Rank: 92  –Rate:10.2   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Jamaica is an island country situated in the Caribbean Sea. Spanning 10,990 square kilometres (4,240 sq mi) in area, it is the third-largest island of the Greater Antilles and the Caribbean (after Cuba and Hispaniola).[  Jamaica lies about 145 kilometres (90 mi) south of Cuba, and 191 kilometres (119 mi) west of Hispaniola (the island containing the countries of Haiti and the Dominican Republic); the British Overseas Territory of the Cayman Islands lies some 215 kilometres (134 mi) to the north-west.

With 2.9 million people, Jamaica is the third-most populous Anglophone country in the Americas (after the United States and Canada), and the fourth-most populous country in the Caribbean. Kingston is the country’s capital and largest city. The majority of Jamaicans are of Sub-Saharan African ancestry, with significant EuropeanEast Asian (primarily Chinese), IndianLebanese, and mixed-race minorities. Due to a high rate of emigration for work since the 1960s, there is a large Jamaican diaspora, particularly in Canada, the United Kingdom, and the United States. The country has a global influence that belies its small size; it was the birthplace of the Rastafari religion, reggae music (and associated genres such as dubska and dancehall), and it is internationally prominent in sports, most notably cricketsprinting and athletics.

Jamaica is an upper-middle income country with an economy heavily dependent on tourism; it has an average of 4.3 million tourists a year. Politically it is a Commonwealth realm, with Elizabeth II as its queen. Her appointed representative in the country is the Governor-General of Jamaica, an office held by Patrick Allen since 2009. Andrew Holness has served as Prime Minister of Jamaica since March 2016. Jamaica is a parliamentary constitutional monarchy with legislative power vested in the bicameral Parliament of Jamaica, consisting of an appointed Senate and a directly elected House of Representatives.

Healthcare in Jamaica is free to all citizens and legal residents at the public hospitals and clinics. This, in theory, includes the cost of prescribed medication. There are long queues at public health facilities. An audit in 2015 identified shortages of manpower, equipment, medications, wheelchairs, stretchers, gloves, beds, and other essential supplies. 3.3% of the national budget is spent on health services. In Jamaica there are over 330 health centres, 24 public hospitals, the University Hospital of the West Indies, a regional teaching institution partially funded by Regional Governments including Jamaica, 10 private hospitals and over 495 pharmacies. There are around 5,000 public hospital beds and about 200 in the private sector. 


Gov’t to Review Laws That Support Breastfeeding

*** We looked for an update to these actions and did not find formalized and related outcomes in Jamaica  yet related to the article below but the future likely holds support for improvement. This improvement in support for breastfeeding reflects a global need for progressive and related action.


Minister of Health and Wellness, Dr. the Hon. Christopher Tufton, says that stakeholders are being engaged to review and improve national laws that support breastfeeding.

In a message delivered by Public Health Nurse, Debbion Pinnock Harvey, at Westmoreland Public Health Services’ ‘Breastfeeding March and Road Show’ in Darliston on Tuesday (September 17), Dr. Tufton noted that the objective is to create a more enabling environment for mothers to breastfeed in order to improve the health of their babies.

“[This will] also ensure that workers in the informal economy and other vulnerable groups are recognised and protected by national laws. We also encourage employers to implement breastfeeding-friendly workplaces by establishing support facilities such as crèches, breastfeeding rooms and flexible work hours,” he noted.

Dr. Tufton said that the Ministry has spearheaded the development of the National Infant and Young Child Feeding Policy, which has the objective of creating “a sustainable environment that will contribute to a reduction in child mortality and morbidity and improvement in child health and nutrition”.

Meanwhile, the Ministry is encouraging greater family support for lactating mothers as the country marks National Breastfeeding Week 2019 from September 16 to 22.

“Although breastfeeding is the mother’s domain, with close support from fathers, partners, families, workplaces and communities, breastfeeding will improve,” Dr. Tufton said.

Breastfeeding is the responsibility of all, the Minister said. “Wherever you are, you can inform, anchor, engage and galvanise the message of breastfeeding as the fountain of life by raising awareness of the risks and disadvantages of artificial feeding and advocating for greater investment in breastfeeding programmes and policies,” he noted.

The Westmoreland Public Health Services ‘Breastfeeding March and Road Show’ was held under the theme, ‘Empower Parents: Enable Breastfeeding, Now and for the Future!’

The event featured health stakeholders from across the parish, who partnered with parents, schools and the police to make presentations on the benefits of breastfeeding.


Neonatology in Beirut, a Country Ravaged by a Financial, Political and Social Crisis

Carine Abi Gerges, MD – December, 2020

While 2020 has been a difficult year for most people, Lebanon has been particularly hit hard by the turn of the decade. In October 2019, thousands took to the streets to demand the overthrow of a corrupt regime. People protested for months while chanting ‘Kellon yaane kellon’ (All of them means all of them) in reference to the entire ruling class. Political and civil unrest rocked the country against the backdrop of an unprecedented economic and financial crisis: the Lebanese pound plummeted in a free-fall, eventually losing over 80% of its value with local banks imposing strict restrictions on cash withdrawals preventing depositors from accessing both their savings and salaries. The Coronavirus pandemic made matters substantially worse. The final blow, however, was the Beirut Port explosion on August 4th, 2020. One of the largest non-nuclear blasts ever recorded, it left 150+ dead with 6,000+ injured, 300,000+ homeless, and many more forever scarred by the detonation of almost three kilotons of ammonium nitrate neglectfully stored in the heart of the capital. Three months later, someone has yet to be held accountable.

The health sector, buckling under the pressure, was not spared and is barely holding in this untenable situation. Not long ago, Lebanon was the medical capital of the Middle East. In Beirut alone, over ten hospitals are fully equipped with neonatal intensive care units (NICU), serving as a referral hub for rural areas and serving hundreds of thousands of patients. Among the 70,000 babies born in Lebanon annually, 12% (9,000) are born prematurely. Additionally, around 9,000 premature births have been recorded among Syrian refugees since 2015, amounting to a total of at least 18,000 documented premature births per year . All patients require appropriate financial health coverage to support their medical management, very costly for admitted neonates.

 Prior to the financial crisis, less than half of Lebanese citizens had private or semi-public health insurance plans while the remaining half paid out-of-pocket, partly relying on the Ministry of Public Health (MoPH). As an increasing number of previously insured families lost their jobs and consequently their insurance coverage due to the crisis, many more now resort to an already overwhelmed MoPH to cover their hospital fees. However, some hospitals refuse to admit MoPH-covered patients due to years of accumulated unpaid dues from the government. Soon, only the upper class will be able to afford the estimated $30,000 in costs for the care of a premature baby.

The cost of NICU hospitalization depends on whether the hospital is public or private, as well as the baby’s condition. While most of Beirut’s patients are admitted with frequently encountered cases such as prematurity, hyaline membrane disease, necrotizing enterocolitis, and neonatal sepsis, some infants transferred from peripheral hospitals require acute care for rare metabolic and genetic diseases. Although not studied in this specific context, rural areas have a higher prevalence of births with inborn errors of metabolism, likely due to more frequent consanguineous marriage. With the population in these areas being largely working class, access to high-quality neonatal intensive care is particularly challenging, the crisis making it even worse.

Dany al-Hamod, the director of the NICU at Saint George Hospital University Medical Center (SGHUMC), describes a substantial increase in the number of families unable to afford hospital bills recently, forcing them to run from one non-governmental organization (NGO) to another to gather funds to avoid having to move their child to different facilities, or worse. The situation is even more dire for refugees. Lebanese is host to the second-largest Syrian refugee population and third largest Palestinian refugee population in the world. This population has increased in the last few years, partly due to the influx of over45,000 ‘twice-refugee’ Palestinians, once settled in Syria, fleeing to Lebanon to escape the civil war . Unable to be employed as a result of their refugee status, most do not have access to either public or private health coverage. Instead, they depend on humanitarian organizations to cover their healthcare needs, namely the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioners for Refugees (UNHCR). These organizations have been essential to the survival of many newborns in this population, especially that they suffer a higher prevalence of neonatal complications due to inconsistent prenatal care, as well as higher rates of consanguinity . These organizations rely entirely on donations and grants, and their ability to cater to their beneficiaries has been severely impacted after the donations they depended on contracted as a result of the ongoing global economic crisis. The severe financial situation that the UNRWA is currently facing threatens millions of refugees and further limits their already minimal healthcare access .

The Carlos Slim Center for Children in the Beirut Governmental University Hospital (BGUH – Karantina) was renovated in 2016 by the NGO ASSAMEH – Birth and Beyond through multiple local and international donations, building the first fully-equipped public NICU. This center’s importance lies in its readiness to “care for those no one cares for.” While only 70% of admitted children are eligible for MoPH-coverage (10), specialized care at this public hospital is provided indiscriminately. Since 2017, six babies found in trash bins and more than twenty-two “undocumented” children have been taken in and treated by the Karantina team (2). Adding fuel to the fire, this center was heavily damaged by the Beirut Port explosion, nearing total collapse. Inside their incubators, babies sheltered from the debris were evacuated within 3 hours. “An apocalypse — one minute was worse than 20 years of war,” says Robert Sacy, head of the Pediatrics Department at the hospital and president of ASSAMEH – Birth and Beyond. What was once a haven for over 1,000 children per year has now been nearly razed to the ground. The remains of paintings of trees, suns, and smiles are now covered with blood on the few walls still standing. What was once joyful is now contaminated with death.

Making matters worse, a surge in the number of cases and ICUs at nearly full capacity, some project that the country might be heading towards an Italy-like scenario if serious long-term precautions measures are not implemented. The daily positivity rate fluctuates between 10 and 20%, and the death toll is 970+ since February 2020. The pandemic appears to be mostly affecting adults, with the case-fatality of children under nine years of age at 0.05% and only one recorded death(7).

Although it has been speculated that neonates, due to their immature respiratory physiology and the immune system, might be at a higher risk for COVID-19 related complications, a review of the literature shows no increased risk of severe disease in infected neonates. Conversely, Martin Filho et al. raised concern about how a cytokine storm in pregnant mothers might increase the likelihood of poor neonatal neurodevelopmental outcomes (6). Associate professor of Neonatology at the American University of Beirut Medical Center (AUBMC), Lama Charafeddine, denied that the pandemic had had any noticeable immediate effects on the rate of perinatal complications or congenital malformations or infections. She did contend, however, that it is too early to draw any conclusions regarding this matter. While COVID-19 does not significantly affect the neonatal and pediatric population, Antoine Yazbeck, head of Neonatology at Serhal Hospital, reports a drop in the overall quality of care and staff morale due to increasing physician burnout. Indeed, as of early November, numbers from the doctors’ syndicate and the order of nurses (5) show that a total of three doctors had died and seventeen admitted to intensive care units, with more than one hundred having been put under home quarantine and over 1,500 nurses having been infected. The pandemic has significantly affected the pediatric healthcare system’s overall capacity, draining it in such that neonatal care is becoming severely compromised.

For physicians around the world, and particularly in Lebanon, working conditions have become increasingly difficult. “We see 4-5 kids per day, on a good day”, reports Yazbeck, who has reported a ten-fold decrease in daily patient attendance to his clinic. Indeed, the pandemic has led many parents – those who have not migrated yet – to opt-out of vaccination programs and avoid routine follow-ups out of fear of exposure. Additionally, due to currency devaluation, consultation fees, still generally fixed at the same price in Lebanese pounds, are much less profitable to the physician (dropping from the equivalent of $60/patient to less than $12/ patient) while still being largely unaffordable for the larger patient population. Maroun Matar, head of the Neonatology Department at Lebanese American University Medical Center (LAUMC), also describes an 80% decrease in his monthly income despite raising his clinic fees by 10% whilst food products and basic necessities witness an inflation rate of more than 400% (3) and half the population is now under the poverty line. Highly qualified and trained physicians, overworked and underpaid, have decided to immigrate for better opportunities abroad. Indeed, over 400 physicians have immigrated in the last couple of months, with more expected to follow suit (8). This has pushed government officials to seek international aid to incentivize doctors to stay in the country by offering financial compensation (8). This exodus of physicians and the shortage of medications and medical equipment (hospital suppliers demanding to be paid in hard currency, largely unavailable on the market) has significantly reduced the quality of healthcare in Beirut, once a regional health hub in the Middle East.

It is crucial to bring to light the difficulties encountered by healthcare workers in developing countries to identify the various factors affecting the quality of care offered to patients. The pandemic has highlighted wide disparities and brought to the fore existing inequalities in developed countries, exposing the need to fill large healthcare delivery gaps to marginalized communities. In a country like Lebanon, shaken by financial precariousness, famine, civil unrest, a large explosion, a mass exodus, and a global pandemic, these disparities have become even more apparent and alarming. This eventful year has highlighted the lack of a national emergency preparedness plan, inadequate infection prevention and control practices, and the absence of an effective healthcare safety net for the uninsured in Lebanon. It is crucial to address these deficiencies for a better-equipped healthcare system in the face of the next blow in order to be able to, at least, give the newborns the gift of time.


Infant who survived in 1920s sideshow incubator dies at 96


Dr.Martin Couney, left, and an identified woman looking at a baby in an incubator

New York Public Library

MINEOLA, N.Y. — Lucille Conlin Horn weighed barely two pounds when she was born, a perilous size for any infant, especially in 1920. Doctors told her parents to hold off on a funeral for her twin sister who had died at birth, expecting she too would soon be gone.

But her life spanned nearly a century after her parents put their faith in a sideshow doctor at Coney Island who put babies on display in incubators to fund his research to keep them alive.

The Brooklyn-born woman who later moved to Long Island, New York, died Feb. 11 at age 96, according to the Hungerford & Clark Funeral Home. She had been suffering from Alzheimer’s disease.

Horn was among thousands of premature babies who were treated in the early 20th century by Dr. Martin Couney. He was a pioneer in the use of incubators who sought acceptance for the technology by showing it off on carnival midways, fairs and other public venues. He never accepted money from their parents, but instead charged oglers admission to see the tiny infants struggling for life.

Horn and her twin were born prematurely in Brooklyn. She told The Associated Press in a 2015 interview that when her sister died, doctors told her father to hold off on a funeral because tiny Lucille, would not survive the day.

“He said, ‘Well that’s impossible, she’s alive now. We have to do something for her,’” Horn said. “My father wrapped me in a towel and took me in a cab to the incubator; I went to Dr. Couney. I stayed with him quite a few days; almost five months.”

Couney, who died in 1950 and is viewed today as a pioneer in neonatology, estimated that he successfully kept alive about 7,500 of the 8,500 children that were taken to his “baby farm” at the Coney Island boardwalk. They remained there until the early 1940s, when the incubators became widely used in hospitals.

He also put infants on display at the World’s Fair and other public venues during his career. There is no estimate on how many still are alive today.

Horn worked as a crossing guard and then as a legal secretary for her husband. She is survived by three daughters and two sons. She said she met Couney when she was about 19 and thanked him for what he had done.

“I’ve had a good life,” she said in 2015.

After a funeral Tuesday, she was buried at the Cemetery of the Evergreens in Brooklyn, next to her twin sister.


Disaster Preparedness in Neonatal Intensive Care Units

Wanda D. Barfield, Steven E. Krug, COMMITTEE ON FETUS AND NEWBORN and DISASTER PREPAREDNESS ADVISORY COUNCIL – Pediatrics May 2017, 139 (5) e20170507; DOI:


Disasters disproportionally affect vulnerable, technology-dependent people, including preterm and critically ill newborn infants. It is important for health care providers to be aware of and prepared for the potential consequences of disasters for the NICU. Neonatal intensive care personnel can provide specialized expertise for their hospital, community, and regional emergency preparedness plans and can help develop institutional surge capacity for mass critical care, including equipment, medications, personnel, and facility resources.


Model of decision-making based on available supplies: example using respiratory support. The figure shows a model of decision-making based on available supplies, personnel, patient acuity, and surge capacity for pediatric EMCC. CPAP, continuous positive airway pressure; ECMO, extracorporeal membrane oxygenation. Reproduced with permission from Bohn D, Kanter RK, Burns J, Barfield WD, Kissoon N. Supplies and equipment for pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12(suppl 6):S120–S127. Copyright © 2011 Wolters Kluwer Health.


Infants in the NICU are highly vulnerable in a disaster because of their need for specialized and highly technical support. As such, NICU preparedness is required for optimal disaster response.

  1. Preparation before a disaster event is critical to optimizing outcomes of NICU patients during public health emergencies and disasters. Health care institutions and providers are strongly encouraged to know and prepare for the most likely disaster scenarios in their communities (eg, hurricane, earthquake, or flood) and also to consider unanticipated events (eg, bioterrorism) that could create a mass casualty event and similarly affect surge capacity and capabilities.
  2. It is important for NICU teams to fully participate in the emergency- and disaster-planning activities of their facility, health care system, or regional, state, and local emergency management agency. Teams should be part of the periodic disaster simulation drills that are now required in every hospital. NICU teams should actively participate in the design of hospital drills to address the unique needs of NICU patients in situations involving “shelter-in-place,” relocation, and/or evacuation. The use of an incident command structure within the NICU, facility, and community is important to maintain structure and an organized response.
  3. Neonatal care systems (providers, administration, information technology, and equipment) can develop appropriate staffing support for safe and effective operations during disasters. NICU care providers, in collaboration with their hospital facility, community practitioners, network, and region, need to identify the surge capacity to provide 3 times the baseline critical care resources and sustain this for 10 days during a major public health disaster. An effective response to specific disaster threats, including maintenance of adequate surge capacity, relies on sufficient supplies of age- and size-appropriate MCMs.
  4. During a disaster, neonatal care providers can maintain situational awareness for decision-making, including patient volume and severity of illness, available equipment, medication, and staffing, transport, evacuation, recovery, and crisis standards of care. Maintaining flexibility is important in adjusting to new situations. Advance planning and coordination with local and state public health and emergency management agencies will additionally support situational awareness and timely decision-making. A process of ethical decision-making and altered standards of care needs to be included in disaster planning.
  5. In addition to the needs of patients, NICU providers may need to consider the medical and psychosocial needs of postpartum mothers and families. To the extent it is feasible, parents and families should remain in contact with patients. Families may have unique needs and/or require assistance in unusual ways during a large-scale disaster. In addition, plans should be made to recognize and respond to the needs of NICU staff, including self-care and support.
  6. Although some guidance in this report is based on systematic reviews (eg, H1N1 and mass critical care), much is based on lessons learned from previous disaster events. Preparedness is an ongoing process that changes on the basis of learned experience and evidence. NICU providers should continue to research best practices, neonatal medications and dosing, and the effects of altered standards of care in disasters.


*** Our Neonatal Womb Warrior Family and global Maternal and Child health at large are substantially and increasingly affected by the direct effects and challenges climate change and natural disasters invoke on our communities. We are closely exploring these issues and the opportunities offered towards supporting positive change/response to these changes.  Education remains foundationally essential towards formulating progressive strategies to interact with the challenges climate change and natural disasters offer. Like the Covid pandemic, physical borders cannot prevent local impacts of increased levels of climate change and natural disasters; and global collaboration towards addressing the associated needs through targeted and effective action in relationship to these elements is vitally essential.

Natural disasters are occurring more frequently with increased ferocity, UN says

  1. Extreme weather events are occurring more often, experts have warned.
  2. In the last 20 years, 7,348 major disaster events were recorded globally, claiming 1.23 million lives.
  3. These events cost $2.97 trillion in economic losses with 8 out of the 10 most-affected countries in Asia.

Extreme weather events have increased dramatically in the past 20 years, taking a heavy human and economic toll worldwide, and are likely to wreak further havoc, the United Nations warned.

Heatwaves and droughts will pose the greatest threat in the next decade, as temperatures continue to rise due to heat-trapping gases, experts said.

China (577) and the United States (467) recorded the highest number of disaster events from 2000 to 2019, followed by India (321), the Philippines (304) and Indonesia (278), the U.N. said in a report issued the day before the International Day for Disaster Risk Reduction. Eight of the top 10 countries are in Asia.

Some 7,348 major disaster events were recorded globally, claiming 1.23 million lives, affecting 4.2 billion people and causing $2.97 trillion in economic losses during the two-decade period.

Drought, floods, earthquakes, tsunamis, wildfires and extreme temperature events caused major damage.

“The good news is that more lives have been saved but the bad news is that more people are being affected by the expanding climate emergency,” Mami Mizutori, the U.N. Secretary-General’s Special Representative for Disaster Risk Reduction, told a news briefing.


This chart shows how much more common natural disasters are becoming


Your Premature Baby’s Development and Medical Follow-Ups

by  Sara Novak    Medically Reviewed by Lauren Crosby, M.D., F.A.A.P. on

March 3, 2020

When it comes to premature babies’ development, parents need a big dose of patience. Thankfully, most preemies catch up with the full-term crowd by toddlerhood.

Premature babies are born weeks and sometimes months before their actual due date, often before their nervous systems have fully developed. As a result, they can fall behind full-term babies after they’re born. That doesn’t mean that they won’t develop into perfectly normal and healthy kids, but it does mean that their timelines can be a little different from those of full-term babies.

How will my preemie’s development differ from that of full-term babies? Premature babies develop at a different rate than other babies, and just because your child has passed her due date doesn’t mean she’s all caught up.

Calculate her corrected age. When you’re considering your premature baby’s development it’s important to consider not just the day she was born, but also the original date she was supposed to be born. Calculating your baby’s corrected age can give you a more accurate understanding of whether she is developing at pace. For example, if your baby is 6 months old, subtract the number of weeks your baby was preterm in order to figure out her corrected age. This means that you can’t expect a 6-month-old preterm baby to sit up at the same time a 6-month-old full-term baby would, because they aren’t the same age developmentally. This “corrected age” is used during the first two years of life. By the time premature children are 2 years old, most have caught up on their milestones (so you won’t need to continue to recalculate your little one’s age).

Fine and gross motor skills could take longer. Preemies often take a little extra time to develop both gross- and fine-motor skills and hit baby and toddler milestones such as rolling over, sitting up and taking that first step. Later on, preemies are more likely than full-termers to have learning disabilities, so being aware of what’s normal and what’s not is vital to getting her the help she needs as soon as possible.

Worry less about dates and more about progress. Full-term babies are more likely to be tied to timelines when compared to preemies. With premature babies there’s less of an emphasis on timelines and more on ensuring they are progressing — from pulling up to standing to walking.

What medical follow-ups will I need for my premature baby

First and foremost, keep in regular contact with your baby’s pediatrician. That doctor will be seeing your baby for years to come, so it’s important to involve him or her from the start, even if you’re taking your child to other specialists.

  1. Make an appointment for a checkup soon after your baby’s release from the hospital. Most doctors will want to see a preemie within a day or two of homecoming. That way, your practitioner can get baseline readings on your premature baby’s weight and general health in order to keep close tabs on him. Note: Make sure you have a discharge summary from the neonatal intensive care unit (NICU), along with a record of your baby’s immunizations in the hospital.
  2. Schedule dental exams. Premature babies are more likely to suffer from delayed tooth growth and discolored teeth. Schedule your baby’s first dental exam either when your baby sprouts a tooth or when he turns 1.

Other tips on how to handle your premature baby’s development: Of course, it’s easier said than done, but try not to make your baby’s prematurity the only thing you think about. Enjoy and appreciate her for the amazing little person she is — and not as you would a delicate piece of china. It might help to remember these tips:

  1. Whatever she’s going through might have nothing to do with prematurity. When you’re parenting a preemie, it’s easy to attribute every small bump in the road to your baby’s premature status. But sometimes a baby’s cold is just a cold. And maybe she’s colicky because she’s got colic, not because she was born early.
  2. Follow your gut. No one knows your baby better than you. If something isn’t quite right, you’re most likely going to be the one to notice first, so don’t underestimate your intuition. Talk to your doctor if something seems off.

You’ve already been on a roller coaster of emotions waiting round the clock for the newest member of your family to finally be released from the hospital. It can be easy to transition that stress to your preemie’s development at home. Patience is a virtue that can’t be underestimated when it comes to your preemie’s development. And don’t worry: She’s going to catch up before you know it!


The NICU Doc Who Works in the NICU and Surrounds Your Baby -Jun 26, 2020

Wanna know who are all the people who surround your baby in the NICU? Want to know who are all the people that work in the NICU? It takes a village to take care of babies. In the NICU, there are medical students, residents, fellows, nurses, neonatal nurse practitioners, neonatologists, and many more. In this video, you can find out all the different people in the neonatal intensive care unit. And in the end, you will learn about someone you would not expect to find in the NICU.

For Family and Friends

Being a parent of an infant in the Neonatal Intensive Care Unit (NICU) is very different than having a newborn at home. When you have a newborn you are trying to squeeze tasks in around their changing, feeding and sleeping schedule. When your child is in the NICU, household tasks get crammed into the brief periods between sleeping, pumping, sterilizing, working, perhaps eating and trips to the NICU. If you are lucky, you have a short trip to the hospital and are able to return home easily, but that often means you are getting home in the wee hours of the morning. If you live further away, you may end up seeking out overnight accommodations.

Regardless of your proximity to the hospital, all parents have one thing in common; they are barely home and when they are at home they are physically and mentally exhausted.

Many people offer help to parents of infants in the NICU by saying “Let me know if you need some help”. This is great and lets the parents know they are not alone. The problem is that parents are often reluctant to admit they need help, or they just don’t know what help they need. The best thing you can do is to make a specific offer to help them. Parents, you just need to accept those offers.

If you are not sure of what things you can do to help here are some ideas:

  1. If they have other children, pets or aging parents, offer to take care of them.
  2. Make them a home cooked meal in a container they don’t have to wash and return to you.
  3. Arrange to drop by and help with the housework.
  4. Offer to pick up their laundry and return it washed and folded.
  5. Help with the house, cut the lawn, shovel the driveway, and/or make the house look lived in.
  6. Pick up their mail and sort addressed mail from unaddressed mail so they can quickly look at bills and important items.
  7. Do some grocery shopping for them.
  8. Ask them “What can I do to help you ? “
  9. Drive parents back and forth to the hospital.
  10. Respect the parents’ wishes about how they want to mark the birth. Some may wish to celebrate. Others may want to wait until the baby is home. It is for the parents to decide and for you to support their wishes.
  11. Learn about prematurity, but don’t feel the need to share what you’re learning with the parents. Be careful about what resources you use, especially if you’re researching online.
  12. Try not to be offended if parents exclude you temporarily. The NICU can be difficult and some people turn inwards in order to cope.
  13. Shop for necessities when the baby is discharged from the hospital.
  14. Respect the rules of the NICU. Don’t visit if you’re sick or if people close to you are sick.
  15. Respect the privacy of other parents and their babies.
  16. Offer to communicate with other family and friends so that the parents don’t have to spend all their time updating everyone.
  17. Coordinate other offers of help so that the parents don’t need to organize who does what.
  18. Resist the urge to compare the new baby with other babies. Please don’t make comments on size or weight, and please don’t talk about other birth experiences unless you have personal experience as a parent of a premature baby.
  19. Keep offering help when the baby is home. The first few months can be isolating and difficult and parents can really use continued assistance.
  20. When a baby goes home, remember that preemies, especially during the winter months, are at risk for infections and sickness. Never visit the parents and baby at home if you’re sick, and respect their wish to keep their baby healthy. They are not being over-protective. They are being good parents.

These things will help to relieve the pressure that they are under and allow them to focus on caring for their child.

Note: these points are also things that would be appreciated by any new parent or anyone with a critically ill family member.


Life After The NICU | Meet Dr. Nathalie Maitre,

Dr. Nathalie Maitre is a neonatologist and developmental specialist who is the Director of the NICU Follow-up Program and NICU Music Therapy Program at Nationwide Children’s Hospital. She works with a diverse team of scientists, engineers and therapists who all believe strongly in the need to identify children at high-risk for disabilities as early as possible, in order to optimize recovery after the neonatal period.

Break Time for Nursing Mothers

Federal law (USA) requires employers to provide reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express the milk (Section 7 of the FLSA). Employers are also required to provide a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.

General Guidance

  1. WHD Fact Sheet #73, Break Time for Nursing Mothers under the FLSA (Spanish Version)
  2. Break Time for Nursing Mothers Frequently Asked Questions (FAQs)
  3. Break Time for Nursing Mothers under the FLSA (Microsoft® PowerPoint®)
  4. Break Time for Nursing Mothers Poster (Spanish)
  5. Break Time for Nursing Mothers Employee Rights Card
  6. FLSA Handy Reference Guide
  7. How to File a Complaint



Panelists discuss how to manage wellness during pandemic winter

Trisha Korioth    Staff Writer    December 02, 2020   Pediatrician Wellness

Be honest. How much time are you spending on self-care right now? For many pediatricians, the answer is “Not enough.”

To be effective in practice, pediatricians must take care of themselves, according to panelists at an AAP town hall, Physician Resilience in the Time of COVID-19.

Anne R. Edwards, M.D., FAAP, AAP chief population health officer, led panelists in a discussion on how to address high stress levels, communicate and connect, give and get help, replenish resilience and maintain a growth mindset.

Connect with others

The pandemic has caused patient volume to drop and forced practices into new routines. Robert J. Riewerts, M.D., FAAP, of Southern California Permanente Medical Group and KP Care Management Institute, noted a silver lining. Phone time at his practice increased from between 3% and 7% to about 40% as pediatricians reached out to check in on patients and families.

Early in the pandemic, Dr. Riewerts’ group also arranged weekly discussions with expert to allay concerns about the virus. Pediatricians unaccustomed to seeking support from colleagues were encouraged to reach outside their comfort zone.

“This year, physicians are being stretched to the limits in all kinds of specialties,” he said. Supporting one another can help pediatricians model a positive example for their patients.

Routine team check-ins can build support within practices and hospitals, according to Riva Kamat, M.D., FAAP, co-lead of the AAP Section on Hospital Medicine Subcommittee on Provider Wellness and a hospitalist at Inova Fairfax Hospital for Children.

Dr. Kamat suggests asking colleagues if they are feeling stressed. “Then let them, what I call, ‘slime you.’ Let them share what’s bothering them.”

Because most problems cannot be solved in one vent session, Dr. Kamat said it is important to stay connected with the person. She asks colleagues how they would like her to check in again, such as by text or a phone call. Her institution also uses accountability partners to ensure people are taking care of themselves.

COVID-19 has isolated us in every way, said Melanie L. Brown, M.D., M.S.E., FAAP, chair of the AAP Section on Integrative Medicine Executive Committee and member of the Wellness Advisory Group. But that shouldn’t stop pediatricians from maintaining connections. This can be done locally or through AAP connections such as Extension for Community Healthcare Outcomes groups, collaboration sites and COVID-19 discussion boards ( login required).

“Being able to find connections with other like-minded colleagues, you’re also modeling for other people the importance of them also finding connections,” she said.

Refuel resilience

The dark days of winter can be challenging for many, which is why pediatricians should take time to figure out what refuels their resilience and identify barriers preventing them from replenishing it, said Christine Moutier, M.D., chief medical officer, American Foundation for Suicide Prevention.

“Sometimes, we react in ways that we are pleased with and other days we don’t. We don’t have to feel like that is fate,” she said. “We can actually make small tweaks that allow us to have whatever that substance is, that reservoir of resilience, that will allow us to keep drawing from that moment by moment.”

Ideas include meditating, journaling, exercising, getting outdoors and confiding with like-minded colleagues.

Dr. Moutier also cautions not to make major life decisions when extremely stressed. Pediatricians should be aware of tendencies toward anxiety or depression, shed stigmas and be proactive.

Manage your mindset

When stress reaches a boiling point, Dr. Moutier suggests trying the “Put It In Perspective” approach to redirect thoughts from irrational to rational. The approach, developed by Martin E.P. Seligman, director, University of Pennsylvania Positive Psychology Center, includes four steps:

  1. Ask yourself: What is the worst possible situation?
  2. Force yourself to think about the best outcome.
  3. Then consider what is most likely to happen.
  4. Finally, develop a plan for the most realistic scenario.

When problems fester, Dr. Moutier said, “Give yourself the gift of just a moment of time that’s set aside to work that through. Any time and effort we spend on that is going to bear fruit for us.”

Dr. Brown added, “Taking care of yourself is not selfish. It’s what’s needed in order for you to go out and then care for others.”


  1. Connecting with the Experts: A COVID-19 Townhall Series
  2. AAP Physician Health and Wellness webpage
  3. American Medical Association’s Steps Forward series


Life of a COVID-19 Nurse at Harborview’s ICU | UW Medicine

UW Medicine

Working 84-hour weeks. Isolating from children and partners. Comforting patients who are dying alone. Tending to a beloved teammate’s battle with a life-threatening illness. At Harborview Medical Center’s COVID-19 ICU, these are the new challenges that nurses take on every day during the coronavirus pandemic. Despite the stress and uncertainty, they find strength in the importance of their work. “I knew what I was getting into, and I chose it,” one nurse explains. “I was meant to be a nurse.”

 *** The pandemic has hit our healthcare provider community/workforce, already globally experiencing a severe provider shortage crisis, hard and will significantly set back the development of new providers available to care for our extensive family members. The road to becoming a  physician, nurse and within so many related healthcare provider specialties is often a very long hard journey, now expanded in length (months to years) due in part to a shortage of clinical opportunities to train. Please support our global healthcare community. Lives depend on it!

Still Want to Be a Doctor Post COVID-19?

How the pandemic could influence the next generation of healthcare professionals

by Jessica Gold, MD, and David Rettew, MD May 4, 2020

Every applicant to medical school has to write a personal statement. It does not have a prompt, but the understood question has always been, “Why do you want to be a doctor?”

Being a physician has always been considered a noble and honorable profession, but ever since COVID-19, physicians, along with the nurses and other healthcare professionals working on the front lines, have become bona fide heroes. The public now sees these courageous men and women risking their lives for others (sometimes without the protective equipment they need) while isolating themselves from their own families to do so.

In photos, their battle-tested faces reveal compassion and fatigue, but, perhaps more than anything, resolve. These pictures and the accounts that come with them have commanded respect and admiration, and have elevated medical professionals to new heights.

But with this adulation has come an enormous cost. As of last month, more than 200 doctors and nurses across the world have died from the novel coronavirus. Such grim numbers have shocked both the public and those already in or considering a career in healthcare. Yes, these careers involve hard work, life or death levels of responsibility, and many stressful situations, but actual danger — that’s only been there in the fine print and has been mostly avoidable for those wishing to do so, at least for those practicing in the U.S.

Until now.

In New York City hospitals and other places that have treated high numbers of COVID-19 patients, many doctors who might have reasonably believed that their career paths would have circumvented close contact with deadly viruses are finding themselves being called into action. Psychiatry residents are working in ICUs, and outpatient primary care doctors are getting enlisted to staff overflow units and field hospitals. For more risk-averse people thinking that being a physician was a cerebral and predictable line of work, it may be time to look elsewhere.

According to the Association of American Medical Colleges (AAMC), the number of applicants to medical school has been a roller coaster over the past 40 years. Since about 2003, however, there has been a steady increase in numbers. The current rise in applicants has occurred through both economic booms and recessions and has occurred despite what many have observed as an erosion in the level of trust and prestige afforded to physicians due to factors such as ties to the pharmaceutical industry and the public’s increasing attraction to “alternative” types of treatment. This rediscovered respect for doctors could make the number of applicants rise even more steeply, but there’s certainly no guarantee.

“I think with COVID-19, we just don’t know,” says Geoffrey Young, PhD, who is the AAMC’s senior director of Student Affairs and Programs and has worked on three medical school admission committees. He does not, however, predict that the current pandemic will scare off a significant amount of applicants as many applicants “at their core, have a service orientation” and “have a desire to have a positive impact on the environment around them,” he said.

For these individuals, “it’s not just a profession, it’s a calling,” Young said, noting that he wonders if there well could be an influx of medical school applications similar to the increase of people joining the armed forces after 9/11. This makes sense, as physicians have, especially lately, often been compared to soldiers, with their healthcare workspaces likened to battlefields.

On social media, a number of actual and future medical students have weighed in on this conversation. The opinions are expectedly mixed, but the majority view the pandemic as a reason to enter medicine if mostly to become an advocate for changing the system.

For example, one medical student in emergency medicine (EM) wrote, “Perhaps this reflects my bias, as someone aspiring to EM, but I feel like this is going to inspire a lot of people. Particularly people who know things could have gone better, need to go better, and want to work on making that possible.”

Another first-year medical student agreed, stating that “the next generation of doctors … tend to be enraged by the status quo. If they had an existing predilection to medicine, they’ll be even more enticed because of the opportunity for radical change.” A third-year in New York added, “I know we all see an issue and think we can change it, but this really is unprecedented and if this isn’t time to try to push the field in the right direction idk what is.”

A few premedical undergraduate students agreed, voicing that their interest and desire to go into medicine had increased as a result of COVID-19. One noted, “This has motivated me even more to be a doctor — we clearly need more physician-activists and more healthcare workers in positions of power.” A mom of a 16-year-old interested in medicine contributed by stating, “My 16-year-old daughter has always flip-flopped on [the] idea of going into medicine (infectious disease specifically) & she is now more energized & feels more sure this is what she wants to do. (I realize she’s 16 & may change, but…) I think it feels more meaningful now than ever.”

One physician poignantly wrote on Twitter, “My hope is that the outpouring of support will restore the feelings of the honorable profession that it is, rather than having people feel like replaceable worker bees. More inspiration, less desperation. One thing[s] for sure — expect change.”

Some, however, have begun to question their specialty choice or motivation for medicine altogether. A fourth-year medical student wrote, “I can imagine the numbers for Emed and IM going down for the next few years, people are naturally going to want to avoid the frontlines. Also, this might affect applications to med school as a whole. These are unprecedented times and people are rightfully spooked …Fear drives people’s actions more than anything else. Also, who wants to be in a position where you’re begging your employer for proper gear, and might be reprimanded for speaking out.”

A third-year added, “It was discouraging for ME (and I’m an MS3!) to see the mistreatment of my future colleagues … I think this will discourage those who are in it for monetary reasons or familial pressure but fuel the flame for those w/humanitarian goals.”

The last comment speaks to the possibility that while the number of applicants may not vary significantly due to the pandemic, the characteristics of those applicants will. While applicants to healthcare professions are hardly monolithic when it comes to their personality or motivations, a study in PLoS One from 2016 found that most medical students fit one of two personality profiles. One was labeled “resilient” and described students who were vigorous and industrious but a bit more on the materialistic side. The other was labeled “conscientious” and included those with higher levels of anxiety.

People with either of these profiles could get pulled in different directions when it comes to how attractive a career in medicine appears post-COVID-19. Noted personality researcher and psychiatrist Robert Cloninger, MD, PhD, who was the senior author of this study, speculates that those with the resilient profile may be “more likely to risk a dangerous job” but are also “unlikely to do things involving sacrifice for others.”

The second profile, by contrast, could be further inspired by the pandemic to help others but more concerned about their own safety. Putting it all together, it would certainly be reasonable to expect a decrease in applicants looking for secure and safe ways to make a good living and an increase in those who, as they say, like to run towards the fire.

Of course, there’s nothing wrong with the applicant pool we already have, who tend to be smart, dedicated, and compassionate people — many of whom are looking for that magic balance of a meaningful career and good job stability and security. That said, the stirring demonstrations of bravery, sacrifice, and persistence coming from the physicians and other healthcare professionals who have answered the call against the coronavirus is going to be a tough act to follow. Many of course will try, and the new crop that does may well be even more prepared to step up to our next major healthcare threat while simultaneously changing the way that healthcare is delivered.

In the years to come, there may well be a number of applicant essays that read “I want to be a doctor because of COVID-19.”



Preterm children’s long-term academic performance after adaptive computerized training: an efficacy and process analysis of a randomized controlled trial

Published: 12 September 2020Julia JaekelKatharina M. HeuserAntonia ZapfClaudia RollFrancisco Brevis NuñezPeter BartmannDieter WolkeUrsula Felderhoff-Mueser & Britta Huening



Adaptive computerized interventions may help improve preterm children’s academic success, but randomized trials are rare. We tested whether a math training (XtraMath®) versus an active control condition (Cogmed®; working memory) improved school performance. Training feasibility was also evaluated.


Preterm born first graders, N = 65 (28–35 + 6 weeks gestation) were recruited into a prospective randomized controlled multicenter trial and received one of two computerized trainings at home for 5 weeks. Teachers rated academic performance in math, reading/writing, and attention compared to classmates before (baseline), directly after (post), and 12 months after the intervention (follow-up). Total academic performance growth was calculated as change from baseline (hierarchically ordered—post test first, follow-up second).


Bootstrapped linear regressions showed that academic growth to post test was significantly higher in the math intervention group (B = 0.25 [95% confidence interval: 0.04–0.50], p = 0.039), but this difference was not sustained at the 12-month follow-up (B = 0.00 [−0.31 to 0.34], p = 0.996). Parents in the XtraMath group reported higher acceptance compared with the Cogmed group (mean difference: −0.49, [−0.90 to −0.08], p = 0.037).


Our findings do not show a sustained difference in efficacy between both trainings. Studies of math intervention effectiveness for preterm school-aged children are warranted.


  1. Adaptive computerized math training may help improve preterm children’s short-term school performance.
  2. Computerized math training provides a novel avenue towards intervention after preterm  birth.
  3. Well-powered randomized controlled studies of math intervention effectiveness for preterm school-aged children are warranted.


What Keeps Neonatal Nurses Up at Night and What Gets Them Up in the Morning?

Walden, Marlene PhD, APRN, NNP-BC, CCNS, FAAN; Janssen, Dalton W. MSN, RNC-NIC; Lovenstein, Austin MA, BS

Editor(s): Dowling, Donna PhD, RN, Section Editors; Schierholz, Elizabeth PhD, MSN, NNP-BC, Section Editors

Advances in Neonatal Care: December 2020 – Volume 20 – Issue 6 – p E102-E110



Occupational stress in neonatal nursing is a significant professional concern. Prolonged exposure to morally distressing patient care experiences and other healthcare issues may lead to worry among nurses. When worry becomes excessive, nurses and advanced practice registered nurses may lose joy that gives meaning to their work. Enhancing meaning in work may have a positive impact on nurse satisfaction, engagement, productivity, and burnout.


To explore neonatal nurses’ top professional satisfiers and top professional worries and concerns.


A descriptive study was conducted in a convenience sample of neonatal nurses to identify the top professional satisfiers that get them up in the morning and the top professional worries and concerns that keep them awake at night.


Complete data were available for 29 neonatal nurses. The top professional satisfiers were caring for infants and families, making a difference, witnessing resilience, intellectual challenge of specialty, positive working relationships with colleagues, and educating parents and families. The top professional worries and concerns were staffing, missed care, workload, making a mistake, and failure to rescue.

Implications for Practice: 

Healthcare and professional organizations must develop strategies to address occupational stress in today’s complex healthcare environment. Identifying professional worries and concerns may help nurses navigate challenging and distressing situations. Furthermore, understanding nurses’ professional satisfiers may promote personal and professional resiliency and help organizations create healthier workplace environments.

Implications for Research: 

Future studies are needed to test effective interventions that may promote professional satisfaction and help neonatal nurses cope with occupational stressors.

Preterm autism spectrum disorder risk linked to changes in cerebellar white matter

Children’s National Hospital   Nov 8, 2019

A study in experimental models suggests that allopregnanolone, one of many hormones produced by the placenta during pregnancy, is so essential to normal fetal brain development that when provision of that hormone decreases – as occurs with premature birth – offspring are more likely to develop autism-like behaviors. Lead study author Claire-Marie Vacher, Ph.D., explains the work of the Neonatology and Neonatal Neurology and Neonatal Neurocritical Care teams at Children’s National.

