to assess the impacts of preterm birth and sociodemographic factors on educational outcomes. Live preterm births in Quebec, Canada, between January 1, 1976, and December 31, 1995, were included in the analysis.

Each preterm individual was matched with 2 full-term patients, defined as 37- to 42-weeks gestation. Exclusion criteria included multiple pregnancies, triplet births, and death between 1976 and 2019 without Quebec Ministry of Education records.

Extremely preterm birth was defined as under 28 weeks, very preterm as 28 to under 32 weeks, and moderate-to-late preterm as 32 to 37 weeks. Forty-three years of follow-up data was obtained from administrative databases.

High school performance was measured using the final high school average recorded in the Quebec Ministry of Education database, using marks obtained in grades 10 and 11. Covariates included year of birth, birth order, sex, stillbirth history, primary language, matrimonial status at birth, maternal education, and neighborhood socioeconomic status.

Participant characteristics and academic performance

There were 297,820 participants included in the final analysis, 0.6% of whom were born extremely preterm, 4.4% very preterm, 27.9% moderate-to-late preterm, and 67% full-term. Under 11 years of maternal school were reported in 20.6%, 24%, 23%, and 20.3%, respectively.

Preterm birth groups also more often reported primary languages other than French or English, and more recent birth years were reported in those born extremely preterm. Overall, the rate of preterm births in Quebec rose from 4.6% between 1976 and 1980 to 6.1% between 1991 and 1995.

Significant differences were not reported in high school performance based on preterm birth, with final mean scores of 69.4, 70.2, 70.7, and 71 for extremely preterm, very preterm, moderately preterm, and term births, respectively. However, rates of not graduating from high school were 40.2%, 34.4%, 31.1%, and 27.1%, respectively.

This data indicated significantly reduced odds of high school graduation from preterm birth. These patients were also more likely not to graduate from university. Rates included:

  • 83.3% for extremely preterm
  • 80.2% for very preterm
  • 78.2% for moderately preterm
  • 75.8% for full-term

Socioeconomic and demographic influences

In regression analyses, a B coefficient range of 0.15 to 1.45 was reported for the link between preterm status and final high school average. Low maternal education, male sex, low neighborhood socioeconomic status, not being first-born, and mother not married had the most significant B coefficients for low average marks of 4.43, 2.84, 2.30, 2.30, and 1.98, respectively.

These results indicated reduced odds of graduating from high school or university among children born preterm vs their full-term counterparts. Investigators concluded long-term follow-up is needed in both health care and education among individuals born preterm.

This data highlights the importance of preterm birth prediction. Identifying individuals at an increased risk of preterm birth may be more accurate through the use of neighborhood-level indices, according to Daniel L. Kuhr, MD, third-year fellow in maternal fetal medicine at the Icahn School of Medicine at Mount Sinai.

According to Kuhr, an increase in prediction was only noticeable when including individual patient characteristics. This highlights a need to evaluate other social determinants of health that may influence preterm birth risk.

“The best thing that you can do is take a really good history when you meet a patient at the beginning of pregnancy, and really make sure you can get accurate gestational ages of delivery when possible, because we do know that history of a prior spontaneous preterm birth is also a risk factor,” said Kuhr.

Source: https://www.contemporarypediatrics.com/view/preterm-birth-linked-to-reduced-odds-of-high-school-graduation

PREEMIE FAMILY PARTNERS

One of the first things that comes to mind when I think about the holidays is…food. Whether I’m crowded around a dinner table with family and friends or pulling my favorite cranberry and pear pie out of the oven to take to a holiday gathering, there’s something special about breaking bread with the ones you love.

Food, it seems, has a language of its own. In communities across the globe, food has a unique way of bringing people together. And this holiday season, we wanted to help you connect with your friends, family and with the World Relief community by sharing a few recipes from around the world in our new ebook — Breaking Bread Across Borders: Global Recipes from Refugee Kitchens.

https://worldrelief.org/blog-breaking-bread-recipes-around-the-world/DOWNLOAD THE RECIPES!

