PRETERM BIRTH RATES – PHILLIPINES
Rank: 12 –Rate: 14.9% Estimated # of preterm births per 100 live births
(USA – 12 %, Global Average: 11.1%)
The Philippines is an archipelagic country in Southeast Asia. It is situated in the western Pacific Ocean and consists of around 7,641 islands that are broadly categorized under three main geographical divisions from north to south: Luzon, Visayas, and Mindanao. The Philippines is bounded by the South China Sea to the west, the Philippine Sea to the east, and the Celebes Sea to the southwest. It shares maritime borders with Taiwan to the north, Japan to the northeast, Palau to the east and southeast, Indonesia to the south, Malaysia to the southwest, Vietnam to the west, and China to the northwest. The Philippines covers an area of 300,000 km2 (120,000 sq mi) and, as of 2021, it had a population of around 109 million people, making it the world’s thirteenth-most populous country. The Philippines has diverse ethnicities and cultures throughout its islands. Manila is the country’s capital, while the largest city is Quezon City; both lie within the urban area of Metro Manila.
The Philippines is an emerging market and a newly industrialized country whose economy is transitioning from being agriculture-centered to services- and manufacturing-centered. It is a founding member of the United Nations, World Trade Organization, Association of Southeast Asian Nations, the Asia-Pacific Economic Cooperation forum, the East Asia Summit and a member of the Non-Aligned Movement since 1993. The Philippines’s position as an island country on the Pacific Ring of Fire that is close to the equator makes it prone to earthquakes and typhoons. The country has a variety of natural resources and is home to a globally significant level of biodiversity.
There were 101,688 hospital beds in the country in 2016, with government hospital beds accounting for 47% and private hospital beds for 53%. In 2009, there were an estimated 90,370 physicians or 1 per every 833 people, 480,910 nurses and 43,220 dentists. Retention of skilled practitioners is a problem. Seventy percent of nursing graduates go overseas to work. As of 2007, the Philippines was the largest supplier of nurses for export. The Philippines suffers a triple burden of high levels of communicable diseases, high levels of non-communicable diseases, and high exposure to natural disasters.
There is improvement in patients access to medicines due to Filipinos’ growing acceptance of generic drugs, with 6 out of 10 Filipinos already using generics. While the country’s universal healthcare implementation is underway as spearheaded by the state-owned Philippine Health Insurance Corporation, most healthcare-related expenses are either borne out of pocket or through health maintenance organization (HMO)-provided health plans. As of April 2020, there are only about 7 million individuals covered by these plans.
This month’s blog embraces the Philippines, our 71st country-focused blog. Throughout our journey you have inspired and amazed us, touched our hearts and fueled our imaginations. We have explored the breadth of our associations, witnessed the global diversities, similarities, needs, barriers, challenges and resources present within our Preterm Birth community. Kat and I began our journey with eyes wide open, minds full of curiosity, hearts wary yet open, following an unseen but deeply compelling call to serve the Community in some guided capacity. We always knew we would receive more than we could ever give. We appreciate and thank you for who you are and your presence in our lives. Within your eternal perfection, such goodness, strength and love abide.
Socioeconomic Disparities in Adverse Birth Outcomes in The Philippines
Kaforau et al. reported the burden of adverse birth outcomes and their risk factors in the Pacific Islands region. Preterm birth prevalence was 13.0%, while low birth weight was 12.0%. Malaria, substance use, obesity, and poor antenatal care were the most significant risk factors associated with adverse birth outcomes.
The Philippines, a lower-middle-income country in the Asia Pacific, continues to experience challenges in addressing adverse birth outcomes. We share the status and the socioeconomic disparities in adverse birth outcomes in the Philippines.
The latest health survey in 2017 showed a 3.0% preterm birth rate in the Philippines.
Low birth weight (LBW) incidence was 11.9% in 2020.
Moreover, in a newborn screening cohort from 2015 to 2016, 13.6% were small-for-gestational age.
Increased antenatal care utilization, essential newborn care, and kangaroo mother care have decreased adverse birth outcomes and neonatal mortality.
However, health inequalities prevail in the Philippines.
Despite no difference in LBW incidence between urban and rural areas, regional disparities exist. The national capital region, Metro Manila, had the lowest LBW rate (9.0%), while two regions in the southern Philippines had the highest LBW rates (Davao at 20.0%, and Zamboanga at 21.0%).
Smokers were more likely to have LBW newborns (21.0%) than nonsmokers (14.0%), agreeing with Kaforau and colleagues findings. A cohort study examining maternal second-hand smoke (SHS) exposure showed significantly lower birth weight in the SHS-exposed group.
Pregnant women exposed to SHS had higher parity, lower educational attainment, and lower monthly household income.
Socioeconomic status and its proxy variables (e.g., educational attainment, household income, and occupation) were shown to affect birth outcomes in the Philippines. LBW incidence decreased with higher maternal educational attainment, with 17.7% of mothers who reached primary school level and 12.5% of mothers who reached college level having LBW newborns. Household wealth was a significant determinant of LBW: mothers in the lowest wealth quintile had higher LBW incidence (16.0%) than mothers in the highest quintile (12.5%).
With increasing socioeconomic inequality exacerbated by the ongoing pandemic, underlying social determinants must be recognized and addressed. We call for more research to investigate the country’s social determinants of adverse birth outcomes, which can be used as the basis for evidence-based policies and health services to improve maternal and neonatal outcomes. We also emphasize the need for good governance, gender equality, and equitable access to women’s and reproductive health services (antenatal care, basic emergency obstetric and neonatal care, and family planning) to reduce widening disparities in adverse birth outcomes.
Magnus Haven – Oh, Jo (Official Music Video)
Premiered Jun 26, 2022 Magnus Haven
Jo is a term of endearment among Kapampangans, which means special someone. So the love song pays tribute to that “Jo” or special someone. A statement of love echoing the romantic joy that that “Jo” brings to her partner’s life.
Pregnancy becomes a more vulnerable time with climate change
Wildfires, natural disasters, rising heat can lead to poor health outcomes for the expectant and their babies – By Katherine Kam – April 11, 2022
In the western United States, where massive wildfires have fouled the air with smoke and hazardous levels of pollutants, Santosh Pandipati, an obstetrician in California, counsels pregnant patients to always check air quality before they venture outside to exercise. “You need to plan your outdoor activities when the air quality is better,” he tells them.
In other parts of the country, where hurricanes and floods have displaced pregnant residents, obstetrician Nathaniel DeNicola has advised patients, including those he saw in New Orleans, to pack a preparedness kit.
In case of evacuation, “they might be away from home for a long time,” he said. DeNicola encourages people to include emergency drinking water, extra supplies of medications and a paper copy of their medical records. “If the power’s out, that’s not typically available” now that most records are electronic, he said.
As scientists study how climate change is affecting human health, pregnant people and their unborn babies are emerging as a vulnerable group.