Family history is a predictor of current preterm birth

American Journal of Obstetrics & Gynecology MFM

Available online 11 November 2020, 100277 Original Research

This work was presented as a poster (number 674) at the Society for Maternal-Fetal Medicine Pregnancy Meeting, Dallas, TX, February 3, 2018.

Author links open overlay panel  AmandaKoireMD, PhDabDerrick M.ChuMD, PhDbcdKjerstiAagaardMD, PhDbcde


Reliable prediction of spontaneous preterm birth remains limited, particularly for nulliparous and multiparous women without a personal history of preterm birth. Although previous preterm birth is a risk factor for recurrent preterm birth, most spontaneous preterm births occur in women with no previous history of preterm birth.


This study aimed to determine whether patients’ self-reported maternal family history of preterm births among siblings and across 3 generations was an independent risk factor for spontaneous preterm births after controlling for potential confounders.

Study Design

This was a retrospective analysis of a prospectively acquired cohort using a comprehensive single, academic center database of deliveries from August 2011 to July 2017. The objective of the current analysis was to evaluate the risk of preterm birth among women with and without a family history of preterm birth. All subjects in the database were directly queried regarding familial history across 3 generations, inclusive of obstetrical morbidities. Index subjects with probable indicated preterm birth (eg, concurrent diagnosis of preeclampsia; hemolysis, elevated liver enzymes, and low platelet count; or placenta previa or placenta accreta) were excluded, as were nonsingleton pregnancies. Univariate and multivariate analyses with logistic regression were used to determine significance and adjusted relative risk.


In this study, 23,816 deliveries were included, with 2345 (9.9%) born prematurely (<37 weeks’ gestation). Across all subjects, preterm birth was significantly associated with a maternal family history of preterm birth by any definition (adjusted relative risk, 1.44; P<.001), and the fraction of preterm birth occurring in women with a positive family history increased with decreasing gestational age at which the index subjects of preterm birth occurred. For nulliparous women, a history in the subject’s sister posed the greatest risk (adjusted relative risk, 2.25; P=.003), whereas for multiparous women with no previous preterm birth, overall family history was most informative (P=.003). Interestingly, a personal history of the index subject herself being born preterm presented the greatest individual risk factor (adjusted relative risk, 1.94; P=.004).


Spontaneous preterm birth in the current pregnancy was significantly associated with a maternal family history of preterm birth among female relatives within 3 generations and notably sisters. The risk persisted among gravidae without a previous preterm birth, demonstrating the capacity for familial history to independently predict risk of spontaneous preterm birth even in the context of a negative personal history. This study provides evidence that self-reported maternal family history is relevant in a US population cohort and across more distant generations than has previously been reported.


Sensory processing patterns of young adults with preterm birth history

Ayla Günal ,Serkan Pekçetin &Çiğdem Öksüz

Pages 288-292 | Received 05 May 2020, Accepted 14 Sep 2020, Published online: 24 Sep 2020



This study aimed to evaluate the sensory processing abilities of young adults with a history of preterm birth and the factors affecting these abilities.

Materials and methods

Thirty-seven young adults with preterm birth history were included. After recording their sociodemographic data, sensory processing functions were evaluated using the Adolescent/Adult Sensory Profile. The participants’ data were compared to normative samples.


Mean score was 43.51 ± 8.29 for sensory sensitivity, 44.45 ± 9.19 for sensation avoiding, 33.43 ± 8.45 for low registration, and 47.97 ± 9.91 for sensation seeking. Compared to normative samples, 78% of participants in sensation avoiding quadrant, 62% of participants in sensory sensitivity quadrant, 40% of participants in low registration quadrant and sensation seeking quadrant had atypical scores. When sensory profile scores were analysed according to mode of birth, percentages of typical sensory sensitivity and sensation avoiding were low in both the normal vaginal and caesarean delivery subgroups. When analysed by gestational age at birth, ratios of abnormality in sensation avoiding were similar between individuals with very early, early, and late preterm delivery history. Statistically significant difference was found in low registration and sensation avoiding quadrants according to mode of birth (p < .05). There were no statistically significant sex-based and gestational age at birth differences in any of the four quadrants of the sensory profile in the preterm group (p > .05).


These results showed that young adults with preterm birth history have differences in sensory processing compared to the general population and should be evaluated for sensory processing patterns.



Kat’s Corner

We are a powerful and motivated community seeking health and well-being in turbulent times.

As a global community 2020 offered challenges that, like a NICU/preterm birth experience, we likely did not anticipate.  We have all endured these challenges, making significant transitions while living through a global pandemic. While 2020 has separated many of us in our professional and personal realms it has also inspired us to create new solutions to a variety of complex problems.

Our hearts wept knowing many of our new family members were  initially faced with prolonged separation from their babies as the pandemic emerged. Data analyses and intelligent planning eventually led to dynamic policies that offered balance and supportive care to the neonates (our brothers and sisters), their families and caregivers.

We consistently and enthusiastically search for resources that target and provide effective treatment for preverbal trauma survivors (a large part of our population). Resources for identifying, acknowledging, and providing effective treatment for preemie preverbal trauma survivors is currently dim. CALL TO ACTION 2021: We ask that the Global Healthcare Community increase attention and research while cultivating effective treatment options towards the mental health and well-being specific to our pre-verbal PTSD Warrior needs in 2021, with increased necessity!

For the families and community members: your stories, voices and engagement is vital to the progression towards health for our entire Community.  Warriors: seek,  with compassion, your preterm birth stories from family members. The process of sharing the experience may be healing for you as well as for your family members.

To our courageous healthcare workers, we hope that 2021 will bring about improved systems of logistical, technological, social, and resource support to empower you in the work you do each day to support the lives of those that you care for.  Most of all, we Thank You for your service and wish for you abundant health and healing.

WARRIORS: Let’s take on this New Year with deep intentions to make it a Great one!

Feel The Rhythm with Shama Beckford and Ivah Wilmot

Feb 23, 2018   SURFER

They say you can’t teach style. They’re right, of course, but oh do we wish they were wrong. If silky surf aesthetics could be easily taught, then Jamaican standouts Shama Beckford and Ivah Wilmot would be welcome in front of the class. In this edit, we get a closer look at the approaches of these two magnetic surfers, whether their laying down buttery lines at Lower Trestles or over concrete in a skatepark. Beckford and Wilmot bring a unique flair to everything they do both in and out of the water, which surfing can always use more of. Keep an eye on these two up-and-coming Caribbean islanders, and be sure to take notes.

Cures Act, Climate, Breast is Best


Indonesia, officially the Republic of Indonesia  is a country in Southeast Asia and Oceania, between the Indian and Pacific oceans. It consists of more than seventeen thousand islands, including SumatraJavaBorneo (Kalimantan), Sulawesi, and New Guinea (Papua). Indonesia is the world’s largest island country and the 14th-largest country by land area, at 1,904,569 square kilometres (735,358 square miles). With over 267 million people, it is the world’s 4th-most-populous country as well as the most-populous Muslim-majority country. Java, the world’s most-populous island, is home to more than half of the country’s population.

The sovereign state is a presidentialconstitutional republic with an elected legislature. It has 34 provinces, of which five have special status. The country’s capital, Jakarta, is the second-most populous urban area in the world. The country shares land borders with Papua New GuineaEast Timor, and the eastern part of Malaysia. Other neighbouring countries include SingaporeVietnam, the PhilippinesAustraliaPalau, and India‘s Andaman and Nicobar Islands. Despite its large population and densely populated regions, Indonesia has vast areas of wilderness that support one of the world’s highest levels of biodiversity.

Government expenditure on HEALTHCARE is about 3.3% of GDP in 2016. As part of an attempt to achieve universal health care, the government launched the National Health Insurance (Jaminan Kesehatan Nasional, JKN) in 2014 that provides healthcare to citizens. They include coverage for a range of services from the public and also private firms that have opted to join the scheme. In recent decades, there have been remarkable improvements such as rising life expectancy (from 62.3 years in 1990 to 71.7 years in 2019) and declining child mortality (from 84 deaths per 1,000 births in 1990 to 25.4 deaths in 2017).  Nevertheless, Indonesia continues to face challenges that include maternal and child health, low air quality, malnutrition, high rate of smoking, and infectious diseases.



Warmer world linked to poor pregnancy results: Study

MARLOWE HOOD    AGENCE FRANCE-PRESSE  Paris, France  /  Wed, November 4, 2020

Women exposed to high temperatures and heatwaves during pregnancy are more likely to have premature or stillborn babies, researchers said Wednesday.

Such outcomes — closely linked to poverty, especially in the tropics — will likely increase with global warming, especially during more frequent and intense heatwaves, they reported in BMJ, a medical journal.

Even small increases “could have a major impact on public health as exposure to high temperatures is common and escalating,” the study concluded.

Each year, 15 million babies are born premature, the leading cause of death among children under five, according to the World Health Organization (WHO). 

That mortality is concentrated in the developing world, especially Africa. 

To quantify the impact of higher heat on pregnancy outcomes, an international team of researchers led by Matthew Chersich from Wits Reproductive Health and HIV Institute in Johannesburg looked at 70 peer-reviewed studies of 27 rich, poor and middle-income nations.

Of the 47 studies that concerned preterm births, 40 reported they were more common at higher temperatures.

The odds of a preterm birth rose, on average, by five percent per one degree Celsius (1C) increase, and by 16 percent during heatwave days, according to the new findings.

Global warming has seen Earth’s average temperature rise by 1C over the last century, with greater increases over large land masses.

The number of exceptionally hot days are expected to increase most in the tropics, according to the UN’s climate science advisory panel, the IPCC.

‘High risk’ for heat

Extreme heatwaves — made more dangerous by high humidity — are projected to emerge earliest in these regions as well.

Limiting global warming to 1.5C instead of 2C — goals consistent with the Paris Agreement — would mean around 420 million fewer people frequently exposed to extreme heatwaves, the IPCC said in a 2018 report.

The new study also found that stillbirths increased by five percent per 1C increase in temperature, with the link most pronounced in the last few weeks of pregnancy.

The impact of warmer days and heatwaves on low birth weight, which is associated with a host of health problems later in life, was smaller, but still significant, the researchers said.

As expected, adverse pregnancy outcomes associated with rising temperatures were strongest among poorer women.

Because other factors such as pollution might play a role in stillbirths and premature babies, the role of warmer temperatures is hard to pin down, the researchers acknowledged.

Nonetheless, the findings are strong enough to suggest that pregnant women “merit a place alongside the groups typically considered as at ‘high risk’ for heat-related conditions,” they concluded.

More research and targeted health policies should be a high priority, they added.


Kat and I study global health issues and developments on an ongoing basis.  Based on the increasing and well documented climate change and global warming challenges that make national “borders” irrelevant in many ways,  and challenge the global community, much like the pandemic, to create ways of collaborating for global and good and even survival,  and considering the overwhelming scientific evidence that climate change and global warming pose a real and present danger, we call for global action and proactive changes. Our Neonatal Womb Warrior/Preterm Birth Community and our global community at large can and with increased necessity, must create progressive people/planet-oriented changes in order to provide a future for our children and our children’s children. 

The technology is here. The people are ready. Scientists have spoken. Progressive businesses are stepping forward. Now we need governments to take climate action!” – WWF International 

You must not gamble your children’s future on the flip of a coin. Instead, you mustunite behind the science. You must take action. You must do the impossible. Because giving up can never ever be an option- Greta Thunberg 

Few challenges facing America and the world are more urgent than combating climate change. The science is beyond dispute and the facts are clearBarack Obama

Check Out:

Maternal smoking and preterm birth: An unresolved health challenge

Sarah J. Stock , Linda Bauld – Published: September 14, 2020

Maternal exposure to tobacco smoke in pregnancy is a key modifiable risk factor for baby death and disability. Smoking is linked to preterm birth (birth before 37 weeks’ gestation), stillbirth, and neonatal mortality, as well as to miscarriage, fetal growth restriction, and infant morbidity . The worldwide prevalence of maternal smoking in pregnancy is 2%, with Europe having the highest prevalence at 8% . Although rates of maternal smoking in pregnancy are decreasing in many high-income countries , this decline is slower among women of lower socioeconomic status, contributing to health inequalities . In certain low- and middle-income countries, maternal smoking rates are static or rising .

In this issue of PLOS Medicine, two studies provide new insights into the implications of exposure to tobacco smoke in pregnancy for perinatal and childhood outcomes. Buyun Liu and colleagues studied preterm birth in relation to timing and intensity of maternal smoking in more than 25 million singleton mother–infant pairs using United States birth certificate data . The size of this “mega-cohort” allowed exploration of whether incremental increases of 1–2 cigarettes per day were associated with increases in preterm birth. Compared to nonsmokers, any maternal smoking during the three months prior to conception and continued into the first trimester of pregnancy was associated with increased preterm birth (odds ratio [OR] 1.17 [95% CI 1.16–1.19]). This risk increased if maternal smoking continued during the second trimester (OR 1.45 [1.45–1.46]). Women who quit smoking during pregnancy still had an increased risk of preterm birth, even if levels of smoking were low and they stopped early in pregnancy. For example, compared to nonsmokers, women who smoked 1–2 cigarettes a day and quit in the first trimester had an increased risk of preterm birth (OR 1.13 [1.10–1.16]). In contrast, if they quit smoking in the three months before pregnancy, even heavy smokers of 20 or more cigarettes per day had a similar risk of preterm birth to that of nonsmokers (OR 1.01 [0.99–1.03]). The authors conclude that there is no safe level for cigarette smoking in pregnancy.

Elise Philips and colleagues found a different pattern of smoking and preterm birth in an individual participant data meta-analysis of 220,000 births from 28 cohort studies, in which smoking status was determined from questionnaires . Compared to nonsmokers, mothers who smoked in the third trimester of pregnancy were at increased risk of preterm birth. However, the effect size was lower than in Liu’s study , with an OR of 1.08 (1.02–1.15). In contrast to Liu’s findings , smoking confined to the first trimester of pregnancy was not associated with preterm birth when compared to nonsmokers (OR 1.03 [0.85–1.25]). Furthermore, no dose response was seen with increasing or decreasing cigarette intake between first and third trimesters.

Philips and colleagues additionally explored the relationship between smoking and being small for gestational age (SGA) at birth and overweight in childhood . Whereas maternal first trimester smoking was associated with childhood overweight (OR 1.17 [1.02–1.35]) but not SGA (OR 0.99 [0.85–1.15]), smoking in later pregnancy was associated with both childhood overweight (OR 1.42 [1.35–1.48]) and SGA (OR 2.15 [2.07–2.23]). Reducing the number of cigarettes from first to third trimester lowered the risks of delivering SGA infants, but risks were still higher compared with nonsmoking mothers. Mothers who increased the number of cigarettes from first to third trimester had increased risk of an SGA infant compared with those who did not.

Several factors may explain the different patterns of association between smoking and preterm birth seen in the two studies. First, at 4.7%, the population risk of preterm birth in the Philips study, in which most of the cohorts were European , was less than half that of Liu’s US-based study (9.3%). Second, the sample size for analyses of cessation, increasing, or decreasing cigarettes smoked between first and third trimester was much smaller in Philips’ study and, at only 1% of the entire cohort (around 2,200 women with 120 preterm births), may not be representative at population level. The low numbers resulted from only around half of the included cohorts having data on both early and late pregnancy cigarette consumption. Third, in the Philips study, smokers who quit prepregnancy were included as nonsmokers, whereas in the Liu study, prepregnancy smokers were considered separately. Finally, cohorts in the Philips meta-analysis collected late pregnancy smoking data in the third trimester . This can be problematic, as most preterm births occur in the third trimester. Liu and colleagues restricted analysis to second-trimester smoking to avoid this.

Despite their differences, both studies add compelling evidence to the idea that there is a dose–response relationship between smoking in pregnancy and preterm birth. The more and the longer women smoke in pregnancy, the higher the associated morbidity. There will also be higher numbers of babies who die, as preterm birth is the major cause of neonatal mortality, and SGA is strongly associated with stillbirth. This message needs to be clearly conveyed to pregnant women and health professionals so that the relevance of surrogate health outcomes is not misinterpreted. Having a “small baby” may not be seen as a bad thing or even, erroneously, be considered advantageous for birth. Health messages should also be directed to wider audiences than just pregnant women and those that care for them. As beliefs about smoking are strongly influenced by family, friends, and peers, risk messages from social networks are frequently more effective than those delivered by health professionals .

Pregnancy is a time when interventions for smoking cessation might be most effective. It is purported that women are more likely to quit smoking in pregnancy than at any other period in their lives . There are certainly opportunities for improvement, with three-quarters of prepregnancy smokers continuing to smoke in early pregnancy and 85% of those that smoke in early pregnancy continuing into late pregnancy . Behavioral support for smoking cessation is recommended as part of antenatal care in many countries and endorsed by guidance from WHO. This should be delivered by staff who have received appropriate training but delivered in a flexible way, tailored to the needs of pregnant women. Some countries combine behavioral support with nicotine replacement therapy, which has been shown to be effective in the general adult population. However, single-product nicotine replacement therapy has not been shown to be effective during pregnancy , and research is now ongoing to explore this further .

Evidence from ongoing trials of promising adjuvant approaches, such as electronic cigarettes and financial incentives , may be key to improving quit rates but will require political will to implement if effective. There are, however, enormous potential benefits from reducing smoking in pregnancy, both in terms of women’s and children’s health and in savings to health services. In the United Kingdom alone, maternal and infant healthcare costs attributed to smoking are estimated at £20–£87.5 million per annum . A concerted effort across multiple sectors is required to prevent this harm and protect the health of future generations.

Citation: Stock SJ, Bauld L (2020) Maternal smoking and preterm birth: An unresolved health challenge. PLoS Med 17(9): e1003386.


Global burden of preterm birth

Salimah R. Walani   First published: 10 June 2020


Preterm birth is a live birth that occurs before 37 completed weeks of pregnancy. Approximately 15 million babies are born preterm annually worldwide, indicating a global preterm birth rate of about 11%. With 1 million children dying due to preterm birth before the age of 5 years, preterm birth is the leading cause of death among children, accounting for 18% of all deaths among children aged under 5 years and as much as 35% of all deaths among newborns (aged <28 days). There are significant variations in preterm birth rates and mortality between countries and within countries. However, the burden of preterm birth is particularly high in low‐ and middle‐income countries, especially those in Southeast Asia and sub‐Saharan Africa. Preterm birth rates are rising in many countries. The issue of preterm birth is of paramount significance for achieving United Nations Sustainable Development Goal 3 target #3.2, which aims to end all preventable deaths of newborns and children aged under 5 years by 2030.


According to WHO, preterm birth is a live birth that occurs before 37 completed weeks of pregnancy. Preterm birth is further classified as extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate (32 to <34 weeks) to late preterm (34 to <37 weeks). Preterm birth may occur spontaneously or may be initiated by a provider through induction of labor or elective caesarean delivery which may or may not be medically indicated. A baby born after 37 weeks of pregnancy is not considered preterm; however, it is recommended that unless medically indicated a pregnancy should be allowed to continue until 39 completed weeks to ensure optimal health outcomes of the baby.

The true prevalence of preterm birth is not known due to lack of actual data in many countries, especially those in lower‐income categories. Estimates of preterm births for 184 countries using 2010 data showed that approximately 15 million babies are born preterm annually worldwide, indicating a global preterm birth rate of about 11%, ranging from 4% in Belarus to 18% in Malawi. Preterm birth rates are rising in most countries. A recent study examining the trends of preterm birth rates found that the global preterm birth rate rose from 9.8% in 2000 to 10.6% in 2014.

Preterm birth is the leading cause of childhood mortality. Approximately 1 million babies die every year due to complications of preterm birth. The issue of preterm birth is of paramount significance for achieving United Nations Sustainable Development Goal 3 target #3.2, which aims to end all preventable deaths of newborns and children aged under 5 years by 2030. Understanding the global burden of preterm birth and disparities in prevalence and mortality of this condition is critical for advocacy and allocation of resources for surveillance, research, prevention, and care related to preterm birth.


Of the 15 million preterm births every year, over 84% occur at 32–36 weeks of gestation. Only about 5% fall into the extremely preterm (<28 weeks) category and the other 10% are born at 28–32 weeks of gestation. Six countries—India, China, Nigeria, Pakistan, Indonesia, and the United States—account for 50% (~7.4 million) of the total preterm births in the world.

There are major variations in preterm birth rates by geographic region and level of income of a country. When countries are grouped by their World Bank income categories, it is found that approximately 90% of all preterm births occur in low‐ and middle‐income countries. The average preterm birth rate for low‐income countries is close to 12%, compared to 9.4% and 9.3% for middle‐ and high‐income countries, respectively. However, there are outliers. For example, Ecuador, a middle‐income county, has a preterm birth rate of 5%, which is lower than in many high‐income countries such as Germany (9.2%), Canada (7.8%), and Israel (8%).

Disparities in preterm birth rates by geographic regions are also very stark. Systematic review and modelling analysis from 2014 data showed that 80% of preterm births occur in countries in sub‐Saharan Africa and South Asia.3 However, there are remarkable variations in the rates within each region. For example, according to one estimate in sub‐Saharan Africa, the preterm birth rate in Uganda of only 6.6% is lower than that of many high‐income countries, including the United States, while Uganda’s neighboring country Tanzania has an estimated preterm birth rate of 16.6%. Within‐region differences are also evident in Europe, where preterm births are in the range of 5%–10%, despite similar development and healthcare infrastructures.

Disparities in preterm birth rates based on maternal education, race, and ethnic origin are also evident in some countries and regions. In the United States, for example, in 2016 the preterm birth rate was 14% among African‐American women compared to 9% among white women. An analysis of preterm birth rates across 12 European countries showed that preterm birth rates were generally higher among women with lower levels of education. In six of the twelve countries, these variations were statistically significant. The differences in preterm birth rates by maternal education were most significant in the Netherlands (P=0.001) and Norway (P=0.009). In the Netherlands, the preterm birth rate among women with a low level of education was 7.0%, compared to 4.9% in those with a high level of education. In Norway, the rates were 9.7% in women with a low level of education and 5.9% in women with a high level of education.

The causes of variations in preterm birth rates among countries and in groups within a country or a region are mainly unknown; however, risk factors associated with preterm birth are discussed in a study by Cobo.


Of the 15 million babies born preterm every year worldwide, more than 1 million die before the age of 5 years due to preterm birth and its complications. There has been an overall decline in deaths in children aged under 5 years in the last two decades due to reductions in mortality related to infectious diseases such as pneumonia, diarrhea, malaria, and measles. As a result, complications related to preterm births are now the leading cause of death among children, accounting for 18% of all deaths in children aged under 5 years. The burden of preterm birth is particularly profound during the first 28 days of life (neonatal period), accounting for 35% of all neonatal deaths globally. As with the prevalence of preterm birth, there are huge variations among countries and regions in preterm birth mortality rates and absolute number of deaths due to complications related to preterm births. For example, preterm birth mortality accounts for close to 28% of all deaths in children aged under 5 years in North America and in Western Europe compared to approximately 13% in sub‐Saharan Africa and 25.5% in South Asia. However, the majority of all deaths due to preterm birth occur in sub‐Saharan African and South Asia. India, a country in South Asia, alone accounts for 330 000 (~33%) of the total global deaths due to preterm births. The high absolute number of deaths related to preterm births in some regions is partly due to their high overall rates of child mortality. In 2016, sub‐Saharan Africa had an average under‐five mortality rate of 79 deaths per 1000 live births compared to only 6 per 1000 live births in North America and Europe. Variations in survival gap is another important issue to be considered in relation to preterm birth mortality. In high‐income countries, where almost all births are attended by skilled staff, 50% of the babies born as early as 24 weeks survive, whereas in a low‐income country, even a baby born at 32 weeks has only a 50% chance of survival due to lack of available resources and/or low quality of specialized care needed to improve the survival of a baby born too soon.


Preterm birth is a major healthcare problem affecting 15 million births every year. It is the leading cause of mortality among children aged under 5 years, with a majority of deaths due to preterm birth occurring in the neonatal period.

Much attention has been devoted to the prevention of preterm birth through research and advocacy by organizations such as March of Dimes. However, there is substantial evidence that preterm birth rates are rising globally and in most countries. An analysis of high‐quality data from 38 countries, comparisons between 2000 and 2014, showed that preterm birth rates increased in 26 countries. Although due to scarcity of good‐quality surveillance and registry‐based data, the published prevalence rates from Asian and African countries must be interpreted with caution, the reports of disparities in preterm birth rates and mortality among regions and countries consistently show that the majority of preterm births and related mortality occurs in low‐ and middle‐income countries and the burden is particularly high in South Asia and sub‐Saharan Africa.



The project was conceived by friends and artists Iris Eichenberg and Jimena Ríos. Its aim is straightforward: for artists, jewelers, students, and professionals to craft medals that will honor the service and sacrifice of health workers. Infused with the gratitude of the ex-voto and the tribute of a medal, these hands have been made and collected since April 2020.

The design is drawn from a historical argentinian ex-voto. Authorship is secondary the medals are not about the maker, but about the receiver. To underscore the unity of this collaborative effort, participants copy a template of the hand, meant to be simple enough for all skill levels, and easily replicated into whatever metal is available. This singular hand design creates a collective voice, reinforcing the shared gratitude that is the project’s mission.


Our current battle with coronavirus is fought with an enemy invisible to the naked eye, its specter made all the more ominous by its intangibility—a danger you cannot see. By contrast, metal, especially jewelry, is known by its weight and shape against the body. When formed into a medal, it provides a physical testimony for both the unseen virus and invisible bravery of those who have fought it. Hands themselves have been powerfully present in this battle. They are symbols not only of how our bodies have become weapons to be washed, sanitized, and gloved, but also of their innate power to heal and to connect. For around 3000 jewelers that join the project, of course, they are the language of skill and expression embodied.



Medical Legal Forum: Simplified, Real-time, Free access to the Complete Medical Record in the NICU is Coming with Implementation of the 21st Century Cures Act

© N.Embleton Jonathan Fanaroff, MD, JD, Robert Turbow, MD, JD Gilbert Martin, M

Parents of NICU patients have had the right to review their child’s medical records for many years, but in the past such efforts required trips to the medical records department in the sub-basement, long delays, and the significant costs of copying the records. In recent years with the shift to electronic medical records and the development of patient portals, families have had an easier time accessing some, but not all, medical records. This is about to change with the implementation of a rule from the Federal Office of the National Coordinator for Health IT requiring health systems to provide greater access to patient health records.

The rule is part of the implementation of the 21st Century Cures Act passed by Congress in 2016. The “Cures Act” was originally designed to accelerate medical product development and to bring new innovations to patients who need these products faster. The program also allowed patients to access all the health information in their electronic medical records without charge by their healthcare provider. The original deadline for the rule, November 2, 2020, was moved to April 5, 2021, due to the coronavirus pandemic. Patients will have access to the following types of clinical notes:

• Consultation notes • Discharge summary notes • History and physical • Imaging narratives •   

Laboratory report narratives • Pathology report narratives • Procedure notes • Progress notes

There are limited exceptions. These include certain psychotherapy notes by mental health professionals as well as information gathered for use in civil or criminal proceedings. A note can also be protected if it places the patient in potential danger, such as a discussion about domestic violence when the abuser can access the information. Additionally, certain health information for adolescents may be protected from access by the parents. It will be important to work with hospital legal and compliance experts to determine the specific application of the rule at your institution.

 An important second aspect of the rule is penalties for anti-competitive behavior and information blocking that impedes the exchange of medical information. For example, some health IT vendors had a “gag clause” prohibiting the sharing of screenshots. These non-disclosure clauses hinder efforts to improve safety and openly discuss safety concerns.

 The destruction of ‘data silos’ and mandated interoperability is designed to improve care and decrease costs by allowing patients to control their electronic health information, download the information to their smartphones, and examine the data with the apps of their choice. For years there has been an issue of who ‘owns’ patient health data, and this question has clearly been answered in favor of patients.

What impact will free, easy access to the medical record have in the NICU? Certainly, some additional education may be necessary. For example, many laboratory ‘normal’ values reflect data for adults, not neonates. Additionally, very sensitive maternal information, such as herpes status and pregnancy history, is part of the neonatal medical record as well. Ultimately the change will likely be very positive, as with most improvements in transparency. Indeed, while a busy NICU team is caring for multiple patients, a family is focused on just one patient and may catch and prevent errors of omission. Let us not forget that in 2013, the NICU Parent Network created the “NICU Parent’s Bill of Rights.” These ten statements are listed from the perspective of the NICU baby. An example of one statement is, “my parents are my voice and my best advocates; therefore, hospital policies, including visiting hours and rounding, should be as inclusive as possible.

The Cures Act “Final Rule,” which was issued on October 29, 2020, provides our healthcare system additional flexibility and clarifies privacy protections. Healthcare workers face quite a challenge. They must try to take the safest possible care of patients while working in extraordinarily complex systems. The High-Reliability theory offers insight into this dilemma. Increasing reliability has the potential to not only improve outcomes but also to decrease a hospital’s liability.


Breastmilk Harbors Antibodies to SARS-CoV-2

An abundance of immunoglobulin antibodies, and a paucity of viral RNA, in breastmilk offer evidence that women can safely continue breastfeeding during the pandemic.

Milk from lactating moms may hold potent antibodies to counter SARS-CoV-2 infections, according to a new study of 15 women. All of the samples from women who had recovered from COVID-19 and who were breastfeeding babies at the time had antibodies reactive to the virus’s spike protein, researchers report in the November issue of iScience

Detecting antibodies against the virus in breastmilk indicates that mothers could be passing viral immunity to their babies. Women can “feel pretty comfortable breastfeeding” during the pandemic, Christina Chambers, a perinatal epidemiologist at the University of California, San Diego, who not involved in the new study, tells The Scientist.

To date, there’s no evidence that a mother can transmit SARS-CoV-2 to her baby through breastmilk, Chambers says. She and others have tested breastmilk for SARS-CoV-2 RNA and found a few positive results, but no live virus. Her latest research also suggests that donor milk is safe for babies’ consumption, too, though she hasn’t assessed antibodies in donor milk banks she works with yet.

I think the potential is really great, if we get past this taboo that it’s breastmilk.

—Rebecca Powell, Icahn School of Medicine at Mount Sinai

Antibodies in breastmilk may be useful for more than protecting nursing infants from the virus. Antibodies extracted from milk—as opposed to the current practice of using convalescent serum—could also serve as a therapeutic for COVID-19. However, “people question that this is something that could really happen,” says study coauthor Rebecca Powell, an immunologist at the Icahn School of Medicine at Mount Sinai in New York City. Because there isn’t a wider understanding of the immune benefits of breastmilk, she says, the concept has not caught on in antiviral drug development.

Detecting breastmilk antibodies

Powell has been investigating human milk immunology for the past four years and was analyzing how the seasonal flu vaccine prompted an immune response in breastmilk when the coronavirus pandemic spread to New York City earlier this year. Switching to study the SARS-CoV-2 immune response in breastmilk was “a no brainer,” she says. “There’s so many unanswered questions in general about milk immunology, but to be able to study it with a novel pathogen was really important.” 

By early April, she and her colleagues had received approval to begin collecting milk samples from lactating mothers who had recovered from COVID-19. The researchers collected samples from eight women who had a SARS-CoV-2–positive PCR test and seven who had suspected cases of the disease but were not tested; all 15 were lactating at the time. The team then compared the samples to ones from different lactating mothers amassed before the pandemic began, first assessing them for the presence of immunoglobulin A (IgA) antibodies using an enzyme-linked immunosorbent assay (ELISA) and then checking the ability of any antibodies found to bind to the SARS-CoV-2 spike protein.

All the of samples from the women who had recovered from COVID-19 had specific SARS-CoV-2 binding activity, while the pre-pandemic samples had low levels of nonspecific or cross-reactive activity, the researchers report. They next tested the antibodies’ response to the receptor binding domain of the SARS-CoV-2 spike protein, and found that 12 out of 15 of the samples from previously-infected donors showed significant IgA binding activity. Some of those samples also included other reactive antibodies such as immunoglobulin G and immunoglobulin M. Compared with the controls, it was IgA and IgG levels that were the highest. 

The results align with a study published in September in the Journal of Perinatology that also detected high levels of IgA and some IgG and IgM that were reactive to the S1 and S2 subunits of the SARS-CoV-2 spike protein in a majority of milk samples collected during the pandemic. None of the breastmilk tested positive for SARS-CoV-2 with a PCR test, suggesting none of the mothers were infected at the time of sample collection. 

There was also no documentation of whether the 41 women who donated samples had ever been infected with the virus, notes study coauthor Veronique Demers-Mathieu, an immunologist at Medolac Laboratories in Boulder City, Nevada, so it’s unclear if these antibodies were the result of SARS-CoV-2 or another viral infection.

The team did collect general health information on the donors of the milk samples and found that S1 and S2 SARS-CoV-2–reactive IgG levels were higher in milk from women who had had symptoms of a viral respiratory infection during the last year than in milk from women who hadn’t had any symptoms of infection. IgG abundance was also higher in the samples from 2020 than from those taken in 2018, long before the pandemic started. The IgA and IgM antibody reactivity, however, didn’t appear to be specific to SARS-CoV-2 S1 and S2 and did not differ between the 2020 samples and the 2018 samples, meaning these responses could be the result of cross-reactivity from antibodies generated after exposure to other viruses. That suggests the antibodies secreted in breastmilk provide a broad immunity to breastfeeding infants, Demers-Mathieu says.

Benefits of breastmilk versus blood antibodies

One important feature of these antibodies, whether specific to the virus or not, is that they are secretory antibodies, Powell notes. The B cells that secrete antibodies into milk originate from the mucosal immune system in the mother’s small intestine. Those B cells travel through the blood to the mammary glands and secrete IgA that’s then shuttled from the mammary tissue to the milk via a transporter protein. Those proteins, called secretory components, leave pieces of themselves on the antibodies, wrapping around them and protecting them from being degraded in the infant mouth and gut. “Secretory antibody is found not only in milk, but in saliva and all other mucosal secretions,” Powell explains. “It’s not unique to milk, but it is not what you find in the blood.”

That difference could give breastmilk-derived antibodies an advantage over blood-based ones as far as therapeutic options go, she explains. Antibodies such as IgG that are extracted from serum and transfused into the blood of a sick person travel throughout the body and might not go where they are needed. But secretory antibodies, such as IgA from breastmilk, could be extracted and then inhaled into the respiratory tract—just where those antibodies are needed in COVID-19. Because of the protective secretory component they have, these antibodies can endure in the mucosa and target the virus, Powell explains.

“What we are finding in the milk is unique compared to what many people have already studied in the blood in terms of antibody response,” she says. Research suggests that blood-derived antibodies can last months. Secretory antibodies in breastmilk might last longer, Powell’s most recent data indicate, and that means there could be a longer window to collect antibodies from lactating donors after they’ve recovered from COVID-19.

Neither Demers-Mathieu’s nor Powell’s studies tested whether the breastmilk antibodies could neutralize SARS-CoV-2, which is a next step in both teams’ research. Powell has early results suggesting the breastmilk antibodies do neutralize the virus, and a company called Lactiga has partnered with her to continue developing the idea of extracting antibodies from breastmilk to counter COVID-19. 

“I think the potential is really great,” says Powell, “if we get past this taboo that it’s breastmilk.”


Climate pregnancy threat: Study shows expectant mothers are negatively affected by climate change

Jun 24, 2020
New research shows climate change has an adverse effect on pregnancy outcomes, with African American mums at higher risk.

Outcomes of the Neonatal Trial of High-Frequency Oscillation at 16 to 19 Years

August 13, 2020           N Engl J Med 2020; 383:689-691

To The Editor:

We previously reported superior lung function and teacher ratings of school performance in young persons who had received high-frequency oscillatory ventilation (HFOV) as neonates. In a multicenter, randomized trial, HFOV was compared with conventional ventilation that commenced within an hour of birth in infants born before 29 weeks of gestation. We hypothesized that the positive outcomes of HFOV would persist after the onset of puberty and now report the results of a reassessment of this cohort at the ages of 16 to 19 years.

Comprehensive lung-function assessments were undertaken and questionnaires completed regarding respiratory health, health-related quality of life, and lung function (see the Supplementary Appendix, available with the full text of this letter at As in our previous assessment of children 11 to 14 years of age, the primary outcome was forced expiratory flow at 75% of the expired vital capacity (FEF75). Because some children were unable to complete all the lung-function tests, we used multiple imputation with chained equations to impute missing data.

Table 1. Lung-Function Test Results According to Ventilation Group.

A total of 161 young people were evaluated, and 159 underwent lung-function assessment (Fig. S1 in the Supplementary Appendix). Baseline characteristics were similar among those who were assessed and those who were not (Table S1). Participant characteristics did not differ significantly between the ventilation groups when assessed as infants or at 16 to 19 years of age (Table S2). The results with respect to the primary outcome did not differ significantly between the ventilation groups at 16 to 19 years of age: mean (±SD) FEF75 z score of −1.07±1.21 with conventional ventilation and −0.94±1.33 with HFOV (adjusted difference in mean z scores, 0.19; 95% confidence interval [CI], −0.18 to 0.56) (Table 1 and Table S3). These differences remained nonsignificant after multiple imputation (P=0.11) (Table S4). The majority of the mean FEF75 results reported when participants were 16 to 19 years of age were below the lower limit of normal (59% with HFOV and 65% with conventional ventilation). Other measures of lung function also did not differ significantly between the ventilation groups (Table 1 and Table S3). However, 15% of participants in the HFOV group received a diagnosis of asthma, whereas only 3% of participants in the conventional ventilation group had such a diagnosis (adjusted difference, 11 percentage points; 95% CI, 3 to 23). Similarly, inhalers were prescribed for asthma treatment in 13% of those in the HFOV group as compared with 3% of those in the conventional ventilation group (adjusted difference, 11 percentage points; 95% CI, 2 to 21) (Table S5).

Our follow-up study of infants who had been enrolled in a randomized trial in which two types of ventilation were prescribed showed that the use of HFOV in the neonatal period was not associated with superior respiratory or functional outcomes at 16 to 19 years of age. Longer-term follow-up is required to determine whether there will be premature onset of chronic pulmonary disease in this vulnerable population.

Christopher Harris, M.R.C.P.C.H.; Alessandra Bisquera, M.Sc.: King’s College London, London, United Kingdom

Alan Lunt, Ph.D.; Imperial College, London, United Kingdom; Janet L. Peacock, Ph.D.:Dartmouth College, Hanover, NH;

Anne Greenough, M.D.: King’s College London, London, United Kingdom-

Supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust and King’s College London.



Optimal practice in neonatal parenteral nutrition: The role of quality improvement and risk management in providing high-quality parenteral nutrition

POSTED ON 06 OCTOBER 2020                                  

An interview with Professor Nicholas Embleton

In some infants, parenteral nutrition is the only way to provide the necessary nutrients for days or weeks. Being an invasive procedure, it also carries potential risks and therefore, requires certain infrastructure and thorough risk management paired with continuous quality assessment in order to ensure high quality of parenteral nutrition in daily practice. In this interview, Professor Nicholas Embleton from The Newcastle-upon-Tyne hospital & Newcastle University shares his view and experiences on means of quality improvement and how a blame-free culture can contribute to efficient risk management.

Question 1: Quality assessment and risk management rely on thorough and transparent reporting practices. Could you elaborate what in general makes the Briefing in a minute (BIM) an efficient method in Quality Improvement (QI) and Risk Management (RM)?

The great thing about BIM is that it is very quick to do, and you can do it repeatedly. We do every day after our morning teaching session, but you could do at every shift change i.e. twice per day. By the end of the week, you might have heard the same message 5 times, but then we have some fun, and we make a quiz “who can remember what the 4 items on BIM were this week?”. It allows us to communicate messages about QI or RM quickly.

Question 2: Concerning parenteral nutrition, which properties of the BIM are particularly advantageous in terms of quality improvement and risk management?

The ability to get a simple message communicated quickly – for example, we had an issue with placement of the filter in relation to the lipid infusion line. We realised some staff were placing the filter at the wrong location, which was leading to alarms. We were able to share that update really quickly. Although we meet as a whole team, shift handover happens separately for medical and nursing teams: the roles and responsibilities also differ. This means we have separate BIM for nursing and medical teams. The items discussed on BIM can be the same or different which allows us to ‘target’ different parts of a complex communication system.

Question 3: Can you say something about the implementation process of the BIM into daily work routines? Did it require training, for instance, to develop a routine in using simple, concise messages for the reporting?

We just started using it a few years ago, to be honest, I am not sure who had the original idea, but quite probably another hospital or department. It doesn’t require any training to use. You just need to give one person the responsibility of coordinating what will be the 3-4 items for that week. You can agree on those items at a departmental meeting, or you send an email to the senior team asking for specific items for BIM in that week. We write the items out and keep them in a folder – if you want you can look back at the last several weeks of BIM items. It is important that you don’t try and cover too much, so 3-4 items are about right. For more complex issues you need a different mechanism. So BIM cannot be used for teaching – it is not really an interactive event. But you could use BIM to say ‘we are using new filters for lipid; make sure you attend the training session before you start to use them’.

Question 4: To establish and to maintain a well-functioning risk management and reporting system, a blame-free culture is crucial. Yet, in healthcare, errors can range from minor mistakes to errors with tremendous consequences. How do you maintain and encourage open communication within your teams?

Establishing trust in the whole team is essential. Even when you know you didn’t mean to make the mistake, and even when it is not serious you can still feel bad. So developing a supportive team is crucial. We need to learn to look after our colleagues and stick together. That is all about being practical and recognising the real world: we are all human. It is not about ‘sticking together’ to hide mistakes away. At the end of the day, the motivation for working on a NICU is to make things better for the babies, so everyone wants to be involved in QI and RM. It is appropriate sometimes to maintain anonymity – if you made a ‘silly’ mistake, you don’t want to be ‘named and shamed’ at a large meeting, so we try hard to always maintain anonymity. It’s also important to recognise that as senior members of the team, we are much more confident in many respects – both in terms of knowledge and experience, but also more confident knowing that our colleagues will support us. More junior members may feel more worried and less confident. I might not perceive a small intravenous extravasation as being important, but the junior nurse responsible may feel really upset. Developing a friendly, supportive team and looking after each other is essential to good QI and RM. We are proud to have a ‘learning culture’ in our NICU. We accept that sometimes things will not go to plan. We deal with that by being honest and supportive. Parents appreciate honesty and deserve to be listened to. Parents appreciate it when a senior healthcare professional says “I am sorry this happened to your baby”. Saying sorry does not mean we made a mistake, it means we empathise and acknowledge that what happened to the baby has caused upset or harm. TEAM is the most important aspects of QI and RM.

We thank Professor Embleton for this insightful interview.

Professor Nicholas Embleton is Consultant Neonatal Paediatrician at the Newcastle-upon-Tyne hospital and a member of the expert panel for the topic of neonatal parenteral nutrition.


Midwife on a motorbike in Indonesia | UNICEF

Unicef Aug,2,2018
Widyani has saved countless lives in her 22 years as a midwife, and now, with the help of a UNICEF-supported training project, Widyani and her team can save even more.


