Estimated # of preterm births: 8.84 per 100 live births (USA 9.56-Global Average: 10.6)

Source- WHO 2014-

Hungary is a landlocked country in Central Europe. Spanning 93,030 square kilometres (35,920 sq mi) of the Carpathian Basin, it is bordered by Slovakia to the north, Ukraine to the northeast, Romania to the east and southeast, Serbia to the south, Croatia and Slovenia to the southwest, and Austria to the west. Hungary has a population of 9.7 million, mostly ethnic Hungarians and a significant Romani minorityHungarian, the official language, is the world’s most widely spoken Uralic language and among the few non-Indo-European languages widely spoken in Europe. Budapest is the country’s capital and largest city; other major urban areas include DebrecenSzegedMiskolcPécs, and Győr.

Hungary is a middle power in international affairs, owing mostly to its cultural and economic influence. It is a high-income economy with a very high human development index, where citizens enjoy universal health care and tuition-free secondary education. Hungary has a long history of significant contributions to artsmusicliteraturesportsscience and technology. It is a popular tourist destination in Europe, drawing 24.5 million international tourists in 2019. It is a member of numerous international organisations, including the Council of EuropeNATOUnited NationsWorld Health OrganizationWorld Trade OrganizationWorld BankInternational Investment BankAsian Infrastructure Investment Bank, and the Visegrád Group.

Hungary maintains a universal health care system largely financed by government national health insurance. According to the OECD, 100% of the population is covered by universal health insurance, which is free for children, students, pensioners, people with low income, handicapped people, and church employees. Hungary spends 7.2% of GDP on healthcare, spending $2,045 per capita, of which $1,365 is provided by the government.

Hungary is one of the main destinations of medical tourism in Europe, particularly for dentistry, in which its share is 42% in Europe and 21% worldwide. Plastic surgery is also a key sector, with 30% of the clients coming from abroad. Hungary is well known for its spa culture and is home to numerous medicinal spas, which attract “spa tourism”.



Exposure to Air Pollution and Emergency Department Visits During the First Year of Life Among Preterm and Full-term Infants

Original Investigation  Environmental Health  February 22, 2023 Anaïs Teyton, MPH1,2,3Rebecca J. Baer, MPH4,5Tarik Benmarhnia, PhD3; et alGretchen Bandoli, PhD1,5 JAMA Netw Open.2023;6(2):e230262. doi:10.1001/jamanetworkopen.2023.0262

Key Points

Question  What is the association between fine particulate matter (PM2.5) exposure and emergency department (ED) visits during the first year of life, and are preterm infants more susceptible to PM2.5 exposure than full-term infants?

Findings  In this cohort study of 1 983 700 infants, a positive association was observed between PM2.5 exposure and all-cause, infection-related, and respiratory-related visits. Preterm and full-term infants were most susceptible to having an all-cause ED visit during their fourth and fifth months of life.

Meaning  These findings suggest that increased PM2.5 exposure was associated with an increased ED visit risk; thus, strategies aimed at reducing PM2.5 exposure for infants may be warranted.


Importance  Previous studies have focused on exposure to fine particulate matter 2.5 μm or less in diameter (PM2.5) and on birth outcome risks; however, few studies have evaluated the health consequences of PM2.5 exposure on infants during their first year of life and whether prematurity could exacerbate such risks.

Objective  To assess the association of PM2.5 exposure with emergency department (ED) visits during the first year of life and determine whether preterm birth status modifies the association.

Design, Setting, and Participants  This individual-level cohort study used data from the Study of Outcomes in Mothers and Infants cohort, which includes all live-born, singleton deliveries in California. Data from infants’ health records through their first birthday were included. Participants included 2 175 180 infants born between 2014 and 2018, and complete data were included for an analytic sample of 1 983 700 (91.2%). Analysis was conducted from October 2021 to September 2022.

Exposures  Weekly PM2.5 exposure at the residential ZIP code at birth was estimated from an ensemble model combining multiple machine learning algorithms and several potentially associated variables.

Main Outcomes and Measures  Main outcomes included the first all-cause ED visit and the first infection- and respiratory-related visits separately. Hypotheses were generated after data collection and prior to analysis. Pooled logistic regression models with a discrete time approach assessed PM2.5 exposure and time to ED visits during each week of the first year of life and across the entire year. Preterm birth status, sex, and payment type for delivery were assessed as effect modifiers.

Results  Of the 1 983 700 infants, 979 038 (49.4%) were female, 966 349 (48.7%) were Hispanic, and 142 081 (7.2%) were preterm. Across the first year of life, the odds of an ED visit for any cause were greater among both preterm (AOR, 1.056; 95% CI, 1.048-1.064) and full-term (AOR, 1.051; 95% CI, 1.049-1.053) infants for each 5-μg/m3 increase in exposure to PM2.5. Elevated odds were also observed for infection-related ED visit (preterm: AOR, 1.035; 95% CI, 1.001-1.069; full-term: AOR, 1.053; 95% CI, 1.044-1.062) and first respiratory-related ED visit (preterm: AOR, 1.080; 95% CI, 1.067-1.093; full-term: AOR,1.065; 95% CI, 1.061-1.069). For both preterm and full-term infants, ages 18 to 23 weeks were associated with the greatest odds of all-cause ED visits (AORs ranged from 1.034; 95% CI, 0.976-1.094 to 1.077; 95% CI, 1.022-1.135).

Conclusions and Relevance  Increasing PM2.5 exposure was associated with an increased ED visit risk for both preterm and full-term infants during the first year of life, which may have implications for interventions aimed at minimizing air pollution.


Considerations for Reducing Maternal Mortality

Elizabeth Filipovich, MPH

Maternal mortality in the United States is on the rise and has been for the past several decades. This trend stands out as other high-income countries, like the United Kingdom and Canada, have lower maternal mortality rates. Birthing people in the United States now experience worse mortality rates than the prior two generations. Maternal mortality ratios, or deaths per 100,00 live births, are used to illustrate the massive racial disparities among birthing people. Non-Hispanic Black birthing people have pregnancy-related mortality rates nearly 3x that of their white counterparts.

The Centers for Disease Control defines maternal mortality as “the death of a woman during pregnancy, at delivery, or soon after delivery.” Maternal deaths are further divided into two categories: pregnancy-related and pregnancy-associated deaths. Pregnancy-related deaths are defined as “the death of a woman while pregnant or within one year of the end of pregnancy, regardless of the outcome, duration, or site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”

Pregnancy-associated but not related deaths are “the death of a woman while pregnant or within one year of pregnancy from a cause or cause unrelated to pregnancy. Often, when maternal mortality is researched and discussed, the body of work emphasizes pregnancy-related deaths. For example, the statistics used in the above paragraph reference pregnancy-related deaths exclusively. However, a better understanding of factors contributing to many accidental, pregnancy-associated but not related deaths is essential for effective methods to reduce the number of maternal deaths in the United States, regardless of cause or manner of death.

Well-documented maternal death causes include hemorrhage, cardiomyopathy, or other cardiac causes, and worsening underlying conditions or other medical causes often deemed pregnancy-related. Equally important are other causes of death, including accidental poisonings or overdoses, maternal suicides, or homicides. These are pregnancy-associated, not related, or not directly caused or exacerbated by pregnancy. The many touchpoints of care in the perinatal period provide opportunities for intervention and opportunities for improved perinatal care, particularly for birthing people who have a history of substance use disorder (SUD), history of anxiety, depression, or other mood disorders, or families who may be at risk for violence, instability, or other significant hardship.

Statewide and local Maternal Mortality Review Committees (MMRC) are convened to examine maternal death trends by comprehensively reviewing deaths that occur during or within one year of pregnancy. MMRCs are multidisciplinary and include representatives from a spectrum of perinatal care providers, including public health, obstetrics, maternal-fetal medicine, pediatrics, nursing, midwifery, community health organizations, mental and behavioral health, and patient/family advocacy groups. MMRCs meet to discuss cases and collaboratively create evidence-based recommendations to prevent future deaths. MMRCs provide critical evidence for legislatures, health systems, and public health leaders to endorse safety bundles and new laws to prevent future deaths.

While MMRCs retrospectively review maternal deaths to understand preventable causes of these deaths further, providers and clinicians across all disciplines, as well as the public, can proactively impact the alarming rate of maternal deaths in this country. Neonatal care providers have a critical role. Despite becoming increasingly standard practice to have postpartum follow-up visits before four weeks postpartum, this is not universally implemented. Even if a postpartum follow-up is scheduled, not all birthing people attend a follow-up visit, as evidenced by several studies documenting that 11-46% do not attend a postpartum visit. However, well-child visits are very well attended by postpartum people. By capitalizing on the touchpoint of the well-child visits, providers capture an opportunity for assessment and potential referral or intervention.

 Neonatal providers can contribute to reducing maternal mortality in several ways. Pediatric and family providers are often left out of the conversation, but the reality is that many providers for infants have more touchpoints with birthing people in the postpartum period than their prenatal providers. Pediatric visits for neonates and infants provide the opportunity for intervention that begins with a thorough assessment of the birthing person and include awareness of resources available to provide to patients, as well as understanding that wellness is facilitated by a host of factors extend beyond the physical health of the patient.

The scope of this newsletter article is not broad enough for the depth of discussion,  but rather draws attention to how social determinants of health contribute to maternal deaths and how providers can continue to care for their patients by addressing them. Providers should attempt to understand the environment of each family. By exploring significant relationships, one can understand the birthing person’s support systems, the likelihood of experiencing violence, housing circumstances, income stability, etc. By connecting identified birthing persons to support services and resources and following up on successive pediatric visits, perinatal providers can reduce maternal mortality. For more information on perinatal mood disorders, perinatal substance use, and many other resources for providers and families, please visit


Want to grab a little sunshine! Take a listen to this fun song!

VALMAR ft. Szikora Robi – Úristen

Valmar is a popular Hungarian artist/band. Szikora Róbert – Hungarian singer and songwriter.

Optimizing Temperature of Preterm Infants in the Delivery Room

Preventing heat loss in infants less than 1500 grams and/or less than 30 weeks’ gestational age.

Bundle care approach

                                                                 Preterm Baby Package    Jan 22, 2023


Recognizing Our Biases, Understanding the Evidence, and Responding Equitably

Application of the Socioecological Model to Reduce Racial Disparities in the NICU-McCarty, Dana B. DPT, PT Editor(s): Christine A., Fortney PhD, RN, Section Editor-Advances in Neonatal Care 23(1):p 31-39, February 2023.



Implicit bias permeates beliefs and actions both personally and professionally and results in negative health outcomes for people of color—even in the neonatal intensive care unit (NICU). NICU clinicians may naïvely and incorrectly assume that NICU families receive unbiased care. Existing evidence establishing associations between sex, race, and neonatal outcomes may perpetuate the tendency to deny racial bias in NICU practice.

Evidence Acquisition: 

Using the socioecological model as a framework, this article outlines evidence for racial health disparities in the NICU on multiple levels—societal, community, institutional, interpersonal, and individual. Using current evidence and recommendations from the National Association of Neonatal Nurses Position Statement on “Racial Bias in the NICU,” appropriate interventions and equitable responses of the NICU clinician are explored.


Based on current evidence, clinicians should reject the notion that the social construct of race is the root cause for certain neonatal morbidities. Instead, clinicians should focus on the confluence of medical and social factors contributing to each individual infant’s progress. This critical distinction is not only important for clinicians employing life-saving interventions, but also for those who provide routine care, developmental care, and family education—as these biases can and do shape clinical interactions.

TABLE 1. – NANN’s Racial Disparity in the NICU Position Statement Recommendations

Elevate awareness of racial disparities, inclusion, and cultural sensitivity by providing education in cultural competence, presenting published research on the issues, and having open discussions about the topics.
Encourage diversity in the workforce.
Examine personal bias and beliefs, some of which may be unconscious. Be self-aware and open to feedback and observations from others.
Examine individual NICU statistics to evaluate significant trends in gestational age, race, and patient outcomes.
Invite families to participate in the culture of the NICU by involving a diverse team of parents on committees, such as a quality improvement committee.
Regularly use interpreters when caring for families who do not speak English. Relying on other family members to interpret for parents may contribute to misinformation and a lack of appropriate education.
Provide written and electronic information in multiple languages whenever possible.
Consider all discharge requirements and available resources to transition families to the home environment.
Advocate for racial awareness and equality in your hospital and community. Connect with hospital administrators, community leaders, and elected officials to discuss health outcomes of racial disparities, and advocate for resources that positively impact the social determinants of health affecting maternal and infant health.



A hidden epidemic of fetal alcohol syndrome

New legislation could help bring awareness and resources to prevention, diagnosis, and treatment of fetal alcohol spectrum disorders-By Kirsten Weir Date created: July 1, 2022

Stress and alcohol use often go hand in hand, a concerning pattern on the heels of the COVID-19 pandemic. Researchers have found that alcohol use increased sharply during the pandemic, and there is some evidence that those patterns were present among pregnant women as well, said Ira Chasnoff, MD, a pediatrician and fetal alcohol spectrum disorder (FASD) researcher at the University of Illinois College of Medicine in Chicago. Experts worry that the trend could result in more babies being born with damage from prenatal alcohol exposure.

Even before the pandemic, FASD was a significant problem. Experts estimate that 2% to 5% of U.S. schoolchildren—as many as 1 in 20—may be affected by prenatal alcohol exposure, which can cause complications with growth, behavior, and learning. The effects on individuals and families, as well as the economic costs, are substantial.

Yet support for FASD research and services is limited. The National Institute on Alcohol Abuse and Alcoholism funds innovative research on FASD, said Christie Petrenko, PhD, a clinical psychologist and research associate professor at Mt. Hope Family Center, University of Rochester, and codirector of the FASD Diagnostic and Evaluation Clinic there. But a Substance Abuse and Mental Health Services Administration (SAMHSA)–funded FASD Center for Excellence program was shuttered in 2016, leaving a big gap between the research being done and practical solutions for children and families affected by FASD, she said. Now, there’s a bipartisan bill before Congress, the FASD Respect Act, which would support FASD research, surveillance, and activities related to diagnosis, prevention, and treatment. (APA has endorsed this bill.)

Such attention is sorely needed, and psychologists have a significant role to play in diagnosis, prevention, and treatment, Petrenko said. “Families are desperate for support.” Yet many people with FASD haven’t even received an accurate diagnosis, let alone appropriate treatments.

Clinicians should be aware that FASD often overlaps with mental health symptoms. These problems begin in early childhood and exist through adulthood, as described by Mary O’Connor, PhD, ABPP, founder of the UCLA Fetal Alcohol Spectrum Disorders Clinic (Current Developmental Disorders Reports, Vol. 1, No. 1, 2014). Her research has also found a higher incidence of suicidal ideation and behavior in adolescents with FASD (Birth Defects Research, Vol. 111, No. 12, 2019). And many adults with FASD who have mental health disorders aren’t getting treatment, said Susan Stoner, PhD, a research associate professor at the University of Washington School of Medicine and director of the Washington State Parent-Child Assistance Program, a program for pregnant and parenting women with substance use disorders (Alcoholism: Clinical and Experimental Research, Vol. 46, No. 2, 2022). “We found those with less severe FASD tend to have worse mental health than those with more severe FASD, which might be because those with more severe FASD are more likely to have a diagnosis and more likely to get support,” she said.

Understanding FASD

Many variables determine whether an infant will be born with FASD and how severe the disorder will be. Such factors include how much a pregnant person drinks, the rate at which they metabolize alcohol, and the stage of fetal development during alcohol exposure. “There are too many variables at play to estimate a safe level of drinking during pregnancy,” Stoner said. “The safest amount of alcohol during pregnancy is zero.”

Prenatal alcohol exposure can result in several conditions that fall under the FASD umbrella. These include fetal alcohol syndrome (FAS) and partial FAS, both of which can cause growth problems, central nervous system problems, and characteristic facial features (including small eye openings, flattening of the ridge between the nose and lip, and a thin upper lip), in addition to problems with learning and behavior. People with alcohol-related neurodevelopmental disorder (ARND) don’t have the characteristic facial features or growth deficiency of FAS, but they may have wide-ranging neurocognitive disabilities and problems with behavior and learning. These diagnoses overlap with a newer term—neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE)—a classification first included in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) as a condition requiring further study (Kable, J. A., et al., Child Psychiatry & Human Development, Vol. 47, No. 2, 2016).

Each of the disorders in the fetal alcohol spectrum can cause problems with self-regulation, executive functioning, social skills, and math skills. These deficits often interfere with children’s performance in school and their ability to make friends. Yet while FASD often causes learning difficulties, the symptoms can be unpredictable. “FASD is the most common preventable cause of intellectual disability in the world. But the majority of alcohol-exposed children have a normal IQ,” Chasnoff said. One notable feature of FASD is a gap between intelligence and adaptive functioning, he added. One of his teen patients, for example, has above average intelligence but is unable to read clocks or count money. “In children affected by alcohol exposure, adaptive functioning is significantly lower than IQ,” he said.

Behavioral problems associated with FASD are common, and often misunderstood, said Petrenko. “So many of the symptoms of FASD can look like intentionally willful or oppositional behavior, when really there are underlying neurodevelopmental explanations,” she said. An accurate diagnosis is the first step toward putting supports in place to address those neurodevelopmental challenges and help people with FASD thrive.

Diagnosis and treatment of FASD

The gold standard for FASD diagnosis is a multidisciplinary evaluation looking at physical features, neurobehavioral impairments, and any known history of prenatal alcohol exposure. The assessment typically involves a variety of specialists such as physicians, speech/language pathologists, psychologists, and geneticists. But those comprehensive evaluations are hard to come by. “There are very few FASD clinics that provide full-service diagnosis,” O’Connor said. “It’s estimated that about only 1% of people with prenatal alcohol exposure can get a diagnosis in that type of situation.”

As a result, many children with FASD are falling through the cracks. Chasnoff and colleagues collected data from 547 foster and adopted children and found that within this group 86.5% of youth with FASD had never been diagnosed or had been misdiagnosed (Pediatrics, Vol. 135, No. 2, 2015). “The great majority of children that are affected by alcohol are misdiagnosed and taking inappropriate medications or receiving ineffective therapy,” Chasnoff said. “FASD should be in the differential diagnosis for any child who presents with behavior problems. And while no single discipline can diagnose FASD, psychologists have a major role to play in the diagnosis.”

Psychologists are also instrumental in designing treatments for children with FASD. To date, only a handful of evidence-based interventions have been developed, each targeting different aspects of FASD. Parents and Children Together (PACT), developed by Chasnoff and colleagues, is a 12-week family intervention that works with children ages 6 to 12 years old and their parents or caregivers to improve self-regulation and executive function. PACT builds on techniques learned from treating traumatic brain injury and sensory processing disorders. The research has found that the intervention improves executive functioning and emotional problem-solving in children with FAS and ARND (Wells, A. M., et al., American Journal of Occupational Therapy, Vol. 66, No. 1, 2012).

The Math Interactive Learning Experience (MILE) program, developed by clinical psychologist Claire Coles, PhD, at Emory University, is a tutoring intervention designed to improve math knowledge and skills, a common area of struggle for children with FASD. A study showed that the 6-week intervention improved both math skills and behavior in alcohol-affected children ages 3 to 10 (Journal of Developmental & Behavioral Pediatrics, Vol. 30, No. 1, 2009).

Children with FASD often have trouble learning social skills as well. The Good Buddies program, developed by O’Connor and colleagues, is designed to teach those skills in a group format over 12 weeks to children ages 6 to 12. The program is derived from an evidence-based treatment for improving children’s friendships, adapted for the specific behavioral and cognitive deficits common in children with FASD (Laugeson, E. A., et al., Child and Family Behavior Therapy, Vol. 29, No. 3, 2007).

The Families Moving Forward Program, created by Heather Carmichael Olson, PhD, and colleagues at Seattle Children’s Research Institute, provides support for families of children with FASD and significant behavioral challenges. The program targets caregivers rather than children themselves and typically lasts about 9 months, in person or by telehealth. Studies have shown the efficacy of the program (Bertrand, J., Research in Developmental Disabilities, Vol. 30, No. 5, 2009), which is now used in multiple states and Canada. Petrenko is collaborating with Olson and colleagues to develop a mobile app, Families Moving Forward (FMF) Connect, to help more families access resources and support (JMIR Formative Research, Vol. 5, No. 12, 2021). The researchers are also adapting the program for children from birth to age 3.

With the right tools, children and adults with FASD can lead successful lives. “The biggest thing we’ve learned is the idea of reframing—looking at behavioral symptoms in a new way,” Petrenko said. Instead of treating a child as oppositional, for instance, reframing helps providers and parents understand that the child may be unable to do what they’re asked because of working memory deficits or other cognitive impairments. “By reframing these interpretations, you can put supports in place to help people be more successful,” she said.

Preventing FASD, attacking stigma

Efforts are also underway to prevent babies from being born with FASD. The Centers for Disease Control and Prevention promotes two strategies to reduce alcohol-exposed pregnancies. CHOICES is an evidence-based program that helps women make decisions around drinking and contraception (Floyd, R. L., et al., American Journal of Preventive Medicine, Vol. 32, No. 1, 2007). The other strategy, alcohol screening and brief intervention (SBI), is a preventive service that involves screening questions about drinking patterns, a short conversation with patients who drink more than recommended amounts, and referral to treatment when appropriate (Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use [PDF, 2.11MB], Centers for Disease Control and Prevention, 2014). “These interventions could easily be incorporated as part of a psychologist’s practice,” O’Connor said. (See more on brief screening interventions.)

Other efforts are underway to reduce the number of children born with FASD. Stoner directs the Washington State Parent-Child Assistance Program (PCAP), a 3-year intensive case management program for mothers who have used alcohol or drugs during pregnancy. PCAP works with pregnant women to stop drinking and also continues to provide support after they give birth. The program connects mothers to social and health services to reduce the likelihood that their future children will be exposed to alcohol or drugs prenatally by reducing substance use or deferring pregnancy. PCAP has 15 sites in Washington covering 19 counties and 90% of the state population, Stoner said. While the program has had success, it was developed several decades ago, and its wide dissemination across the state makes it difficult to do a modern trial to evaluate its effectiveness. To develop that evidence base, Stoner and colleagues have launched a randomized controlled trial in Oklahoma, where they will compare outcomes for women in PCAP with those who receive services as usual.

While education and awareness of FASD have increased among physicians and mental health providers, many are still reluctant to speak with pregnant women about substance use, O’Connor said. Clinical psychologists can and should raise the topic with women in their care who are or might become pregnant. “Prevention can begin in the therapy room,” Stoner said. But it’s important to ask a woman about pregnancy and substance use in ways that encourage honesty and reduce stigma, O’Connor added. “So, for example, instead of asking, ‘Did you drink during pregnancy?’, it’s better to ask, ‘How often did you drink before you found out you were pregnant? And how much did you drink after?’” she said.

While careful conversation can help, stigma continues to be a challenge. Discomfort around the subject often prevents medical providers from asking women about alcohol use during pregnancy at all. Stigma also prevents women from seeking help for alcohol dependence and may prevent them from pursuing a FASD diagnosis for their child. Addressing negative perceptions about alcohol use during pregnancy is an important step toward reducing rates of FASD and improving lives for people with these conditions, Petrenko said. “People with FASD and their families are capable. They can thrive if we recognize their strengths and provide appropriate services and supports.


3 big factors that drive resident physician burnout


Jennifer Lubell Contributing News Writer-After surveying more than 20,000 physicians and other health professionals across the country, Mark Linzer, MD, has learned a great deal about the drivers of burnout—and possible remedies.

Physician burnout demands urgent action

The AMA is leading the national effort to solve the growing physician burnout crisis. We’re working to eliminate the dysfunction in health care by removing the obstacles and burdens that interfere with patient care.

“Feeling valued was a big mitigator, with burnout rates 30% lower if present. Teamwork was also a big mitigator, while work overload and fast-paced environments were key aggravators,” said Dr. Linzer. He was lead author of the study reporting on these findings that was published in JAMA Health Forum™.

Burnout is real. Rates skyrocketed at the end of 2021 to over 60%, noted Dr. Linzer, who is vice-chief of medicine at Hennepin Healthcare in Minneapolis and also directs the Institute for Professional Worklife there. Making changes at the residency training level is an important strategy for tackling burnout, he advised.

Research by Dr. Linzer and colleagues has revealed “several strong correlates of work conditions with resident burnout, which means there are many ways that programs can address this,” he said. Work-life factors such as teamwork, control of workload, fast-paced, chaotic environments, and time pressure can all affect burnout.

Researchers also identified three resident-specific items contributing to burnout:

  • Sleep impairment.
  • Program recognition of the resident.
  • Interruptions.

“One of our key findings is that work overload and sleep matter, even in the era of duty-hour restrictions,” noted Dr. Linzer.

Residency programs that take physicians’ well-being seriously are more attractive to residency applicants, he stressed. In an episode of “AMA Update,” Dr. Linzer discussed the innovative tool he uses to analyze resident burnout and specific actions residency program and health system leaders can take to increase well-being.

Mini Z research

Dr. Linzer developed the Mini Z measurement instrument, a tool that efficiently measures burnout. It takes two minutes to complete, reducing a six-page survey to a single page.

“Recent studies show it performs very well in measuring in terms of reliability and validity,” said Dr. Linzer. Mini Z versions exist for physicians, residents, nurses, leaders and other clinical staff.

Mini Z core items include three outcomes—satisfaction, stress and burnout, and seven predictors, including the main burnout causes of time pressure. There’s also the three C’s—control, chaos and culture—such as values alignment with leaders.

Translated into several languages, it’s used throughout the world.

Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.

Far too many American physicians experience burnout. That’s why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.

Innovations to promote well-being

Evidence-based program interventions usually work best at mitigating and prevent resident physician burnout, advised Dr. Linzer. These may include jeopardy coverage for essential life events, a newsletter celebrating resident achievements, removal of after-hours consult pager call, an extra day off for senior residents on the wards, and care packages distributed through night teams.

“Faculty being on the alert for adverse work environments, such as excess admissions and inability for residents to unplug from the work environment and head home, or in people being distanced on rounds—so they’re not really connecting—might prompt faculty to go deeper and discuss with the resident or program director if they can help,” Dr. Linzer said.

Residency program leaders should also involve residents in data review and interventions. “This is a team effort,” he said. “Let the team guide what needs to be changed and where to go and then let you know if you got there.”

Learn more with the AMA STEPS Forward® toolkit, “Resident and Fellow Burnout: Create a Holistic, Supportive Culture of Well-Being.”

Experts weigh in on the joys and woes of virtual nursing

PULSE  By Hunter Boyce, The Atlanta Journal-Constitution Feb 22, 2023

Telehealth has reached new heights in popularity following a workforce-crippling pandemic. That being said, not all healthcare heroes are behind the concept of virtual nursing.

According to a survey by NSI Nursing Solutions, registered nurse turnover stood at roughly 27% in 2022. Meanwhile, RN vacancy rates were at 17.1%. According to Medpage Today, all of those nursing vacancies have hit the healthcare industry with a growing knowledge gap. Virtual nursing is partially designed to close that gap.

New nurses are “scared to death” of making a mistake when they first come onto the floor, Wendy Deibert, MBA, BSN, senior vice president of clinical solutions for Caregility, told Medpage Today.

“They’re thrown into a world… with not a lot of experience behind them,” she said. “So having a button on the wall where you can push… at a moment’s notice and get a nurse in that room to assist (is a huge help).

“I can zoom in to [see] exactly what they’re doing and give direction and support, so that they don’t feel like they’re out there on a limb by themselves. Not only does that boost their confidence, but it also really stops that turnover, because if they get too scared and do not feel supported, they’re not going to stay there.”

Steve Polega, BSN, RN, chief nursing officer of University of Michigan Health-West, however, believes utilizing virtual nursing is a lost cause.

“As a nurse of 25 years, I believe that nursing is a calling and a gift,” he told Becker’s Hospital Review. “It is a huge responsibility to be trusted by our patients and families to be the eyes, ears and caring hands at the bedside. Nursing is all about connecting with people. To earn that trust, I believe that you need to be at the bedside. Nursing is about that kind touch, that smile, those reassuring things that we can do for patients and families.

“It is very challenging to have that real human connection through virtual care. I think we all lose if this trend continues. We have to optimize our technologies to make our nurses more efficient and effective, but at the end of the day, nurses put the humanity into care and need to be present and at the bedside.”

It’s a point that perhaps needs to be put to the test.

Saint Luke’s Health System of Kansas City took advantage of an opportunity to significantly implement virtual nursing in 2019, before the pandemic. The hospital constructed a 33 bed nursing unit at one of its four facilities, utilizing a new care model and workflow.

“It was important that the model had an impact for both the nursing staff and the patient experience,” Jennifer Ball, RN, BSN, MBA, director of virtual care at Saint Luke’s Health System, told the American Nurses Association. “We looked at what could be taken off the plate of the bedside RN and completed by a nurse on camera in the patient room. We included tasks such as admission database, discharge teaching, medication reconciliation, completing procedure checklists, second nurse sign off for meds/skin checks, general education/teaching for the patients, contacting families, answering questions, and the list goes on.

“When these items are completed by the virtual RN, that frees up the time of the bedside RN to have more time to manage physical needs of the patents, answer call lights sooner, and generally have more time with the patients.”

The unit opened in Feb. 2021 and has since experienced several workflow changes. According to Ball, the unit’s operation since its opening has allowed for a few lessons.

“You can never have too much education, training, and information shared,” she said. “Staff have to be flexible, like change, and be willing to try new things. Start your planning early, be wiling to adjust things, and figure out your technology early on. Get everyone involved from the beginning: other disciplines and staff that will be interacting with the new care model.”



A day in the neonatal follow-up clinic

Nov 23, 2022 CanadianPreemies

What to expect and how to prepare for a neonatal follow-up appointment with your baby born preterm.


All babies, whether born preterm or term, need to have regular visits with a paediatrician for check-ups and immunisations. Preterm babies will probably need to have more regular and thorough follow-up visits beyond what is usually recommended for babies. The purpose of follow-up visits lies in the surveillance of the baby’s progress in growth and development and looking out for potential problems as early as possible.

In general, follow-up visits are scheduled at 4, 8, 12, 18, 24 and 36 weeks corrected age in the baby’s first year, meaning the age if the baby had been born at the expected time.

Usually these visits are there for assessing and tracking the baby’s growth and discussing feedings and sleeping patterns. The developmental level of the baby regarding sensors and the baby’s physical state is evaluated, as well as checks for jaundice are performed. The doctor will also provide the recommended immunisations for the baby. Any questions parents may have about the baby’s health are discussed.

Some countries offer structured preventive early intervention programmes for very preterm infants such as the ToP programme in the Netherlands. It is funded by the Dutch health insurance, consequently every very preterm infant and parent can get this support after discharge. Parents should always take the chance to consult the health care team before going home about specialised care programmes.

Last but not least follow-up practices or clinics are also forums for exchange with doctors and other parents on their baby’s behavior and on recommendations what to do about it.

Parents are often faced with an ‘information flood’ which can be challenging for them to absorb. Information is often new and specific, and parents – commonly worried about their preterm baby – may be overwhelmed.

Tips to help get the most out of follow-up appointments

Starting a file

It can be very helpful to write down the advice given in a file. This will support parents to run a commentary on the baby’s progress which they ca refer to later. In connection with immunisations and vaccinations the GP or paediatrician will record all vaccinations given to the baby in an international immunisation card. It is important and helpful to keep the record for future medical treatment of the baby to track the vaccination history.

Asking questions

Even if parents may suspect their questions to be amateurish, no health care professional will expect parents to understand the various possible health conditions entirely. It is better to ask twice than to leave a visit with uncertainties.

Managing appointments continuously but not too tightly

Sometimes, follow-up appointments for preterm babies can mount up and families may have more than one fixed date in a week. They can take up a lot of time and be very tiring, especially if families have to travel long distances. If it becomes difficult to manage the number of appointments, asking the health visitor to re-organise some of them, if possible, is a reasonable move in order to keep everyday life manageable.

*** The European Foundation for the Care of Newborn Infants (EFCNI) is the first pan-European organisation and network to represent the interests of preterm and newborn infants and their families.


NICU Follow-up Program – Brigham and Women’s Hospital

May 18, 2022   Brigham And Women’s Hospital

The Neonatal Intensive Care Unit (NICU) Follow-up Program at Brigham and Women’s Hospital provides close, frequent monitoring for babies who spent time in the NICU. Care is provided from discharge until kindergarten using a comprehensive, team-based approach to ensure the child is meeting all developmental milestones.

Premature twin separated from his sibling, has only lived in hospital for first three years of life

 KMOV St. Louis     Mar 26, 2019

March of Dimes 2022 Report Card Shows US Preterm Birth Rate Hits 15-year High Rates Increase for Women of All Races, Earning D+Grade

     November 15, 2022

March of Dimes, the nation’s leader in mom and baby health, released its 2022 Report Card today, revealing that the U.S. preterm birth rate increased to 10.5% in 2021 – a significant 4% increase in just one year and the highest recorded rate since 2007.1 Despite reporting a slight decline last year, the preterm birth rate has steadily increased since 2014, earning the country a D+ grade in the Report Card.  The data also shows persistent racial disparities across maternal and infant health measures that were compounded by the COVID-19 pandemic, making the U.S. among the most dangerous developed nations for childbirth.

The report shows that the number of preterm births increased from 364,487 to 383,082 for women of all races. Black and Native American women are 62% more likely to have a preterm birth and their babies are twice as likely to die as compared to White women. In 2021, preterm birth rates for Black mothers increased from 14.4% to 14.7% and increased from 11.6% to 12.3% for Native American/Alaskan Native mothers.  What’s more, while Asian women saw a 3% decline in births, they had the largest increase (8%) in preterm births compared to all other women.

Several factors may contribute to the high rate of preterm births, including inadequate prenatal care and preexisting maternal health conditions such as hypertension and diabetes.  Over 21.1% of Black women and 26.8% of American Indian/Alaskan Native women in the U.S. do not receive adequate prenatal care. The pandemic has further exacerbated the struggle for parents to access maternal care from hospitals and other prenatal providers.

“This year’s report sheds new light on the devastating consequences of the pandemic for moms and babies in our country,” said Stacey D. Stewart, President and CEO of March of Dimes. “While fewer babies are dying, more of them are being born too sick and too soon which can lead to lifelong health problems. Pregnant women with COVID have a 40% higher risk of preterm birth and we know more women are starting their pregnancies with chronic health conditions which can further increase their risk of complications.  It’s clear that we’re at a critical moment in our country and that’s why we’re urging policymakers to act now to advance legislation that will measurably improve the health of moms and babies.” 

The report also reveals that low-risk Cesarean births remain alarmingly high, with the highest rates among Black mothers (31.2%). Overall Cesarean delivery rates increased from 31.8% to 32.1% in 2021 and represent nearly one third of all births. While Cesarean birth is lifesaving in medically necessary situations, this form of delivery is a major surgery and does have immediate and long-term risks.  With about eight in 10 maternal deaths now preventable according to the CDC, reducing rates of Cesarean births may reduce adverse maternal health outcomes associated with medically unnecessary Cesarean birth.

“We know that the pandemic impacted the way that providers delivered care. Low staffing, resource issues, and fears around COVID-19 transmission put added pressure on providers to get patients delivered and out of maternity units in a timely fashion, and may have also contributed to increases in use of obstetric interventions such as inductions and Cesareans,” said Dr. Zsakeba Henderson, Senior Vice President and Interim Chief Medical and Health Officer at March of Dimes. “These interventions have also been shown to contribute to the rise in preterm births, especially late preterm births.”

For this reason, March of Dimes is working to reduce adverse outcomes driven by non-medically indicated inductions and Cesareans.

March of Dimes recognizes that the maternal and infant health crisis does not have one root cause or a singular solution. Present day structures and systems rooted in racist, biased and unfair policies and practices over centuries contribute to and magnify racial differences in access to resources, social conditions and opportunities.

To better understand and address the social drivers to healthcare, this year’s report includes the Maternal Vulnerability Index (MVI) – a new measure of the contextual, clinical, and social determinants of health that impact pregnant people and their babies. Developed by Surgo Ventures, the MVI is the first county-level, national-scale, open-source tool to identify where and why moms in the U.S. are vulnerable to poor health outcomes. It explores 43 indicators across six themes, including reproductive health care, physical health, mental health and substance use, general health care, socioeconomic determinants, and environmental factors. The MVI shows that while some parts of the country are more vulnerable, 4 out of 5 counties have some aspect of maternal health that can be improved. Black women in the lowest vulnerability counties are still at higher risk of death and poor outcomes than White women living in the highest vulnerability counties.

Supplemental Report Cards also provide an in-depth analysis of the national and state maternal and infant health data found in the report. New this year, the reports include a summary of March of Dimes programmatic initiatives and legislative advocacy efforts in each state.

2022 March of Dimes Preterm Birth Grades

Each year, the March of Dimes releases its Report Card with grades for individual states, Washington, D.C., Puerto Rico and the 100 cities with the greatest number of births. Between 2020 and 2021, 45 states, Washington D.C. and Puerto Rico experienced an increase in preterm birth rates.