This ebook is filled with stories and recipes from immigrants who are part of  World Relief Western Washington’s Commercial and Teaching Kitchen — an innovative program that connects members of the community with their immigrant neighbors through workshops and events led by immigrant chefs while providing low-cost commercial kitchen space for immigrant caterers to rent and run their businesses. 

For women like Katya, who owned a bakery when she lived in Ukraine, the commercial and teaching kitchen is a way to bring people joy while pursuing her passion here in the U.S.
“​​I love to bring joy to people with my baking,” Katya said. “You become a piece of people’s special events [when you bake for them]. You become a piece of the joy.”

Source: https://worldrelief.org/blog-breaking-bread-recipes-around-the-world/

ABSTRACT

Background: 

The formation of the family is interrupted following a Neonatal Intensive Care Unit (NICU) admission, and fathers report experiencing delayed infant bonding due to unit barriers and separation. Fathers state comfort with early infant bonding through language, fearing physical contact with the sick newborn. During hospitalization, active engagement supports ongoing infant/parent vocalization and infant stabilization.

Purpose: 

This prospective descriptive pilot study explored the infant’s physiological response to the father’s voice during a live reading activity.

Methods: 

After Institutional Review Board approval and consent, 27 infant/father dyads were observed pre/post and during a live reading activity. All infants were in private rooms and positioned supine in open cribs, adjusted to 36 weeks or greater postmenstrual age, in a 34-bed Level III NICU in the Midwest. Outcome measures included cerebral oxygenation, oxygen saturation, heart rate (HR), and respiratory rate. Infants were monitored for 30 minutes prior to father reading, 10 minutes during and 30 minutes post reading.

Results: 

A clinically significant increase in cerebral oxygenation was noted, based on near-infrared spectroscopy readings in response to the father’s voice. Most infants had HR stabilization during the father’s active reading time frame.

Implications for Practice and Research: 

NICU nurses and staff can encourage a father’s engagement through speaking or reading to their infant. Nursing staff can promote verbal engagement between father–infant dyads by role modeling this behavior at the bedside. NICUs can provide books for families to further encourage exposure to father’s voices. Further study of premature infants at earlier chronological and adjusted ages is needed.

Source:https://journals.lww.com/advancesinneonatalcare/abstract/9900/the_response_of_the_infant_to_the_father_s_voice.231.aspx

About the Study

Anxiety disorders are defined and classified in diagnostic systems like the Diagnostic and Statistical Manual of Mental Disorders (DSM, currently version IV-TR, American Psychiatric Association) and the International Classification of Diseases (ICDS) (ICD, currently version 10, World Health Organization). Many anxiety disorders have clinical aspects across multiple systems, such as high levels of anxiety, physiological anxiety symptoms, and behavioural problems such as severe avoidance of fearful situations, and related discomfort or impairment. However, there are distinctions, and it’s worth noting that narrowly classified anxiety disorders like panic disorder, agoraphobia, and subtypes of certain phobias have a lot of phenotypic variety or heterogeneity.

From time to time, all children have worries and fears. However, anxiety in children can sometimes cross the line to a disorder that prevents them from normal everyday concerns doing the things they need to do. It may even prevent them from properly understanding life.

How do we determine whether the child’s worries and fears are more than just passing thoughts?

Here are a few questions to ponder:

• Do they express fear or anxiety on a regular basis, for weeks at a time?

• Is it difficult for them to sleep at night? Do they seem abnormally drowsy or exhausted during the day?

• Is it difficult for them to concentrate?

• Do they seem angry or easily irritated?

Anxiety disorders can manifest itself in a variety of ways in children. Some of the most common are:

Generalized Anxiety Disorder (GAD)

GAD children are overly concerned about a variety of things, including school, their own safety and health, the health of family members and friends, money, and the security of their families. The list could go on indefinitely. A child suffering from GAD may constantly imagine the worst-case circumstance. These anxieties may induce physical symptoms in children with GAD, such as headaches and stomach-aches. Because they are so burdened by their fears, your child may isolate themselves, avoiding school and friends.