 Cannula With Long and Narrow Tubing vs Short Binasal Prongs for Noninvasive Ventilation in Preterm Infants

Noninferiority Randomized Clinical Trial

Ori Hochwald, MD1Arieh Riskin, MD2Liron Borenstein-Levin, MD1; et alIrit Shoris, RN2Gil P. Dinur, MD1Waseem Said, MD2Huda Jubran, MD1Yoav Littner, MD1Julie Haddad, MD1Malka Mor, RN1Fanny Timstut, RN1David Bader, MD2Amir Kugelman, MD1 Author Affiliations: JAMA Pediatr. Published online November 9, 2020. doi:10.1001/jamapediatrics.2020.3579  

Original Investigation   November 9, 2020

Key Points

Question  Is a cannula with long and narrow tubing inferior to short binasal prongs and masks in preterm infants who require nasal intermittent positive pressure ventilation?

Findings  In this noninferiority randomized clinical trial that included 166 preterm infants at 24 weeks’ to 33 weeks and 6 days’ gestation requiring nasal intermittent positive pressure ventilation, intubation within 72 hours occurred in 14% in the group using a cannula with long and narrow tubing and in 18% in the short binasal prongs and masks group (95% CI within the noninferiority margin). Moderate to severe nasal trauma was significantly less common in the group using cannulas with long and narrow tubing.

Meaning  Cannulas with long and narrow tubing were noninferior to short binasal prongs and masks in providing nasal intermittent positive pressure ventilation for preterm infants, while causing significantly less nasal trauma.


Importance  Use of cannulas with long and narrow tubing (CLNT) has gained increasing popularity for applying noninvasive respiratory support for newborn infants thanks to ease of use, perceived patient comfort, and reduced nasal trauma. However, there is concern that this interface delivers reduced and suboptimal support.

Objective  To determine whether CLNT is noninferior to short binasal prongs and masks (SPM) when providing nasal intermittent positive pressure ventilation (NIPPV) in preterm infants.

Design, Setting, and Participants  This randomized controlled, unblinded, prospective noninferiority trial was conducted between December 2017 and December 2019 at 2 tertiary neonatal intensive care units. Preterm infants born between 24 weeks’ and 33 weeks and 6 days’ gestation were eligible if presented with respiratory distress syndrome with the need for noninvasive ventilatory support either as initial treatment after birth or after first extubation. Analysis was performed by intention to treat.

Interventions  Randomization to NIPPV with either CLNT or SPM interface.

Main Outcomes and Measures  The primary outcome was the need for intubation within 72 hours after NIPPV treatment began. Noninferiority margin was defined as 15% or less absolute difference.

Results  Overall, 166 infants were included in this analysis, and infant characteristics and clinical condition (including fraction of inspired oxygen, Pco2, and pH level) were comparable at recruitment in the CLNT group (n = 83) and SPM group (n = 83). The mean (SD) gestational age was 29.3 (2.2) weeks vs 29.2 (2.5) weeks, and the mean (SD) birth weight was 1237 (414) g vs 1254 (448) g in the CLNT and SPM groups, respectively. Intubation within 72 hours occurred in 12 of 83 infants (14%) in the CLNT group and in 15 of 83 infants (18%) in the SPM group (risk difference, −3.6%; 95% CI, −14.8 to 7.6 [within the noninferiority margin], χ2 P = .53). Moderate to severe nasal trauma was significantly less common in the CLNT group compared with the SPM group (4 [5%] vs 14 [17%]; P = .01). There were no differences in other adverse events or in the course during hospitalization.

Conclusions and Relevance  In this study, CLNT was noninferior to SPM in providing NIPPV for preterm infants, while causing significantly less nasal trauma.


A Randomized Trial of Laryngeal Mask Airway in Neonatal Resuscitation

List of authors: Nicolas J. Pejovic, M.D., Ph.D., Susanna Myrnerts Höök, M.D., M.Med., Josaphat Byamugisha, M.D., Ph.D., Tobias Alfvén, M.D., Ph.D., Clare Lubulwa, M.D., M.Med., Francesco Cavallin, M.Sc., Jolly Nankunda, M.D., Ph.D., Hege Ersdal, M.D., Ph.D., Mats Blennow, M.D., Ph.D., Daniele Trevisanuto, M.D., and Thorkild Tylleskär, M.D., Ph.D.



Face-mask ventilation is the most common resuscitation method for birth asphyxia. Ventilation with a cuffless laryngeal mask airway (LMA) has potential advantages over face-mask ventilation during neonatal resuscitation in low-income countries, but whether the use of an LMA reduces mortality and morbidity among neonates with asphyxia is unknown.


In this phase 3, open-label, superiority trial in Uganda, we randomly assigned neonates who required positive-pressure ventilation to be treated by a midwife with an LMA or with face-mask ventilation. All the neonates had an estimated gestational age of at least 34 weeks, an estimated birth weight of at least 2000 g, or both. The primary outcome was a composite of death within 7 days or admission to the neonatal intensive care unit (NICU) with moderate-to-severe hypoxic–ischemic encephalopathy at day 1 to 5 during hospitalization.


Complete follow-up data were available for 99.2% of the neonates. A primary outcome event occurred in 154 of 563 neonates (27.4%) in the LMA group and 144 of 591 (24.4%) in the face-mask group (adjusted relative risk, 1.16; 95% confidence interval [CI], 0.90 to 1.51; P=0.26). Death within 7 days occurred in 21.7% of the neonates in the LMA group and 18.4% of those in the face-mask group (adjusted relative risk, 1.21; 95% CI, 0.90 to 1.63), and admission to the NICU with moderate-to-severe hypoxic–ischemic encephalopathy at day 1 to 5 during hospitalization occurred in 11.2% and 10.1%, respectively (adjusted relative risk, 1.27; 95% CI, 0.84 to 1.93). Findings were materially unchanged in a sensitivity analysis in which neonates with missing data were counted as having had a primary outcome event in the LMA group and as not having had such an event in the face-mask group. The frequency of predefined intervention-related adverse events was similar in the two groups.


In neonates with asphyxia, the LMA was safe in the hands of midwives but was not superior to face-mask ventilation with respect to early neonatal death and moderate-to-severe hypoxic–ischemic encephalopathy. (Funded by the Research Council of Norway and the Center for Intervention Science in Maternal and Child Health; NeoSupra number, NCT03133572. opens in new tab.)


This randomized trial of the effectiveness and safety of the LMA in neonatal resuscitation conducted by midwives in a low-income country showed the LMA to be safe in the hands of midwives but to confer no benefit over the face mask with respect to the composite of early neonatal death or moderate-to-severe hypoxic–ischemic encephalopathy. The cuffless LMA that was used in this trial is designed to provide an efficient seal to the larynx without the inflatable cuff used in conventional LMAs. Positioning is easy, and the risk of tissue compression or dislodgement is low. Thus, the device provides a useful alternative to the face mask and endotracheal intubation, especially in settings where skills in performing positive-pressure ventilation or intubation are insufficient. A study in Uganda that used mannequins showed that after a brief training, midwives could easily insert this LMA, and it was more effective than the face mask in establishing positive-pressure ventilation in a mannequin. A phase 2, randomized, controlled trial at the same site showed that midwives could perform resuscitation in neonates effectively and safely with the cuffless LMA.

Data from previous trials have suggested that LMA use results in shorter ventilation times than use of a face mask and may reduce the hypoxic–ischemic insult. Resuscitations in these studies were conducted by physicians or supervised midwives. In the present trial, midwives used the LMA unsupervised, and the insertion technique could have been suboptimal, which may have affected the effectiveness of the LMA. The observation of a higher likelihood of treatment failure in the face-mask group than in the LMA group and the suggestion that rescue with the LMA might result in better outcomes than rescue with the face mask in the current trial are consistent with the results from previous trials. The frequency of failure with the face mask appeared to be lower than in our pilot trial; this may reflect improved skills regarding face-mask ventilation among midwives because of additional and repeated training during the trial.

Although our trial did not show superiority of the LMA over the face mask and the trial was not designed to assess noninferiority, the findings appear consistent with current ILCOR recommendations.24 Thus, our findings suggest that the LMA can be safely used as an alternative device during newborn resuscitation, including when performed by trained midwives.

Most studies show that 3 to 6% of neonates require positive-pressure ventilation at birth. In our trial, 8.6% needed positive-pressure ventilation, and a large proportion of neonates were severely compromised; 61.2% had meconium-stained or foul-smelling amniotic fluid, and very early neonatal death occurred in 15.1%. This percentage is considerably higher than those in previous reports and could reflect the hospital demographics, with large numbers of late referrals and mainly neonates with severe asphyxia; previous reports that showed benefits of the LMA largely involved neonates who had mild asphyxia.  Differences between our trial population and those in previous trials are a potential explanation for the discrepancy between our results and the results of previous trials.

This trial extends our knowledge about LMA use among severely compromised neonates in a low-income setting — where more neonatal deaths occur than in higher-income settings and advanced resuscitation is often not available — by having a larger number of participants, relevant outcomes, rigorous methods (including video documentation), and a strong adherence to trial-group assignments with minimal loss to follow-up or exclusions. The trial also has some limitations. It was a single-site trial in a high-volume hospital, where fetal heart-rate monitoring was not routinely available, and there was inconsistent capacity of staff to provide advanced resuscitation; thus, the findings may not be generalizable to better-resourced settings. For trial conduct, we had additional staff on site. Crossovers, which occurred for safety reasons, were more frequent in the face-mask group than in the LMA group (10.9% vs. 3.5%), and this might have improved the outcomes of the neonates initially treated with the face mask. The neurologic outcome (hypoxic–ischemic encephalopathy) was based on the Thompson score without advanced examinations (e.g., electroencephalography or neuroimaging). In addition, it was an open-label trial, but hard outcomes were used and outcome assessors were not aware of the trial-group assignments.

In our trial, the LMA was safe in the hands of midwives but did not result in a lower incidence of early neonatal death or moderate-to-severe hypoxic–ischemic encephalopathy than face-mask ventilation among neonates with asphyxia.



Breastfeed Your Baby to Reduce the Risk of SIDS

Dec 10, 2018
Many moms and moms-to-be know that breastfeeding offers many benefits for moms and babies. But they may not know that breastfeeding also reduces baby’s risk for Sudden Infant Death Syndrome (SIDS). Watch this 79-second video to learn how to practice safe sleep for baby when breastfeeding. A handout is also available at To watch other Safe to Sleep® videos visit….

How Families Can Help Support Breastfeeding Moms

Breastfeeding moms can always use encouragement – here’s how you can help!

A breastfeeding mom needs lots of things – to stay hydrated, to eat extra calories, to get more sleep (hopefully!), and to build a successful nursing relationship with her little one. And she needs support from her loved ones and family! A supportive and encouraging partner, spouse, or family member can make all the difference in encouraging and helping a breastfeeding mom meet her goals. Here are some ways to help the breastfeeding mom in your life.

Supporting Mom’s Needs

When mom comes home with a new baby and is beginning her breastfeeding journey, there are several things that can be done to make things easier for her.

  1. Create a comfortable home environment where she can practice and get used to breastfeeding and all that it physically and emotionally requires.
  2. Run interference with phone calls and visits – and limit them if necessary.
  3. Take on additional household chores like cooking, cleaning, and laundry.
  4. Bring any needed items during a nursing session, like water, a snack, her phone, or a book.
  5. Give supportive words or encouragement when she’s facing breastfeeding difficulties – and start the process to get additional help or support from your healthcare provider or a Lactation Consultant, if needed.

Bonding with Baby

Sometimes helping mom means taking over care for the little one and giving her some time to herself. And, since breastfeeding provides a unique opportunity for closeness between mom and baby, you’ll want to form your own special bond with the little one. Here are ways to interact one-on-one with baby and encourage your own special connection.

  1. Make time for skin-to-skin contact when cuddling
  2. Take over bath duties
  3. Change diapers after each feeding
  4. Burp the baby after a nursing session
  5. Rock the baby to sleep
  6. Walk with baby in the stroller or in a carrier
  7. If your loved one is pumping, take over the night feeding by warming and feeding a previously expressed bottle of breast milk

If you’re unsure, just ask the breastfeeding mom in your life what would most help, and then do it! Even small tasks done every day can help over time to show that you support breastfeeding and make her feel more confident in her decision to nurse. It may not always be easy, but it’s always worth it! 


Mothers of premature babies struggle to get donor breast milk

      Namibian Broadcasting Corporation

Jack Shonkoff Discusses Early Childhood Development

Jun 1, 2018 – The Duke Endowment
Noted child development expert Jack Shonkoff says constant, unrelenting negative experiences – toxic stress – in early childhood affect a developing brain in ways that can herald lifelong learning and behavior problems.

Kat’s Korner

In regard to the video above I believe ACES is something some of us who are preemie infant survivors may connect with personally.

While our experience receiving life-saving care was essential for our long-term outcomes and wellness the process came undoubtedly for many of us with some difficult measures. As neonates many of us underwent traumatic experiences undergoing critical interventional care, significant time away from our caregivers/parents or human contact, and submersion in a prolonged high-stress environment.

 I encourage us as preemie infant survivors to explore the ACES model above and consider the ways our earliest human experiences may have impacted our development and has influenced our personal interaction with the world around us. Reflecting on the ways we may connect ACES to our human experience as preemie survivors may inspire us to discover new and exciting ways to approach enhancing our health and well-being.

I am calling for continuous research in this area of trauma informed care which may significantly influence the fields of neonatology and the health and well-being of our Neonatal Womb Warrior/Preterm Birth Survivor Community.

Surfing in Nias Utara (North of Nias)

Oct 2, 2019
Nias is one of the well known surfing destination in the world. Most of the surfers go to the south side of Nias. This time Wet Traveler was invited by the Ministry of Tourism of The Republic of Indonesia to make a promotional video for Surfing in Nias Utara. Tell us what do you think about this place. Especially if you have your own experience there.

Polyvagal Theory, Community Collaboration, Stories


Preterm Birth Rates – Portugal

Rank: 138 –Rate: 7.7% Estimated # of preterm births per 100 live births (USA – 12 %)

Portugal, officially the Portuguese Republic is a country located mostly on the Iberian Peninsula, in southwestern Europe. It is the western most sovereign state of mainland Europe, being bordered to the west and south by the Atlantic Ocean and to the north and east by Spain. Its territory also includes the Atlantic archipelagos of the Azores and Madeira, both autonomous regions with their own regional governments. The official and national language is Portuguese.

Portugal ranks 12th in the best public health systems in the world, ahead of other countries like the United KingdomGermany or Sweden. The Portuguese health system is characterized by three coexisting systems: the National Health Service (Serviço Nacional de Saúde, SNS), special social health insurance schemes for certain professions (health subsystems) and voluntary private health insurance. The SNS provides universal coverage. In addition, about 25% of the population is covered by the health subsystems, 10% by private insurance schemes and another 7% by mutual funds.



TAG: PORTUGALCovid Story 5

Posted on June 13, 2020

Joana Mendes, São Francisco Xavier Hospital, Lisbon, Portugal

I am a NICU nurse since I left nursing school. It was my big and only passion. I work now for about 18 years with babies and families. My main areas of expertise are ethics and palliative care. When Covid-19 was spreading quickly in Europe, I was doing a pediatric palliative care clinical practice in Cardiff. One of the first challenges, was returned home safely, when boarders where closing, all over the world. I got to Portugal 2 days just before the lockdown. The news, papers and social posts on internet, arriving from China, Italy and Spain, were really scary. Portuguese boards (medical, nursing and even veterinary’s) asked for health care professionals, from all backgrounds and scenarios, to come and help in human medicine, especially in adult emergency department and intensive care, if needed. They even asked the retired ones to volunteer. And they came. Neonatal nurses knew in advance, one could be mobilized anywhere, anytime. If the situation turned really bad, some would have to go and work in adult department. It sounded very unreal. Some of us when to the pediatric emergency department, when a lot of nurses were home due to quarantine needs.  How would we help in adults? The second challenge faced, was the decision to left my sons (2- and 7-years old) with my husband and fathers in law. I felt heartbroken with all the uncertainty. I experienced strong and mixed feelings. Like never before, I listened the silence shouting and felt time passing in a very painful slow-motion way.  In the hospital I work, one building was converted in a Covid-19 area. The other, the maternity, neonatal and pediatric building, was considered the non-Covid-19. NICU would admit babies that where born from mothers that tested positive or babies, during neonatal period, suspected to be or tested positive. Since, labor and delivery unit started testing all women, some, with no symptoms or risk factors, tested positive. Evidence was lacking, but the risk of vertical transmission seemed to be low (hopefully).

Neonatal health care team were daily, adapting, adjusting and reframing institutional guidelines. Would using CPAP would increase the risk for professionals’ transmission as suggested in adult literature? Was it possible to do the test properly to smaller babies, if the swab used is the same size in adults and newborns? Planning was very dynamic and all we were learning from one another, around the globe.

When the time came, NICU nurses, that had previous working experience in adult ICU and had with no risk factors for Covid-19, went to work full time there. NICU also admitted a nurse from ICU that had a chronic condition. The others non-risk nurses, like me, would be the first to take care of Covid-19 babies. First admissions came in Easter time. NICU nurses were committed to promote mother-baby bonding, holding concept and family centered care. Even before the first baby was born, were all brainstorming. A mobile phone or a tablet was identified as a good option to send video, photo or promote face time with the mother, if possible. Nurses phone called mother’s, each shift, to update about baby’s situation, lactation advices and other areas of counselling and promote emotional support.

Full protection equipment use was hard. No possibility to eat, drink or use toilets to optimize the deficiency in the number of equipment’s available. Even for a couple of hours, makes you feel hot, dehydrated, sometimes dizzy, with fogged glasses and with a sort of shortness of breath. After you remove it bruises and pressure zones in your face can remains for hours or days. All babies that were born during this pandemic time, not only Covid-19, suffered touch and human face interaction deprivation. Parents stayed in the NICU for short periods of time, because they were afraid. Professional were all wearing masks and gloves. The noxious sensory hyper stimulation seemed to gain preponderance to Kangaroo care, holding or breastfeeding. Difficult balance: health safety or human healthy development? What will be the consequences of this new crazy reality for next generation? What lessons do we have to learn, in order to elevate the quality of nursing care in the near future? This would be, the huge, third challenge. It was really inspired to feel that neonatal and pediatric palliative care were supporting one another in the globe. I felt we were really as one, sharing emotions and difficulties and being inspired to move forward.


Violence Against Healthcare Workers: A Worldwide Phenomenon With Serious Consequences

Sandro Vento1*Francesca Cainelli1,2 and Alfredo Vallone3

1Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia, 2Raffles Medical Group Clinic, Phnom Penh, Cambodia, 3Infectious Diseases Unit, G. Jazzolino Hospital, Vibo Valentia, Italy


Verbal and physical violence against healthcare workers (HCWs) have reached considerable levels worldwide, and the World Medical Association has most recently defined violence against health personnel “an international emergency that undermines the very foundations of health systems and impacts critically on patient’s health”. Two systematic reviews and meta-analyses published at the end of 2019 found a high prevalence of workplace violence by patients and visitors against nurses and physicians , and show that occupational violence against HCWs in dental healthcare centers is not uncommon .

Recent Studies

In the first study , the authors systematically searched PubMed, Embase, and Web of Science from their inception to October 2018, and included 253 eligible studies (with a total of 331,544 participants). 61.9% of the participants reported exposure to any form of workplace violence, 42.5% reported exposure to non-physical violence, and 24.4% experienced physical violence in the past year. Verbal abuse (57.6%) was the most common form of non-physical violence, followed by threats (33.2%) and sexual harassment (12.4%). The prevalence of violence against HCWs was particularly high in Asian and North American countries, in Psychiatric and Emergency departments, and among nurses and physicians .

In the second study , a systematic review and analysis of the literature was done using PubMed, ScienceDirect, Scopus, Web of Science, Cochrane Library and ProQuest. Original articles published between January 1992 and August 2019 and written in English were included in the analysis. The violence experienced by dental healthcare workers was both physical and non-physical (shouting, bullying, and threatening) and also included sexual harassment , and in most cases, male patients, or coworkers were responsible. Violent events ranged from 15.0 to 54.0% with a mean prevalence of 32%, and physical abuse ranged from 4.6 to 22% .

Most recently, the World Medical Association has condemned the increasingly reported cases of health care workers being attacked because of the fear that they will spread SARS-CoV-2. The situation in India is particularly shocking, with health care workers stigmatized, ostracized, discriminated against, and physically attacked, but incidents have been reported across the world, for instance from France, Mexico, Philippines, Turkey, UK, Australia, and USA.


The recent systematic reviews and meta-analyses and the World Health Organization condemnation of the attacks against HCWs treating patients with COVID-19 have confirmed the seriousness of the situation regarding violence against doctors and nurses worldwide. Many countries have reported cases of violence, and some are particularly affected by this problem. A Chinese Hospital Association survey collecting data from 316 hospitals revealed that 96% of the hospitals surveyed experienced workplace violence in 2012, and a study done by the Chinese Medical Doctor Association in 2014 showed that over 70% of physicians ever experienced verbal abuse or physical injuries at work . An examination of all legal cases on violence against health professionals and facilities from the criminal ligation records 2010–2016, released by the Supreme Court of China, found that beating, pushing, verbal abuse, threatening, blocking hospital gates, and doors, smashing hospital property were frequently reported types of violence. In India, violence against healthcare workers and damage to healthcare facilities has become a debated issue at various levels , and the government has made violence against HCWs an offense punishable by up to 7 years imprisonment, after various episodes of violence and harassment of HCWs involved in COVID-19 care or contact tracing . In Germany, severe aggression or violence has been experienced by 23% of primary care physicians . In Spain, there has been an increase in the magnitude of the phenomenon in recent years . In the UK, a Health Service Journal and UNISON research found that 181 NHS Trusts in England reported 56,435 physical assaults on staff in 2016–2017 . In the USA, 70–74% of workplace assaults occur in healthcare settings . In Italy, in just one year, 50% of nurses were verbally assaulted in the workplace, 11% experienced physical violence, 4% were threatened with a weapon ; 50% of physicians were verbally, and 4% physically, assaulted . In Poland, Czech Republic, Slovakia, Turkey many nurses have been physically attacked or verbally abused in the workplace . According to the South African Medical Association, over 30 hospitals across South Africa reported serious security incidents in just 5 months in 2019 , and in Cape Town violence against ambulance crews is widespread . In Iran, the prevalence of physical or verbal workplace violence against emergency medical services personnel is 36 and 73% respectively . The World Health Organization lists Australia, Brazil, Bulgaria, Lebanon, Mozambique, Portugal, Thailand as other countries where studies on violence directed at HCWs have been conducted .

The consequences of violence against HCWs can be very serious: deaths or life-threatening injuries , reduced work interest, job dissatisfaction, decreased retention, more leave days, impaired work functioning , depression, post-traumatic stress disorder , decline of ethical values, increased practice of defensive medicine . Workplace violence is associated directly with higher incidence of burnout, lower patient safety, and more adverse events .

Which are the most at-risk services and what are the underlying factors of this growing violence? Emergency Departments, Mental Health Units, Drug and Alcohol Clinics, Ambulance services and remote Health Posts with insufficient security and a single HCW are at higher risk. Working in remote health care areas, understaffing, emotional or mental stress of patients or visitors, insufficient security, and lack of preventative measures have been identified as underlying factors of violence against physicians in a 2019 systematic review and meta-analysis .

In public hospital/services, insufficient time devoted to patients and therefore insufficient communication between HCWs and patients, long waiting times, and overcrowding in waiting areas , lack of trust in HCWs or in the healthcare system, dissatisfaction with treatment or care provided , degree of staff professionalism, unacceptable comments of staff members, and unrealistic expectations of patients and families over treatment success are thought to contribute. Indeed, in public hospitals worldwide, staff shortages prevent front-line HCWs from adequately coping with patients’ demands. In private hospitals/services, too extended hospital stays, unexpectedly high bills, prescription of expensive and unnecessary investigations are key factors. Finally, the media frequently report extreme cases of possible malpractice and portray them as representative of “normal” practice in hospitals .

What can be done to reduce the escalating violence against HCWs? HCWs worldwide generally advocate for more severe laws, but harsher penalties alone are unlikely to solve the problem. Importantly, evidence on the efficacy of interventions to prevent aggression against doctors is lacking, and a systematic review and meta-analysis found that only few studies have provided such evidence . Just one randomized controlled trial indicated that a violence prevention program decreased the risks of patient-to-worker violence and of related injury in hospitals , whereas contrasting results in violence rates after implementation of workplace violence prevention programs have been observed from longitudinal studies . There is no evidence on the effectiveness of good place design and work policies aimed to reduce long waiting times or crowding in waiting areas . More studies are clearly needed to provide evidence-based recommendations, and interdisciplinary research with the involvement of anthropologists, sociologists, and psychologists should be encouraged. However, certain measures have to be taken and can be corrected, should they be shown as ineffective in properly conducted studies.

Security measures have been advocated for years and should be taken to safeguard particularly the most at-risk services. First, staff shortages, so common in public hospitals worldwide, should be acted upon, and increased funding should be allocated to employ more doctors and nurses. Hence, the duration of each patient encounter would be augmented, particularly in overburdened public hospitals, allowing the (often young) doctors to develop a meaningful relationship with the patient. Second, healthcare organizations and universities should considerably improve the communication skills of current and future HCWs to reduce unrealistic expectations or misunderstanding of patients and families. Third, HCWs who denounce any verbal or physical violence should be fully supported by their healthcare organizations; this would reduce the huge issue of under-reporting of workplace violence . Good courses should be organized for HCWs to learn how to identify early signs that somebody may become violent, how to manage dangerous situations, and how to protect themselves.

Prompt communication about delays in service provision should be given to patients and their relatives when waiting times are long because certain conditions are prioritized. Alarms and closed-circuit televisions should be placed in the higher-risk departments and in areas where doctors and/or nurses work in isolation. Sanctioning of violence by patients, relatives or visitors must be imposed. Staff should be increased and security officers should be placed, particularly at night, in remote Health Posts and Emergency Departments and at particular times (violence tends to happen in the evenings/nights, when more patients under the influence of drugs and alcohol present); the number of night shifts should be limited . Efforts should be made to improve job satisfaction of HCWs . Finally, media should cease to contribute to the general public’s distrust toward HCWs and institutions. Many patients report their negative experiences of medical care to news or media outlets which are highly interested in these stories and very often do not check the information before publishing it . These biased media reports may exacerbate the tension.

All workers have a right to be safe on their job, and healthcare workers are no exception. The idea that violence is inherent to doctors and nurses’ work, especially in certain departments, needs to be fought; urgent measures must be implemented to ensure the safety of all HCWs in their environment, and the needed resources must be allocated. Failure to do so will worsen the care that they are employed to deliver and will ultimately negatively affect the whole healthcare system worldwide.


Self-care during COVID-19

The Partnership for Maternal, Newborn & Child Health (PMNCH, the Partnership) is the world’s largest alliance for women’s, children’s and adolescents’ health (WCAH), bringing together over 1,000 partner organizations across 192 countries.

Emerging evidence has shown how critical and effective self-care can be. When women, children and adolescents are empowered to adopt healthy self-care practices, they can play a critical role in protecting their own health.

To promote self-care practices around key sexual, reproductive, maternal, newborn, child and adolescent health issues during the COVID-19 pandemic, PMNCH is partnering with WHO and other UN partner agencies to develop a series of short animated videos to promote healthy behaviours during the pandemic. These videos help translate the latest WHO guidance on self-care practices for women, children adolescents and their families in relation to key issues arising in the context of COVID-19.



Breastfeeding during COVID-19

This video demonstrates how mothers with Covid-19 can breastfeed safely, providing their newborn with the best source of nutrition and protection to survive and thrive. The 60-second film was produced by award-winning Studio Eeksaurus of Mumbai with UK-based Medical Aid Films. It has reached more than 40 million viewers on social media since the launch on 28 May 2020. The video is also available in the five official languages of the United Nations (Arabic, Mandarin, French, Russian and Spanish).

Is This Normal? How the NICU Impacts Your Emotional Health

by Hand to Hold Staff | Jun 7, 2018

Having a baby in the neonatal intensive care unit is a traumatic experience. No one is ever really prepared. You have probably felt emotions during your baby’s NICU stay that you never imagined feeling. You have celebrated things you never knew you would and seen things you never imagined.

All of the emotions that you experience in the NICU – grief, guilt, depression, anxiety, fear – are normal and appropriate. They are natural responses to traumatic events. They are not a sign of weakness. They are a healthy part of adapting and adjusting to being your baby’s parent.

Here are some of the things you may be feeling or may feel in the coming weeks and months. While all these feelings are normal, it is important for you and your family to recognize if they become a problem and know how to get the help and support you need if they do.

Grief & guilt

Grief is what you feel when you lose something that is important to you. If your baby is in the NICU, it is normal to grieve. You are allowed to feel sad and angry that your pregnancy didn’t go as you expected and that your baby needs critical care. Maybe you feel guilty that you might have done something to cause this. The truth is that you can do everything right and still end up in the NICU, and you can do everything wrong and still have a healthy birth. Talk to your doctors and ask questions. You may or may not be able to find reasons why this happened. Most of the time we don’t know the reason. While it’s important to find out what you need to do to take care of your baby and yourself, it is also important for you to forgive yourself and your body.


Sometimes it can be hard to tell the difference between feeling tired and feeling depressed. While your baby is in the NICU, you are probably trying to keep up with a busy schedule of driving back and forth to the hospital and managing things both in the NICU and at home. It’s understandable if you’re feeling emotional and exhausted. It is important for you to recognize signs of depression and to know what to do if the symptoms persist.

Postpartum depression is common. If you feel any of these symptoms for more than a month or two, talk to someone and make a plan. There are things you can do to feel better and medications that can help. You may have depression if you have these symptoms:

  1. Exhaustion – You feel tired and overwhelmed by everything you need to do.
  2. Inability to Sleep – You have difficulty falling asleep or staying asleep.
  3. Loss of Appetite – You make time to eat, but aren’t interested in food, and you don’t get hungry when you should.
  4. Sadness and Mood Swings – You feel like you are sadder than you should be or you feel like your emotions are more than you can manage.
  5. You Know Something is Wrong – You know how you are feeling is not right and doesn’t make sense.

Anxiety & acute stress

While your baby is in the NICU, you learn to be hyper-vigilant. You wash your hands hundreds of times and watch the monitors and equipment to keep track of everything your baby is doing. It can all make you feel a little crazy. Anxiety can feel like:

  1. Nervousness – You’re aware of all the things that can go wrong and feel like you’re waiting for the next bad thing to happen.
  2. Fearfulness – You are afraid of what happens in the NICU and worried about what your baby is feeling.
  3. Anger and Irritation – You are either mad at the people around you or mad at the situation, but you can’t stop feeling annoyed.

Many NICU parents will experience symptoms of a condition called Acute Stress Disorder (ASD). ASD develops when you witness traumatic events. You may feel:

  1. Frightened – You may have witnessed terrible and terrifying things.
  2. Disconnected – You might feel like this isn’t “real” and that this isn’t possible.
  3. Surprised by What You’re Feeling – A sound or smell might trigger an overwhelming reaction or make you feel like you’re reliving something that already happened.

Acute Stress Disorder is a normal physiological response. It is how our brains and bodies react to trauma. The symptoms usually appear within a month and get better over the next few weeks. If your symptoms don’t get better – or they get worse – you may have developed a more serious condition called PTSD.

Post-traumatic stress disorder (PTSD)

PTSD is an anxiety disorder characterized by persistent, debilitating physical and emotional symptoms. The symptoms are grouped into three types:

  1. Intrusive Memories – Having flashbacks or feeling like you’re reliving the experience over and over again.
  2. Avoidance & Numbing – Trying not to feel the intense emotions that you fear you might.
  3. Increased Anxiety & Emotional Arousal – Feeling like you can’t relax because something bad might happen.

How to get help

There are two important things you need to know about these feelings and conditions. They are normal, and they are temporary. You will feel better. All of these people can help:

  1. Your doctor – Talk to your doctor, OB/GYN or pediatrician. Print this screening tool to take with you.
  2. Social worker – Call the NICU social worker. They will know how to get help.
  3. Professional counselor – Many professionals specialize in helping with these conditions.
  4. Community resources – Support is available online and by phone. Connect with Hand to Hold’s online communities for valuable resources and support.
  5. Family and friends – They want to help even if they’re not sure how. Tell them what you need. Read how you can help a loved one.
  6. Peer support – Hand to Hold can connect you with families just like yours who know what you’re feeling and how to get better.

Caring for your emotional and mental health is an important part of taking care of yourself. You don’t deserve to feel this way. You deserve to feel healthy, and you can get better.

3 Resources you should know

Postpartum Support International provides resources about perinatal mood and anxiety disorders.doing

Postpartum Progress is a community website that shares the stories of other women and men who have experienced PPD, as well as valuable resources and information about perinatal mood disorders.

NICU Family Forum is Hand to Hold’s online peer support group for NICU parents who are going through or who had a NICU experience with their preterm or full-term infants. Join us on Facebook.


Why language development is especially challenging for premature babies and what the team at the Montreal Children’s Hospital’s Neonatal Intensive Care Unit (NICU) is doing to help parents interact with their babies.

McGill University Health Centre (MUHC)   Sep 15, 2020


Catching infections in premature babies before they happen using AI


Using Artificial Intelligence to help premature babies stay healthy is the aim of a European research project.… READ MORE : Source:…

Maternal Work and Spontaneous Preterm Birth: A Multicenter Observational Study in Brazil

Scientific Reports volume 10, Article number: 9684 (2020) Published 16June2O


Spontaneous preterm birth (sPTB) is a major pregnancy complication involving biological, social, behavioural and environmental mechanisms. Workload, shift and intensity may play a role in the occurrence of sPTB. This analysis is aimed addressing the effect of occupational activities on the risk for sPTB and the related outcomes. We conducted a secondary analysis of the EMIP study, a Brazilian multicentre cross-sectional study. For this analysis, we included 1,280 singleton sPTB and 1,136 singleton term birth cases. Independent variables included sociodemographic characteristics, clinical complications, work characteristics, and physical effort devoted to household chores. A backward multiple logistic regression analysis was applied for a model using work characteristics, controlled by cluster sampling design. On bivariate analysis, discontinuing work during pregnancy and working until the 7th month of pregnancy were risks for premature birth while working during the 8th – 9th month of pregnancy, prolonged standing during work and doing household chores appeared to be protective against sPTB during pregnancy. Previous preterm birth, polyhydramnios, vaginal bleeding, stopping work during pregnancy, or working until the 7th month of pregnancy were risk factors in the multivariate analysis. The protective effect of variables compatible with exertion during paid work may represent a reverse causality. Nevertheless, a reduced risk associated with household duties, and working until the 8th-9th month of pregnancy support the hypothesis that some sort of physical exertion may provide actual protection against sPTB.

Full Article:

Therapeutic approach of stem cell transplantation for neonatal white matter injury

Received: 31 March 2020; Accepted: 24 July 2020; Published: 31 August 2020.

Ling Ma1, Xiaoli Ji1, Chuanqing Tang2, Wenhao Zhou1,3, Man Xiong2,3

1Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China; 2Stem Cell Research Center, Institute of Pediatrics, Children’s Hospital of Fudan University, Shanghai, China; 3Key Laboratory of Neonatal Diseases, Ministry of Health, Children’s Hospital of Fudan University, Shanghai, China

Abstract: The white matter in brain are mainly composed of oligodendrocytes and myelinated axons, and are important for the transmission of neural signals in central nervous system. White matter injury (WMI) is a leading cause of neurocognitive deficits in premature infants as the oligodendrocytes progenitors are easily attacked by hypoxia-ischemia (HI). Various clinical methods are used to treat this disease, while none of them could reverse the sequelae of WMI completely. With the development of stem cell technology, stem cell therapy has attracted huge interest as a novel treatment for WMI. A number of investigations have demonstrated the potential therapeutic effects of stem cell transplantation on WMI. Different types of stem cells have also been used by many researchers to test the therapeutic effect on WMI animal models, such as neural stem cells (NSCs), glial progenitor cells, mesenchymal stem cells (MSCs). In addition, some clinical trials have been conducted. Evidence suggests that transplantation of these stem cells into animals contributes to functional recovery after experimental WMI. The mechanisms of stem cells therapy may include differentiation into neurons and glial cells to replace lost cells, activation of endogenous NSC regeneration, and promotion of the release of neurotrophins. In this review, we summarized effects of different types of stem cells transplantation, the underlying mechanisms, the unsolved problems and concerns before clinical trials and transformation of stem cell therapy for WMI.        


Full Article:

Dr. Stephen Porges: What is the Polyvagal Theory

              Apr 23, 2018

                Dr. Stephen Porges explains Polyvagal Theory in his interview with

Learn More about Dr. Porges at


The World Health Organization says that there is currently a global shortage of more than seven million health workers and that number could rise to nearly 13 million by 2035. We  rely on our Healthcare Partners to provide lifesaving and ongoing medical care to our Warriors, Family Partners, Community Partners and to the Healthcare Partners themselves.  Our Global preterm birth community must actively support the development, training, safety, retainment, health and wellness, and Global collaboration of our Healthcare Partners in order to support the needs of the Preterm Birth Community at large. We need each other.

2020 Infant Health Policy Summit

Sep 29, 2020

The sixth annual Infant Health Policy Summit welcomed health care providers, parents, policymakers, advocates and other stakeholders to explore how policy solutions can improve the health and lives of infants and their families. This year’s event, held virtually, examined issues such as:

  1. Disparities in infant health
  2. Congenital gut disorders
  3. Human milk.
  4. Late preterm infants
  5. Respiratory syncytial virus and COVID-19
  6. Isolation and disruption during COVID-19
  7. Vaccines

The summit, which included a series of panel discussions, individual stories and interviews, was convened by the National Coalition for Infant Health and co-hosted by the Institute for Patient Access and Alliance for Patient Access. Read the report and watch the summit recording to learn more.

Full Article:


Pasteurization inactivates COVID-19 virus in human milk: new research

August 11, 2020 – University of New South Wales – A new study has confirmed what researchers already suspected to be the case: heat inactivates SARS-CoV-2 in human milk.

A team of medical researchers has found that in human milk, pasteurisation inactivates the virus that causes COVID-19, confirming milk bank processes have been safe throughout the pandemic, and will remain safe going forward, too.

The study — published this month in the Journal of Paediatrics and Child Health — was a partnership between UNSW and a multidisciplinary team from Australian Red Cross Lifeblood Milk.

There are five human milk banks in Australia. As the COVID-19 pandemic evolves, these milk banks continue to provide donated breast milk to preterm babies who lack access to their mother’s own milk. Donors are screened for diseases, and milk is tested and pasteurised to ensure that it is safe for medically fragile babies.

“While there is no evidence that the virus can be transmitted through breast milk, there is always a theoretical risk,” says Greg Walker, lead author and PhD candidate in Professor Bill Rawlinson’s group at UNSW Medicine.

“We’ve seen in previous pandemics that pasteurised donor human milk (PDHM) supplies may be interrupted because of safety considerations, so that’s why we wanted to show that PDHM remains safe.”

For this study, the team worked in the Kirby Institute’s PC3 lab to experimentally infect small amounts of frozen and freshly expressed breast milk from healthy Lifeblood Milk donors.

“We then heated the milk samples — now infected with SARS-CoV-2 — to 63?C for 30 minutes to simulate the pasteurisation process that occurs in milk banks, and found that after this process, they did not contain any infectious, live virus,” Mr Walker says.

“Our findings demonstrate that the SARS-CoV-2 virus can be effectively inactivated by pasteurisation.”

The researchers say their experiments simulated a theoretical worst-case scenario.

“The amount of virus we use in the lab is a lot higher than what would be found in breast milk from women who have COVID-19 — so we can be really confident in these findings,” Mr Walker says.

Dr Laura Klein, Research Fellow and Lifeblood Milk senior study author, explains that the purpose of the research was to provide evidence behind what people already expected.

“Pasteurisation is well known to inactivate many viruses, including the coronaviruses that cause SARS and MERS,” she says.

“These findings are also consistent with a recent study that reported SARS-CoV-2 is inactivated by heat treatment in some contexts.”

Kirby Institute researcher and study co-author, Associate Professor Stuart Turville, says this work was a first.

“We’ve been working in real time to grow and make tools against this new pathogen, which has been an exponential learning curve for everyone involved. This work and many others that are continuing in the PC3 lab tell us how we can be safe at the front line working with this virus in the real world.”

Cold storage doesn’t inactivate the virus

The researchers also tested if storing SARS-CoV-2 in human milk at 4°C or -30°C would inactivate the virus — the first time a study has assessed the stability of experimentally infected SARS-CoV-2 in human milk under common storage conditions.

“We found that cold storage did not significantly impact infectious viral load over a 48-hour period,” Mr Walker says.

“While freezing the milk resulted in a slight reduction in the virus present, we still recovered viable virus after 48 hours of storage.”

The researchers say the fact that SARS-CoV-2 was stable in refrigerated or frozen human milk could help inform guidelines around safe expressing and storing of milk from COVID-19 infected mothers.

“For example, we now know that it is particularly important for mothers with COVID-19 to ensure their expressed breast milk does not become contaminated with SARS-CoV-2,” Dr Klein says.

“But it’s also important to note that breastfeeding is still safe for mothers with COVID-19 — there is no evidence to suggest that SARS-CoV-2 can be transmitted through breastmilk.”

Donated breast milk is recommended by the World Health Organisation when mother’s own milk is not available to reduce the risks of some health challenges premature babies can face. Lifeblood Milk has provided donor milk to over 1500 babies born premature in 11 NICUs across New South Wales, South Australia, and Queensland since launching in 2018.


Shining a light on physician suicide

Sep 17, 2020 – 12:25 PM by Elisa Arespacochaga – vice president of the AHA Physician Alliance.

The COVID-19 pandemic makes working in health care especially exhausting both physically and mentally. These front-line care workers face putting their families and colleagues at risk for exposure to the virus, working extended shift hours and confronting an unimaginable death toll.

The number of Americans who have died from COVID-19 is approaching 200,000, and due to the nature of the virus, the vast majority occur in the hospital, a place for healing and hope. The pandemic’s staggering death count blankets all caregivers in heavy sadness. Unlike so many of the disasters that hospitals and their teams are ready to help address, this one isn’t lasting just a few days. Our caregivers are experiencing a protracted state of grief over six months and counting. The ongoing challenges are making it difficult to find time to grieve, address stress and deal with feelings of distress.

Each year roughly 400 physicians die by suicide. Hundreds more harbor serious thoughts of suicide. The suicide completion rate among doctors is 44% higher than the expected population; female physicians have a higher suicide completion rate than male doctors[i]. Stress, burnout, and trauma all contribute to this devastating toll. And, COVID-19 will likely intensify those emotions.

We must tackle these grim statistics head on. “Shine a Light, Speak its name” is the theme for National Physician Suicide Awareness Day, Sept. 17.

To shed light on the issue and highlight prevention strategies, the AHA’s Physician Alliance and the Education Development Center (EDC) have produced the Be Well: Preventing Physician Suicide podcast series. It shares stories of recovery and ideas for supporting colleagues struggling with thoughts of suicide. Other resources to foster well-being include the AHA Physician Alliance’s Well-Being Playbook, as well as EDC’s Suicide Prevention Resource Center which provides technical assistance, training and materials.