  • 9 states and Puerto Rico earned an “F” (Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, West Virginia)  
  • 4 states earned a “D-” (Missouri, Nevada, Tennessee, Texas) 
  • 6 states earned a “D” (North Carolina, Nebraska, Florida, Indiana, Delaware, Wyoming)  
  • 5 states earned a “D+” (Ohio, Illinois, Michigan, Maryland, South Dakota)  
  • 2 states and Washington D.C. earned a “C-“(Hawaii, Alaska) 
  • 11 states earned a “C” (Arizona, Colorado, Iowa, Kansas, Montana, New Mexico, New York, Pennsylvania, Utah, Virginia, Wisconsin)  
  • 5 states earned a “C+” (North Dakota, Connecticut, Maine, Minnesota, Rhode Island) 
  • 4 states earned a “B-” (New Jersey, Massachusetts, California, Idaho,) 
  • 2 states earned a “B” (Washington, Oregon) 
  • 1 state earned a “B+” (New Hampshire) 
  • 1 state earned an “A-” (Vermont) 

Actions to Address the Crisis

Alongside the release of the report, March of Dimes is delivering the Mamagenda for #BlanketChange, an emergency call-to-action to Congress to improve the health of moms and babies. The Mamagenda calls for immediate action to advance policies that support equity, access and prevention, advocating for the enactment of the Black Maternal Health Act of 2021 (H.R. 959/S. 346) and the Pregnant Workers Fairness Act (H.R. 1065/S.1486) to help prevent racial and ethnic discrimination in maternity care, expand access to midwifery care, provide reimbursements for doula support, and more.  It calls for adopting Medicaid expansion and permanently extending Medicaid postpartum coverage to 12 months as authorized under the American Rescue Plan Act. Additionally, the Mamagenda calls for funding for Maternal Mortality Review Committees and Perinatal Quality Collaboratives that work to improve data collection for maternal deaths and make improvements in quality of care and maternal and infant health outcomes.

Visit to learn more and join the growing number of partners committed to improving maternity care for all.



Babies born in rural settings are more likely to experience trauma during birth, and one way Mayo Clinic is addressing this

By Elizabeth Zimmermann – January 25, 2022

Birth trauma rates are one of the measures of hospital quality used by the Joint Commission. Recent Mayo Clinic-led research, published in the Maternal and Child Health Journal, shows that babies born at rural hospitals are more likely to experience a birth-related injury than those born in urban hospitals.

This disparity is of concern to researchers and clinicians.

To address gaps and disparities in care, the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery works with the medical practice to investigate factors that contribute to high quality, high value care.

“In order to provide care that meets the needs of patients and the overall population, there is a need to understand current outcomes, in the context of current care settings and processes,” says Aaron Spaulding, Ph.D., a health services researcher at Mayo Clinic in Jacksonville, Florida, and the study’s senior author.

This is not Dr. Spaulding’s first study into the disparities of care and outcomes that are multi-faceted and not easily assessed. Within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, he has led several multiinstitutional collaborations investigating differences in hospital quality outcomes between geographical settings, including the current study.

“Our work in this area seeks to understand better how communities in which hospitals reside influence hospital outcomes and vice versa,” he says. “We are led by the belief that many policies attempt to use a one-size-fits-all mentality which may be inappropriate and may punish or reward hospitals based on aspects they have little control over.”

Dr. Spaulding and his team hope that as they gain a better understanding of the association between communities and their hospitals, they will find better opportunities for policy or practice interventions that can make a difference. 

Babies in distress

In the current study, Dr. Spaulding, along with Hanadi Hamadi, Ph.D.; Jing Xu, Ph.D.; and Farouk Smith all of the University of North Florida, Jacksonville; and Aurora Tafili, University of Alabama at Birmingham; used Florida hospitals’ inpatient data from 2013 to 2018. Originally collected by the Florida Agency for Health Care Administration, the study data included information from 125 inpatient hospitals across the state. It included information for 1,192,336 singleton births and noted up to 31 diagnoses present on admission, as well as up to 31 injury-related diagnoses for the births.

“The most notable finding of the study is that no matter your race, a rural location was associated with an increased odds of birth trauma compared to an urban location,” says Dr. Spaulding.

His team is especially concerned about people of Hispanic ethnicity receiving care at a rural location, he continues, since the greatest birth trauma risk was among rural Hispanic or Latino babies.

The dataset they used only included Florida, however many states make this type of data available, which could be used for a similar analysis. It would not be unreasonable to assume that many states would show disparities between urban and rural outcomes much like those the researchers found in Florida, he says.

Teleneonatology consult allows specialist to see what the local care team is seeing, and to direct lifesaving care for infants in distress.

A possible solution to rural health care disparities at birth

Telemedicine has taken hold as a viable means by which people can access care not available in their geographic area. Mayo Clinic has been steadily implementing and evaluating a wide range of solutions to connect with patients wherever they are, and whenever they need that connection.

For babies born in rural settings or even urban hospitals with no access to neonatologists — pediatricians specializing in medical care for newborns (neonates) — Mayo’s Teleneonatology Program may bridge an essential gap, leading to better outcomes following birth-related traumas like those noted in Dr. Spaulding’s study.

“With this technology, we can be at the bedside of any newborn in need of critical care,” says Jennifer Fang, M.D., medical director of Mayo Clinic’s Teleneonatology Program.

In another recent publication, Dr. Fang describes how she and her colleagues are able to use telemedicine to remotely respond to newborn emergencies. In the paper, she notes the significant improvements in outcomes since teleneonatology consultations were integrated into the family birth centers and emergency departments of nineteen participating community hospitals. These include advancements in quality, safety and provider experience.

During a teleneonatology consult, a neonatologist at Mayo Clinic in Rochester, Minnesota, connects with the local care team in real time, via a telemedicine platform incorporating high resolution, secure audio and video capabilities.

“We are able to see and assess the infant, and guide the local doctors and nurses through resuscitation, including positive pressure ventilation, advanced airway placement and umbilical catheter placement, when needed” says Dr. Fang.

“As one of the acute care telemedicine services developed at Mayo Clinic, we were looking for a way to help more babies – even before they arrive to the neonatal ICU,” she says.

“Before our teleneonatology program we would try to help via a phone call with the care team during a particularly complex delivery. But nothing compares to being able to visualize the baby, to see what the local team is seeing, and how the newborn responds in the minutes after birth and following interventions.” Says Dr. Fang.

Other research has shown that approximately 10% of newborns require breathing assistance after delivery, and one in 1,000 require extensive resuscitation. These babies are much more likely to die in when delivered in hospitals with lower levels of neonatal care. Mayo’s Teleneonatology Program aims to reduce that risk.

In Dr. Fang’s paper, she reviews some of Mayo’s program results, including:

  • Substantially higher quality resuscitation for infants whose care team used the service.
  • Safer care — as demonstrated by significant reduction in birth injury cases.
  • Willingness to use the capability is good. In fact, 99% of providers would use teleneonatology support again — and recommend it to their colleagues.

Mayo’s various telemedicine capabilities are enabled by Mayo Clinic’s Center for Digital Health. Much of the research validating and evaluating new telemedicine and remote care capabilities is done in collaboration with the Mayo Clinic Kern Center for the Science of Health Care Delivery.

Next steps for researchers

Dr. Spaulding’s team continues to work on topics assessing disparities, geographic location and care outcomes. Also in an effort to understand factors that contribute to healthier infants, they are assessing the value of designation under the Baby-Friendly Hospital Initiative. They hope to determine which hospital and community characteristics are associated with hospital attainment of the designation.

On a broader scope, he and his colleagues seek to better understand the effect of community characteristics and health care outcomes. For example, his team is evaluating the presence of Magnet-designated hospitals and differences in associated health care outcomes between Magnet and non-Magnet-designated hospitals. (Read a related publication, “The influence of community health on hospitals attainment of Magnet designation: Implications for policy and practice.”)

“We hope to develop further our understandings of how community characteristics influence health outcomes and how hospital characteristics affect community health,” says Dr. Spaulding. 

Dr. Fang agrees that more research will be helpful for her program in particular.

“If we could get this program into every rural setting, I am confident we would see positive health outcomes for babies,” she says. “Research can help us determine costs and savings (a cost analysis of teleneonatology performed by the Division of Neonatal Medicine and the Kern Center is currently under review for publication), as well as quantifiable public health outcomes that can help shift perceptions among the people and agencies who oversee policies, payment, and care offerings at local, regional, state and national levels.”

In general Drs. Fang and Spaulding both agree that it is high time the health care community pays attention to diversity and inclusion research and the associated attempts to improve care for all. This research sheds light on the importance of the community in which one lives, which impacts health from the cradle to the grave.

“We hope that our research can help further clarify areas of needed policy and practice intervention,” concludes Dr. Spaulding. “Improved measurement of disparities and comparisons between communities and geographic locations will provide us with better tools to fight unequal access to quality care.”


Implementation of A Neurodevelopmental Care Bundle to Promote Optimal Brain Development in the Premature Infant

Author: Pamela S Hackman, MSN, RNC-NIC, C_ELBW Registered Nurse Hershey Medical Center Children’s Hospital, Hershey PA 629 Thoreau Drive 7173301589

Background and Purpose: When an infant is born prematurely, the external environment, routine or emergent nursing care actions performed on the infant can be detrimental. Neonatal nurses are keenly aware the premature infant is at risk for developing behavioral, cognitive, and physical impairments which can be short term or last a lifetime.  The purpose of a neuroprotective care bundle is two-fold:  First, for nurses, the bundle optimizes the health and well-being of the infant by incorporating seven core measures:   healing environment, partnering with families, positioning, and handling, safeguarding sleep, minimizing stress and pain, protecting skin, and optimizing nutrition. Second, for families, therapeutic touch, and skin-to-skin contact cultivates positive neurodevelopmental outcomes, nurturing and health for the infant as well as enhances the bonding experience for the family. Comprehensive, evidence-based research was conducted looking at the role of developmental care and prematurity and how it can correlate to a healthy environment for the premature infant. Result of that research indicates that decreasing negative effects of extrauterine life, decreasing touch times, and implementing a Neuroprotective care bundle in the neonatal intensive care unit can be modified to simulate an intrauterine environment, thereby promoting optimal brain development and outcomes for that infant.

Materials and Methodology: A quantitative research study was conducted in a level 4 neonatal intensive care unit with an average admission rate between 350-400 infants per year, with approximately 120 of those infants are born prematurely. Research was conducted over a twelve-week period. Eighteen premature infants 23-32 weeks gestation were tracked for the first 7 days of life. 

A Pareto chart was developed. Information on the chart included: birthweight, and gestational age. The chart was divided into 4-hour increments for a 24-hour (1day total). A list of variables disturbances to the infant included such interventions as opening the top of the isolette for CXR, or other medical test, opening the port holes to the isolette for attaining vital signs including blood pressure, diaper change, repositioning, suctioning, heel stick for blood, parental interaction with infant, answering an apnea, bradycardia, or desaturation alarm, consoling a crying infant, and assessment by medical team. The goal of the project was for the nurse to check off each intervention during an identified time slot. Data was collected for 7 days.

At the end of twelve weeks, each variable in the time interval and tic mark for that time was tabulated. Then all interventions were added together for each day.  To find out the average number of times an infant was disturbed, the total number of disturbances per day divided by 7 for the total study period was identified. This information indicated the number of times in a day that an infant was disturbed. Further calculation was done to figure out the number of times per day the infant was disturbed by dividing total number of interventions per day by 24 (hours in a day).

Results: Main outcome results indicated an infant was disturbed between 89 to 242 times during the first week of like. Further breakdown indicated that infants were disturbed 3.7 to 10.1 times per hour.  Barriers recognized when research study complete included: staff unaware of study so did not complete project, despite education and communication to all staff members. Multiple shifts did not have documentation complete. Documentation of tic mark for variable but no tic mark for opening port holes (assumption made here). No report of position change. No documentation noted on one patient for one shift. One patient did not have documentation for 2.5 days. Not all activities/interventions were captured. Too busy/ high acuity/ did not understand project request. Multiple pts/activities due at the same time. Totally dependent on RN to document data. Some variables were documented but no documentation for opening the port holes or popping the top of isolette that needed to happen first before taking care of the infant (assumption made here when looking at the intervention completed). Despite interventions being missed in the total tabulation of disturbances to the infant, the study was an eye-opening experience for the nurse to see the total number of times an infant is disturbed per day and per hour. The number of disturbances to the premature infant is detrimental to their health and something that is not often thought about when caring for the infant. Based on the limited results of this study, the intensive care unit in which this study was conducted is currently looking at interventions that promote the developing behavioral, cognitive, and physical needs of the premature infant by instituting specific touch times with infant that correlate with the infant’s wake cycle, implementation of a neurodevelopmental care bundle and promoting a family centered approach to care. To assimilate the intrauterine environment a neurodevelopmental care bundle ought to be utilized.  

Conclusion: A family- care, neuroprotective and developmentally supportive care approach, in conjunction with standard of care practices, promote brain development and a healthy environment.   The implementation of a neurodevelopmental care bundle provides an opportunity to promote optimal brain development as the infant grows in the intensive care, thereby, fostering a positive experience for the family, decreasing length of stay, decreasing hospital cost, and improving medical outcomes.

 Learning Objectives: At the end of this presentation the learner will be able to:

1. Identify the how the implementation of a neurodevelopmental care bundle promotes the developing behavioral, cognitive, and physical aspects of the premature infant.

2. Identify external environmental factors that are detrimental to the premature infant and how the intrauterine environment can be assimilated in the external environment.

3. Identify the positive outcomes of promoting a neurodevelopmental care bundle. 


Mayo Clinic Teleneonatology Program: Simulated Teleneonatology Consult

Mayo Clinic Jun 14, 2017    Mayo Clinic

The Power of Pets Health Benefits of Human-Animal Interactions

Nothing compares to the joy of coming home to a loyal companion. The unconditional love of a pet can do more than keep you company. Pets may also decrease stress, improve heart health, and even help children with their emotional and social skills.

An estimated 68% of U.S. households have a pet. But who benefits from an animal? And which type of pet brings health benefits?

Over the past 10 years, NIH has partnered with the Mars Corporation’s WALTHAM Centre for Pet Nutrition to answer questions like these by funding research studies.

Scientists are looking at what the potential physical and mental health benefits are for different animals—from fish to guinea pigs to dogs and cats.

Possible Health Effects

Research on human-animal interactions is still relatively new. Some studies have shown positive health effects, but the results have been mixed.

Interacting with animals has been shown to decrease levels of cortisol (a stress-related hormone) and lower blood pressure. Other studies have found that animals can reduce loneliness, increase feelings of social support, and boost your mood.

The NIH/Mars Partnership is funding a range of studies focused on the relationships we have with animals. For example, researchers are looking into how animals might influence child development. They’re studying animal interactions with kids who have autismattention deficit hyperactivity disorder (ADHD), and other conditions.

“There’s not one answer about how a pet can help somebody with a specific condition,” explains Dr. Layla Esposito, who oversees NIH’s Human-Animal Interaction Research Program. “Is your goal to increase physical activity? Then you might benefit from owning a dog. You have to walk a dog several times a day and you’re going to increase physical activity. If your goal is reducing stress, sometimes watching fish swim can result in a feeling of calmness. So there’s no one type fits all.”

NIH is funding large-scale surveys to find out the range of pets people live with and how their relationships with their pets relate to health.

“We’re trying to tap into the subjective quality of the relationship with the animal—that part of the bond that people feel with animals—and how that translates into some of the health benefits,” explains Dr. James Griffin, a child development expert at NIH.

Animals Helping People

Animals can serve as a source of comfort and support. Therapy dogs are especially good at this. They’re sometimes brought into hospitals or nursing homes to help reduce patients’ stress and anxiety.

“Dogs are very present. If someone is struggling with something, they know how to sit there and be loving,” says Dr. Ann Berger, a physician and researcher at the NIH Clinical Center in Bethesda, Maryland. “Their attention is focused on the person all the time.”

Berger works with people who have cancer and terminal illnesses. She teaches them about mindfulness to help decrease stress and manage pain.

“The foundations of mindfulness include attention, intention, compassion, and awareness,” Berger says. “All of those things are things that animals bring to the table. People kind of have to learn it. Animals do this innately.”

Researchers are studying the safety of bringing animals into hospital settings because animals may expose people to more germs. A current study is looking at the safety of bringing dogs to visit children with cancer, Esposito says. Scientists will be testing the children’s hands to see if there are dangerous levels of germs transferred from the dog after the visit.

Dogs may also aid in the classroom. One study found that dogs can help children with ADHD focus their attention. Researchers enrolled two groups of children diagnosed with ADHD into 12-week group therapy sessions. The first group of kids read to a therapy dog once a week for 30 minutes. The second group read to puppets that looked like dogs.

Kids who read to the real animals showed better social skills and more sharing, cooperation, and volunteering. They also had fewer behavioral problems.

Another study found that children with autism spectrum disorder were calmer while playing with guinea pigs in the classroom. When the children spent 10 minutes in a supervised group playtime with guinea pigs, their anxiety levels dropped. The children also had better social interactions and were more engaged with their peers. The researchers suggest that the animals offered unconditional acceptance, making them a calm comfort to the children.

“Animals can become a way of building a bridge for those social interactions,” Griffin says. He adds that researchers are trying to better understand these effects and who they might help.

Animals may help you in other unexpected ways. A recent study showed that caring for fish helped teens with diabetes better manage their disease. Researchers had a group of teens with type 1 diabetes care for a pet fish twice a day by feeding and checking water levels. The caretaking routine also included changing the tank water each week. This was paired with the children reviewing their blood glucose (blood sugar) logs with parents.

Researchers tracked how consistently these teens checked their blood glucose. Compared with teens who weren’t given a fish to care for, fish-keeping teens were more disciplined about checking their own blood glucose levels, which is essential for maintaining their health.

While pets may bring a wide range of health benefits, an animal may not work for everyone. Recent studies suggest that early exposure to pets may help protect young children from developing allergies and asthma. But for people who are allergic to certain animals, having pets in the home can do more harm than good.

Helping Each Other

Pets also bring new responsibilities. Knowing how to care for and feed an animal is part of owning a pet. NIH/Mars funds studies looking into the effects of human-animal interactions for both the pet and the person.

Remember that animals can feel stressed and fatigued, too. It’s important for kids to be able to recognize signs of stress in their pet and know when not to approach. Animal bites can cause serious harm.

“Dog bite prevention is certainly an issue parents need to consider, especially for young children who don’t always know the boundaries of what’s appropriate to do with a dog,” Esposito explains.

Researchers will continue to explore the many health effects of having a pet. “We’re trying to find out what’s working, what’s not working, and what’s safe—for both the humans and the animals,” Esposito says.

The Power of Pets | NIH News in Health

Dogs or cats with SUPERPOWER?!

Dec 5, 2018     CurioSips

Dogs or cats with SUPERPOWER?! We all have had that one time at least that our pet goes crazy and scratches us for no reason! Or when your cat starts staring at the window but there is nothing there? That is what happens at my house every single day! No matter how exaggerated these things seem, if this happens in your house as well, it might be that your pet is truly haunted, didn’t you think?


Kat’s Update:

When the pandemic hit, I was in the second year towards pursuing my medical education. Due to the impact of the pandemic on medical education and clinical surgery education in particular, I chose to defer and postpone my medical studies. 

In order to progress my knowledge, engagement, and expertise in global surgery and the medical community I have continued to participate in ongoing academic and independent research. Over the past two years, I have had the privilege and pleasure of presenting my research at 8 conferences in over 3 countries, expanding my professional network and growing my passion for advocacy and promotion of surgical care globally.

During the past year, I chose to pursue my MSc in London with a focus on global surgery and research pertaining to surgical system strengthening in austere environments. The opportunity to learn from and study alongside my fellow global surgery pathway cohort members and our respective global health cohort has allowed me to build strong relationships and gain close colleagues from over 15 nations.  

Perhaps the most impactful aspect of my program was the gift of gaining unimaginably strong friendships with four of my colleagues, each of whom are physicians from different countries (England, Ireland, Colombia, Ethiopia), all of whom embrace career aspirations in various areas of global surgery/medicine including obstetrics, neurosurgery, otolaryngology, and anesthesia. Each of these individuals has inspired me to become more present, gracious, composed, and joyous in my life and interaction with others. 

To my brilliant, compassionate, strong, and resilient friends Oscar, Martina, Heaven, and Tina THANK YOU for sharing your wisdom, hopes, dreams, and kind hearts! Your support and friendship have strengthened my ongoing intention towards completing my medical education. I look forward to the day I can join you all in service as a physician.

To my amazing cohort, I am GRATEFUL for the various perspectives, intellect, care, love, joy, passion, fire,  fun, and the positive challenges you have each provided us as a whole in order for us all to grow, develop, and strive to become better global citizens.

Beloved Neonatal Womb Warrior Brothers and Sisters! Your unique and personal journeys will create joyful and meaningful opportunities for magnificent manifestations and personal growth. Please take a moment or two to breath, relax, acknowledge, and experience the gratitude you feel towards those in your lives who gift you with their presence and spectacular beingness……

In 2023, I look forward to continued engagement in professional research with the goal of strongly contributing to the mission of those I have the pleasure of working alongside and towards creating a tangible impact in the communities and lives we seek to serve.

Kathy and Kat: Our precious and powerful Neonatal Womb Warrior/Preterm Birth Family! Our hearts are continually vitalized by your powerful presence. Every month you educate, challenge us towards change, surprise, and enchant us through your intellect, humanity, and courage. As we voyage forward into this next year, the seventh year of our Neonatal Womb Warrior collaboration; let us live wholeheartedly, let us remember the moments in life which empower our presence, the people in our lives who light up our world, that we are capable of living our dreams, and that with open hearts we belong to each other!

Let us go forward fully and fiercely, immersed within the journeys of our destinies…….

Pets! They are just full of surprises! The highlighted  video shows us a primary example of the kind of lighthearted fun and joy pets bring us each day! 

In my experience with our cat, Gannon, he has often taken us off-guard by scattering his numerous toys in odd places and through occasionally pouncing on our feet from underneath a bed as we pass. Perhaps the most fulfilling surprise he has graced us with is his requirement that when we show him affection, we must allow him to give it back (licking/cleaning and gripping our hands, snuggling).

Throughout the years each of our pets has brought us great joy and a sense of belonging in our lives. Pets are not just family; for me they are guardian angels who help me navigate the world and provide opportunities to learn more about myself and my relationships with others. The countless pets in our neighborhood have certainly helped me develop newfound friendships and participate in important, unexpected, and depth-filled conversations with others. There have been a scattering of belly laughs and a few occasional tears, focused on owner love for their pet!

 It’s never a dull moment when the pets are front and center. My hope is the comfort, love, and even those pesky and annoying challenges they bring about in our daily lives may help encourage us to send out unconditional love into the world in the ways in which they do every day.  

Do you have a pet? What do the pets in your life inspire?

Surf Team Hungary – 1. Rész

Peiman Lotfi       Sep 30, 2013

We have chosen a serious challenge for the 2013 surfing season, because this year the first Hungarian surfing team was assembled, which for the first time in history will compete in the European Championship (Eurosurf 2013) held this year in the Azores Islands. Unfortunately, the team was not able to enter the originally planned full team, as some key surfers could not come, especially Miki Rigler, but we still have 4 competitors in the “Open Men” category. By name, András Ajtai, Lotfi Peiman, Dávid Liptay and Krisztián Kövesdán. In the first part, we introduce our players and learn about the history of participation in the European Championship.

Fostering, Follow-up, Mortality


Estimated Number Of Preterm Birth Rates –  11.97 per 100 live births

(Global Average: 10.6, USA: 9.56)

Ethiopia, officially the Federal Democratic Republic of Ethiopia, is a landlocked country in the Horn of Africa. It shares borders with Eritrea to the northDjibouti to the northeastSomalia to the east and northeastKenya to the southSouth Sudan to the west, and Sudan to the northwest. Ethiopia has a total area of 1,100,000 square kilometres (420,000 square miles). As of 2022, it is home to around 113.5 million inhabitants, making it the 13th-most populous country in the world and the 2nd-most populous in Africa after Nigeria. The national capital and largest city, Addis Ababa, lies several kilometres west of the East African Rift that splits the country into the African and Somali tectonic plates.

The World Health Organization‘s 2006 World Health Report gives a figure of 1,936 physicians (for 2003), which comes to about 2.6 per 100,000. A brain drain associated with globalization is said to affect the country, with many educated professionals leaving Ethiopia for better economic opportunities in the West.

Ethiopia’s main health problems are said to be communicable (contagious) diseases worsened by poor sanitation and malnutrition. Over 44 million people (nearly half the population) do not have access to clean water. These problems are exacerbated by the shortage of trained doctors and nurses and health facilities.

The state of public health is considerably better in the cities. Birth ratesinfant mortality rates, and death rates are lower in cities than in rural areas due to better access to education, medicines, and hospitals. Life expectancy is better in cities compared to rural areas, but there have been significant improvements witnessed throughout the country in recent years, the average Ethiopian living to be 62.2 years old, according to a UNDP report. Despite sanitation being a problem, use of improved water sources is also on the rise; 81% in cities compared to 11% in rural areas. As in other parts of Africa, there has been a steady migration of people towards the cities in hopes of better living conditions.

Source- WHO 2014-


Neonatal mortality in neonatal intensive care unit hospitals in Ethiopia remains unacceptably high: a systematic review and meta-analysis: Magnitude and determinants of neonatal mortality in NICU

Gizachew Tadele Tiruneh , Tesega Mengistu Birhanu, Abdurahaman Seid, Mahteme Haile Workneh, Dareskedar GetieTenagnework Antefe Abebe, Ambanesh Necho Mulat, Taye Zeru Tadege, Kassahun Alemu Gelaye, Tadesse Awoke Ayele


Background: In Ethiopia, the neonatal mortality rate has not shown significant changes over time and is among the highest in the world. This review aimed to explore the pooled magnitude and determinates of neonatal mortality in the neonatal intensive care unit hospitals in Ethiopia.

Methods: The research team retrieved global peer-reviewed journal articles available as electronic databases including PubMed, Popline, and Scopus databases. Random-effects meta-analysis model was used to pool the estimates of the magnitude of mortality among studies. The results were presented as the pooled estimates (odds ratio and proportion) with 95% confidence intervals, at less than 0.05 significant levels. 

Results: In this review, 10 studies were included with a total of 8,729 neonates. Of these, 1,779 (20.4%) neonates died in the neonatal intensive care unit. The pooled neonatal mortality rate was 19.0% (95% CI: 14.0-25.0).  The neonatal mortality is three times higher among early age (OR: 2.80; 95% CI: 1.45-5.40) and preterm newborns (OR: 3.27; 95% CI: 2.12-5.07) than their counterparts. Early age of the newborn, prematurity, low birth weight, perinatal asphyxia, mode of delivery, hypothermia, late initiation of breastfeeding, and having antenatal care visits were the main determinants for neonatal mortality. 

Conclusion: Neonatal mortality in the intensive care unit is high. It is unacceptably high amongst early and preterm neonates. Special care for preterm and early age newborns, timely initiation of breastfeeding, exclusive breastfeeding, and appropriate mode of delivery, essential obstetric and newborn care, and promoting antenatal visits are recommended to reduce neonatal mortality.


Saving babies’ lives in Ethiopia

Paul Driscoll  Aug 5, 2021

It was Rahel Beyan’s lifelong ambition to nurse people back to health. In Tigray, Ethiopia, where she lives, she’s been working as a nurse alongside VSO volunteer Miriam Etter to improve conditions at Suhul Hospital – making her dream a reality.

Maternova Enters Distribution Agreement for Preemie-Test, the First Medical Device Capable of Accurately Assessing a Newborn’s Gestational Age

Hand-held, noninvasive device uses light to identify preterm newborns by analyzing the photobiological properties of the baby’s skin

July 27, 2022

PROVIDENCE, R.I.–(BUSINESS WIRE)–​Maternova Inc., empowering global health through innovative solutions, today announced that they have signed an agreement with BirthTech Lda, Portugal, to distribute its Preemie-Test in multiple geographies around the world. The Preemie-Test is the first medical device clinically proven to accurately assess the gestational age of a newborn, which is the major marker of neonatal survival. Maternova has an exclusive distribution agreement across Africa, Asia (except India) and Latin America (except Brazil) and non-exclusive rights in Brazil, India, the United States and Europe. Initial areas of regulatory approval and marketing focus for the Preemie-Test are Peru, Colombia, Philippines, Bangladesh and specific states in India.

Immediately after childbirth, a newborn with unknown or unreliable gestational age often requires resuscitation and hospitalization. Without this critical care, preterm newborns are at risk of mortality or serious, life-long health problems. According to the WHO, every year around 15 million babies are born too early and one million die due to prematurity complications. While most of these lives could be saved with prompt prematurity identification, in the absence of a prenatal ultrasound (often too expensive and not accessible), there has been no reliable method for pregnancy dating.

“The commercial launch of the Preemie-Test is a significant milestone in providing a new way of measuring gestational age and addressing a crucial need in low-resource settings,” said Rodney Guimarães, PhD, BirthTech CEO and the inventor of the device. “With a shared commitment to maternal and infant healthcare, we are proud to work with Maternova and believe its unique distribution network will help us quickly place this cost-effective solution into the hands of healthcare professionals from midwives to obstetricians.”

“I am delighted we were selected to commercialize and distribute the Preemie-Test,” said Meg Wirth, founder and president of Maternova. “Demand for effective and affordable maternal, newborn and child health innovations continues to grow across the globe. The Preemie-Test answers the call for a highly accurate solution that can be used in time-sensitive situations where self-sufficiency and portability are essential to newborn lives.”

Maternova is an exhibitor at the Florida International Medical Expo (FIME 2022) being held at the Miami Beach Convention Center from July 27-29. Representatives, including the inventor of the device, will be at booth V64 to demonstrate the Preemie-Test.

About the Preemie-Test

  • Portable, hand-held device
  • Rapid, accurate results
  • Easy to use
  • Noninvasive
  • Affordable

The Preemie-Test is the first medical device capable of accurately assessing gestational age within +/- 4 days immediately after an infant is born. The hand-held device features a probe containing light emitters and receivers that is applied against the newborn’s foot and, using mathematical algorithms, can estimate dating in a matter of seconds. This noninvasive optoelectronic device measures the thickness of the skin through backscattering of light using a light-emitting diode, and the battery lasts up to three years allowing hundreds to thousands of measurements. Support is available through a mobile app.

Multiple clinical trials to date have validated the effectiveness and 96% accuracy of the Preemie-Test in Brazil, Portugal, Mozambique, India and Malawi. According to ANVISA, the Brazilian regulatory health agency, this medical device is categorized as Class II Safety: Noninvasive and Medium Risk.

***WE really appreciated access to this Associated Video:


SOL ABA – Yene Nesh – የኔ ነሽ – ملكتي – New Ethiopian music 2022 – (Official video)

#Ethiopianmusic #Sol_Aba #eritreanmusic 1,611,376 views Dec 9, 2022 BAHGNA TV Ethiopian amharic music /Yene Nesh/ 2022/2023 bahgnatv production – Yene Nesh – amharicmusic


National Prevalence of Social Determinants of Health Screening Among US Neonatal Care Units

NOVEMBER 01 2022 

Erika G. Cordova-Ramos, MD; Stephen Kerr, MPH; Timothy Heeren, PhD; Mari-Lynn Drainoni, PhD; Arvin Garg, MD, MPH; Margaret G. Parker, MD, MPH


The extent that universal social determinants of health (SDH) screening in clinical encounters, as recommended by the American Academy of Pediatrics, has been implemented in inpatient pediatric settings is unknown. We aimed to determine the national prevalence and predictors of standardized SDH screening in US level 2 to 4 neonatal care units (NICUs), describe characteristics of SDH screening programs, and ascertain beliefs of clinical leaders about this practice in the NICU setting.


We randomly selected 100 hospitals with level 2 to 4 NICUs among each of 5 US regions (n = 500) and surveyed clinical leaders from January to November 2021 regarding standardized SDH screening. Responses were weighted for number of level 2 to 4 NICUs in each region and nonresponse.


Overall response rate was 34% (28%–40% by region). Twenty-three percent of US level 2 to 4 NICUs reported standardized SDH screening. We found no associations of hospital characteristics, such as region, size, or safety-net status, with implementation of this practice. Existing programs conducted systematic screening early in the hospitalization (84%), primarily led by social workers (92%). We identified practice variation regarding the type of screening tool, but there was substantial overlap among domains incorporated in the screening. Reported barriers to implementation included perceived lack of resources, inadequate referrals, and lack of an inpatient screening tool.


The prolonged neonatal hospitalization provides opportunities to systematically address SDH. Yet, only 23% of US level 2 to 4 NICUs have implemented this practice. To scale-up implementation, quality improvement may support adaptation of screening and referral processes to the NICU context.


Fostering Resilience to Very Preterm Birth Through the Caregiving Environment

Trecia A. Wouldes, BA, MA, PhD1 – October 21, 2022 JAMA Netw Open. 2022;5(10):e2238095. doi:10.1001/jamanetworkopen.2022.38095

Preterm birth remains an important public health challenge for improving the quality of immediate and long-term care of the child and their family. Nearly 1 in 10 live births worldwide are preterm, with higher rates in marginalized populations and developing countries.1 Advances in medical intensive care of these infants mean more infants born very preterm and extremely preterm are surviving. The preponderance of research on children born very preterm has revealed the linkages between numerous risks and acute and long-term adverse health and developmental outcomes for the children, and social and psychological challenges for the families.2 Although children born earlier in gestation are at increased risk for poor outcomes, there is wide variability, with many children doing well. Therefore, research that can identify the protective factors or identify who, when, or under what circumstance some preterm children thrive is essential for informing interventions to assist those preterm children who are at risk of ongoing emotional problems. Very preterm (<32 weeks’ gestational age) and very low birth weight (<1500 g) children are more at risk than their full-term peers for developing internalizing symptoms (eg, anxiety and/or depression). Emerging evidence suggests that maternal sensitivity is a long-term resilience factor in the development of internalizing problems in early adolescence in very preterm children.

McLean et al provide further evidence that supportive parenting of infants born very preterm is associated with more optimal emotional outcomes across early and middle childhood. They report the findings from a prospective, longitudinal cohort study of 186 very preterm neonates (24-32 weeks’ gestational age) recruited from the level III neonatal intensive care unit (NICU) at BC Women’s Hospital in Vancouver, Canada. This report aimed to investigate whether neonatal pain-related stress experienced by neonates in the NICU was associated with trajectories of internalizing behaviors at ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years and whether supportive parenting behaviors and lower self-reported parental stress at ages 1.5 and 3 years attenuated this association. Cumulative pain and stress was defined as the number of invasive procedures performed in the NICU. The main outcome was parent reports of child internalizing behaviors measured with the Child Behavior Checklist at every follow-up. At ages 1.5 and 3 years, parental stress was obtained from the Parenting Stress Index, and parent-child interactions were obtained from videotapes of a 5-minute teaching task coded by independent examiners using the Emotional Availability Scale–IV. After accounting for gestational age at birth and neonatal clinical factors, greater exposure to neonatal pain-related stress, related to invasive procedures from birth to NICU discharge, was associated with increased internalizing symptoms across follow-up. At 1.5 years, internalizing behaviors were within the normative range; however, by age 8 years, parent reports indicated that 24 of 153 children (16%) had symptoms that put them in the clinical range for internalizing behaviors. Latent profile analyses of parenting behaviors observed in parent-child interactions at ages 1.5 and 3 years and parenting stress at 3 years identified 3 profiles: average support with average stress, high support with low stress, and low support with high stress. Higher parenting stress at 1.5 years contributed to parent reports of greater internalizing problems across development to age 8 years. At age 3 years, the profile of high support and lower stress was associated with a reduction in the development of parent reports of internalizing behavior across development to age 8 years. Parents in this group demonstrated more behaviors that were characterized as sensitive, nonhostile, and nonintrusive and provided more structure in parent-child interactions.

The Bidirectional Nature of Parenting

Although sensitive supportive parenting in the general population is important for a child’s development, it is even more critical for preterm-born children. However, the communication abilities, atypical behavior, and regulation systems of very preterm-born children can affect the quality of these interactions. McLean et al found at 3 years, but not 1.5 years, children exhibited lower parent-reported internalizing behaviors related to supportive parenting interactions, even after accounting for child behavior in parent-child interactions in a teaching task.

Supportive parenting interactions rely on several social and psychological determinants of the mother-infant dyad, including maternal culture, depression, socioeconomic status, substance use disorders, the home environment, and whether the child was unplanned or unwanted.5 The prevalence rates of posttraumatic stress or acute stress disorders in mothers of preterm infants in the NICU range from 23% to 28%. Several factors contribute to the traumatic stress experienced by parents of preterm infants in the NICU; however, the most stressful aspects of the NICU experience reported by parents were the physical separation from their infant and their feelings of a loss of control and helplessness in their inability to shield their infant from the numerous painful procedures.7 The findings of McLean et al4 show that reduced parental stress and sensitive supportive parenting may temper the association between the effects of neonatal pain-related stressors in the NICU and internalizing behaviors throughout early and middle childhood. Therefore, interventions that help reduce stress should be part of postnatal care for mothers of very preterm children.

