The Neonatal Womb Warriors

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

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

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

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

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

PERPOWERS!

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

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

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

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

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

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

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

• GLOBAL PRETERM BIRTH RATES – Botswana
• Estimated # of preterm births: 12 per 100 live births
• (Global Average: 10.6)
• Source- https://worldpopulationreview.com/country-rankings/preterm-birth-rates-by-country

COMMUNITY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HEALTHCARE PARTNERS

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

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

What is a Certified Child Life Specialist (CCLS)?

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

What is the Role of a Certified Child Life Specialist?

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

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

 Certified Child Life Specialists in the NICU

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

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

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

PREEMIE FAMILY PARTNERS

ABSTRACT

Background

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

Objective

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

Search Strategy

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

Selection Criteria

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

Data Collection and Analysis

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

Main Results

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

Conclusion

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

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

Key Points

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

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

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

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

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

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

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

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

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

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

What emotions are common for grandparents in the NICU?

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

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

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

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

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

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

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

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

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

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

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

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

How can you prepare your older children for the NICU?

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

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

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

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

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

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

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

 Watch your baby.

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

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

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

Five Levels Of Infant Behaviour

1. The physiological level.

 2. Muscle tone and quality of physical movements.

3. The level of state and alertness.

 4. The level of interactive behaviour.

 5. The stress level.

Physiological Signs

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

Breathing and Pattern of Breathing

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

Motor Tone and Motor Control

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

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

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

 3. Sleeping and Waking Behavioural States

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

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

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

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

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

Actively Awake

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

Crying

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

4. Interactive Behaviour

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

Opportunities to observe interaction

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

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

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

Cues that your baby is ready to interact:

Babbling

– Soft smooth movement with arms and legs.

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

– General muscle tone is average or lower.

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

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

– His mouth is relaxed and slightly open.

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

– He calms upon hearing your voice

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

– He closes his eyes or turns away.

– His breathing becomes irregular.

– He may stretch or wriggle or arch his back.

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

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

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

– He falls asleep.

– His skin appears mottled or pale.

– Paroxysmal (at the extremities), circumoral (around the mouth) or periocular (around the eyes)    

   cyanosis (blue colour) is visible.

– He displays roving eye movements or tight blinking.

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

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

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

   comfortable.

– Sucks his hand.

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

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

– Turns away from strong stimuli.

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

INNOVATIONS

Abstract

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

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

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

Tiny Tech: Innovations Reshaping Neonatal Care

By Juliane Crafton, MSN RNC-NIC

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

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

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

What’s New and What’s Coming

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

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

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

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

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

Evolving Tools, Evolving Roles

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

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

Conclusion

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

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

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

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

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

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

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

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

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

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

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

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

Environmental conservation is another form of protecting life.

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

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

Every effort counts.

Together, we are not only survivors.

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

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

Jul 21, 2025

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

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

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

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

• GLOBAL PRETERM BIRTH RATES – Cambodia
• Estimated # of preterm births: 10.5 per 100 live births
• (Global Average: 10.6)
• Source- WHO Preterm Birth Rate (Per 100 Live Births)

COMMUNITY

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

20 February 2025

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

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

Strengthening health systems 

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

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

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

Strong leadership and strategic framework 

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

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

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

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

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

Remaining challenges  

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

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

The way forward 

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

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

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

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

12 June 2025

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

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

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

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

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

Those are our babies

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

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

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

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

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

Fortifying our commitment to pediatric academic medicine during turbulent times

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

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

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

Fiscal pressure on the future of pediatric academic medicine

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

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

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

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

Call to action

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

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

Abstract

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

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

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

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

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

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

HEALTHCARE PARTNERS

Why it matters: 

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

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

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

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

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

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

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

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

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

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

Design and Define

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

Manage

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

Sustain

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

Train and Feedback

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

Manage Team Boundaries

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

Manage Organizational Context

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

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

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

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

PREEMIE FAMILY PARTNERS

New insights into brain and behavior development:

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

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

Signaling behavior:

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

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

Signaling behavior of hospitalized babies:

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

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

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

IFCDC standards provide a foundation for supporting signaling behavior:

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

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

The continuum after discharge:

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

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

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

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

Conclusion:

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

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

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

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

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

INNOVATIONS

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

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

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

Is a Wireless NICU Possible?

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

Is a Wireless NICU Desirable?

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

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

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

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

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

Non-Contact

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

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

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

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

Wireless Wearables

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

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

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

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

Abstract

Background

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

Methods and findings

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

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

Conclusion

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

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

First Responders

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

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

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

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

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