Those who must evacuate during natural disasters are often extremely distressed and might find their pregnancy health care interrupted. “If you have to flee, how do you make sure you continue to have access to your OB/GYN or to the hospital you plan to deliver in?” said Pandipati, who has seen patients who have escaped wildfires. “If you end up needing to go live with family an hour or two hours away, you have a disruption in care.”
Pregnancy & Parenthood
It doesn’t take a catastrophe to create problems. Ongoing exposure to hot temperatures and air pollution might raise the risk of adverse pregnancy outcomes, such as preterm birth and low birth weight.
Spurred by growing evidence on climate-related effects, Pandipati and DeNicola have tailored their medical advice, not to alarm people, but to prepare them. “The reality is that we need to start telling our patients right now that the climate is changing,” Pandipati said. “We need to empower patients.”
In 2016, the American College of Obstetricians and Gynecologists issued a position statement on climate change, calling it “an urgent women’s health concern and a major public health challenge.”
Air pollution and heat exposure
Amid widespread changes wrought in the environment, air pollution and heat exposure have been significantly associated with preterm birth, low birth weight and stillbirth in the United States, according to a 2020 review published in JAMA Network Open. Such exposures are becoming increasingly common, according to the paper.
DeNicola, an obstetrician at the Johns Hopkins Health System in Washington, was one of the review’s co-authors.
Exposure to high temperatures can cause dehydration. During pregnancy, dehydration can lead to the release of oxytocin, a hormone that contributes to labor contractions, he said. “The extreme heat could very well be causing an increase in that mechanism,” DeNicola said. “It’s revved up.”
If labor occurs and a baby is born before 37 weeks, it’s a preterm birth, compared with a normal pregnancy of 40 weeks. Some of these newborns may have immature organ systems and experience trouble with breathing, feeding and regulating body temperature. Long term, premature babies might develop other problems, including learning disabilities and hearing or vision problems. The more premature the baby, the more serious the health risks.
Racial disparities in exposure
In the JAMA study, women of all races were at increased risk for poor pregnancy outcomes when exposed to heat and air pollution, but disparities emerged. Black women consistently had the highest risks of preterm birth and low birth weight, said Rupa Basu, an epidemiologist who also co-wrote the JAMA study. She is chief of the air and climate epidemiology section at the California Office of Environmental Health Hazard Assessment.
Because of historical redlining, higher-risk communities might be exposed to more pollution from sources such as freeways, she said. Residents may also dwell within “heat islands,” urban locations that have higher temperatures than outlying areas. “There’s less green space and more buildings and cement and blacktops to really absorb and retain the heat,” Basu said.
Anecdotally, Pandipati said he has seen the effects of heat waves on his patients, some of whom work in agriculture. He consults on high-risk pregnancies as a maternal and fetal medicine specialist with Obstetrix of San Jose. Some women travel to the Bay Area clinic from as far away as California’s Central Valley.
During one record-breaking heat wave before the pandemic, Pandipati noticed many ultrasounds with low levels of amniotic fluid in the womb — a situation that might require doctors to deliver a baby early. “These were moms who were saying that they don’t always have access to air conditioning, they’re often working more manually, either in agriculture or manual labor-type jobs, not always able to stay hydrated adequately,” he said. “I was starting to wonder, wow, I think this is really from the heat waves that we’re experiencing.”
“We just kept monitoring these pregnancies and then things just turned around and the fluid improved. They turned around as the heat wave dissipated,” he said. “We didn’t have to end up delivering them early.”
Air pollution and poor pregnancies
Air pollution, whether from urban pollutants or wildfires, has also been linked to poor pregnancy outcomes.
Air pollution affects preterm birthrates globally, study finds Wildfire pollution may have contributed to as many as 7,000 additional preterm births in California between 2007 and 2012, according to a study that Stanford researchers published in 2021. Wildfire smoke contains fine particulate matter called PM 2.5, which can enter the lungs and bloodstream to create serious health problems. The researchers hypothesized that wildfire pollution might have triggered an inflammatory response that led to preterm delivery.
Weather disasters and mental health
There’s debate about whether human-caused climate change is producing stronger or more frequent hurricanes. But Hurricane Sandy, which struck New York and New Jersey particularly hard in 2012, offered a glimpse into how such devastating superstorms can place severe stress on pregnant people.
In a 2019 study that looked at pregnancy complications in New York after Sandy, researchers found a heightened risk of problems such as early delivery and mental illness. The latter peaked about eight months after the hurricane. In the aftermath of community disasters, post-traumatic stress disorder, depression and anxiety can develop.
Natural disasters trigger a cascade of health consequences, DeNicola said. While there may not be direct cause and effect on birth outcomes, “a lot of it is considered to be because of the stress of the event, either the stress of evacuation or the stress of difficulty getting potable water, the stress of maybe not having the typical indoor living conditions that you’re expecting,” DeNicola said. “You’re not having heat or not having air conditioning.”
“There are a number of physical stressors and psychosocial stressors that come with bracing for a natural disaster like a hurricane and an evacuation,” he said. “People posit, and I think it’s a reasonable concern, that that all prompts some kind of cascade in pregnancy that creates things like preterm contractions.”
A safer pregnancy
Both obstetricians routinely talk to their patients about air and water.
“You need more hydration in pregnancy in general. A woman’s blood volume will increase roughly 50 percent during pregnancy,” DeNicola said. “That’s a lot of extra volume to maintain, so hydration’s really important anyway. I make the extra point that as the seasons get hotter, which happens more often now, you’ll need even more hydration and you need to be aware of things like preterm contractions that are prompted by extreme heat and dehydration.”
Pandipati said he warns patients to watch out for heat waves and to keep an eye on the air quality index, too.
“Ideally, 1 to 50 is good air quality. If you’re starting to get up into the 50 to 100 range, you need to start modifying your activities, doing less outdoor exercise, not as long, not as hard,” he said. “If you’re already not feeling well, you’re coughing, you already have respiratory illness, you shouldn’t be out there.”
Such illnesses include asthma, respiratory allergies and other chronic lung conditions, Pandipati said.
“By the time the AQI is 100, you need to just exercise indoors,” he said. “You need to plan your outdoor activities when the air quality is better, so usually, very early in the morning.” Air quality over 100 begins to enter the unhealthy range.
During wildfires, those who are pregnant must be especially careful about spending time outside, DeNicola said. “During covid, we all wear masks for everything, so it’s kind of redundant,” he said, “but I do mention that wearing a mask is advised and to really limit outdoor activity.”
Basu, the epidemiologist, has advocated for pregnant people to be included in heat advisories. “There are still a lot of heat advisories that don’t include pregnant women, but include other groups, such as the elderly,” she said. Many heat advisories also mention children, people with illnesses, even pets, but not pregnant people.
A natural experiment
A few pregnant patients have asked DeNicola about environmental concerns, but that small number is increasing, he said.
“I have had patients ask about where they should buy their new home because they heard that if you live near coal power plants, that could create worse air quality,” he said. “I’ve had them say similar things related to homes near a highway.”