Where to Now?

Many of the stressors experienced by neonates and parents in the NICU and after discharge from the hospital have been addressed by interventions in the NICU, such as the Newborn Individualized Developmental Care and Assessment Program. This intervention is designed to identify both what is supportive and regulating, and what is disruptive to infant neurodevelopment. Further approaches include the redesign and reorganization of the NICU environment from large, open bays with multiple babies close to each other, to single-family rooms combined with neuroprotective approaches that emphasize developmentally appropriate care. The transition to single-family rooms aims to protect the infant from intrusive environmental stimuli of open bay NICUs while facilitating parental care and around-the-clock family presence.

Notwithstanding the advances made in caring for these vulnerable infants in the NICU, there are important questions left to answer. Preterm birth is increasing worldwide,1 but most studies on very preterm infants have involved White Western populations. The cohort in the study by McLean et al was predominantly a more mature, well-educated sample of parents (60% White and 84% with partial or complete university degree or postgraduate degree) with universal access to health care. Culture, poverty, and maternal mental well-being strongly influence parenting; therefore, more research is needed to determine who and under what social and psychological circumstances parents of children born very preterm require parenting support.

In addition, parental perceptions and attitudes toward the child born very preterm may be distorted and impact the developing parent-child relationship, particularly in circumstances where the pregnancy was unintended or unwanted. With the recent legal constraints to obtaining terminations for unintended or unwanted pregnancies, maternal mental health, stress, and the financial burden of very preterm birth is likely to escalate, particularly in already marginalized populations. Therefore, research is needed to understand what the potential impact of the lack of access to termination of an unwanted pregnancy will have on parenting very preterm infants.


Futility and Withdrawal of Intensive Care in Term Infants with Brain Injury

Ciara Terry, MRCPI , Breda C Hayes MD, FRCPI

Neonatal brain injury is a major challenge in modern perinatal care, including obstetric and neonatal care. Advances in the care of the newborn, including resuscitation improvements and the introduction of therapeutic hypothermia (TH) for the management of neonatal encephalopathy, have allowed us to sustain and improve life for babies that previously may have been deemed too unwell to continue life-sustaining treatments. From an obstetric perspective, there has been an increase in the detection of serious fetal anomalies with better antenatal scanning regimes and the use of MR imaging in fetal medicine to detect congenital brain malformations.

The decision to redirect the focus of care to comfort-only measures usually follows a detailed neurological examination of the baby in conjunction with neuroimaging (typically MR imaging) aided by EEG monitoring when available. Congenital causes of severe brain dysfunction, such as severe congenital brain malformations (e.g., giant encephalocele, lobar holoprosencephaly) leading to a plan for palliative care following delivery, are encountered. However, most term babies where palliative care is initiated do so following acquired perinatal brain injury. Major conditions that lead to the development of perinatal brain injury include hypoxic ischaemic encephalopathy (HIE), perinatal stroke, perinatal central nervous system infection, and intracranial haemorrhage. Hypoglycaemia can result in brain injury or potentiate injury due to other causes, e.g., HIE.

 HIE is one of the commonest reasons for acquired brain injury in the normally formed term newborn. The incidence of HIE is approximately 1.5 per 1000 births, and globally there are 700,000 cases of death or disability from birth asphyxia annually. Therapeutic hypothermia (TH) has resulted in significant improvements in the outcomes of neonates with HIE. However, greater than 40% of neonates who undergo TH will still have impaired neurological outcomes at school-going age. TH does not improve outcomes in babies with severe HIE.

A perinatal stroke is a cerebrovascular event occurring between 20 weeks gestation and up to 28 days after birth. Prevalence has been estimated at 1/1600 to 1/5000 live births and is recognised as the second most common cause of neonatal seizures after neonatal encephalopathy accounting for up to 20% of neonatal seizures . Presentation is usually in the first three days after birth. The outcome of neonates with perinatal stroke is difficult to predict.

Intracranial haemorrhage in term infants is rare but can result in significant neuro disability. Intracranial haemorrhage can be epidural, subdural, subarachnoid haemorrhage, or intracerebral.

Central nervous system infections, including meningitis and encephalitis, can be bacterial, viral, or fungal in aetiology. The incidence of early-onset meningitis is approximately 0.39 per 1000 live births. Herpes virus infection is the most common non-bacterial cause of central nervous system infection, with an estimated incidence of 1 in 50,000 live births, and can lead to severe neurodevelopmental delay.

Being told that their newborn has a brain injury is amongst the most devastating news that parents can receive. Existing data suggests that parents of encephalopathic neonates experience predictable communication difficulties. Medical information is complex and uncertain prognosis is challenging. It is well-accepted that parents value participation in medical decision-making. Parent-centered decision-making is preferred in the NICU when discussing longer term goals and potential harm. The fundamental goal of shared decision-making is to open the process to benefit from both the physician’s and the parent’s respective experiences, knowledge, and beliefs. This does not imply a value-neutral role for clinicians but instead requires a more delicate balancing as an advocate for the baby while respecting parental views. Parents who perceive a shared role in end-of-life decision-making may experience less long-term grief than parents who perceive either making the decision on their own or having no involvement. Palliative care teams are an important source of added support to all caregivers. Attempting prognostication in neonatal encephalopathy is essential to help parents formulate their concept of best interest for their newborn. However, estimating prognosis is complicated by the wide range of potential neurodevelopmental outcomes, evolving course, and role of extrinsic factors like access to rehabilitation. Even in cases of anticipated death, infants may unexpectedly survive. In the face of uncertainty, describing the best case, worst case, and most likely outcome is an effective strategy to characterize the potential range of outcomes.

Clinical history, neurologic examination, serum biomarkers, neurophysiology [amplitude-integrated electroencephalography (aEEG) or EEG], near-infrared spectroscopy, and magnetic resonance imaging have all been studied as predictors of severe neurologic injury and poor outcome, although none is 100% predictive. Serial evaluation over time facilitates discussion regarding anticipated poor prognosis and decision-making for transition to comfort care. Serial assessments with a particular test are more predictive than a single observation. The time over which a test remains abnormal together with the trend over time yields the best information(9). Thus far, brain monitoring in the form of aEEG and conventional EEG seems to be the best objective tools to identify the highest-risk patients. Specifically, a severe depression or burst suppression pattern which persists is suggestive of poor outcome. Magnetic resonance imaging (MRI) is known to retain its predictive abilities when performed in the window of 5-10 days after birth. Where MRI is performed, the pattern and extent of injury remain important predictors of outcome even after TH. However, MRI is sometimes not possible due to clinical instability or accessibility. In these cases, cranial ultrasound is important and predictive if it shows hyperechogenic subcortical grey matter structures (basal ganglia and thalamus) and/or focal parenchymal lesions. The presence of cystic lesions early in the neonatal course is also predictive of poor outcome and helps to identify prenatal injury. Many scoring systems are available and can be applied to help predict outcomes, including the Barkovich and the Rutherford scoring system. The Weeke scoring system is a comprehensive scoring system that assesses several different functional areas of the brain, including motor, visual, and memory. Complete and careful neurological examination remains of critical importance. In predictive models, time to improvement in stage and time to reach no or mild HIE were important predictors of death/disability. The advent of bedside aEEG allows neonatologists to continuously trend the background pattern and hence the degree of recovery alongside serial clinical examination during TH. In cases where clinical examination and EEG are in keeping with profound injury, and there is no sign of improvement over 24-48 hours, MRI brain does not add greatly to prognostication. However, MRI should be considered in this setting if the baby has received anti-epileptic medications, which may affect the reliability of both clinical examination and EEG findings.

The term life-limiting condition refers to any illness for which there is no reasonable hope of cure and where the child is unlikely to survive beyond early adulthood. Many of these conditions cause a progressive deterioration leaving the child increasingly dependent on their family or carers. Such illnesses have been categorised into four categories . The fourth category includes conditions leading to severe disability and the likelihood of premature death, such as severe cerebral palsy and multiple disabilities following brain injury.

Decisions that involve the withdrawal or withholding of life-sustaining treatment should have the child’s best interest as the central focus(7). A futile intervention is different from an intervention that is not pursued because it is not perceived to be in the overall best interests of the child.  With shared decision-making, medical facts must be reflected alongside the family’s preferences, values, and goals. Even when care is not futile, care may be against the child’s best interests when the likely harms outweigh possible benefits (6). Perinatal palliative care input is paramount in the care of the term neonate with significant brain injury. Palliative care stages have been defined in the British Association of Perinatal Medicine Framework for Clinical Practice in Palliative Care. This describes a transition period from routine or intensive care to palliative care. Supportive care includes considerations for oral nutrition, hydration, and analgesia. The overall goal of palliative care is to achieve the best quality of life for patients and their families.

In conclusion, decisions around the futility of care and redirection to comfort measures for newborns with brain injury is a complex decision that should only occur following a process of shared decision-making involving all caregivers for the baby. Certainty about prognosis is not possible despite advances in medical care, but clear and honest discussions with parents are paramount to the decision-making process. The involvement of palliative care physicians is recommended in patients with severe brain injury leading to a life-limiting condition.


More male midwifes in Ethiopia | METROPOLIS

 Metropolis  Jan 31, 20

In Ethiopia, a large proportion of midwives are men. Like Gashaw, who lost a beloved neighbor during childbirth. Metropolis is a video project by Dutch broadcast organizations HUMAN and VPRO, that started in 2008. Metropolis is made by a global collective of young filmmakers and TV producers, reporting on remarkable stories from their own country or city. More videos and full episodes on


Without additional support, families of preemies can fall through the cracks

Families of prematurely born babies are calling for increased paid leave, insurance, and mental health support to manage the emotional and economic impacts.

Pamela Appea – March 30th, 2022

Brooke Jones was in her late 20s when she became pregnant with her first child. Employed full-time as a medical assistant in Connecticut, Jones fully expected to work right up until her due date. Jones described her pregnancy as “normal” and didn’t believe she had any symptoms that were significantly worrisome. But that changed when a routine ultrasound at 25 weeks revealed that her amniotic fluid levels were dangerously low. Shortly after, medical professionals realized Jones’ blood pressure had spiked “through the roof,” she told Prism. She was diagnosed with preeclampsia and was admitted to the closest hospital for immediate treatment. 

“They told me I might give birth that day,” Jones said. She was subsequently transferred to Yale New Haven Children’s Hospital, where she was treated for a host of other complications, including fluid buildup in her lungs, which meant Jones had to go on medical leave immediately. “I was on autopilot,” she said.  

After two weeks of strict hospital bedrest, Jones gave birth to her baby boy at 27 weeks via an emergency C-section. A micro preemie, he weighed only 1 pound, 8 ounces at birth. Earlier in her pregnancy, Jones had carefully thought about her maternity-leave schedule, finances, childcare logistics, and more, but suddenly she needed a whole new plan. 

But as Jones discovered, balancing medical care, a lack of work leave and the need for aftercare support and mental health counseling as a caregiver often proves challenging for families with preemies. Jones’ son spent four months in the neonatal intensive care unit (NICU), where doctors treat sick and premature newborns, but her maternity leave only lasted six weeks after he was born, so she had to go back to work long before he was released from the hospital.  

In search of emotional and mental health support

Women of color like Jones, who is Black, compose a significant number of parents who give birth prematurely. According to the March of Dimes, over 380,000 babies are born preterm every year in the U.S. about 1 in 10 of every live birth. Black and Indigenous women are 60% more likely to give birth preterm than white women.

For the families of preemies, the whole birth experience can be fraught. Often, preemie caregivers aren’t given a lot of time to process that their baby may have short- and long-term medical, developmental, and other complications that require a NICU stay, high-risk surgeries, and other medical procedures. 

Additionally, caregivers can feel overwhelmed and experience a wide range of postnatal mental health issues, including depression, anxiety, guilt, and NICU-specific PTSD. 

“The caregivers’ primary need is emotional support. Prematurity is something that is a surprise, and it has a very traumatic effect on the family,” said Tina Tison, executive director of the Tiny Miracles Foundation. The Connecticut-based nonprofit partners with several hospital NICUs in the area to provide counseling, mentoring, and socio-emotional support to preemie caregivers. Jones received peer mentor support and financial assistance from The Tiny Miracles Foundation after the birth of her son, including during his lengthy four-month hospitalization in the NICU.

“Any caregiver takes comfort in knowing that they are not alone,” said Tison. 

Aftershocks of the pandemic continue to impact caregivers well after their baby has been discharged from the NICU, according to Dr. Angelica Moreyra, an expert in perinatal mental health at the Children’s Hospital in Los Angeles. 

“There is currently an enhanced need for advocacy for our families that we serve due to environmental stressors that create barriers for caregiver presence in the unit such as public transit … changes in school and child care options, increased financial, occupational, and housing instability, and more,” Moreya told Prism. “When caregivers encounter barriers in being able to present in the unit, it impacts the nature of our services, as we are focused on supporting bonding/attachment between caregivers.” 

Balancing work and care

Apart from the mental and emotional strain, the economic impact of having a preemie can also be significant. According to the March of Dimes, the average NICU bill starts at $65,000. But depending on surgeries, medical procedures, and other complications, many families are expected to pay hospital bills that are hundreds of thousands of dollars or higher. For many, access to health insurance or emergency state health insurance for preemies is crucial. However, more than 2.2 million women in the U.S. live in “maternity care deserts” where families often lack access to necessary prenatal care or don’t have health insurance to cover the costs. 

Prematurely born babies are eligible to receive Medicaid and Supplemental Security Income through Social Security. Regardless of a parent’s income level, state insurance typically covers nearly all of the child’s NICU hospital bills, surgeries, post-discharge medical treatment, and other medical and mental health services for both the caregiver and the baby during their first year.  Speech, occupational therapy, physical therapy, and other rehabilitative services are typically covered either through insurance, early intervention, and occasionally through Department of Education public education services after the age of 3-5, depending on the state. However, the process for access to these services is fraught with governmental red tape, making it difficult for caregivers to access.

Even as families face mounting expenses, without extra paid leave caregivers of preemies can find it difficult to hold onto a full-time job given the need for medical appointments, early intervention services, special education services, evaluations, operations, and other treatments for medical issues preemies may struggle with even after “graduating” from the NICU. While Jones’ son’s medical bills and her mental health care were covered by state insurance, her husband ultimately left his job to manage their son’s care and medical appointments.

Working toward policy shifts

As Jones and her husband have looked toward the future and considered having another baby, they’ve become doubtful about the financial feasibility. Without the same state Medicaid services, more paid family leave, and the ability to take time off work for medical appointments, Jones said she was unsure they could afford another child. Her family is far from alone, and advocates for families of preemies argue that a number of policy changes need to be put in place to provide caregivers the support they need, including ensuring universal access to public health insurance programs and a minimum of 12 weeks of paid family leave, with more for families of babies with more significant health and developmental needs. March of Dimes is also pushing for the elimination of racial and geographic disparities in prenatal care and expanded access to coverage for doula and midwifery support to offer caregivers more options both during and after birth. 

If she could wave a magic wand around government policy changes for family caregivers, Jones told Prism: “Let us have our time as caregivers with our children. For me, I only got six weeks. Some people are allowed more time. But as a law, I wish it was implemented to give mothers and fathers the [paid] time we need with our kids.”


Common NICU Discharge Tests

While you’re learning all you can about your baby’s care, the discharge coordinator or case manager is planning your baby’s final tests and making preparations for discharge. Common discharge tests are explained here, but not all NICU babies require all of the tests discussed. Ask your baby’s nurse what to expect as discharge draws near.

Eye exam

If your baby was 30 weeks’ gestation or less or weighed less than 1,500 grams (3 pounds, 5 ounces) at birth, they will have an eye examination at between 4 and 7 weeks of age. Babies born after 30 weeks’ gestation and weighing between 1,500 and 2,000 grams may also have this type of eye examination if they had an especially difficult NICU course. Follow-up exams will be scheduled if the findings of the first exam warrant them. The exam is to identify any changes in the eye tissue caused by retinopathy of prematurity.

Hearing test

Hearing tests—also called audiology screenings—are done in most nurseries before discharge. Electronic sound and response monitoring determine if your baby can hear. Environmental conditions, such as surrounding noise or a crying baby, can cause inconclusive results, however. If this happens, a retest should be scheduled in a more controlled environment. If your baby responds to your voice or to noise-making toys held where they can’t see them, there is usually no reason for concern.

After discharge, your child’s hearing should be monitored by your health care provider at periodic health exams. If you are concerned about your baby’s hearing, never hesitate to insist on a more extensive hearing exam. These are available at a pediatric audiologist’s office or in pediatric outpatient rehabilitation centers.

Newborn metabolic screening

Every baby is tested soon after birth to identify some rare but potentially serious or life-threatening conditions. The number of tests varies by state. Newborn metabolic testing can yield inconclusive results if the baby is very premature, is critically ill or needed a blood transfusion prior to metabolic testing. If the screening test suggests a problem, your baby’s doctor will speak directly with you and will order follow-up testing. Become aware of the screening test results prior to discharge from the NICU and communicate the findings with your community pediatrician.

Blood count

A final hematocrit or hemoglobin and reticulocyte level are usually done the week of discharge. Although it’s unlikely, your baby might be anemic and either need a blood transfusion or iron medication to help their bones make new red blood cells. If so, follow-up lab tests will usually be done in the pediatrician’s office or an outpatient clinic.

Sleep study (pneumogram)

Infants with continuing apnea and bradycardia may have a special test to help determine the cause of these episodes. Depending on your region of the country, the test is called a sleep study, a pneumocardiogram, or a pneumogramPhilosophies vary regarding the use of pneumograms, and not all NICUs use them. A pneumogram does not answer every question about the baby’s apnea and bradycardia, and interpretations of the test vary regionally. The American Academy of Pediatrics (AAP) states that “pneumograms are of no value in predicting sudden infant death syndrome (SIDS) and are not helpful in identifying patients who should be discharged with home monitors.”

Cranial ultrasound

If your baby was born younger than 30 weeks’ gestation, she has probably had several ultrasounds of her head to detect intraventricular hemorrhage. Some NICUs will perform a cranial ultrasound or other brain imaging study near the time of hospital discharge for babies weighing less than 1,000 grams at birth. Your neonatologist may also suggest magnetic resonance imaging near your baby’s original due date to help predict the need for early intervention services and ensure the best possible developmental outcome. Sometimes a different brain imaging technique may show abnormalities that a screening ultrasound will not. This does not mean that the initial ultrasounds were misinterpreted, but merely that each test has limitations.
 Last Updated 1/24/2023:

Father’s Perspective on Breast Feeding: A Cross-Sectional Questionnaire Based Study

Aparna VelmuruganPrahankumar RajendranManaikandan Mani



Despite global efforts to promote exclusive breastfeeding, the rates in India have been in the sub-optimal range. Higher levels of paternal support and encouragement are linked to better maternal confidence in breastfeeding. This study was aimed to assess the knowledge, attitude, and practice of fathers of infants towards the importance of breastfeeding practices.


Fathers of infants visiting the Pediatric OPD, were interviewed with a structured, pre-tested questionnaire after obtaining written informed consent. This is a cross-sectional study where 158 fathers were given the questionnaire on knowledge, attitude, and practice about breastfeeding along with the sociodemographic details. The sections of the questionnaire were scored using the five-point Likert scale.


Among the 158 fathers who participated in the study, majority (51%) had moderate scores in knowledge, attitude, and practice about breastfeeding. Around 131 fathers (83%) have not received any counseling about support and their role in breastfeeding and majority (58%) fathers felt the need to get education and training regarding parenting skills. Around 66% of the fathers were aware of the ideal duration of exclusive breastfeeding. About 35% of the fathers were not comfortable letting their wives breastfeed the child in public places. Around 25% of the participants had the idea that breastmilk production is reduced after child delivery through Cesarean section.


Fathers should have active participation during maternal check-ups, delivery, and antenatal counselling. This will help a better bonding and may lead to successful and prolonged breastfeeding. Educating fathers may help in increasing breastfeeding rates and duration.


Eleni Gebremedihin


Variation in NICU Head CT Utilization Among U.S. Children’s Hospitals

RESEARCH ARTICLE| JANUARY 09 2023 Megan M. Shannon, MDHeather H. Burris, MD, MPHDionne A. Graham, PhD


Evaluate nationwide 12-year trend and hospital-level variation in head computed tomography (CT) utilization among infants admitted to pediatric hospital NICUs. We hypothesized there was significant variation in utilization.


We conducted a retrospective cohort study examining head CT utilization for infants admitted to the NICU within 31 United States children’s hospitals within the Pediatric Health Information System database between 2010 and 2021. Mixed effects logistic regression was used to estimate head CT, head MRI, and head ultrasound utilization (% of admissions) by year. Risk-adjusted hospital head CT rates were examined within the 2021 cohort.


Between 2010 and 2021, there were 338 644 NICU admissions, of which 10 052 included head CT (3.0%). Overall, head CT utilization decreased (4.9% in 2010 to 2.6% in 2021, P < .0001), with a concomitant increase in head MRI (12.1% to 18.7%, P < .0001) and head ultrasound (41.3% to 43.4%, P < .0001) utilization. In 2021, significant variation in risk-adjusted head CT utilization was noted across centers, with hospital head CT rates ranging from 0% to 10% of admissions. Greatest hospital-level variation was noted for patients with codes for seizure or encephalopathy (hospital head CT rate interquartile range [IQR] = 11.6%; 50th percentile = 12.0%), ventriculoperitoneal shunt (IQR = 10.8%; 50th percentile = 15.4%), and infection (IQR = 10.1%; 50th percentile = 7.5%).


Head CT utilization within pediatric hospital NICUs has declined over the past 12-years, but substantial hospital-level variation remains. Development of CT stewardship guidelines may help decrease variation and reduce infant radiation exposure.

Source:Variation in NICU Head CT Utilization Among U.S. Children’s Hospitals – PubMed (

Keypoints in movement analysis graphically displayed

Artificial intelligence and video as a resource to timely discover anomalies in premature babies

               Published November 15, 2022

Due to an increased risk of various problems concerning growth, movement and development, premature babies are in need of special care. According neonatologist and professor of Pediatrics at the UMC Groningen, Arie Bos, it is important for early detection to discover possible anomalies on time in these premature babies, to minimize the consequences at a later age. In a movement analysis based on video images, such anomalies could be better assessed with the assistance of artificial intelligence.

At the University Medical Center Groningen (UMCG) 80 to 120 premature babies are admitted anually to the hospital from the provinces Groningen, Friesland, Overijssel and Drenthe. The babies end up on the Intensive Care Neonatology, which is the only intensive care unit for neonates out of eight hospitals in the Northern Netherlands. Due to a premature birth of ten weeks or more before the due date, these babies need special care. When the neonates are no longer in need of intensive care, they are transferred to one of the eight regional hospitals. There, the care is taken over by a pediatrician and the child is closer to the parents.

Periodic check

Periodic checks are of great importance in the case of an extreme preterm. Parent and child will visit the outpatient neonatology clinic of the UMCG during prebooked appointments to discover potential areas of concern in the development at an early stage. This consists of five moments in total, the first of which takes place when the baby is six months old and the last taking place when the child is eight years old.

The NeoLifeS cohort

To learn more about the development and most sufficient treatment of premature babies, the need arose for a central database of all the hospitals. In 2016, Bos together with his colleagues started NeoLifeS, a cohort with the purpose to identify problems and risk factors, and to improve the care for prematures. Premature babies are more at risk of various issues with growth, movement and development – including spasticity.

Within this cohort, data is collected on health and development issues of premature babies. The database contains information on the brain, lungs, eyes, respiration, the gastrointestinal system, infections, the placenta and on the start and course of the pregnancy of mother and child. Bos: “By systematically collecting and assessing clinical data of all the hospitals, of completed questionnaires by parents, and of movement patterns of the baby at three months past the calculated age, we can improve our intensive care for premature babies even further. After all, we want a bright and healthy future for these vulnerable kids.”

Since the start in 2016, after receiving permission from the parents, all clinical data of prematures has been collected from the moment of birth and stored in one databank. At present, the databank contains the data on 340 babies that were born before 30 weeks and/or weighed less than 1000 grams.

Movement analysis with own smartphone

Babies are often allowed to go home with the new parents if they are as old as they would originally be on the mother’s due date. This almost always occurs from one of the regional hospitals. Afterwards, it is essential that measurements are put in place to record the movements of the baby. Throug these measurement moments the baby is monitored for, amongst other things, spasticity. Spasticity occurs regularly and is often caused by a brain haemorrhage as a complication of preterm birth.

At the moment, spasticity is often only discovered after eighteen months. In the past this occured under the watchful eye of the specialist at the hospital, however, now, it can take place in a home environment, as the baby’s movements can be viewed with a smartphone. This new situation results in less stress for both parent and child, which ultimately provides a more reliable image.

Based on the video images, it is possible to determine whether there is a normal development or a potential anomaly as soon as three motngs. In this case, a rehabilitation specialist can be quickly called in for issues regarding arm and hand functions as a consequence of spasticity and these effects can be minimized when the child is older.

Timely recognition of certain patterns

The recorded video images are subsequently sent to the UMCG, where the NeoLifeS-team starts an analysis. The researchers watch approximately six to eight videos an hour, whereby it only takes 5 to 10 minutes of video to determine whether there is a case of normal or abnormal movement patterns and whether there is a need for closer examination. If it is suspected that there is a higher risk of a deviation in the motor development (especially spasticity), a consultation with the parents and the regional pediatrician is advised to refer to a rehabilitation center.

Bos explains: “The movement patterns at the age of three months is extremely important. With children that develop normally, you will see small, moderate speed, dancelike movements of the entire body, so in the shoulders, arms, hips, legs, torso and neck; then here, then there. Children who have a spastic movement disorder later on, do not display these movements at all. This knowledge has existed for a while, but only in the last few years we have discovered that by starting targeted therapy early, we can greatly improve the future results of children with spasticity.”

Technology as an essential factor

Neolook Solutions supports NeoLifeS with the development and expansion of the used movement analysis, which is internationally known as the General Movement Assessment (GMA). Marco D’Agata, Managing Director at Neolook Solutions: “UMCG is the national academic expertise center for the General Movement Assessment. If we want the GMA to be accessible for those thousands of children who are at risk every year in the Netherlands, just like in other countries, than we better work together with existing parties such as NeoLifeS.”

Neolook thinks ahead: where previously the specialist received the parents in the hospital or the nurse came by the house to record the video, it is now possible to virtually visit the parents. A livestream provides the nurse or the specialist with a direct view of the child. This takes less time and causes less stress for both the parent and the child. The video is then safely stored at the UMCG for the team of NeoLifeS to watch and analyse the video at a suitable moment.

Innovation with Artificial Intelligence

The next step in the process is to apply artificial intelligence. By visualizing the movements in the video with so-called ‘key points’ (key points which together form a wire figure of the child), potential deviations can be recognized by artificial intelligence software. Artificial intelligence makes it possible to automatically detect certain patterns in the movement of new-born babies. The application of the abovementioned form of artificial intelligence in the movement analysis of NeoLifeS can enable the specialists whom assess the movements to be more efficient and better supported in the assessment process.

The results from the recording are graphically displayed for the specialist, with any peculiarities being highlighted. Thus, the specialist can immediately investigate possible anomalies. The application of artificial intelligence in the movement analysis therefore supports the specialists in their tasks and speeds up the assessment process.

 D’Agata: “You cannot use just any livestream. Parents need to be coached live, because the quality has to be good. Then, we can overlay the 23 key points on the small body, mapping simple and complex movements for the specialist.”

At the moment, NeoLifeS works on the direct application of AI on livestream videos in an international consortium. It is therefore possible to act more rapidly, leading to earlier detection of potential anomalies in premature babies.

More about cohorts and biobanks

Currently, there are 175 cohorts and biobanks at the UMCG. These cohorts and biobanks collect data over extended periods, as well as body materials for future medical scientific research. The Cohort and Biobank Coordination Hub (CBCH) unites all these cohorts and biobanks, supports researchers and stimulates new research and cooperations.


Telemedicine Improves Rate of Successful First Visit to NICU Follow-up Clinic

January 2023 Lilly Watson, BAChristopher W. Woods, MSN, RN, NNP-BCAnya Cutler, MS, MPHJohn DiPalazzo, MPH, MSAlexa K. Craig, MD, MS, MSc



NICU graduates require ongoing surveillance in follow-up clinics because of the risk of lower cognitive, motor, and academic performance. We hypothesized that multiple programmatic changes, including availability of telemedicine consultation before hospital discharge, would improve NICU follow-up clinic attendance rates.


In this retrospective study, we included infants who survived and were premature (≤29 6/7 weeks/<1500 g) or had brain injury (grade III/IV intraventricular hemorrhage, stroke or seizure, hypoxic ischemic encephalopathy). We compared rates of follow-up for the early cohort (January 2018-June 2019; no telemedicine) with the late cohort (May 2020-May 2021; telemedicine available); and performed a mediation analysis to assess other programmatic changes for the late cohort including improved documentation to parents and primary care provider regarding NICU follow-up.


The rate of successful 12-month follow-up improved from 26% (early cohort) to 61% (late cohort) (P < .001). After controlling for maternal insurance, the odds of attending a 12-month follow-up visit were 3.7 times higher for infants in the late cohort, for whom telemedicine was available (confidence interval, 1.8-7.9). Approximately 37% of this effect was mediated by including information for NICU follow-up in the discharge documentation for parents (P < .001).


Telemedicine consultation before NICU discharge, in addition to improving communication regarding the timing and importance of NICU follow-up, was effective at improving the rate of attendance to NICU follow-up clinics.


 Surakshit Sagar India undertakes a massive 75-day campaign to clean up 75 beaches

As highlighted in the video above, I believe that learning how to hold our ground and maintain a positive perspective when difficult and unexpected situations arise in life may allow us to learn new ways to overcome difficult situations, cope with our emotions, and build our resilience.  

Recently, I was met with an unexpected and very challenging situation in my personal life that has required an internal response of focus on building my personal resilience in order to best move forward with the task at hand.  

As preemie survivors and global neonatal community members we are innately resilient, learning to overcome the challenges in life we have been dealt. As we know, it isn’t about what happens to us in life, it is about how we respond.  

As surfers are pushed to be present in the moment in order to ride the waves they chase, we too learn to surf the waves of life.  

What have the challenges in your life taught you to overcome and revealed to you about yourself? How have such experiences helped you develop your character, integrity, and sense of self so that you may rise on the other side as a stronger, more composed, and introspective individual?  

Moving into 2023 my hope is that the collective challenges we have experienced as a global community over the past few years and the challenges we face as individuals may compel us to stand grounded and even more composed as we work to pursue excellence in our lives and strive to give the best of ourselves to ourselves, to our family, to our friends, to our mentors, to our communities and to our world.  

Wishing you and our global neonatal community fruitful abundance and enhanced resilience for 2023! 

I did Paragliding in Ethiopia….**Just Awesome**

Ferils Mad World  Apr 5, 2022  #addisababa #ferilsmadworld

Hey, Ferfam I had a wonderful experience doing the paragliding activity organized by #greathikers in Ethiopia. We traveled to Sandafa city which is on the outskirts of #addisababa. It was such a beautiful experience, gliding in the air like a bird, It is a once-in-a-lifetime experience. The activity is done by a professional from Bulgaria, and it’s such a smooth ride. Watch the vlog on #ferilsmadworld and don’t forget to shower your love


Saudi Arabia


Estimated Number Of Preterm Birth Rates –  3.96per 100 live births

(Global Average: 10.6, USA: 9.56)

Source- WHO 2014-

Saudi Arabia, officially the Kingdom of Saudi Arabia (KSA), is a country in Western Asia. It covers the bulk of the Arabian Peninsula, and has a land area of about 150,000 km2 (830,000 sq mi), making it the fifth-largest country in Asia, the second-largest in the Arab world, and the largest in Western Asia and the Middle East. It is bordered by the Red Sea to the west; JordanIraq, and Kuwait to the north; the Persian GulfQatar and the United Arab Emirates to the east; Oman to the southeast; and Yemen to the south. Bahrain is an island country off the east coast. The Gulf of Aqaba in the northwest separates Saudi Arabia from Egypt. Saudi Arabia is the only country with a coastline along both the Red Sea and the Persian Gulf, and most of its terrain consists of arid desert, lowland, steppe, and mountains. Its capital and largest city is Riyadh. The country is home to Mecca and Medina, the two holiest cities in Islam.

Saudi Arabia is considered both a regional and middle power.[35][36] The Saudi economy is the largest in the Middle East; the world’s eighteenth-largest economy by nominal GDP and the seventeenth-largest by PPP. As a country ranks 35th, very high, in the Human Development Index, it offers a tuition-free university education, no personal income tax, and a free universal health care system. Saudi Arabia is home to the world’s third-largest immigrant population. It also has one of the world’s youngest populations, with approximately 50 per cent of its population of 34.2 million being under 25 years old.[ In addition to being a member of the Gulf Cooperation Council, Saudi Arabia is an active and founding member of the United NationsOrganisation of Islamic CooperationArab LeagueArab Air Carriers Organization and OPEC.

Health care in Saudi Arabia is a national health care system in which the government provides free health care services through a number of government agencies. Saudi Arabia has been ranked among the 26 best countries in providing high quality healthcare.


Meaningful Manifestations for 2023

As we celebrate the year of 2022 and TRANSITION into the New Year, we would like to share a few of our aspirations for advancements within our global neonatal community for 2023.  Feeling passion, we desire:

  • Enhanced efforts to drive strong and focused innovation in preterm birth technology, preterm birth research and  prevention, targeted diagnostic and treatment options, and effective healthcare  workforce development.
  • Collaborative global engagement focused towards provider/patient education and support, preemie-focused developmental and time sensitive interventional care, the development of  Preterm Birth Community lifespan wellness,  and focused health care/resource  access for our global pre-term birth survivor community (10-12% of our total global population). 
  • Comprehensive research and associated development of effective diagnostics and impactful treatment for preterm birth related preverbal PTSD effecting  preterm birth survivors of all ages.
  • Longitudinal research targeted towards investigation of the gestational neurological development of the preterm birth population, with increased identification of gestational development and advanced cohort/diagnostic classifications in order to improve diagnostics, treatment planning, and best practices supporting neonatal health outcomes. 
  • Expansion of healthcare provider specialization in medical and mental health care targeting pediatric and adult preterm birth survivor needs and resources.  
  • Advancements towards holistic, comprehensive, and accurate diagnostic care management of preemie neurological development, health and wellness conditions free from potentially harmful bias and assumptions that similar symptom presentation in preterm neonates vs. non equates  to similar  diagnoses, etiology, treatment and time sensitive interventions.  


We stand firmly in the expectation that as innovation, technology, diagnostics, research, integrated care management, and global collaboration expands within the preterm birth community we will witness improvements in the quality of life for all members of our global preterm birth family.

Kathy, Kat, and our cat Gannon anticipate that 2023 will lead to the joyful amplification and manifestation of our shared hopes, wishes, dreams and more within the Global Neonatal Womb/Preterm Birth Community! Wishing us all a Joyful, Love-filled, Healthy, Satisfying,  and Adventurous 2023!  


Lack of innovation in neonatal respiratory care is the biggest problem for both preterm and term neonates: to be remembered on World Prematurity Day

Daniele De Luca   09 NOV 2022

This is an editorial commissioned to the President of the European Society for Pediatric and Neonatal Intensive Care, on the occasion of World Prematurity Day 2022. It celebrates this important event by summarizing how the most crucial (and forgotten) problem in neonatal respiratory care is the lack of active translational research. Translational research is pivotal in this context, as it allows to understand the diseases, diagnose them, and imagine new strategic pathways. The lack of translational research means no innovation, and this is jeopardizing the possibility to improve healthcare for both preterm and term critically ill neonates. Historical and more recent examples of the problem are given, together with some basic suggestions to move forward.

On November 17 every year, many countries celebrate World Prematurity Day. Purple is the color of the initiative; thus, hospitals and monuments are highlighted, whereas gadgets and people show something with this color. Since 2011, this fruitful initiative succeeded in raising the attention on the problems related to prematurity, particularly on the care of preterm babies and the important role of parents. This is a commendable and needed initiative. In fact, neonatal care risks being perceived as something taken for granted in the Western world, where birth rates and infant mortality are low and the main current health problems, particularly in the COVID-19 era, are those of the adult age and elderly.

However, we cannot forget that preterm neonates are not the only ones at risk, and, as a matter of fact, the most crucial issue for neonatal medicine has been forgotten. In fact, although many focus on preterm developmental care and parental role, we must admit that neonatology has not meaningfully improved its global clinical results, as there have not been many relevant innovations in the last two decades.

This is particularly true for neonatal respiratory critical care which is, together with hemodynamics, the core problem to be addressed for most patients in life-threatening situations. After the introduction of prenatal steroids and surfactants, we have seen no other game changers for preemies. The situation is even worse for term neonates since the last improvement has been represented only by the introduction of whole body hypothermia for perinatal asphyxia. Thus, we still lack effective drugs and clear diagnostic-therapeutic strategies for bronchopulmonary dysplasia as well as for other disorders more typical of term neonates, such as refractory pulmonary hypertension or congenital diaphragmatic hernia and other congenital lung disorders.