AHA’s Caring for Our Health Care Heroes During COVID-19 offers real-world examples of how hospitals and health systems are helping care for, and support, their workforce during the pandemic. It also provides a list of national well-being programs and resources developed for health care workers.

In this AHA Members in Action case study, ChristianaCare of Newark, Del., shares its multi-year journey to create the Center for WorkLife Wellbeing, that has spawned numerous innovative programs, such as a calming OASIS room, COMPASS (Clinician-Organized Meetings to Promote and Sustain Satisfaction), and the Care for the Caregiver peer support program.

By acknowledging the heavy sadness caused by the pandemic’s death toll and shining a light on the problem of physician suicide and openly addressing the issue, we can help support and care for physicians. Does your hospital have a formal clinician well-being program? If so, please share your story with me at

If you or anyone you know is struggling, please reach out to the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) to speak to a trained professional.


Fast Five: Strategies for Addressing Moral Distress in Frontline Health Care Workers

In this Fast Five from the Center to Advance Palliative Care (CAPC), Dr. Ira Byock, Chief Medical Officer for the Providence Health System Institute for Human Caring shares three practical initiatives that can foster human connection among patients, families, and clinical care teams when in-person visits are restricted or the heavy use of personal protective equipment limits the ability to connect in a meaningful way.



Historically mental health for youth and adolescents has been overlooked and under-valued. Covid-19 has resulted in elevated levels of mental health disparities and stress among the Global community. For our youth, mental health support has been challenging to gain as many schools have transitioned to online platforms for some and for others school has been cancelled all together.  While families and individual’s grapple to find ways to navigate pandemic challenges we have an opportunity to move forward in creative and resilient ways.  The pandemic is a direct challenge to our Warriors to take action towards building and strengthening  their personal and community well-being.

If you are a youth, or interact with youth, who may need and benefit from mental-health resources we encourage you to review the article below, understand the impact the pandemic may have on youth mental health and explore the variety of recommendations the article offers to youth worldwide. 

OPINION: In this time of COVID-19 a new consensus on how we should be working to improve adolescent well-being is long overdue

5 October 2020 – By Enes Efendioğlu and Souzana Humsi, Adolescents and Youth Constituency Board Members

Every generation of adolescents grapples with the difficult transition from childhood into adult life: juggling social and academic pressures at school; coping with changing dynamics within family and friendship groups; experiencing the physical and mental transformation of puberty; and making crucial decisions about whether to pursue further education or embark on careers.

This generation of 10-19-year olds is no exception – except they are also having to navigate adolescence during a global pandemic that is causing unprecedented harm to people’s health, and damaging the social and economic fabric of countries world-wide.

Adolescents have been among the worst affected by the indirect consequences of the pandemic. It has severely disrupted education provision, which can have adverse effects on adolescents’ social skills at a critical time in their development. When adolescents are unable to attend schools, they may experience depression, social anxiety and stress that can lead to deeper mental health issues, or even push them toward risky behaviours, including drug abuse and self-harm.

With so many pressures on governments to address the direct health consequences of COVID-19, limit its transmission and kick-start economies, finding time and resources to tackle its indirect consequences, including those affecting adolescents, is a challenge.

Adolescents are sometimes underserved by policies intended to improve their health and well-being, and sometimes are not consulted when interventions for their benefit are being developed. A recent study, for example, estimated that development assistance for adolescent health only accounted for 1.6% of all development assistance between 2003 and 2015.

Occasionally, issues that are of importance to young people are under-resourced, or not addressed in the appropriate way. For example, in some countries, comprehensive sexuality education interventions can be very limited, or actively restricted. Many young people are denied access to age-appropriate information to protect themselves from unintended pregnancy and sexually transmitted infections, or to avoid situations that put them at risk of domestic or gender-based violence or sexual exploitation, which have also increased during the pandemic. If they do access helpful information, they may often find that they don’t have any youth-friendly services to address the repercussions of these issues.

Another major issue that has made work in the field of adolescent well-being more complex than it needs to be has been the lack of a specific unified framework for addressing the issues. This can affect the quality of strategies and interventions being developed for adolescents, because having piecemeal guidelines, research, toolkits and documents covering broadly similar issues – all claiming to be authoritative – inevitably leads to costly duplication and confusion for programme implementers about the right approaches to take.

Fortunately, a recent, extremely welcome initiative is seeking to reframe the narrative around adolescent well-being, and lay the foundations for improved interventions that fully take account of young people’s self-articulated needs.

After the introduction and adoption of the Sustainable Development Goals (SDGs) in 2015, one big objective was to provide access to universal healthcare for people of all ages, everywhere in the world. The task before the coalition of governments, UN organizations, non-governmental organizations and academic institutions who have come together to support a Call to Action for Adolescent Wellbeing, backed by a new definition and conceptual framework, was to define what adolescent well-being looks like.

The resulting definition and conceptual framework for adolescent health is published this week in the Journal of Adolescent Health. The paper defines adolescent wellbeing as being a state where: ‘Adolescents have the support, confidence, and resources to thrive in contexts of secure and healthy relationships, realizing their full potential and rights’ and also stresses the importance of five interconnected domains:

  1. Good health and optimum nutrition
  2. Connectedness, positive values and contribution to society
  3. Safety and a supportive environment
  4. Learning, competence, education, skills and employability
  5. Agency and resilience.

The five domains encompass both objective and subjective terminology, and are underpinned by gender, equity and rights considerations. Collectively, the definition and framework provide a new basis for building global consensus around working to improve adolescent well-being.

One key challenge in this process was to ensure that those with the deepest insights to what this generation of adolescents need – adolescents and young people themselves – were fully consulted.

As Board Members representing an Adolescents and Youth Constituency at one of the key organisations involved in this process, the Partnership for Maternal, Newborn & Child Health (PMNCH), the co-authors of this opinion are proud to have driven the consultation process to develop the framework.

Carrying out a global consultation in the time of COVID-19 is challenging, as many adolescents could only be reached online, so additional outreach was required towards some marginalised groups, including indigenous youth and young migrants, to ensure their perspectives were included. Consultations continue, however, and under-represented groups, particularly those without internet access, will be reached.

The framework provides a new way of working, by looking at adolescent well-being through a comprehensive lens, which is even more important in these dynamic and critical times.

Ultimately, the aim is to have a globally adopted, evidence-based definition and framework governing how best to partner with adolescents and young people in designing interventions they will access and use, because they should be owned by and for them. This will be presented in a UN Summit on Adolescent Well-being, which partners such as PMNCH are working closely with Member States to mobilize towards in 2022 or 2023, the mid-way point towards the SDGs 2030 Agenda.

Since COVID-19 began, we have seen an immense amount of co-operation and collaborations, both within and between countries, such as the COVAX mechanism, the international partnership to distribute any COVID vaccine equitably, regardless of any country’s ability to pay.

Hopefully this spirit of international collaboration will be seen as the global definition and conceptual framework for adolescent wellbeing is rolled out.

Not only will such collaboration help to avoid costly duplication of effort. It will also enable programme managers to plan and co-ordinate their efforts around particular domains, so that collectively they will have a greater chance of meeting more international targets for adolescent health and wellbeing by 2030.


5 Digital Platforms That Offers Support During Coronavirus Outbreak - BW  Businessworld

The Medical Home organization recommends the following APP friendly resources to kids coping with anxiety. Each of the following Apps may be accessed directly via the hyperlinks listed below. For additional information on The Medical Home Portal and a summary of each APP please follow the Full-Article link listed below.   

Apps to Help Kids and Teens with Anxiety

  1. Breathe, Think, Do with Sesame Street 
  2. Breathe 2 Relax 
  3. CBT Tools for Youth 
  4. Cosmic Kids 
  5. DreamyKid 
  6. HappiMe and HappiMe for Young People 
  7. Healing Buddies Comfort Kit 
  8. Manatee & Me 
  9. Moshi: Sleep and Mindfulness 
  10. Smiling Mind 
  11. SuperBetter 
  12. Super Stretch Yoga


La gigantesca OLA de 35 Metros en Nazaré Portugal 🌊The largest WAVE EVER Nazaré Portugal 115 feet🌊

Sep 20, 2020 Berna SUPer SURFers

Big Wave Surfer, Hugo Vau, surfed the largest wave ever in Nazare, Portugal. This beautifully poetic and intimate documentary follows Hugo Vau as he recalls the strength, ambition and fears that lead up to the day that forever changed his life and career. Directed by Nina Meredith



Preterm Birth Rates – ROMANIA

Rank: 151Rate: 7.3% Estimated # of preterm births per 100 live births (USA – 12 %)

Romania is a country located at the crossroads of CentralEastern, and Southeastern Europe. It has a predominantly temperatecontinental climate. With a total area of 238,397 square kilometres (92,046 square miles), Romania is the twelfth-largest country in Europe and the seventh-most populous member state of the European Union, having approximately 20 million inhabitants. Its capital and largest city is Bucharest

Romania has a universal health care system; total health expenditures by the government are roughly 5% of GDP. It covers medical examinations, any surgical interventions, and any post-operative medical care, and provides free or subsidised medicine for a range of diseases. The state is obliged to fund public hospitals and clinics. The most common causes of death are cardiovascular diseases and cancer. Transmissible diseases are quite common by European standards. In 2010, Romania had 428 state and 25 private hospitals, with 6.2 hospital beds per 1,000 people, and over 200,000 medical staff, including over 52,000 doctors. As of 2013, the emigration rate of doctors was 9%, higher than the European average of 2.5%.



Babies born prematurely can catch up their immune systems

March 9, 2020  Source: King’s College London

Researchers from King’s College London & Homerton University Hospital have found babies born before 32 weeks’ gestation can rapidly acquire some adult immune functions after birth, equivalent to that achieved by infants born at term.

In research published today in Nature Communications, the team followed babies born before 32 weeks gestation to identify different immune cell populations, the state of these populations, their ability to produce mediators, and how these features changed post-natally. They also took stool samples and analysed to see which bacteria were present.

They found that all the infants’ immune profiles progressed in a similar direction as they aged, regardless of the number of weeks of gestation at birth. Babies born at the earliest gestations — before 28 weeks — made a greater degree of movement over a similar time period to those born at later gestation. This suggests that preterm and term infants converge in a similar time frame, and immune development in all babies follows a set path after birth.

Dr Deena Gibbons, a lecturer in Immunology in the School of Immunology & Microbial Sciences, said: “These data highlight that the majority of immune development takes place after birth and, as such, even those babies born very prematurely have the ability to develop a normal immune system.”

Infection and infection-related complications are significant causes of death following preterm birth. Despite this, there is limited understanding of the development of the immune system in babies born prematurely, and how this development can be influenced by the environment post birth.

Some preterm babies who went on to develop infection showed reduced CXCL8-producing T cells at birth. This suggests that infants at risk of infection and complications in the first few months of their life could be identified shortly after birth, which may lead to improved outcomes.

There were limited differences driven by sex which suggests that the few identified may play a role in the observations that preterm male infants often experience poorer outcomes.

The findings build on previous findings studying the infant immune system.

Dr Deena Gibbons: “We are continuing to study the role of the CXCL8-producing T cell and how it can be activated to help babies fight infection. We also want to take a closer look at other immune functions that change during infection to help improve outcomes for this vulnerable group.”

King’s College London. “Babies born prematurely can catch up their immune systems.” ScienceDaily. ScienceDaily, 9 March 2020.


The Premature Association donated protective equipment and devices against COVID 19 in 5 maternity hospitals

Bucharest, 09/09/20.

The Association of Premature Babies, always with medical staff and newborns in maternity hospitals, came to an end with the project “Support for medical staff and newborns in maternity hospitals – protective equipment and apparatus against COVID 19”, funded by the program “In condition good ”, supported by Kaufland Romania and implemented by the Foundation for Civil Society Development.

The Premature Association purchased and donated 30 UV biocidal lamps for air disinfection, for use in the presence of people, 2,000 pairs of surgical gloves, 2,000 disposable gowns , 2,000 simple surgical masks , 500 disposable coveralls , 250 visors , 5,000 shoe protection boots, 1 air conditioner , 550 FFP2 medical masks , 150 liters of disinfectant surfaces with biocide approved by MS, 150 liters of disinfectant soap. These donations have already arrived and are used by the Maternity of the Bacău County Emergency Hospital, the Maternity of the Călărași County Emergency Hospital, the Maternity of the Târgoviște County Emergency Hospital, the Obstetrics-Gynecology Philanthropy Hospital of Bucharest, the Bucharest Maternity Hospital.

“It is a maxim that says that the friend in need knows himself, and you, our dear friends from the Premature Association, are with us in these moments, especially difficult, by our side. Your support in moments of balance supports us both materially and morally. We appreciate the effort of those who contributed to go through an economic crisis, not only medical and human.

We use ultraviolet lamps every day to disinfect the spaces and share them with our friends and colleagues from the obstetrics department for the rooming-in salons. Sanitary materials, masks, gowns, gloves, were extraordinarily welcome, consumption growing exponentially during this period.

Thank you very much for everything! Let’s get over this pandemic healthy! Dr. Camelia Husac, head of the neonatology department, Matenitatea of ​​the Bacău County Emergency Hospital.

The products delivered through this project are useful for over 100 medical staff, over 2,000 parents and about 2,000 newborns who have been born since July or will be born in the above-mentioned maternity hospitals in the coming months.

“Thank you for your involvement and support in these difficult times. The babies from Târgoviste Maternity Hospital, through the professionals, thank you! All the respect and good thoughts for the Premature Association and for Kaufland Romania! Preventing the transmission of infections in a maternity hospital is a safety standard for patients. Thank you again for your involvement! ” Dr. Anca Georgescu, head of the neonatology department, Maternity of the Târgoviște County Emergency Hospital.

The total value of the project “Support for medical staff and newborns in maternity – protective equipment and apparatus against COVID 19” reaches 150,000 lei, funded by the program “In good condition” 2020, supported by Kaufland Romania and implemented by the Foundation for Development Civil Society.

” Thank you from the bottom of my heart for the generous donation, the equipment is already in use and is very useful to us, especially in this difficult period!” Dr. Carmen Ștefan, head of the neonatology department, Călărași County Emergency Hospital Maternity Hospital.

About the Premature Association

The Premature Association develops in Romania programs dedicated to premature babies, parents and medical staff in neonatology and brings together experts from various disciplines, parents, media representatives and public figures, to improve the quality of public health services in Romania.

The Premature Association is the only accredited prematurity NGO in Romania, in accordance with the provisions of Law no. 197/2012 on quality assurance in the field of social services by the Romanian Ministry of Labor, Family, Social Protection and the Elderly.

The Premature Association is a member of EFCNI, European Foundation for the Care of Newborn Infants – the only pan-European organization representing the interests of premature and newborns, and brings together parents’ organizations from around the world, health professionals from different specialties, in the long term of their health, through prevention, treatment, care and support programs, they also celebrate World Prematurity Day in Romania.

Discriminatory Housing Practices Tied to Premature Births

By Traci Pedersen   Associate News Editor   Last updated: 28 Aug 2020

A new study suggests that past discriminatory housing practices may play a role in perpetuating the significant disparities in infant and maternal health faced by minorities in the United States.

For decades, banks and other lenders refused loans to people if they lived in an area the lenders deemed to be a poor financial risk. This policy, called redlining, led lenders and banks to create maps marking neighborhoods considered too risky for investment. These maps were first drawn in 1935 by the government-sponsored Home Owners’ Loan Corp. (HOLC), and labeled neighborhoods in one of four colors — from green representing the lowest risk to red representing the highest risk.

These designations were based, in part, on the race and socioeconomic status of each neighborhood’s residents.

To analyze the link between historical redlining and infant and maternal health today, a research team from the University of California (UC), Berkeley obtained birth outcome data for the cities of Los Angeles, Oakland and San Francisco between 2006 and 2015 and compared them to HOLC redlining maps.

The findings, published online in the journal PLOS ONE, show that adverse birth outcomes — including premature births, low birth weight babies and babies who were small for their gestational age — occurred significantly more often in neighborhoods with worse HOLC ratings.

“Our results highlight how laws and policies that have been abolished can still assert health effects today,” said Rachel Morello-Frosch, a professor of public health and of environmental science, policy and management at UC Berkeley and senior author of the study.

“This suggests that if we want to target neighborhood-level interventions to improve the social and physical environments where kids are born and grow, neighborhoods that have faced historical forms of discrimination, like redlining, are important places to start.”

Non-Hispanic Black women living in the U.S. are one-and-a-half times more likely to give birth to premature babies than their white counterparts and are more than twice as likely to have babies with a low birth weight. Hispanic women face similar, though less dramatic, disparities, compared to non-Hispanic white women.

While the legacy of public and private disinvestment in redlined neighborhoods has led to well-documented disparities in income level, tree canopy coverage, air pollution and home values in these communities, the long-term health impacts of redlining are just now starting to be explored.

“Children born during the time of our study would be the great-great-grandchildren of those who were alive at the time of redlining, whose options of where to live would have been determined by redlining maps,” said study lead author Anthony Nardone, a medical student in the UC Berkeley-UCSF Joint Medical Program.

“We chose to look at birth outcomes because of the stark inequities that exist across race in the U.S. today, inequities that we believe are a function of long-standing institutional racism, like historical redlining.”

Previous research led by Nardone showed that residents of neighborhoods with the worst HOLC rating were more than twice as likely to visit the emergency room with asthma than residents of neighborhoods with the highest HOLC rating. And a recent study from the Harvard School of Public Health found a link between redlining and preterm births in New York City.

In the new study, the researchers discovered that neighborhoods with the two worst HOLC ratings — “definitely declining” and “hazardous” — had significantly worse birth outcomes than those with the best HOLC rating.

However, Los Angeles neighborhoods rated “hazardous” showed slightly better birth outcomes than those with the second worst, or “definitely declining,” rating. In San Francisco and Oakland, neighborhoods with these two ratings showed similar birth outcomes.

This pattern might be due to the effects of gentrification on previously redlined neighborhoods, the authors speculated. They added that residents of the hardest hit neighborhoods may also rely more on community support networks, which can help combat the effects of disinvestment.

“We also saw different results by metropolitan area and slightly different results by maternal race,” Morello-Frosch said. “This suggests that maybe the underlying mechanisms of the effect of redlining differ by region and should be investigated further.”

Source: University of California- Berkeley



Premature baby – Home at last! What next?

Jun 23, 2020    KK Women’s and Children’s Hospital

This YouTube video provided by KK Women’s and Children’s Hospital in Singapore shares preemie care practices, a Singapore preterm birth family  experience and many practical care recommendations. The video may inspire you to  talk  to your provider regarding care recommendations for your precious baby.

Your baby is now ready for home. The nursing and medical team will prepare you to bring your baby home and will go through the common concerns that you may encounter at home. Close follow-up of your baby’s health, development and growth is still much needed in order to ensure that your premature child achieves his / her best potential. This will be managed in the regular outpatient clinic reviews. In this video, we will highlight what is to be expected during your baby’s outpatient clinic review.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Victoria A. Grunberg  Pamela A. Geller  Chavis A. Patterson   First published: 14 February 2020


Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family‐focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self‐care may be effective to prevent negative psychosocial sequelae among families.

Track your preterm baby’s milestones


Baby+ a baby tracking app for premature babies and their parents


Baby+, the popular baby tracking apps, is now offering new content particularly targeted at the questions and needs of parents of preterm babies. EFCNI is honoured to have supported the developers of the Baby+ app with 20 articles dedicated to this topic. Parents as well as family members or friends can now inform themselves about a wide range of questions concerning preterm birth via the mobile app.

Topics range from information about preterm birth, special nutritional needs of preterm babies, the rights of parents or how to bond with a baby in the NICU to name but a few.

With 1 baby out of 10 being a preterm baby, the app now acknowledges the large group of preterm parents and supports them in their journey.

The Baby+ app is available for free for iOS and Android and supports the following languages:

English, German, Spanish, French, Dutch, Portuguese, Russian and Italian.

The Award Winning Globally Inspirational Irish Neonatal Health Alliance Shares Heartfelt Inspiring Preterm Birth Family Stories. Take a peak (see link below) into the stories of our Irish family. You may find solace and inspiration within these shared experiences.


Our Vision: to increase awareness of preterm birth, improve pre-conceptual &
antenatal education, equitable neonatal care & better long term care for neonates in Ireland.



Wall of Hope The Rights of Parents & Infants  INHA Family Publications

INHA NICU Milestone Cards  INHA Position Papers  INHA Angel Babies

Link: Global Premature Parent Organisations

WALL OF HOPE – Our Stories (enter link below)


Every woman’s right to a companion of choice during childbirth

9 September 2020

WHO strongly recommends supporting women to have a chosen companion during labour and childbirth, including during COVID-19. 

When a woman has access to trusted emotional, psychological and practical support during labour and childbirth, evidence shows that both her experience of childbirth and her health outcomes can improve.  

In Companion of choice during labour and childbirth for improved quality of care, WHO and HRP present updated information on the benefits of labour companionship for women and their newborns, and how it can be implemented as part of efforts to improve quality of maternity care. 

The current COVID-19 pandemic is no exception. 

WHO Clinical management of COVID-19: interim guidance strongly recommends that all pregnant women, including those with suspected, probable or confirmed COVID-19, have access to a companion of choice during labour and childbirth.


Balancing the Needs of the Patient and the Needs of the System

Rob Graham, R.R.T./N.R.C.P

I learned to drive long ago. The process began with me sitting on my maternal grandfather’s knee behind the wheel of a half-ton truck or his ’58 Oldsmobile. This progressed to the mowing down small trees in a vacant field in my uncle’s jalopy, then driving a tractor pulling a hay wagon on my grandmother’s farm at age 9. When 16 finally arrived, I took driver’s while education in a ’73 Oldsmobile Cutlass. Our family had two vehicles: a ’66 Ford ½ ton, and a ’67 Meteor Rideau 500. (Note to car buffs: Meteor was the Canadian brand of Mercury). The truck had the standard “3 on the tree” transmission, and the other was an automatic. No one was permitted to drive the automatic until they had mastered the standard. This was no small feat! If the shift between first gear to second was precisely done, the entire transmission would lock up, bringing the truck to a screeching stop. What, you may be asking about now, does this have to do with the subject at hand. There are, it seems, a few parallels.

Technology has improved the care and outcomes of all patients, be they young or old. Graphics give us information about lung compliance and over-distention; transilluminators make finding and cannulating veins and arteries easier; fiber-optic laryngoscopes provide brighter light, and fiber optic laryngoscopes aid in the visualisation of the airway and placement of the endotracheal tube. There are many more aids and adjuncts available to modern clinicians that were not available when many of us were training. These and other devices constitute a double-edged sword. In the adult world, “old school” anesthetists complain the skill of laryngoscopy is quickly becoming a lost art. With the relatively recent availability of video laryngoscopy devices in the N.I.C.U., there is fear the same may happen in the world of neonatology. This fear is justified, although experience with the video laryngoscope recently purchased for teaching purposes by the unit in which I work has demonstrated that new devices also have a learning curve. Just how steep that learning curve is, and whether video laryngoscopy becomes standard practice in the N.I.C.U., remains to be seen.

With fewer and fewer babies being intubated for invasive ventilation or even resuscitation, and the advent of “minimally invasive” surfactant administration, there are fewer and fewer opportunities for trainees to learn this very basic yet essential skill. Even babies born with meconium are now rarely intubated.

 In many NICUs, respiratory therapists (RRTs) are the ones doing most of the intubations; thus, RRT trainees are also in the training queue. This would not be such a problem were it not for the fact that many of our fellows in training will never again work in a level 3 or 4 facility, but rather a level 2 facility or even a hospital with only a well-baby unit. Why does this present a problem?

n a world experiencing increasingly shrinking health care budgets, it is unlikely that a facility without higher-level neonatal care will invest in the technology we find commonplace in our level 3 and 4 units. Should a patient in one of these facilities require intubation, the ability of the clinician to perform this procedure, “the old-fashioned way” is essential. That clinician may be the only person with neonatal intubation skills available. As well, there are facilities that do not have in-house anesthesia overnight. Similarly, there is likely a dearth of other technological aids; ultrasound, for instance, available for inserting intravenous, arterial, or umbilical lines. Ventilators may be limited to “jack of all” machines primarily used for adult ventilation but with pediatric and neonatal functionality.

What we take for granted is simply not widely available in lower functioning facilities. In addition, many foreign trainees return to their home countries and facilities, where the level of technological assistance available to us in the “first world” may be non-existent. The problem is obvious. Without learning basic skills, the training we provide for these future neonatologists is incomplete.

Simulations and simulators offer some mitigation, but as anyone who has intubated a mannequin can attest to, they are not a perfect substitute for the real thing. Anatomical anomalies, secretions, and extremely anterior airways are common challenges that a mannequin is unable (to the best of my knowledge) to duplicate. This should not be construed as an “anti-sim” opinion piece. As in the field of aviation, simulations hold great promise in medical training. They are a safe place to make mistakes, practice judgment, and decision-making skills, and offer a degree of skill development. Perhaps it is neonatology that poses a bigger challenge to simulations. There are situations that cannot be adequately taught in a simulation setting.

Simulators ranging from 25-weeks (“micro-preemie”) are available. These offer a chance to practice oral intubation, umbilical line placement, IV placement, nasogastric tube placement, and can present a variety of birth defects. To the best of my knowledge, these devices do not offer experience with false-tracking umbilical lines or femoral artery or hepatic catheterisation. There are clinical signs of these occurrences in real life that a simulator can’t simulate. These devices are a great start, but they are not a true substitute for a real patient, nor are they a complete substitute for clinical practice.

This is of concern as simulation sessions become an increasingly large part of basic training and substitution for real-life experience for trainees. Anecdotally, there is a subtle difference observed in students with extensive simulator training; however, literature does not support these observations1 . It is worth noting that the amount of clinical time replaced by simulation in this study was limited to 50%. While there was no difference in pass rates or educational outcomes, passing does not always equate to real-world competence. Every trainee I have worked with has passed their didactic and clinical programs. The real test might be how many of the simulator group actually pass orientation in a critical care setting. It is also interesting that there is some evidence that higher fidelity simulations do not necessarily improve learning objectives, including neonatal resuscitation program learning.

As real as simulations are, there is no substitute for the adrena line-fueled panic that can ensue in real life (although I have witnessed just that during simulations). There is no “time out” function in the resuscitation room. Simulators do offer opportunities to experience a variety of clinical situations that a trainee may never see during a typical rotation.2 Whatever one’s personal views are, it is undeniable that simulation training has become an integral part of medical education and is here to stay.

I recall attending a lab session during my training, where we practiced intubating anesthetized cats. I learned two things: cats are easy to intubate, and cats are not babies. While in my adult training program, we were also encouraged, where possible, to practice laryngoscopy on cadavers post unsuccessful resuscitation to improve competency. The ethics of doing this today may be called into question, but the experience gained cannot be disputed.

The micro-premature infant presents another quandary. It is generally accepted where I practice that the most experienced person present at resuscitation is the one who manages the airway. Compounding the problem in the unit in which I practice is we intubate nasally wherever and whenever possible. I have yet to find a mannequin that allows for nasal endotracheal tube placement. How then are trainees to learn these skills? Clearly, when it comes to patient care, we want what is best for our babies, and the needs of trainees are secondary. The question here is, how does this philosophy serve future patients and those destined to be treated by those trainees? Where is the balance? What are the ethical implications?

 Perhaps it is time that we, as practitioners, should be addressing these issues to improve training as a whole. Perhaps the same technology creating these problems will, with evolution and innovation, create needed solutions. Some higher end mannequins have anatomy with a range of adjustments (the size of the palate, for instance). While I have faith in the ability of technology to save us from technology, it comes with a price and a very high one at that. The cost of furnishing a complete simulation suite is steep. The question of whether cash strapped institutions will be amenable to this investment remains. Until that time, we must make do with what is available to us as teachers.

The one place where endotracheal intubation is still commonplace is the operating room. This could be the ideal venue for learning laryngoscopy and intubation in a controlled environment and under the watchful eyes of a skilled, experienced pediatric anesthetist. This would require liaising with our anesthesia colleagues but could also have an impact on the training of new anesthetists who also must have excellent intubation skills. There are only so many trainee vacancies on their roster and only so many patients for neonatology trainees on whom to practice. Therefore, the limited opportunity the N.I.C.U. affords trainees to learn intubation skills could, at present, leave us with no choice but simulation.

Finally, I believe that neonatal fellowship programs should offer a respiratory rotation. While RRTs are the primary drivers of ventilation in some units, outside North America, this is a profession that does not exist. When foreign trainees return to their native lands, it is they who must run the ventilators. Who better to learn the intricacies of ventilators and mechanical ventilation from than those who have made it their life’s work? A four-week rotation acting as an RRT orientee could prove invaluable, especially to our foreign trainees.

To use the driving analogy, we all should learn standard before availing ourselves of the luxury of an automatic. By the way, to this day, my vehicles have standard transmissions. I also intubate the “standard” way. When Armageddon comes, I will be doing it the “old fashioned way.” How about you?


What is a Neonatal Nurse Practitioner?

Jan 15, 2016

National Association of Neonatal Nurses

Learn what goes into being a Neonatal Nurse Practitioner (NNP) as well as the excitements, rewards, and challenges that comes with this profession.

Assessment of Neonatal Intensive Care Unit Practices and Preterm Newborn Gut Microbiota and 2-Year Neurodevelopmental Outcomes

Original Investigation Pediatrics  September 23, 2020

Key Points

Question  What are the long-term outcomes associated with dysbiosis of gut microbiota in very preterm newborns?

Findings  In this cohort study of 577 very preterm newborns across 24 neonatal intensive care units from a French nationwide cohort, gut microbiota at week 4 after birth showed 6 bacterial patterns that varied according to gestational age, perinatal characteristics, individual treatments, and neonatal intensive care unit strategies. Three clusters were associated with 2-year outcomes after adjustment for these confounders.

Meaning  Modifying strategies associated with alterations in microbiota, such as promoting enteral nutrition, reducing sedation use, promoting early extubation, or skin-to-skin practice, may be correlated with outcomes in preterm newborns.


Importance  In very preterm newborns, gut microbiota is highly variable with major dysbiosis. Its association with short-term health is widely studied, but the association with long-term outcomes remains unknown.

Objective  To investigate in preterm newborns the associations among practice strategies in neonatal intensive care units (NICUs), gut microbiota, and outcomes at 2 years.

Design, Setting, and Participants  EPIFLORE is a prospective observational cohort study that includes a stool sample collection during the fourth week after birth. Preterm newborns of less than 32 weeks of gestational age (GA) born in 2011 were included from 24 NICUs as part of the French nationwide population-based cohort, EPIPAGE 2. Data were collected from May 2011 to December 2011 and analyzed from September 2016 to December 2018.

Exposures  Eight NICU strategies concerning sedation, ventilation, skin-to-skin practice, antibiotherapy, ductus arteriosus, and breastfeeding were assessed. A NICU was considered favorable to a practice if the percentage of that practice in the NICU was more than the expected percentage.

Main Outcomes and Measures  Gut microbiota was analyzed by 16S ribosomal RNA gene sequencing and characterized by a clustering-based method. The 2-year outcome was defined by death or neurodevelopmental delay using a Global Ages and Stages questionnaire score.

Results  Of 577 newborns included in the study, the mean (SD) GA was 28.3 (2.0) weeks, and 303 (52.5%) were male. Collected gut microbiota was grouped into 5 discrete clusters. A sixth cluster included nonamplifiable samples owing to low bacterial load. Cluster 4 (driven by Enterococcus [n = 63]), cluster 5 (driven by Staphylococcus [n = 52]), and cluster 6 (n = 93) were significantly associated with lower mean (SD) GA (26.7 [1.8] weeks and 26.8 [1.9] weeks, respectively) and cluster 3 (driven by Escherichia/Shigella [n = 61]) with higher mean (SD) GA (29.4 [1.6] weeks; P = .001). Cluster 3 was considered the reference. After adjustment for confounders, no assisted ventilation at day 1 was associated with a decreased risk of belonging to cluster 5 or cluster 6 (adjusted odds ratio [AOR], 0.21 [95% CI, 0.06-0.78] and 0.19 [95% CI, 0.06-0.62], respectively) when sedation (AOR, 10.55 [95% CI, 2.28-48.87] and 4.62 [1.32-16.18], respectively) and low volume of enteral nutrition (AOR, 10.48 [95% CI, 2.48-44.29] and 7.28 [95% CI, 2.03-26.18], respectively) was associated with an increased risk. Skin-to-skin practice was associated with a decreased risk of being in cluster 5 (AOR, 0.14 [95% CI, 0.04-0.48]). Moreover, clusters 4, 5, 6 were significantly associated with 2-year nonoptimal outcome (AOR, 6.17 [95% CI, 1.46-26.0]; AOR, 4.53 [95% CI, 1.02-20.1]; and AOR, 5.42 [95% CI, 1.36-21.6], respectively).

Conclusions and Relevance  Gut microbiota of very preterm newborns at week 4 is associated with NICU practices and 2-year outcomes. Microbiota could be a noninvasive biomarker of immaturity.

Jean-Christophe Rozé, MD, PhD1Pierre-Yves Ancel, MD, PhD2,3Laetitia Marchand-Martin, MSc, PhD2; et alClotilde Rousseau, PharmD, PhD4,5,6Emmanuel Montassier, MD, PhD7Céline Monot, BS8Karine Le Roux, BS8Marine Butin, MD, PhD9Matthieu Resche-Rigon, MD, PhD10Julio Aires, PhD4,5Josef Neu, MD11Patricia Lepage, PhD8Marie-José Butel, PharmD, PhD4,5; for the EPIFLORE Study Group

JAMA Netw Open. 2020;3(9):e2018119. doi:10.1001/jamanetworkopen.2020.18119




Obesity Among Former Extremely Premature Infants: From Too Small to Too Big?

Lydia Furman, MD, Associate Editor, Pediatrics – October 26, 2018

In a recently released article in Pediatrics, Dr. Charles Wood and colleagues (10.1542/peds.2018-0519) examined the antecedents of obesity among infant born extremely premature. The study team used data gained prospectively from the ELGAN (Extremely Low Gestational Age Newborn) Study, which enrolled infants born prior to the 28th week of gestation, and followed them to age 10 years. Of the original cohort of 1,506 infants, 871 former premature infants had height and weight data at age 10 years, representing a remarkable 74% of survivors.  Full neonatal and perinatal information, infant weight at birth and ages 1 and 2 years, as well as maternal characteristics including pre-pregnancy BMI (body mass index), were available for the analysis. The authors took this treasure trove of data and used a “TORM” or “time-oriented risk model” to conduct the analysis; the statistics are explained very clearly and non-statisticians will feel comfortable that they have grasped the essence of the approach throughout.

The initial examination identified multiple factors potentially associated with overweight and obesity at age 10 years, but the final model which took these variables into account showed that just a few of these factors were significantly associated with the overweight and obesity outcomes. While I hope you will enjoy learning what these key significant factors are, I’d like to focus on the one I think is most potentially modifiable: rate of weight gain in the first and second years.

Since by age 1-2 years most infants are receiving well child care from primary providers in the community, we as providers have a great opportunity to make a difference. It’s hard not to initially celebrate every ounce of weight gain outside of the hospital as a major achievement! What we can do, though, is then introduce parents to the same thinking we apply to the routine well care of former full term infants. For infants, we can focus on cue-based feeding: what are the signs the baby is giving that he or she is hungry, and just as importantly, what are the signs that he or she is getting full?1 The signs of satiety may be subtle and include shorter sucking bursts with fewer sucks, hand relaxing and fist opening, a milk drizzle at the corner of the mouth and outright sucking pauses. Rather than urging the baby on to an “empty plate” (i.e. empty bottle), parental attentiveness to satiety cues may build self-regulation skills for eating, which may mitigate risk for future overweight and obesity. Additional research in this fascinating area of infant-to-parent feeding cue communication is needed.2 The toddler years give additional opportunity for supporting healthy eating habits, for example, turning the television off during meals, and neither using food as a reward nor pressuring the child to eat.3 I agree with the study authors that “…attention [should] be paid to rapid growth in the first years of life, even in this vulnerable population of children.”  This simple yet elegant ELGAN follow up is a terrific example of how a well-designed and large prospective study can bear fruit well beyond what was initially expected.


Developmental care for little patients FINE trainings in Romania

POSTED ON 13 NOVEMBER 2018 – A guest article by Corina Croitoru, President of the Association Unu și Unu

Preterm babies, and ill newborns are properly treated from the medical point of view, but, the human dimension is often neglected. They are ‘just’ patients and the parents are ‘just’ visitors. By supporting FINE training in Romanian hospitals, Unu si Unu Association aims to change this situation. 

The aim: “Through this project we want to support the babies and their parents. At birth, both the baby and the mother are very vulnerable and they need each other. The experience of the countries who applied the concept of infant- and family-centred developmental care showed us that this is the way to change the neonatal units. Because the units following the family-centred care concept have a huge impact on the neurological development level of the child, it could prevent disabilities and raise the bond and attachment between mother and child”, says Corina Croitoru, the president of the Association Unu și Unu. She initiated the project and her goal is to introduce these kind of centres where parents can take care of their babies in all neonatal units in Romania within the next five to ten years.

The project “Little human in therapy” offers the chance that the little patient can be taken care by his or her own family. This approach respects one of the fundamental rights that every newborn has the right to not be separated from his parents (United Nations Convention, Children Rights, 1989). In this way, the parents will not only be accepted in neonatal intensive care units, but they also will be able to practice Kangaroo care, to take care of their babies, to feed them, taking them into their arms during the painful procedures. All this will take place, of course, after the children are stabilised and while respecting babies’ needs.

Details of the project: Unu si Unu Association started the project “Little human in therapy” in 2 maternities: Polizu, National Institute for Health of Mother and child Bucharest and Maternity Dominic Stanca, Emergency Hospital Cluj-Napoca. 110 participants (20% doctors and 80% nurses) from both maternities attended the FINE LEVEL 1 training (3 sessions of 2 days each) by Inga Warren, Senior Trainer NIDCAP, UK NIDCAP from the University College London Hospital. Additional 12 guests from other maternities from Romania joined the course, in preparation of a future expansion of the project. 

The feedback received from the medical staff was very positive: “The approach according to FINE principles will enhance the quality of medical care procedures with impact on neuro-development on short and long term for this category of newborns. The change of experience with the founder team from Great Britain, helped us with the implementation of the project in Polizu maternity. Our goal is to apply as many of the methods that we have learned as the position of the new born, building “nests” adequate for the needs of the preterm baby and create a special environment for the sensory development by respecting the epidemiological rules. said Corina Datu neonatologist doctor in I.N.S.M.C. – maternity Polizu.

“It was an amazing experience, and the presentation was very good. Things about all of us knew are good, both for the baby’s and their parents. It is good to remember them and to try to apply as many as possible. I think is very good for the nurses to see these things and to apply them together after. Thank you so much for this experience.” Doctor Bogdana Todea, Dominic Stanca Maternity, Cluj.

The FINE Level 2 training focused on practical skills and on baby’s individual needs. This involves studying the way preterm and newborn babies behave. The baby may not speak but the way he/she reacts gives us an idea about how he/she is feeling and what kind of help he/she may need. It is important for staff and parents to understand these reactions so that they can care for the baby in the safest, most sensible and sensitive way. 6 healthcare professionals joined this level 2 training course, two doctors and two nurses from Bucharest and one doctor and one nurse from Cluj accepted the challenge of further training with the aim of introducing the family-centred care approach in their hospitals.

Outcome: Soon, the results of the course became apparent. Inga Warren declared that when she visited the intensive care neonatal unit from Polizu Maternity after finishing the course, she observed that some of the techniques from the course were already used.

After six months since the FINE Level 1 training, Kangaroo care has been practiced almost daily in Stanca Maternity. The smallest children who received Kangaroo Care weighed 800 grams, and we started to also involve fathers. In order to involve even more parents in the care of their hospitalised baby in the NICU, Association Unu si Unu supports, with the help of its voluntary team, weekly, practical workshops for parents and hand hygiene seminars, in the Maternity in Cluj.

Another result is the donation of products for the implementation: nests for a good positioning, gel positioning pillows, incubator covers, Kangaroo Care blouses and Kangaroo Care chairs, chairs for parents, baby feeding pillows, mini pacifiers, lamps with dimmer, weighing, blankets, storage boxes.

In 2018, Unu și Unu received an award by the Coalition of Patient Associations in Romania (COPAC) for the project. 

Timing: The project needed a 6 months fundraising period, 3 months for signing contracts with hospitals, 3 months for FINE Level 1 training, 1 month for donation of necessary materials for the implementation, 6 months for organizing FINE Level 2 training + seminars for parents + parents inclusion, step by step, in the NICUs.

DJI – Delivering the Future of Healthcare

   Feb 12, 2020

Traditional methods of delivering medicine to rural communities have not been considered the most efficient solutions. Patients in smaller areas of the Dominican Republic, for example, would often go weeks without receiving the care they needed, increasing mortality rates. A reliable and cost-efficient solution became necessary. Thankfully, drone technology would answer the call. Watch how powerful equipment like the Matrice 600, and a strong collaboration between the local medical staff, Ministry of Health, WeRobotics and the Drone Innovation Center, has led to increased efficiency during important medical deliveries.

Potential preterm births in high risk women predicted to 73% accuracy, by new technique

July 29, 2020 Source: University of Warwick

A new technique that can spot a potential preterm birth in asymptomatic high-risk women, with up to 73% accuracy months before delivery, has been developed by scientists at the University of Warwick.

Utilising cutting-edge volatile organic compound analysis technology, designed to characterise airborne chemicals, the scientists ‘trained’ the device using machine-learning techniques to identify the chemical vapour patterns from preterm birth using vaginal swabs taken during routine examinations.

Their technique is detailed in a paper for Scientific Reports and could lead to a cost-effective, non-invasive, point-of-care test that could form part of routine care for women identified as being at risk of delivering prematurely. This could enable healthcare staff to better support those women during pregnancy and birth and help to reduce the risks to their baby.

Preterm birth is the leading cause of death in children under five and at present there are few accurate tools to predict who is going to deliver preterm.

The researchers initially analysed volatile organic compounds (VOCs) present in the vagina for a condition called bacterial vaginosis, in which the bacteria of the vagina have become imbalanced. Previous research has shown that bacterial vaginosis in early pregnancy is associated with an increased risk in having a preterm birth, although treating bacterial vaginosis doesn’t decrease that risk.

The technology they used works by separating the vapour molecules by combining two techniques that first pre-separates molecules based on their reaction with a stationary phase coating (a gas-chromatograph), followed by measuring their mobility in a high-electric field (an Ion Mobility Spectrometer). Using machine learning techniques, the team ‘trained’ the technology to spot patterns of VOCs that were signs of bacterial vaginosis.

The researchers then analysed vaginal swabs taken from pregnant women attending a preterm prevention clinic as part of their routine care. These women either had prior histories of preterm births or a medical condition that makes it more likely that they would deliver preterm but had shown no other indications that they would deliver preterm and were considered asymptomatic.

Vaginal swabs were taken during the second and third trimesters of pregnancy and the outcome of all pregnancies followed up. The first test had an accuracy of 66% while the second, closer to the time of delivery, had an accuracy of 73%. The test results means that 7/10 women with a positive test went on to deliver preterm. 9/10 women with a negative test delivered after 37 weeks.

Lead author Dr Lauren Lacey of Warwick Medical School and an obstetrics and gynaecology registrar at University Hospitals Coventry and Warwickshire NHS Trust said: “We’ve demonstrated that the technology has good diagnostic accuracy, and in the future it could form part of a care pathway to determine who would deliver preterm.