Pandipati talks to fellow doctors about slipping climate change into the conversation naturally, for instance, while talking about outdoor exercise or staying hydrated during pregnancy. He tells doctors, “You don’t need to be an expert on climate emissions,” he said. “What you need to understand is that those emissions are leading to environmental changes that are now measurably increasing risks to the patients you care for.”
When DeNicola speaks to health-care professionals, he often mentions “a really strong natural experiment,” he said.
Researchers studied preterm birthrates before and after eight coal and oil power plants in California were retired. When the plants shuttered, pollution levels fell. In the 10 years following the closures, the rate of preterm births in the neighboring communities dropped 27 percent, a larger-than-expected reduction.
“When you knock out air pollution over a good 10-year period, the preterm birthrate dropped in a way that no other intervention can achieve,” DeNicola said. “It gives us a bit of hope.”
Doctors can start discussing climate change with pregnant patients, but in the long run, the solutions are much bigger, Pandipati said. “We need to be ensuring that we are enacting policies that stabilize or improve the environment, that really don’t neglect the science.”
“We’ve got to address the problem at the source,” he said. “That’s the real, ultimate preventive care.”
Chemicals Found in Cosmetics, Plastics Linked to Preterm Delivery
July 14, 2022
THURSDAY, July 14, 2022 (HealthDay News) – Phthalates, chemicals that are typically used to strengthen plastics, are in millions of products people use every day, but a new analysis confirms their link to a higher risk for preterm births.
The largest study to date on the topic analyzed data from over 6,000 pregnant women in the United States to better understand the link between phthalate exposure and pregnancy. It found that women with higher concentrations of phthalates in their urine were more likely to deliver preterm babies. Preterm babies, by definition, are delivered three or more weeks before their due date.
“Having a preterm birth can be dangerous for both baby and mom, so it is important to identify risk factors that could prevent it,” said senior study author Kelly Ferguson, an epidemiologist at the U.S. National Institute of Environmental Health Sciences (NIEHS).
For the study, the researchers pooled statistics from 16 studies conducted across the United States that included data on individual phthalate levels as well as the timing of the mothers’ deliveries, with the data spanning from 1983 to 2018. Approximately 9% (or 539) of the women delivered premature babies, with phthalate byproducts detected in over 96% of those urine samples.
The study, published online July 11 in JAMA Pediatrics, examined 11 different phthalates found in the pregnant women, and discovered that four of them were associated with a 14% to 16% greater probability of having a premature baby. The most consistent exposure was linked to a phthalate found commonly in nail polishes and other cosmetics.
“It is difficult for people to completely eliminate exposure to these chemicals in everyday life, but our results show that even small reductions within a large population could have positive impacts on both mothers and their children,” first study author Barrett Welch, a postdoctoral fellow at NIEHS, said in an institute news release.
The effort could be worth it: Reducing the level of phthalates exposure by 50% could prevent preterm births by 12%, on average, the researchers said. The interventions focused on specific changes, such as choosing phthalate-free personal care products, companies reducing the number of phthalates in their products on their own or changing regulations that would reduce exposure to these chemicals.
In the meantime, the researchers suggested avoiding processed food or food wrapped in plastic, instead opting for fresh, home-cooked meals. They also recommended choosing fragrance-free products, which are lower in phthalates. Limiting the amount of product used can also lower exposure. More information:
Visit the U.S. Centers for Disease Control and Prevention for more on phthalate exposure.
SOURCE: NIH/National Institute of Environmental Health Sciences, news release, July 11, 2022 https://consumer.healthday.com/b-7-14-chemicals-found-in-cosmetics-plastics-linked-to-preterm-delivery-2657652790.html
Forced Retirement Spotlighted as Risk Factor for Physician Suicide
— Also time to do away with the “myth of the never-ill physician,”study author says by Shannon Firth, Washington Correspondent, MedPage Today July 5, 2022
Systemic support systems need to be implemented for physicians to prevent work-related stressors that could lead to suicide, a thematic analysis of 200 physician deaths suggested.
Among physician suicides included in the National Violent Death Reporting System database from 2003 to 2018, six themes were found to precede such deaths, including inability to work due to physical health, substance use, mental health issues, relationship conflicts, legal problems, and increased financial stress, all leading to work-related stress, reported Kristen Kim, MD, of the University of California San Diego, and colleagues.
The results further suggested that suicide risk is associated with premature retirement due to health issues that affect employment, they noted in Suicide and Life-Threatening Behavior.
Among 200 physician death narratives, nearly all that reported earlier-than-expected retirement were linked to a physical ailment, Kim told MedPage Today, including a surgeon with a tremor, a physician with dementia, and a physician with alcohol and prescription drug use problems who had lost hospital privileges.
Investigations by state medical boards, employers, and law enforcement were also common in the narratives, and a re-examination of the data found that a majority of the physicians who died by suicide during the study period were unemployed or “pending job loss and typically not by choice,” the authors noted.
While interpersonal conflicts, including those occurring at work, were common, “strained relationships with family members,” often in the context of a divorce or extramarital affair, were even more common, they added.
The study showed “substantial overlap” with a prior study on job-related problems preceding nurse suicides, with a few exceptions. While nurses experienced difficulty accessing mental health supports and medications following job loss, physicians did not. Furthermore, legal issues were a factor in the physician suicide data but not in the nurse data.
Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.
“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” they wrote.
Kim said that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”
To that end, Kim and team offered some anonymous screening tools and “confidential pathways” to treatment, including UC San Diego’s Healer Education Assessment and Referral Program, which links physicians to counseling and outpatient treatment.
In addition, the “Dr. Lorna Breen Health Care Provider Protection Act,” which was signed into law in March, includes funding for hospitals to implement suicide prevention initiatives and to promote help-seeking.
Kim also stressed the urgent need to reform the licensure application process to eliminate “invasive” questions about physicians’ mental health and substance use history, which serve to discourage help-seeking and have unintended consequences for patient care.
For this study, Kim and colleagues used a mixed methods approach combining thematic analysis and natural language processing to develop themes representing narratives of 200 physician suicides included in the National Violent Death Reporting System database from 2003 to 2018.
Of the 200 physicians, mean age was 53, 83.5% were men, 89.5% were white, and 62.5% were married. Over half had mental health problems, 16% had problems with alcohol, 14.5% had other substance use problems, and 22% had physical health problems.
Using natural language processing, the authors confirmed five of the six identified themes — except “incapacity to work due to deterioration of physical health” — which “was likely not identified by natural language processing because physical health issues were described as the various, specific conditions affecting work performance (e.g., back pain, tremor), which were not grouped as a common theme.”
Limitations to the study included the fact that the evaluations were conducted postmortem based on short narratives — usually two paragraphs long — developed following interviews with loved ones.
“We’re using the best available data that we have on the reasons for why they decided to do what they did,” Kim said, but most of the data, with the exception of quotes from suicide notes in the narratives, were not first-hand accounts.
In addition, because most of the physicians in the study were men and white, the results may not be reflective of the work-related stressors of underrepresented minorities.