The reasons behind this lack of innovation are many. The regulatory procedures are too strict, time-consuming, and do not consider the peculiarities of the newborn patient and the rarity of his diseases. They are supposed to protect the patient from “wrong” innovations, but they forgot to protect him from the lack of innovation, i.e., the unavailability of drugs or medical devices. Surfactant was intensively studied in the 1980s, following animal and bench experiments performed by Mary Allen Avery and Bengt Robertson. Most likely, this would be extremely difficult, if not impossible, with current regulations, and, if these basic experiments would have been needed today, no surfactant would be available.

The neonatal market is smaller than that represented by several adult medicine specialties, and the relatively low neonatal mortality has decreased the interest of many public grant programs; as a combination of these two factors, neonatal research often lacks specific funding and this is particularly true for respiratory research. Most of the neonatal ventilation research is done without public or industry fundings ; in other words, without the charities and the dedication of researchers, we would not have several respiratory support techniques such as the newest noninvasive ventilation modalities. Other cases are less lucky: some respiratory drugs [including potentially life-saving pulmonary vasodilators do not achieve enough clinical evidence, because they are not suitable from a marketing point of view (i.e., low price, rare use) despite strong translational and clinical data supporting them.

Nonetheless, we shall admit that, besides these problems, the difficulties in finding new solutions for neonatal respiratory care are also due to our own carelessness about what has been learned in close fields, such as anesthesiology, intensive care medicine, regenerative medicine, transplantation surgery, and other fields of adult healthcare. Neonatal respiratory care, and neonatology in general, has suffered a lack of cross-disciplinary awareness that has prevented or delayed important advancements. The reason behind this was the supposition that the neonate was completely distinct from all other patients; newborn physiology may be different in some aspects, but this cannot prevent to recognize similitudes and take advantage from experience accumulated in other fields. In 1964, Gilbert Hualt provided mechanical ventilation for the first time to a newborn infant with congenital tetanus. Without his vision, the introduction of neonatal ventilation would have been delayed; ironically, this technique is now considered the basis of intensive care. How many of us have the same vision regarding strategies, tools, and research lines investigated in adult respiratory care? I still remember a professor stating, no more than 15 years ago, that applying ECMO to neonates was technically impossible. Lung transplantation in neonates and infants is still regarded as an extreme procedure, but some centers practice it with satisfactory results. Are we enough interested in artificial organs and regenerative medicine applied to neonatal respiratory disorders?

The examples are countless and the combination of all these factors leaves many neonatal disorders without a full understanding of their pathobiology and orphan of diagnostic-therapeutic tools; this creates relevant clinical unmet needs. 

Despite all of these problems, some innovations have been achieved, such as the recognition of neonatal acute respiratory distress syndrome (an entity that was forgotten for several decades;  and the implementation of point-of-care lung ultrasound, following the adult intensive care experience (although its diffusion is still variable among countries. Nonetheless, translational research is essential if we really want to fill the many clinical unmet needs. Translational projects are important to understand the mechanisms of disease, how to “intercept” them with diagnostic tools, how to personalize the treatment as much as possible and to discover new therapeutic possibilities. Thus, neonatal translational research, particularly in the respiratory field, must receive greater attention, be facilitated in the regulatory process, and take advantage from quicker industry-academy and cross-disciplinary collaborations. The work might not be exclusively unidirectional. As neonates today are the patients of tomorrow, good results achieved by neonatal research can impact on patient health for several decades ahead. Although we celebrate World Prematurity Day, we shall remember that the actual main problem, both for preterm and for full-term neonates, is that there is no future without active research.


US gets D+ grade for rising preterm birth rates, new report finds

By Jacqueline Howard, CNN   Published 8:00 AM EST, Tue November 15, 2022

The US preterm birth rate peaked in 2006 at 12.8%, according to data from the National Center for Health Statistics.

Since then, some March of Dimes reports have found US preterm birth rates much higher than 10.5%, but those rates were based on calculations that have since been updated, according to March of Dimes.

“There are too many babies being born too soon: 1 in 10. If you were to have 10 babies in front of you and one of them is having to face the complications that comes with prematurity, that’s unacceptable, and we need to do better,” Henderson said, adding that those 1 in 10 are more likely to be Black, American Indian or Alaska Native.

March of Dimes data in the new report shows that infants born to Black and Native American mothers are 62% more likely to be born preterm than those born to White women.

States with the highest and lowest rates

The new March of Dimes report also highlighted state-by-state differences in the rate of babies born prematurely across the country.

The report grades a preterm birth rate less than or equal to 7.7% as an A and a preterm birth rate greater than or equal to 11.5% as an F.

The national preterm birth rate of 10.5% is graded as a D+.

No state has achieved an A rate, and only one has a state-level preterm birth rate that would be graded as an A-: Vermont, which has the lowest preterm birth rate in the US at 8%.

Meanwhile, nine states and one territory have preterm birth rates that received an F grade: Georgia and Oklahoma with 11.9%; Arkansas, Kentucky and Puerto Rico with 12%; South Carolina with 12.1%; West Virginia with 12.8%; Alabama with 13.1%; Louisiana with 13.5%; and Mississippi with the highest preterm birth rate of all states at 15%.

“The areas that have the worst grades are the same areas we’ve been seeing consistently for a long time, and it’s past time for us to do what we need to do to make health better and make our country a better place to give birth and be born,” Henderson said. “It’s unfortunate that we don’t have policies in place to protect the most vulnerable in our country, and without protecting our moms and babies, we can’t secure the health of everyone else.”

To address these state-by-state disparities in preterm births and help improve the national preterm birth rate as a whole, March of Dimes has been advocating for certain policies, Henderson said, including the Black Maternal Health “Momnibus” Act of 2021, a sweeping bipartisan package of bills to provide pre- and postnatal support for Black mothers – but most of the bills in the package are still making their way through Congress.

March of Dimes also has been urging more states to adopt legislation expanding access to doulas and midwives, among other maternal health care services, and reduce the prevalence of maternity care deserts across the country.

How Covid-19 plays a role

There are many potential factors contributing to the nation’s rising preterm birth rate, and Henderson said the Covid-19 pandemic remains one of the biggest.

“We cannot forget about the impact of the Covid-19 pandemic and recognize that there is likely a huge contribution of that, knowing that Covid-19 infection increases the risk of preterm birth,” she said. “But we also know that this pandemic brought many other issues to the forefront, knowing that issues around structural racism and barriers to adequate prenatal care, issues around access, were brought to the forefront during this pandemic as well.”

She added that many mothers in the United States are starting pregnancies later in life, and there has been an increase in mothers with chronic health conditions, who are at higher risk of having to give birth early due to pregnancy complications.

Pregnant women with Covid-19 may be at increased risk of preterm delivery, CDC study suggests

Henderson also said that preterm birth is one of the top causes of infant deaths and disproportionately affects babies born to women of color.

“The United States is one of the worst places to give birth and be born among industrialized countries, unfortunately. When we look at maternal deaths and infant deaths, we’re at the bottom of the pack among countries with similar profiles in terms of gross domestic product,” Henderson said. “It’s because of our disproportionate numbers of preterm births –particularly for populations that are disproportionately impacted, such as Black families and American Indian and Alaskan Native families – that our rates are so much higher than other countries.”

An ‘urgent public health issue’

Globally, about 10% of births are preterm worldwide – similar to the US preterm birth rate.

About 15 million babies are born preterm each year, amounting to more than 1 in 10 of all births around the world, according to the World Health Organization, which has called prematurity an “urgent public health issue” and “the leading cause of death of children under 5.”

Separate from the March of Dimes report, WHO released new guidelines Tuesday on how nations can improve survival and health outcomes for babies born too early, at 37 weeks of pregnancy or less, or too small, at 5½ pounds or less.

These WHO recommendations advise that skin-to-skin contact, also known as kangaroo mother care, be provided to a preterm infant immediately after birth, without any initial time spent in an incubator.

“Previously, we recommended that kangaroo mother care to only be for babies that were completely stable,” said pediatrician Dr. Karen Edmond, medical officer for newborn health at WHO, who was the lead on the new guidelines.

“But now we know that if we put babies in skin-to-skin contact, unless they are really critically ill, that this will vastly increase their chances of surviving,” she said. “So what’s new is that we now know that we should provide kangaroo mother care immediately after birth, rather than waiting until the baby’s stable.”

Edmond added that immediate kangaroo mother care can help infants better regulate their body temperature and help protect against infections, and she said that these guidelines are for on-the-ground health care providers as well as families.

The new WHO guidelines also recommend that emotional, financial and workplace support be provided for families of babies born too early or at low birth weights.

“Preterm babies can survive, thrive, and change the world – but each baby must be given that chance,” WHO Director-General Tedros Adhanom Ghebreyesus said in a news release.

“These guidelines show that improving outcomes for these tiny babies is not always about providing the most high-tech solutions,” he said, “but rather ensuring access to essential healthcare that is centered around the needs of families.”


RedOne ft. Enrique Iglesias, Aseel and Shaggy | Don’t You Need Somebody

platinumrecordsmusic  236,826,729 views Jul 27, 2016

* Aseel Omran (Arabicأسيل عمران) is a Saudi Arabian singer

Consider What Happens When We Don’t Care for NICU Parents

Here’s how hospitals can support parental mental health

by Alexa Grooms, BSN, RN December 23, 2022

Evidence shows opens in a new tab or window it is the emotional opens in a new tab or window, rather than the medical, complications of pregnancy that are most impactful on the long-term well-being of the parent and child. These emotional complications, known as perinatal mood and anxiety disorders (PMADs), may occur during pregnancy until the first few years after giving birth. PMADs include the most widely known postpartum depression, as well as the lesser-known postpartum anxiety, panic disorder, postpartum obsessive-compulsive disorder, post-traumatic stress disorder, and postpartum psychosis.

Neonatal intensive care unit (NICU) parents are particularly vulnerable to PMADs. Parents rarely expect their child to require intensive care, and the journey is emotional and unpredictable. Studies most often focus on mothers, or the birthing parent, rather than fathers or the supporting parent. However, we know that NICU parents have 28-70% higher opens in a new tab or window incidences of depression. At a minimum, being separated from your child can cause distress and impaired bonding.

As a NICU nurse, I can testify that staff know parent mental health is pervasive. So why aren’t we addressing it? Unfortunately, few of us have the tools, resources, and confidence to intervene. After all we were hired to take care of babies, and adults can be intimidating, especially on such a stigmatizing topic. However, hospitals and healthcare professionals must ask ourselves: What are we missing if we do not also care for the family? Parents are the key to their child’s emotional and cognitive wellness and the effects last a lifetime, for the positive or negative. Mood disorders can be debilitating both for the individual and the family.

This year, a cross-sectional study opens in a new tab or window by Cooper Bloyd, MD, MS, and fellow researchers surveyed which NICUs were incorporating mental health screening and treatment following the 2015 release of the National Perinatal Association guidelines. Among respondents, 44% routinely screened parents for disorders, most often depression. They also found that 47% offered mental health education to families, and between 3-11% employed some type of mental health specialist in their unit. The figures, they acknowledged, were likely high because of low study participation and the respondents wanting to advertise their practices.

As the National Perinatal Association outlines opens in a new tab or window, mental health initiatives can be implemented with families via universal distress screening; “layered levels of support” through education, especially peer support groups; and employment of mental health professionals. Here are my recommendations for how these may be best incorporated into standard care.

Incorporate Universal Screening

Screening can be integrated by making it part of the admission and discharge educational packages. For example, when parents are filling out initial admission forms or upon discharge when families either transfer to another facility or go home with their follow-up pediatrician appointments. There are also opportunities to screen families during infant care milestones, such as 100 days in the NICU. Whenever possible, screening can be placed alongside standard information such as safe sleep and feeding education to minimize stigma. The Edinburgh Postnatal Depression Scale is a validated screening tool specific to postpartum depression. Other useful screening tools may include the PHQ-2 for depression or PTSD-5 for trauma. Positive results should trigger follow up with a unit-based mental health provider such as a social worker, psychologist, psychiatrist, psychiatric nurse practitioner, or nurse with extensive perinatal mental health training.

This year, a cross-sectional study opens in a new tab or window by Cooper Bloyd, MD, MS, and fellow researchers surveyed which NICUs were incorporating mental health screening and treatment following the 2015 release of the National Perinatal Association guidelines. Among respondents, 44% routinely screened parents for disorders, most often depression. They also found that 47% offered mental health education to families, and between 3-11% employed some type of mental health specialist in their unit. The figures, they acknowledged, were likely high because of low study participation and the respondents wanting to advertise their practices.

As the National Perinatal Association outlines opens in a new tab or window, mental health initiatives can be implemented with families via universal distress screening; “layered levels of support” through education, especially peer support groups; and employment of mental health professionals. Here are my recommendations for how these may be best incorporated into standard care.

Incorporate Universal Screening

Screening can be integrated by making it part of the admission and discharge educational packages. For example, when parents are filling out initial admission forms or upon discharge when families either transfer to another facility or go home with their follow-up pediatrician appointments. There are also opportunities to screen families during infant care milestones, such as 100 days in the NICU. Whenever possible, screening can be placed alongside standard information such as safe sleep and feeding education to minimize stigma. The Edinburgh Postnatal Depression Scale is a validated screening tool specific to postpartum depression. Other useful screening tools may include the PHQ-2 for depression or PTSD-5 for trauma. Positive results should trigger follow up with a unit-based mental health provider such as a social worker, psychologist, psychiatrist, psychiatric nurse practitioner, or nurse with extensive perinatal mental health training.

Additional follow up could also take the form of obstetricians reaching out to patients prior to the 6-week postpartum follow up. Screening and support should also include pediatrics, as pediatricians are in a unique position to continuing assessing the child’s development and parent-child relationship.

Education for Parents and Staff

There are many opportunities to enhance parent and staff education. Parent support groups are especially therapeutic. Parents should be welcomed in by other parents as they go through this unexpected journey together. Veteran NICU families often play an important role in facilitating and leading these groups. Parents who pump also find exceptional reward and meaning in donating breast milk back to other NICU infants.

In terms of staff, mental health education should be ongoing, as going into pediatrics means partnering with families. Patient psychosocial history and discussion about how to support families should be incorporated into daily provider rounds.

Seeing It Through With Usable Referrals

Parents who want or require psychiatric care after discharge must be referred. Most importantly, these referrals must be usable. I will argue that hospitals must guarantee NICU parents’ appointments or spots in follow up care. We cannot build the trust of these families only to refer them to help that is a dead end. Hospitals will argue it is impossible to guarantee appointments, as demand for psychiatric care is high. However, hospitals must recognize the risk of both child and parent hospital readmission if they aren’t connected to care. There is also the added benefit of building patient loyalty. Labor and delivery are where most families first interact with medical care, and a good experience can lead them to return for future care.

Of course, adding mental health staff and resources will come at a cost. As cost is an understandable concern, the value of these services can be demonstrated first in low- to zero-cost quality improvement or nurse residency projects before investing dollars. Once value is demonstrated, hospitals can leverage funding from Magnet or Baby Friendly Hospital designation budgets. Applications for these hospital designations are lengthy but worth pursing as funds are allocated for pilot projects such as these.

Final Thoughts

It is clear NICU parents need our help. My recommendations are clear and feasible, and unit staff can help integrate them into standard care practices. Hospitals have a responsibility to be part of the solution and allocate funding from existing initiatives to offset costs. Staff must be educated to support parents, and hospitals must create systems within existing infrastructure to address mental health concerns. We can no longer omit parents’ health when we care for their child.



The NICU: The palliative care team would ask us, “How do you feel about what you just heard?”

Courageous Parents Network Nov 6, 2019

The palliative care team would ask us, “How do you feel about what you just heard?” Parents of a baby son who was born with Arteriovenous Malformation (AVM) and died at age 3 months, talk about how the palliative care team interacted with and supported them, and helped manage their son’s pain and consider the future. “They really saw us as people and as parents. It was an awesome help to have them there.”

Holding Your Baby in Intensive Care

Published on Jun 19, 2022

“Yes, your baby can be held today!”

Hearing these words can trigger strong emotions. Every parent is eager to hold their baby. But holding a baby who is very small or on a breathing machine with lots of tubes and wires can be scary (even for experienced parents). Below are some common questions parents have about holding their baby in intensive care and our recommendations.

“I know I will want to hold my baby, but isn’t it better to just let my baby rest in bed?”

Babies are born needing your touch. Your touch is very different than touch from the hospital sta­ff.

When you hold your baby, you help your baby:

  • Get to know you and develop an attachment
  • Maintain body temperature
  • Develop and grow brain connections
  • Learn language
  • Develop muscles and strength
  • Gain weight
  • Feel less pain
  • Cry less
  • Stabilize breathing and heart rate
  • Sleep better
  • Reduce stress
  • Feel safe and protected

Holding your baby also helps you:

  • Feel more confident as a parent
  • Feel connected to your baby
  • Reduce stress
  • Produce milk for your baby, if you pump

“Holding my baby for the first time feels like a big deal. How can I prepare when it is time to hold my baby?”

  • Request a comfortable chair with arms and a footrest.
  • Choose a time when you can take your time and are not rushed.
  • Go to the restroom, and make sure you eat beforehand.
  • For moms who pump, pump before holding your baby.
  • Have a water bottle nearby in case you become thirsty.

“I want to hold my baby, but I don’t know whether it is safe, and I feel nervous. What are some tips?”

  • It’s never too early to start a conversation with your nurse about when your baby will be ready to be held. If your baby is not yet ready, ask your nurse, “What are some signs that tell me my baby is ready to be held?”
  • Talk to your baby’s therapists (e.g., occupational therapists, physical therapists) about suggestions for how to hold your baby.
  • Ask your baby’s nurse for ideas about how to make your baby comfortable.
  • Remember that sometimes babies have a little stress while being moved out of bed but then become very comfortable in your arms.
  • All babies (not just premature babies) benefit from skin to skin holding, which is called kangaroo care. Kangaroo care has amazing benefits for children and parents and is encouraged whenever possible. To learn more about kangaroo care, please see the Skin to Skin Care (Kangaroo Care) handout in the patient family education manual (13:B:08).
  • Before holding your baby, take some calming deep breaths.
  • Ask the social worker or psychologist for tips on how to feel more comfortable holding your baby.
  • Remember that the more you hold your baby, the easier and more comfortable it will become!

My baby’s team says my baby is not yet ready to be held. What else can I do?”

If your baby is not ready to be held, your touch is still important!

  • “Hand hugs” are a great option when your baby is not yet ready to get out of bed. This will also support your baby’s growth and your relationship.
  • Gentle, constant touch to your baby’s head, chest or feet can have a calming effect.
  • If your baby is in a warmer bed or isolette, ask for a taller chair so you can sit comfortably next to your baby and be together.


Mom shares story of premature baby now hospitalized with RSV

CBS 8 San Diego

Nov 17, 2022 – Nov 17, 2022

On World Prematurity Day, a Southern California mom is sharing her story about having a premature baby who is now hospitalized with RSV. The three-month-old has been at Children’s Health of Orange County for more than three weeks, but his story is similar to other families whose children are being treated right here in San Diego.

Respiratory syncytial virus (RSV

Respiratory syncytial virus (RSV) What is RSV Respiratory syncytial virus (abbreviated as RSV) is a virus that can cause cold-like symptoms but can also lead to severe breathing difficulties or even a severe infection of the lung. Almost all children have already once been infected with RSV by their second birthday. Since there are a lot of different forms of RSV, one can be infected several times in life.1 At risk for an RSV infection Everybody can be infected by RSV. Usually people don’t really note this, but have a cold or sniffle and recover within a few days. But the virus can also cause a very severe infection. Certain people are at risk for a more severe infection and may require hospitalisation, need of oxygen therapy and long-term damages like asthma.

Symptoms of an infection with RSV:

 The symptoms of an infection with RSV are similar to common cold symptoms, like runny nose, coughing or wheezing (a whistling sound during breathing) and a decreased appetite. An adult infected with RSV can show symptoms, but does not have to, while children usually do show symptoms. Especially in very young children the symptoms might consist of irritability and decreased activity and appetite. Also breaks in breathing (apnoea) might occur. Fever can be a symptom, but is not always present. At the beginning, the symptoms might be relatively low pronounced, but especially in people at risk for a more severe infection it can lead to hospitalisation and severe inflammation of the small airways in the lung (bronchiolitis) and infection of the lungs (pneumonia).1 Ways of transmission of the virus The virus is mainly spread by droplets from a person who is infectious to another person. This means by sneezing or coughing of an infected person into the air. When a person inhales these droplets or when they touch the mouth, nose or eye, this can lead to an infection. Also a direct or indirect contact with nasal or oral secretions from a contagious person can lead to an infection. Be aware that also kissing can lead to a transmission of the virus. Another possible form of being infected with RSV is by touching something (surfaces, toys, doorknobs, gloves,…) that an infectious person had touched before and then rubbing eyes or nose. People who are infected with the virus, but do not show symptoms or only light symptoms can still be contagious for others.

At Risk for Severe Infection:

– preterm babies young children (particularly up to 6 months)

– children with heart or lung disease (especially up to 2 years)

– certain congenital anomalies (for example trisomy 21)

 – children with a neuromuscular disease (for example children who cannot swallow easily or have – – problems clearing mucus secretions)

– elderly people who have a weak immune system

Additional Risk Factors for the babies:

– multiple birth

– male siblings in early childhood

–  passive smoking close domestic conditions

– malnutrition

– lack of breastfeeding

– family history of allergic diseases or asthma

You can help protect your baby by taking some precautions:

 The virus is able to survive quite a long time on hands (about half an hour), tissues (up to an hour) and toys/surfaces (several hours).

 Therefore the following precautions and recommendations are very important to be followed:

 Don’t share your mug, plate or cutlery with others Avoid rubbing your nose or eyes If possible, avoid interaction with high-risk children if you have cold-like symptoms When coughing or sneezing cover your mouth and nose with a tissue and throw it away afterwards Stay at home when you have cold-like symptoms Don’t kiss high-risk children while you or they show cold-like symptoms High-risk children should spend little time in potentially infectious places (for example child-care centres) Don’t smoke near your child. Wash your hands after smoking Breastfeeding reduces the risk for an infection with RSV Wash your hands frequently and wipe hard surfaces with soap and water (15-20 seconds!) or disinfectant.

Treatment of RSV Most people who are infected with RSV only show a mild form of infection and usually do not need treatment at all. For the ones suffering from a more severe form of the disease, there is no causal therapy and only the symptoms can be treated by for example lowering fever and drinking enough. Some children may even require hospitalisation and need help with breathing.4 Vaccination against RSV At the moment there is no vaccine that can help prevent RSV infection.3 Nevertheless, there may be options to prevent contracting the virus. And of course, you can help avoid RSV infection by following the already mentioned tips for hygiene! For further questions please ask your paediatrician.

A Stay in Neonatal Care – Preparing to Take Your Baby Home

The NICU Foundation Oct 14, 2021

Funded by The NICU Foundation and created in partnership with The South West Neonatal Network, this animation was created to support parents, as they navigate their journey home following a stay in neonatal care with a premature or sick baby.

*** Ask your healthcare provider what community resources are available to support you, your family, and your baby. Knowing resources in advance will empower your ability to be proactive and prepared!


Stanford Fetal Therapy VR: An inside look at complex fetal conditions

Stanford Medicine Children’s Health Apr 29, 2022

Stanford Fetal Therapy VR gives patients and doctors an unprecedented view of two complex fetal conditions—spina bifida and twin-to-twin transfusion syndrome—and how we can treat them using cutting-edge surgical techniques.

Clinical outcomes for babies born between 27 31 weeks of gestation: Should they be regarded as a single cohort?

Abdul Qader Tahir Ismail a,b,*, Elaine M. Boyle a, Thillagavathie Pillay a,c, For the OptiPrem Study Team

Journal of Neonatal Nursing 29 (2023) 27–32

  1. Introduction

 Within the UK, babies born below 27 weeks of gestation are recommended to be born in maternity services attached to neonatal intensive care units (NICU). For those babies born between 27 and 31 weeks of gestation, care can be delivered in maternity services attached to either a NICU or a local neonatal unit (LNU). While the first recommendation is evidence based (Marlow et al., 2014; Watson et al., 2014), our systematic review found a paucity of evidence for optimal location of birth and care for babies born between 27 and 31 weeks (Ismail et al., 2020).

 This reflects a more general lack of research aimed at babies born between 27 and 31 weeks of gestation. During our systematic review we found that most of the data available for this population comes from subgroup analyses in studies of larger gestational age ranges (Ismail et al., 2020; Lasswell et al., 2010). Of these, most report outcomes for this group as a whole rather than by gestational week (Watson et al., 2014). Neonatal research is logistically difficult, especially in relation to very preterm babies, as the population size decreases with each extra gestational week of prematurity. Therefore, it is common practice to cohort babies. While not ideal, this makes more sense for certain gestational age ranges than others.

 Babies born between 27 and 31 weeks do not form a ‘natural’ cohort as do those born extremely preterm. There is a significant degree of heterogeneity in the clinical presentation between babies born at either end of this spectrum. Over this five-week period the foetus is undergoing significant growth and developmental changes in-utero. In this review we describe the limited available literature on the variation in clinical presentation and outcomes for babies born between 27 and 31 weeks of gestation in the context of fetal developmental biology and preterm birth. In doing so, we highlight the importance of future research reporting gestation specific outcomes for preterm babies in general, but especially this cohort.

  • Survival and key morbidities for babies born at 2731 weeks

Table 1 and Fig. 1 summarises outcomes for major neonatal morbidities by each week between 27 and 31 weeks of gestation. They include international mortality data from national statistical bodies. An identical trend is evident for all, demonstrating increasing incidence with decreasing gestational age and substantially different outcomes for the most preterm babies within this gestational age range compared to the most mature. There is, on average, a greater than 4-fold difference in mortality between babies born at 27 weeks of gestation compared to 31 weeks, and a 4-fold increase in rates of survival to discharge without morbidity for babies born at 30 weeks compared to 27 weeks.

  • Understanding postnatal outcomes through the lens of foetal development

 The medical and nursing care required for babies in this group is likely to be more intense for those at the lower than the higher end of the gestational age spectrum, based on their degree of immaturity, and existence of co-morbidities.

  • Respiratory system

Babies born at the lower end of this gestational age range are often first supported with non-invasive ventilation (NIV) if they display sufficient respiratory drive and have a good heart rate. Those that do not will be intubated and invasively ventilated within delivery suite, and a proportion of those who initially managed on NIV may require subsequent intubation and ventilation due to significant apnoea and/or respiratory failure. These babies may benefit from a dose of surfactant and regular caffeine, with the aim to extubate onto NIV as soon as appropriate, to minimise ventilator associated lung injury while still providing an adequate level of support, which may be required for several weeks. In contrast, the majority of babies born at the upper end of this gestational age range will only require a brief period of NIV, usually in the form of high flow nasal prong oxygen or continuous positive airway pressure (CPAP) support.

How can we understand this in the context of foetal development? In-utero breathing stimulates lung growth (Harding and Hooper, 1985). By 24–28 weeks, fetal breathing movements occur for 10–20% of the time, increasing to 30–40% by 30 weeks (Fraga and Guttentag, 2012). Correspondingly, during the saccular stage of fetal lung development (24–26 weeks to 36–38 weeks), surface area for gas exchange increases as does vascularisation and surfactant production. Following preterm birth, this immaturity of central respiratory drive manifests as periods of hypoventilation and apnoea, the incidence falling from 54% at 30–31 weeks to 7% at 34–35 weeks (Henderson-Smart, 1981). In those born at 24–27 weeks, apnoeic episodes are more likely to continue for longer compared to those born ≥28 weeks (Eichenwald et al., 1997). Therefore, respiratory compromise, the need for mechanical ventilation and intensive care support is more likely with increasing prematurity, with the incidence of RDS at 60–80% for babies born at 26–28 weeks, falling to 15–30% by 32–36 weeks [14]. The more immature the lung, the greater the risk of ventilator associated lung injury, abnormal development, and chronic lung disease (CLD) [15]. Its incidence is nine times greater in babies born at 27 weeks than at 31 weeks of gestation (Bolisetty et al., 2015; Egreteau et al., 2001).

  • Cardiovascular system

Babies born at 27 weeks of gestation who are difficult to successfully extubate will often be found to have a haemodynamically significant patent ductus arteriosus (PDA) on echocardiography (although clear evidence is lacking for a causal relationship – (El-Khuffash et al., 2019; Benitz et al., 2016)). Management protocols vary unit to unit, but many will commence pharmacological treatment with ibuprofen, or more recently paracetamol. If this is unsuccessful, and on serial echocardiograms there is evidence of developing heart failure, the baby will be referred for surgical ligation. While some babies born at 31 weeks may have clinical signs of a PDA (i.e., a murmur, easily palpable femoral pulses), it is unlikely to be haemodynamically significant and can be left to close on its own. If at the time of discharge these signs are still present, an echocardiogram can provide a definitive diagnosis to arrange appropriate follow-up.

Following preterm birth, constriction of the ductus arteriosus is less likely to occur because of reduced vessel tone and pulmonary clearance of prostaglandins, to which the ductus in preterm babies is more sensitive (Clyman, 2012). This explains the increase in incidence of patent ductus arteriosus (PDA) at day 7 of life with reducing gestation (68%, 33%, and 2% at 26–27 weeks, 28–29 weeks, and ≥30 weeks, respectively) (Clyman, 2012), and a 10-fold increase in the likelihood of requiring surgery for a clinically significant PDA in those born at 27 weeks gestation when compared to those at 31 weeks (Bolisetty et al., 2015).

  • Ocular system

 Babies born at the lower end of this gestational age range most often require supplemental oxygen as part of their respiratory support. This is recognition receptors (including toll like receptors) continue development until 33 weeks, however, for up to 28 days after preterm birth at <30 weeks, toll like receptor responses are significantly reduced (Marchant et al., 2015). Regarding the complement system, average levels of terminal pathway components, C5, C6, and C8 in preterm babies are at 60–73%, 36–39%, and 29%, respectively, compared to adult levels (McGreal et al., 2012). Considering overall functional capacity, CH50 assay results increase from 32 to 36% at 26–27 weeks, to 52–81% at term.

Physical and external contributing factors, such as skin barrier integrity, repeated invasive procedures and indwelling plastic catheters, are also related to degree of prematurity.

3.6. Renal system

 Babies born at the lower end of this gestational age range receive a significant proportion of their hydration/nutrition intravenously, while simultaneously exposed to nephrotoxic drugs, e.g., gentamicin for treatment of suspected EOS, ibuprofen for treatment of a haemodynamically significant PDA, and vancomycin for treatment of CLABSI, warranting close monitoring of their electrolytes, renal function, and fluid balance. In contrast, babies born at the upper end of this gestational age range relatively quickly establish enteral feeds and much less frequently require treatment with nephrotoxic drugs.

The incidence of renal failure is 2-fold higher for a baby born at 27 weeks compared with 30 weeks of gestation (Walker et al., 2011; Jetton et al., 2017). Two thirds of new nephrons form between 28 and 36 weeks, after which no new glomeruli develop (Stritzke et al., 2017; Hinchliffe et al., 1991). Following preterm birth, nephrogenesis can continue for up to 40 days (Rodriguez et al., 2004; Black et al., 2013), but a significant proportion of new glomeruli have cystic dilatation of the Bowman’s capsule (Sutherland et al., 2011).

3.7. Neurological system

 As routine, babies born at the lower end of this gestational age range will have a cranial ultrasound scan (CrUSS) within the first few days of life, which will be repeated two to three times within the first month. It is not uncommon to diagnose uni/bilateral grade I-II intraventricular haemorrhage (IVH) and increased echogenicity in the periventricular areas even in those babies without any discernible risk factors except prematurity. However, for the more unwell (who may have required a degree of resuscitation, intubation and invasive ventilation, periods of hypoxaemia, hyper/hypocapnia and acidosis, and hypotension requiring fluid expansion and inotropic support), more severe grades of IVH (III/IV) and cystic periventricular leukomalacia (PVL) are more common. This would necessitate increasing the frequency of scanning to monitor for complications (e.g., post-haemorrhagic hydrocephalus) and plan for longer term neurodevelopmental follow-up and support. Babies born at the upper end of this gestational age range are much less likely to experience this degree of homeostatic disturbances and so are routinely scanned once within the first week of life and may not have a second scan until term equivalent or ready for discharge.

This variation in scanning frequency is based on the inverse correlation gestational age at birth has with risk of IVH (Brouwer et al., 2008; Synnes et al., 2001). Babies born at 27–28 weeks have a 2-fold increased risk of developing intraventricular haemorrhage (IVH) of any grade, compared to those born at 31 weeks (Brouwer et al., 2008; Synnes et al., 2001). Severe IVH (stage III/IV) is three times more common in those born at 27 weeks than 31 weeks.

The germinal matrix has a dense supply of fragile blood vessels that are prone to rupture with fluctuations in cerebral blood flow, causing the bulk of what is described in the literature as IVH. The risk is increased due to immature cerebral autoregulation, in which hypoxaemia, hypercapnia, hypocapnia, and acidosis cause pressure passivity (Soul et al., 2007; Tsuji et al., 2000). This, combined with increasing severity of respiratory illness and homeostatic disturbances in the more preterm baby, may explain the inverse correlation of IVH with gestational age.

The trend is similar for periventricular leucomalacia (PVL) (Luan-ying, 2011). Non-cystic PVL is characterised by hypomyelination (Volpe, 2009). By 28–30 weeks, increasing differentiation of oligodendrocyte progenitors (pre-OL) coincides with the start of myelination (Jakovcevski et al., 2009; Tau and Peterson, 2010), stimulated by microglia that are also proliferating (Menassa and Gomez-Nicola, 2018; Gould and Howard, 1991; Billiards et al., 2006). Hypoxia, infection or inflammation cause pathogenic activation of microglia and death of pre-OL cells through release of reactive nitrogen and oxygen species (RNS/ROS) (Merrill et al., 1993; Haynes et al., 2003).

Preterm babies with severe IVH (grade III/IV) and cystic PVL are at increased risk of cerebral palsy (Himmelmann and Uvebrant, 2014). There is a nearly 2-fold increase in incidence of cerebral palsy for a baby born at 27 weeks compared with 31 weeks of gestation, but the absence of cranial ultrasound abnormalities does not always mean normal neurodevelopment for babies born preterm. In utero, cortical volume increases from 13% at 28 weeks to 53% at 34 weeks. Babies born preterm have reduced growth trajectories of their cerebrum, cerebellum, and brainstem compared to the foetus within the last trimester (Bouyssi-Kobar et al., 2016). Each extra week of maturity at birth between 27 and 32 weeks is associated with an increased IQ of 2.5 points (Johnson, 2007).

  • Implications for practice

The degree of clinical support that a preterm baby may receive is graded into intensive care, high dependency and special care (BAPM, 2011). Most babies born at the lower end of this gestational age spectrum require some degree of intensive care support, based on the clinical manifestations of their prematurity. In contrast, the majority of ‘well’ preterm babies at the upper end may never require intensive care support, but rather high dependency and special care support. This dichotomy in their clinical presentation means that grouping them into a single cohort may have the following consequences:

 a) Cohorting this group in terms of decision-making regarding place of birth and care may mean over utilisation of intensive care support for those babies at the upper end of the spectrum. This in turn may limit intensive care availability for those babies who need it, especially in resource and cost constrained environments.

 b) Grouping them as a single cohort in the literature makes it more likely significant outcomes for babies at the lower end of this spectrum will be obscured.

5. Conclusion

 This review highlights the variation and range of clinical profiles and associated outcomes for babies born between 27 and 31 weeks of gestation, and how these relate to key aspects of organ/system development occurring in-utero during this 5-week period. The data summarised in Table 1 and graphically represented in Fig. 1 consistently demonstrate a gradient of risk across multiple outcomes with rates of mortality and morbidity increasing from birth at 31 to 27 weeks. Outcomes at the two extremes of this range may differ significantly, yet babies born between 27 and 31 weeks of gestation are often regarded as a single entity with respect to place of birth and care, and for research purposes. In future studies relating to very preterm birth, understanding gestation specific morbidities and outcomes may be more informative, compared to outcomes as a single collective group. This may be a useful concept for policy makers involved in preterm health service delivery, and might allow more finely tuned, appropriate utilisation of resources for this group of babies.

Full Report, Data, Charts/References


AAP Issues Reports on Point-of-care Ultrasonography Applications in the NICU


Point-of-Care Ultrasonography (POCUS) can be performed at the bedside of patients in neonatal intensive care units (NICU). If performed in a timely fashion, POCUS has the potential for enhancing quality of care and improving outcomes. The clinical report, “Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes,” along with an accompanying technical report, are published in the December 2022 Pediatrics (published online Nov. 28). Although the performance and interpretation of ultrasonography have traditionally been limited to pediatric radiologists and pediatric cardiologists, POCUS refers to ultrasonography performed at the bedside by non-radiology and non-cardiology practitioners in the NICU for diagnostic, therapeutic, and procedural purposes. The reports, written by the Committee on Fetus and Newborn and the Section on Radiology, state that the technology is increasingly used worldwide. Yet, there are no published guidelines on implementation of point-of-care ultrasonography programs in U.S. neonatal intensive care units. The AAP suggests institutional guidelines for the use of point-of-care ultrasonography and other steps to help overcome barriers in use of the technology.