“Although the first test taken earlier in pregnancy is diagnostically less accurate, it could allow interventions to be put in place to reduce the risk of preterm delivery; for the test towards the end of pregnancy, high risk women can have interventions put in place to optimise the outcome for baby.

“There are a number of different factors that could cause a woman to go into preterm labour. Because of that, prediction is quite difficult. There are lots of things we can look at — the patient’s history, the examination, ultrasound scan, various other biomarkers that are used in clinical practice. No single test fits all.

“VOC technology is really interesting because it reflects both the microbiome and the host response, whereas other technologies look for a specific biomarker. It’s the beginning of looking at the association of VOCs with preterm delivery. We want to develop this and look at whether these patterns could be implemented into a care pathway.”

The next stage of research would see a small VOC analysis device stored at a hospital so samples could be analysed on site. The hope is that it could eventually be developed for use in a labour ward triage so tests can be administered and results obtained rapidly.

Professor James Covington from the University of Warwick School of Engineering said: “There is a strong interest around the world in the use of vapours emanating from biological waste for the diagnosis and monitoring of disease. These approaches can non-invasively measure the health of a person, detect an infection or warn of an impending medical need. For the need described in the paper, the technology can be miniaturised and be easily located in a maternity ward. The analysis only takes few minutes, the instrument needs no specialised services (just power) and is easy to use. We believe that the analysis of odours will become commonplace for this and many other diseases in the near future.”

The researchers behind this study are part of the newly established Centre for Early Life, based at Warwick Medical School at the University of Warwick, which launches on 31 July. The new Centre builds on the University’s existing expertise in early life research by aiming to pioneer research into the formative factors in our lives such as this latest research.

Professor Siobhan Quenby, Co-Director of the new Centre and Honorary Consultant at University Hospital Coventry and Warwickshire NHS Trust said: “I am delighted that the new Centre for Early Life will facilitate further interdisciplinary collaborations, to the benefits of my patients.”



If Covid -19 were a rabbit hole…. Used especially in the phrase going down the rabbit hole or falling down the rabbit hole, a rabbit hole is a metaphor for something that transports someone into a wonderfully (or troublingly) surreal state or situation.”

We share this global pandemic experience in many similar and in unique ways.  This month we want to shine a light on mental health (awareness and resources) in our Warrior and Neonatal Womb community at large.  Our lives have all been altered in various ways, and this is a walk in the dark for most if not all of us. The light at the end of the tunnel may not be visible, and when the darkness becomes light, things may look different. Within chaos there are opportunities for positive change. An openness to new perspectives, feelings of curiosity, awareness of personal and community growth opportunities may allow us to thrive even in these tough times.  We must lead and in order to lead it is critical we listen to and acknowledge the feelings we experience along the way. It is powerful to look deeply into our emotional selves, to choose to identify, pursue and experience coping strategies that will lead to our healing and empowerment. Seek support and choose wonderful!

Pandemic having ‘astronomic’ effect on young people’s mental health: ILO

   Aug 12, 2020  CNBC International TV

Drew Gardiner, youth employment specialist for the International Labour Organization, discusses the impact of the coronavirus pandemic on education and young people’s mental health.


Young Adults:

Popular APPS:
Calm:   Sleep more. Stress less. Live better.
Moodpath:   Depression & Anxiety

Health Care Providers: National Academy of Medicine

Stigma Compounds the Consequences of Clinician Burnout During COVID-19: A Call to Action to Break the Culture of Silence

By Jennifer B. Feist, J. Corey Feist, and Pamela Cipriano – August 6, 2020 | Commentary

 If you are suicidal and need emergency help, call 911 immediately or 1-800-273-8255 if in the United States. If you are in another country, find a 24/7 hotline at

Preterm Birth Parents:


USA Regional Contact Information:


INTERNATIONAL SUPPORT: Please connect with your local healthcare organization for local Preterm Birth Parent Support resources

 GENERAL/USA: Take care of your mental health: You may experience increased stress during this pandemic. Fear and anxiety can be overwhelming and cause strong emotions. Get immediate help in a crisis



Covid-19 has brought upon transitions for all of us. Creativity during this time has been essential in finding ways to keep up on academic knowledge, seek out work opportunities, build relationships, support our families & friends, and maintain good health. From implementing new workout routines via YouTube, forming new work habits, and incorporating mask into our daily wardrobe routine Covid-19 has challenged us all to take on our daily lives in some unfamiliar and challenging ways.  

This past month we sought to partake in the spirit of creativity by including a Covid-19 mask theme in our Annual Instagram Celebration series. In each of the photos highlighting the 13 nations we have explored this year is a mask. (Instagram Link- @katkcampos)  

As a central theme of each photo the mask is meant to symbolize our connection to each other, our resilience, our need to support each other and our responsibility to one another. As preterm birth has impacted each of us as individuals and members of a dynamic global community, Covid-19 likewise caused a significant and traumatic impact on all of us and has inspired us even more so to seek out ways to raise awareness and take action in addressing the health and wellness needs of humanity as a whole. Our resilience is what keeps us moving one foot in front of the other during this turbulent and historic time in our world.  

Kitesurf Constanta, Romania 15.02.2020 Ep. 2 Plaja 3 papuci

•Feb 18, 2020                                                Kite Inspiration

kitebeginner Prima iesire din 2020. Temperatura apa 7 grade Celsius

Self Empowerment, Trauma Informed Care

Preterm Birth Rates – Samoa

Rank: 181 –Rate: 5.5% Estimated # of preterm births per 100 live births (USA – 12 %)

Samoa officially the Independent State of  and until 1997 known as Western Samoa, is an island country consisting of two main islands, Savai’i and Upolu, two smaller inhabited islands, Manono and Apolima, and several small uninhabited islands including the Aleipata Islands (Nu’uteleNu’uluaFanuatapu, and Namua). The capital city is Apia. The Lapita people discovered and settled the Samoan Islands around 3,500 years ago. They developed a Samoan language and Samoan cultural identity.
Samoa is a unitary parliamentary democracy with eleven administrative divisions. The sovereign state is a member of the Commonwealth of Nations. Western Samoa was admitted to the United Nations on 15 December 1976. The entire island group, which includes American Samoa, was called “Navigator Islands” by European explorers before the 20th century because of the Samoans’ seafaring skills. The country was governed by New Zealand until its independence in 1962.
The National Health Service is the main government provider of health services for Samoa. They operate all of the hospitals and health centres and the main provider for medical imaging services, the sole provider of medical laboratory testing, and our pharmacy services cater to a significant portion of national pharmaceutical needs.


Scaling up breastfeeding policy and programs in Samoa: application of the Becoming Breastfeeding Friendly initiative

International Breastfeeding Journal volume 15, Article number: 1 (2020) Christina Soti-UlbergAmber Hromi-FiedlerNicola L. HawleyTake NaseriAnalosa Manuele-MageleJohn Ah-ChingRafael Pérez-Escamilla & on behalf of BBF Samoa Committee



Breastfeeding is a critical, evidence-based intervention that addresses malnutrition, improves early childhood development outcomes, and influences long-term maternal and infant health by reducing the non-communicable disease risk. Scaling up breastfeeding is an indisputably strong action countries can take to prevent suboptimal maternal and infant health outcomes. The Becoming Breastfeeding Friendly (BBF) initiative assists countries with scaling up breastfeeding policy and programs. BBF has been successfully implemented within Latin America, Africa, Europe and South-East Asian regions. This study assessed its application in Samoa.


In 2018, BBF was implemented in Samoa by a 20 member committee of breastfeeding experts who participated in collecting and utilizing national level data to score the degree of friendliness of Samoa’s breastfeeding environment, identify gaps, and propose policy recommendations to address those gaps. This eight-month process resulted in a public event where priority recommendations were widely disseminated to decision makers and actions agreed upon.


The total BBF Index score for Samoa was 1.6 out of 3.0, indicating a moderate breastfeeding friendly environment for scaling up policies and programs that protect, promote, and support breastfeeding. Gear total scores indicated that seven of the eight gears were moderately strong within Samoa, while the eighth gear, funding and resources, was weakest in strength. Six prioritized recommendations emerged: 1) development and implementation of a National Breastfeeding Policy and Strategic Action Plan; 2) strengthening monitoring and evaluation of all breastfeeding activities; 3) ratifying the International Labour Organization’s Maternity Protection Convention 2000 (No 183); 4) identifying high-level advocates to champion and serve as role models for breastfeeding; 5) creation of a national budget line for breastfeeding activities; and 6) hiring of a national breastfeeding coordinator and trainer. Decision makers demonstrated commitment by signing the breastfeeding policy for hospitals ahead of the BBF dissemination meeting and electing to move forward with establishing lactation rooms within government ministries.


Implementation of BBF in Samoa yielded important policy recommendations that will address current gaps in national level breastfeeding support. The BBF consultation process can be successfully applied to other countries within the Western Pacific region in order to strengthen their breastfeeding programs.


To ALL of you sharing resources with our Global Community, and there are LOTS of you,

THANK YOU (Faʻafetai)  

Hinari Access to Research for Health programme

Hinari Access to Research for Health Programme provides free or very low cost online access to the major journals in biomedical and related social sciences to local, not-for-profit institutions in developing countries. Hinari was launched in January 2002, with some 1500 journals from 6 major publishers: Blackwell, Elsevier Science, the Harcourt Worldwide STM Group, Wolters Kluwer International Health & Science, Springer Verlag and John Wiley, following the principles in a Statement of Intent signed in July 2001. Since that time, the numbers of participating publishers and of journals and other full-text resources has grown continuously. Up to 165 publishers’ content are If your institution is in a Group A (free access) country, area, or territory, then Hinari is free. If your institution is in a Group B (low-cost access) country, area, or territory, Hinari costs US$ 1500 per institution per calendar year (from January through December). All eligible institutions registering from Group B countries, areas, or territories will receive a six month trial without payment.

If your institution is in a Group B (low-cost access) country, area, or territory, and cannot or chooses not to pay the annual fee, the institution will still be eligible for free access to a small number of information resources.

Samoa is on the A lists for free access to this services.

***Refugee Camps recognized by UNRWA or categorized by UNHCR as “planned/managed camps” are eligible for free Hinari access regardless of their geographical location.


Risk of Preterm Birth and Newborn Low Birthweight in Military Women with Increased Pregnancy-Specific Anxiety

Karen L Weis, USAF, NC, PhDKatherine C Walker, MSN, RNWenyaw Chan, PhDTony T Yuan, PhDRegina P Lederman, PhD, RN, FAANMilitary Medicine, Volume 185, Issue 5-6, May-June 2020, Pages e678– e685,    Published: 06 December 2019



Prenatal maternal anxiety and depression have been implicated as possible risk factors for preterm birth (PTB) and other poor birth outcomes. Within the military, maternal conditions account for 15.3% of all hospital bed days, and it is the most common diagnostic code for active duty females after mental disorders. The majority of women (97.6%) serving on active duty are women of childbearing potential. Understanding the impact that prenatal maternal anxiety and depression can have on PTB and low birthweight (LBW) in a military population is critical to providing insight into biological pathways that alter fetal development and growth. The purpose of the study was to determine the impact of pregnancy-specific anxiety and depression on PTB and LBW within a military population.

Material and Methods

Pregnancy-specific anxiety and depression were measured for 246 pregnant women in each trimester. Individual slopes for seven different measures of pregnancy anxiety and one depression scale were calculated using linear mixed models. Logistic regression, adjusted and unadjusted models, were applied to determine the impact on PTB and LBW.


For each 1/10 unit increase in the anxiety slope as it related to well-being, the risk of LBW increased by 83% after controlling for parity, PTB, and active duty status. Similarly, a 1/10 unit rise in the anxiety slope related to accepting pregnancy, labor fears, and helplessness increased the risk of PTB by 37%, 60%, and 54%, respectively.


Pregnancy-specific anxiety was found to significantly increase the risk of PTB and LBW in a military population. Understanding this relationship is essential in developing effective assessments and interventions. Results emphasize the importance of prenatal maternal mental health to fetal health and birth outcomes. Further research is needed to determine the specific physiological pathways that link prenatal anxiety and depression with poor birth outcomes.



In the NICU, both parents are essential and need to be at their child’s bedside

By Jennifer Canvasser, Kurlen Payton, and Elizabeth Rogers – July 13, 2020

Micah Canvasser, born at 27 weeks gestation, spent 299 days in a NICU. His parents were constantly at his bedside learning how to best contribute to their son’s care.

As Covid-19 surged through the United States this spring, Reina and James were told they could no longer stay with their severely ill newborn in the hospital’s neonatal intensive care unit and could visit for only a few hours — separately.

“My husband was allowed to visit for just one hour a week and had to prebook his time,” Reina (the parents’ names have been changed to protect their privacy) shared with one of us. “I was allowed to visit for two hours each day. Our baby sadly gained his wings seven days after he was born.”

The coronavirus pandemic has forced billions of people and institutions to make difficult decisions to prevent harm and save lives. Many of these decisions affected how patients experience health care. One particularly traumatizing change has been directed at parents of newborns receiving care in neonatal intensive care units (NICU).

That might be good for infection control, but it goes against everything we know about caring for sick newborns. Both parents (or a parent plus a support person) need access to their infant’s bedside often and at the same time. The risks of Covid-19 must be weighed against the known risks and harms of separating babies in the NICU from their parents.

In the NICU, parents are not visitors: They are essential members of the care team. Parents know their babies better than anyone else and are often the first to recognize when something is wrong. It is intuitive to understand that babies need their parents, yet this is also borne out in research. For vulnerable newborns, their mother’s milk is a lifesaving intervention. Infant skin-to-skin care with parents promotes growth and healthy development.

Shared decision-making is critical in the NICU, where parents and providers must work together to optimize decisions that can have lifelong health implications for the infant. Because things can change so rapidly in a sick newborn, parents need to be at their child’s bedside so they can be informed and participate in these vital health decisions. Limiting parents’ access harms the therapeutic alliance that needs to exist between NICU providers and parents.

Bonding during this developmentally fragile period is crucial. Limiting parents’ access disrupts the nurturing interactions that are necessary for an infant’s cognitive development and that are also essential to parents’ mental health. “Even though our daughter is now home, our NICU’s one-parent policy has left us with deep psychological scars,” a father shared with us.

The wide variation in Covid-19 visitor policies between hospitals fuels mistrust. NICU parents and providers have reported a range of policies: Some hospitals allow unrestricted access for two parents at the bedside, others allow just one parent to visit for only two hours a day, and there’s just about every possibility in between. Permitting just one parent at a time to be with their child is an unlikely Covid-19-reduction strategy, as most parents are in close contact outside of the hospital.

That might be good for infection control, but it goes against everything we know about caring for sick newborns. Both parents (or a parent plus a support person) need access to their infant’s bedside often and at the same time. The risks of Covid-19 must be weighed against the known risks and harms of separating babies in the NICU from their parents.

In the NICU, parents are not visitors: They are essential members of the care team. Parents know their babies better than anyone else and are often the first to recognize when something is wrong. It is intuitive to understand that babies need their parents, yet this is also borne out in research. For vulnerable newborns, their mother’s milk is a lifesaving intervention. Infant skin-to-skin care with parents promotes growth and healthy development.

Shared decision-making is critical in the NICU, where parents and providers must work together to optimize decisions that can have lifelong health implications for the infant. Because things can change so rapidly in a sick newborn, parents need to be at their child’s bedside so they can be informed and participate in these vital health decisions. Limiting parents’ access harms the therapeutic alliance that needs to exist between NICU providers and parents.

Bonding during this developmentally fragile period is crucial. Limiting parents’ access disrupts the nurturing interactions that are necessary for an infant’s cognitive development and that are also essential to parents’ mental health. “Even though our daughter is now home, our NICU’s one-parent policy has left us with deep psychological scars,” a father shared with us.

The wide variation in Covid-19 visitor policies between hospitals fuels mistrust. NICU parents and providers have reported a range of policies: Some hospitals allow unrestricted access for two parents at the bedside, others allow just one parent to visit for only two hours a day, and there’s just about every possibility in between. Permitting just one parent at a time to be with their child is an unlikely Covid-19-reduction strategy, as most parents are in close contact outside of the hospital.

We need to close this gap and ensure that all NICU families receive high-quality care by giving parents access to their medically fragile infants. Seemingly strict but malleable visitor policies are also inequitable in that families who advocate for themselves are often told that both parents can be at the bedside, while families with less ability to advocate for themselves are required to comply.

Parents’ basic rights to see and care for their own child are infringed upon when they are inaccurately categorized as visitors. Infants’ basic right to physically access both of their parents must also be considered. Health care providers and parents should work together at local and state levels to assure safe practices that honor the unique situation and needs of sick newborns.

Parents can be screened with the same protective procedures applied to all essential care team members who come in and out of the hospital every day. While certain parental restrictions may be justified in specific high-risk situations, extensive parental limitations should always be minimized. Efforts must be made to mitigate public health risks while maximizing parental rights.

Babies in the NICU need both of their parents at their bedsides, and their parents’ psychological well-being depends on being there. The way families experience care in the NICU remains with them for their lifetimes. When asymptomatic, two-parent access to their infant’s bedside should be the standard of care. Anything less is indefensible.

Jennifer Canvasser is the mother of a child who died from necrotizing enterocolitis after spending several months in the NICU and is the founder and director of the Necrotizing Enterocolitis (NEC) Society, a member of the Chan Zuckerberg Initiative’s Rare As One Network. Kurlen Payton is a neonatologist, interim director of the neonatal intensive care unit at Cedars-Sinai Medical Center in Los Angeles, and co-director of quality improvement collaboratives for the California Perinatal Quality Improvement Collaborative. Elizabeth Rogers is a neonatologist and director of the ROOTS Small Baby Program at UCSF Benioff Children’s Hospital in San Francisco. The authors thank Jochen Profit, a neonatologist and associate professor of pediatrics at Stanford University School of Medicine, for his help writing this article.


A Teen-Led, Volunteer-based NICU Reading Program: A Model for Supporting Family Reading and Family Integrated Care


NICU babies are at high risk of neurodevelopmental impairment for multiple reasons, including prematurity, critical illness, and family emotional and economic stressors associated with hospitalization in the NICU. (1) Care in single-patient-room NICUs can compound the issues of sensory deprivation and contribute to speech and language deficits in NICU graduates. (2) Reading aloud with babies creates and strengthens neural connections that “promote … social-emotional development…and language and literacy skills during this critical period of early brain and child development.” (3) Providing parents and other caregivers books and encouraging them to read to their infants in the NICU is a low-cost intervention to increase infants’ speech and language interactions. Parent reading with their baby in the NICU supports family integrated care and bonding (4) and improves the NICU experience.

Babies With Books, a teen-led volunteer organization, began its first NICU Reading Program at Randall Children’s Hospital (RCH) in 2017.  The NICU Reading Program is a collaboration between teen volunteers and NICU providers, consisting of four discrete components – Admit Reading Packets, One-on-one Book Rounds, a Family Shared Reading Library, and literacy events and celebrations.  Admit Reading Packets contain a book, bookmark, and information on how and why to read aloud with babies beginning in the NICU. Teens source and assemble these admit packets, which are given by healthcare providers to each infant at NICU admission. One-on-one Book Rounds encourage and reinforce NICU reading. During book rounds, teen volunteers meet weekly with NICU families to  talk with them about how to read with their infant and why reading aloud to their babies beginning in the NICU is important. Some of this information was developed in collaboration with Reach Out And Read® (ROR).  Families are offered their choice of 3 books from a mobile book cart to read with their infant, keep in the NICU, and bring home at NICU discharge. The Family Shared Reading Library is a library located outside of the NICU (ex. in the NICU lobby or lounge) stocked with donated, gently used books. Literacy Events & Celebrations include NICU reada-thons, book nooks at NICU reunions, and other literacy promoting events that engage families in shared reading. In BWB’s first NICU read-a-thon at RCH, 45% of families participated, and all surveyed staff and families expressed high satisfaction. BWB has also hosted a “book nook” program at the RCH NICU reunion, during which we provided more than 200 donated books to NICU graduates and their siblings and read stories with them. Through this NICU Reading Program, BWB has served more than 850 NICU babies at RCH.

Books used in the Reading Program include a variety of high contrast board books, children’s stories, and “I love you” type books. Only new books are used with babies. Donated, gently used books may be used in the Family Shared Library and in “book nooks” at NICU reunions for NICU families and graduates. Books are available in multiple languages, and picture books are available for families whose primary language is not represented and for non-reading families. We recommend books by a wide range of authors that engage and represent the diversity of the NICU patient population.  Funding is through generous foundation grants as well as individual and corporate donations. We receive donated books from a local book bank and a used bookstore.

Like all hospital-based programs, BWB has been impacted by the COVID-19 pandemic.  The BWB teens have continued to source and assemble admit reading packets but do so offsite and deliver these to the hospital where they are stored for at least 72 hours prior to being given to NICU families. To assemble and deliver admit packets, volunteers must be symptom-free, wear masks, and adhere to strict hand hygiene. One-on-one volunteer-led book rounds have been paused during COVID-19 but can be performed by personnel with continued access to the NICU. Shared Family Reading Libraries are not recommended during COVID-19. Reada-thons remain a great way to support infants and families and build NICU morale during COVID-19.

Conclusion:  By engaging motivated, passionate, and creative teen volunteers in our BWB Reading Program, we provide valuable service to NICU babies and families with limited burden and cost to healthcare providers and hospitals.


Preemie Siblings may feel abandoned, displaced, dis-empowered during and after the preterm birth experience within a family. Preterm birth changes everything for preemie families for a short or for a very long time. Preemie parents are often overwhelmed and immersed in a sea of chaos, destination unknown.  Family Partners,  please consider implementing the simple concepts shared in the article below in order to provide all family members with the support needed to move forward with purpose and intent upon a foundation of family trust. Simple inclusion of preemie siblings may dynamically and positively alter the course of their precious lives and ultimately reduce the stress the family unit experiences during this challenging time.

NICU: Helping Siblings Cope

When a baby is in the Neonatal Intensive Care Unit (NICU), the entire family can be affected. Here are some tips for helping siblings cope.

Northwestern Memorial Hospital – Patient Education – HEALTH AND WELLNESS

What Siblings Need


Help siblings maintain their regular routines as much as possible. Providing structure and normal daily activities will help siblings feel safe and supported when separated from parents and family.


Be honest and use simple words they can understand when explaining why their brother/sister is in the hospital. This will help them feel less afraid.


Talk to siblings and help them understand what is happening. Allow siblings the chance to express their feelings and ask questions.

Behaviors to Watch For

It is not uncommon to notice a change in behavior in siblings when their brother/sister is in the hospital. Here are some typical reactions to watch for:

■ Guilt – Feeling that they did something to cause their sibling’s to be in the hospital.

■ Fear–Worrying that they or another loved one will get sick and have to go to the hospital.

■ Anger –Being angry about change in routine, separation from parents, less attention.

■ Loneliness – Feeling lonely when parents visit their brother/sister without them and wondering why they’re not getting as much attention as usual.

■ Confusion– Feeling confused about what will happen to their brother/sister, why they are there and when their life will return to “normal.” These feelings may be expressed in your child’s behavior.

Watch for:

■ Aggressive play or behavior

■ Increased need for attention/clinginess

■ Returning to younger behavior (bed wetting, temper tantrums, thumb sucking)

■ Changes in routine (sleeping and eating patterns)

How You Can Help

Siblings need lots of love and support when their brother or sister is in the NICU. Try to include your children as much as possible to answer questions and decrease fears.

Here are some resources and activities to use with siblings while supporting them.

Activities to Promote Positive Coping

■ Before visiting the hospital, make sure siblings know what to expect and remind them that it’s okay to ask questions.

■ Have the sibling choose a special item to bring to their sibling in the hospital (such as a favorite teddy bear, blanket or book).

■ Draw pictures or make decorations for the baby’s room (at home or in the NICU).

■ Write a letter to take to the baby.

■ Have the child draw a picture that they would like to share with their sibling.

■ Display a chart with different emotions or feelings on it in your home (you and your child can choose where to hang it). Ask the child each day how they are feeling and talk to them about why they are feeling that way. Always let them know that it is okay to talk and express all types of feelings.

Books You Can Read Together

■ “No Bigger Than A Teddy Bear” by Valerie Pankow

     A book for 3 to 7 year olds about what it is like to have a sibling in the NICU.

■ “My Brother is a Preemie” or “My Sister is a Preemie” by Joseph Vitterito

A book for 3 to 7 year olds that discusses what it is like to have a premature sibling in the NICU.

■ “What About Me? When Brothers and Sisters Get Sick” by Allan Peterkin

     A book for 5 to 10 year olds with hospitalized siblings.

■ “When Someone Has a Very Serious Illness” by Marge Eaton Heegaard

      A workbook for 7 to 13 year olds who have a sibling that is hospitalized or

     chronically ill.

■ “The Kissing Hand” by Audrey Penn

     A book about separation– this book is helpful if siblings are having a difficult time

     coping with separation from parents while they visit their child in the NICU.

■ “In My Heart” by Jo Witek

A book about emotions.file:///C:/Users/sacre/Downloads/northwestern-medicine-nicu-helping-siblings-cope-nmh%20(2).pdf


Vanderbilt develops computational method to explore evolution’s influence on preterm birth

by Marissa Shapiro Jul. 24, 2020

Human pregnancy can easily be taken for granted as a natural and regularly occurring event, but it is the product of the complex, coordinated function of two bodies, mother and baby, that has evolved side by side with other important human adaptations. For the first time, researchers have established how a complex disorder associated with pregnancy – spontaneous preterm birth (sPTB) – has been shaped by multiple evolutionary forces.

The article, “Accounting for diverse evolutionary forces reveals mosaic patterns of selection on human preterm birth loci” was published in the journal Nature Communications on July 24.

Preterm or premature birth, medically defined as labor starting at 37 weeks of gestation or earlier (instead of the usual 40 weeks), affects more than 15 million pregnancies each year and is the leading cause of infant mortality worldwide. Both the associated medical conditions of the mother which cause sPTB and the outcomes of sPTB on an infant’s health have been well-defined. It is not well understood, however, how and why genetic factors influence sPTB and birth timing. A team of scientists led by Antonis Rokas, Cornelius Vanderbilt Chair in Biological Sciences and director of the Vanderbilt Evolutionary Studies Initiative and Tony Capra, associate professor of biological sciences, set out to demystify this element of pregnancy and human life.

The research, co-led by postdoctoral scholar Abigail LaBella and by M.D./Ph.D. candidate Abin Abraham, developed a computational approach to detect how evolution has shaped genomic regions associated with complex genetic traits, such as height or obesity. “Our approach integrates techniques developed in labs from all over the world to quantify how natural selection has influenced genomic regions involved with complex diseases,” said Capra. “We hypothesized that parts of our genome involved in disease might experience contrasting evolutionary pressures due to their involvement in multiple and different traits.”

This work was done in cooperation with Louis J. Muglia, co-director of the Perinatal Institute at Cincinnati Children’s and president and CEO of the Burroughs Wellcome Fund and Ge Zhang, associate professor at Cincinnati Children Hospital Medical Center and collaborator at the March of Dimes Prematurity Research Center-Ohio Collaborative. Zhang and Muglia recently completed the largest genome-wide association study (GWAS) on sPTB which identified multiple genomic regions associated with this complex disease. “Preterm birth is a global health concern, affecting ten percent of pregnancies in the United States. Understanding the evolution of genomic regions associated with spontaneous preterm birth is a major step forward in how we understand the foundations of human life and provide the best possible care to mother and child,” said Muglia.

Using this GWAS, the researchers found that genomic regions associated with sPTB have experienced multiple types of natural selection. From this information researchers can hypothesize why these risk-related genomic regions remain in human populations and what their potential functions may be. “While we knew of a few examples of selection like negative selection acting on genes associated with spontaneous preterm birth, we uncovered that every type of selection we tested had acted on at least one genomic region. Our initial figures looked like a mosaic made up of all the different metrics we had tested,” says Rokas.

The team’s results suggest that genomic regions associated with sPTB have experienced diverse evolutionary pressures, such as population-specific selection, and provide insights into the biological functions some of these regions. “It is difficult to study pregnancy in humans and we lack good models for laboratory studies,” LaBella explains. “We still have much to learn about the mechanisms through which human pregnancy is initiated.” For example, the group uncovered differences in a region near the gene OPRL1, involved in both the relaxation of maternal tissues and pain perception during childbirth, that are specific to certain human populations. Population-specific differences in this region may contribute to the uneven risk of sPTB between human populations. “This work is a part of a burgeoning field of evolutionary medicine, one of the types of interdisciplinary research that many of the investigators of the Vanderbilt Evolutionary Studies Initiative are engaged in,” says Rokas.

Both Abraham and LaBella plan to continue to foster collaboration between medicine and evolution in their future research. “Having this pipeline at our disposal opens up a range of new, exciting questions such as asking whether diseases of pregnancy, which involve two genomes, that of mom and baby, experience different evolutionary pressures than other complex genetic diseases,” says Abraham.

This work will be critical for researchers studying the genetics of pregnancy-associated disorder and is of broad interest to scientists researching human evolution, human population genomics and how evolutionary analyses relate to complex diseases like cancer and heart disease.

The research was supported by the March of Dimes Prematurity Research Center-Ohio Collaborative, the Burroughs Wellcome Fund and National Institutes of Health grants R35GM127087 and T32GM007347.


Caring For Babies And Their Families: Providing Psychosocial Support In The NICU”: An Innovative Online Educational Tool To Empower Neonatal Nurses To Support NICU Families

Hall, Sue L. MD; Sorrells, Keira BS; Eklund, Wakako Minamoto DNP, APRN, NNP-BC Editor(s): Eklund, Wakako DNP, NNP-BC, Section Editors; Smith, Heather E. PhD, RN, NNP-BC, CNS, Section Editors Advances in Neonatal Care: August 2020 – Volume 20 – Issue 4 – p 263-264

Parents whose newborns are hospitalized in the neonatal intensive care unit (NICU) nearly always experience stress. These parents have a higher prevalence of both postpartum depression (PPD) and posttraumatic stress disorder (PTSD) than new parents of infants born healthy, related in part to their perceptions of their experiences surrounding the birth of their infant or their NICU experiences that are traumatic. Prevalence of PPD among NICU mothers is 25% to 63% and for NICU fathers, approximately 36%, while rates of PTSD among NICU parents have been reported as 15% to 53% for mothers and 8% to 33% for fathers.

A comprehensive evidence-based program is now available to empower neonatal nurses to support NICU families. The program is designed to psychosocially minimize the occurrence of both PPD and PTSD, and to optimize infant and family outcomes. This online continuing education (CE) program is entitled “Caring for Babies and Their Families: Providing Psychosocial Support in the NICU,” and it represents an exemplar for interprofessional collaboration in which family and other stakeholders improve education for neonatal health professionals, and ultimately the care in neonatal settings.

My NICU Network was launched in January, 2018, with a mission of becoming the preeminent provider of compelling perinatal education on psychosocial support created with interprofessional collaboration. My NICU Network was recently expanded to become My NICU Network-My Perinatal Network (MNN-MPN), and is a collaborative endeavor between the National Perinatal Association and the NICU Parent Network. The goal is to provide online evidence-based education and “hands-on” bedside tools to empower healthcare staff working with mothers and infants. The focus of the education is to strengthen the critical parent–infant bonds and family functioning, and to improve developmental outcomes in the infant and mental health outcomes in their parents.

The 3 key guiding principles of course development are: (1) supporting NICU parents is equally as important to providing medical care to their baby; (2) healthcare staff must also be emotionally supported, so that they will have the emotional capacity to support the patients and parents in their care; and (3) interprofessional collaboration models are the foundation to fully realize family-centered care. These principles have been central to program development from inception to conclusion of this project. Stakeholders who are recipients of care (NICU parent leaders) collaborated every step of the way in designing and implementing these educational programs. The courses are rich with parent stories, audio clips, and videos that illustrate learning points. Parents helped to create the courses, conducted the surveys from which parent stories have been gleaned; contributed resources including web links and downloads to be available for the learners who take the course; have been instrumental in the development of the course’s trauma-informed care scripts. There are examples of what providers should not say to parents, how the parent interprets what the provider has said, and what is a better way to communicate the idea based on principles of trauma-informed care. Other parents have reviewed and provided feedback, which was used to refine the course content. All of this parental input has been the key to success of the program, as parents’ testimonials bring the evidence from the literature to life. As one nurse stated after taking the program: “It was very eye opening to see things through the eyes of the parents.” Few educational programs exist that include NICU parent leaders at every level from content development to content delivery, making this a truly unique and comprehensive educational experience.

All of the educational programs of MNN-MPN are based on principles of trauma-informed care, and NICU programs are based on the “Interdisciplinary Recommendations for Psychosocial Support of NICU Parents.” All are also available for CE credits. A study has demonstrated the efficacy of the initial learning program to improve nurses’ knowledge and attitudes toward providing psychosocial care. The program consists of 7 courses including: communication skills, providing emotional support, peer-to-peer support, family-centered developmental care, palliative and bereavement care, discharge planning and follow-up, and caring for the caregiver (staff support).

To date, over 700 NICU staff have completed the program, including the majority of nursing staff in 14 NICUs across the country. The goal for an entire NICU staff completing the program together is to transform the culture in the NICU to become more family-centered, and to mitigate long-term parental emotional complications such as PPD and PTSD. A condensed version of this program, called the Advanced NICU Provider Program, offers 2 CE credits for neonatologists and neonatal nurse practitioners. In mid-2020, 2 additional programs will be launched:

  1. “Caring for Pregnant Patients and Their Families: Providing Psychosocial Support During Pregnancy, Labor and Delivery” (for maternity care staff), and
  2. “Giving Birth During the Coronavirus Pandemic: Using Trauma-informed Care to Support Patients, Their Families, and Staff Through This Crisis” (for both NICU and maternity care staff).

NICU parents need, desire, and benefit from the emotional support from the nurses. Nursing interventions may mitigate the evolution of parents’ typically expected distress upon entering the NICU, preventing it from developing into full-blown depression or PTSD. Neonatal nurses who are at the bedside daily form more intimate relationships with infants and their families than other health professionals and are in a position to make a positive impact when well-equipped with strategies to address their complex psychosocial needs. NICU families value nurses; one study reported how the quality of relationship parents have with the nurses supported parental ability to cope and bond with their infants in the NICU.

One of the most critical goals for neonatal nurses is to improve the parent–infant bond in NICU to optimize families’ mental health/resilience, so that they can emerge as the empowered, confident, and knowledgeable advocates for their fragile infants who can achieve optimal development. Utilizing an innovative educational model, created through involvement of family stakeholders, can give nurses the tools they need to achieve this very important goal for the families in their care. For more information, please visit or


Decolonizing Parents Cuts NICU Staph Transmission Risk

Nicola M. Parry, DVM – January 13, 2020

Treating colonized parents of neonates hospitalized in the neonatal intensive care unit (NICU) may reduce the risk of parents spreading Staphylococcus aureus to the infants, a recent study published online December 30 in JAMA has shown.

“Treating parents of neonates in the NICU with intranasal mupirocin and 2% chlorhexidine-impregnated cloths compared with placebo reduced the risk of a neonate acquiring S aureus colonization with strains that were the same as S aureus strains identified from the parent(s) at time of study enrollment,” write Aaron M. Milstone, MD, MHS, from Johns Hopkins University, Baltimore, Maryland, and colleagues.

“In this trial, more than half of neonates who acquired S aureus had the same strain as their parent(s).”

According to the authors, neonates have an immature microbiome at the time of their admission to the NICU and rarely are already colonized by S aureus. Instead, they become colonized in the NICU after exposure to the organism from colonized or infected people and contaminated objects in the environment.

Staphylococcus aureus remains a common cause of outbreaks and healthcare-associated infections in NICUs and can seriously impact affected infants, with long-term sequelae such as poor neurodevelopmental and growth outcomes.

Although infection prevention strategies in NICUs typically center on healthcare workers and the physical environment as reservoirs for exposure of infants to S aureus, parents may also serve as an important reservoir for transmission of the bacterium.

With this in mind, Milstone and colleagues conducted their double-blinded, randomized controlled trial across two tertiary care NICUs to investigate whether treating parents would reduce the risk of their infants becoming colonized with S aureus.

The Treating Parents to Reduce Neonatal Transmission of Staphylococcus aureus (TREAT PARENTS) trial enrolled 236 infants. It included infants who had not had a previous culture positive for S aureus, had at least a 5-day NICU stay, were no more than 7 days old if admitted to the NICU from an outside location, and had at least one parent who tested positive for S aureus at screening.

The study’s primary endpoint was infants’ acquisition within 90 days of the same S aureus strain that their parent had. Secondary outcomes included infants’ acquisition of any strain of S aureus and neonatal S aureus infections.

Parents in the study received 5 days of treatment. They were randomly assigned to intranasal mupirocin and topical bathing with 2% chlorhexidine-impregnated cloths (n = 117) or placebo treatment with petrolatum intranasal ointment and nonmedicated soap cloths (n = 119).

Of the 236 enrolled infants, 208 (55% male; 76% singleton births; mean birthweight 1985 grams; 76% vaginal births) were included in the analytic sample, although 18 of these were lost to follow-up.

A total of 190 infants were included in the final analysis: 89 in the intervention group and 101 in the placebo group. Of these, 74 (38.9%) acquired S aureus colonization by 90 days, 42 (56.8%) of whom had a strain concordant with a parental baseline strain.

According to the researchers, fewer (n = 13; 14.6%) infants in the intervention group than in the placebo group (n = 29; 28.7%) acquired concordant S aureus colonization (risk difference, –14.1%; hazard ratio [HR], 0.43).

Similarly, fewer infants in the intervention group acquired any S aureus strain
(n = 28; 31.4% vs n = 46; 45.5%; HR, 0.57).

One infant (1.1%) in the intervention group and 1 (1.0%) in the placebo group developed a S aureus infection before colonization. Skin reactions in parents occurred commonly in both groups (4.8% vs 6.2%).

“This trial suggests that parents are a major reservoir from which neonates acquire S aureus in the NICU,” the authors write.

“Treating colonized parents may reduce risk of S aureus transmission to neonates, but these findings are preliminary and require further research for replication and to assess generalizability.”

This study “offers a novel and promising strategy to address a highly relevant, often intractable, clinical problem”, and “provides an explanation why interventions that primarily target patients and health care workers can fail to eradicate MSSA [methicillin-susceptible S aureus] in the NICU,” pediatric infectious disease specialists Philip Zachariah, MD, MSc, and Lisa Saiman, MD, MPH, write in an accompanying editorial.

However, they highlight some features of the study that indicate a need for further investigation before this strategy could be widely adopted by other NICUs. For example, both study NICUs already used active surveillance and decolonization protocols for both MSSA and MRSA, which limits generalizability of this treatment strategy.

In addition, the study was not powered to detect differences in infections or mortality, the editorialists say. Scalability is another concern, they add, noting that the study took 4 years to complete and that 92.7% of infants who were screened for eligibility failed to meet its inclusion criteria.

“Cost-effectiveness will also need to be determined,” Zachariah and Saiman add. Zachariah is from Columbia University Irving Medical Center, New York City, and Saiman is from NewYork-Presbyterian Hospital in New York City.

Nevertheless, the editorialists conclude that regardless of whether future research will support integration of this strategy into routine care, “Milstone and colleagues have made an important advance into this difficult area with the promise of having a meaningful benefit on neonatal care.”

This study was supported by the Agency for Healthcare Research and Quality. Three authors report receiving grants from the Centers for Disease Control and Prevention, the National Institutes of Health, Sage Products Inc, Singulex Inc, Curetis Inc, Accelerate Inc, and GenMark. The same three authors report personal fees from Becton Dickinson, Novartis, Theravance, Basilea, Pattern Diagnostics, and GenMark. The remaining authors and the editorialists have disclosed no relevant financial relationships.

JAMA. Published online December 30, 2019. AbstractEditorial



How Premature Birth Shapes Future Heart Health

Meredith S. Campbell, MD, Editorial Fellow, Pediatrics, Neonatal-Perinatal Medicine Fellow, Vanderbilt University Medical Center, Nashville, TN          July 07, 2020

Advancements in neonatal care have led to a growing cohort of preterm-born individuals that have now reached adulthood. While population-based birth cohorts have provided us with a better understanding of long-term complications of premature birth such as risk for neurodevelopmental impairment, much less is known about potential cardiac consequences.

In a newly released review article in Pediatrics (10.1542/peds.2020-0146), Dr. Fernando Telles and colleagues present the first meta-analysis to compare cardiac structure and function between former preterm and term infants from the time of birth to young adulthood. A total of 32 observational studies were included in the review to quantify the impact of preterm birth on the heart across developmental stages. The results were intriguing—former preterm individuals have persistently lower left ventricular diastolic function, right ventricular systolic impairment, and an accelerated rate of left ventricular hypertrophy. The authors proposed that these cardiac alterations may make the heart more vulnerable to secondary insults, which may explain why preterm birth is a risk factor for early heart failure and long-term risk of ischemic heart disease.

As we dig deeper into what’s different about the hearts of those born preterm, further longitudinal studies are needed to determine how cardiac remodeling in preterm infants progresses over time. This is particularly important in the adolescent age range, for which there is a paucity of data. While this article adds to our understanding of how premature birth shapes future heart health, a number of questions and research gaps regarding the long-term cardiac outcomes after preterm birth remain including the need for earlier detection of former preterm individuals at higher risk for cardiac issues, screening guidelines, preventative strategies, and a plan for better clinical monitoring. Additional research will hopefully allow us to get to the heart of the matter.


Trauma-informed Care in the NICU

Caring Essentials Collaborative, LLC – Mar 9, 2018

Mary Coughlin MS, NNP, RNC-E presents a quick overview of the biological relevance of this paradigm for hospitalized newborns, infants and families.

Premature babies experience high exposure to noise in the incubator

by Medical University of Vienna– JULY 20, 2020

What do premature babies hear while lying in an incubator? That is the question addressed by an interdisciplinary team from the Medical University of Vienna, led by Vito Giordano (neuroscientist at the Division of Neonatology, Pediatric Intensive Care and Neuropediatrics at the Comprehensive Center for Pediatrics (CCP) of Medical University of Vienna), by musicologist/acoustician Christoph Reuter and by music physiologist Matthias Bertsch from the University of Music and the Performing Arts in the recent study, “The Sound of Silence,” published in the journal Frontiers in Psychology

This study shows that premature babies are exposed to a high level of noise in the incubator, particularly if they are on respiratory support in the neonatal intensive care unit (NICU).

According to data from the World Health Organization (WHO), approximately 15 million babies a year are born prematurely, the proportion varying between 5% and 18% depending on the country of origin. Despite general improvements in intensive care medicine, many premature babies face life-long impairments. The intrauterine hearing experience differs strongly from the extrauterine auditory load encountered in a neonatal intensive care unit (NICU).

“It is primarily low frequency noises (note: below 500 Hz) that are transmitted and filtered through the mother’s body. Several studies have indicated that the noise level inside the NICU repeatedly far exceeds the recommended threshold of 35 dB. Signals from monitoring equipment, loud talking, sudden opening of doors or medical procedures result in a high level of background noise and reach peak values well above 100 dB,” explains Giordano.