Panic disorder

A panic attack is a sudden, acute experience of worry that occurs for no particular reason. The child’s heart may race, and he or she may be out of breath. The child may have tremors, dizziness, or numbness. (If the child is hyperventilating, encourage them to breathe gently and deeply.) Breathing through a brown paper bag can be beneficial.) Panic disorder is diagnosed when the child has experienced two or more of these episodes and is preoccupied with fears of them happening again.

Separation Anxiety Disorder (SAD)

Separation anxiety affects all children to some extent. It’s a normal developmental stage for babies and toddlers. Even older children, especially in new situations, may become clingy with their parents or caretakers. Separation anxiety disorder may affect older children who become especially upset when leaving a parent or another close relative, who have difficulty calming down after saying goodbye, or who become highly homesick and disturbed when away from home at school, camp.

Social phobia

In typical, everyday social circumstances, a child with social phobia experiences extreme anxiety and self-consciousness. This isn’t just a case of timidity. When talking with classmates, answering a question in class, or doing other common activities that require interacting with people, the socially anxious child is afraid of embarrassing themselves. This fear may prevent your child from attending school and participating in extracurricular activities. In severe instances, young children may even be unable to speak.

These are the type of anxiety disorders and their assessments on the children, to be considered by the parents, and treat their children accordingly.

Source: https://www.omicsonline.org/open-access/the-assessment-of-anxiety-in-children-and-the-types-of-anxiety-disorders-118047.html

✨ December Kindness for Neonatal Womb Warriors ✨

As December arrives—a month shaped by reflection, generosity, and deeper emotions—the Neonatal Womb Warriors community is reminded that kindness is one of the most powerful tools we have for calming fear and nurturing resilience. Many of us began life in fragile circumstances, where uncertainty, hope, and anxiety coexisted side-by-side. Because of that beginning, we understand how small comforts can soothe big worries. The neonatal world teaches us that healing happens moment by moment, and that gentleness, patience, and compassion are essential for helping families and children navigate anxious seasons.

For families with babies in the NICU, the holidays can intensify feelings of overwhelm, isolation, or emotional strain. Parents may carry silent anxiety about outcomes, siblings may sense stress without understanding it, and clinicians may feel the weight of supporting so many families at once. A simple act—sharing a grounding story of your own journey, sending a message of reassurance, offering a listening ear, or just showing presence without expectation—can ease the mental load for someone facing long days beside an incubator. These gestures remind families that they are not alone in managing the fear that often accompanies the NICU experience.

This month, we invite every Womb Warrior to choose a way—large or small—to give back emotionally or practically. Create a comfort bag for parents spending the holidays in the NICU. Donate time to a local children’s charity, NICU support network, or preemie nonprofit. Offer to read aloud or do a calming activity with siblings who may be feeling anxious. Volunteer at a community event that supports vulnerable families, or simply check in on someone who has been quiet. These actions not only lift others but also model for children that kindness is a powerful antidote to anxiety.

The strength of our community lies in its shared empathy—preemie survivors who have lived through uncertainty, NICU families who have learned courage through adversity, and clinicians who bring dedication and steadiness to every fragile moment. When we turn these lived experiences into acts of compassion, we help others feel grounded, less overwhelmed, and more hopeful. Kindness becomes the bridge between anxiety and reassurance, especially during a season that invites us to slow down and connect.

As we move through December, we encourage each of you to commit to one intentional act of kindness each week. Whether it’s offering comfort to a NICU family, expressing gratitude to a clinician, volunteering in your community, or choosing patience with yourself or your child during moments of stress—every act matters. Together, we carry forward the heart of Neonatal Womb Warriors: grounded in hope, strengthened by compassion, and united in helping families and children navigate anxiety with courage and care.

The whatifs/ A book to help kids overcome anxiety/bedtime story

Fun Story Time Kids Mar 30, 2022

What if my dog run away? what if I forget my homework? what if the sun stops shining? What if my crayon breaks? Will Cora be able to change her worry-filled thoughts into hopeful ones? Find out in this timely picture book about overcoming anxiety.