Healthcare providers should consider RSV in patients with respiratory illness, particularly during the RSV season.

Respiratory syncytial virus (RSV) was discovered in 1956 and has since been recognized as one of the most common causes of childhood illness. It causes annual outbreaks of respiratory illnesses in all age groups. In most regions of the United States, RSV circulation starts in the fall and peaks in the winter, but the timing and severity of RSV season in a given community can vary from year to year. Scientists are developing several vaccines, monoclonal antibodies, and antiviral therapies to help protect infants and young children, pregnant people (to protect their unborn babies), and older adults from severe RSV infection.

Clinical Description and Diagnosis

In Infants and Young Children

RSV infection can cause a variety of respiratory illnesses in infants and young children. It most commonly causes a cold-like illness but can also cause lower respiratory infections like bronchiolitis and pneumonia. One to two percent of children younger than 6 months of age with RSV infection may need to be hospitalized. Severe disease most commonly occurs in very young infants. Additionally, children with any of the following underlying conditions are considered at high risk:

  • Premature infants
  • Infants, especially those 6 months and younger
  • Children younger than 2 years old with chronic lung disease or congenital heart disease
  • Children with suppressed immune systems
  • Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Infants and young children with RSV infection may have rhinorrhea and a decrease in appetite before any other symptoms appear. Cough usually develops one to three days later. Soon after the cough develops, sneezing, fever, and wheezing may occur. In very young infants, irritability, decreased activity, and/or apnea may be the only symptoms of infection.

Most otherwise healthy infants and young children who are infected with RSV do not need hospitalization. Those who are hospitalized may require oxygen, intubation, and/or mechanical ventilation. Most improve with supportive care and are discharged in a few days.

In Older Adults and Adults with Chronic Medical Conditions

Adults who get infected with RSV usually have mild or no symptoms. Symptoms are usually consistent with an upper respiratory tract infection which can include rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. Disease usually lasts less than five days.

Some adults, however, may have more severe symptoms consistent with a lower respiratory tract infection, such as pneumonia. Those at high risk for severe illness from RSV include:

  • Older adults, especially those 65 years and older
  • Adults with chronic lung or heart disease
  • Adults with weakened immune systems

RSV can sometimes also lead to exacerbation of serious conditions such as:

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure

Clinical Laboratory Testing

Clinical symptoms of RSV are nonspecific and can overlap with other viral respiratory infections, as well as some bacterial infections. Several types of laboratory tests are available for confirming RSV infection. These tests may be performed on upper and lower respiratory specimens.

The most commonly used types of RSV clinical laboratory tests are

  • Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR), which is more sensitive than culture and antigen testing
  • Antigen testing, which is highly sensitive in children but not sensitive in adults

Less commonly used tests include:

  • Viral culture
  • Serology, which is usually only used for research and surveillance studies

Some tests can differentiate between RSV subtypes (A and B), but the clinical significance of these subtypes is unclear. Consult your laboratorian for information on what type of respiratory specimen is most appropriate to use.

For Infants and Young Children

Both rRT-PCR and antigen detection tests are effective methods for diagnosing RSV infection in infants and young children. The RSV sensitivity of antigen detection tests generally ranges from 80% to 90% in this age group. Healthcare providers should consult experienced laboratorians for more information on interpretation of results.

For Older Children, Adolescents, and Adults

Healthcare providers should use highly sensitive rRT-PCR assays when testing older children and adults for RSV. rRT-PCR assays are now commercially available for RSV. The sensitivity of these assays often exceeds the sensitivity of virus isolation and antigen detection methods. Antigen tests are not sensitive for older children and adults because they may have lower viral loads in their respiratory specimens. Healthcare providers should consult experienced laboratorians for more information on interpretation of results.

Prophylaxis and High-Risk Infants and Young Children

Palivizumab is a monoclonal antibody recommended by the American Academy of Pediatrics (AAP) to be administered to high-risk infants and young children likely to benefit from immunoprophylaxis based on gestational age and certain underlying medical conditions. It is given in monthly intramuscular injections during the RSV season, which generally starts in the fall and peaks in the winter in most locations in the United States.


Seattle Embraces 2018 Special Olympics USA Games With Joyous Opening Ceremony Celebrating 50 Years Of Inclusion Through Sports

“Diversity really means becoming complete as human beings – all of us. We learn from each other. If you’re missing on that stage, we learn less. We all need to be on that stage.”

Juan Felipe Herrera

Daniel Laurie from Call the Midwife | Our Voice Interviews


A Little Book About Bravery by Rick DeLucco

A Kids Co. Sep 20, 2021

A Little Book About Bravery

Kiteboarding with Jasmina: Saudi Arabia Special

Bo Van Wyk  Apr 14, 2016

Kiteboarding Saudi Arabia I had the chance to go kiting at two amazing spots in Saudi Arabia. Let me take you to this unusual place. Enjoy!

ABP, Protect, Act, Progress


Estimated # of preterm births: 5.40 per 100 live births

(USA Global Average: 9.56)

Source- WHO 2014-

Latvia, officially the Republic of Latvia, is a country in the Baltic region of Northern Europe. It is one of the Baltic states; and is bordered by Estonia to the north, Lithuania to the south, Russia to the east, Belarus to the southeast, and shares a maritime border with Sweden to the west. Latvia covers an area of 64,589 km2 (24,938 sq mi), with a population of 1.9 million. The country has a temperate seasonal climate.  Its capital and largest city is RigaLatvians belong to the ethno-linguistic group of the Balts; and speak Latvian, one of the only two surviving Baltic languagesRussians are the most prominent minority in the country, at almost a quarter of the population.

Latvia is a developed country, with a high-income advanced economy; ranking very high in the Human Development Index. It performs favorably in measurements of civil libertiespress freedominternet freedomdemocratic governanceliving standards, and peacefulness. Latvia is a member of the European UnionEurozoneNATO, the Council of Europe, the United Nations, the Council of the Baltic Sea States, the International Monetary Fund, the Nordic-Baltic Eight, the Nordic Investment Bank, the Organisation for Economic Co-operation and Development, the Organization for Security and Co-operation in Europe, and the World Trade Organization.

The Latvian healthcare system is a universal programme, largely funded through government taxation. It is among the lowest-ranked healthcare systems in Europe, due to excessive waiting times for treatment, insufficient access to the latest medicines, and other factors. There were 59 hospitals in Latvia in 2009, down from 94 in 2007 and 121 in 2006.



How to Protect Staff and Patients From Violence in the Hospital

From detection tools to staff training, children’s hospitals are upping their security measures in response to growing violence across the country. By Megan McDonnell Busenbark – Published Oct. 21, 2022

Mark Moore has spent his life in the business of protection. Since serving in the United States Marine Corps for more than a decade, he has provided security services for business leaders and world events—from Bill Gates to the Olympic Games. His first foray into the health care industry came in 2018 when he joined Dayton Children’s Hospital in Ohio as corporate director of Protective and Support Services, where he’s charged with keeping 27 locations safe—from the main campus to clinics and all other locations dedicated to care.

His first order of business: approaching senior leaders about new ways of protecting staff, patients and families from violence in the hospital—specifically, shootings. He quickly gained approval from his leadership team to make a million-dollar investment in gunshot detection technology. Since that time, the need for such measures has only grown.

“The events of the world have created a sense of urgency,” says Moore. When COVID-19 turned the world on its head, the health care setting saw increased incidents of violence brought on primarily by higher levels of patient and family stress, frustrations due to mask and visitation policies, and staffing shortages. The vulnerability of health care facilities has been coming to new light over the last year, as staff have been injured or killed in shootings in the workplace across the country. On a single day back in June, four staff members were fatally shot in two different adult hospitals—one in Dayton, Ohio, and the other in Tulsa, Oklahoma, where the shooter blamed his surgeon for his back pain.

These and other shootings have raised concerns about the health care setting becoming more of a soft target, like schools—prompting new discussion and action on security approaches to keep patients, families and staff safe in both inpatient and outpatient settings. This is coming in many forms—from increased staff training and safety officer deployment to visitor management strategies and weapon detection systems. It’s placing children’s hospitals in a delicate balancing act: deploying the most effective safety and security measures without losing the warm, welcoming environment they’ve worked for years to create.

Detection tools

In the past year, the University of Vermont Children’s Hospital in Burlington has experienced an unprecedented surge in violence in its emergency department. “The number of assaults on staff members has increased significantly,” says Stephen Leffler, M.D., president and COO at Vermont Children’s. “The number of episodes where weapons are discovered on someone who’s made it into the ED or even an inpatient floor has gone from essentially zero to happening more than occasionally—and they are very scary.”

As part of a larger hospital system, the emergency department serves both adults and children. Adding metal detectors became a necessity for staff safety, even though Leffler and his team were concerned about the effect it would have on patients’ experience and perception. “Clearly, going through metal detectors is not what you’re hoping for in the entrance of your ED. It sets a certain potential tone,” he says. “But we decided that in the interest of the safety of everyone, this was the right thing to do. And it was a tough decision.”

Since installing the detectors a couple of months ago, violence has already decreased, Leffler says. And so far, patients are more accepting of them than he anticipated. “We haven’t had many complaints, and they’re grateful to know we’re thinking about their safety,” he says. This sentiment is in line with published research showing that most patients respond favorably to the presence of metal detectors in pediatric emergency departments, feeling safer.

Metal detectors come with other challenges, however. They require enough space to install and to allow for adequate traffic flow. They require capital to purchase and maintain, as well as cash flow to keep them staffed 24 hours a day by officers who are trained in using the equipment and in responding to visitors who refuse to give up their weapon. At Vermont Children’s, two security officers operate the detectors—a job which includes searching bags and escorting contraband to secure lockers before visitors are allowed into the ED.

One potential drawback of metal detectors in emergency departments is patients having to wait in long lines, Leffler says. Even if the weather isn’t an issue, someone waiting might have an urgent medical need. To solve that, Vermont Children’s has an EMT evaluating those in line to determine if someone needs triage or prioritization. “Although these drawbacks are not ideal, this is the best thing we can do to help keep our patients, families and staff as safe as we possibly can,” Leffler says.

Many of the drawbacks and limitations of metal detectors can be circumvented with newer detection technology. Children’s National in Washington, D.C., is piloting a touchless security screening system that combines metal detection and artificial intelligence to spot concealed weapons. Unlike traditional screening systems—like those in airports—a person can walk through this unobtrusive device without stopping, without removing anything from their pockets or bags, without taking off their jewelry or belts. “You’re looking to provide care to people quickly—so you want to get them into your building in the most convenient and safest way possible,” says Paul Quigley, executive director of security, parking and transportation at Children’s National.

The system will alarm when someone brings anything that is shaped like a weapon and will show the security team exactly where the potential weapon is located on that individual. “It shows a picture of the person and a region of the body or bag or cart they’re wheeling in,” he says. “But the alarm is not alerting on keys, cell phones or change in your pocket because of the advanced analytics. So, most people walking through it don’t get detected in any way.”

In addition to keeping all patients, families and staff—including security—safer, it keeps the line moving and the visitor experience positive. During a one-day demo in June, more than 1,000 people entered the hospital through this system, and 90% of them were never stopped. The security team was able to process the other 10% within five seconds each time, once the individual opened their jacket or bag, according to Quigley—and there was never a line of people waiting to enter the building.

“During our demo, it did what it was supposed to do,” Quigley says. “That is, making the staff feel comfortable because we’re screening everybody coming through—and the patients and families loved it too, because they were able to feel like the hospital was safe.” Additionally, the screening system can be branded, making the technology fit into the environment.

In the emergency department, Quigley’s team uses metal detection wands in behavioral health cases and “if there’s a fear that some harm is going to be done toward either a provider or the patient themselves,” he says, adding that families have always understood the need for the wands in such instances. “This is to keep your family member safe and our staff safe,” he says. “That’s the thing that ends up making people feel more comfortable being in our environment.”

In addition to x-ray machines and walk-through detection systems, other detection and prevention methods children’s hospitals have implemented include K-9 security dogs, video surveillance, and weapon detection systems that integrate with security cameras. Generally, detection tools are more common in emergency departments where violence most frequently occurs and traffic is high.

These tools focus on detecting guns and weapons before they enter the building, but Dayton Children’s has also installed technology that detects guns after they are fired inside the hospital. Originally developed by the U.S. Department of Energy, the technology reads the energy instead of the sound of the gunshot, which helps reduce false alarms. The system alerts first responders in seconds—and the sensors are so specific, they can detect what caliber gun was used in the shooting. And because they look like smoke detectors, they blend right in with the hospital environment.

Moore and his team collaborated with about 10 groups across the hospital to test and implement the technology—from senior leadership and facilities to IT and systems integration. “We ran the technology in a sandbox for 30 days,” he says. “We had to make sure it played nicely with our access control system, our video management system and our mass notification system before going live.” Along with this rollout came Crisis Prevention Institute (CPI) training for staff, including active shooter response classes.

Staff training

Nick Markham, assistant vice president of facilities, has been with Cook Children’s Health Care System in Fort Worth, Texas, for 19 years. While training staff to reduce risk in the case of a shooting or other act of violence has long been a priority, the team has upped its game in the face of the events of the past year.

“We can create videos, webinars and just-in-time training for any event that takes place,” Markham says, citing a 20-minute training video that was created for staff within one week of the Tulsa shooting. Ongoing safety and security training covers situational awareness, de-escalation strategies and active criminal event response. The training, while not required, is available to all staff—and features active shooter drills where the instructor wears a body camera to simulate a shooting.

“He’s in the active shooter role, and he shows people what happens should a person enter the building and how quickly the escalation takes place,” says Markham. “So, he shows how people gain access to the back of house or the back of a clinic; how they try to get through a locked door; how easy it is to jump a reception desk—those types of things.” Then, he teaches staff about Avoid, Deny and Defend, meaning how to run, how to barricade yourself or how to fight back when faced with an incident.

Public safety officers

Both Cook Children’s and Dayton Children’s employ uniformed, armed public safety officers. Neither sees them as the traditional “officer” but rather an integral part of the hospital family and patient care.

“The officer should not be an opposing figure. This should be someone who’s protective, nurturing and offering assistance,” says Markham. Public safety officers at Cook Children’s are licensed police officers in the state of Texas, with compassion as part of their training.

“You have no idea what a person is going through—families are in a very hard place when they’re here with a sick child,” Markham says. “Our officers understand that. There’s a huge compassion component when you’re an officer.”

Another huge component is the connection with patients. The personification of that is Officer Louis White. “Everybody knows Officer Louis,” says Markham. “He is everywhere. He’s at orientation, he interacts with patients on our rehab unit—he is part of the care team that goes to that unit and does music therapy with the kids. So, we have folks ingrained into the organization in ways that go far beyond the role of a security officer.”

At Dayton Children’s, special care is taken when it comes to the role of behavioral health officers. They wear a different uniform in behavioral health units and don’t look the usual part of a public safety officer, which can help keep situations from escalating, Moore says. “They are still very clearly Dayton Children’s public safety officers, but they have none of what you would consider the tools of policing,” he says. “No handcuffs, no baton, no Taser, no pepper spray—they even have cloth Velcro badges.”

Across the board, children’s hospitals are reevaluating their approach to public safety officers, asking how many to deploy, what level of weaponry to carry, and what kind of protection to wear. Some officers carry pepper spray, others firearms; some wear ballistic vests, others plain clothes. Many hospitals, including Children’s National, hire off-duty law enforcement, who are armed, in addition to staff security. These officers enforce compliance during high-threat situations, deal with weapon-related incidents, and aid in arrests when necessary, says Quigley.

Managing visitors

While much of the work being done is focused on those who may be entering a facility with bad intent, the pressures are higher than ever to manage those who are supposed to be there—including families and other visitors. At the same time, children’s hospitals have always been built to be accessible—where staff can move patients easily and families can visit their children quickly and conveniently.

To help satisfy the need for safety and mobility, Cook Children’s uses an extensive network of cameras throughout the hospital. The cameras monitor visitors and all other activity in the hospital—as well as panic buttons in strategic places, like nurse stations and areas with a psychiatric component, to help minimize risk around potential events involving visitors.

At Children’s National, the team at the welcome desk checks all visitors against a robust database, ensuring all personnel, vendors and patient visitors are authorized to be there and pose no known threat. They also work closely with the staff upstairs in the care units to help determine which visitors—and how many—should be in a patient’s room at any time.

Because of the pandemic, Vermont Children’s reduced its number of visitor entrances to three, including the emergency department, to screen for COVID-19, and they decided to keep the limited number of entry points to better monitor visitors. Most floor entrances are locked as well, including the pediatric and mother-babies areas. They would like to implement strict visitor policies and management tools, but as with other security initiatives, staffing remains an obstacle.

Social workers

The Social Work Interventions with Families and Teams (SWIFT) program at Children’s National is designed to protect the frontline care team from incidents with patients and families inside the hospital while also ensuring those patients and families feel heard and supported. Verbal escalation, threatening behavior, physical aggression or impeding care on the part of a parent or other visitor often stem from the stress of having a sick or injured child in the hospital and being unable to communicate properly, says Brenda Shepherd-Vernon, director of the Department of Family Services at Children’s National Hospital. With SWIFT, social workers help mitigate such incidents to make staff feel safe, make families feel heard, and, ultimately, keep those families at the child’s bedside when possible.

“As social workers, we’re going to be impartial and look at what happened during the encounter—and we’ll work with the family and the team to resolve it,” Shepherd-Vernon says.

“In the past, the model dictated that security would be called if a parent was upset. Now, we’re trying to hear more about the families’ concerns and deal with those concerns in real time.”

Still, security is a close partner in SWIFT, along with a committee that reviews all cases of individuals who are asked to leave the premises due to aggressive behavior. The team also shares the expectations of conduct with the families to build a shared understanding and help prevent further incidents. There is also a huddle with the care team after an incident to discuss the concerns of the family and how to best address them going forward, as well as the resolution shared with the family and the plan to keep the staff safe.

Like none other

Leffler is part of a multi-sector collaborative that is seeking broader solutions to target the root causes of violence before it ever makes it to the children’s hospital. “What we’re seeing is just a piece of what is happening everywhere right now,” he says. “We want to come up with some recommendations to try and think about this problem in a bigger way than only once they arrive at the door of the hospital.”

For Moore’s part, protecting people, property and assets from harm has been at his core for the better part of 35 years. But he’s found that the children’s hospital setting is a world unto itself—one where keeping everyone safe physically, mentally and emotionally is paramount and constant.

“When I was running a protection team in my previous life, there were ebbs and flows,” he says. “We would ramp up to go on round-the-world trips with our protectees, working 16 to 18 hours a day—then we’d come home, catch our breath and ramp up for the next big thing. Here, the pace of the hospital is relentless. It never stops, it never closes. And everybody here wants to make the place better.”

Source:How to Protect Staff and Patients From Violence in the Hospital (

Empowering Parent and Educator resource. See the essential components as identified by this innovative resource provider!

Preterm Birth Information for Education Professionals

These five learning resources have been developed to improve your knowledge and confidence in supporting prematurely born children in the classroom.

  • What is preterm birth?
  • Educational Outcomes following preterm birth
  • Cognitive and Motor Development following Preterm Birth
  • Behavioural, social, and emotional outcomes following preterm birth
  • How can education professionals support preterm children?



This section provides advice on how education professionals can support children born preterm. You may not know if a child was born preterm. Some parents are in favour of the school knowing their child’s birth history, but others prefer not to disclose this information. Don’t assume a child was born preterm just because they fit the profile described here. There are many reasons a child may have difficulties at school.

Regardless of whether you know a child’s birth history, the advice and strategies provided in this section are likely to be beneficial to any child with the difficulties described.

Children and young adults born preterm, and their parents, were asked what they wished their teachers had known about how they think and learn, and about how their preterm birth may have affected them later in life. Select the icons to hear some of their answers.


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Ticking timebomb: Without immediate action, health and care workforce gaps in the European Region could spell disaster

40% of medical doctors are close to retirement age in one third of countries in Europe and central Asia, finds new WHO/Europe report

14 September 2022

All countries of the WHO European Region – encompassing 53 Member States across Europe and central Asia – currently face severe challenges related to the health and care workforce, according to a new report released today by WHO/Europe. An ageing workforce is chief among them. The analysis finds that 13 of the 44 countries that reported data on this issue have a workforce in which 40% of medical doctors are already aged 55 years or older. 

An ageing health and care workforce was a serious problem before the COVID-19 pandemic, but is even more concerning now, with severe burnout and demographic factors contributing to an ever-shrinking labour force. Adequately replacing retiring doctors and other health and care workers will be a significant policy concern for governments and health authorities in the coming years. WHO/Europe is urging countries to act now to train, recruit and retain the next generation of health and care workers. 

Another key finding of the report is the poor mental health of this workforce in the Region. Long working hours, inadequate professional support, serious staff shortages, and high COVID-19 infection and death rates among frontline workers – especially during the pandemic’s early stages – have left a mark. 

Health worker absences in the Region increased by 62% amid the first wave of the pandemic in March 2020, and mental health issues were reported in almost all countries in the Region. In some countries, over 80% of nurses reported some form of psychological distress caused by the pandemic. WHO/Europe received reports that as many as 9 out of 10 nurses had declared their intention to quit their jobs.  

“My own personal journey through this pandemic has been a rollercoaster,” said British nurse Ms Sarah Gazzard. “I was holding a phone next to a dying woman’s ear while her daughter said her final goodbyes. That was very, very difficult for me, so I sought out some support to help me cope.”

Mixed picture across the Region  

While the 53 countries of the Region have on average the highest availability of doctors, nurses and midwives compared to other WHO regions, European and central Asian countries still face substantial shortages and gaps, with significant subregional variations.  

Health worker availability varies 5-fold between countries. The aggregate density of doctors, nurses and midwifes ranges from 54.3 per 10 000 people in Türkiye to over 200 per 10 000 people in Iceland, Monaco, Norway and Switzerland. At the subregional level, central and western Asian countries have the lowest densities, and northern and western European countries have the highest.  

“Personnel shortages, insufficient recruitment and retention, migration of qualified workers, unattractive working conditions, and poor access to continuing professional development opportunities are blighting health systems,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. 

“These are compounded by inadequate data and limited analytical capacity, poor governance and management, lack of strategic planning, and insufficient investment in developing the workforce. Furthermore, WHO estimates that roughly 50 000 health and care workers may have lost their lives due to COVID-19 in Europe alone.”  

Dr Kluge warned, “All of these threats represent a ticking time bomb which, if not addressed, is likely to lead to poor health outcomes across the board, long waiting times for treatment, many preventable deaths, and potentially even health system collapse. The time to act on health and care workforce shortages is now. Moreover, countries are responding to the challenges at a time of acute economic crisis, which demands effective, innovative and smart approaches.”

Ms Annika Schröder is a midwife from Germany who works in a hospital where around 950 births take place every year. There, the challenges mirror those seen across the Region. “I often work shifts without even the possibility to go to the toilet, without breaks or time to eat,” she told WHO/Europe. 

“The doorbell and the phones ring while we rush from one room to the other. On average, I take care of 2 women in labour at a time. This is not how I imagined my profession or my everyday working life to be. I am often exhausted and tired. The shortage of midwives makes births unsafe. And since the pandemic, things have got even worse. It is affecting the physical and mental health of us midwives, of mothers, women in labour and babies,” Ms Schröder explained.

Based on the latest data available for 2022, the Region has on average:  

  • 80 nurses per 10 000 people 
  • 37 doctors per 10 000 people  
  • 8 physiotherapists per 10 000 people 
  • 6.9 pharmacists per 10 000 people  
  • 6.7 dentists per 10 000 people 
  • 4.1 midwives per 10 000 people.

In WHO’s 2016 Global Strategy on Human Resources for Health, the threshold for aggregate health worker density was set at 44.5 doctors, nurses and midwives per 10 000 people. All countries in the Region are therefore currently above the threshold, but this does not mean they can afford to be complacent. There are serious gaps and shortages in the health and care workforce, which will only get worse with time without policies and practices to address them. 

Rising to the challenge: country examples 

“Countries will need to rethink how they support and manage their health workforce. They will need to design strategies that reflect their own contexts and needs, because there is no one-size-fits-all approach,” said Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems at WHO/Europe. 

“The Region is at a critical juncture: strategic planning and smart investment are crucial next steps to make sure our health workers have the tools and support they need to care for themselves and their patients. Society will pay a heavy price if we fail to rise to this challenge. This new report and the data it includes about each of our Member States offer solutions and opportunities we shouldn’t miss.”  

Many countries across the Region have already begun taking bold and innovative steps. In Ireland, where more people will be over the age of 65 than under the age of 14 by 2028, the Government has introduced the Enhanced Community Care programme to help the ageing population maintain independence. The programme releases pressure on the hospital system by bringing enhanced community care services to older people in towns and villages across the country. 

In Kyrgyzstan, the Government has introduced a pay-for-performance system in primary health care. The aim is to attract more doctors by increasing salaries for those who perform well in their duties. The system also includes an offer for specialists to retrain as family doctors, as 30% of family doctors were of retirement age in 2020.  

In the United Kingdom, the Government has been steadily recruiting foreign-trained nurses and midwives to replace those who are retiring or leaving the profession. At present, almost 114 000 foreign-trained nurses are registered there – a 66% increase since 2017/2018. Conversely, the number of nurses trained in the European Union (EU)/European Economic Area (EEA) dropped by nearly 18% over the same period. This is likely driven by the United Kingdom’s decision to leave the EU, and reflects a major shift from recruiting nurses from the EU/EEA to recruiting from other regions and countries, notably India, Nigeria and the Philippines.  

Despite progressive steps in many places, much more investment, innovation and partnership are needed to avert further health and care workforce shortages in the future. WHO/Europe is urging all Member States – even those that currently have above-average workforce densities – to waste no time by taking the following 10 actions to strengthen the health and care workforce:  

  1. align education with population needs and health service requirements
  2. strengthen professional development to equip the workforce with new knowledge and competencies
  3. expand the use of digital tools that support the workforce
  4. develop strategies that recruit and retain health workers in rural and remote areas
  5. create working conditions that promote a healthy work–life balance
  6. protect the health and mental well-being of the workforce  
  7. build leadership capacity for workforce governance and planning
  8. improve health information systems for better data collection and analysis
  9. increase public investment in workforce education, development and protection
  10. optimize the use of funds for innovative workforce policies.  



A new patient population for adult clinicians: Preterm born adults

Amy L. D’Agata  Carol E. Green  Mary C. Sullivan Open Access Published: January 28, 2022

What if a single event could sway health, exercise capacity, learning style, social interactions, and even personal identities–yet individuals had no memory of the event? Adults born preterm are an under-recognized and vulnerable population. Multiple studies of individuals born prematurely, including our 35-year longitudinal study, have found important health concerns that adult healthcare providers should consider in their assessments. Concerns include increased rates of cardiovascular disease, metabolic syndrome, depression, anxiety and attention problems, lower educational attainment and frequency of romantic relationships.

A Nordic study of over six million individuals found a linear relationship between gestational age and protection against early adult mortality, with preterm individuals showing 1⋅4 times increased likelihood of early mortality as full-term peers.

At the same time, surviving premature birth has become increasingly common. For the last several decades, nearly one in nine U.S. babies is born early, and now more than 95% survive.

Global prevalence and survival data indicate more than 15 million preterm birth survivors annually reach adulthood.

This suggests a new population of individuals with emerging healthcare needs for adult health providers.

Birth history should be part of every patients’ medical record.

Due to the varied risks and prevalence of premature birth, all healthcare practitioners should be aware of the potential for long-term effects. With one in ten 30-year-old patients born preterm, clinical specialists who treat long-term complications of prematurity (i.e., neurology, psychiatry, cardiology) may have more preterm-born patients. Recognizing preterm birth as a cumulative, lifelong risk factor is the first step.

As clinicians and researchers, we have observed the medical community, like society at-large, tends to view prematurity as a health event localized to infancy-something kids outgrow. Ironically, some pediatric providers report limited training and understanding of health complications for children born preterm, and little evidence exists regarding adult practitioners’ knowledge to care for these adults.

Preliminary adult primary care guidelines were recently created to screen and manage prematurity-related health complications.

Health risks from prematurity are also risks to equality and justice. Women who bear social risk factors are more likely to give birth early. This includes Black women, those living in socio-economically depressed areas, and women with two or more Adverse Childhood Experiences.

The many arms of racism and caste-based inequalities can complicate and worsen the health of people already at risk from preterm birth.

Attention also needs to be drawn to the prematurity research community. To date, research has focused on younger age groups and predominantly White populations. Future research needs to seek out ethnically diverse populations and comprehensively examine potential life course complications of early birth. This is especially important when considering how socioeconomic factors may influence the allostatic load of individuals.

For many born preterm, prematurity is not just a health concern, it’s a matter of who they are. Their perception of health over time, or health related quality of life (HRQL), is a critical outcome. To date, this evidence varies with age, degree of prematurity and reporter; clinicians and parents tend to rate HRQL more negatively than survivors.

Preterm-born individuals may not have event memories but, early birth repercussions can reverberate through family narratives and unique life experiences. Some identify as typically developed individuals who happen to have been born early, others as functional and well-adapted “preemies”, and others see prematurity as having colored their lives in negative ways.

As prematurity researchers, we aim to uncover and bring awareness to the health outcomes and risks from early birth. A critical need exists for more evidence about adult health following preterm birth and yet, how do we protect individuals with statistically increased risk without unnecessarily pathologizing them?

In clinical practice and research settings, we can take the opportunity to listen to people who were too young as patients to speak for themselves but have riveting and complex stories about preterm birth’s effects. We are aware of just one other published qualitative study about the experiences of adults born preterm.

 Because most adult healthcare providers have yet to acknowledge and factor this experience into patient care, individuals born preterm are finding alternative avenues to be seen. Adults born preterm report seeking online community and support, connecting globally with people over shared early life experiences, while simultaneously making their needs and identities known.

As a research team, we strive to avoid labels for people born early but have nonetheless found that they are, in often subtle ways, a special group. They beat the odds as infants. Their birth and subsequent survival affected their families and communities in unprecedented ways. As clinicians and researchers, we can attend to the health risks of those born premature while acknowledging and celebrating their unique strengths and perspectives, often resulting from their early life experiences.


WHO advises immediate skin to skin care for survival of small and preterm babies

15 November 2022

WHO today launched new guidelines to improve survival and health outcomes for babies born early (before 37 weeks of pregnancy) or small (under 2.5kg at birth).

The guidelines advise that skin to skin contact with a caregiver – known as kangaroo mother care – should start immediately after birth, without any initial period in an incubator. This marks a significant change from earlier guidance and common clinical practice, reflecting the immense health benefits of ensuring caregivers and their preterm babies can stay close, without being separated, after birth.

The guidelines also provide recommendations to ensure emotional, financial and workplace support for families of very small and preterm babies, who can face extraordinary stress and hardship because of intensive caregiving demands and anxieties around their babies’ health.

“Preterm babies can survive, thrive, and change the world – but each baby must be given that chance,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “These guidelines show that improving outcomes for these tiny babies is not always about providing the most high-tech solutions, but rather ensuring access to essential healthcare that is centred around the needs of families.”

Prematurity is an urgent public health issue. Every year, an estimated 15 million babies are born preterm, amounting to more than 1 in 10 of all births globally, and an even higher number – over 20 million babies – have a low birthweight. This number is rising, and prematurity is now the leading cause of death of children under 5.

Depending on where they are born, there remain significant disparities in a preterm baby’s chances of surviving. While most born at or after 28 weeks in high-income countries go on to survive, in poorer countries survival rates can be as low as 10%.

Most preterm babies can be saved through feasible, cost-effective measures including quality care before, during and after childbirth, prevention and management of common infections, and kangaroo mother care – combining skin to skin contact in a special sling or wrap for as many hours as possible with a primary caregiver, usually the mother, and exclusive breastfeeding.

Because preterm babies lack body fat, many have problems regulating their own temperature when they are born, and they often require medical assistance with breathing. For these babies, previous recommendations were for an initial period of separation from their primary caregiver, with the baby first stabilized in an incubator or warmer. This would take on average, around 3-7 days.

However, research has now shown that starting kangaroo mother care immediately after birth saves many more lives, reduces infections and hypothermia, and improves feeding. 

“The first embrace with a parent is not only emotionally important, but also absolutely critical for improving chances of survival and health outcomes for small and premature babies,” said Dr Karen Edmond, Medical Officer for Newborn Health at WHO. “Through COVID-19 times, we know that many women were unnecessarily separated from their babies, which could be catastrophic for the health of babies born early or small. These new guidelines stress the need to provide care for families and preterm babies together as a unit, and ensure parents get the best possible support through what is often a uniquely stressful and anxious time.”

While these new recommendations have particular pertinence in poorer settings that may not have access to high-tech equipment, or even reliable electricity supply, they are also relevant for high-income contexts. This calls for a rethink of how neonatal intensive care is provided, the guidelines state, to ensure parents and newborns can be together at all times.

Throughout the guidelines, breastfeeding is strongly recommended to improve health outcomes for preterm and low birthweight babies, with evidence showing it reduces infection risks compared to infant formula. Where mother’s milk is not available, donor human milk is the best alternative, though fortified ‘preterm formula’ may be used if there are no donor milk banks.

Integrating feedback from families gathered through over 200 studies, the guidelines also advocate for increased emotional and financial support for caregivers. Parental leave is needed to help families care for the infant, the guidelines state, while government and regulatory policies and entitlements should ensure families of preterm and low birthweight babies receive sufficient financial and workplace support.

Earlier this year, WHO released related recommendations onantenatal treatments for women with a high likelihood of a preterm birth. These include antenatal corticosteroids, which can prevent breathing difficulties and reduce health risks for preterm babies, as well as tocolytic treatments to delay labour and allow time for a course of corticosteroids to be completed. Together, these are the first updates to WHO’s preterm and low birth weight guidelines since 2015.

NEW Guidelines:

Neonatal Brain Protocol

Ultrasound Protocols Sonographic Tendencies  Mar 23, 2021

How I do it. Neonatal Brain Ultrasound Protocol As I’ve said before, every institution may do it a bit different but these are required views.

Blogpost:… Medical Disclaimer:

Patent to be Issued to LSU Health New Orleans for Technology to Diagnose Life-Threatening Preemie Condition

November 7, 2022

US Patent 11,493,515 will be issued to LSU Health New Orleans on November 8, 2022, for a noninvasive test that more accurately diagnoses a potentially fatal condition in premature infants. Sunyoung Kim, PhD, Professor of Biochemistry and Molecular Biology at LSU Health New Orleans Schools of Medicine and Graduate Studies, led a research team that invented a diagnostic biomarker test for necrotizing enterocolitis (NEC) called NECDetect.

According to the National Institute of Child Health and Human Development, NEC is the most common, serious gastrointestinal disease affecting newborn infants. The tissue lining the intestine becomes inflamed, dies, and can slough off. Health care providers consider this disease as a medical and surgical emergency. X-rays are now used to diagnose advanced disease, but their sensitivity can be as low as 44%. Conversely, the noninvasive NECDetect biomarker panel performed on stool samples identifies 93% true positives and 95% true negatives in diagnosing the disease.

In 2017, Dr. Kim founded Chosen Diagnostics Inc, a spinout company, to develop and commercialize the technology. An Express License for Faculty Startups (ELFS) agreement executed by LSU Health and Chosen Diagnostics Inc in 2020 grants the company the exclusive license to this portfolio of patent and patent applications.

“This patent is an important milestone in protecting the commercial potential of molecular diagnostic tools in intensive care units,” notes Dr. Kim. “Necrotizing enterocolitis continues to be a devastating disease for preemie babies who require long hospital stays. This utility patent is attractive to diagnostic companies that already provide equipment to hospital pathology labs and for drug companies interested in tackling gut disease therapies.”

The National Institute of Child Health and Human Development estimates that NEC affects about 9,000 of the 480,000 infants born preterm each year in the United States. The population most at risk for NEC is increasing because the number of very low birth weight babies who survive continues to grow due to technological advances in care. The percentage of very low birth weight infants who develop NEC remains steady, however, at about 7%. NEC continues to be one of the leading causes of illness and death among preterm infants, although it can also affect full-term babies, usually those with another serious illness or risk factor. Fifteen to forty percent of infants with NEC die from the disease. Surgical survivors require lifelong care.

Rebecca Buckley, PhD, LSU Health New Orleans Research Assistant Professor of Biochemistry (and former postdoctoral research associate), is a co-inventor and Chosen Diagnostics’ Chief Operating Officer. LSU Health inventors also included two other females — Dr. Duna Penn, a member of the Neonatology faculty at the time, and Zeromeh Gerber MD, a former LSU Health neonatology fellow, along with Carl Sabottke, a medical student at the time of the initial application.

This patent is a rarity in that the majority of the team are women,” adds Dr. Kim. “In the 2020 United States Patent and Trademark Office database of all patents issued, only four women in Orleans Parish are inventor-patentees for the whole year. This number has not changed much since 1976.”