However, high noise levels can lead to hearing impairment or even hearing loss—the incidence being between 2% and 10% in very premature babies, as opposed to only 0.1% -0.2% in infants born at term. “Premature babies in an incubator lack the natural filtering and absorption of background noise that occurs in the mother’s womb. New acoustic stimuli and/or noises have a marked impact upon postnatal maturation of the auditory system, as pointed out by the Medical University Vienna expert. However, silence, which leads to deprivation, a feeling of isolation, is just as harmful as loud stimuli. The problem is not essentially new: nowadays, educational concepts and visual indicators to reduce noise are already standard in neonatal wards.

The aim of the recently published study was firstly to record the dynamics of sounds inside an incubator and secondly to enable others to understand the hearing experience of premature babies. “Everyone, especially clinicians, nurses, music therapists and parents are now able to imagine what it sounds like inside the incubator by listening to examples of the sounds themselves. Inside it sounds quite different from outside, since the incubator acts as a bass booster, i.e. lower frequencies below 250 Hz are significantly louder,” explains music physiologist Matthias Bertsch.

The results of the study show that the incubator has a “protective effect,” especially against medium- and high-frequency sounds, but amplifies lower frequency sounds. Moreover, the incubator lid has practically no protective effect against noise, there is an increase in high-frequency sounds when access doors are left open, and there is a high noise level generated by a respiratory support device. “What listeners find particularly surprising is how loud these respirators can become inside the incubator, even if the air-flow is only slightly increased. At a high flow-rate with the associated roaring sound, the increase is such that it equates to the noise of a vacuum cleaner at a distance of one meter (75 dB),” the study authors explain. Neonatologists are therefore advised to set the air flow of respiratory support devices to the necessary minimum.

“We feel it is important to raise awareness of the problem, not only with acoustic noise level tables but with understandable audible results,” the authors highlight. The consequences of early exposure to noise can be wide-ranging, e.g. impaired ability to discriminate speech compared to children born at term, which was demonstrated in a parallel study of the same study group. This was conducted in July 2019 under the supervision of neurolinguist Lisa Bartha-Doering at the Comprehensive Center for Pediatrics (CCP) and published in the journal Developmental Cognitive Neuroscience.

“These study findings show that it is important to invest in new technologies,” Angelika Berger, Head of the Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, explains, “and our research teams are currently working on such new technologies in order to improve the acoustic comfort and long-term outcome of our smallest patients.”


Six Tips for Managing Stress and Improving Self-Care in a COVID-19 Environment

Duke School Of Nursing    Apr 9, 2020 Duke University School of Nursing Assistant Professor Sean Convoy discusses suggestions for managing stress and improving self-care in a COVID-19 environment.


Warriors have the capacity to capitalize on the challenges Covid-19 presents by focusing on what we choose to experience within the  containments required to support our mutual health and well-being at this time. I challenge us to recognize the value of the here and now and not only recreate our relationships with ourselves during this moment in time but affirm our intention to prosper and grow ourselves. Don’t wait! Within the quiet isolation and uprooted rhythms of our pre-Covid-19 lives there is an open door to our hearts, and our souls.  In this moment, let’s leave the longing for what was and  follow our intuition towards lives of happiness and fulfillment beyond our imaginations. Take time to let go, to heal, to replenish and re-invent (re-discover) the wholeness of each of us! We have offered many self-empowerment resources over the past (almost 5) years. Here  are a couple of additional self-empowerment resources for our older Warriors to consider.  I like the kinesthetic experience the Toltec Path to Recapitulation offers, and am looking forward to exploring the ideas and wisdom offered through the books mentioned below.

Recapitulation: Release your past and reclaim trapped energy

Mar 16, 2016
All Things Perceptual
Recapitulation: how to, from beginning to end, obtain a perfect recapitulation of your life, freeing you from the bonds of your life experiences, replenishing you with boundless energy and making you light and flexible in your spirit. The Legend of the perfect recapitulation and the Toltec theory of near immortality as a warrior of the third attention!

8 Self-Empowerment Books to Help You Take Back 2020

Take a break from the everyday unrest of this year to be inspired by the stories of others who have faced adversity and overcame it.

Peter Daisyme – August 28, 2020

It doesn’t matter who you ask — 2020 has been an exhausting year. Between a global pandemic, political unrest and an unprecedented economic downturn, it’s easy to feel downtrodden.

While there’s no easy way to get out of this funk, it never hurts to listen to the perspectives of others. By reading books focused on self-empowerment and overcoming adversity, you can feel prepared to take on whatever the world has to throw at you in 2020 and beyond. Here are some of the top choices out there right now.

1. Learn, Improve, Master: How to Develop Any Skill and Excel at It by Nick Velasquez

With lots of people having more free time than ever on their hands, many are taking this opportunity to pick up new skills. But doing so is often easier said than done. Learn, Improve, Master doesn’t teach the basics of any one skill; it gives you the tools you need to learn things more quickly and fully in the future. Nick Velasquez’s new book is a valuable investment for anyone looking to continually grow and evolve over time.

2. Grit: The Power of Passion and Perseverance by Angela Duckworth

The title here says it all. In Angela Duckworth’s Grit, the secret to success can be found entirely in one’s own dedication and work ethic. Duckworth looks at standouts everywhere from West Point to the National Spelling Bee and has found one thing in common: sheer determination. If you’re looking to learn how to take your career to the next level through hard work, this book is the one for you.

3. Responsibility Rebellion: An Unconventional Approach to Personal Empowerment by Kain Ramsay

It can seem like we achieve some of the greatest joys in life by avoiding responsibility — goofing off, taking vacations and ignoring the real problems at the heart of it all. Responsibility Rebellion turns this logic on its head by arguing that getting ahead in life isn’t about ignoring the underlying issues. It’s about facing them head on. Kain Ramsay’s unconventional approach to success may surprise some, but the results are hard to ignore. 

4. Across That Bridge: A Vision for Change and the Future of America by John Lewis

The death of John Lewis sent the country into a national state of mourning, but his influence doesn’t have to end there. Across That Bridge is a powerful collection of his thoughts, memories and reflections on what it was like to fight during the Civil Rights Movement and how people can use that spirit to continue to fight for justice today. The book is no easy read, but the wisdom contained therein is well worth it.

5. The Empowerment Paradox: Seven Vital Virtues to Turn Struggle Into Strength by Ben Woodward

Why is it that many of people’s biggest, most life-changing revelations often come after moments of deep pain and tragedy? There’s no easy answer to this question, but The Empowerment Paradox is a powerful look into what we might learn from it. Ben Woodward offers a unique perspective on how we might take some of the difficulties we face and turn them into personal progress.

6. Ignite Your Career!: Strategies and Tactics to Unleash Your Potential by Kris Holmes

This year’s college graduates are currently facing more uncertainty in the job market than any generation before them, and there’s no clear end in sight. Kris Holmes’s new book may have been written before the pandemic struck, but the advice is more relevant than ever. Ignite Your Career! is a must-have for any first-time job seekers.

7. Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones by James Clear

Less than two years old, Atomic Habits is already something of a modern classic. James Clear uses his book to give a clear, simple guide for remaking your life, starting with the small stuff. If you want a big change to come into your life, beginning with daily habits might just be the method that works best.

8. Boot Straps & Bra Straps: The Formula to Go from Rock Bottom Back into Action in Any Situation by Sheila Mac 

The pandemic has been hard on businesspeople of all shapes and sizes, but there’s no doubt that women have faced a particularly poignant challenge. Boot Straps & Bra Straps is a how-to guide for any woman hoping to bring her career to the next level without sacrificing any of herself in the process. Sheila Mac has already been through it all herself, meaning that her book has a lifetime’s worth of wisdom for you to glean from.

They may not have all the answers, but books are a good place to start when it comes to empowering yourself. By picking a couple of the options off of this list, you can introduce yourself to a whole world of ideas that you can use to learn and grow.


AND for our younger Neonatal Womb Warriors: Ruby Finds a Worry by Tom Percival Ruby’s Worry (Read Aloud) | Storytime

Feb 10, 2020        Toadstools and Fairy Dust

Please join us for a dramatic read of Ruby Finds a Worry, Ruby’s Worry by Tom Percival read by Miss Jill. Great story about feelings and overcoming anxiety and worry and what to do.

The Samoan Surfers

Apr 27, 2013  Iva Motusaga

The Motusaga Wave Riders




Chad, officially known as the Republic of Chad is a landlocked country in northcentral Africa. It is bordered by Libya to the northSudan to the east, the Central African Republic to the southCameroon to the south-westNigeria to the southwest (at Lake Chad), and Niger to the west.

Chad has several regions: a desert zone in the north, an arid Sahelian belt in the centre and a more fertile Sudanian Savanna zone in the south. Lake Chad, after which the country is named, is the largest wetland in Chad and the second-largest in Africa. The capital N’Djamena is the largest city. Chad’s official languages are Arabic and French. Chad is home to over 200 different ethnic and linguistic groups. While many political parties are active, power lies firmly in the hands of President Déby and his political party, the Patriotic Salvation Movement. Chad remains plagued by political violence and recurrent attempted coups d’état. Chad is one of the poorest and most corrupt countries in the world; most inhabitants live in poverty as subsistence herders and farmers. Since 2003 crude oil has become the country’s primary source of export earnings, superseding the traditional cotton industry. Chad has a poor human rights record, with frequent abuses such as arbitrary imprisonment, extrajudicial killings, and limits on civil liberties by both security forces and armed militias.


In 1987 Chad had 4 hospitals, 44 smaller health centers, 1 UNICEF clinic, and 239 other clinics—half under religious auspices. Many regional hospitals were damaged or destroyed in fighting, and health services barely existed in 1987. Public health care expenditures were estimated at 2.9% of GDP. As of 2004, it was estimated that there were fewer than 3 physicians, 15 nurses, and 2 midwives per 100,000 people.


Preterm Birth Rates – Chad

Rank: 35 –Rate: 13.1% Estimated # of preterm births per 100 live births (USA – 12 %)




Connecting with Chad from an informational standpoint has been challenging, especially in relationship to healthcare, and specifically preterm birth. The emotional connection we feel for the people living in Chad is one of great love, concern, hope and admiration for the resilience of our global family living in Chad.


From 1969 to 1988, 25,000 infants were born early each year as a result of hot weather, and with global warming pushing temperatures higher, more babies will be at risk for early birth.

Hot weather increases pregnant women’s risk of giving birth early, and more babies could be born early as a result of global warming, researchers report today (December 2) in Nature Climate Change. The average reduction in gestational length is six days, they find.

“Increased exposure to hot weather with climate change is likely to harm infant health,” write coauthors Alan Barreca, an economist at the University of California, Los Angeles, and Jessamyn Schaller, an economist at Claremont McKenna College, in the study. That’s because early birth is tied to poorer physical and mental health later in life.

Reviewing county birth rates around the time of extreme heat waves in the United States from 1969 to 1988, the researchers estimated that roughly 25,000 infants per year were born earlier than their due dates as a result of heat exposure, and that the heat led to the loss of 150,000 gestational days each year. Using data from climate models for the end of this century, they calculate pregnant women in the US will lose around 253,000 gestational days per year, with an additional 42,000 early births annually.

“More study needs to be done,” Mitchell Kramer, the chair of obstetrics and gynecology at Northwell Health’s Huntington Hospital in New York who was not involved in the study, tells HealthDay, “but certainly we must help protect pregnant women from extremes of heat as well as work on the causes of climate change.”

What causes pregnant mothers to have their babies earlier in hotter weather isn’t clear, but scientists have suggested heat leads to cardiovascular stress, which can induce pregnancy, or heat increases the levels of oxytocin, a hormone plays a role in labor, Time reports.

“There may even be a third cause,” Barreca tells Time, “which is loss of sleep. Minimum temperature on a hot day occurs at night, but it can still be hot enough to disrupt sleep, and that might be an important avenue to early birth.”

Income and exposure to heat make a difference, the team notes. For instance, access to air conditioning, typically associated with higher income, cut early birth risk. And, expecting mothers in regions of the US where temperatures are typically high didn’t have as many early births as women who live where temperatures are cooler.

“Electrification and access to air conditioning should be a part of any effort to protect pregnant women and infants in developing countries,” Barreca tells The Guardian. “But developed countries, like the US or England, should be paying developing countries to electrify with renewable sources, like wind or solar, so we avoid producing more greenhouse gas emissions.”

Ashley Yeager is an associate editor at The Scientist. Email her at

L Maintaining Safety and Service Provision in Human Milk Banking: a call to action in response to the Covid-19 pandemic.

When a mother’s own milk is not available, WHO recommends pasteurised donor human milk as the first alternative.

Human milk banks screen and recruit donors, and have wide-ranging precautions to ensure the safety of donor milk. Screened donor milk principally feeds babies of very low birthweight, protecting them from a range of complications, as well as babies with congenital anomalies or neurological conditions.

The benefits of a human milk diet highlight the importance of providing these infants with donor milk for short periods—with appropriate use in the context of optimal support for lactation, such provision can support mothers to establish their milk supply without the need for supplementation with infant formula milk.

The coronavirus disease 2019 (COVID-19) pandemic is presenting many challenges to human milk banks worldwide and highlights a range of vulnerabilities in service provision and emergency preparedness. For the first time, the global human milk bank community is coming together to share learnings, collaborate, and plan. A Virtual Communication Network of milk bank leaders started to form on March 17, 2020, and now has more than 80 members from 34 countries. Data collated from regional and country leads in the Virtual Communication Network show that more than 800 000 infants are estimated to receive donor milk worldwide annually. However, the inadequate quality of the data is a major flaw, and the true global scale of milk banking is unknown.

The group actively discusses COVID-19-specific challenges and has developed mitigation strategies to ensure donor milk safety and service continuation, which will shortly be made available as a publication. During this crucial COVID-19 response period, human milk banks are facing the logistical challenges of adequate staffing, difficulties in donor recruitment, questions around the safe handling and transportation of donor milk, and increased demand as a result of mothers and infants being separated.

The global nature of this network supports breastfeeding advice from WHO, which is appropriate in both low-income and high-income nations.

Human milk bank leaders who have lived and worked through the HIV pandemic have brought insights into the mistakes that occurred in the 1980s, with fear leading to breastfeeding cessation and costing the lives of many babies who received infant formula in unsafe conditions.

Unlike HIV, where transmission via breastfeeding was a source of infection, there is no evidence around severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from breastfeeding or human milk,  and the virus is inactivated by heat treatment.

Similar patterns have emerged during other viral outbreaks (eg, Zika in 2016), where uncertainty about donor milk use meant that milk was withheld, and then used again once pasteurisation was proven to be effective or the virus shown not to be transmissible through milk. In the meantime, vulnerable infants have received suboptimal care. This constraint does not affect similar services (eg, blood transfusion and organ transplantation) to the same extent, where oversight and rapid research are prioritised.

To avoid further straining the health system during the COVID-19 pandemic, the best chance to keep infants healthy is to promote breastfeeding and a human milk diet. WHO notes that where donor milk provision can play a part, human milk bank services should be supported. The consensus from this Virtual Communication Network is that a comprehensive approach should be implemented to maintain contact between mothers and babies, with skin-to-skin contact and breastfeeding support. If donor milk is provided during any separation linked to COVID-19, this should be for as short a time as possible as a bridge to receiving mother’s own milk. By reducing the amount of mother–infant separation time and supporting the use of mother’s own milk, the excess demand for donor milk will diminish, ensuring that the global supply can continue to be used for those who need donor milk most, when maternal breastfeeding is disrupted or not possible. This approach increases the chances that these infants will leave the neonatal intensive care unit breastfeeding exclusively, which is essential for the long-term health of mother and baby. Emphasis on the importance of human milk for infants within neonatal units creates an environment where the mother’s own milk is seen as the valuable lifesaving resource that it is.

It is imperative that human milk bank systems are not inadvertently affected by efforts to contain COVID-19, but milk banks are facing unprecedented challenges to maintain safe supplies in volatile health system infrastructures. Local issues have been deepened by the absence of globally agreed operational safety guidelines, no global mechanism for rapid communication among milk banks, with little data and infrastructure to ensure responsiveness during a crisis. The strengthening of human milk bank systems is required to ensure that safe provision of donor milk remains an essential component of early and essential newborn care during routine care or emergency scenarios, such as natural disasters and pandemics.

We therefore collectively call on global policy leaders and funding agencies to recognise and prioritise the need to address four high-impact areas: (1) ensuring neonatal nutrition is an essential focus during emergencies; (2) funding research to optimise human milk bank systems in response to new infectious threats; (3) investing in innovation across all aspects of milk banking processes to improve the responsivity, access, and quality of donor milk provision; and (4) supporting the integration of learnings and innovations by the global milk bank community during COVID-19 into newborn, nutrition, and emergency response planning for future emergencies.

The Virtual Communication Network is now focused on building a formal global alliance to enable enhanced communication, sharing of data, and maintenance of optimal practices. Human milk banks constitute a necessary but chronically under-resourced service that deserves better protection against this and future emergencies.

NS reports funding from UK Research and Innovation, as a Future Leaders Fellow at Imperial College London; and is a cofounder and trustee of the Human Milk Foundation. All other authors declare no competing interests.




Premature births have gone down during the pandemic — and doctors are baffled as to why

Amid the pandemic, premature births have dropped precipitously around the world.      A few scientists have theories.    Matthew Rozsa July 21, 2020 11:58PM (UTC)

Medical experts are baffled as to why that has there has been a surprising drop in the number of premature babies born during the coronavirus pandemic, as first reported by The New York Times.

At University Maternity Hospital Limerick in Ireland, a neonatologist named Dr. Roy Phillip began investigating the matter when he learned that the hospital had not ordered any of the breast milk-based fortifier that doctors feed to the tiniest premature babies, as the Times story recounts. After being told that no babies had been born who required it, Dr. Phillip and his team compared the birth weights of babies (which tends to correlate to whether a baby is premature) born in their hospital between January and April of 2001 all the way through that same period in 2020.

They found that the number of babies born under 3.3 pounds had been reduced by 75%, while none at all had been born under 2.2 pounds. Even after the Irish lockdown began to end in June, the numbers continued to stay at unprecedented lows, according to Dr. Phillip.

At the same time that Ireland was discovering its own reduced number of preemies, medical professionals in other countries were finding the same thing. A neonatologist named Dr. Stephen Patrick at Vanderbilt Children’s Hospital in Nashville discovered that roughly 20 percent fewer NICU [neonatal intensive care unit] babies were born at his hospital in March than usual. A neonatologist at the University of Calgary in Alberta, Dr. Belal Alshaikh, learned that premature births across the province dropped by nearly half during his country’s lockdown.

At the Statens Serum Institut in Copenhagen, Dr. Michael Christiansen learned that the rate of babies being born before 28 weeks had dropped by 90 percent from March 12 to April 14 in 2020 (during the main lockdown period in Denmark) compared to the rates over the previous five years. Doctors in Australia and the Netherlands made similar discoveries of their own.

According to the Times article, potential explanations for the drop in premature births tend to involve the consequences of women staying at home, including the increase in physical rest, reduced exposure to infectious diseases and reduced exposure to air pollution.

“I saw this as well. I, too, was intrigued,” Mark Mercurio, a professor of neonatology at Yale University told Salon by email. “Our NICU has been as busy as ever, and I don’t personally have the specific numbers at hand from the most recent months to tell you whether our premature birth rate, especially the very preterm ones, is down. I have contacted those who keep those stats.”

It is worth noting that the two papers discussing this phenomenon have been posted on the preprint server medRxiv but have not yet been peer reviewed. Speaking to the Australian Financial Review, Professor of Obstetrics at the University of Western Australia John Newnham said that “it would extraordinary if the described reduction had occurred. Such a quantum leap would be a major advance and may have been discovered by accident.”

He added, “But these results need to be replicated because very early preterm births have been stable over the last decades. The first explanation to be excluded is whether pregnant women have gone to a closer hospital because of the lockdown.”

The seeming drop in premature baby births is only one of the medical mysteries that has emerged from the coronavirus pandemic. There are questions about why people respond so differently to being infected with the virus, the correlation between being asymptomatic and health issues arising from the virus, where the virus originated, how much of the virus can make you sick, how long one can remain immune after infection and the role played by children in spreading it.






Effective Communication in the NICU

Britt Days, MSN,RN details strategies for effective communication with families & team members in the NICU.


Visual‐motor functions are affected in young adults who were born premature and screened for retinopathy of prematurity

Dýrleif Pétursdóttir

Institution of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden



To assess visual‐motor integration in young adults previously included in a prospective study on the incidence of retinopathy of prematurity (ROP).


The study encompassed 59 preterm individuals, born 1988‐1990, with a birth weight ≤1500 g, and 44 full‐term controls, aged 25‐29 years. Ophthalmological examination, including visual acuity and contrast sensitivity, and the Beery Visual‐Motor Integration (VMI) with supplemental tests of visual perception and motor coordination, were performed. A short questionnaire was filled in.


The preterm individuals had significantly lower scores than the controls in all VMI tests, median values and interquartile ranges: Beery VMI 87 (21) vs 103 (11), visual perception 97 (15) vs 101 (8) and motor coordination 97 (21) vs 102 (15), respectively. Within the preterm group, no correlations were found between the VMI tests and ROP, gestational age, birth weight or visual acuity. Contrast sensitivity was correlated to visual perception. Neurological complication at 2.5 years was a risk factor for lower scores on Beery VMI. The preterm subjects reported six times as many health problems as compared to the controls.


Being born preterm seemed to have life‐long effects. This study shows that visual‐motor integration was affected in young adults born preterm.



Signs of postpartum depression in dads are often mistaken or missed, study shows

By Manas Mishra Reuters  Posted June 10, 2019

While many people can pick up on signs of postpartum depression in new mothers, the same signs are often mistaken for something else or missed entirely in fathers, a British study suggests.

There needs to be greater awareness that the mental health disorder can occur in either parent for up to a year after the birth of a child, researchers say.

In fact, a previously published research review found that one in four fathers experienced postpartum depression within three to six months after a child was born.

Study leader Viren Swami, a professor of social psychology at Anglia Ruskin University in Cambridge, UK, started researching the subject after he was diagnosed with the disorder after the birth of his son.

“Once I was diagnosed, I wanted to do more research into it and find out why so many people, like myself, think that men can’t get postnatal depression,” Swami told Reuters Health via phone.

Swami and his colleagues recruited 406 volunteers, ages 18 to 70, and had them read two vignettes describing almost identical situations where the subject suffered from postpartum depression, but one with a man and another with a woman.

Participants were initially asked if they believed anything was wrong with the subjects. Almost everyone — 97 percent — responded “yes” for the vignette with the woman, and 79.5 percent responded “yes” for the male.

Next, participants were asked what they thought was wrong. In the case of the mother, 90.1 percent correctly listed postpartum depression, postnatal depression or depression, while only 46.4 percent did so for the father.

Answers listing “baby blues” as the reason were scored as incorrect because this kind of short-lived mood swing is different from postnatal or postpartum depression and usually resolves within a week after birth, Swami and his team write in the Journal of Mental Health.

For the woman, a clear majority of 92.9 percent said depression was the problem.

Among those who did feel something was off with the man in the case study, 61 percent correctly thought it could be some form of depression. But 20.8 percent thought the father’s symptoms could be stress, 11 percent responded with tiredness and stress, and a few others said it could be anxiety, feeling neglected or “baby blues.”

The invisibility of their depression may force fathers to cope on their own instead of seeking professional help, the research team says.

One shortcoming of the study is that participants were recruited online, so they may not represent all adults, the researchers note

But some of the new results are encouraging, he said. “Although a much higher percentage of respondents recognized PND in women, there was still a substantial amount that recognized PND in father,” Eddy said via email.

“There are many fathers out there who suffer from PND who think they are alone and nobody sees their suffering. More people are beginning to recognize that paternal PND is real,” he added.

Previous research has shown that educational programs about maternal postnatal depression can improve awareness of the disease, the researchers wrote.

“Similarly rigorous programs to support new fathers and raise awareness of paternal postnatal depression are now urgently required,” they said.




Male Postpartum Depression – Tips For New Dads To Overcome It | Dad University

02/14/2019 – Dad University

Putting out a “WAKE-UP” call to Family Partners, Healthcare Providers and Educators. Late pre-term birth babies (still preemies) have challenges both medically and developmentally. Each one is unique. Late preterm infants are considered an at-risk population. So often we hear preemie parents and families “blow off” the importance of awareness related to the ongoing research, findings, and recommendations regarding late term preemie health and wellness. If you are a healthcare provider, parent/caregiver or educator attending to a late term preemie infant/child, please stay informed and empowered in order to provide dynamic proactive care for these amazing preterm birth survivors!



Concerns About Preterm Birth Extend to the Last Few Weeks


THE CHECKUP – Infants born at 37 or 38 weeks were more likely to have developmental delays than full-term babies.

When I was training in pediatrics, back in the 1980s, we spent a lot of time working in the newborn intensive care unit, where relatively new — and rapidly evolving — technologies made it possible to save extremely premature infants. A full-term pregnancy lasts for 40 weeks, and we were often taking care of babies born at 27 or 28 weeks, and sometimes earlier, impossibly tiny infants who were clearly not ready to exist outside the womb.

We worried less about the bigger, more clearly mature babies who were just a month or a little more early; the chief question was whether they weighed enough to go home — otherwise they had to stay in the hospital to “feed and grow.” And there was a general sense that that was also what those last weeks in the womb were mostly about.

But the thinking has shifted as new research has shown that every week that a baby stays in the womb makes a difference in health and development, even those last few.

“They’re not done yet, they’re just not done yet,” said Dr. Wanda Barfield, the director of the division of reproductive health at the Centers for Disease Control and Prevention. In that excitement over being able to save the profoundly premature infants, medicine lost sight for a while of the fact that the infants born at 34 and 35 and 36 and 37 weeks gestation “weren’t just little term babies, weren’t mature, had a lot of needs to continue their physiological maturity,” she said.

This led, in some cases, to a rather cavalier attitude toward delivering babies early, even when not medically indicated. But when researchers looked more closely at these “late preterm” infants, they found that they were at increased risk of a whole range of medical problems and developmental issues.

One important result of the research on late preterm infants was that the American College of Obstetricians and Gynecologists recommended strongly against early deliveries, unless they were medically necessary. Between 2007 and 2014, Dr. Barfield said, late preterm births declined, but since 2014, there has been an uptick. “We’re losing ground,” Dr. Barfield said. And there are also concerning disparities with higher rates of prematurity among African-American and Hispanic women.

Dr. Prachi Shah, an associate professor of pediatrics at C.S. Mott Children’s Hospital at the University of Michigan, said, “when we think about the morbidities of preterm birth, most studies have focused on the very preterm infant, less than 32 weeks, less than 28 weeks.” However, she said, from a public health point of view, late preterm births — from 34 to 37 weeks — account for the majority of preterm births — about 70 percent — and for 7 percent of all live births.

The terminology was revised in a 2007 report by the American Academy of Pediatrics: Babies born from 34 to 36 6/7 weeks gestation were classified as “late preterm,” rather than “near term.” Those born from 37 to 38 6/7 weeks are now called “early term” babies, and only those who stay inside for 39 to 40 6/7 weeks are considered full term. Early term infants represent another 26 percent of all live births.

In pediatrics, late preterm infants are now considered an at-risk population. Most immediately, they are at higher risk of medical problems in the newborn period, including poor feeding, dehydration, jaundice and hyperbilirubinemia. They may have trouble maintaining their blood sugar levels, and they may have trouble maintaining their temperatures. They are more likely to be readmitted after they go home from the hospital.

When researchers control for underlying conditions associated with early deliveries, like maternal hypertension or diabetes, late preterm infants are still at higher risk than full-term infants whose mothers have those same problems.

As they grow, the late preterm children are also at increased risk for developmental problems, Dr. Shah said. “Beyond the perinatal period, at a population level, when compared to full-term infants, there is a higher incidence of learning difficulties and minor cognitive and neurologic issues.”

In a recent study, researchers looked at data from a group of almost 6,000 children in New York (the Upstate KIDS cohort, born outside New York City from 2008 to 2010) who were regularly assessed during the first three years of life through parental questionnaires. The researchers also looked to see whether children had been found eligible for early intervention services, which are provided to those with developmental delays.

Edwina Yeung, a senior investigator at the Eunice Kennedy Shriver National Institute of Child Health and Development division of intramural population health research, who was the senior author, said, “We were trying to look at this in a longitudinal way, as a continuum of gestational age.”

Although the most marked risks were found in children born at the lower gestational ages (32 weeks and below), the relationship was consistent: The longer babies stayed in the womb, the less likely they were to show developmental delays on the questionnaires, and to qualify for early intervention services. The late preterm infants were at higher risk than the early term infants, but those born at 37 and 38 weeks gestation were also at higher developmental risk, with a greater likelihood of failing the gross motor and communication domains of the questionnaire. Even 39 weeks was not as good as 40 or 41.

“Nobody doubts that preterm delivery is a problem,” Dr. Yeung said. “The question of interest is in that small window around 40 weeks with term deliveries and early term deliveries.”

Dr. Shah, who was not involved with this study, said, “The key take-home message is that every week seems to make a difference in terms of developmental delay — the earlier you were born, the higher your risk for developmental delay.”

Dr. Shah was the first author of a 2016 study which found that at preschool and kindergarten entry, children born in the late preterm period had lower math and reading scores than children born at term. “Compared to full-term infants, there is an increased risk of developmental vulnerability, but the magnitude of effect is not as great as those born very preterm,” she said.

Still, these are children who should be identified — and helped — before they get to school. “We have missed a window to intervene,” Dr. Shah said. “If we have evidence that there are population-based differences, we should be thinking about them as a vulnerable population that may need targeted surveillance.” It may be important to look closely at which late preterm infants should be monitored most closely, she said, and to consider extending the eligibility for services like early intervention.

In terms of development, Dr. Shah said, many of the risks for late preterm and early term infants seem to be around communication and language delays, and around math. “Every week of intrauterine life makes a difference in these neurodevelopmental processes,” Dr. Shah said. “Even a week early can seem to result in structural changes.”

Dr. Barfield was the co-author of a 2019 update on the late preterm infant from the American Academy of Pediatrics, which emphasizes the importance of strategies for preventing prematurity. The A.A.P. recommends against early discharge for these newborns, and suggests that they come back for follow-up visits after discharge.

They need to be breastfeeding well, and able to maintain their body temperatures. Their families need to be clear on the rules of safe sleep and fully informed about all the other warning signs to watch for, from jaundice to lethargy to breathing problems.

“We need to understand that these babies are premature,” Dr. Barfield said. “Although they may be closer in terms of time, they are still premature infants.”




NICU Nurse Adopts Baby She Felt ‘Instant Connection’ With

insidSep 16, 2019

Baby Jackson is the apple of his mom’s eye. The two share a special bond, and the way it came about is even more special. Claire Mills, 25, is a NICU nurse at a hospital in Houston, Texas. When Jackson was born five weeks premature at the same hospital, he quickly became more than Mills’ patient. So when his biological mother worried she couldn’t care for him in the way he deserved, she asked Mills if she would adopt him. She said yes and has been raising the sweet little boy ever since.




Exposure to iodine in the NICU may affect infant thyroid function

HealthDay News – JULY 7, 2020

Exposure to iodine in the neonatal intensive care unit (NICU) may increase a baby’s risk for loss of thyroid function, a new study suggests.

Iodine solutions are often used as disinfectants on the skin before surgical or other medical procedures. Iodine also is given internally for imaging procedures used in infants, researchers explained.

Investigators found higher blood levels of iodine in babies with congenital hypothyroidism (partial or total loss of thyroid function) who had a stay in the NICU. All these infants had normal thyroid function when they went to the NICU.

“Limiting iodine exposure among this group of infants whenever possible may help lower the risk of losing thyroid function,” researcher Dr. James Mills said in a news release from the U.S. National Institutes of Health.


Mills is from the epidemiology branch of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

For babies with congenital hypothyroidism, treatment with thyroid hormone has to start within four weeks after birth or permanent intellectual disability can happen.

For the study, Mills and his colleagues compared iodine levels from more than 900 children with congenital hypothyroidism to more than 900 children who did not have the condition.


Among the kids, 183 were cared for in the NICU. Of these, 114 had congenital hypothyroidism and 69 did not.

Children with congenital hypothyroidism were more likely to have been in a NICU than those without the condition, the researchers found.

When they looked at only kids who had been in the NICU, they found those with congenital hypothyroidism had higher iodine levels than those without the condition.


Higher iodine levels among babies with congenital hypothyroidism and a NICU stay might be linked to exposure to iodine during treatment, although only an association was observed and the research didn’t include information on the infants’ exact medical procedures.

The researchers caution NICU staff not to use disinfectants containing iodine and to avoid exposing babies to iodine unless necessary. Preemie infants absorb iodine more readily through their skin than older infants, they noted.

The report was published July 7 in the Journal of Nutrition.




Telehealth helps Mayo Clinic neonatologists better treat newborns in emergencies

The new technology connects on the first attempt 96% of the time, compared with 73% for the previous telemedicine carts; with enhanced monitoring and support, tele-neonatology availability is 99%. By Bill Siwicki -November 06, 2019

The Mayo Clinic in Rochester, Minnesota, implemented tele-neonatology six years ago. Prior to that, Mayo Clinic neonatologists were assisting community hospital care teams via telephone when a newborn required advanced resuscitation or critical care.


“Because we were unable to visually assess the newborn, this limited our ability to closely collaborate with the local team and guide care over the phone,” said Dr. Jennifer Fang, medical director, tele-neonatology, at Mayo Clinic. “This was especially relevant when our neonatal transport team was not present for a high-risk delivery due to weather or geography, and the local team had to resuscitate and stabilize the critically ill newborn independently.”

These challenges prompted Mayo Clinic to develop a tele-neonatology program that allows neonatologists to establish a real-time audio/video telemedicine connection with care teams in community hospitals during these high-risk, low-frequency neonatal emergencies.

The tele-neonatology program is now offered at 19 community hospitals with Level I (well-baby) or Level II (special care) nurseries located in Minnesota and Wisconsin. Mayo Clinic board-certified neonatologists have performed more than 425 tele-neonatology consultations.

“During the initial pilot program, local care teams and neonatologists identified that tele-neonatology was feasible and seemed to improve the quality and safety of care provided to newborns requiring advanced resuscitation,” Fang explained. “However, we also realized that the initial technologies used for our program did not provide the level of reliability and audio/video quality that our program required.”


Previously used telemedicine technologies for Mayo Clinic’s tele-neonatology program had issues with reliability, including ability to establish and maintain a connection for the duration of the tele-neonatology consultation.

For example, when using a consumer-grade wireless tablet with HIPAA-compliant video conferencing software, neonatologists were able to connect on the first attempt during only 70% of consults. Further, 15% of consults were interrupted by an unintended disconnection.

After the initial pilot phase, Mayo Clinic transitioned to a wired telemedicine cart with a hardware CODEC. While this technology improved the ability to connect on first attempt to 83% and reduced dropped connections to 6%, it still did not meet the reliability requirements for tele-neonatology given the emergent, critical nature of the consultations.

“In addition to suboptimal reliability, previous technologies were not meeting provider expectations for audio and video quality,” Fang reported. “When assessing satisfaction with audio/video quality on a 1 (poor) to 5 (excellent) scale, the wireless tablet had a mean rating of 3.3 and 3.2 for video and audio quality, respectively. After transitioning to the wired telemedicine cart, the video and audio quality ratings significantly improved to 4.6 and 4.3, respectively.”

However, users still reported issues with device size and difficulty positioning it in a constricted care environment, lack of mobility due to the wired connection, and audio delay and fragmentation.

“Because reliability and audio/video quality of the previous technologies did not meet our programmatic goals, the Mayo Clinic tele-neonatology program sought a telemedicine product that could provide 99% reliability in rapidly establishing and maintaining a connection, a more responsive remotely controlled camera, seamless high-fidelity audio, and a mobile form factor that fit well into the typical neonatal work space, for example, the labor and delivery room, nursery, and operating room,” Fang said.


There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, InTouch Health, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.


In October 2016, Mayo Clinic’s tele-neonatology program transitioned from a wired telemedicine cart with hardware CODEC to a proactively monitored, fully supported wireless telemedicine product from vendor InTouch Health.

Care teams in the community hospitals activate tele-neonatology when there is a high-risk delivery or a newborn that requires advanced resuscitation. Providers at the community hospital place the wireless telemedicine device at the newborn’s bedside and call Mayo’s Admission and Transfer Center to request a tele-neonatology consult.

A Mayo Clinic neonatologist then establishes a synchronous, audio/video connection with the care team via the telemedicine device in the room. If the newborn requires transfer to Mayo Clinic’s neonatal intensive care unit (NICU), the neonatologist can dispatch the transport team to retrieve the patient as part of the tele-neonatology workflow.


The objective of the Mayo Clinic tele-neonatology study (McCauley et al, Telemed and e-Health, 2019) was to compare the performance of two telemedicine technologies used to provide tele-neonatology consults.

“We hypothesized that the InTouch Health Lite Version 2 telemedicine device (ITH Lite) would provide superior reliability and a higher-quality user experience when compared with a wired telemedicine cart,” Fang said.

“When considering reliability of connection, we demonstrated that the neonatologist was able to connect on first attempt more reliably with the ITH Lite compared with the wired telemedicine cart (96% versus 73% of consults). The improved connection reliability was likely due to proactive monitoring of the device by the vendor and implementation of formal support processes by both the vendor and Mayo Clinic’s Center for Connected Care.”

With enhanced monitoring and support, product availability with the ITH Lite was 99%, Fang added. When compared to the wired telemedicine cart, Mayo Clinic found that a significantly great percentage of incidents were resolved proactively and did not impact patient care when using the ITH Lite (incidents that impacted care, ITH Lite 7% versus wired cart 32%).

The percentage of consults complicated by unplanned disconnections was not significantly different between the two technologies.

“After each tele-neonatology consult, an electronic survey is sent to the community physician and neonatologist,” Fang explained. “Providers rate the technology performance on a 1 (poor) to 5 (excellent) Likert scale. Overall user satisfaction and video quality were not significantly different between the wired cart and the ITH Lite. However, the average audio quality rating was significantly higher for the ITH Lite compared with the wired telemedicine cart: 4.6 versus 4.1.”

This is an important finding because communication is fundamental to a successful newborn resuscitation, and may be even more critical when team members are separated by time and space as is experienced during tele-neonatology consults, Fang explained. To provide high-quality care during neonatal resuscitations, the team needs to share information and communicate intentions and plan of care; for these reasons, exceptional audio quality is imperative during tele-neonatology consults, she added.

“Local providers found the wired telemedicine cart to be bulky and less maneuverable,” Fang reported. “They either had to work around the cart or the neonatologist’s view of the neonate was compromised due to obstruction by the local care team. Comparatively, qualitative data suggested that the ITH Lite was more maneuverable, particularly when moving from one location to another – for example, operating room to nursery.”

Correct positioning of the ITH Lite within the workspace was still important, however, to ensure the neonatologist could secure the necessary view of the neonate, she added.


“The focus of Mayo Clinic’s tele-neonatology program has always been the needs of our neonatal patients, whether they are located in Mayo Clinic Rochester or elsewhere in our region,” Fang said. “By leading with patient care and identifying unmet needs of patients or care teams, organizations can design telemedicine programs that are impactful, effective and highly utilized.”

When developing a tele-neonatology program, the multi-specialty team must consider many factors including service activation and workflow, staff education and training, team building and communication – and the telemedicine technology itself, she advised.

“Our recently published study (McCauley et al, Telemed and e-Health, 2019) focuses on one of these domains, the telemedicine technology,” she said. “We demonstrated that the ITH Lite improved audio quality and ability to connect on first attempt when compared with a wired telemedicine cart. Organizations should consider the reliability of connection, audio/video quality, and fit within the care environment when selecting a technology for their tele-neonatology program.”

In addition, proactive monitoring is broader than hardware and network monitoring, she cautioned. In this study, incidents were not only identified by vendor monitoring of the devices but also during care team and physician training, tele-neonatology simulation sessions, and physician on-call preparation activities.

“When developing a tele-neonatology program,” Fang concluded, “organizations should consider comprehensive support models for incident management and tracking.”





Is This My Home? A Palliative Care Journey Through Life and Death in the NICU


Abstract – A Case Report


With advancements in neonatology, patients in the neonatal intensive care unit (NICU) are living in the hospital with complex life-limiting illnesses until their first birthday or beyond. As palliative care (PC) becomes a standard of care in neonatology, a level IV NICU developed an interdisciplinary PC team with the mission to ease the physical, mental, and moral distress of the patients, families, and staff. This case report highlights the teamwork and long-term palliative care and ultimately end-of-life care that an infant received by this dedicated NICU palliative care team.

Clinical Findings: 

This case discusses a premature ex-27-week gestation male infant who initially presented to the emergency department at 5 months of age with significant tachypnea, increased work of breathing, and poor appetite.

Primary Diagnosis: 

The primary diagnosis was severe pulmonary vein stenosis resulting in severe pulmonary hypertension.


The severity of the infant’s pulmonary vein stenosis was incurable. He required substantial life-extending surgical procedures and daily intensive care interventions. In addition to his life-extending therapies, the infant and his family received palliative care support by the NICU PC team and the hospital-wide PC team (REACH team) throughout his admission. This was specialized care that focused on easing pain and suffering while also addressing any social/emotional needs in the infant, his family, and in the hospital staff. The PC teams also focused on protecting the families’ goals of care, memory making, and providing a positive end-of-life experience for the infant and his family. The infant’s end-of-life care involved providing adequate pain and symptom management, education, and communication to his family about the dying process and allowing unlimited family time before and after his death.


After 11 months in the NICU and despite aggressive therapies, he required more frequent trips to the cardiac catheterization laboratory for restenosis of his pulmonary veins. He was dependent on iNO to treat his pulmonary hypertension and he continued to require an ICU ventilator. His parents ultimately decided to pursue comfort care. He died peacefully in his mother’s arms.

Practice Recommendations: 

The American Academy of Pediatrics and the National Association of Neonatal Nurses both have statements recommending that palliative care be standard of care in NICUs. Establishing a NICU-dedicated interdisciplinary PC team can improve outcomes for infants and families living in the NICU with complex life-limiting illnesses.

Walters, Aurora RN, BSN, RNC-NIC; Grosse, Jordan RN, BSN, RNC-NIC

Editor(s): Fortney, Christine A. PhD, RN, Section Editor

Advances in Neonatal Care: April 2020 – Volume 20 – Issue 2 – p 127-135 – doi: 10.1097/ANC.0000000000000697




Rising Virginia Apgar (1909-1974)

If we neonatologists ever get a patron saint of our own, it will probably be Virginia Apgar. We are reminded of Dr. Apgar’s dedication, wisdom, wit, tenacity, and many contributions to infant care every time we are called to the delivery room to evaluate a baby. Dr. Apgar originally intended to become a surgeon, but to our great good fortune, ended up in anesthesia instead, where she soon turned her attention to the care of mothers and the assessment and resuscitation of newborns. Her elegant paper of 1952 established the scoring system that now bears her name, but she was also famous for her work in the March of Dimes, her love of cars and fast driving, and her construction of her owned stringed instruments — among other things.






Smiling with your eyes: Communication in a face-masked COVID-19 world

Health & WellbeingBy Rich Haridy – July 12, 2020

As the COVID-19 pandemic continues to transform the world, millions of people are suddenly wearing face masks. But for people used to relying on facial expressions to effectively communicate, how are masks changing the way we interact? And what can we do to compensate for losing that all-important smile?