Furthermore, the database used in the study is voluntary. While the number of states participating rose from six in 2003 to 42 in 2018, including the District of Columbia and Puerto Rico, 10 states still do not report these data.
If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care
Front. Pediatr., 23 March 2022
Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8
Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.
Karen M. Puopolo, MD, PhD
CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference
Published on Mar 21, 2022 in CHOP News
Children’s Hospital of Philadelphia (CHOP) is proud to announce that Karen M. Puopolo, MD, PhD, a national leader in the field of neonatology, has received the prestigious Pennsylvania Pediatrician of the Year Award from the American Academy of Pediatrics (AAP) after a unanimous selection by the Pennsylvania AAP Governance Committee and Board of Directors. Each year, this prestigious award is granted to a Pennsylvania pediatrician who exemplifies the ideals of the pediatric profession and participates in activities that reflect the foundation of the chapter.
As an attending neonatologist at CHOP and Chief of the Section on Newborn Medicine at Pennsylvania Hospital, Dr. Puopolo has dedicated her career to quantifying the risk for neonatal infection. She developed a clinical tool known as a sepsis calculator to estimate risk at the individual infant level to avoid unnecessary antibiotic use in neonates. This research has drastically changed newborn care in birth hospitals throughout the U.S. and world.
Most recently, Dr. Puopolo conducted important research related to the COVID-19 pandemic. Dr. Puopolo led efforts of the national AAP Section on Neonatal Perinatal Medicine (SONPM) to draft clinical guidance on the screening and care of COVID-19-exposed and COVID-19-positive newborns.
“The naming of Dr. Puopolo as the PA AAP Pediatrician of the Year highlights her enormous contributions to perinatal health,” said Eric Eichenwald, MD, Chief of the Division of Neonatology at CHOP. “She embodies the AAP’s commitment to recognize women leaders who go above and beyond to provide excellent, evidenced-based care of newborns. What’s more, Dr. Puopolo’s unwavering dedication to advance the care of neonates during the COVID-19 pandemic has been unsurpassed.”
In addition to her clinical work, Dr. Puopolo serves as Associate Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She has authored hundreds of peer-reviewed publications, scientific abstracts, chapters, and editorials. A member of AAP since 1993, Dr. Puopolo has served many roles within the organization, including as a member of the Committee on Fetus and Newborn and on the Editorial Board of NeoReviews and Pediatrics.
Currently, Dr. Puopolo serves as chair for the AAP Southeastern Central Conference on Perinatal Research, where perinatal trainees can present their research and receive high-quality feedback.
Providing A Potential Treatment Option To Infants Where There Is None
Celia Spell April 21, 2022
A little over 1% of babies born in the U.S. in 2020 fell under the category of very low birthweight, meaning they weighed less than 1,500 grams at birth or 3 pounds, 4 ounces. And considering that the Centers for Disease Control and Prevention says more than 3.5 million babies were born that year, almost 48,500 were considered to be at very low birthweight.
Many of these babies are born premature, at 30 weeks or less, and they have a high chance of having a hemorrhage in their brains shortly after birth, known as a germinal matrix hemorrhage (GMH). Bleeding like this within the substance of the brain is a form of stroke that can lead to a buildup of fluid in the brain known as hydrocephalus – both of which put babies at an increased risk of neurodevelopmental disability, and many don’t survive.
There is currently no medical treatment for GMH, and since these blood vessels are even more delicate when a baby is born prematurely, there is no way to predict or prevent bleeding in the brain after birth.
When Ramin Eskandari, M.D., a pediatric neurosurgeon at MUSC Children’s Health, read about the work that Stephen Tomlinson, Ph.D., vice chair of the Department of Microbiology and Immunology at MUSC, was conducting related to a specific part of the immune system known as the complement system, he thought it might have applications to infants as well.
“We were just having to wait for bad things to happen,” Eskandari said. “And then we had to react to them. We have no treatment for the actual hemorrhage or for preventing the stroke or hydrocephalus that comes after. Tomlinson was looking at adult pathologies in the brain, and we thought it would be a great opportunity to apply his methods to an animal model for premature infants.”
As joint principal investigators for their recent paper in the International Journal of Molecular Sciences, Tomlinson and Eskandari created a mouse model to represent premature infants of very low birthweight and to find treatment options for GMH. Mohammed Alshareef, M.D., a senior neurosurgery resident at MUSC and member of the collaborative lab, discovered that by inhibiting the complement system at a specific site within the brain immediately after a hemorrhage, they could prevent many of the permanent and temporary deficits that accompany hydrocephalus and stroke.
By treating GMH mouse models with the complement inhibitor known as CR2Crry, Tomlinson and Eskandari found improved survival and weight gain, reduced brain injury and incidence of hydrocephalus, and improved motor and cognitive performances in adolescence.
As part of the immune system, the complement system helps antibodies and phagocytic cells activate inflammation and remove microbes and damaged cells from the body, labeling and attacking them. But inflammation activation also leads to the detrimental effects of GMH, and while there is still no way to prevent the initial hemorrhage, Tomlinson and Eskandari are excited about the potential opportunity to prevent the events that occur after the brain bleed.
Cases of GMH are on the rise, and according to Eskandari, this rise is actually due to better care and clinical advancements. With improved prenatal care and better treatment options for premature infants, more babies are surviving being born early. But with more survival, comes higher chances of GMH.
“We’re seeing younger and younger babies viable,” Eskandari said. “I remember when a 23-week-old baby wasn’t viable, and even in the last eight years since my residency, we’re now seeing babies at 20 weeks not only be viable but live full lives and attend school.” It’s these medical advancements that show Eskandari just how important the findings of this study are. And treatment of GMH has the potential to alter an infant’s life course.
Success in inhibiting the complement system has led to a recent boom in research, with over 100 clinical trials currently ongoing, according to Tomlinson. But CR2Crry inhibitor has its own niche. By targeting the therapeutic specifically to the point where the pathology begins, physicians don’t need to knock out the complement system in the entire body, which can lead to increased risk of infections and other immune disorders. They can use less of the inhibitor and target it to a local site, which is safer for patients.
“It’s because this is targeted,” Tomlinson said. “We can actually inject fairly small concentrations directly into the bloodstream to target the injured brain.”
In addition to using the CR2Crry inhibitor to develop a novel therapeutic for premature babies, Eskandari and Tomlinson think it has promise for treating other forms of brain injuries too. “These babies are a really good overall model of how all brain injury could potentially be helped,” Eskandari said. “Having a hemorrhage that leads to stroke and hydrocephalus checks a lot of boxes that we see in many patients.”
Tomlinson’s future research plans include looking at the complement system at different points following an injury in an effort to understand more fully the point at which it becomes part of an injury’s pathology rather than part of its healing process.
Eskandari hopes to host human clinical trials with the human equivalent of the CR2Crry inhibitor at MUSC next. He wants to help his premature patients to live the fullest lives possible. “We want to allow these babies to reach their full potential,” he said.