Chosen Diagnostics Inc has been awarded $3M in SBIR and STTR grants, and NECDetect’s development was fast-tracked with a Breakthrough Device Designation by the Food and Drug Administration (FDA).

“Intellectual property is the foundation upon which successful biotech businesses are built,” says Patrick Reed, RTTP, LSU Health New Orleans Assistant Vice Chancellor, Innovation & Partnerships. “Working with external counsel, the inventors, and Chosen Diagnostics, we have ensured that this important work is adequately protected, enabling Chosen to attract investment for further R&D and commercialization.”

In addition to this US patent, patent applications are pending in Canada, Europe, Hong Kong, Australia, New Zealand, and China.



Preterm Birth – What you need to know about babies born early and a NICU hospitalization

Week 24 of pregnancy is a HUGE milestone as it means the developing baby now has greater than 50% chance of survival with medical help if born today! This week we cover the big things to know about baby’s chances if born early, what some of the concerns are for babies born early, and some tips for new parents with a baby in the neonatal intensive care unit (NICU).

Lost in Transition: Health Care Experiences of Adults Born Very Preterm—A Qualitative Approach

Front. Public Health, 30 November 2020 Anna Perez1*†, Luise Thiede1†Daniel Lüdecke2Chinedu Ulrich Ebenebe1, Olaf von dem Knesebeck2 and Dominique Singer1 Section Neonatology and Pediatric Intensive Care Medicine, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany – Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Introduction: Adults Born Very Preterm (ABP) are an underperceived but steadily increasing patient population. It has been shown that they face multiple physical, mental and emotional health problems as they age. Very little is known about their specific health care needs beyond childhood and adolescence. This article focuses on their personal perspectives: it explores how they feel embedded in established health care structures and points to health care-related barriers they face.

Methods: We conducted 20 individual in-depth interviews with adults born preterm aged 20–54 years with a gestational age (GA) below 33 weeks at birth and birth weights ranging from 870–1,950 g. Qualitative content analysis of the narrative interview data was conducted to identify themes related to self-perceived health, health care satisfaction, and social well-being.

Results: The majority (85%) of the study participants reported that their former prematurity is still of concern in their everyday lives as adults. The prevalence of self-reported physical (65%) and mental (45%) long-term sequelae of prematurity was high. Most participants expressed dissatisfaction with health care services regarding their former prematurity. Lack of consideration for their prematurity status by adult health care providers and the invisibility of the often subtle impairments they face were named as main barriers to receiving adequate health care. Age and burden of disease were important factors influencing participants’ perception of their own health and their health care satisfaction. All participants expressed great interest in the provision of specialized, custom-tailored health-care services, taking the individual history of prematurity into account.

Discussion: Adults born preterm are a patient population underperceived by the health care system. Longterm effects of very preterm birth, affecting various domains of life, may become a substantial burden of disease in a subgroup of formerly preterm individuals and should therefore be taken into consideration by adult health care providers.


Sensors are first to monitor babies in the NICU

An interdisciplinary Northwestern University team has developed a pair of soft, flexible wireless body sensors that replace the tangle of wire-based sensors that currently monitor premature babies in hospitals’ neonatal intensive care units (NICU) and pose a barrier to parent-baby cuddling and physical bonding. The team recently completed a series of first human studies on premature babies at Prentice Women’s Hospital and Ann & Robert H. Lurie Children’s Hospital of Chicago. The researchers concluded that the wireless sensors provided data as precise and accurate as that from traditional monitoring systems. The wireless patches also are gentler on a newborn’s fragile skin and allow for more skin-to-skin contact with the parent. Existing sensors must be attached with adhesives that can scar and blister premature infants’ skin.

After premature birth: your emotions

Key points

  • Mixed and powerful emotions are common after premature birth.
  • All emotions are OK. Accepting and talking about emotions can help you cope.
  • It can help to focus on your baby’s successes and milestones.
  • When you look after yourself, you’ll be in better shape to care for your baby.

Your emotions after premature birth: what to expect

It’s natural to have many mixed, powerful and conflicting emotions about premature birth.

There are positive emotions, of course, like joy and love for your newborn.

But it’s common to wonder about what happened and what caused the premature birth. You might feel helpless, sad, guilty, anxious or traumatised by the birth experience. There might also be concern, fear and confusion about seeing your premature baby in the neonatal intensive care unit (NICU) or special care nursery (SCN).

Some parents might feel angry at themselves or their doctors. Or they might feel angry at their premature baby for making them feel this bad or for being born early. This might mean they feel reluctant to hold their baby or visit the neonatal intensive care unit (NICU). This is OK too.

Many people feel like things aren’t quite real. And it’s easy to feel powerless or as if you have no control over the future. It’s common to feel lonely. Some people find it hard to see themselves as parents while their premature baby is in the NICU.

Many parents find it very hard to leave their premature baby at the hospital while they go home.

Over time, there are generally fewer challenges, and they get easier to cope with. And as your premature baby gets bigger and more medically stable, you’ll be able to hold and care for them more often. As you get to know the NICU, it will feel more comfortable too. The nursing staff and other members of your baby’s care team will help you as well as care for your baby.

All of this can help you to feel more confident, less anxious and better able to connect and bond with your premature baby.

Tips for managing emotions about premature birth

Here are some ideas that might help you manage your emotions.

Managing emotions

  • Accept your feelings, whatever they are – don’t push them away. Acknowledging and naming your emotions is a healthy thing to do.
  • Be kind to yourself, and remind yourself that you’re doing the best you can.
  • If you can, get to know other parents who are in a similar situation. It helps to hear how other parents are coping, but remember that there’s no one right way to feel or respond.
  • Accept your partner’s way of coping if it’s different from yours. Try to let your partner do things their own way, and find out how your partner is feeling by talking to each other and listening to each other.

Looking after yourself

  • Eat healthy food, do physical activity, and get as much rest as you can. It’s also a good idea to limit caffeine and alcohol and other drugs.
  • Surround yourself with people who help you to feel supported.
  • Avoid unnecessary stress, if you can. It’s OK to let some things go or not do things the way you usually do while you focus on your premature baby and your family for a while.
  • Take a day off from the NICU every now and then so you can do things for yourself as well.
  • Take time to relax and do things you enjoy each day, even for just a few minutes. For example, do breathing exercises, listen to your favourite music, or go for a walk around the block. You can also do breathing exercises or listen to music while sitting next to your baby in the hospital.

Being with your baby

  • Celebrate successes, positives and progress – yours and your premature baby’s. Your baby might be in the NICU, but they’ll be reaching their own goals and milestones.
  • Get involved in your premature baby’s day-to-day care. This can help you bond with your baby, which is good for your baby and good for you.
  • Find out how you can help your premature baby. For example, you might learn about one piece of technology or your baby’s stress signs, or about how to change a nappy gently. Just focus on one thing at a time.
  • Remember that there are things only you as a parent can do. Your touch, smell and voice are all very important for your premature baby. You’re also your baby’s most important advocate.

Seeking support

  • Talk with trusted family members or friends about your emotions. It’s OK to share negative feelings and to say what you need. This might be someone just to listen or someone who doesn’t mind if you cry.
  • Seek support only from people you feel comfortable with. It’s OK to not to seek support from people who cause you tension and stress.
  • Ask your nurse if you can speak with someone at the hospital who can help you manage your emotions.
  • Speak with your GP, who can guide you to an appropriate mental health professional.
  • Contact LifelineBeyond Blue or your state or territory parent helpline.

It’s important to look after yourself in these early days and weeks of your premature baby’s life. When you look after yourself, you’ll be in better shape to care for your baby.

More than baby blues: postnatal depression after premature birth

Mood changes are common after you’ve had a baby. They can vary from mild to severe.

Many birthing mothers experience the ‘baby blues’ – a mild depression in the days after childbirth. If it continues and becomes more severe, it could become postnatal depression (PND). Non-birthing parents can suffer from PND too.

Signs of PND include a persistent feeling of sadness, low mood, feelings of hopelessness, lack of energy, low self-esteem and sleep problems.

If you think you’re experiencing the signs of postnatal depression in birthing mothers or postnatal depression in non-birthing parents, it’s important to get professional help as soon as you can. Your GP is a good place to start. With proper diagnosis, treatment and support, you can make a full recovery.



Late-Onset Sepsis Among Very Preterm Infants

Dustin D. Flannery, DO, MSCEErika M. Edwards, PhD, MPH; Sarah A. Coggins, MD; Jeffrey D. Horbar, MD;Karen M. Puopolo, MD, PhD


To determine the epidemiology, microbiology, and associated outcomes of late-onset sepsis among very preterm infants using a large and nationally representative cohort of NICUs across the United States.


Prospective observational study of very preterm infants born 401 to 1500 g and/or 22 to 29 weeks’ gestational age (GA) from January 1, 2018, to December 31, 2020, who survived >3 days in 774 participating Vermont Oxford Network centers. Late-onset sepsis was defined as isolation of a pathogenic bacteria from blood and/or cerebrospinal fluid, or fungi from blood, obtained >3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without late-onset sepsis.


Of 118 650 infants, 10 501 (8.9%) had late-onset sepsis for an incidence rate of 88.5 per 1000 (99% confidence interval [CI] [86.4–90.7]). Incidence was highest for infants born ≤23 weeks GA (322.0 per 1000, 99% CI [306.3–338.1]). The most common pathogens were coagulase negative staphylococci (29.3%) and Staphylococcus aureus (23.0%), but 34 different pathogens were identified. Infected infants had lower survival (adjusted risk ratio [aRR] 0.89, 95% CI [0.87–0.90]) and increased risks of home oxygen (aRR 1.32, 95% CI [1.26–1.38]), tracheostomy (aRR 2.88, 95% CI [2.47–3.37]), and gastrostomy (aRR 2.09, 95% CI [1.93–2.57]) among survivors.


A substantial proportion of very preterm infants continue to suffer late-onset sepsis, particularly those born at the lowest GAs. Infected infants had higher mortality, and survivors had increased risks of technology-dependent chronic morbidities. The persistent burden and diverse microbiology of late-onset sepsis among very preterm infants underscore the need for innovative and potentially organism-specific prevention strategies.


New wireless monitors let premature babies have skin-to-skin contact even in the NICU

Premature and ill babies thrive with direct contact, but wires from traditional sensors get in the way

Parents may feel helpless when their children are in the neonatal intensive care unit (NICU), and they can develop anxiety, depression, and anger. Seeing their infants isolated and entangled in wires that tether them to massive medical devices for monitoring vital signs is gruesome and heart-wrenching.

Approximately 450,000 babies are born premature in the US every year, sometimes weighing as little as 500 grams. They need constant clinical monitoring in the NICU as they might develop complications by being born unusually early in development. An additional 480,000 children spend time in the NICU or pediatric intensive care unit annually because of a critical illness.

Biosensors indeed enhance the quality of neonatal and pediatric clinical care by allowing parents to hold their babies, feed them conveniently, and clean them in a timely manner.

Precise monitoring of NICU patients is essential but invasive, typically requiring specialized catheters inserted into the patient’s tiny veins. Wired monitoring can cause scarring and increase the risk of infections and complications, such as blood clots and blood vessel blockage. Wires also get in the way of feeding and cleaning. Above all, a major disadvantage of wired monitoring is that it impedes skin-to-skin contact between parent and newborn, which has been scientifically shown to have clinical advantages for the newborn.

New technology developed by a group of American, Chinese, and Korean researchers headed by Debra Weese-Mayer, John Yoon Lee, and John Rogers may solve many problems introduced by wired monitoring of NICU patients. The first of its kind, these non-invasive, wireless biosensors can continuously monitor vital parameters by merely attaching as a patch on a skin surface.

The wireless biosensor consists of two parts, a chest and a limb unit, both of which fit inside the palm of an adult hand. The chest unit can be gently mounted on to the infant’s chest or back, while the limb unit has can go around a foot, palm, or toe. This means that the biosensor covers a wide range of infant ages and anatomies, including interfaces such as wrist-to-hand and foot-to-toe sensing. Researchers have demonstrated its successful clinical use in extremely premature infants, as young as 27 weeks of gestational age but who have been out of the womb for 6 weeks. At that point, they are about the size of a head of lettuce.

The sensor can simultaneously monitor a range of health indicators, including breathing and blood oxygen levels, at a level that is comparable to standard FDA-approved monitoring systems. It harbors an accelerometer that measures chest vibrations to generate a seismocardiogram (SCG), which provides similar information as an electrocardiogram (EKG) that monitors cardiac muscle activity and valve motion, but is better suited for small infants because it provides a direct assessment of the mechanical activity of the heart. The device also records an infant’s cries, which can be used to analyze an infant’s pain and stress levels.

The previous prototype of biosensors created by the researchers worked wirelessly, although it lacked several features compared to the current design, such as relaying the recorded patient data to a computer system placed far from the sensor. Another challenge was fixing the fragile nature of the sensor without compensating its flexibility, which is key to recording on highly curved surfaces such as the chest, ankles, and toes.

A year later, the same researchers came up with a novel model with additional built-in features that solve many of the issues that the earlier version had. The electronic components of the device are sandwiched between waterproof silicone covers, so they sit comfortably on the sensitive skin of infants. The sensor can draw power from onboard batteries or from a nearby antenna placed 30-50 cm away from the biosensor, ensuring that it never lose’s track of it’s patient’s vital signs.

The device uses Bluetooth and can transmit data into a computer system 10 meters away, meaning they can take records within a standard-sized patient room. The sensors can be sterilized between patients, and they do not generate heat for up to 24 hours, making them reliable and safe to use.

Biosensors enhance the quality of neonatal and pediatric clinical care by allowing parents to hold their babies, feed them conveniently, and clean them in a timely manner. The design is also inexpensive, durable, cost-effective, and can even be used outside a hospital setting with the data being recorded on a tablet or a cell phone.

This simple technology can be expanded beyond infants and children. Patients who need outpatient monitoring, such as those sent home after a surgery, or those with chronic conditions, could also use the device. Sharing the monitoring data with a physician online could also cut down on non-emergency hospital visits.

Although this technology is wonderful, it will probably be some time before it can be used in hospitals. This is one of the first studies to record data in real NICU patients, so more confirmation is required to ensure the reliability of these biosensors.

A physician’s human touch gives an emotional connection, but if parents are comfortable, this biosensor technology can serve as a boon by monitoring infants continuously to watch out for anomalies.


Role of Neurosonography in Critically Ill Neonates in NICU

Rupesh Rao, Amar Taksande, Sneh Kumar+2View all authors and affiliations Volume 36, Issue 3

Journal of Neonatology



Neurosonography has been commonly used for screening in neonatal intensive care unit (NICU), for early detection of defects in the central nervous system (CNS) which include findings like intracranial hemorrhage, hydrocephalus, cerebral edema, and other structural abnormalities.


To detect the CNS abnormality in critically ill neonates by neurosonography.

Materials and Methods

This was a cross-sectional study done in the NICU of AVBR Hospital, Sawangi Meghe, Wardha. Neonates were defined as “critically ill” after taking their detailed history and performing a complete physical examination. Following this, the newborns who fulfilled the studies’ inclusion criteria were subjected to neurosonogram. The following factors were considered: gestational age, clinical examination, investigations, neurosonography findings, and outcomes.


A total of 150 critically ill newborns were subjected to neurosonography, 24 of them had abnormal findings. There was a significant correlation of gestational weeks, mode of delivery, and diagnosis of critically ill neonates with abnormal neurosonography (P = .000, P = .000, and P = .000). Prematurity was the most common diagnosis followed by meningitis. A total of 16% of the newborns had abnormal results in neurosonography. About 6.67% of these had hydrocephalus, 5.34% had an intraventricular hemorrhage (IVH), 1.34% had periventricular echogenicity, 0.66% had cerebral edema, 0.67% had germinal matrix hemorrhage, and 0.66% had brain abscess. A total of 109 (72.67%) participants in the study had a positive outcome at the time of discharge from NICU; whereas, 27 (18%) unfortunately did not survive.


Neurosonography is thus a valuable, safe, and effective diagnostic tool used for screening critically ill neonates for abnormalities of the brain.


For our little family members! A fun story…

Joy by Corrinne Averiss

Why Happiness Matters

Think how wonderful the world would be if we all did what made us happy. Wouldn’t it be amazing to live in a world where we let go of the “should” and followed our hearts to what was truly important to us?

By Nathalie Thompson, Contributor Feb 1, 2016, 04:47 PM EST|Updated Dec 6, 2017

“Happiness is the meaning and the purpose of life, the whole aim and end of human existence.” – Aristotle

Happiness matters, more than you might realize. It’s important to your physical and mental health, your resiliency in the face of obstacles and crises, and believe it or not, your happiness is important to the happiness of the world at large.

Your Happiness Matters to the Whole World

Yes, you heard me — your personal happiness is important to the happy quotient of the entire world. But somewhere along the way, we’ve picked up this horribly damaging belief that wanting to be happy is selfish and arrogant. We’ve made ourselves believe that what we want most in life is not important, and that we don’t deserve it.

We’ve somehow managed to twist ourselves so out of alignment with Who We Really Are that we’ve come to believe that suffering is expected, and even virtuous! We’ve come to believe that in pursuing our own happiness, we will somehow destroy or negate the happiness of others. And so we give up on believing that our own happiness matters and we resign ourselves to a lifetime of misery because we don’t want to hurt anyone and we don’t want anyone to think badly of us.

But here’s the thing: Being happy yourself is one of the best things you can do to help other people be happy, too! We’ve all had the experience of knowing someone who seems to light up a whole room when they enter it — the kind of person who makes other people feel happy, just be being around them. Happiness has a ripple effect far beyond a single individual — when you are happy, other people (your partner, your kids, your friends, etc.) notice and are themselves influenced by your mood.

This is not just anecdotal, there’s scientific evidence: When you are happy, you boost the moods of everyone you encounter and (here’s where it gets really cool) those people whose moods you have affected will then affect the moods of everyone they encounter, too!

The Happiness Cascade Effect

This happiness “cascade effect” was documented in a study published in 2008 in the British Medical Journal. Researchers from Harvard and the University of California, San Diego discovered that “clusters of happiness result from the spread of happiness and not just a tendency for people to associate with similar individuals” and that the happiness of single individuals affects even those they don’t know… through three degrees of separation!

That means that if you are happy, not only does it make your friends happier, it also makes their friends happier and their friends’ friends happier, too!

If one person is happy, that increases the chances of happiness in a friend living within a mile by 25 percent. The “cascade” effect, as the researchers put it, continues: a friend of the friend has almost a 10 percent higher likelihood of being happy, and a friend of that friend has a 5.6 percent increased chance.

See? Happiness is contagious! So, far from being a selfish thing, the pursuit of your own happiness can be seen as a generous public service — and perhaps even a civic duty of sorts, to increase the happiness of society as a whole!

Think how wonderful the world would be if we all did what made us happy. Wouldn’t it be amazing to live in a world where we let go of the “shoulds” and followed our hearts to what was truly important to us?

Your happiness matters — to all of us. So figure out what makes your heart sing… and then go out there and do it.


Author Sheryl Sandberg said happiness is made up of numerous small moments of joy. The more you experience joyous emotions, the happier you are. Learning to shift our perspective to a positive one can greatly impact our outlook on navigating life. Through my life experience I have learned over time that choosing happiness is a skill. Thus, making the choice to become more aware of what brings us joy in life can help us cultivate our own happiness.

There is joy in the daily things we do if we just pay attention. Discovering what brings us joy through our passions, purpose, daily activities, interest, and close relationships can drive “the happiness cascade” in how we interact with the world and others around us.

What are the small moments in your life that bring you great joy?

For me, the simplicity of enjoying my daily workout, greeting my cat after the workday, catching up with internationally located friends, cooking with my mom and going on walks throughout the city with a coffee in hand brings snippets of joy into my daily life.

As we move into the holiday season, we wish you and yours great joy and happiness in the big and small moments in life.

#News #Reuters #adventuresports

Mar 28, 2021: A group of friends in Latvia have adapted their hobby to the harsh weather conditions to create a new sport they have dubbed ‘kiteskating.’

Strategies, Shifts, NICU Blues


Rank: 183  –Rate: 5.1%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Ecuador, officially the Republic of Ecuador, is a country in northwestern South America, is bordered by Colombia on the north, Peru on the east and south, and the Pacific Ocean on the west. Ecuador also includes the Galápagos Islands in the Pacific, about 1,000 kilometers (621 mi) west of the mainland. The country’s capital and largest city is Quito.

The sovereign state of Ecuador is a middle-income representative democratic republic and a developing country[19] that is highly dependent on commodities, namely petroleum and agricultural products. It is governed as a democratic presidential republic. The country is a founding member of the United NationsOrganization of American StatesMercosurPROSUR and the Non-Aligned Movement.

Ecuador currently ranks 20, in most efficient health care countries, compared to 111 back in the year 2000.  Ecuadorians have a life expectancy of 77.1 years. The infant mortality rate is 13 per 1,000 live births,  a major improvement from approximately 76 in the early 1980s and 140 in 1950. 23% of children under five are chronically malnourished. Population in some rural areas have no access to potable water, and its supply is provided by mean of water tankers. There are 686 malaria cases per 100,000 people. Basic health care, including doctor’s visits, basic surgeries, and basic medications, has been provided free since 2008. However, some public hospitals are in poor condition and often lack necessary supplies to attend the high demand of patients. Private hospitals and clinics are well equipped but still expensive for the majority of the population.

Between 2008 and 2016, new public hospitals have been built, the number of civil servants has increased significantly and salaries have been increased. In 2008, the government introduced universal and compulsory social security coverage. In 2015, corruption remains a problem. Overbilling is recorded in 20% of public establishments and in 80% of private establishments.

Source:Ecuador – Wikipedia


New recommendations from WHO to help improve the health of preterm infants

30 September 2022            


Preterm birth is the leading cause of death in newborns less than 28 days old with more than a million preterm infants dying each year. Those that do survive risk a range of disabilities throughout their lives. Alarmingly, in almost all countries with reliable data, preterm birth rates are increasing.

In order to improve the health outcomes for these newborn babies, the World Health Organization has issued updates for two interventions. One set of recommendations focuses on the use of antenatal corticosteroids. These drugs cross the placenta and enhance the structural maturity of the fetus’ developing lungs, helping to prevent respiratory-related morbidity and mortality in preterm newborns. 

Safe and effective for use in low-income countries

This recommendation (and its nine sub-recommendations) resolves previous confusion about evidence on their use in low-resource settings. Clinical trials in high-resource settings suggested that antenatal corticosteroids were safe and beneficial to newborn outcomes. The Antenatal Corticosteroids Trial in lower-income countries however found a significant increase in the number of perinatal deaths (5 excess deaths per 1000 women exposed to the treatment) and maternal infections. A subsequent trial (WHO ACTION-1) also in lower-income countries found that under the right conditions, antenatal corticosteroids were safe and effective.

New recommendation on tocolytic drugs

Another new WHO recommendation out today, is for the use of tocolytic treatments.  Tocolytic drugs inhibit contractions of the uterus and can be used to delay preterm labour and prolong pregnancy. This has multiple benefits; giving more time for fetal development, and for administering antenatal corticosteroids. It also creates a window of time for women to be transferred to a higher level of care, if necessary. 

“These recommendations provide clear guidance to health professionals on the management of preterm birth and have the potential to improve the health of newborn babies, even in low-resource settings.” Dr Doris Chou, Medical Officer, Department of Sexual and Reproductive Health and Research.

In the 2015 WHO recommendations on interventions to improve preterm birth outcomes, tocolytic treatments (acute and maintenance treatments) were not recommended for women at risk of imminent preterm as there was insufficient evidence demonstrating substantive benefits. A review of the evidence in 2022, however, has recommended in favour of nifedipine for acute and maintenance tocolytic therapy for women with a high likelihood of preterm birth, when certain conditions are met.

In formulating these recommendations, WHO, in addition to considering the clinical evidence also considered aspects of cost-effectiveness, feasibility and resources, equity and whether the intervention was valued by and acceptable to stakeholders including clinicians as well as women and their families.

Useful links- WHO recommendations

Global trends in preterm birth from 1990-2019


In a recent study from China, data from the 2019 Global Burden of Disease study have been analysed to show trends in preterm birth. Deaths and incident cases decreased globally, but on a regional and national level, preterm birth rates also increased.

Preterm birth is a global issue. Almost 15 million infants were born too soon (preterm) in 2014, with a global incidence rate of 10.6%. Despite improvements in medical care, increases in preterm births were also observed in high-income countries, as for example in the USA. Due to the higher risk of infections and other complications, preterm birth is still the leading cause of death in children under five years.

Cao et al. have analysed global trends from 1990 to 2019 regarding the occurrence and death rate in preterm born infants. For this purpose, the researchers used data from the 2019 Global Burden of Disease study. Amongst others, the yearly rate of preterm birth cases and deaths was analysed, together with age-standardised incidence rates (ASIRs: expected disease rate in a certain time period in a reference/standard population) as well as age-standardised mortality rated (ASMRs: weighted average of the age-specific mortality rates per 100 000 persons).

Globally, the good news is that the rate of preterm birth has declined by about five percent (16.06 million in 1990) to 15.22 million in 2019. Also, fewer deaths of preterm newborns could be noted; a reduction of even 48% from 1.27 million (1990) to 0.66 million in 2019.

Interestingly, the findings were also compared according to the socio-demographic index (SDI), which shows the development status of a region and is strongly related to health. It was found that regions with a high SDI show a decrease in incident cases of preterm births by about five percent. Also, the number of deaths of preterm born newborns halved in low-, middle-, middle-high-, and high-SDI regions.

Across all global burden of disease regions, the largest decrease in incident cases and deaths could be noted in East Asia. On a national level, one third of all global incident cases, in absolute numbers, accounted for India (3.10 million) and Pakistan (1.04) in 2019. The most striking increase in preterm birth rates, however, was noted in Niger (182.10%), together with the highest increase in preterm birth related deaths (105.52%). In Greece, the highest increase of age-standardised incident rates could be observed.

Finally, the overall decrease in global incidence and mortality of preterm born children can be explained by improvements in medical care and a better general health status. However, incidence of preterm birth has increased in some countries, also high-income ones. Possible explanations could be higher rates of multiple births, delayed parenthood and other changes in clinical practices. Further research is needed to find the underlying reasons and measures to prevent preterm birth worldwide. 

Paper available at:

Paulina Aguirre – La Tierra Llora

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Let Them Be Girls, and Not Mothers Before Time


Jenny Benalcazar Mosquera, Coordinator of the delivery room of the Obstetric Gynecology Hospital Isidro Ayora de Loja (Ecuador)

The World Health Organization (WHO) defines adolescence as the period between the ages of 10 and 19 years, a time of life characterised by growth and development. In my country, Ecuador, 12% of girls in this age group have had a child or at least one pregnancy—the highest rate of adolescent pregnancy in South America. According to the statistics published by Ecuador’s National Institute of Statistics and Census (INEC), 49.3 of every 100 live births in the country involve adolescent mothers. These statistics are cause for concern.

Equally worrying is the fact that over the last decade we have seen a 78% increase in births among girls in the 10 to 14 year age group and an 11% increase in motherhood among girls aged between 15 and 19 years. According to the National Sexual and Reproductive Health Plan, Ecuador has the third highest rate of adolescent pregnancy in Latin America and the highest in the Andean region, surpassed only by Nicaragua and the Dominican Republic.

Over the last decade we have seen a 78% increase in births among girls in the 10 to 14 year age group and an 11% increase in motherhood among girls aged between 15 and 19 years.

Sexual and reproductive health rights imply guaranteeing girls and women safe and effective control of their own fertility, enabling them to decide how many children they want and when they have them, facilitating access to contraception and other family planning methods. Access to family planning has improved over the last two decades in Ecuador, but gaps still exist between different social, ethnic, and age groups.

According to research carried out for UNICEF by the Observatory for the Rights of Children, 50% of indigenous adolescents do not complete their basic education, and this figure is higher among girls who become pregnant. Consequently, these adolescent girls are less likely to be integrated into the educational system and improve their living conditions than their non-indigenous peers. From childhood, these children grow up in poverty and inequality and live in a culture of punishment, especially in the provinces of the Ecuadorian Highlands (Chimborazo, Cotopaxi and Imbabura).

Sexual and reproductive health rights imply guaranteeing girls and women safe and effective control of their own fertility, enabling them to decide how many children they want and when they have them, facilitating access to contraception and other family planning methods.

Even though they may know something about contraceptive methods, in most cases they do not use them. However, the main cause of adolescent pregnancy continues to be sexual abuse and violence, which affects 42.7% of adolescents. In more than half of all cases (55%) this sexual violence occurs within the family circle. The national survey of family relations and gender violence against women carried out by the INEC estimated that 60.6% of women in the country have experienced some kind of gender violence (physical, psychological and/or sexual).

Pregnancy in adolescence is associated with serious health effects as well as economic and social repercussions. For example, while the school dropout rate in Ecuador has fallen (and pregnancy is the cause in only 2.8% of cases), the number of pregnancy-related deaths has increased by 2.5% among adolescent girls (aged 10 to 19 years).

Pregnancy in adolescence is associated with serious health effects as well as economic and social repercussions.

The available data are essential to inform decisions on public policy relating to the present adolescent population. After two decades marked by an increase in adolescent fertility, during which profound gender gaps have persisted, the challenge for the state as well as for international and local organizations working in the field of reproductive health is to prioritise strategies aimed at avoiding or postponing motherhood in the adolescent population. Indispensable prerequisites to progress include strengthening the state and the role of public institutions, especially by way of the National Plan for the Eradication of Gender Violence Against Children, Adolescents and Women—a comprehensive plan that addresses the problem of violence—and by implementing the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030).

Among the interventions announced in July 2018, the Intersectoral Strategy for the Prevention of Pregnancy in Girls and Adolescents 2018-2025 is of particular interest. This strategy will involve the cooperation of four ministries: Health, Education, Justice, and Economic and Social Inclusion. The strategy will work towards ensuring universal access among adolescents to sexual and reproductive health information, education and services, with a view to giving young people the freedom to make their own decisions; facilitating access to contraception will also be a priority. The ultimate goal is to achieve the targets for adolescent health defined by the WHO’s Global Strategy.

To reduce adolescent pregnancy rates, Ecuador must successfully tackle major challenges. Early pregnancy is a problem with serious implications for the present and future of girls and adolescents. Beyond that, it is a problem that affects not only young mothers but also the country as a whole because it is a determining factor in the intergenerational cycle of poverty.


Hospital System Saw Fewer Attacks From Patients With New Crisis Strategies

Emergency response teams, de-escalation training likely contributed to dip in violence by Randy Dotinga, Contributing Writer, MedPage Today October 21, 2022

LONG BEACH, Calif. — A Pittsburgh-based hospital system has seen a rapid decrease in violent attacks by mental health patients against staff members, a psychiatric nurse told colleagues here.

From 2020 to 2021, reported violence at Allegheny Health Network facilities fell by 20%, and reported cases of staff being struck by combative patients dropped by 29%, reported Jamie Elyse Malone, MSN, RN, during a presentation at the American Psychiatric Nurses Association annual meeting.

These improvements are likely due to a series of strategies such as emergency response teams, the flagging of violent patients, and crisis intervention training, she noted.

“We’ve seen really positive results from all these different initiatives,” Malone said. “We can’t say there’s causation from the data, but it looks like they really work.”

Any reduction in workplace violence against healthcare workers would make Allegheny Health’s hospital system an outlier. According to a report from earlier this year by the Joint Commission, “U.S. healthcare workers in the private sector are 5 times more likely to experience nonfatal violence-related injury compared to workers in all other private industries combined.”

Violence rates at general hospitals have doubled since 2011, and “overall, nearly three-quarters of all violence-related nonfatal injuries and illnesses in 2018 were incurred by healthcare workers,” the report noted.

While data are sparse, surveys have also suggested that violence against healthcare workers has increased during the COVID-19 pandemic.

A 2018 survey of 990 Allegheny staff members found that only 24% said they reported cases of workplace violence, with 74% reporting that they were instructed to do so. Only 11% said they felt prepared to deal with aggressive/violent behavior. “We realized that we needed to change in order to better protect our team members, patients, and visitors,” Malone said.

Subsequently, the hospital system developed a centralized police force with sworn officers, and spent the next several years developing other strategies to address violence.

Crisis response teams are now in place and led by clinicians with de-escalation training. Depending on availability, the teams can include security/hospital police, behavioral health staff, physicians, and hospital managers. In addition, “crisis response bags” are available that include tools such as “hard” restraints with keys, bite sleeves, spit masks, and towels, Malone added.

However, the protocol only calls for crisis teams to respond in the most severe situations, she noted. “Sometimes somebody might be yelling, they might be acting up a little bit, so you call the whole team to help and it just escalates the situation more,” she explained. “So we have four levels in our crisis response, which helps us get the appropriate response.”

The full crisis teams only respond at the highest two of the four levels when patients actually become physical/violent. “If there’s a threatening act — somebody with an IV pole trying to break a window, somebody’s trying to strangle a nurse — our police and security are trained to get into that room as quickly as possible,” she said.

Debriefing and reporting are important parts of the protocol, Malone noted, and have led to administrative action. “Because you reported that incidences of delirium have gone up, and they’ve caused 50% of our violent offenses in the last month, we’ve set up this whole program to help prevent delirium. That is the way we get staff to actually report — by being transparent with the data and letting them know how that has driven our initiatives and our processes to make things better,” she said.

Over the last 4 years, Allegheny Health has also created councils and committees devoted to preventing workplace violence, added metal detectors to emergency department entrances, conducted simulations, and adopted a violence prediction tool that provides risk notifications.

Patients at risk of being violent are now flagged in the EPIC system, Malone noted. “We wanted to make sure we very clearly but subtly communicated with our staff when a person is likely to become violent.”

Personal panic alarms are now available for staff members, along with specially designed pens and toothbrushes that prevent injury when wielded by a violent patient.

Over 3 years, more than 3,000 staff members were trained in de-escalation techniques, Malone reported, and evidence suggests that “calls for a crisis response appeared to decrease incidents of reported injury from violence.”

What’s next? Malone said she’s working on ways to keep hospital leaders focused on preventing workplace violence instead of letting their attention wander to other projects. “I also would really like to see us do a little bit better with reporting and find out how we can do more projects to continue to prevent violence. One of the big specialty projects that we hope to work on next is alcohol withdrawal. It’s a struggle at our hospitals, and we can do a lot better.”



How the mother’s mood influences her baby’s ability to speak

OCTOBER 07, 2022

Communicating with babies in infant-directed-speech is considered an essential prerequisite for successful language development of the little ones. Researchers at the Max Planck Institute for Human Cognitive and Brain Sciences have now investigated how the mood of mothers in the postpartum period affects their child’s development. They found that even children whose mothers suffer from mild depressive mood that do not yet require medical treatment show early signs of delayed language development. The reason for this could be the way the women talk to the newborns. The findings could help prevent potential deficits early on.

Up to 70 percent of mothers develop postnatal depressive mood, also known as baby blues, after their baby is born. Analyses show that this can also affect the development of the children themselves and their speech. Until now, however, it was unclear exactly how this impairment manifests itself in early language development in infants.

In a study, scientists at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig have now investigated how well babies can distinguish speech sounds from one another depending on their mother’s mood. This ability is considered an important prerequisite for the further steps towards a well-developed language. If sounds can be distinguished from one another, individual words can also be distinguished from one another. It became clear that if mothers indicate a more negative mood two months after birth, their children show on average a less mature processing of speech sounds at the age of six months. The infants found it particularly difficult to distinguish between syllable-pitches. Specifically, they showed that the development of their so-called Mismatch Response was delayed than in those whose mothers were in a more positive mood. This Mismatch Response in turn serves as a measure of how well someone can separate sounds from one another. If this development towards a pronounced mismatch reaction is delayed, this is considered an indication of an increased risk of suffering from a speech disorder later in life.

“We suspect that the affected mothers use less infant-directed-speech,” explains Gesa Schaadt, postdoc at MPI CBS, professor of development in childhood and adolescence at FU Berlin and first author of the study, which has now appeared in the journal JAMA Network Open. “They probably use less pitch variation when directing speech to their infants.” This also leads to a more limited perception of different pitches in the children, she said. This perception, in turn, is considered a prerequisite for further language development.

The results show how important it is that parents use infant-directed speech for the further language development of their children. Infant-directed speech that varies greatly in pitch, emphasizes certain parts of words more clearly – and thus focuses the little ones’ attention on what is being said – is considered appropriate for children. Mothers, in turn, who suffer from depressive mood, often use more monotonous, less infant-directed speech. “To ensure the proper development of young children, appropriate support is also needed for mothers who suffer from mild upsets that often do not yet require treatment,” Schaadt says. That doesn’t necessarily have to be organized intervention measures. “Sometimes it just takes the fathers to be more involved.”

The researchers investigated these relationships with the help of 46 mothers who reported different moods after giving birth. Their moods were measured using a standardized questionnaire typically used to diagnose postnatal upset. They also used electroencephalography (EEG), which helps to measure how well babies can distinguish speech sounds from one another. The so-called Mismatch Response is used for this purpose, in which a specific EEG signal shows how well the brain processes and distinguishes between different speech sounds. The researchers recorded this reaction in the babies at the ages of two and six months while they were presented with various syllables such as “ba,” “ga” and “bu.