In the late 1960s a psychologist named Albert Mehrabian co-authored two influential studies investigating how important the semantic meaning of words were in regards to how people communicate emotions. Mehrabian ultimately quantified his ideas into a specific ratio, occasionally referred to as the “7:38:55 rule.”

Mehrabian’s rule suggests three elements need to be effectively co-ordinated for the successful communication of feelings or emotion: words, vocal tone, and body language. Breaking down the effect of each of these elements, Mehrabian concluded only seven percent of communication is related to the actual meaning of a given word, while 38 percent relates to tone of voice, and 55 percent is body language (primarily facial).

Mehrabian’s findings have been debated, criticized and misinterpreted over the decades. Whether or not one agrees the efficacy of communication can be reduced to such specifically quantified ratios, the general observation arguably holds strong. Effective communication stems from a congruent combination of factors beyond the specific semantic meaning of words.

So how can we effectively communicate when millions of people are suddenly required to cover two-thirds of their face?

A bigger problem for North America

Stanford psychologist Jeanne Tsai has long studied the relationship between culture and communication. She says, some cultures around the world have more experience negotiating the complexities of communication while wearing facial coverings. East Asians, for example, have long incorporated protective mask wearing into public activities. North Americans, on the other hand, in particular will likely find it very difficult to quickly learn effective communication with masks, Tsai suggests.

“The mouth seems particularly important in the United States partly because mouths are a critical part of conveying big smiles, and for Americans, bigger smiles are better,” says Tsai. “Our work finds that North Americans judge people with bigger smiles to be more friendly and trustworthy. In fact, smiles have an even stronger influence on judgments of friendliness and trustworthiness than more structural facial features associated with race or sex.”

Taking away one’s ability to smile in public settings is challenging enough but it presents particularly unique challenges in cultural contexts with pre-existing racial disparities. In the United States, for example, African American men are already expressing anxiety over being perceived as threatening while wearing face masks. A video from March showing a police officer removing two black men from a Walmart for wearing surgical masks highlighted the unique problems faced by widespread mask wearing in the United States.

“At the very least, I think people will have to learn to smile with their eyes and voices, and to read the eyes and voices of others more,” Tsai suggests.

The Duchenne Smile

In the mid-19th century French scientist Guillaume Duchenne published an iconic book titled Mecanisme de la physionomie Humaine (The Mechanism of Human Facial Expression). Duchenne was fascinated by the relationship between communication and facial anatomy and part of his research focused on the anatomical differences between a real smile and an insincere smile.

He found a simple smile involves the contraction of the zygomatic major muscle. This muscle is basically all one needs to raise the corners of their mouth. However, a truly positive, genuine and exuberant smile also involves contracting the orbicularis oculi muscle.

The orbicularis oculi muscle surrounds the eye and is primarily involved in controlling blinking. However, it also plays a role in smiling by helping raise the cheeks and create a wrinkling around the eyes. At the time, Duchenne suggested this more holistic type of smile could not be faked, and only the “sweet emotions of the soul” could lead to contraction of the orbicularis oculi.

This type of holistic smile became known as the Duchenne Smile. And, although researchers have since discovered the Duchenne Smile can indeed be faked, not everyone can easily fake it, and an exaggerated Duchenne Smile can be an effective signal someone is lying.

Interestingly, researchers have found botulinum toxin, or botox, the neurotoxin used in beauty therapies to paralyze certain facial muscles and slow the development of wrinkles, can also prevent a person from effectively contracting the orbicularis oculi muscle. A 2018 study found botox therapy does prevent a person from performing a Duchenne Smile, which not only stifles their ability to effectively communicate positive emotion, but may even induce depression as forming a facial expression has been found to strengthen the internal embodied feeling of that emotion.

Face masks are not a novel experience for everyone

While many North Americans struggle with communicating effectively in a world of newly masked faces, perhaps the best advice moving forward comes from cultures that have already adapted to this kind of behavior. For many Muslim women around the world, facial coverings, called a niqab, are normal. And both wearers and non-wearers have developed techniques to maintain effective communication.

Samar Al Zayer, a psychologist currently working in Europe, grew up in Saudi Arabia and, although she never wore a niqab, she remembers how facial coverings changed how one interpreted different social cues. Speaking to the BBC, Al Zayer recalls how communication wasn’t necessarily more difficult when one party’s face was covered, but it certainly was profoundly different.

“I would be a bit more aware of their non-verbals, keeping more eye contact to understand how they were feeling, to try and pick up on some sort of emotion,” she says. “I would be more attentive to their tone and hand gestures as well.”

The onus needs to be on both parties to overcome the limitations of communicating while wearing face masks. For those wearing masks, experts recommend using more exaggerated gestures to compensate for the loss of half of one’s face. From expressive eyebrows to a simple thumbs-up, it is suggested people amplify other elements used in communication.

“Over-communicate – use more words than you normally would, and ask more questions, to make sure you’re correctly picking up on the other person’s emotions,” says Al Zayer. “Learn how to use your other senses and body language, too.”




Masks…. We have to wear them. Why? Because we are smart, caring, socially conscious and efficacious survivors.

Sometimes it’s a challenge….accessing a supply, accessorizing it for the appropriate time and place, keeping one on hand (I mean-face) at all times, and ahhhh flirting? Just kidding…..

We can make wearing a mask fun through individual expression, on-going education, and by cheering our friends and family to partake in mask attire in creative or just plain practical ways. We can choose to shop and frequent business that are invested in our well-being.

I do, despite the bickering  in my head, judge people’s actions when they are not wearing a mask in Public when it is required.  I feel like they are making a pretty strong statement, and not one that values me or others.

Let’s team up and do what we can to slow down this global pandemic. We know what it takes to survive. It takes the love and commitment of others and that is why we are here.


No surfing in CHAD


Climate change is a critical factor in Lake Chad crisis conflict trap -“Shoring Up Stability” report

aJul 15, 2019- ADELPHI

Lake Chad is caught in a conflict trap. It is experiencing one of the world’s worst humanitarian emergencies with an estimated 10.7 million people in need of assistance. Now a new G7 mandated report from the Berlin based think tank adelphi shows, for the first time, how climate change is interacting with the conflict to compound the crisis and sets out how these challenges might be overcome. DOWNLOAD the report here The report “Shoring Up Stability” shows that climate change and conflict dynamics create a feedback loop where climate change impacts seed additional pressures while conflict undermines communities’ abilities to cope.

Nature, Dancing and a Cuddle!



Preterm Birth Rates – Colombia

Rank: 114 –Rate: 8.8% Estimated # of preterm births per 100 live births (USA – 12 %)


Colombia, officially the Republic of Colombia  is a country largely in the north of South America, with territories in North America. Colombia is bounded on the north by the Caribbean Sea, the northwest by Panama, the south by Ecuador and Peru, the east by Venezuela, the southeast by Brazil, and the west by the Pacific Ocean. It comprises 32 departments and the Capital District of Bogotá, the country’s largest city. With an area of 1,141,748 square kilometers (440,831 square miles), Colombia is the fourth-largest country in South America, after Brazil, Argentina and Peru. It is also the 25th-largest country in the world, the fifth-largest country in Latin America, and the fourth-largest Spanish-speaking country.

The overall life expectancy in Colombia at birth is 74.8 years (71.2 years for males and 78.4 years for females). Healthcare reforms have led to massive improvements in the healthcare systems of the country, with health standards in Colombia improving very much since the 1980s. Although this new system has widened population coverage by the social and health security system from 21% (pre-1993) to 96% in 2012, health disparities persist.

Through health tourism, many people from over the world travel from their places of residence to other countries in search of medical treatment and the attractions in the countries visited. Colombia is projected as one of Latin America’s main destinations in terms of health tourism due to the quality of its health care professionals, a good number of institutions devoted to health, and an immense inventory of natural and architectural sites. Cities such as Bogotá, Cali, Medellín and Bucaramanga are the most visited in cardiology procedures, neurologydental treatmentsstem cell therapyENTophthalmology and joint replacements because of the quality of medical treatment.





Cuddling Preemies Kangaroo Style Helps Into Adulthood

By Maggie Fox -Dec. 12, 2016

Cuddling small and premature babies in a style known as “kangaroo mother care” helps them in life decades later, researchers reported Monday.

They found that babies held upright and close to bare skin and breastfed, instead of being left in incubators, grew up with fewer social problems. They were far less likely to die young.

It’s a reassuring finding for parents who may worry that tiny and premature babies are safer in an incubator than in their arms, the team wrote in their report, published in the journal Pediatrics.

Kangaroo mother care was first described in Colombia, and the team of experts there who first showed it was safe did a 20-year follow-up to see how the babies fared as they grew up. They tracked down 494 of the original 716 children who were born prematurely from 1993 to 1996 and randomly assigned to get either kangaroo mother care or standard handling.

“The effects of kangaroo mother care at one year on IQ and home environment were still present 20 years later in the most fragile individuals, and kangaroo mother care parents were more protective and nurturing,” Dr. Nathalie Charpak and colleagues at the Kangaroo Foundation in Bogota, Colombia, wrote in their report.

“At 20 years, the young ex-kangaroo mother care participants, especially in the poorest families, had less aggressive drive and were less impulsive and hyperactive. They exhibited less antisocial behavior, which might be associated with separation from the mother at birth,” they added.

“Kangaroo mother care may change the behavior of less well-educated mothers by increasing their sensitivity to the needs of their children, thus making them equivalent to mothers in more favorable environments.”

Twenty million babies are born at a low birth weight every year around the globe, the World Health Organization reports. The U.S. has one of the highest rates of pre-term and low-weight births — about one in 12 births, according to the March of Dimes.

It defines low birthweight as being when a baby is born weighing less than 5 pounds, 8 ounces.

Most of these small babies are premature and they are at high risk of dying, of developing cerebral palsy, or having learning disabilities, and they can grow up more prone to a range of diseases.

High-tech care can help, but WHO promotes the simpler, low-tech approach alongside modern medical care — or instead of it in some poor settings.

“Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. Its key features are: early, continuous and prolonged skin-to-skin contact between the mother and the baby; exclusive breastfeeding (ideally); it is initiated in hospital and can be continued at home; small babies can be discharged early; mothers at home require adequate support and follow-up,” WHO said.

“It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward with preterm infants.”

And it’s safe, WHO added. “Almost two decades of implementation and research have made it clear that kangaroo mother care is more than an alternative to incubator care.”

Charpak’s team found the babies randomly assigned to get this treatment were 39 percent more likely to live into adulthood. They had stayed in school longer and earned more as adults.

It didn’t work miracles. Children with cerebral palsy were equally likely to have symptoms whether they had the kangaroo care or not, and more than half the people in the entire group needed glasses. The children given standard care had higher math and language scores in school, while IQ levels were about the same in both groups.

But overall, the findings support the benefits of kangaroo mother care, the team concluded.

“Our long-term findings should support the decision to introduce kangaroo mother care to reduce medical and psychological disorders attributable to prematurity and low birth weight,” they wrote.

“We suggest that both biology and environment together might modulate a powerful developmental path for these children, impacting until adult age,” they added.

“We firmly believe that this is a powerful, efficient, scientifically based health intervention that can be used in all settings.”



Kat and I have danced Zumba for the past 13 years and are both certified instructors. Kat teaches several Zumba and Strong Nation (HITT) classes every week.  Zumba founders Alberto “Beto” Pérez (Colombian native), Alberto Perlman, and Alberto Aghion built a worldwide global health and fitness community (180 countries)  that we are grateful to be a part of.  Zumba in the streets? That’s what it’s all about! And our Neonatal Womb Community? We all need to do a little dancing. This pandemic has been challenging and we have a ways to go! Let’s move forward with curiosity, creativity, some crazy footwork and a focus on taking active care of ourselves and each other.

Colombia: Bogota Police help fight corona-virus isolation blues with dance classes

Apr 1, 2020

Colombian national police officers took to Bogota’s streets on Tuesday with loud speakers and dance tunes to encourage citizens to get some exercise and help them get through self-isolation with high spirits. “We are working at the moment on the idea of prevention to help people in everything that relates to tranquility in terms of their spiritual, physical and mental control in relation to the entire quarantine due to COVID-19,” said national police colonel Doris Manosalva. Footage shows police officers coordinating the dance operation before heading out to the streets to dance, calling on people to join them as well as reminding everybody the importance of staying inside. Police officers go to a different area of the city every day to reach as many citizens as possible.


How California Became The Only State To Lower Its Infant Mortality Rate

Here’s how they’re saving the lives of more premature babies.

By Anna Almendrala08/08/2018

California was the only state to significantly reduce the rate of stillbirths and newborn deaths from 2014 to 2016.

In 2014, Dr. Elizabeth Rogers and her colleagues at the UCSF Benioff Children’s Hospital in San Francisco noticed a disturbing trend among the tiniest preemies in their neonatal intensive care unit: a high rate of brain bleeds among these babies born before 28 weeks’ gestation.

Rogers wondered if other NICUs had seen an increase as well or if there was something about her patient population that put them at particular risk.

Intracranial hemorrhages, caused by the rupture of immature blood vessels in the brain, are a major cause of death in very preterm babies, as well as a complication linked to developmental delays and cognitive deficits later in life. Driving down the rate of such complications is one way that hospitals can help reduce the number of early infant deaths.

Compared to other rich countries, the U.S. has unacceptably high rates of perinatal deaths, a category that covers stillbirths and deaths within the first week of life. And the most recent data suggest those numbers are not improving ― except in California. That state was the only one to see a decrease in perinatal deaths from 2014 to 2016, according to a report published Wednesday by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

The reason for California’s success may be a statewide data project that has been gathering information from hospitals for the past two decades. In any other state, Rogers and her colleagues would have struggled to find an answer to her initial question about the prevalence of brain bleeds. But because they were in California, Rogers was able to log into a data dashboard created by the California Perinatal Quality Care Collaborative. The easy-to-use clearinghouse of real-time information from more than 90 percent of California hospitals that treat babies in NICUs let her compare her unit’s outcomes to those at similar units.

What she found shocked her. UCSF was seeing brain bleeds in more than 15 percent of NICU babies, or nearly four times the rate at comparable hospitals of the same size and expertise.

“I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem,’” said Rogers, who is director of the hospital’s intensive-care small-baby program.

Armed with that information, she persuaded hospital administrators to allocate resources to the issue; gathered a group of doctors, nurses, therapists, technicians, janitors and parents to consider what steps to take; and produced a training manual for staffers.

I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem.’ Dr. Elizabeth Rogers

It isn’t clear what causes brain bleeds in premature babies, so Rogers’ group tackled the issue in multiple ways. Starting in 2014, women who went into labor preterm received a shot of steroids to strengthen their babies’ brains. Immediately after birth, the clamping of a preemie’s umbilical cord was delayed 45 seconds, which is known to decrease brain bleeds.

Everyone who interacted with the babies, from X-ray techs to sanitary workers, received training on how to create a calm environment, which included intervening as little as possible and using low voices if they had to speak.

In about three years, UCSF reduced the rate of brain bleeds to 3.8 percent, just a quarter of what it had been and on par with comparable hospitals in the state. This decrease set off a cascade of other positive outcomes. Deaths in the NICU were cut almost in half, dropping from 11.9 percent to 6.8 percent over that time period. Rates of necrotizing enterocolitis ― another common complication among premature babies ― went down as well, which Rogers attributed to the hospital’s increased attention to their littlest patients.

The speed at which Rogers and her team implemented research-based change was remarkable and unusual. It takes an average of 17 years for research data to alter standard medical practice, in part because of entrenched hospital bureaucracies that favor tradition, a systemic reluctance to spend money on monitoring and prevention, and medical staff who may feel competitive and territorial.

Without the initial comparative data, Rogers is convinced she wouldn’t have been able to revamp her NICU’s systems so fast and the rates of hemorrhage would have remained high.

Hospitals in general need to become better at rapidly adjusting and refining their care when it’s lacking or when new research points to a better way of doing things, Rogers argues.

Across the rest of the country, rates of stillbirths and deaths within a week after birth remain at a standstill. In one state, Missouri, the rate has actually gone up since 2014. California has the third-lowest rate, following Washington state and Wyoming.

“To see the results … is a huge reward,” said Rogers. “It’s a huge validation that all of this effort is worth it.”

They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors. Dr. Jeffrey Gould, co-founder of the California Perinatal Quality Care Collaborative

While the larger issue of American infant mortality is now more widely recognized, it wasn’t in the public consciousness 21 years ago when Dr. Jeffrey Gould, then a researcher with the University of California, Berkeley, began to compile a single statewide database of numbers on newborn deaths and complications, paid for by the state.

The project grew as Gould convinced neonatologists, hospitals, insurance payers, public health experts and state agencies that it was in everyone’s interest to share NICU data in real time. With its wealth of information, the California Perinatal Quality Care Collaborative also develops best practice standards and toolkits to help hospitals implement those practices. It periodically launches initiatives aimed at improving care in one particular area, such as breastfeeding in the NICU, using antibiotics and reuniting these vulnerable newborns with their families.

The model of the California Perinatal Quality Care Collaborative has spread across the country, albeit only in recent years. Most states now have some kind of perinatal quality collaborative, but they aren’t created or funded equally. Because California was the first, none of the other state collaboratives has as much data or experience. And though some of them provide education on better practices, they don’t seek to help hospitals implement specific changes ― an aspect of California’s collaborative that makes membership so worthwhile. This means the gains California has seen are not guaranteed in other parts of the country.

Gould, now a professor of neonatal and developmental medicine at Stanford, is especially frustrated that hospitals still hesitate to invest real money in trying to improve the quality of care.

“One of the big drawbacks in this country is that quality improvement is not really seen by hospital administrators as a line item kind of thing,” Gould said. “They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors.”

The annual cost of membership in the California Perinatal Quality Care Collaborative is $13,000 to $15,000, depending on the size of the hospital, and it gives them access to the data dashboard. Participation in each individual initiative is optional and costs an additional fee ― around $8,500 per hospital ― to defray the additional costs for data collection, training and network access.

Meanwhile, the average daily cost of one baby’s care in a NICU is more than $3,000.

More data may ultimately ease this problem too, Rogers said. Besides helping doctors make the case to administrators for more resources for the NICU, as she did, better information leads to more effective and efficient care, which can lead to cost savings.

When a state does decide to invest in improving outcomes for preemies, hospitals may not know where to start. Gould’s suggestion: Use the data to find the low-hanging fruit, and then build on those first successes.

That’s exactly what Rogers is doing. The doctor is now turning her attention to necrotizing enterocolitis, a bacterial infection in the gut that can destroy intestinal walls. As brain bleeds have continued to decrease, necrotizing enterocolitis has become the biggest contributor to preemie deaths in her unit.

Again, armed with data, Rogers convinced the hospital to free up some funding for her unit to take part in the California Perinatal Quality Care Collaborative’s current effort to improve nutrition in NICUs. For premature babies, this boils down to hospital policies that encourage and assist mothers to pump breast milk soon after the baby’s birth ― a difficult task for women who have just experienced a stressful and unexpected early delivery.

Because formula feeding is one of the only consistent risk factors for necrotizing enterocolitis, breast milk ― especially milk produced by the baby’s mother ― decreases the odds that a premature baby will develop the infection. It’s so good for NICU patients, Rogers said, that doctors look at it more like medicine than food.




Brazil changes maternity leave for mothers of premature babies – a step to a fairer and more humane scenario of the labour market for all women 

Brazil (2019): The maternity leave for mothers of premature babies is extended. Last month Brazil’s Supreme Federal Tribunal decided to prolong the period of maternity leave for mothers of premature infants. We talked to Denise Leao Suguitani, founder and executive director  of GLANCE partner parent organisation Brazilian Parents of Preemies’ Association (, member of the GLANCE advisory board, about this important adjustment in Brazilian law.

  1. Ms Suguitani, Brazil took another big step to strengthening maternal rights. What brought this change to come?

We, the organized civil society, were finally able to raise awareness for the Brazilian Governments about the challenges prematurity brings along. It seems they have understood the essentiality of protecting motherhood and childhood, especially for more delicate babies like the premature ones. Although the decision is valid only for mothers working on a formal contract, it is a huge step towards a fairer and more humane scenario of the labour market for all women.

  1. Ms Suguitani, your parent organisation spoke to the lawyers who placed the injunction that was eventually approved. What changes for mothers of premature babies in Brazil from now on?

Women in the workforce in Brazil have 120 days of standard maternity leave, which begins on the day of the delivery. From now on, mothers of premature babies can require a new beginning of maternity leave, if their baby needs to be in the hospital for more than two weeks. Once the baby is discharged, the maternity leave with its 120 days starts anew – regardless of how long the baby had to stay in hospital.

  1. The initial decision of Minister Fachin was valid until the Brazilian Federal Supreme Court plenary confirmed the new law, on April 3rd. How do you assess that victory in the Court?

We were really optimistic that the injunction would not be overturned since we have been working for the approval of this law for over 5 years now, dialoguing with politicians and decision makers. It is such a great achievement for the cause of prematurity in our country and a big step for our society.

Ms Suguitani, thank you so much for taking the time to speak with us.




Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the USA Systematic Review

Bruce Bekkar, MD1Susan Pacheco, MD2Rupa Basu, PhD3,4; et alNathaniel DeNicola, MD, MSHP5 – June 18, 2020

Key Points:

Question  Are increases in air pollutant or heat exposure related to climate change associated with adverse pregnancy outcomes, such as preterm birth, low birth weight, and stillbirth, in the US?

Findings  In this systematic review of 57 of 68 studies including a total of 32 798 152 births, there was a statistically significant association between heat, ozone, or fine particulate matter and adverse pregnancy outcomes. Heterogeneous studies from across the US revealed positive findings in each analysis of exposure and outcome.

Meaning  The findings suggest that exacerbation of air pollution and heat exposure related to climate change may be significantly associated with risk to pregnancy outcomes in the US.


Importance  Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country.

Objective  To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth.

Findings  Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The sub-populations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality.

Conclusions and Relevance  This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.


The current climate crisis, also known as climate change or global warming, has been widely recognized as an environmental emergency that threatens many critical resources and protections including sustainable food and water supplies, natural disaster preparedness, and US national security. However, as the World Health Organization and The Lancet Countdown have identified, one of the greatest consequences of climate change is its association with human health.

Specific to women’s health, the American College of Obstetricians and Gynecologists position statement recognizes that “climate change is an urgent women’s health concern as well as a major public health challenge.” The associations of climate change with women’s health have been further outlined to include a wide range of undesirable outcomes, such as worsening of cardiac disease, respiratory disease, and mental health, and exposure to an increasing number of infectious diseases.

These adverse health effects are most consequential to at-risk populations, which include a high number of pregnant women and developing fetuses. The obstetrical literature has included numerous observational studies demonstrating an association between air pollution and heat and increased risk of adverse birth outcomes. Two components of air pollution that are exacerbated by climate change and continued use of fossil fuels are fine particulate matter less than 2.5 μm in diameter (PM2.5) and ozone.

In this review, we assessed the associations between exposure to PM, ozone, and heat and preterm birth, low birth weight, and stillbirth. Although these associations have largely been studied in a global setting, we focused specifically on the US population, in which these exposures are increasingly common.


Scope of Review

For this systematic review, we evaluated evidence of the association between air pollution and heat on the adverse obstetrical outcomes of preterm birth, low birth weight, and stillbirth. The Arskey O’Malley methodologic framework for a scoping review was used.18,19 This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Research Questions

The following specific key questions were addressed in this review. Is prenatal exposure to PM2.5 or ozone associated with increased risk of preterm birth? Is prenatal exposure to PM2.5 or ozone associated with increased risk of low birth weight? Is prenatal exposure to PM2.5 or ozone associated with increased risk of stillbirth? Is prenatal exposure to heat associated with increased risk of preterm birth? Is prenatal exposure to heat associated with increased risk of low birth weight? Is prenatal exposure to heat associated with increased risk of stillbirth?


Studies across diverse US populations were identified that reported an association of PM2.5, ozone, and heat exposure with the adverse obstetrical outcomes of preterm birth, low birth weight at term, and stillbirth. More than 32 million births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. In each analysis of climate change–related exposure and adverse obstetrical outcome, most of the studies found a statistically significant increased risk (Table). The highest number of studies were found for risk of preterm birth (29 studies) and low birth weight (32 studies), whereas limited studies were identified for stillbirth (7 studies) because of the lack of available data for health studies.

Our review contributes the largest number of recent studies (2007-2019) focusing solely on US populations and is the first, to our knowledge, to combine the increasingly common exposures of air pollutants and heat associated with a series of adverse obstetrical outcomes. Our findings are consistent with other review articles that were not included in our analysis (all included non-US participants). Reviews that examined PM2.5 found consistently positive association with preterm birth and low birth weight or continuous birth weight, and 1 systematic review and meta-analysis on stillbirth risk showed elevated effect estimates for both PM2.5 and ozone, although they did not achieve significance. Five reviews that focused on heat exposure found an association with preterm birth in most studies, as did 4 that analyzed low birth weight and 2 analyzing stillbirth risk.

The adverse obstetrical outcomes examined in this study are known to be complex, heterogeneous, and multifactorial in origin; several animal studies suggested that both air pollutant and heat exposure may contribute to adverse obstetrical outcomes. Regarding preterm birth, mechanisms that implicate toxic fine particulates include maternal hematologic transport of inhaled noxious chemicals, the triggering of systemic inflammation, or alterations in function of the autonomic nervous system. Low birth weight may be associated with air pollutants by direct toxic effects from fetal exposure, altered maternal cardiac or pulmonary function, systemic inflammation from oxidative stress, placental inflammation, altered placental gene expression, or changes in blood viscosity; multiple effects may operate simultaneously. Mechanisms for the association of air pollutants with stillbirth may involve alterations in oxygen transport, DNA damage, or placental injury. The cause-specific analysis by Ebisu et al of stillbirths reinforces the apparent association of injury to the fetal-placental unit with air pollutant exposure compared with other possible causes.

Heat exposure may contribute to prematurity through labor instigation from dehydration (via prostaglandin or oxytocin release), from altered blood viscosity, and/or by leading to inefficient thermoregulation; it may also trigger preterm premature rupture of membranes and thus preterm birth during the warm season. Likewise, heat exposure may impair fetal growth by reducing uterine blood flow and altering placental-fetal exchange. Mechanisms associated with elevated temperatures and stillbirth include the initiation of premature labor (as noted above), lowering amniotic fluid volume, damaging the placenta, or causing abruption.

Biologic plausibility is further supported by other recent studies not included in this review. The study by Casey et al of preterm birth rates in California before and after coal power plant closures showed a 27% reduction during the 10-year period after closure. Currie et al found that among 1.1 million live births in Pennsylvania, the risk of low birth weight was higher within 3 km of a fracking site compared with the background risk and increased by 25% within 1 km of a site.

This review revealed a disproportionate effect on populations defined as pregnant women with certain medical conditions or specific race/ethnicities. Women with asthma may be particularly susceptible to adverse outcomes, such as preterm birth and stillbirth, in association with PM2.5 exposure during gestation. Among racial/ethnic groups, our findings suggest that black mothers are at greater risk for preterm birth and low birth weight. Social determinants of health, including residence in urban areas with higher exposure to air pollutants and long-term high levels of stress, are known to contribute to adverse obstetrical outcomes. A recent study from California suggested that PM2.5 exposure alone was associated with an equivalent amount of the racial disparity (black vs white) in preterm birth rates as did other demographic and social factors. Our research suggests that these environmental exposures further exacerbate that background risk and could be included among these social determinants.

Regarding both air pollutant and heat exposure, associations with adverse birth outcomes were found across the continental US. For example, studies on air pollution and low birth weight found an association in 19 states in the Northeast (10), Southeast (5), Midwest (2), Mountain (1), and West (1) regions. California, known for both high temperatures and unhealthy particulate and ozone levels, was included in the greatest number of studies showing a positive association (13), followed by Massachusetts (6), Georgia (5), and Florida (4). The exposures are complex; even within 1 state, the weather patterns, geography, and urbanization may create zones with widely different pollution risks, as shown by Tu et al in Georgia.

Future research is needed to further identify at-risk populations, high-exposure geographic areas, and effects of seasonality. This ongoing research may be enhanced by improved geographic information systems that can be mapped onto existing US public health data-banks such.


This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US. It appears that the medical community at large and women’s health clinicians in particular should take note of the emerging data and become facile in both communicating these risks with patients and integrating them into plans for care. Moreover, physicians can adopt a more active role as patient advocates to educate elected officials entrusted with public policy and insist on effective action to stop the climate crisis.



Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep

Fulmer, Megan BSN, RN-NIC; Zachritz, Whitney MSN, CPNP-BC, RN; Posencheg, Michael A. MD

Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC, Section Editor

Advances in Neonatal Care: June 2020 – Volume 20 – Issue 3 – p 229-232



Although the incidence of sudden unexplained infant deaths has decreased over time with the use of safe sleep practices, one area that remains unclear is the safety of hats during infant sleep.


Decrease the risk of overheating or suffocation by removing NICU infants’ hats during sleep without increasing the relative risk of hypothermia during transition to an open crib.


Removal of hats for routine thermoregulation, beyond the initial infant resuscitation and stabilization of NICU infant was implemented in 2015. Retrospective chart audits were conducted on all NICU infants between February 2015 and December 2016. Hypothermia (≤ 97.6°F) data during transition to an open crib was collected. Exclusion criteria included concurrent diagnosis of: sepsis, hyperbilirubinemia, congenital anomaly inhibiting infants thermoregulation and noncompliance with unit guideline for weaning infant to open crib.


Over 18 months, 2.7% of infants became hypothermic (≤ 97.6°F) during transition to open crib, requiring return to isolettes.

Implications for Practice: 

Hats were found to be unnecessary in maintaining thermoneutrality after weaning infants to an open crib in our NICU. By avoiding the use of hats in an open crib, it’s possible infants will avoid overheating and a risk of suffocation, creating a safer sleep environment.

Implications for Research: 

The removal of hats during sleep to promote infant health should be considered for all infants.



Premature Baby Makes Full Recovery After Experimental Coronavirus Treatment | NBC News NOW

newsJun 22, 2020

Born premature at just 27 weeks, one baby is finally on his way home after battling both sepsis and COVID-19. NBC News’ Helena Humphrey spoke with the baby’s mother about his 47-day battle.



Preemie Parent Perspective: Addressing Health Equity and Cultural Competency in the NICU

Jenné Johns, MPH

In 2016, I published Once Upon A Preemie, a first- of its kind children’s book written to comfort parents of premature infants during their journey through the Neonatal Intensive Care Unit (NICU). During my journey, I discovered that reading to my micropreemie was the one activity as a mother that I could offer my son that helped normalize my overwhelming and traumatic NICU experience. During our nearly three-month stay in the NICU, I read to my son every day as research studies suggest that reading stimulates healthy brain development in preemies, and also helps to form a bond between parent and baby. Many of the bedtime stories that we read ended with a parent tucking the child into bed at home with Mommy and Daddy. That wasn’t our reality for three months. There were no books about us. Little did I know that in publishing my deepest emotions carried during and post NICU would lead me to become an author and speaker, but also an advocate and advisor for the needs of preemie parents, especially African Americans. As the mother of a micro-preemie and miracle baby born at 26 weeks and weighing 1 lb 15.3 ounces, I found myself advocating for his needs as I knew his life depended on it. Despite my 10-year career working to eliminate racial and ethnic disparities in health care, nothing prepared me for the heart-wrenching experience of my son’s premature birth. “Disparity” became real for me as my son joined the ranks of the nearly 500,000 premature babies born in the United States, nearly half to African American and Hispanic mothers. It was through this dual role that I experienced the NICU, one as a vulnerable micro-preemie mother, and the other as a health equity professional.

At birth, my son required life-saving medical interventions; oxygen, photo-therapy lights, feeding tubes, a heart monitor, medication, vitamins, and even caffeine. Over our nearly three-month stay in the NICU, I traveled through snowstorms and blizzards, to parent and nurture my baby. I only missed three days (two due to inclement weather and one self-care day). A typical day in the NICU lasted from 7 am until midnight, with many breaks to pump breast milk. My lactation consultant promised that my breast milk was liquid medicine. Midway through our NICU journey, I had to return to work, unlike many of my new NICU parent friends who were Caucasian. My advocacy skills were tested daily, as his life depended on how well I could speak “neonatology” language, I had to be his voice and articulate his needs. This was challenging because, after all, “I’m just a Mom,” an African American Mom, and not a doctor.

As a mother, my NICU journey was traumatic and filled with a sea of emotions, including fear, anxiety, helplessness, and isolation. Much of which NICU parents are facing due to the current COVID-19 pandemic. Many of my fears, concerns, and feelings of isolation were due to the NICU environment, which was not as culturally friendly and supportive, as I assumed it would be. I’m being generous by saying there was little cultural diversity; it was dismal at best. There were times when the lack of cultural sensitivity and bedside manner caused more pain than my son’s actual health status, and it made me very uncomfortable because as the end of each night, I had to trust my most prized possession with nurses and doctors who I did not always trust. Another challenge I faced as an African American preemie parent, was that although our larger hospital system had active and robust NICU parent support groups, these resources were not made available at the smaller hospital where I delivered my son. This hospital served more African American and lower-income families than the other hospitals. Many of the parents I developed a relationship with, felt as if our socio and emotional needs did not matter and were oftentimes dismissed because of this missing resource.

Lastly, I experienced inconsistent positive communication and relationships with many of the NICU staff. Although I now believe that all of the members of my son’s care team, held his safety and the quality of care they delivered to him with the utmost regard, our daily communication and interaction lacked humility, respect, and sensitivity. I will admit, I was not always the easiest or most cheerful mother to deal with, I now believe, that with trauma-informed and implicit bias training among hospital staff, the professional staff would have been better equipped to communicate and support my delicate and fragile nature.

Overall, a good deal of our NICU experience was positive; some experiences left permanent and negative memories that, to this day, cannot be erased. As much as I tried checking my professional credentials at the door before entering the NICU, my interactions with the NICU staff begged, yelled, and warranted us to have those tough cultural sensitivity conversations. Not in a negative way, but as an opportunity for forming better communication, respect, and, most importantly, trust. In my professional view, the NICU is a microcosm of the larger hospital system on steroids, particularly NICU’s serving low income and racially, ethnically, and linguistically diverse populations. Health disparities impacting the NICU are also a reflection of a larger hospital ecosystem. Below are my preemie parent and professional recommendations for integrating health equity and cultural competency in the NICU:

1. Prioritize health equity and cultural competency as strategic priorities and goals. Establishing opportunities for integrating and addressing health equity in short and long terms strategies ensures layers of accountability, allocation of funding, measurement, and documentation of outcomes. One example of an important health equity priority includes staff diversity. Peer-reviewed studies have shown that cultural congruence among patients and providers yields better health outcomes, better communication, and trust.

2.Make health equity, cultural competency, and implicit bias training mandatory for all NICU Staff. Participating in an annual training program is a great start to begin addressing and delivering equitable care to all NICU families. However, one-time training is not sufficient. Integrating health equity and implicit bias content into clinical rounds, staff development, and training opportunities are critical to reducing racial and ethnic disparities in the NICU.

3.Communicating in lay terms should be standard in every NICU. Literacy and health literacy levels are important considerations for family-centered and culturally appropriate care in the NICU. Regardless of one’s educational level, the NICU terminology is overwhelming and confusing for a new parent entering the NICU. Literacy and health literacy considerations are also important factors for families who are limited or non-English speaking. Break the communication barriers by speaking the same language and utilizing interpreters even if everyone speaks English. I had a great deal of respect and appreciation for the NICU staff who used lay terms and avoided NICU jargon when communicating with me. In time, I began understanding the NICU language; however, that wasn’t my job as a preemie parent. Preemie parents should be made to feel as comfortable speaking and interacting with NICU staff regardless of their literacy and health literacy levels.

4.Partner with parents to address the cultural competency, spiritual diversity, and unconscious biases that exist in the NICU. Listen to the voices of parents with multicultural backgrounds to be more sensitive to racial, ethnic, language, income, education, transportation, and spiritual needs. Encourage preemie parents to speak up. Staff should value their input. Allow parents to give their insights on their baby’s health status, and any gut feelings they may have about a diagnosis or new development. This is extremely important for minority parents who assume their voice and parental role is undervalued.

5.Engage and establish culturally congruent NICU family supports. Many minority parents may not immediately express a need for mental or emotional help while in the NICU for fear of being labeled. Where and when possible, make culturally congruent resources available to support these parents, even if the supports are outside of the NICU.

6.Make digital technology and virtual solutions available to parents with transportation, competing work schedules, or other barriers to delivering care to their preemies. This is most critical during the current COVID season, where parental fears and social distancing may prohibit them from visiting their baby. Creating safe opportunities for parents to connect with their babies is vital bonding via smart devices or other safe technology solutions.



Coastal Sunrise Father dances on TikTok for his son in NICU

3waveWSAV3 – Feb 5, 2020




Using Neonatal Intensive Care Units More Wisely for At-Risk Newborns and Their Families

DeWayne M. Pursley, MD, MPH1,2John A. F. Zupancic, MD, ScD1,2   June 18, 2020

Escalating US health care expenditures, including estimates that 20% to almost 50% of these costs involve processes, products, and services that do not improve outcomes, have brought renewed attention to the need to improve value in health care.1 Among the 6 waste categories outlined by Berwick and Hackbarth, there has been considerable focus on opportunities to reduce overtreatment, “the waste that comes from subjecting patients to care that… cannot possibly help them… rooted in outmoded habits, supply-driven behaviors, and ignoring science.”

Neonatal intensive care unit (NICU) services are at particularly high risk of overuse. Hospital and professional services reimbursements, reflecting the acute and highly technical nature of intensive care, are favorable and remain closely linked to admission volume and patient days in most regions. Both a legacy of intervention and a fear of litigation in caring for an at-risk population can also contribute to ineffective testing and treatments. The neonatology community is, however, starting to recognize the potential for improving care and controlling resource utilization. A 2015 study describing a systematic process to identify ineffective or harmful neonatal tests and treatments yielded a “Choosing Wisely Top Five” list in part to guide these efforts. In recent years, the neonatal care value literature has evolved to also focus more broadly on trends relating to NICU utilization—specifically, increasing admission rates and longer lengths of stay.

In the study by Braun et al,3 investigators from Kaiser Permanente share a population-based study describing a decline in NICU utilization—both admission rates and patient days—during a 9-year period. This is an important study, as it describes a trend that is counter to several recent reports of unexplained increasing NICU utilization, particularly for more mature and higher birth-weight infants, using a clinical rather than administrative data set. It is also important because the results may have been associated with several intercurrent performance improvement initiatives. Kaiser Permanente is a large, integrated health care system with a diverse population and a population-based financial payment structure and is in many ways uniquely suited (and motivated) to undertake a project to identify and characterize potential approaches to safely reduce neonatal care that is costly, may be ineffective, separates families, and is potentially harmful. The authors used a risk-adjustment model to ensure that the improvements were associated with postnatal care practices and not with changes in case mix reflecting patients less in need of acute neonatal care. They were also careful to include balancing measures, such as readmission and mortality, among the outcomes. Also important is the residual practice variation, which may hint at future opportunities for reduction in NICU utilization.

In the study by Braun et al, 12% of more than 300 000 liveborn infants were admitted to the NICU. Contrary to public perceptions of NICUs as prematurity colonies, more than two-thirds of these admissions were infants born after 34 weeks gestational age with birth weights more than 2000 g. The risk-adjusted NICU admission rate, accounting for socioeconomic, prenatal, and delivery room variables to control for independent factors that might affect admission or length of stay, decreased 25% over the study period to 10.9% of births, with 92% of the decline represented by infants with greater gestational age and higher birth weights. Importantly, these changes occurred without evidence of higher 30-day readmission or mortality rates.

There are compelling reasons that these results might not have been a random occurrence, as the health care system’s clinical leadership had implemented several concurrent performance improvement initiatives associated with decreased NICU admissions. A revised policy raised the threshold for NICU admission by lowering the gestational age (<35 weeks) and birth weight (<2000 g) for which well-appearing preterm infants were routinely admitted. A decision support tool based on individual infant estimates of early onset sepsis risk was introduced to guide laboratory testing and empirical antibiotic treatment. Finally, obstetric policies to decrease the rate of nonmedically indicated deliveries before 39 weeks of gestation and to reduce nonmedically indicated nulliparous, term, singleton, and vertex cesarean births were introduced.

The findings by Braun et al3 stand in contrast to a national trend documented in a 2015 population-based study. In that study using a public data set, birth-weight–specific NICU admission rates of US neonates were examined over a 6-year period (2007-2012). During this time, despite adjustment for maternal and neonatal characteristics, NICU admissions increased by 23%. These increases were generally represented by larger and less premature infants, such that by the end of the study period, most NICU admissions were for infants with birth weight more than 2500 g.

Although not population-based, observations by NICU member collaboratives, such as the California Perinatal Quality Care Collaborative and the Vermont-Oxford Network, have documented substantial variations in NICU admission and length-of-stay profiles. One California Perinatal Quality Care Collaborative study from 2018 observed that 79% of NICU admissions in 2015 were among infants born at or after 34 weeks gestation, while 10% of infants with 34 or more weeks gestation were admitted to the NICU. Schulman et al5 documented a 40-fold variation among member hospitals in the proportion of NICU admissions meeting high acuity definitions. In a Vermont-Oxford Network6 study involving approximately 500 000 infants hospitalized for nearly 10 million days in 381 NICUs from 2014 to 2016, 74% of NICU admissions were infants at 34 or more weeks gestation and only 15% of admissions met high acuity criteria. The proportion of admissions, patient days, high acuity, and short stays varied significantly both within and between different NICU types.

The origins of NICUs go back a half century, and NICUs have contributed substantially to reductions in US infant mortality during this time, a period during which rates of prematurity and low birth weight have actually increased. In 1967, the infant mortality rate was 22.4 per 1000 live births.  Fifty years later, in 2017, the rate had declined to 5.8 per 1000 live births, a remarkable 74% reduction. Neonatal intensive care is highly effective and has achieved these outcomes and corresponding reductions in morbidity by mitigating the effects of prematurity, congenital anomalies, and pregnancy and perinatal complications. In the early days, NICUs were in short supply and public health entities mobilized to develop regionalized perinatal systems to ensure that obstetric and neonatal patients at high risk had access to specialized services when indicated. As the neonatology workforce and NICU bed capacity increased, hospitals and hospital systems, seeking to become full-service systems, contributed to deregionalization, and there was increasing reliance on economic forces to regulate growth and distribution. In some areas, infants at high risk were distributed more broadly, including to smaller, lower-level units, resulting in less favorable outcomes. Because NICUs are high-margin services, there are significant pressures to expand capacity and maintain volume. This can lead to overuse, including more frequent admission of infants at low risk or a failure to focus sufficiently on care practices that could potentially reduce demand.

There is a cost to these practices. Although NICUs are effective, they are also expensive. Health care system costs are largely borne by government and business, and unwarranted increases may potentially compromise funding of other essential services. Importantly, there may be hidden financial harms for families as well, including costs associated with transportation or lost work days. There are also risks. Short NICU stays by infants at low risk may interfere with breastfeeding, expose them to infection, or increase antibiotic exposure. Additionally, family-infant separation may contribute to emotional risk.