PREEMIE FAMILY PARTNERS
It takes a village: NICU parents share their experience as reminder that partners need support, too
Apr 5, 2022
Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner
ALEXANDRA ROTHSTEINJUNE 7, 2022
Some preterm neonatal patients can be discharged from the hospital sooner through the unique Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota.
This one-of-its-kind program in Minnesota allows infants that qualify to receive expert care and monitoring at home through the use of an app on a tablet and a scale. The parent caregiver inputs the baby’s vitals daily, which are then shared and monitored by the baby’s neonatal care team.
The Children’s Minnesota Neonatal Intensive Care Unit (NICU) in St. Paul conducted a pilot study with 20 patients during a one-year period to evaluate how at-home care impacts babies’ ability to learn to feed, rates of breastfeeding and overall patient-family satisfaction. The results of the pilot were overwhelmingly positive and, for one family, meant that a father could spend precious time with his newborn while battling his own illness.
A challenging time
The year of 2021 was a time of mixed emotions for Amanda and Rob Calvin. They were excited to be welcoming their first baby, but Rob was also battling pancreatic cancer. “When we found out about Rob’s diagnosis, he was given one year to live, so we decided to have a child,” Amanda recalled.
The Calvins expected their baby to arrive in early April, but around mid-February, Amanda started having complications from a bleeding disorder she’s had since birth. “My condition had been flaring up with my pregnancy and getting worse to the point where I had to be admitted to the hospital,” Amanda said.
With the pandemic still at its height – and in light of her illness and her husband’s cancer – Amanda had a virtual baby shower from her Minneapolis hospital room. There, she also dealt with another serious health concern called preeclampsia, a severe high blood pressure condition in pregnant women. Amanda had a C-section procedure the day after her baby shower at The Mother Baby Center, a partnership between Allina Health and Children’s Minnesota.
Baby Finn arrived early
On Valentine’s Day 2021, baby Finn entered the world nearly eight weeks early – weighing just 3 pounds and 13 ounces. Finn’s care team rushed the newborn to the NICU at Children’s Minnesota and placed the tiny infant on a breathing machine. Finn spent the next month splitting time between the NICU and the special care nursery.
“I remember all of his caregivers being the most compassionate people and they made sure I knew what was going on,” recalled Amanda, a physician specializing in pulmonary and critical care medicine with HealthPartners Park Nicollet. “I’m an ICU provider and my son was in the ICU. Vital signs for infants are completely different than vital signs for adults. I tried to shut out paying attention to that stuff. There was too much for me to process.”
Time was of the essence
As Finn and Amanda navigated the NICU, Rob continued his fight with pancreatic cancer. “Rob no longer responded to chemo and was about to transition to hospice,” said Amanda. “He was so sick he couldn’t make it to the hospital.”
Preterm babies usually stay in the hospital with their care team until when they would have been full-term to grow, learn how to eat and breathe on their own. But CHAMP allowed Finn to go home a month early. Amanda used the app to stay connected with his care team and took over feeding using a nasogastric (NG) feeding tube that was inserted before heading home.
“It ended up being a major blessing,” Amanda said. “We were stretched thin going back and forth to the hospital. We were making it work. Without this program, we would not have had time together as a family at home in the place where we wanted to be.”
Finn graduated from CHAMP after a week on the special care program. Rob passed away soon after his infant’s graduation. “Rob died six days before Finn’s original due date. Finn got to be home with his dad before he died. I can’t quantify the value of that,” Amanda said while reflecting on her late husband.
Today, Finn is a healthy 1-year-old and meeting or exceeding all of his physical and developmental milestones. “Everybody at Children’s Minnesota went out of their way to make sure Finn was cared for – that we were heard, and they knew what we needed more than we did,” Amanda said while holding back tears. “I can’t thank those people enough. They gave us time we would have never had.”
About CHAMP at Children’s Minnesota
Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota is the only program of its kind in Minnesota. Before heading home, babies have a nasogastric tube (NG) inserted. Families are provided with a scale and a tablet equipped with a program called Locus, which allows parents to input vitals that are shared with their neonatal team. Families are also trained by the team on proper NG and oral feeding techniques as well as CPR.
To qualify for CHAMP, a newborn must be a current Children’s Minnesota NICU patient, be able to breathe without any respiratory or oxygen support, weigh more than four pounds and consistently gain around 30 grams of bodyweight per day.
“Children’s Minnesota will always strive to pioneer cutting-edge programs that continue to put our patients first and keep families as part of their care team – CHAMP accomplishes all of these goals,” explained Dr. Cristina Miller, medical director of the NICU follow-up clinic at Children’s Minnesota, and founder and director of CHAMP. “Even though the babies who qualify for CHAMP are home, their clinical care team still remains at their bedside virtually to ensure they are growing, healthy and thriving.”
“The first question any parent asks when their child is admitted to the NICU is, ‘When can we go home?’ We’re hoping that this method helps families return to their normal daily lives faster, especially with the additional COVID-19 pandemic restrictions that have been in place,” said Dr. Miller. “But even after the pandemic is over eventually, this could be a game changer.”
Importance The Of Support For NICU Families
Mar 7, 2020 LivingHealthyChicago
A health complication involving kids can really rock a family’s world- especially when it involves the very youngest in our families. This mother is sharing her family’s story in hopes of raising awareness about the importance of support for NICU families. Plus, we learn about an innovative treatment being utilized to help with a heart health issue that’s more common in premature babies.
Chatting to your premature baby
Talking and listening to children from the moment they are born helps them develop. This is especially true for babies who are born prematurely.
When a child is born prematurely, they might spend some time in the neonatal unit at hospital. Talking to your baby from day one will help the two of you get to know each other. The stimulation of your voice will help your baby develop and bond with you in the early days.
Premature babies will get tired more quickly and sleep more, but there are lots of ways to communicate with your baby such as touch, eye contact and facial expressions are all ways of communicating.
Babies can communicate before they start talking. As soon as your baby is born, they can recognise the sound of your voice.
Tips for talking to your premature baby
- Kangaroo Care is when your baby is placed skin-to-skin on your chest. The contact will help to form a bond between you. Talk quietly and take time to listen to them – if they make noises try to respond.
- When you are ready, care staff will support you to do some routine tasks such as nappy changing, tube feeding, or bath time. This is a great time to talk to your baby about what you are doing or sing to them as you are doing it.
- When your baby is very small, they will like to grasp your finger and enjoy the feeling of your hands on their body.
- Call them by their name. The sound of your voice will help relax and soothe them.
- As the weeks go by, your baby will look at you for longer and see your face more clearly. Smile and respond to your baby.
- It’s never too early to read a story! Choose a baby book and read. Your voice will help your baby relax and fall asleep.
- Like adults, babies don’t always feel like being sociable. If your baby starts to hiccough, look away or yawn, these are signs they need to rest.