How the mother’s mood influences her baby’s ability to speak | Max Planck Institute for Human Cognitive and Brain Sciences (

Fortifying Family Foundations:Assistant Professor Ashley Weber’s intervention empowers parents to care for their premature infants

By Evelyn Fleider – July 20, 2021

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

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

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

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

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

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

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

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

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

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

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


Late Preterm Infants in the NICU – Tala Talks NICU

NICU Tala Talks

Welcome to Tala Talks NICU! In this video, we talk about late preterm infants (those born between 34 and 37 weeks gestation) and the 8 main reasons a late preterm infant would need admission to the NICU.

Joe’s Legacy: The Family Making A Difference For NICU Babies

#TheProjectTV #NICU #Fundraising  The Project

Three years ago, we introduced you to baby Joe Blackwell. Now, Joe’s legacy lives on with an annual spinathon to raise money for the Royal Hospital For Women’s newborn intensive care unit.


“NICU Blues”:A Novel Term for Common Parental Experiences

Beth Buckingham, Ph.D., HSPP, Grace LeMasters, Ph.D., MSN

Approximately one in ten babies will spend time in a newborn intensive care unit (NICU).  Studies indicate that preterm birth significantly contributes to infant morbidity and mortality. Though mortality rates have been declining for preterm infants, there remains a significant percentage of infants born at the earliest gestational age who die in the NICU. Regardless of gestational age or medical diagnosis, NICU parents often fear their baby’s neonatal death or severe morbidity. There commonly exists some level of acute disorienting parental distress.

A single definition of parental distress in the NICU does not exist.  A novel non-pathological term, “NICU blues,” is proposed to identify common parental experiences specific to the newborn intensive care unit. Giving a name to “NICU blues” for parents provides optimal understanding, relief, and meaning for parents and caregivers moving through a unique NICU journey. Over several years, confidential comments were collected by the principal author from parents with newborns in a Level III family-centered care NICU. These condensed comments, shown in quotes, are many shared voices of pain, including reflecting parental narratives used in developing the term “NICU blues” Parents in the NICU described numerous symptoms of psychological distress not fully meeting specific pathological psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). However, the clinical reflection of these vulnerable expressions of NICU parental distress helped us formulate the proposed conceptualized term “NICU blues” to shape those collective narrative stories.

Parental “NICU blues” are defined by the intersection of four factors in figure 1: NICU trauma, baby blues, postpartum mood and anxiety disorders (5), and NICU grief. NICU blues may contain varying levels of these four factors. Both parents are included in this biopsychosocial, transitory, and non-pathological model of predicted cogent symptoms in the NICU. NICU blues normalize feelings of being out of control emotionally and behaviorally with responses and experiences for any parent in the NICU. The concept of NICU blues sets an initiative-taking stage for the healthcare professional to offer adaptive coping responses and interventions within the NICU setting. Parents were suffering from extreme emotional pain, a sense of hopelessness, and despair in response to a potential NICU death or long-term morbidity of their newborn we view as an expected and understandable transitory state of parental functioning. The proposed term “NICU blues” gives voice to the logical collective voices of “feeling like I am crazy and losing my mind.” Hence, we define “NICU blues” as a condition unique to the NICU setting that includes common emotional and behavioral responses to a succession of abnormal parenting events and experiences. These responses include parental guilt, specifically maternal guilt as it relates to pregnancy loss and the baby’s NICU admission, father’s guilt as it relates to not protecting his family from the NICU stay, negative cognition and mood, decreased interest, anger, concentration problems, sleep disturbances, and struggles to experience positive emotions.

NICU blues provides a paradigm for validating parental adaptation experiences within a NICU setting and is viewed similarly to the transitory phenomena of matrescence described by anthropologist Dana Raphael.  Maltrescence is a typical physical, emotional, hormonal, and social process of transitioning into motherhood. In this sense, NICU blues is a typical process of psychosocial adjustment into parenthood occurring within the NICU. The term NICU blues normalizes perceived “out of control and helplessness emotions,” but with awareness and interventions, these emotions can transition to periods of adaptation.

Parents in the NICU need a meaningful relationship with their baby to establish a sense of parenthood, and their baby needs parental contact for optimal physiologic and psychoemotional development. Parents in the NICU often feel an additional layer of angst and guilt with physical separation from their baby. Research documents the interrelationships between NICU parents’ mental health on the functioning of their infants’ physical and psychological development.

Postpartum mothers in the NICU may try to numb the intense emotional pain of “not wanting to deal with the possible mortality of their precious long, imagined baby.” Fathers in the NICU may experience a sense of panic and doom with potential mortality for their partner and his baby, “I’m going to lose my entire family.” Parents often spend infinite initial hours in the NICU without regard for their own needs, “wanting a parent to be with the baby if they die.” This perception, real or imagined, adds to the NICU blues. Often, the father may undertake to stay in the NICU as the mother cannot leave the postpartum floor until physically mobile. The father may or may not be able to express feeling alone and isolated without his partner.

Most research on NICU parents has focused on the high prevalence rates of postpartum mood and anxiety disorders (5) and post-traumatic stress disorder (PTSD). We strongly support the National Perinatal Association (NPA) 2015 recommendations for universal screening and treatment protocols for both parents in the NICU to identify mental health challenges. Studies reveal elevated levels of depression, anxiety, and trauma symptoms shortly after their baby’s birth. Without screening and identification of common parental distress, we will be unable to support the mental health needs of our parents in the NICU as partners in their newborn care. 

We propose a novel term, NICU blues, for consideration by the NICU team within an ongoing supportive relationship with our parents. Identifying and treating complex emotional and mental health needs, such as NICU blues, provides parents in the NICU with additional consideration for robust universal standards of family-centered care. Figure 1 captures the interrelationship of clinical factors, including NICU trauma, baby blues, postpartum mood and anxiety disorders , and NICU grief, to identify a theoretical construct of a transitional, typical, and expected “NICU blues” paradigm.

NICU Trauma:

Considerable evidence exists that both parents in the NICU are at risk for psychological symptoms from traumatic birth events, including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). We suggest that NICU psychological trauma symptoms may overlap with clinical symptoms in addition to and separate from NICU blues in Figure 1. There exists an intersection of NICU trauma symptoms, including actual or threatened mortality and morbidity for the baby or mother, with symptoms of NICU blues. Parents in the NICU may have the perception and experiences birth trauma events without meeting DSM-5 diagnostic criteria. In this sense, our psychological approach is expanded beyond the narrow psychiatric diagnosis focused solely on ASD or PTSD. In our clinical experience, NICU blues symptoms for parents include attributions of self-blame for their baby’s NICU admission, guilt, fear/horror, feeling detached from self and others, avoidance behaviors from the NICU, decreased parental involvement with their baby, struggles to focus while in the NICU and sleep disturbance.

A parent in the NICU needs a meaningful, loving, and nurturing relationship with their baby. In Ainsworth and colleagues’ classic maternal attachment studies,(10) maternal attachment involves physical and psychological accessibility. Parents of babies in the NICU are largely limited from these crucial parental attachment behaviors. Bonding may be at risk. As mothers may be recovering from a traumatic delivery, fathers may typically be the first visitor to the NICU.

Qualitative research identifies themes for fathers in the NICU. . Fathers may believe they need to be stoic for their family, often hiding feelings of anxiety, fear, helplessness, disconnection, powerlessness, and being out of control. They encompass charting unfamiliar waters, including being the backbone of the family, shouldering heavy responsibilities alone, being torn between his partner and baby in the NICU, and the unexpected journey as an active and possibly only participant.  Parents may question how their involvement and participation in the NICU is important in seeing nurses and others fulfill their caregiving roles.

Trauma during a newborn’s medical stay is now considered an adverse childhood experience (ACE). Toxic stresses or adverse childhood experiences are strongly linked to poor health outcomes. For optimal physiologic and psychoemotional development, a baby may need buffering protection from a lack of parentally connected caregiving. The dearth of physical and emotional closeness between infants and their parents and parental distress can negatively affect the relationship and the infant’s developmental outcomes. Research links possible long-term protective factors for parents who participate in NICU infant care.

Psychosocial education and intervention using the paradigm of the NICU blues are paramount at these initial stages for normalization and validation that these distressing thoughts and feelings are common for most parents in a NICU setting. Unique clinical themes and identification of NICU blues provide parents with alternative schemas for assimilation and adaptation.

Discussion of NICU blues normalizes parents’ turmoil as understandable and predictable within the NICU. Early attunement and co-regulatory caregiving are the foundation for attachment and bonding. We provide a new lens of parenting in the NICU with these caregiving-bonding discussions. In highlighting NICU blues, parents are more apt to discover “what’s lovely about their baby at this moment” apart from the barrage of NICU equipment and stressful environment. Normalization of NICU blues promotes parental discovery of their baby’s physical and emotional nuances.

Parents often need a pause for adaptation from the many successive invasive medical procedures with their babies. With this conversation of NICU blues, parents have reported a much greater understanding of commonly shared universal NICU trauma reactions. With ongoing discussions by the staff of NICU blues, parents gain some psychological distance from their trauma symptoms, reporting greater acceptance, psychological flexibility, and adaptation for continued engagement in the NICU. In our clinical experience, identification of NICU blues sets a family-centered stage for later engagement with parents for other bedside compassionate family-centered interventions and connection between staff and parents in the NICU.

Baby Blues and Postpartum Mood and Anxiety Disorders: Baby blues, also known in the literature as postpartum blues or postnatal blues (with these latter terms excluding the father), is a mild transient disruption of mood occurring several days following delivery. It is imperative for NICU psychologists and medical and nursing staff to help parents make sense and meaning of their initial distress specific to identifiable physical changes, situational stressors, and loss . Parents often express relief in knowing that predictable NICU blues may be additive to or better explained to both parents than the term baby blues in addition to hormonal changes.

Parents in the NCIU report that discussion of possible NICU blues around admission to the NICU gives them a sense of hope and being understood. Our clinical impression is that this initial connection with parents in the NICU gives clarity to an internal disruption not fully understood. Perhaps with this safe therapeutic, nourishing NICU staff-parent connection, parents may be better able to bond with their babies. In our discussion of NICU blues with parents, relationship building for parent-child bonding and meaningful parent-NICU staff communication begins another positive launch for family-centered care.

Baby blues is identified as one potential risk factor for postpartum depression. These authors posit that the risks of developing perinatal mood and anxiety disorder (PMAD) may be lessened or eliminated when identifying NICU blues or baby blues. Early parental psychological identification and intervention by the psychological, medical, and nursing staff is key. Research studies indicate that both parents of babies in the NICU are at risk for postpartum depression and anxiety. There currently does not exist a DSM-5 diagnosis specific to postpartum depression. There is a specifier of “with peripartum onset” with symptom onset during pregnancy or in the four weeks following delivery, with the focus generally on the mother.

PMAD symptoms fail to voice the entire story of NICU parents. Underlying parental NICU distress reveals clinical themes. Using a 4-stage model by Beck, research authors identify maternal loss of control as the underlying problem with a NICU postpartum depressive experience. Beck identified a 4-stage process termed “teetering on the edge” between sanity and insanity with stages of encountering terror, dying of self,  struggling to survive, and regaining control. The author described stages with four identifying themes: incongruity between expectations and the reality of new motherhood, a spiraling downward process, pervasive loss, and making gains. Like Beck’s proposed process of “teetering on the edge of insanity,” parents in the NICU express “a sigh of relief knowing sanity exits and feelings expected within the term NICU blues.” 

A Father’s expectations of ideal fatherhood may, too, be affected by the fears and challenges of parenting a medically fragile baby in the NICU and supporting a mother who is not coping well. (20) Themes of loss fill the NICU room with both parents experiencing the loss of the “perfect” birth to the shocking experiences of seeing their fragile baby for the first time, often with tubes that may affect parental identity and self-esteem. Paternal feelings of helplessness may be incredibly overwhelming.

Parental suffering is often silent. NICU parents may encounter various symptoms, including NICU blues, baby blues, or PMADs. In our clinical experience, parents present with some level of emotional and behavioral NICU distress. They commonly experience an intrusive cognitive disruption to their expected and perceived positive parental role. 

Parents often experience elevated levels of negative self-blaming and misattributions for the baby’s NICU admission exacerbating parental guilt. Dreams of completing a term pregnancy, of expecting a typical delivery complete with physically holding your baby in the delivery room, are abruptly crushed. Multiple losses for any NICU parent are monumental. Parents do not dream of finding themselves as a family in a NICU. As staff present to parents the clinical term NICU blues as a common reaction to their loss of anormal newborn experience, they often feel understood and comforted. In ruling out psychiatric pathology, NICU blues provides an intersecting paradigm of composite reactions, including baby blues and postpartum mood disorder, guilt, sadness, and feelings of parental worthlessness.

NICU Grief:

Parents in the NICU may experience an avalanche of immense losses accompanied by grief associated with those losses. Significant losses for parents may include sudden pregnancy termination, medical complications, loss of anticipated motherhood and fatherhood roles, and loss of hopes and dreams of a highly anticipated future with a healthy full-term baby coming home shortly after delivery.

Symptoms of NICU blues for parents may be further conceptualized within Kubler-Ross’s model of grief and loss. Those stages include shock/denial, anger, bargaining and self-blaming, depression, and acceptance with the recent inclusion of an additional newly defined stage, meaning. Overlap of NICU blues symptoms with stages of Kubler-Ross’s model of grief exists. As Kubler-Ross’s model reflects, these symptoms of grief are experienced in stages without the nuance of diagnostic pathology. Considerations for different cultural, ethnic, and races may also affect expressions of grief and stressors within the NICU setting.

These disorienting grief responses may disrupt parental NICU involvement in baby care bonding behaviors. Parents may further isolate themselves from family and peers, intensifying experiences of NICU blues. This withdrawal from meaningful social support fuels feelings of helplessness and shame with possible stigma adding to their secret “of being different” from other parents leaving the hospital with healthy newborn babies.


Life in the NICU does not make sense. Many parents express negative self-blaming attributions for “causing” their baby’s NICU admission and stay. These parental experiences seem to coincide with feelings and thoughts of NICU blues. We suggest that parental expressions of grief, loss, and shame are strong predictive variables contributing to NICU blues. There is no clear clinical definition for the array of parental psychological distress unique to the NICU. Identifying the NICU blues seeks to add to the understanding of psychological distress as a common contextual response. Thus, parental adaptation to the NICU is viewed as adaptive versus non-adaptive. Awareness of these parental responses by NICU staff and early intervention can ease the experience of NICU blues, foster increased bonding between parent and baby, increase interactions among NICU staff and between staff and parents, and promote an overall more positive parental NICU experience. However, this new paradigm and theoretical concept “NICU blues” for parental distress, needs further empirical qualitative and quantitative evaluation to determine its efficacy and effectiveness for NICU family-centered clinical standards of care.


The Impact of Advanced Practice Registered Nurses’ Shift Length and Fatigue on Patient Safety

Position Statement #3076 – NANNP Council September 2022-  NANN Board of Directors September 2022

The National Association of Neonatal Nurse Practitioners (NANNP) and its members are committed to providing safe, ethical, and professionally accountable care. All healthcare professionals are affected by the challenges associated with role expectations and human performance factors. NANNP recognizes that fatigue, sleep deprivation, and the extended shift lengths or hours that neonatal nurse practitioners (NNPs) often work present potential safety risks for patients, providers, and employers.

As the professional voice of neonatal nurse practitioners, NANNP recommends that, regardless of work setting and patient acuity, NNPs’ maximum shift length in house be 24 hours, that a period of protected sleep time be provided following 16 consecutive hours of working, and that the maximum number of working hours per week be 60 hours. In addition, it is recommended that NNPs, their employers, and institutions collaborate to implement supportive risk-reduction strategies based on current evidence. This is in the best interest of patient safety and NNP health.

 Association Position:  Research addressing sleep deprivation, fatigue, and patient outcomes as related to nurses, and specifically NNPs, is limited. In addition, the uniqueness of the patient population and NNP responsibilities further complicate the delineation of strict scheduling limitations. Based on current evidence, regardless of work setting and patient acuity, (1) NNPs’ maximum in house shift length should be limited to 24 hours, (2) a period of protected sleep time should be provided to NNPs following 16 consecutive hours of working, and (3) the maximum number of working hours per week for NNPs should be 60 hours.

Furthermore, although healthcare providers are susceptible to the negative effects of fatigue and sleep deprivation, NNPs are professionally accountable and, as such, are responsible for minimizing any patient and personal safety risk.

Background and Significance: A number of healthcare organizations, both nursing and other disciplines, have adopted strategies to address concerns related to shift lengths and fatigue as well as the connection with risks to patients and care providers. Although no data exist to support an optimal shift length for the NNP, the safety of extended provider work hours for both the patient and the provider has been questioned in light of concerns raised by healthcare organizations and regulatory bodies (e.g., American Nurses Association [ANA], 2014; Texas Nurse Practitioners, n.d.; New York State Education Department Office of the Professions, 2021). NNPs have workflow patterns analogous to those of medical residents or fellows, flight nurses, and air medical staff (LoSasso, 2011). These healthcare providers are involved in direct patient care but not necessarily during their entire shift. Therefore, it is acceptable to examine published data from both nursing practice and other healthcare disciplines to provide a foundation upon which to form recommendations for shift length for NNPs.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) began limiting shift length and duty hours of residents and fellows, with revisions in 2011 and 2017. The most recent ACGME program revision took effect in 2017 and was based on stronger evidence than the earlier versions. The revision incorporated new language: “clinical and educational work hours” in place of “duty hours.” The limitation of no more than 80 hours per week, averaged over four weeks, was unchanged but clinical hour limits for first-year residents increased from 16 to 24 hours (ACGME, 2011 & 2017). The National Academy of Medicine (NAM), formerly known as the Institute of Medicine (IOM), has published guidelines and recommendations regarding nurses’ roles in the protection of patient safety and improved patient outcomes (IOM, 2004). The Agency for Healthcare Research and Quality (AHRQ) contracted with the IOM to study key aspects of the work environment of nurses as it relates to patient safety. Some of the pertinent issues that have risen to the federal and state policy arenas are extended work hours, fatigue, and mandatory overtime (Page, 2008).

The nursing practice of the certified registered nurse anesthetist (CRNA) has some general similarities to that of the NNP. Professionals in the two groups share the 3 hospital work setting, the need for immediate response time when on call, and long shift lengths. The American Association of Nurse Anesthesiology (AANA) is responsible for protecting and facilitating CRNA professional practice and patient safety. Anesthesia care requires continuous services and at times involves high acuity and intensity of care, which are known contributors to provider fatigue. AANA recommends shift-length guidelines based on variable settings, caseloads, and patient acuity (AANA, 2015). Included in a 2015 AANA document on the topic are considerations regarding minimum required sleep (7–9 hours), effect of circadian rhythm, scheduling in compliance with state and federal statutes and regulations, and the importance of monitoring safety recommendations from relevant organizations such as AANA, AHRQ, Institute for Healthcare Improvement, and NAM.

In the American College of Obstetricians and Gynecologists (ACOG) Committee Opinion “Fatigue and Patient Safety” (2018), a minimum of 5 hours of sleep per night was recommended to help physicians communicate effectively (e.g., during handoffs, to patients). Additional recommendations included training faculty and providers to recognize signs of fatigue and sleep deprivation and the importance of balancing continuity of care and the need for rest.

Another professional organization that has addressed the issues of fatigue and shift length is the American Nurses Association (ANA). In its 2014 position statement on the topic, ANA recommends that registered nurses in all care settings perform no more than 40 hours of professional nursing work (paid or unpaid) in a 7-day period. In addition, employers should limit shifts (including mandatory training and meetings) to a maximum of 12 hours in a 24-hour period, including both on-call hours worked and actual work hours. The ANA document was written for registered nurses and employers but states that it is relevant to other healthcare providers who collaborate to create and sustain a healthy interprofessional work environment. The American Academy of Nursing on Policy described health and safety risks related to shift work, long hours, and worker fatigue in a 2017 position statement.

NANNP conducted neonatal nurse practitioner workforce surveys in 2011, 2014, 2016, and 2020. The most recent data (2020) revealed that most NNPs still work either 24- hour shifts (41%) or 12-hour shifts with day-night rotation (37%), but these numbers decreased from the 2014 data: when 50% of NNPs worked 24-hour shifts and 46% worked 12-hours shifts with day-night rotation. Although the 2020 survey data reflected that NNPs prefer the 24-hour shift, 77% of those responding do not have protected downtime during those 24 hours. The average age of the NNP workforce is unchanged from 2014 data, with more than 50% older than 50 years of age.

The most recent NNP workforce survey also revealed that 63% of respondents worked more than their scheduled hours (up from 33% in the 2014 survey) and that most NNPs have other duties in addition to those related to patient load during their night shifts. These other duties include delivery-room coverage (77%), ER emergencies (47%), Level I consultations (37%), maternal health consultations (36%), and transports (26%). Few NNPs who work night shifts get guaranteed downtime. For those who do, the 4 downtime averaged 3 hours per shift in 2014 (Kaminski et al., 2015). Less downtime was reported in Level IV neonatal intensive care units (NICUs). Forty-seven percent of NNPs report that their practice does not have enough staff. Ninety percent of NNPs spend more than 75% of their clinical practice time in the NICU, and the average work week is 37 hours (this number is higher in Level IV practices) (Snapp et al., 2021).

 The NNP role is a mainstay staffing option for many NICUs. Shift lengths for NNPs vary and are uniquely related to the dynamics of each NICU. Actual time spent providing patient care during prolonged shifts may vary, as do anticipated periods of rest (Snapp & Reyna, 2019). In addition, NNPs may be directed to work beyond their scheduled shift lengths to meet unexpected patient care needs or to satisfy organizational or practice expectations. There is limited data examining mandatory overtime, but it is clear that mandatory overtime presents a higher risk for work-related injury (e.g., needlesticks), illness, and missed shifts (Caruso, 2014). Only 18 of 50 states have legislation against mandatory overtime for registered nurses (WorkforceHub, 2018).

In December 2011, The Joint Commission (TJC) published a Sentinel Event Alert on the connection between healthcare workers’ fatigue and patient safety. It acknowledged research linking extended-duration shifts, fatigue, and impaired performance and safety. TJC suggested evidence-based actions to help mitigate the risks of fatigue resulting from extended work hours (2011), including:

● assessing the organization for fatigue-related risks, especially during patient handoff

● inviting staff input into designing work schedules to minimize potential for fatigue

● implementing a fatigue management plan that includes scientific strategies for fighting fatigue.

● educating staff about sleep hygiene and the effects of fatigue on patient safety

● providing opportunities for staff members to express concern about fatigue and taking actions to   

     address those concerns

● encouraging teamwork as a strategy to support staff who work extended shifts or hours and to

     protect patients from potential harm

● considering fatigue as a potential contributing factor when reviewing adverse events

● assessing the environment provided for sleep breaks to ensure it fully protects sleep.

In 2018, TJC issued an addendum to the 2011 document that adds a new resource, Fatigue and Patient Safety from American College of Obstetricians and Gynecologists (ACOG), and the 2017 ACGME updated program requirements. Some of the updated TJC suggestion actions were assessment of off-shift hours, handoffs, and staffing (2018).

The IOM (now NAM) has published papers on patient and personal safety as they relate to resident duty hours. In Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, the IOM cites prolonged wakefulness, shifts longer than 16 consecutive hours, the variability of shifts, and the volume and acuity of patient load as factors that increase 5 the risk of harm to patients (IOM, 2009). Additionally, prolonged work hours may result in harm to the provider and others. The risks of being involved in a motor vehicle accident after working more than 24 hours were explored by Johnson (2011). Residents who worked more than 24 hours had a 16% higher risk of having a motor vehicle accident post-call.

It is known that sleep deprivation slows reaction time and decreases the ability to concentrate, retain, and learn (Caruso, 2014). Another example is found in a New Jersey law that imposes penalties for reckless driving if the driver is experiencing sleep deprivation (LoSasso, 2011). The Centers for Disease Control and Prevention (CDC) reports that shift work is a cause of drowsy driving and that “being awake for at least 18 hours is the same as someone having a blood alcohol content (BAC) of 0.05%. Being awake for at least 24 hours is equal to having a BAC of 0.10%. This is higher than the legal limit (0.08% BAC) in all states” (CDC National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 2017).

 Nursing research suggests that shift length affects vigilance and safety. Scott, Rogers, Hwang, & Zhang (2006) and Rogers, Hwang, Scott, Aiken, and Dinges (2004) conducted descriptive self-report studies and found statistically significant increases in errors and near errors when staff nurses worked shifts of 12.5 hours or longer. Caruso (2014) found that risks are 15% higher for evening shifts and 28% higher for night shifts when compared to day shifts. When compared with 8-hour shifts, 10-hour shifts increased the risk by 13% and 12-hour shifts increased the risk by 28%. Risk increased by 17% for the third consecutive night shift and 26% for the fourth. In 2011, Trinkoff et al. found a significant relationship between nurse work schedules and patient mortality. Scott et al. (2007) found a relationship between nurses’ work schedules, sleep duration, and drowsy driving that raised concerns for the safety of the nurses and the public.

Insufficient sleep is the critical link between work and fatigue (Akerstedt et al., 2004). Sleep deprivation, resultant fatigue, and interruptions in circadian rhythm are commonly experienced by nurses performing shift work (Peate, 2007); NNPs commonly do shift work (LoSasso, 2011). Variable working shift patterns have been suggested to affect performance, learning, and memory function (Peate, 2007). Fatigue can be predicted by several additional factors, including high work demands, female sex, the supervisor role, and advanced age (Akerstedt et al., 2004).

Circadian rhythm disruptions, fatigue, and sleep deprivation may affect the NNP’s clinical performance during night and extended shifts, with specific impact on levels of alertness (Lee et al., 2003). Additional fatigue factors include time awake, health factors (i.e., sleep disorders, medications), environmental issues (i.e., light, noise), and workload (Lerman et al., 2012). The potential consequences of altered alertness may include delayed identification or lack of identification of critical markers of clinical deterioration. Effects of fatigue on patient safety include delayed reaction time, delayed processing of information, diminished memory, failure to respond at the appropriate time, impaired efficiency, and inappropriate responses (Dingley, 1996; Caruso, 2014). These alterations in functioning have been summarized as “increased errors of 6 omission and commission” (Lim & Dinges, 2008). Patient safety is threatened when nurses work long and unpredictable hours, especially when the duration of prior awake time increases beyond 17 hours (Berger & Hobbs, 2006). Errors are increased with long shifts; in one study, the number of errors was three times higher with more than 12.5 consecutive hours of nursing practice, and the majority of errors were medication errors (Phillips & Moffett, 2013).

The relevance of these findings should be considered in relation to work hours and executive functioning necessary for the role and responsibilities of NNPs. Reduction in the occurrence of adverse events among patients requires NNPs to recognize important information from a variety of sources, to integrate complex processes and signs into a sensible thought and decision-making process, and to formulate an accurate, appropriate set of actions or reactions. Extended work shifts for nurses in critical-care settings have been associated with decreased levels of alertness and vigilance (Scott, et al., 2006).

In addition to compromising patient safety, sleep deprivation jeopardizes the well-being of providers who work extended hours. Extended workdays can have significant effects on homeostatic balance and circadian rhythm (Johnson, 2011). An increased prevalence of physical and psychiatric disorders—including but not limited to cardiovascular and gastrointestinal disturbances, diminished immunological response, infertility, spontaneous abortions, the birth of premature and low-birth-weight infants, sleep apnea, obesity, miscarriage, mood disorders, and depression—have been reported (Caruso, 2014; National Sleep Foundation, 2008; Peate, 2007). Cognitive difficulties have been cited, as well as long-term consequences of fatigue for nurses (Phillips & Moffett, 2013). Increasing age compounds the physiological and cognitive effects of fatigue (Dean, Scott, & Rogers, 2006). Older individuals are also more likely to experience sleep problems (33% of women aged 18-24 vs. 48% of women aged 55-64; Caruso, 2014).

Research specific to the NNP role in relation to fatigue and shift length is needed. However, a foundation for the following recommendations is provided by current knowledge of the science of sleep deprivation and fatigue, research from nursing and medicine, and outcome data related to shift length and patient safety. It is important to note the discrepancy in the literature regarding the definition of extended hours. The most common definitions of extended hours are shifts longer than 12, 16, or 24 hours.

Recommendations; Existing literature supports the concern that healthcare provider fatigue has a negative impact on both healthcare recipients and providers. NNPs are affected by fatigue the same way other healthcare providers are affected. Therefore, while acknowledging the lack of data clarifying the impact of fatigue on NNPs specifically and recognizing that these professionals are subject to some degree of fatigue-related sequelae, NANNP 7 provides the following recommendations in the areas of education, fatigue management, and system management.


1. NNP program education should include the recognition and management of fatigue regardless of shift length (AANA, 2015). Study areas should include sleep physiology and sleep inertia (grogginess upon awakening), personal and professional performance limitations, and identification of fatigue and fatigue mitigating strategies.

2. NNP employer education should be aimed at recognition of the relationship between extended working hours and fatigue and burnout. The unique critical care working environment, workload, and scheduling of NNPs should be included in this discussion. Education of the entire healthcare team, hospital administration, and private employers is essential to fatigue management. Workload has been identified by NNPs as a key factor in fatigue on the job (Welch-Carre, 2018; Dye, 2017).

3. NNP self and continuing education should address the individual’s responsibility to be adequately rested and fit to deliver optimal patient care. Most employment contracts state that the NNP’s responsibility is to come to work “rested and ready for work.”

 Fatigue Management

4. Fatigue-related risks should be alleviated by research-based strategies. One important aspect of fatigue management is observance of good sleep habits and routines. Sleep-hygiene measures should include monitoring sleep hours on both working and nonworking days and nights (Dean et al., 2006). To avoid chronic sleep deprivation, healthy adults should obtain approximately 8 hours of sleep per day (Dean et al., 2006).

5. Disruption of the circadian rhythm should be reduced by providing the NNP with an opportunity or designated time to sleep in the afternoon before working overnight (Landrigan et al., 2004). Working long, irregular hours, particularly at night, can disrupt the circadian rhythm even when an individual is adequately rested (Rogers, 2019). Additional fatigue mitigation strategies include minimizing shift rotations and optimizing rest time between scheduled shifts.

6. NNPs who are older than 40 years of age should be aware that they are at increased risk of experiencing fatigue and related physiological and cognitive effects that may affect performance (Reid & Dawson, 2001). Because the average NNP age is reported as 51 years old (Snapp et al., 2021), this increased risk is highly relevant to NNPs. For NNPs older than 50, night-shift hours should be optional (NANN, 2018). NNPs who have worked extended shifts for more than 20 years have an increased risk of health problems and illness (Clendon & 8 Walker, 2013) and should have the opportunity to work 8-12-hour shifts at their current position and institution.

7. Opportunities for rest should be incorporated as required by the work environment. Tools for tracking and reporting rest should be utilized. Fatigue can occur anytime in a 24-hour period. Napping is an effective non-pharmacological technique for sustaining alertness (Caldwell, Caldwell, & Schmidt, 2008). Strategic naps of 10–60 minutes have been shown to decrease fatigue and sustain performance (Arora et al., 2006; Rosekind et al., 1995). To maximize the benefit of naps, it is important to provide protected, uninterrupted time so that naps are of adequate length (Caldwell, 2001). The environment must be quiet, secluded (away from the work area), and dimly lit (Phillips & Moffett, 2013). Any on-call communication device should be handed off with sign-out to a colleague during this protected rest time. Personal phones should be put in Do Not Disturb mode.

8. Individuals should be cautious about consuming caffeine, especially 4–7 hours prior to planned sleep time (AANA, 2015). The use of stimulants, most commonly caffeine, is a fatigue management strategy often used by clinicians to temporarily improve alertness. Its effectiveness as a stimulant to temporarily improve alertness varies according to individual tolerance (Dean et al., 2006). Increased consumption of caffeine can interrupt restorative sleep. Various pharmacologic stimulants are available, but information regarding long-term side effects, tolerance, and potential for abuse is very limited (Caldwell, 2001). Behavioral and system counter-fatigue strategies are preferred over drug-based measures.  

9. Education is essential and should cover the dangers of fatigue, the causes of drowsiness on the job, and the importance of sleep and proper sleep hygiene. NNPs should assume personal responsibility to avoid excessive fatigue and use fatigue-mitigating strategies whenever possible. NNPs have a responsibility to recognize and address their fatigue before it becomes a safety concern (Salmon, 2013). Moonlighting (i.e., working a second job) and overtime hours are the responsibility of the employer and employee and need to be tracked and reported. Primary and secondary employers should be informed of any moonlighting hours by the employee.

10. Nutrition and adequate meal breaks are needed, along with respite time, to reduce fatigue (AANA, 2015).

11. Sleep applications for smartphones should be considered to facilitate better sleep practices. Applications can assist with difficulty falling asleep or staying asleep, relaxation, and best awakening time based on sleep-wake cycles (Phillips & Moffett, 2013). However, electronic sleep-tracking tools rely on Internet data tracking, so security risks must be kept in mind. Screen time on electronic devices during rest times is discouraged and use prior to sleep likely decreases ability to fall asleep, further contributing to fatigue (AANA, 2015). 9

System Management

12. Systems or processes should be designed to prevent errors associated with fatigue in the clinical setting. Collaborative efforts should be made among NNPs, their employers (including hospital risk management departments), and institutions to enhance health, safety, and productivity through the development of a fatigue risk management system with periodic review (Lerman et al., 2012). Individual practices and settings should have a written, practice-specific guideline that includes maximum hours worked per week, maximum hours worked per month, maximum number of consecutive shifts, and guidelines and monitoring of moonlighting hours (Blum et al., 2011).

13. Scheduling is vitally important. Optimal scheduling patterns may vary depending on the setting; however, the following recommendations are offered with the goal of providing safe, effective patient care and protecting the wellbeing of NNPs: a. Maximum shift lengths should be 24 hours, in-house, regardless of work setting and patient acuity. b. A relief-call system should be developed to provide coverage for NNPs who feel impaired by fatigue. c. A period of protected sleep time following 16 consecutive hours of working should be provided. d. A work assignment that compromises the availability of sufficient time for sleep and recovery from work should be negotiated or rejected (ANA, 2014). NNPs must be vigilant in pacing their own schedules to avoid fatigue by overscheduling with overtime and moonlighting hours. NNPs must be aware of the consequences of overwork (work hours and patterns) and fatigue-related errors (AANA, 2015). Avoidance of day and night shift swings is important in scheduling of 8–16 hour shifts to avoid drastic changes to sleep patterns. If alternating day/night rotations, consider 1 month on days, then 1 month on nights.

14. Team-based care models (Van Eaton et al., 2005) should be used to manage fatigue. Key aspects of this model include timely and accurate communication of information among team members, appropriate workload distribution, and use of information and documentation systems. Rather than having a single NNP responsible for patient care, team-based models make patient care a shared responsibility. Checks of medications, doses, and procedures should be requested as necessary (ENA, 2013).

15. An inherent value of team-based care is greater conciseness and accuracy in communicating information from one clinician to another, thus ensuring safer hand-offs at the end of shifts. McAllister (2006) proposed that continuity of care is a “process that optimizes our use of people, information, and management strategies.”

16. Employers and institutions should prioritize the education of NNPs and all other caregivers to ensure their understanding of the responsibility to be adequately rested and fit to deliver optimal patient care; the effects of fatigue and sleep deprivation; and strategies to mitigate fatigue and maintain alertness. Employers should conduct regular audits to ensure that scheduling policies are maintained and that meal and rest breaks are taken during work shifts (ANA, 2014). They must promote a work culture that allows the employee to express concern of fatigue (TJC, 2018).

17. Employers should provide fair and sufficient compensation and appropriate staffing to foster a safe and healthful environment (Phillips & Moffett, 2013). Employers are responsible for using scheduling practices that align with research and evidence-based recommendations. Every nurse should be able to decline extra working hours or overtime without being penalized (ANA, 2014). Mandatory overtime or on-call time as a staffing strategy should be eliminated (ANA, 2014).

18. Extended commutes after long shifts should be discouraged or the NNP should be provided with an opportunity to rest prior to leaving the institution (ANA, 2012). Transportation should be offered to fatigued employees who have completed an extended work shift. Blum et al., (2011). recommend transportation after 24-hour shifts, but we suggest it after 16-hours or longer.

19. Employers must provide safe staffing patterns and patient loads consistently for safe patient care and to provide healthy work environments (Snapp et al., 2021; ANA, 2014).

 20. Recruitment and retention of NNPs is dependent on the promotion of healthy work-life balance and on safe staffing patterns and workload. Providing an environment that attracts and retains the NNP workforce is a responsibility of employers and reduces fatigue that is caused by overwork, frequent new hire orientations, and burnout by seasoned NNPs (NANN, 2018).

21. Provider-to-provider handoff is a critical time for error after a long shift. Employers should have standardized electronic health records (EMR) with integrated patient information for the handoff process (Blum et al., 2011).

22. “Home call” should be incorporated into the overall hours worked at each institution and established guidelines for maximum hours worked with a work relief system built in (Blum et al., 2011).