It is not clear that increases in short term, low acuity, and high gestational age and birth-weight NICU admissions have benefited these infants and their families. In fact, the study by Braun et al suggests that it may be possible to reverse these trends without compromising and even potentially enhancing care. Rigorous adoption of evidence-based clinical practices, such as use of early onset sepsis decision support and obstetric policies to reduce non-medically indicated early deliveries and low-risk cesarean delivery rates is a start. There is also a need to examine the opportunities demonstrated by the enormous variation in NICU utilization and in specific NICU practices. These include gestational age thresholds for NICU admission; preferred sites of clinical evaluation, intravenous placement, and antibiotic administration for well-appearing infants with sepsis risk; preferred sites for monitoring and treatment and guidance for length of treatment for opiate withdrawal; and duration of apnea monitoring of preterm infants nearing discharge.

Neonatal intensive care is one of the major achievements of the last half century, and it has resulted in substantial reductions in mortality and long-term morbidity that benefit infants at high risk, including those born to mothers at substantial social risk. If the neonatology community is to successfully achieve the Triple Aim goal for neonatal intensive care—improved neonatal health, better family experience, and reduced cost—we must intensify efforts to learn how to use NICUs more wisely.

Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.5693

Corresponding Author: DeWayne M. Pursley, MD, MPH, Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (



Why The Trauma Parents Experience In The NICU Follows Them Home


Parents who’ve spent time in the neonatal intensive care unit (NICU) carry anxiety with them even after their baby is released.

The NICU’s constant barrage of doctors and beeping monitors is traumatic — and that trauma lingers.

Kepley Wakefield approaches life with typical 13-month-old vigor. A lot of smiling, excellent crawling acceleration and a fair amount of shrieking.

Her parents Courtney and Hollis Wakefield cherish her. They were by her side for each of the 95 days Kepley spent in the NICU.

“I had some bleeding at 21 weeks. So at that point, they put me on bed rest and we were having really difficult conversations,” Hollis said. “Viability is considered 24, so we had like two-and-a-half or three weeks to get through — which was a really, really scary time.”

Giving Birth At 24 Weeks

Hollis knew her pregnancy was going to be high risk. She was a 39-year-old cervical cancer survivor, so she and her wife had a plan for early labor. Even they weren’t prepared for delivery at 24 weeks, five days. But that’s when Kepley arrived, at 1 lb 10 ounces. The NICU team braced the Dallas couple for a long and frustrating road.

“They told us it would be like a roller coaster,” Hollis said. “They were like it’s going to be, you know, minute-to-minute some days. It’s not a straight line at all.”

Kepley started out in the NICU at UT-Southwestern’s Clements University Hospital, but eventually moved to the higher level NICU just down the road at Children’s Medical Center in Dallas. She was on a ventilator for three months.

When she was discharged, she still was tiny not even five pounds. She still needed supplementary oxygen and had weekly doctors appointments. Courtney says the stress from the NICU followed them home.

“I’m anxious all the time,” she said. “I have said, I have not been myself since Kepley was born.”

At-Home Risks

Because Kepley was born so early, her lungs weren’t fully developed. And because a ventilator helped her breathe for so long, those tiny lungs were also damaged. So even though Kepley is now thriving, flu season is a real threat. Her parents second guess every public outing, even quick trips to the store.

“And you’re thinking, do we risk it? Are we both going to be home where one of us could stay home?” Courtney said. “Just kind having to deal with that, even just for day-to-day tasks that we might normally bring a baby to. We’re having to kind of think twice.”

That’s not an overreaction. Doctors say catching a respiratory virus like RSV or the flu might put a premature baby right back in the hospital, which could re-traumatize those parents who’ve already spent time in the NICU.

Dr. Rashmin Savani is the chief of neonatal medicine at Children’s Health and UT Southwestern. He says even just the noise of endlessly beeping NICU monitors can overwhelm parents.

“The medical team and the nursing team they’re phenomenal, they understand what all these beeps are and when to respond, when to not respond.” Savani said. “But the family is bombarded with this sort of cacophony of alarms that are all designed to say ‘hey, pay attention to me.’ But for the family, it’s really scary.”

Children’s Health has a support crew in place to handle everything but the medicine. Every family has access to a team that includes a social worker, a psychologist and a chaplain.

‘Cutting The Umbilical Cord The Second Time’

Dr. Savani says Children’s Health also has a team devoted to helping a family transition to home — learning the ins and outs of complicated equipment and medication, as well as making sure the house is set up for a preemie, without the constant surveillance of doctors and nurses.

“And I actually call it you’re cutting the umbilical cord the second time,” he said. “And it’s a very scary thing for parents to go through.”

Hollis and Courtney Wakefield have been there. And while some things about caring for a preemie are old hat by now, they say some of those visceral NICU memories will never fade. There’s a visual reminder in the house too — a strand of colorful beads, so long it could wrap around Kepley’s tiny waist a dozen times. Courtney says each bead stands for something different Kepley went through in the NICU, for example: blood draws, surgeries and overnight stays.

One day, Kepley might decide to hang these beads on the wall — a memento of her earliest triumph.

For now though, she’s happy to use them as a teething toy.



Cultura de surf hecho en Chocó – Surf culture made in Chocó

  Apr 10, 2017

Nestor Tello, Termales, Chocó, Colombia, 2015. Directed by Guillaume Parent y Sina Ribak Suport: Fundación Buen Punto: In this mini video series we meet with some persons from the Colombian Chocó region who live on the Pacific Coast, south of Nuquí. In Chocó exists a big contrast between the wealth of natural resources and the few opportunities of what we call development for its population. Same as in many rural areas in Colombia, corruption and violence are reality. Nevertheless, the visitor experiences an impression of freedom, tranquility and solidarity. Here, you (re-)connect with nature – you almost dissolve into it – and you feed on the philosophy and dreams of the Chocó people.



We need these articles to inspire, guide and support our precious community


Survival of the littlest: the long-term impacts of being born extremely early


Babies born before 28 weeks of gestation are surviving into adulthood at higher rates than ever, and scientists are checking in on their health.

Amber Dance- NEWS FEATURE  – 02 JUNE 2020


Scientists are watching out for the health of adults born extremely premature, such as these people who took part in a photography project. Credit: Red Méthot

They told Marcelle Girard her baby was dead.

Back in 1992, Girard, a dentist in Gatineau, Canada, was 26 weeks pregnant and on her honeymoon in the Dominican Republic.

When she started bleeding, physicians at the local clinic assumed the baby had died. But Girard and her husband felt a kick. Only then did the doctors check for a fetal heartbeat and realize the baby was alive.

The couple was medically evacuated by air to Montreal, Canada, then taken to the Sainte-Justine University Hospital Center. Five hours later, Camille Girard-Bock was born, weighing just 920 grams (2 pounds).

Babies born so early are fragile and underdeveloped. Their lungs are particularly delicate: the organs lack the slippery substance, called surfactant, that prevents the airways from collapsing upon exhalation. Fortunately for Girard and her family, Sainte-Justine had recently started giving surfactant, a new treatment at the time, to premature babies.

After three months of intensive care, Girard took her baby home.

Today, Camille Girard-Bock is 27 years old and studying for a PhD in biomedical sciences at the University of Montreal. Working with researchers at Sainte-Justine, she’s addressing the long-term consequences of being born extremely premature — defined, variously, as less than 25–28 weeks in gestational age.

Families often assume they will have grasped the major issues arising from a premature birth once the child reaches school age, by which time any neuro-developmental problems will have appeared, Girard-Bock says. But that’s not necessarily the case. Her PhD advisers have found that young adults of this population exhibit risk factors for cardiovascular disease — and it may be that more chronic health conditions will show up with time.

Girard-Bock doesn’t let these risks preoccupy her. “As a survivor of preterm birth, you beat so many odds,” she says. “I guess I have some kind of sense that I’m going to beat those odds also.”

She and other against-the-odds babies are part of a population which is larger now than at any time in history: young adults who are survivors of extreme prematurity. For the first time, researchers can start to understand the long-term consequences of being born so early. Results are pouring out of cohort studies that have been tracking kids since birth, providing data on possible long-term outcomes; other studies are trialing ways to minimize the consequences for health.


These data can help parents make difficult decisions about whether to keep fighting for a baby’s survival. Although many extremely premature infants grow up to lead healthy lives, disability is still a major concern, particularly cognitive deficits and cerebral palsy.

Researchers are working on novel interventions to boost survival and reduce disability in extremely premature newborns. Several compounds aimed at improving lung, brain and eye function are in clinical trials, and researchers are exploring parent-support programmes, too.

Researchers are also investigating ways to help adults who were born extremely prematurely to cope with some of the long-term health impacts they might face: trialing exercise regimes to minimize the newly identified risk of cardiovascular disease, for example.

“We are really at the stage of seeing this cohort becoming older,” says neonatologist Jeanie Cheong at the Royal Women’s Hospital in Melbourne, Australia. Cheong is the director of the Victorian Infant Collaborative Study (VICS), which has been following survivors for four decades. “This is an exciting time for us to really make a difference to their health.”

The late twentieth century brought huge changes to neonatal medicine. Lex Doyle, a paediatrician and previous director of VICS, recalls that when he started caring for preterm infants in 1975, very few survived if they were born at under 1,000 grams — a birthweight that corresponds to about 28 weeks’ gestation. The introduction of ventilators, in the 1970s in Australia, helped, but also caused lung injuries, says Doyle, now associate director of research at the Royal Women’s Hospital. In the following decades, doctors began to give corticosteroids to mothers due to deliver early, to help mature the baby’s lungs just before birth. But the biggest difference to survival came in the early 1990s, with surfactant treatment.

“I remember when it arrived,” says Anne Monique Nuyt, a neonatologist at Sainte-Justine and one of Girard-Bock’s advisers. “It was a miracle.” Risk of death for premature infants dropped to 60–73% of what it was before.

Today, many hospitals regularly treat, and often save, babies born as early as 22–24 weeks. Survival rates vary depending on location and the kinds of interventions a hospital is able to provide. In the United Kingdom, for example, among babies who are alive at birth and receiving care, 35% born at 22 weeks survive, 38% at 23 weeks, and 60% at 24 weeks.

For babies who survive, the earlier they are born, the higher the risk of complications or ongoing disability (see ‘The effects of being early’). There is a long list of potential problems — including asthma, anxiety, autism spectrum disorder, cerebral palsy, epilepsy and cognitive impairment — and about one-third of children born extremely prematurely have one condition on the list, says Mike O’Shea, a neonatologist at the University of North Carolina School of Medicine in Chapel Hill, who co-runs a study tracking children born between 2002 and 2004. In this cohort, another one-third have multiple disabilities, he says, and the rest have none.

“Preterm birth should be thought of as a chronic condition that requires long-term follow-up,” says Casey Crump, a family physician and epidemiologist at the Icahn School of Medicine at Mount Sinai in New York, who notes that when these babies become older children or adults, they don’t usually get special medical attention. “Doctors are not used to seeing them, but they increasingly will.”

Outlooks for earlies

What should doctors expect? For a report in the Journal of the American Medical Association last year, Crump and his colleagues scraped data from the Swedish birth registry. They looked at more than 2.5 million people born from 1973 to 1997, and checked their records for health issues up until the end of 2015.

Of the 5,391 people born extremely preterm, 78% had at least one condition that manifested in adolescence or early adulthood, such as a psychiatric disorder, compared with 37% of those born full-term. When the researchers looked at predictors of early mortality, such as heart disease, 68% of people born extremely prematurely had at least one such predictor, compared with 18% for full-term births — although these data include people born before surfactant and corticosteroid use were widespread, so it’s unclear if these data reflect outcomes for babies born today. Researchers have found similar trends in a UK cohort study of extremely premature births. In results published earlier this year, the EPICure study team, led by neonatologist Neil Marlow at University College London, found that 60% of 19-year-olds who were extremely premature were impaired in at least one neuropsychological area, often cognition.

Such disabilities can impact education as well as quality of life. Craig Garfield, a paediatrician at the Northwestern University Feinberg School of Medicine and the Lurie Children’s Hospital of Chicago, Illinois, addressed a basic question about the first formal year of schooling in the United States: “Is your kid ready for kindergarten, or not?”

To answer it, Garfield and his colleagues analysed standardized test scores and teacher assessments on children born in Florida between 1992 and 2002. Of those born at 23 or 24 weeks, 65% were considered ready to start kindergarten at the standard age, 5–6 years old, with the age adjusted to take into account their earlier birth. In comparison, 85.3% of children born full term were kindergarten-ready.

Despite their tricky start, by the time they reach adolescence, many people born prematurely have a positive outlook. In a 2006 paper, researchers studying individuals born weighing 1,000 grams or less compared these young adults’ perceptions of their own quality of life with those of peers of normal birth-weight — and, to their surprise, found that the scores were comparable. Conversely, a 2018 study8 found that children born at less than 28 weeks did report having a significantly lower quality of life. The children, who did not have major disabilities, scored themselves 6 points lower, out of 100, than a reference population.

As Marlow spent time with his participants and their families, his worries about severe neurological issues diminished. Even when such issues are present, they don’t greatly limit most children and young adults. “They want to know that they are going to live a long life, a happy life,” he says. Most are on track to do so. “The truth is, if you survive at 22 weeks, the majority of survivors do not have a severe, life-limiting disability.”


But scientists have only just begun to follow people born extremely prematurely into adulthood and then middle age and beyond, where health issues may yet lurk. “I’d like scientists to focus on improving the long-term outcomes as much as the short-term outcomes,” says Tala Alsadik, a 16-year-old high-school student in Jeddah, Saudi Arabia.

When Alsadik’s mother was 25 weeks pregnant and her waters broke, doctors went so far as to hand funeral paperwork to the family before consenting to perform a caesarean section. As a newborn, Alsadik spent three months in the neonatal-intensive-care unit (NICU) with kidney failure, sepsis and respiratory distress.

The complications didn’t end when she went home. The consequences of her prematurity are on display every time she speaks, her voice high and breathy because the ventilator she was put on damaged her vocal cords. When she was 15, her navel unexpectedly began leaking yellow discharge, and she required surgery. It turned out to be caused by materials leftover from when she received nutrients through a navel tube.

That certainly wasn’t something her physicians knew to check for. In fact, doctors don’t often ask if an adolescent or adult patient was born prematurely — but doing so can be revealing.

Charlotte Bolton is a respiratory physician at the University of Nottingham, UK, where she specializes in patients with chronic obstructive pulmonary disease (COPD). People coming into her practice tend to be in their 40s or older, often current or former smokers. But in around 2008, she began to notice a new type of patient being referred to her owing to breathlessness and COPD-like symptoms: 20-something non-smokers.

Quizzing them, Bolton discovered that many had been born before 32 weeks. For more insight, she got in touch with Marlow, who had also become concerned about lung function as the EPICure participants aged. Alterations in lung function are a key predictor of cardiovascular disease, the leading cause of death around the world. Clinicians already knew that after extremely premature birth, the lungs often don’t grow to full size. Ventilators, high oxygen levels, inflammation and infection can further damage the immature lungs, leading to low lung function and long-term breathing problems, as Bolton, Marlow and their colleagues showed in a study of 11-year-olds.

VICS research backs up the cardiovascular concerns: researchers have observed diminished airflow in 8-year-olds, worsening as they aged, as well as high blood pressure in young adults. “We really haven’t found the reason yet,” says Cheong. “That opens up a whole new research area.”

At Sainte-Justine, researchers have also noticed that young adults who were born at 28 weeks or less are at nearly three times the usual risk of having high blood pressure. The researchers figured they would try medications to control it. But their patient advisory board members had other ideas — they wanted to try lifestyle interventions first.

The scientists were pessimistic as they began a pilot study of a 14-week exercise programme. They thought that the cardiovascular risk factors would be unchangeable. Preliminary results indicate that they were wrong; the young adults are improving with exercise.

Girard-Bock says the data motivate her to eat healthily and stay active. “I’ve been given the chance to stay alive,” she says. “I need to be careful.”

From the start

For babies born prematurely, the first weeks and months of life are still the most treacherous. Dozens of clinical trials are in progress for prematurity and associated complications, some testing different nutritional formulas or improving parental support, and others targeting specific issues that lead to disability later on: underdeveloped lungs, brain bleeds and altered eye development.

For instance, researchers hoping to protect babies’ lungs gave a growth factor called IGF-1 — which the fetus usually gets from its mother during the first two trimesters of pregnancy — to premature babies in a phase II clinical trial reported in 2016. Rates of a chronic lung condition that often affects premature babies halved, and babies were somewhat less likely to have a severe brain hemorrhage in their earliest months.

Another concern is visual impairment.

Retina development halts prematurely when babies born early begin breathing oxygen. Later it restarts, but preterm babies might then make too much of a growth factor called VEGF, causing over-proliferation of blood vessels in the eye, a disorder known as retinopathy. In a phase III trial announced in 2018, researchers successfully treated 80% of these retinopathy cases with a VEGF-blocking drug called ranibizumab, and in 2019 the drug was approved in the European Union for use in premature babies.

Some common drugs might also be of use: paracetamol (acetaminophen), for example, lowers levels of biomolecules called prostaglandins, and this seems to encourage a key fetal vein in the lungs to close, preventing fluid from entering the lungs.

But among the most promising treatment programmes, some neonatologists say, are social interventions to help families after they leave the hospital. For parents, it can be nerve-racking to go it alone after depending on a team of specialists for months, and lack of parental confidence has been linked to parental depression and difficulties with behaviour and social development in their growing children.

At Women & Infants Hospital of Rhode Island in Providence, Betty Vohr is director of the Neonatal Follow-Up Program. There, families are placed in private rooms, instead of sharing a large bay as happens in many NICUs. Once they are ready to leave, a programme called Transition Home Plus helps them to prepare and provides assistance such as regular check-ins by phone and in person in the first few days at home, and a 24/7 helpline. For mothers with postnatal depression, the hospital offers care from psychologists and specialist nurses.

The results have been significant, says Vohr. The single-family rooms resulted in higher milk production by mothers: 30% more at four weeks than for families in more open spaces. At 2 years old, children from the single-family rooms scored higher on cognitive and language tests. After Transition Home Plus began, babies discharged from the NICU had lower health-care costs and fewer hospital visits — issues that are of great concern for premature infants. Other NICUs are developing similar programmes, Vohr says.

With these types of novel intervention, and the long-term data that continue to pour out of studies, doctors can make better predictions than ever before about how extremely premature infants will fare. Although these individuals face complications, many will thrive.

Alsadik, for one, intends to be a success story. Despite her difficult start in life, she does well academically, and plans to become a neonatologist. “I, also, want to improve the long-term outcomes of premature birth for other people.”



Cloud Surfing Roldanillo, Colombia in a Paraglider

Jan 30, 2017 Jonathan Kelley

Cloud Surfing Roldanillo, Colombia in a paraglider in January 2017



Climate Migrants, Microfluidic Systems, GoMo



Rate: 14% Rank 24 Global Average 11.1%

Bangladesh  is the eighth-most populous country in the world, with a population exceeding 161 million people. In terms of land mass, Bangladesh ranks 92nd, spanning 147,570 square kilometres (56,980 sq mi), making it one of the most densely-populated countries in the world. Bangladesh shares land borders with India to the west, north, and east, Myanmar to the southeast, and the Bay of Bengal to the south. It is narrowly separated from Nepal and Bhutan by India’s Siliguri Corridor, and from China by the Indian state of Sikkim, in the north, respectively. Dhaka, the capital and largest city, is the nation’s economic, political and cultural hub. Chittagong, the largest sea port, is the second largest city. With numerous criss-crossing rivers and inland waterways, the dominant geographic feature of Bangladesh is the Ganges delta, which empties into the Bay of Bengal with the combined waters of several river systems, including the Brahmaputra river and the Ganges riverHighlands, with evergreen forests, cover the northeastern and southeastern regions, while the country’s biodiversity comprises a vast array of plants and wildlife, including the endangered Royal Bengal tiger, which is the national animal. The seacoast features the world’s longest natural sandy beach in Cox’s Bazar as well as the Sundarbans, which is the world’s largest mangrove forest.

Healthcare facilities in Bangladesh are considered less than adequate, although they have improved as poverty levels have decreased significantly. Findings from a recent study in Chakaria (a rural Upazila under Cox’s Bazar District) revealed that the “village doctors”, practicing allopathic medicine without formal training, were reported to have provided 65% of the healthcare sought for illness episodes occurring within 14 days prior to the survey. Formally-trained providers made up only four percent of the total health workforce. The Future Health Systems survey indicated significant deficiencies in the treatment practices of village doctors, with widespread harmful and inappropriate drug prescribing. Receiving health care from informal providers is encouraged.

Malnutrition has been a persistent problem in Bangladesh, with the World Bank ranking the country first in the number of malnourished children worldwide. More than 54% of preschool-age children are stunted, 56% are underweight and more than 17% are wasted. More than 45 percent of rural families and 76 percent of urban families were below the acceptable caloric-intake level.


Born on Time: Fathers Clubs in Bangladesh

planPlanCanadaVideos   Jun 4, 2019

The Born on Time project educates communities on the risk factors of preterm birth. The risk of preterm birth can be decreased by addressing unhealthy lifestyle factors and harmful gender discriminatory behaviors such as: heavy workloads for mothers, domestic violence, and child, early and forced marriage. Born on Time Fathers Clubs encourage male engagement in birth preparedness, safe pregnancy and delivery, and in preterm birth prevention. See how Born On Time supported Abdur take part in a Fathers Club in Bangladesh, transforming local gender roles and teaching dads to put family first.





One-fifth of babies born premature in Bangladesh

Published at 10:47 pm November 16th, 2019
Bangladesh has managed to curb the premature deaths in recent years, according to the United Nations (UN).

Although the deaths caused by communicable diseases have decreased over the past years, the death of premature babies is still a concern for the authorities.

Even a few years ago, Bangladesh was a country where communicable diseases were responsible for the death of many newborn babies. But with the recent awareness programs by different organizations, about how to take care of neonates, mortality rate of infants from communicable diseases have decreased noticeably.

When asked, DGHS officials said more than 3 million children are born every year in Bangladesh, and very few die of communicable diseases.

Though, death from premature birth now tops the list. Out of 3 million children born every year in Bangladesh some 0.6 million are born premature, and out of that 0.6 million premature births 20,000 infants die, said UN.

According to 2018 UN estimation, the newborn mortality rate in Bangladesh is 18 per 1000 infants.

Dr Shamim Jahan, director of Health, Nutrition & HIV/AIDS, Save the Children, said the number has decreased in comparison to 2016 as 23620 infants died due to premature birth that year.

Experts opinion

The UN estimation said that complications of premature birth is the cause for it to top the list of infant deaths.

Experts opined that this situation has not been addressed for a long time, resulting in such number of deaths in the country.

Though, experts themselves are still unaware of the real reason as to why premature birth tops the list for infant mortality.

Professor Dr Begum Sharifun Nahar, head of Neonatology department of Sir Salimullah Medical College and Mitford Hospital, said “A premature child do not live for long, as most of the time the infant’s vital organs are not completely developed, and they suffer from lung problems, which leads to breathing issues. In conjunction with low birth weight, feeding disorders and hypothermia causes the death of premature infants. But she added that many of these issues can be avoided if people are more aware of the procedure, and the baby is taken care of by proper doctors, and nurses who have good knowledge about premature birth related issues, she added.


A miracle touch keeps child breathing without stress

When Popy (25) became pregnant for the second time, her family became very cautious, as she went through a miscarriage two years back.

She was married at the age of 20 and when she first conceived at 22. In her second pregnancy she was supposed to give birth to twins.

But her joy turned into tears, as the low birth weight caused death to one of her children ten days after their birth on October 29, following their premature birth weight of only 1500 grams. The babies had breathing difficulties along with other health hazards.

Her child was given treatment at NICU of Mitford Hospital, and later given to her as part of KMC.

“You can’t explain the feelings of its breath, when it takes its food from you. It seems like the world started living on my chest,” Popy told the reporter.

Professor Dr Begum Sharifun Nahar said KMC, a method of contacting a skin–to–skin contact between a mother and her newborn facilitating frequent or exclusive breastfeeding, and early discharge from the hospital has been effective in reducing the risk of mortality among preterm, and low birth weight infants.

“KMC helps the children to be stress free, and easiest breast feeding process. We have witnessed that the child going through KMC treatment have good growth, more sleep, less infections, and control temperature lessening chances of hypothermia,” she said.

Dr Shamim Jahan director – Health, Nutrition & HIV/AIDS, Save the Children said:  “As part of their objectives to make Bangladesh controlling deaths from premature birth, Save the Children is providing assistance in capacity building, establishing a monitoring system, and by providing technical assistance to the government for effective implement of KMC.”

Government initiatives to end premature birth

Dr Shamim Jahan said Bangladesh is at the seventh position among the top 10 countries with the largest numbers of preterm births, and deaths.

In the course of changing paradigm of diseases that are causing neonatal deaths, without controlling premature deaths, achieving SDGs new global target to end preventable newborn, and child deaths by 2030 (SDG 3.2) would never be possible, he said, adding that the theme for World Prematurity Day 2019 has put forth our course of action rightly — ‘’Born Too Soon: Providing the right care, at the right time, in the right place.”

Recognizing premature birth and death as a matter of concern, Dr Shamsul Haque, line director of Mother Neonatal Care and Adolescent Health (MNC&AH) under Directorate General of Health Services (DGHS) said, under the fourth sectoral program DGHS has established some 42 Special Care Newborn Units (SCANU) in tertiary, and district level hospitals.

Besides, as part of keeping the child alive, government has taken KMC as a trusted way, and have already established 132 centres in tertiary, district, and upazila level government hospitals. Besides, the private hospitals have also been asked to use the method.

The government started the programme (January 2017-June 2022) with an aim to reduce the newborn mortality rate to under 12 per 1,000 live births by 2030.

Directorate General of Family Planning (DGFP) and Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare are implementing the programme at a cost of around Tk 422 crore.

To meet the manpower problem, necessary training is being provided to pediatric specialists, and nurses in the hospitals, as many as they can. So that, wherever the doctors are transferred, they could continue the process.

“The government has planned to establish SCANU in every district, and all the upazila would have the facility of KMC treatment within 2022,” the line director stressing the need for creating awareness among rural people regarding premature births.

About KMC he said it is a very low cost treatment, and costs almost nothing. Besides, it takes only Tk 85,000 to set up a two bed unit.

The early result of KMC methods has made them hopeful of the fact that it would play a key role in preventing premature birth, and infant death in the country within the timeline they targeted, he added.



Rohingya Refugee Children Are in Desperate Need of Help

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Perinatal health of refugee and asylum-seeking women in Sweden

2014–17: a register-based cohort study

Published:  04 July 2019   Can Liu, Mia Ahlberg, Anders Hjern, Olof Stephansson

European Journal of Public Health, Volume 29, Issue 6




An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.


Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.


Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).


Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.



Taking care of premature babies with Kangaroo Mother Care

UNICEF Bangladesh   Sep 1, 2019

Learn how to take care of premature babies with Kangaroo Mother Care




Successfully leveraging mobile technology to reduce preterm births

A maternal population risk study

Mary E. Cramer PhD, RN, FAAN – Elizabeth K. Mollard PhD, APRN‐NP – Amy L. Ford DNP, RN –  Kevin A. Kupzyk PhD, Fernando A. Wilson PhD

In Nebraska, nearly half of the counties on average – mostly rural – have a higher percentage of preterm births than the March of Dimes national average of 8.1%. Many of these rural counties are home to 30% or more soon-to-be mothers who receive inadequate prenatal care. Access to prevention and resources are rural barriers in Nebraska that contribute to preterm births.

Through a pilot study conducted under the direction of the University of Nebraska Medical Center (UNMC) and with funding from Blue Cross Blue Shield of Nebraska, we sought to positively impact these issues within Nebraska’s prenatal patient population. GoMo Health collaborated with Dr. Amy Ford and Dr. Mary Cramer from UNMC to develop a program with specialized content to help reduce preterm births.


Objectives: (1) Assess feasibility of a smartphone platform intervention combined with Community Health Worker (CHW) reinforcement in rural pregnant women; (2) Obtain data on the promise of the intervention on birth outcomes, patient activation, and medical care adherence; and (3) Explore financial implications of the intervention using return on investment (ROI).

Sample: A total of 98 rural pregnant women were enrolled and assigned to intervention or control groups in this two‐group experimental design.

Intervention: The intervention group received usual prenatal care plus a smartphone preloaded with a tailored prenatal platform with automated texting, chat function, and hyperlinks and weekly contact from the CHW. The control group received usual prenatal care and printed educational materials.

Measurements: Demographics, health risk data, interaction with platform, medical records, hospital billing charges, Client Satisfaction Questionnaire‐8, satisfaction comments, and the Patient Activation Measure.

Results: A total of 77 women completed the study. The intervention was well‐received, showed promise for improving birth outcomes, patient activation, and medical care adherence. Financial analysis showed a positive ROI under two scenarios.

Conclusions: Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at‐risk population to appreciate the impact of the intervention.



New preclinical study shows promise for treating necrotizing enterocolitis

Reviewed by James Ives, M.Psych. (Editor)May 6 2020

Necrotizing enterocolitis (NEC), a rare inflammatory bowel disease, primarily affects premature infants and is a leading cause of death in the smallest and sickest of these patients. The exact cause remains unclear, and there is no effective treatment.

No test can definitively diagnose the devastating condition early, so infants with suspected NEC are carefully monitored and administered supportive care, such as IV fluids and nutrition, and antibiotics to fight infection caused by bacteria invading the gut wall. Surgery must be done to excise damaged intestinal tissue if the condition worsens.

A new preclinical study by researchers at the University of South Florida Health (USF Health) Morsani College of Medicine and Johns Hopkins University School of Medicine offers promise of a specific treatment for NEC, one of the most challenging diseases confronting neonatologists and pediatric surgeons.

The team found that inhibiting the inflammatory and blood-clotting molecule thrombin with targeted nanotherapy can protect against NEC-like injury in newborn mice.

Their findings were reported May 4 in the Proceedings of the National Academy of Sciences.

Our data identified the inflammatory molecule thrombin, which plays a critical role in platelet-activated blood clotting, as a potential new therapeutic target for NEC. We showed that anti-thrombin nanoparticles can find, capture and inactivate all the active thrombin in the gut, thereby preventing or reducing the small blood vessel damage and clotting that accelerates NEC.”

Samuel Wickline, MD, Study Co-Author and Professor of Cardiovascular Sciences, Morsani College of Medicine. Dr Wickline is also the director of the USF Health Heart Institute.

PNAS paper’s senior author is Akhil Maheshwari, MD, professor of pediatrics and director of neonatology at the Johns Hopkins University School of Medicine.

Before joining Johns Hopkins Medicine (Baltimore) in 2018, Dr. Maheshwari’s group at USF Health was the first to demonstrate that platelet activation is an early, critical event in causing NEC, and therapeutic measures to block these platelets might be a new way to prevent or reduce intestinal injury in NEC.

The nanotherapy platform created by Dr. Wickline and USF Health biomedical engineer Hua Pan, PhD, delivers high drug concentrations that specifically inhibit thrombin from forming blood clots on the intestinal blood vessel wall without suppressing the (clotting) activity needed to prevent bleeding elsewhere in the body.

This localized treatment is particularly important for premature infants, Dr. Wickline said, because the underdeveloped blood vessels in their brains and other vital organs are still fragile and susceptible to rupture and bleeding.

For this study the researchers used a model they created — infant mice, or pups, induced to develop digestive tract damage resembling human NEC, including the thrombocytopenia commonly experienced by premature infants with NEC.

Thrombocytopenia is characterized by low counts of blood cell fragments known as platelets, or thrombocytes, which normally stop bleeding from a cut or wound by clumping together to plug breaks injured blood vessels.

The molecule thrombin plays a key role in the bowel inflammation driven by overactive platelets. While investigating role of platelet depletion in NEC-related thrombocytopenia, the USF-Johns Hopkins researchers were surprised to find that thrombin mediates platelet-activated blood clotting early in the pathology of NEC-like injury – before bacteria leaks from inside the gut to circulating blood or other organs.

This clotting clogs small blood vessels and restricts blood flow to the inflamed bowel. Eventually, the lining of the damaged intestinal wall can begin to die off.

The investigative therapy essentially works “like a thrombin sponge” that is exponentially more potent than current agents used to inhibit clotting, Dr. Wickline explained. “It literally puts trillions of nanoparticles at that damaged (intestinal wall) site to sponge up all the overactive thrombin, which tones down the clotting and inflammation processes promoted by thrombin.”

“We are so excited about finding this new way to attenuate intestinal injury in NEC,” Dr. Maheshwari said.

The same approach has also been shown in preclinical studies to inhibit the growth of atherosclerotic plaques and certain kidney injuries without causing systemic bleeding problems. Dr. Wickline added. “The nanoparticles can be tailored to other inflammatory diseases highly dependent on thrombin for their progression.”

The study authors conclude that their experimental targeted treatment for NEC merits further evaluation in clinical trials.

Source: University of South Florida (USF Health)

Journal reference: Namachivayam, K., et al. (2020) Targeted inhibition of thrombin attenuates murine neonatal necrotizing enterocolitis. Proceedings of National Academy of Sciences.



Climate change is causing an increase in preterm births: Study

Myupchar Dec 12, 2019

With the change in climate, the emergence of vector-borne diseases (insects-bearing diseases) like dengue and chikungunya, has spiked. This is subsequently leading to more than 7 lakh deaths annually.

That’s just the beginning though. The increase in temperature directly affects health by compromising the body’s ability to regulate its internal temperature. With the inability to control the internal temperature of the body, we become more prone to a cascade of illnesses like heat cramps, heat exhaustion, heatstroke, and hyperthermia during extreme heat and hypothermia and frostbite in extremely cold temperatures.

And now we find that climate change is having an insidious effect on pregnant women.

Studies have claimed that, with the rise in temperature, the cases of preterm delivery have increased. Any birth that occurs at least three weeks before the due date is considered by doctors to be a premature delivery. Some of the complications that this could lead to are slow weight gain, immature lungs, poor feeding, etc.

Heat and preterm labour

Long span research was conducted by Alan Barreca, an associate professor at UCLA’s Institute of Environmental Sustainability, and economist Jessamyn Schaller of Claremont McKenna College in a two-decade window, i.e., from 1969 to 1988, to find out the link between the change in temperature and preterm deliveries.

The researchers found that when the temperature exceeded or reached 32.2ºC (90ºF), the premature birth rate per 100,000 women increased by 0.97. It was also noted that on days when the temperature was hot but not extreme, the premature births increased by 0.57.

They further concluded that with an increase in temperature, the gestation period was decreased by two weeks. The gestation period is the time period of 40 weeks that it takes for fetal development, starting right from the conception till the day before the delivery.

Across the entire 20-year period of the study, around 25,000 infants were born prematurely every year, leading to the loss of more than 150,000 gestational days, all because of exposure to an exceptionally hot environment.

Another long span study was conducted by scientists led by Dr Lyndsay A. Avalos in Northern California for a time window of 14 years, i.e., between January 1, 1995, to December 31, 2009, to investigate the impact of apparent temperature on spontaneous preterm delivery.

Dr Lyndsay concluded the research by stating that with the increase in temperature by 10 °F (5.6 °C) during warm seasons, the cases of spontaneous preterm delivery increased by 11.6%.

All the preterm deliveries in this study took place between 28 and 37 weeks of gestational period, instead of 40.

The uncertain reason

Scientists have not been able to find the exact cause, but have laid down some possible reasons that could lead to premature labour:

  • Scientists believe that due to the increased heat, the mother could have cardiovascular stress that in turn could trigger the body to go into labour early.
  • The second theory proposed by the scientists is that the high temperatures could trigger an increase in the levels of the hormone oxytocin, which plays a role in inducing labour.
  • The third theory stated that because of the hot temperature the mother might unable to sleep properly. This could increase the chances of preterm labour and preeclampsia (complication in pregnancy marked with high BP) in the mother.

The alarming situation

It’s time to realize that climate change is real. And not only is it adversely affecting the environment but it has serious health implications as well, especially for the coming generation.

For more information, please read our article on Preterm Labour.



Microfluidic Systems for Sweat Analysis and Neonatal Care

newsApr 24, 2020: In this interview, Professor John Rogers talks to News-Medical Life Sciences about his research and work in developing biocompatible electronics and microfluidic systems with skin-like properties.

Biological systems are traditionally mechanically soft however modern electronic and microfluidic technologies are rigid, meaning the layouts are completely different. Eliminating this mismatch will create huge opportunities in man-made systems that can be used for diagnostics, therapeutics and in clinical and healthcare. Can you tell us about the new opportunities these man-made systems will create?

There are all kinds of interesting and compelling opportunities that could come from thinking about how to reformulate the kinds of systems that form the core foundations of devices that you see in consumer gadgetry, so computer chips, integrated circuit chips that are flat and rigid and planar, into forms that are more naturally biocompatible – compatible with the soft surfaces of the human body.  And integrated circuits are not the only kind of man-made technology that has those kinds of physical characteristics and geometrical shapes.

You see the same type of thing in optoelectronic devices, lab-on-a-chip type technologies and microelectromechanical systems. The goal behind our research, and that of a growing community of researchers, is to create new ideas in material science and manufacturing, mechanical engineering and electrical engineering that will allow us to reformulate those sorts of technologies, without sacrificing the performance or capabilities, into platforms with geometries and mechanical properties that are inherently biocompatible and can be interfaced with soft tissue systems — the skin, the brain, the heart, the peripheral nervous system, the bladder, and the kidneys. And the idea is to develop those technologies into system that can ultimately enhance human health and extend life.

Can you tell us more about these ‘biocompatible’ electronic and microfluidic systems with skin-like physical properties?

The skin-like devices that we have developed are specifically designed to interface with the skin and to use the skin as a window for measuring clinical-grade physiological status parameters associated natural processes of the human body. For example, looking at cardiac activity, respiratory activity, flow properties associated with blood through near-surface arteries and veins; to reproduce what’s done in the hospital, but in platforms that can be worn continuously for wireless streaming of data outside of the hospital in the home setting, to develop a deep foundational basis of information on health status. This information can be used with artificial intelligence algorithms to assess a person’s well-being at any given moment and to make predictive assessments of health trajectories over time. This kind of personalized, digitally oriented model for healthcare enabled by these kinds of skin-like platforms will be a very powerful way that healthcare will evolve into the future for reduced costs and improved outcomes.

You presented the Wallace. H. Coulter Lecture this year at Pittcon 2020 in Chicago. What did you discuss in your talk?

In this talk, I will focus on skin-interfaced systems, devices that provide not only this electronic monitoring functionality but those that also embed tiny networks of microchannels. The microchannels along with very small reservoirs and valves that are designed to capture sweat that is pumped to the surface of the skin through the Eccrine glands and the connective ducts for capture and analysis of biomarkers in sweat.

Sweat is a relatively under-explored but very potentially important class of bio-fluid that could provide information content to substitute for blood draws. The idea is to use sweat and the noninvasive ability to collect sweat to do biochemical based assessments of health status to complement the sort of physics-based measurements that we can achieve with our electronic devices.

What sparked your interest in ‘soft’ materials?

My core expertise is in electronic materials, and I like to think about novel electronic materials in the context of technologies with capabilities that go beyond what is currently supported with conventional sorts of electronic materials. We got our start in this area thinking about flexible displays, so paper-like displays that could replace the kind of liquid crystal and organic light-emitting diode displays that you see in consumer devices today. So, thinking about thin paper-like systems, lightweight, mechanically rugged, capable of rolling up in storage when they’re not being used. And so that was interesting for us for a while, and it remains a major focus at most large display companies.

I happened to be giving a talk at the University of Pennsylvania on that kind of technology. It turned out that a couple of curious neuroscientists were in the audience and they came up to me after the talk and asked whether we could take those kinds of flexible electronic devices and put them on the brain to study the electrical activity of the brain. That was the first suggestion that these kinds of devices could be brought to bear to important problems in human health and in research around the fundamental mechanisms that govern the behavior of living systems. That interaction catalyzed a whole new set of research opportunities for us and it has been a sustained area of activity now in the group for the last 10 years.

What extra levels of functionality do soft electronics provide? How were they discovered?

Soft electronics allow you to intimately and persistently integrate advanced biosensors, radios, stimulators, microprocessors and digital memory technologies with the human body, in ways that go far beyond what’s possible with conventional wearable technologies that you see on the market today. Commercial devices are dominated by bulky, clunky pieces of electronics, loosely strapped to the body, typically at the wrist. That kind of technology approach can allow you to measure certain parameters, qualitative assessments of health and wellbeing, you can count steps, you can get a rough estimate of heart rate, but those are parameters that physicians can’t readily interpret and act upon.

What we’re thinking about is the next generation of wearable technology that integrates more intimately with the body, almost serving as a second skin that laminates in a physically imperceptible way on the surface of your actual skin. Almost like a temporary tattoo or a bandaid to provide ICU grade measurements of health status to allow physicians to, at a very detailed level, track health progression over time, not in an episodic way, which is currently the way that measurements are made when a patient comes to a hospital or a clinic. But now thinking about those same types of measurements performed continuously and I feel that it’s going to open up new frontiers to think about how to manage health conditions and to promote healthy living as well.

What ‘skin-like’ physical properties do biocompatible electronic and microfluidic systems have?

We target a set of physical properties that are precisely matched to the skin itself. The skin stretches somewhat, it can flex and bend and wrinkle, it has certain thermal characteristics, it has a whole set of properties, water permeability characteristics as well, thermal. And we try to embody those exact skin-like properties into electronic devices. And that’s the trick and the centroid of the research that we’ve been doing over the last decade or so. You think about a silicon-based integrated circuit, the mechanical properties are a million times different than those of the skin. So, there’s a huge chasm and a gap there. It’s perfectly flat, it really can’t conform to a natural curvature and the sort of sub-millimeter scale texture associated with the skin. So we try, to the best of our ability, to take a collection of materials and build them into an electronic system that has the same type of functionality you achieve with a silicon-based electronic platform today, but with mechanical properties, geometrical features that precisely match those of the skin.

The goal is to develop almost like a second skin that interfaces directly and naturally with your natural skin so you can wear these devices for long periods of time without even realizing they’re there because they’re matched to the skin. You don’t have a physical sensation that they’re there. And we think that that’s not just a convenience, that’s an essential characteristic of the devices because if they can’t be worn in a comfortable way that doesn’t introduce irritation at the surface of the skin, then nobody will wear the devices. The patient compliance will be unacceptably low.

That’s the goal around engineering and it turns out that with a few relatively simple ideas, we can get very close. The thickness of these devices is thinner than the epidermis, the mechanical properties almost precisely matched, the overall thermal mass is almost the same, there’s no thermal load as a result.

Could you name some of the main advantages of using soft, skin-like electronics over using conventional hospital apparatus?

What’s used in hospitals today, are primarily biosensors that are attached to the surface of the skin just with adhesive tapes. They connect via hard wires to external boxes of electronics that do all the data acquisition and storage and processing. And that works fairly well for an adult patient who’s in a hospital bed and not moving around a lot.

The wires, however, even in that kind of scenario, create a pretty serious inconvenience and in many cases, they frustrate basic operations in clinical care, surgical operations are confounded by the presence of the wires.

The idea is to go to a platform that gets rid of the wires, so it’s wireless. And the forces that are inevitably imparted through the wires to the interface between the biosensors and the skin also go away, we can get away with an adhesive that has an adhesive strength to the skin that’s a factor of 10 or a hundred times lower than that which is required for the wired based devices. And the consequence of that is that you end up with a much more comfortable interface to the skin and one that is much less prone to create skin irritation.

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