Innovative Music Therapy for the Brain Development of Premature Babies
Apr 3, 2022 HEC Science & Technology
It only takes a few chords to capture Ayla Campbell’s attention. She arrived 16 weeks early, weighing less than two pounds. While staying in MU Health Care’s neonatal intensive care unit, or NICU, Ayla received her first visit from a music therapist Emily Pivovarnik. “Her heart rate would just go down, and her oxygen was going up,” said Angel Campbell, Ayla’s mom. “If someone had told me that this could happen just from singing, I wouldn’t have believed it.” Pivovarnik is a trained music therapist who helps babies eat better, regulate their stress levels and adjust to stimulation. Pivovarnik is part of a team starting a research project to look at the long-term effects of a specific music therapy intervention called multimodal neurological enhancement, or MNE. This therapy combines music, gentle touch and rocking to help a baby’s brain develop. About 135 babies will be involved in the research project. After leaving the hospital, they’ll receive neurodevelopment testing.
Snuggling With Dad: Fathers’ Contact Can Help Preemies Thrive
THURSDAY, July 14, 2022 (HealthDay News) — Decades of research have shown the power of skin-to-skin contact between preemies and their moms, but would the same technique, dubbed “kangaroo care,” work with fathers?
Yes, claims a new Australian study that found when dads held their premature babies close to their bare chest, they reported feeling a “silent language of love and connection.”
“It’s like when your finger touches a fire, there are receptors there letting you know that it’s hot,” said study author Qiuxia Dong, a nurse and master’s candidate at the University of South Australia. “It’s the same thing [in kangaroo care], when the attachment happens between father and baby or mother and baby, it’s just another reaction.”
First-time father Joel Mackenzie experienced it with his tiny daughter, Lucy, when he was first able to hold her, two weeks into her time in the neonatal intensive care unit (NICU). Mackenzie explained that the NICU experience can be a really isolating one for parents, especially dads who are not often considered by the health care system when it comes to reconnecting with their child after a medical intervention.
“I felt like I was actively fostering her survival and her development by giving her a cuddle,” said Mackenzie, who was one of 10 dads followed in the study.
The findings were published online recently in the Journal of Clinical Nursing.
One expert in neonatal care described how the bonding process works.
“There are biologic phenomenon that exist that allow babies and their parents to bond, and there are hormones that get released that allow you to fall in love,” explained Dr. Robert Angert, a neonatologist at NYU Langone in New York City. “Those are stimulated by all your senses — your sight, but also your smell and touch. If you cut out some of those senses, you’re going to miss out on those opportunities,” he said.
“On the other side, you have anxiety and stress, and those make it harder to fall in love. As they describe in the article, a lot of parents, particularly non-birthing parents, are stressed and anxious and worried about the well-being of their child, especially a baby who’s in the ICU,” Angert added. “Bringing them together safely and in a way that’s helpful to the baby reduces that anxiety to the parent.”
Research has shown that during kangaroo care, the close contact activates nerve receptors in mammals that increase the production of hormones that lower pain and stress for both babies and parents.
The latest study illustrated that: Many of the fathers described the NICU environment as “overwhelming,” but the ability to hold their children next to their skin fostered strong bonds and relaxed them, which helped build confidence and made them very happy.
“It was palpable how much of an impact it had on her,” Mackenzie said. “Of course, it helped me in bonding with her and helping me understand her and what was good for her as a child, but also as well you could almost tell that she almost drew energy from us. She started to move better, she started to develop faster. I’d see her move better on a day-to-day basis. Eat more, be more responsive. Her eyes would open and move and engage more each time we took her out of the crib.”
Having to separate a newborn from its parent for medical reasons isn’t just traumatic for parents, it can have emotional and developmental impacts on the infant as well.
Angert said that “separation is an incredibly traumatic event in the life of a newborn, and I think we underestimate the impact that that event has on a baby. So we have an opportunity here to restore some of that togetherness, and it’s not without good reason that we’re taking the baby away. We’re saving their life. But it’s also good to think about when we can reestablish contact and allow them to give kangaroo care to their babies.”
Parents who go through the NICU process have no doubts about the efficacy of staying by their child’s side when they’re sick. Mackenzie, whose child will celebrate her first birthday next week, said the bonding made all the difference.
“She still has mild lung disease and chronic cerebral palsy, but [the kangaroo care] part of her NICU experience was definitely a contributing factor to where she is now, I have no doubt about it,” Mackenzie said. “Children who’ve gone through this experience definitely have a better chance of survival in my opinion.”
More information: To learn more about skin-to-skin contact benefits between parents and newborns, visit the Cleveland Clinic.
Alexis Ferko, B.A., OTS
Occupational Therapy and Infancy: Occupational therapy (OT) is a holistic, client-centered, occupation-based profession focused on assisting individuals to independently participate in daily activities to the best of their ability . Occupational therapy practitioners (OTP) are board certified, have extensive academic training and clinical experience and treat individuals across the lifespan in various settings while considering the “biological, developmental, and social-emotional aspects of human function in the context of daily occupations”. OTPs utilize the power of occupation to support families and infants in achieving positive outcomes . The first year of an infant’s life is a rapid period of growth; infants are learning how to actively interact with their environment and family system. Occupations of infancy are defined as “any activity or task of value in which the family or setting expects the infant to engage” including activities of daily living (ADL) like feeding and bathing, health management including social and emotional health promotion and maintenance, rest and sleep, play and social participation . Infants also participate in co-occupations, meaning infants share an occupation with their caregiver; examples such as play and breastfeeding . OTPs also assist families with adapting to new performance patterns including habits, roles, routines, and client factors. OTPs treat infants in settings including hospitals or NICU’s, early intervention (EI), outpatient, and community-based settings. Infants may be referred to OT for concerns with maintaining homeostasis or bonding in the NICU, feeding or sensory concerns, physical development, social-emotional skills, and sleep .
OT in the NICU: Many infants and families have their first experience with OT in the NICU setting. NICU OTPs have extensive knowledge in neonatal medical conditions, development and understand the complex medical needs of infants in this setting . OTPs are members of an interdisciplinary team of professionals including pediatricians, physical therapists (PT), speech-language pathologists (SLP), lactation consultants, respiratory therapists, nurses, midwives, neonatologists, among others. OTPs administer assessments related to sensory processing, motor function, social-emotional development, pain, activities of daily living (ADL), neurobehavioral organization, and environmental screenings to identify and create an appropriate infant and family-centered intervention plan. The primary functions of an OT in the NICU is to focus on developmentally appropriate occupations, maintaining homeostasis (stable vitals, feeding, breathing), self-regulation, sensory development, feeding, motor function, coping and attachment skills, bathing and dressing, and nurturing interactions with caregivers including skin to-skin contact. OTPs utilize various interventions including sensory integration, neurodevelopmental techniques, positioning/handling, infant massage, feeding, bonding, and environmental modifications to minimize stress and overstimulation while in this setting. Therapists must also address the family system by forming a therapeutic relationship with the family. The NICU can cause separation between infant and caregivers especially if there are maternal complications after delivery which can increase stress and instability within the family system . Parent-infant attachments and occupations must be prioritized, including bonding such as skin-to-skin contact, or kangaroo care. Kangaroo care is an essential intervention to support infants in the NICU by having the infant lay on the caregiver’s bare skin. Benefits to this intervention include more stable heart rate, breathing patterns and temperatures, faster weight gain, more successful feeding, and increased bonding. OTPs also consider the Neonatal Integrative Developmental Care Model, meaning therapists are fostering a healing environment in the NICU setting – a setting known to be stressful and overstimulating for infants and their families. Core measures of this model include skin protection, optimizing nutrition, positioning/handling to promote breathing and stability, safeguarding sleep, optimizing nutrition, minimizing stress and pain through environmental and sensory modifications, and partnering with families . Research shows that interventionists who follow this model have better growth development outcomes.
Breastfeeding and Feeding: As of 2020, over 83% of infants are breastfed at some point in their young life. 60% of mothers stop breastfeeding before they intend to stop due to various reasons including latching difficulties, infant weight concerns, lack of work and family support, and concerns with medication while breastfeeding. OT can assist with facilitating breastfeeding which improves parent-infant attachment and bonding and can also reduce postpartum depression . OTPs must consider various aspects of the infant caregiver dyad during breastfeeding including infant arousal state, respiratory ability, overall stability, oral reflexes, oral strength and endurance and caregiver arousal, attention, posture and upper extremity strength, cognition, and cultural values/beliefs related to feeding . It is also important to consider sensory and environmental stimulation, social supports, and bottle/nipple type if the infant is not being breastfed. OTPs can assist breastfeeding caregivers with developing routines and habits to promote breastfeeding and education related to their infant’s hunger and stress cues, positioning, ergonomics, self-regulation, and environmental modifications . Infant interventions include suck training, positioning, and various sensory strategies to promote arousal levels. Environmental and activity modifications include changing the position of feeds, adapting the lighting, touch, sound and using supportive equipment during feeding and adapting the type, thickness or volume of milk and feeding schedule . Feeding is a very important occupation for an infant as it takes up much of their early life and helps facilitate secure attachments to their caregiver as well as promoting self-regulation .
OT’s Role in Transitioning Home: OT also plays a role in assisting families with the transition from NICU to home. Transition planning begins at NICU admission with OTPs educating families on various interventions and considerations for the infant’s unique medical needs. Upon discharge from the NICU, OTPs may recommend follow-up with EI, outpatient OT or PT, or a feeding clinic to address various concerns including feeding, global developmental delay, ROM or joint limitations, tone management, among others . OTPs also educate families on general infant care like signs of stress and how to relax or calm an infant, feeding strategies, home environment set-up and safe sleep strategies. OTPs also work with lactation consultants to address any concerns or strategies related to breastfeeding.
Early Intervention and Infancy: Infant occupations vary based on family, contextual and cultural factors. OT is a primary service under IDEA Part C and delivers services related to the infant’s individualized family service plan (IFSP) outcomes . Gorga (1989) identified seven areas of occupational therapy treatment practices for infants in EI including motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills and play . OT interventions include handling, positioning, adapting the environment, sensory registration, arousal, attention, emotional regulation, cognition, feeding and play activities like reach and grasp. The American Occupational Therapy Association (AOTA) elaborated on various interventions in early intervention including promoting healthy bonding and attachment, family education and training, adapting tasks and the environment, participation in ADLs, rest and sleep and play related to the infant’s IFSP outcomes.
Conclusion: Occupational therapy practitioners are client-centered, occupation-based and address the infant and their family holistically. Various occupations OTPs can address include feeding, bathing, rest and sleep, health management, play and social participation, among others. Breastfeeding is also an important co-occupation OTPs can address in this setting. OT can also work with the family to promote carryover of strategies, encourage developmental care, and optimize infant well-being in the NICU, EI and home setting. Various professions work with occupational therapists on multidisciplinary, transdisciplinary, and interdisciplinary teams including PT, SLP, pediatricians, lactation consultants, nursing, midwives, neonatologists, and other specialists. These professions would benefit from working with OT to help increase independence, improve overall well-being and participation in infant and family occupations all of which leads to a greater quality of life for both the infant and family. Occupational therapists serve a unique role in the neonatal intensive care setting by identifying, promoting, and advocating for developmental care practices that aim to support families in participating in these early occupations.
An estimated 15 million babies are born prematurely every year, posing a significant risk to both maternal and neonatal health. The EU funded WISH project promotes a novel tool for monitoring the risk of preterm labour at home.
Preterm birth is defined as any live birth before the 37th week of pregnancy and is associated with complications that lead to neonatal and infant mortality. Additionally, premature babies are prone to serious long-term illnesses, lifelong disabilities such as cerebral palsy and respiratory illnesses as well as poor quality of life. Consequently, preterm birth is the cause of great suffering and psychological stress to parents. For further information see the IDTechEx report on Wearable Sensors 2021-2031.
Machine learning to predict preterm birth
Currently, regular medical check-ups and clinical examinations in a hospital setting are the only available solution for expectant women to diagnose preterm labour. However, expecting couples often mistake Braxton Hicks contractions, which occur normally during a healthy pregnancy, as preterm labour contractions. This increases hospital visits and concomitant healthcare costs. To address this issue, the EU-funded WISH project has developed an innovative platform for antepartum maternal and foetal monitoring. “WISH integrates seamlessly into the daily activities of expectant women in a way that will enable remote antepartum monitoring at home,” explains Julien Penders, co-founder and COO of Bloomlife. The WISH system consists of a specifically designed electrode patch, a consumer app, a web-based dashboard and a secure cloud data platform. It measures maternal and foetal health parameters, such as heart rate and uterine activity, through a specific sensor. This real time information is processed using advanced algorithms and machine learning to provide the probability of a woman being in labour.
Clinical validation and prospects
The WISH solution was tested and validated during the project in a two-centre, interventional study on 150 pregnant women. Study participants received a WISH system and were asked to use it at least three nights per week until they gave birth. Results demonstrated that the WISH system had similar accuracy in labour detection with current diagnostic methods used in hospital. “This clearly illustrated the feasibility of applying non-invasive wearable technology at home as an alternative labour management strategy,” emphasises Penders.
Preterm birth is a global health problem and one of the EU healthcare priority areas. The high socioeconomic impact of preterm birth necessitates novel solutions for predicting and prolonging the gestational age at delivery. The WISH project laid the foundation for a new non-invasive approach for preterm labour detection and a much needed tool for high-risk pregnancies. Implementation of WISH is expected to provide essential data for both expectant women and healthcare providers, facilitating more efficient prenatal care across Europe. Importantly, WISH will offer reassurance to women throughout the last stages of pregnancy through the provision of trustworthy information. Future efforts will focus on how to exploit the WISH solution to improve doctor-patient communication, implement preventive actions and timely interventions to reduce preterm births and radically change prenatal care across Europe. Penders envisions pivotal clinical trials will support the CE marking of WISH as a medical device and render it ready for commercialisation.
CDC: Infant outcomes vary by maternal place of birth
JUNE 29, 2022
Maternal characteristics and infant outcomes vary by maternal place of birth, according to a report published in the June issue of Vital and Health Statistics, a publication of the U.S. Centers for Disease Control and Prevention National Center for Health Statistics.
Anne K. Driscoll, Ph.D., and Claudia P. Valenzuela, M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, describe and compare maternal characteristics and infant outcomes by maternal place of birth among births occurring in 2020.
The researchers found that 21.9 percent of women who gave birth in the United States in 2020 were born outside of the United States. Women born in Latin America accounted for 12.0 and 54.9 percent of all women giving birth and those born outside of the United States, respectively, while women born in Asia accounted for 5.9 and 27.2 percent, respectively. Maternal characteristics varied by region, subregion, and country of birth, with the percentage of women giving birth under age 20 higher for women born in the United States (5.0 percent) than for those born in other regions, and obesity rates varying from 10.7 percent for women born in Asia to 38.1 percent for women born in Oceania. Infant outcomes varied by mother’s place of birth, with preterm birth rates varying from 6.90 to 11.43 percent of infants of women born in Canada and Oceania, respectively. Similar variation was seen for low birthweight and neonatal intensive care unit admission rates.
“The characteristics, residence patterns, and infant outcomes of women born outside the United States vary considerably,” the authors write.
NICU Lighting Tech Licensed to NASA Spinoff
Post Date: April 11, 2022
Cincinnati Children’s has licensed technology that mimics sunlight in the NICU of the new Critical Care Building to a NASA spinoff, which is marketing a consumer product called the SkyView Wellness Table Lamp.
California-based Biological Innovations and Optimization Systems LLC, or BIOS, focuses on the biological application of LED lighting for people and plants.
BIOS announced it has licensed the exclusive rights to the violet light technology invented and developed at Cincinnati Children’s, which optimizes light exposures and can influence circadian rhythms, eye development and metabolism.
The violet light technology is a component in the world’s first full-spectrum, tunable lighting system in a neonatal intensive care unit, which was installed in the Critical Care Building that opened on the Burnet Campus of Cincinnati Children’s in November 2021.
Richard Lang, PhD, director of the Visual Systems Group at Cincinnati Children’s, has worked with colleagues for more than a decade to better understand the role that sunlight plays in fetal development. Their discoveries, coupled with growing scientific knowledge about the importance of circadian rhythms to human health, sparked the idea to install lights in the NICU that could provide the full range of wavelengths found in sunlight.
“Our recent discoveries showed that violet light plays a crucial role in normal human physiology,” Lang said. “This prompted us to work with BIOS lighting to deploy a new human-centric lighting technology in our neonatal intensive care unit. We believe everyone can benefit from human-centric lighting.”
The licensing agreement comes in the wake of global studies by researchers into sleep complaints and circadian disturbances observed during the COVID-19 pandemic, BIOS stated. The science behind the company’s biological lighting expertise was first developed for the International Space Station.
“BIOS is committed to creating human-centric lighting designed to promote health and wellbeing,” Robert Soler, a former NASA engineer who is vice president of biological research and technology for Bios, said in a news release. “When the opportunity arose, we were excited to work with Cincinnati Children’s and co-develop new human-centric lighting technology. We now offer this technology in our SkyView Wellness Table Lamp.”
Over the past few weeks extreme heat waves have resulted in record breaking temperatures worldwide. Living in London, I witnessed the impact of the 105-degree temperature on the local community, nature parks, infrastructure, and public transportation. With tube station, railway, and plane shutdowns due to fires and melting roadways it was clear that this was an event that would mark an obvious need to shift towards increased climate action both within the UK and Worldwide. Millions of residents were encouraged to stay home, avoid attending events and work outside of the home and were provided emergency warning resources and information about ways to stay safe. The impact of this recent climate event has now moved along to the Pacific Northwest Region where many of my family members and friends have reported similar disruptions in their communities as consecutive high temperatures throughout the last week of July into August will reach an all-time high.
Climate change has and will continue to impact every community in a variety of anticipated and unexpected ways. Amongst our global neonatal community studies have shown a direct correlation between the effects of rising temperatures and increased risk for preterm labour. For example, a recent 2020 BMJ meta-analysis study found that “the odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. “ (Cherish et al,2020)
Increased research efforts to investigate the impact of climate change on preterm birth rates and outcomes will be instrumental in addressing collaborative solutions to implement preventative interventions and improved care to those negatively impacted as a result of climate change on maternal and neonatal health. As an active community we can do our part to enhance our knowledge and find creative ways to be a part of the solution towards helping to improve our carbon footprint within our communities and homes.
Personally, I believe our global youth have in many ways led the forefront towards addressing climate change. We have included a few engaging videos discussing ways we can help to address climate change and the experiences of young climate activists like Greta and friends who may inspire us to pick up some new habits and get involved in doing our part to bring about the prioritization of climate action to improve the health of our planet and our livelihood now and in the future.
Climate Change for Kids | A fun engaging introduction to climate change for kids
Hey Teachers and Parents! In this video we explore climate change for kids. We learn all about the causes of climate change like the greenhouse effect, fossil fuel burning, farming, and even deforestation and why these are big dilemmas in today’s world. We also cover ways that we can help prevent climate change and be friendlier to our environment including: walking, planting trees, using less electricity and other fun ways. We hope you and your students have fun as they learn about climate change and what we can each do to help planet earth. We also invite you to download our FREE climate change lesson plan (for grades 4-6) that is complete with more content, worksheets, activities for kids, and more!
Greta and eight young activists reveal how the climate crisis is shaping their lives | UNICEF
Nine young activists explain how climate change is affecting their lives and who inspires their efforts to make our planet a better place. Greta Thunberg (Sweden) is joined by Alexandria Villasenor (USA), Catarina Lorenzo (Brazil), Carlos Manuel (Palau), Timoci Naulusala (Fiji), Iris Duquesn (France), Raina Ivanova (Germany), Raslene Jbali (Tunisia) and Ridhima Pandey (India).
SURFING In PHILIPPINES BRITISH Mum So HAPPY To Do This
Oct 22, 2020
Surfing in the Philippines was not something that we thought about when planning our holiday. Usually you think of Hawaii’s waves and the surf vibe and culture. So when we realized we’d stumbled into Siargao Island the little Hawaii of the Philippines, we knew one of us had to take to the water and try out a surf lesson. As a British family, most of us didn’t grow up around surf culture because of the cold water and weather so we were so happy to do this here in the bath warm pacific ocean. We booked a private lesson with Racel from Makulay Resort Santa Fe in General Luna. It cost 1400 pesos or around £21 for a two hour teaching session, and Racel is actually a professional competing surfer so it felt even better to get our first experience of surfing in the Philippines with him. I stood up multiple times on the board and I highly recommend lessons with Racel if you find yourself on Siargao Island wanting to learn to surf. If this mum can do it, anyone can!