 Future Recommendations

 Future study and research areas identified in this position statement are directly related to NANNP’s mission to provide recommendations for patient safety and promote NNP health and wellness. There is a lack of evidence in the literature to answer critical questions about shift length for NNPs (i.e., 12- versus 24-hour schedules) and fatigue, burnout, and job satisfaction were identified as critical areas of question that were 11 lacking in evidence in the literature. Because the NICU is evolving with increased patient complexity, workload, and NNP responsibilities, research must be conducted to determine whether all healthcare organizations should consider limiting shift length to 12 hours in Level IV units or all practice level nurseries and NICUs by 2030. There is limited evidence regarding patient safety and overall NNP health, so it is recommended that future research grants or areas of study address these questions.


Workplace fatigue remains a critical issue in healthcare and patient safety. NNPs are professionally accountable for ensuring that they are fit to provide patient care, and they should be proactive in minimizing risks to patient and personal safety. NNPs are encouraged to collaborate with colleagues and employers to create responsible staffing patterns and work models that reduce the risk of threats to patient and personal safety caused by fatigue. Employers have a responsibility to limit NNP workloads and schedules to reasonable levels

Source:Impact_of_Advanced_Practice _Shift Length_and_Fatigue_2022.pdf (

The Future Looks Bleak for Surgical Residents Like Me

Looming Medicare cuts will force surgeons to do more with less, undermining trainee succes

by Erfan Faridmoayer, MD September 28, 2022

“But you’re walking away from your dream!”

“Think about all of the years of hard work you have invested.”

“What will you do instead?”

These are common reactions people have when they hear about a surgeon walking away from medicine. It’s hard to imagine a surgeon would ever do such a thing. But the past few years may have changed that commitment to medicine for many.

My peers and I have invested nearly a decade to become surgeons. We’ve spent years in the classroom and hospital rotations, taking various standardized tests, and interviewing for competitive training positions around the country for the privilege of standing in the operating room — a humbling opportunity to serve patients from all walks of life. This is why it’s so disheartening to witness healthcare workers across the country, including residents, walk away from medicine. They are just too frustrated by the challenges of a healthcare system that is crippling surgeons and other doctors from providing effective care.

Now, a looming 8.5% cut in Medicare payments to surgical care threatens to make matters worse.

My Experience in Surgical Training

I went into medicine because I wanted to have a positive impact on people’s lives, and I chose to pursue a career in surgery because I loved the immediacy of improving patients’ health in critical situations.

These are common reactions people have when they hear about a surgeon walking away from medicine. It’s hard to imagine a surgeon would ever do such a thing. But the past few years may have changed that commitment to medicine for many.

My peers and I have invested nearly a decade to become surgeons. We’ve spent years in the classroom and hospital rotations, taking various standardized tests, and interviewing for competitive training positions around the country for the privilege of standing in the operating room — a humbling opportunity to serve patients from all walks of life. This is why it’s so disheartening to witness healthcare workers across the country, including residents, walk away from medicine. They are just too frustrated by the challenges of a healthcare system that is crippling surgeons and other doctors from providing effective care.

Now, a looming 8.5% cut in Medicare payments to surgical care threatens to make matters worse.

My Experience in Surgical Training

I went into medicine because I wanted to have a positive impact on people’s lives, and I chose to pursue a career in surgery because I loved the immediacy of improving patients’ health in critical situations.

I distinctly remember the first time I witnessed a patient wake up from a kidney transplant. The patient, a mother in her sixties, had been on dialysis for years. When I told her that her kidneys were functioning again — that she would no longer need to travel every other day to the hospital for dialysis — her expression was priceless. “I have my life back,” she said, with gratitude for the chance of an improved quality of life. That encounter, and many more, inspired me to become a surgeon.

Medicine is by no means a conventional field. While many of my college classmates are now 5 or 6 years into their careers, my decade-long training after school has just begun. Stepping foot into the hospital as newly minted physicians in 2020 was a rocky start. My co-residents and I began our program just months into the pandemic when elective surgical practice was nearly halted. The vast majority of admissions to the hospital were from complications of COVID-19, impacting our ability to gain the broad knowledge classically acquired in the junior years of surgical training.

On top of this, we’ve continuously faced staffing and equipment and drug shortages, along with pressures from the staggering rise in medical inflation.

The Impact of Looming Medicare Cuts

The challenges that impact patients and their care just keep coming. The latest? The impending sky-high Medicare cuts for the surgical field.

While I’m pleased to see that Congress recently passed legislation aimed at lowering the cost of prescription drugs for seniors, there is much more that needs to be done. It’s alarming to hear that CMS is planning to make significant cuts to Medicare payments for surgical care starting January 1, 2023.

These misguided cuts will force surgeons to do more with less, promising a bleaker future for myself and my peers.

With fewer resources, more senior surgeons will have less time to spend with residents like me. I’ve had amazing role models during my training so far. But these cuts threaten future surgeons’ access to the sound mentorship and necessary resources needed to adequately build the next generation of healthcare providers.

On top of this, these cuts will exacerbate the burnout that surgeons across the country already face, leading more surgeons to close their practices and walk away from medicine toward an early retirement. Put simply, there will be fewer surgeons to care for patients. We will be left with a vicious spiral that jeopardizes the stability of our healthcare system.

I am particularly concerned about the consequences of physician shortages on patients living in underserved areas, where there is already a scarcity of surgeons, anesthesiologists, and operating room staff. I can speak to that by the virtue of my training at the highest volume safety-net hospitals in Brooklyn. Additional cuts to the bedrock — Medicare — on which such systems rely will lead to delays in care, worsening patient outcomes, and eventually, increasing the cost of care with patients walking through our doors with more advanced disease down the road.

Year-after-year proposed cuts by CMS underscore the need for long-term reform to the broader Medicare payment system.

Without congressional action, the cuts to surgical budgets, staffing, and services will hit seniors in my area and many other regions harshly. Now, more than ever, we must support the type of thoughtful, responsible healthcare policies that ensure capable, wide-ranging surgical options for patients and their families across New York and the rest of the country.

Erfan Faridmoayer, MD, is a surgical resident at Downstate Health Sciences University in Brooklyn, New York. He is in his third year of a seven-year program.



Practice of Cuff Blood Pressure Measurements

Cistone, Nicole MSN, RN, RNC-NIC; Erlenwein, Danielle MSN, RN; Bapat, Roopali MD, FAAP; Ryshen, Greg MS, MBA, CSSGB, QIS; Thomas, Leslie MSN, APRN, NNP-BC; Haghnazari, Maria S. MSN, RN; Thomas, Roberta MPT, PT; Foor, Nicholas BS; Fathi, Omid MD Advances in Neonatal Care: August 2022 – Volume 22 – Issue 4 – p 291-299 doi: 10.1097/ANC.0000000000000947



Extreme preterm infants face lengthy hospitalizations and are often subjected to painful stimuli. These stimuli may be related to routine caregiving that may negatively impact long-term developmental outcomes. Frequently obtained cuff blood pressure (BP) measurements are an example of a potentially noxious stimulus to preterm infants that may have a cumulating impact on development.


The primary aim was to explore the frequency of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the neonatal intensive care unit (NICU). Our secondary aim was to reduce the number of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the NICU.


Quality improvement methodologies per the Institute for Healthcare Improvement were used combined with a multidisciplinary approach. Participants were infants born less than 27 weeks of gestation and discharged home. The baseline period was 2015 through Q2-2018 and the intervention period was Q3-2018 through Q1-2020. The electronic medical record was used to collect data and Minitab Statistical Software was used for data analysis.


A baseline of 5.0% of eligible patients received the desired number of cuff BP measurements and increased to 63.2% after the intervention period.

Implications for Practice: 

Findings demonstrate that using quality improvement methodology can improve clinical care. Findings suggest the feasibility and safety of reducing the number of cuff BP measurements obtained on hemodynamically stable infants in the NICU.

Implications for Research: 

Future endeavors should aim to reduce the quantity of painful stimuli in the NICU. Long-term developmental outcomes should be correlated in these patients.

Association of Neonatal Pain-Related Stress and Parent Interaction With Internalizing Behaviors Across 1.5, 3.0, 4.5, and 8.0 Years in Children Born Very Preterm

October 21, 2022

Mia A. McLean, PhD1,2Olivia C. Scoten, Bsc, Hons1Cecil M. Y. Chau, Msc1,2; et alAnne Synnes, MDCM, MHSc1,2,3Steven P. Miller, MDCM, MAS4,5Ruth E. Grunau, PhD1,2,3 JAMA Netw Open. 2022;5(10):e2238088. doi:10.1001/jamanetworkopen.2022.38088

Key Points:

Question  Does supportive parenting ameliorate the association between neonatal pain-related stress and child internalizing behaviors in children born very preterm?

Findings  In this cohort study of 186 children born very preterm, internalizing behaviors increased across ages 1.5, 3.0, 4.5, and 8.0 years, and more neonatal pain-related stress was associated with greater internalizing behaviors across ages. At 1.5 years, parenting stress was associated with more internalizing behaviors, whereas at age 3.0 years, a more supportive parenting environment was associated with fewer internalizing behaviors across development.

Meaning  These findings suggest that supportive parenting is associated with reduced child anxiety and depressive behaviors from toddlerhood through school-age in children born very preterm.


Importance  Internalizing (anxiety and/or depressive) behaviors are prevalent in children born very preterm (24-32 weeks’ gestation). Procedural pain-related stress in the neonatal intensive care unit (NICU) is associated with long-term internalizing problems in this population; however, whether positive parenting during toddlerhood attenuates development of internalizing behaviors across childhood is unknown.

Objective  To investigate whether neonatal pain-related stress is associated with trajectories of internalizing behaviors across 1.5, 3.0, 4.5, and 8.0 years, and whether supportive parenting behaviors and lower parenting stress at 1.5 and 3.0 years attenuate this association.

Design, Setting, and Participants  In this prospective longitudinal cohort study, preterm neonates (born at 24-32 weeks’ gestation) were recruited from August 16, 2006, to September 9, 2013, with follow-up visits at ages 1.5, 3.0, 4.5, and 8.0 years. The study was conducted at BC Women’s Hospital, Vancouver, Canada, with recruitment from a level III neonatal intensive care unit and sequential developmental assessments performed in a Neonatal Follow-up Program. Data analysis was performed from August to December 2021.

Main Outcomes and Measures  Parental report of child internalizing behaviors on the Child Behavior Checklist at 1.5, 3.0, 4.5, and 8.0 years.

Results  A total of 234 neonates were recruited, and 186 children (101 boys [54%]) were included in the current study across ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years. After accounting for clinical factors associated with prematurity, greater neonatal pain-related stress was associated with more internalizing behaviors across ages (B = 4.95; 95% CI, 0.76 to 9.14). Higher parenting stress at age 1.5 years (B = 0.17; 95% CI, 0.11 to 0.23) and a less supportive parent environment (less sensitivity, structure, nonintrusiveness, nonhostility, and higher parenting stress; B = −5.47; 95% CI, −9.44 to −1.51) at 3.0 years were associated with greater internalizing problems across development to age 8.0 years.

Conclusions and Relevance  In this cohort study of children born very preterm, exposure to repetitive neonatal pain-related stress was associated with persistent internalizing behavior problems across toddlerhood to age 8.0 years. Supportive parenting behaviors during early childhood were associated with better long-term behavioral outcomes, whereas elevated parenting stress was associated with more child anxiety and/or depressive behaviors in this population. These findings reinforce the need to prevent pain in preterm neonates and inform future development of targeted parent-led behavioral interventions.


Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years

List of authors: Jacqueline F. Gould, Ph.D., Maria Makrides, Ph.D., Robert A. Gibson, Ph.D., Thomas R. Sullivan, Ph.D., Andrew J. McPhee, M.B., B.S., Peter J. Anderson, Ph.D., Karen P. Best, Ph.D., Mary Sharp, M.B., B.S., Jeanie L.Y. Cheong, M.D., Gillian F. Opie, M.B., B.S., Javeed Travadi, D.M., Jana M. Bednarz, G.Dip



Docosahexaenoic acid (DHA) is a component of neural tissue. Because its accretion into the brain is greatest during the final trimester of pregnancy, infants born before 29 weeks’ gestation do not receive the normal supply of DHA. The effect of this deficiency on subsequent cognitive development is not well understood.


We assessed general intelligence at 5 years in children who had been enrolled in a trial of neonatal DHA supplementation to prevent bronchopulmonary dysplasia. In the previous trial, infants born before 29 weeks’ gestation had been randomly assigned in a 1:1 ratio to receive an enteral emulsion that provided 60 mg of DHA per kilogram of body weight per day or a control emulsion from the first 3 days of enteral feeds until 36 weeks of postmenstrual age or discharge home, whichever occurred first. Children from 5 of the 13 centers in the original trial were invited to undergo assessment with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 5 years of corrected age. The primary outcome was the full-scale intelligence quotient (FSIQ) score. Secondary outcomes included the components of WPPSI.


A total of 1273 infants underwent randomization in the original trial; of the 656 surviving children who had undergone randomization at the centers included in this follow-up study, 480 (73%) had an FSIQ score available — 241 in the DHA group and 239 in the control group. After imputation of missing data, the mean (±SD) FSIQ scores were 95.4±17.3 in the DHA group and 91.9±19.1 in the control group (adjusted difference, 3.45; 95% confidence interval, 0.38 to 6.53; P=0.03). The results for secondary outcomes generally did not support that obtained for the primary outcome. Adverse events were similar in the two groups.


In infants born before 29 weeks’ gestation who had been enrolled in a trial to assess the effect of DHA supplementation on bronchopulmonary dysplasia, the use of an enteral DHA emulsion until 36 weeks of postmenstrual age was associated with modestly higher FSIQ scores at 5 years of age than control feeding.

Source:Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years | NEJM

Animated 🐾Where Does Kitty Go in the Rain?

133,247 views – Apr 7, 2022  #readaloud #storytime #kidsbooksonline

Toadstools and Fairy Dust

🍄We all want to know, where do the animals go…during the rain? 🌧️Do they even like the rain? Come find out and learn a few science facts along the way by joining us for a kid’s book read aloud, “Where does Kitty go in the rain” created by Vooks. Watch even more stories like this on the Vooks app today!

9 reasons why you shouldn’t let a rainy day derail your walk (or run)

No rain, no gain!

Shona Hendley  – MAY 25, 2022 9:30AM

Thanks to La Nina we’ve all be dealing with the effects of wet weather more than we’d like; umbrellas, sodden shoes, and probably cancelling more than a few of your regular ‘mental health walks’ or runs. Shona Hendley explains why the latter should never come at the expense of a bit of harmless precipitation.

For decades, musicians like Gene Kelly, the Ronettes and even Rihanna have been merrily singing and dancing in the rain; while over the past couple of months many Sydneysiders have probably inadvertently and maybe not so happily found themselves walking in it.

No, perhaps not ideal for the unprepared but for those who are equipped with an umbrella or raincoat, there are actually some pretty impressive benefits of walking or running in the rain which may have even the most reluctant soon singing along too.

Dr Vivienne Lewis, a clinical psychologist at the University of Canberra says walking in the rain is actually great for our mental health for “a range of reasons.”

1. It’s a sensory experience

“Human beings need touch. It is an essential need and rain can provide this,” she tells Body+Soul.

“When we walk (or run) in the rain it provides a sensory experience completely different to non-rain. We can feel it on our face and body and this sensory experience can feel lovely on our skin and fresh on our face.”

2. It is freeing and endorphin releasing!

“Have you ever run in the rain and just felt so free? It gets our adrenalin pumping, and this releases stress,” Lewis says.

She also says that when we walk endorphins, the feel-good chemicals are released, and this also makes us feel good.

“In the rain, the release of endorphins can be enhanced especially if we are raising our heart rate to get out of the rain!”

3. It gives us time to think

“A walk in the rain can give us time to think. To be alone with our thoughts. To feel connected to nature. It can clear our head,” explains Lewis.

4. The sound and smell are calming

Because rain is a type of white noise, it can be soothing, meaning you can get your steps up, while taking in natures calming soundtrack at the same time.

Sydneysider and regular rain walker, Leanne Lusher agrees and identifies this as one of her favourite things about walking in the rain.

“I find walking in the rain so refreshing! I love the sounds and smell it creates,” she says.

The distinctive smell that soothes your mind and body even has its own name– Petrichor which was coined in the 1960s by two Australian scientists.

5. There are less people

Lusher says another great benefit to walking in the rain, especially for those who don’t like crowds is that there are usually less people which can make it a more relaxing experience.

“I like that hardly anyone else is out walking as they are hiding from the rain,” she explains.

6. It metaphorically washes the day away

Rain can also be a metaphor for washing the day away or washing our troubles away says Lewis.

“Think of the rain running down your body as a way to release negative emotions. A bit like we might do in the shower after a hard day. It’s that sense of just letting go. Just enjoying what nature has provided. Letting go of all your cares. Allowing yourself to just be in the moment and get soaked.”

7. The air is cleaner

An MIT study published in the journal of Atmospheric Chemistry and Physics showed that the air is actually cleaner during and after heavy rainfall.

Dr Lewis adds that this freshness can make the “smell and touch of fresh water feel exhilarating.”

If the mental health benefits aren’t enough to sell the experience to you, there are also some pretty impressive physical health benefit that may just get it across the line.

8. It’s good for your skin and hair

A 2016 study found that the rain plays a pivotal role in skin health driving humidity which helps freshen and moisturise our skin and hair. Ah, yes please.

9. Walking or running in the cold can burn more fat

And if burning fat is your goal, walking or running in the rain maybe exactly what you need to do.

Japanese scientists have carried out research on the effects of rain on energy metabolism while running in cold weather which showed that “energy demand increases when running in cold conditions.”

In other words, you burn more calories walking or running in the wet and cold than in a dry and warm environment.

So, if you haven’t already, it’s time to invest in a good set of water-resistant shoes, quality raincoat and start walking around those muddy puddles.

Dr Vivienne Lewis is a clinical psychologist at the University of Canberra. She treats people with anxiety and depression.


Taking advantage of the gifts that nature provides within our environment creates opportunities for us to connect, reflect, and reset ourselves in the midst of our daily lives. 

What gifts in nature bring you a sense of joy in life and help you feel present in the world? 

For me, walking in the rain is invigorating, providing a sense of calm tranquility. I love the fresh scent of the earth, the positive ion exchange within the air and calming sounds of the pitter-pattering rain drops. The rain is representative of a new beginning, a simple reset during the day. It reminds me of the joy of being alive and present with the world around me. This Fall season in Seattle, I look forward to basking in the seasonal downpour and crunching leaves as nature transitions into its winter hibernation before the spring re-awakening. 

Wishing you all joyful wonders and rejuvenating adventures in nature’s bounty this Fall season! 

        Dec 30, 2017     Wandering_higher

Coastal towns, national parks, chill vibes, and sick waves! Stayed in Montanita and Ayampe. The people are awesome, the parties are fun, and it’s not overrun with tourists or too Americanized. First time in South America but will be back!

Law, Virtual Health, History


Rank: 162  –Rate: 6.6%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Greece, officially the Hellenic Republic, is a country in Southeast Europe. It is situated on the southern tip of the Balkans, and is located at the crossroads of EuropeAsia, and Africa. Greece shares land borders with Albania to the northwest, North Macedonia and Bulgaria to the north, and Turkey to the northeast. The Aegean Sea lies to the east of the mainland, the Ionian Sea to the west, and the Sea of Crete and the Mediterranean Sea to the south. Greece has the longest coastline on the Mediterranean Basin, featuring thousands of islands. The country consists of nine traditional geographic regions, and has a population of approximately 10.4 million. Athens is the nation’s capital and largest city, followed by Thessaloniki and Patras.

Greece has universal health care. The system is mixed, combining a national health service with social health insurance (SHI). 2000 World Health Organization report, its health care system ranked 14th in overall performance of 191 countries surveyed.  In a 2013 Save the Children report, Greece was ranked the 19th out of 176 countries for the state of mothers and newborn babies. In 2010, there were 138 hospitals with 31,000 beds, but in 2011, the Ministry of Health announced plans to decrease the number to 77 hospitals with 36,035 beds to reduce expenses and further enhance healthcare standards. However, as of 2014, there were 124 public hospitals, of which 106 were general hospitals and 18 specialised hospitals, with a total capacity of about 30,000 beds



Remembering Dr. Lorna Breen, an emergency room physician who died by suicide during COVID-19

Feb 28, 2022 

The following episode contains emotional content and a discussion about suicide. It’s intended for mature audiences. Viewer discretion is advised. If you or someone you know is in crisis, please call the National Suicide Prevention Hotline at 800-273-8255 or text ‘HELLO’ to 741741 to get 24/7 support. Corey Feist, co-founder of the Dr. Lorna Breen Heroes’ Foundation, remembers his late sister-in-law, Dr. Lorna Breen, who was a healthcare worker at the New York Presbyterian Hospital during the height of the pandemic. Dr. Lorna Breen died by suicide on April 26, 2020, and Corey shares her story in hopes to normalize conversations around mental health and prioritize the wellbeing of our healthcare workers. To learn more about how you can help support healthcare workers, please visit:


A training program for nurses in North-Eastern Greece

   Full length Article| Volume 66  | E22-E26| Sept 01, 2022


  • Tutoring NICU nurses to recognise basic mesothoracic structures by ultrasound
  • Training improved the ability to accurately identify more lung structures
  • Collaboration of nurses and interdisciplinary teams can benefit high-risk infants



To demonstrate methods and landmarks for mediastinum ultrasound as part of ultrasound examination of the lung for nurses. This will be the first step in their education to detect finally the tubes and lines malpositioning in order to distinguish emergency conditions of the lungs in neonates hospitalized in neonatal intensive care units.

Design and methods

Theoretical and practical interventions were developed to create a 3-month training program based on similar medical courses. The study was approved by the hospital’s ethics committee. The program was performed in the neonatal intensive care unit of a single academic institution. Participating nurse was supervised by a paediatric surgeon and trained in lung ultrasound (a safe method without radiation) by a paediatric radiologist.


During the practical period (2 months), the neonatal intensive care unit nurse examined 50 neonates (25 + 6–40 + 4 weeks gestational age; 21 males) separated into two subgroups of 25 neonates each for each training month. In the first month under supervision, the nurse was trained to recognise the aortic arch, the right pulmonary artery, the esophagus, the tracheal air, and the ‘sliding lung sign’ in the anterior, lateral, and posterolateral aspects of the thoracic cage. In the second month, the nurse recorded the ultrasound examinations. The identified structures were then assessed and graded by the supervising radiologist. The overall estimated success rate (5 landmarks × 25 neonates = 125) was 90.4%.


Although this is the first report of the design of a ‘hands-on,’ lung ultrasound training program for neonatal intensive care unit nurses, our findings demonstrate that it is a safe and useful program for all neonatal intensive care unit nurses because the overall success rate of the 3-month program was determined by accurate identification of basic anatomical structures (90.4%) by the nurse.

Practice implications

This study describes the first educational training program for NICU nurses designed to recognise basic structures in the neonatal mediastinum. If the program is effective, NICU nurses will be able to identify respiratory emergencies. NICU nurses can inform doctors about emergencies according to tubes and lines malpositioning in a timely manner to avoid negative consequences.


Expanding International Access to Children’s Mental Health Care

April 7, 2021

As families everywhere continue to cope with the extraordinary challenges of the coronavirus pandemic, the Child Mind Institute is proud to announce a new initiative to advance children’s mental health treatment.

Supported by a landmark grant from the Stavros Niarchos Foundation (SNF), we are launching an ambitious five-year project to bring our evidence-based clinical expertise to children’s mental health professionals across Greece. The initiative will develop a comprehensive care and referral system that will revolutionize Greek children’s access to the care, support and guidance they need to thrive.

In partnership with local providers, our work with SNF will build children’s mental health infrastructure in Greece through three main avenues:

•  Extensive training and clinical supervision of children’s mental health professionals

•  Development of a national referral center to give providers guidance on complex cases

•  Expansion of technological capacity for telehealth services and specialized online tools

“Every child deserves access to professional, compassionate and dignified health care — including for mental health — and this program represents a significant first step toward a new paradigm for children’s mental health in Greece,” said SNF Co-President Andreas Dracopoulos.

The new grant is part of SNF’s Health Initiative, which aims to ensure access to quality care for everyone in Greece by strengthening the country’s health system. SNF has been a steadfast supporter of the Child Mind Institute since its founding, partnering to address challenges to child mental health for over a decade.

“Building on our rich history and partnership, we have an unparalleled opportunity to transform children’s mental health care in Greece,” said Child Mind Institute Founding President and Medical Director Dr. Harold Koplewicz. “Bringing together the visionary leadership of the Stavros Niarchos Foundation and the proven experience of the Child Mind Institute, we can create an international model for mental health care that will change the trajectory for children and adolescents struggling with their mental health in Greece and beyond.”

For all the latest updates on the Child Mind Institute’s work supporting children and families dealing with mental health and learning challenges, sign up for our newsletters.


wrs x Andromache – If you were alone / Sta matia sou | official video

1,263,884 views     Jul 8, 2022     wrs

Maria Delivoria-Papadopoulos: the legendary pioneer in perinatology and mother of neonatology- Obituary

Pages 3631-3632 | Published online: 27 Sep 2020

Maria Delivoria-Papadopoulos was born in Athens, Greece. The hard times before, during and after World War 2, followed by the Greek civil war, severely affected her leftist family. However, hardships did not prevent her from receiving a scholarship and finishing with distinction her secondary education in the Greek-French School “Saint Josef;” from studying philosophy at the Greek section of the Sorbonne University; from occupying herself with literature, poetry, arts and theater, attending -despite her very limited resources- numerous theatrical performances; from receiving her medical degree from the National and Kapodistrian University of Athens, Medical School. Upon graduation Maria was trained in Pediatrics in “Aghia Sophia” Children’s University Hospital in Athens, where she gained great experience in using the iron lung in children with polio. Later, in Canada and the US, she will be the first clinician worldwide to apply mechanical respiratory support to another category of children: premature neonates.

A special feature of young Maria was her enthusiastic involvement with Girl Guiding, the principles of which, especially the offer to fellow human beings and society as a whole, Maria not only deeply embraced, but applied throughout her life. She quickly gained a high degree and educated a large number of children (me included) and adolescents, among them Princess Sophia, the later queen of Spain.

Her desire to participate to the latest developments in Pediatrics, urged her to move to the US. Nevertheless, the political history of her family was an insurmountable obstacle in getting a visa. Help will come from the highest possible level: the then Head of the body of Greek Girl Guides, Princess Sophia, signifying Maria’s incredible ability to unite opposite ends! Thus, with her husband, physician Christos Papadopoulos, Maria departs from Greece in 1959 to spend 61 years, the rest of her life, in the US, Canada and again the US, becoming a naturalized U.S. citizen in 1970, but always keeping with pride, deep in her heart, her beloved country of origin and her characteristic double Greek name. Extremely arduous, yet so productive years will follow, leading her soon to international recognition.

In the US and Canada, she completed residencies and fellowships in several state and University hospitals, training in Pediatrics, Neonatology, Obstetrics/Gynecology, Physiology and Embryology, thus, in all fields of Perinatal Medicine. She received a post-doctorate degree in Physiology from the University of Pennsylvania, where she spent the next 29 years as a faculty member. Further, she held numerous faculty and hospital appointments in the Philadelphia area. In 2006 she was awarded the Ralph W. Brenner Chair in Pediatrics at St. Christopher’s Foundation for Children.

Maria has given Grand Rounds several times per year at Universities and Medical Centers throughout the U.S, and functioned as Visiting Professor and keynote speaker in innumerous countries in South America, Europe and Asia for over 50 years. She has received a great number of prestigious awards, starting in 1961, e.g. “Teacher of the Year Award” for 1962, 1964, 1973, 1974, 1978, 1992, 1993, 1996, 2004, 2006, “NIH Special Research Fellowship Award 1966”, “NIH Young Investigator Award 1968”, “NIH Career Development Award 1968”, “American Academy of Pediatrics Lifetime Achievement Award”, “National Lifetime Achievement Award from Castle Connolly”, “Legends in Neonatology Award” (2007) together with Mildred Stahlman and Mary-Helen Avery. She was named “Top Doctor” by Philadelphia magazine (2012–2016). She had served several terms for the National Institutes of Health, as well as for many academic and hospital committees; she was a member of numerous scientific societies; had received honorary degrees from three universities (Nancy, Thessaloniki and Athens); was a reviewer for top scientific journals, including the New England Journal of Medicine. Her publications are over a thousand, mostly focusing on neonatal care, neonatal brain injury and neonatal physiology.

Maria’s clinical work was marked by two innovations. The implementation for the first-ever time of mechanical respiratory support to premature neonates in 1963, and a bit later of parenteral fluids to preterms, saving hundreds of thousands of lives. Her pioneering scientific work focused besides respiratory distress syndrome and physiology of pulmonary fluid, on oxygen-hemoglobin binding in adults and fetuses/newborns, cerebral blood flow, mechanisms of hypoxic/ischemic encephalopathy in the fetus and neonate, as well as the mechanisms of cerebral cells apoptosis.

Maria had generously mentored countless young doctors from countries all over the world, devoting them endless time, care and love. Despite her phantastic achievements, she remained a person of exemplary modesty, contemptuous for material goods, with huge charitable activity not only for children but also for any adult in need. She used to spend every summer a month in her favorite Greek island Ithaca, fishing, donating her “catch” to the poor and gratis examining each evening consecutively all children of the island.

This homage to Maria will close with spontaneous words by colleagues, when informed on her passing: “so impressed by her sweetness, smartness and profound culture, but also her firm capability to teach and to carry on research, she as a woman in times when the most was run by men!” (Gian Carlo Di Renzo), “a true trailblazer in our field, a kind, gentle care giver” (Helen Christou), “a unique, wonderful, exemplary, inspiring woman” (Umberto Simeoni), “Maria leaves a great legacy” (Neena Modi), “really impressed by her legacy” (Hugo Lagercrantz), “Maria is an example for all of us” (Vassilios Fanos), “we will strive to honour her” (Mark Hanson).

May she rest in peace!


Health-care workers reveal how pandemic affected their mental health, home lives

Apr 8, 2022    CBC News

Health-care workers say the emotional and physical toll of the COVID-19 pandemic has had an impact on them at work and at home.

Health-care workers reveal how pandemic affected their mental health, home lives – YouTube


New Guidance Encourages Moms to Nurse for Two Years

Michelle Winokur, DrPH    

According to the American Academy of Pediatrics new guidelines, mothers are now encouraged to nurse for two years – up from one year. A mother’s willingness or ability to initiate breastfeeding is dependent on many factors, including support from family, close friends, and the hospital or birth center where the child is born. However, many other barriers can potentially keep moms from exclusively nursing for even six months, long considered the benchmark before introducing “nutritious complementary foods.”

Barriers to Breastfeeding:In recognition of the challenge of a lengthened breastfeeding period, the AAP concurrently released a technical report (2) identifying hurdles and approaches to support nursing moms. Among the challenges moms face are:

Societal judgment: Upwards of 80% of women breastfeed initially, establishing the practice as a “cultural norm.” However, just one-third of infants are nursed beyond one year. (3) This sharp decline can lead to judgment and comments from well-intentioned yet misinformed relations – or strangers – who may not recognize the value of longer-term breastfeeding. Similarly, providers should support nursing beyond one year, though there is evidence that is not always the case.

Workplace barriers: The United States is one of only a handful of upper-income countries that does not guarantee paid maternity leave. Lack of income or loss of job protection forces some moms back to work sooner than they would like. Furthermore, few businesses provide on-site childcare, making it more convenient for moms to nurse during the workday. The country also lacks requirements for workplace breaks and the provision of a clean, private space to nurse or express milk.

Insurance coverage: In most cases, insurance will provide or reimburse for select breast pumps, but coverage varies by plan and is not guaranteed. Similarly, only some insurers cover lactation support. While most hospitals and birth centers provide an initial consultation, many moms require additional guidance and support to continue nursing.

Benefits of Breastfeeding:The benefits of breastfeeding for babies and moms are numerous. Babies who nurse receive immunities from their moms, making them less likely to develop ear infections and less susceptible to stomach bugs. They also experience sudden infant death syndrome at lower rates. Moreover, breastfed babies have a lower risk of developing certain conditions, including asthma, obesity, and type 1 diabetes, as they grow. Moms who nurse likewise reap long-term benefits, including reduced risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure.

There is no better time than now, during National Breastfeeding Month, to reflect on the AAP’s updated guidance and recommit to reducing barriers that discourage moms from breastfeeding. Providers, policymakers, employers, insurers, and communities all have opportunities to support nursing moms and their babies

Source:nt-aug22.pdf (

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Managing relationships after premature birth

Having a premature baby can have a huge impact on the whole family. Here we talk about how you may all feel and what you can do to support each other.

How premature birth may affect the parents

Research has found that both parents of premature babies are more likely to experience extreme stress and mental health problems than parents whose babies arrived full term. 

A lot of parents have told us that they felt a lot of complex emotions after their baby was born, such as helplessness, fear and confusion. Some even feel guilty or wonder if they could have done something to prevent it. Feelings of failure are also common. Some parents feel like their body has failed them or that they have failed at parenthood before they have even started.

Dads and partners may also feel helpless or out of control. Some partners have told us that they felt alienated in the baby unit.

Depending on how long the baby is in hospital, partners may need to go back to work before your baby goes home. This may mean that they can’t spend as much time with the baby as the other parent. This may leave them feeling isolated, scared or stressed that they can’t do more. 

This can create anxiety and tension. Even the healthiest relationships can strain in stressful situations, so try not to let any worries about you as a couple overwhelm you. It’s really important that you stay open and honest with each other about how you feel. Talking to each other about your fears, worries and feelings can help you to support each other better and understand each other. Try to understand things from each other’s point of view and give each other space. 

How premature birth can affect siblings

If you have any older children, they may be affected by the experience of having a new baby brother or sister who is born prematurely. Children are very sensitive to what is going on, and if you are concerned about the baby – even if you don’t talk openly about it – they will probably be aware of this. They are also likely to be confused if the baby needs to stay in hospital for a while.

The way they react will depend on how old they are and their personality. Try to explain what’s happening in a way you think they’ll understand. Try to be as honest with them as you can and be prepared for the possibility that they may have some questions. Let them know that they can talk to you about what’s happening whenever they need to. 

Try to involve them as much as you can. Perhaps they could draw a picture for the new baby or you could take them to buy a present for them. If it’s possible for them to visit their new sibling, explaining what the hospital environment may be like before you go may help.

There are books available that are aimed at siblings of premature babies to help them understand what’s happening. Ask your local bookseller or go online to find recommended books about prematurity for children.

How premature birth can affect grandparents

Grandparents may be feeling anxious for all of you. Try to keep them in the loop about what’s happening. 

They may be keen to help but unsure of what they could do. You could suggest they could do some practical things like make some frozen meals for you, help to keep your house tidy or look after any older children if you have them. 

Managing competing demands after premature birth

Your family and friends will hopefully become a vital support for you during the early weeks and months of your baby’s life.

But because everyone has different needs, having lots of people to worry about can make it stressful too. For example, you may feel that you need to spend all your time at the baby unit, but perhaps you have older children who need your time too. Or perhaps one parent wants to talk about a traumatic birth, but the other is not ready. Or maybe family and friends want to check in and see how you are, but you are feeling too tired or stressed to call or message anyone. 

This can be stressful. You will also be trying to cope with your own feelings so it can be difficult when you feel you need to look after other people too. 

If tensions are rising, try to talk things through. If you can be honest and open about how you’re feeling, it can often help prevent misunderstandings, hurt or resentment later.

How others can help

Family and friends may be an essential support at this difficult time, but not everyone is good at dealing with this sort of situation. You may be surprised by the people who rally round, and disappointed that others offer less support than you hoped for. 

Don’t be afraid to ask for help or take it when it’s offered. They will probably be pleased to help by keeping you company, cooking meals or offering to help with your other children.

If people say unhelpful or insensitive things, try to ignore them. Most people will have no understanding of what you’re going through and would probably be horrified at their own insensitivity if they did.

Celebrating your premature baby’s breakthroughs

Many families find that they are so busy focusing on their baby’s health problems that there is little space to think about the good things. It is important to allow yourself to feel grief when you’re going through hard times. But when your baby has a breakthrough, such as coming off a particular treatment, or going home, it can be helpful to celebrate that too.

Sharing good news

Many parents like to mark these events in some small way and to share them with others. This might simply involve sending out a group text to loved ones telling them the news, sharing a glass of bubbly or having a meal with close friends or family. You might prefer to simply note them down in a journal if you keep one.

Try to hold on to that positive feeling for as long as you can and focus on how far your new family has come already. 

Tommys: Our Story

From a campaign that began in a spare cupboard in St Thomas’ Hospital, Tommy’s is now the largest UK charity researching the causes and prevention of pregnancy complications, miscarriage, stillbirth, premature birth and neonatal death.



Dr. Lorna Breen Health Care Provider Protection Act Signed Into Law

March 18, 2022

On March 18, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act, named for a Columbia emergency medicine physician, into law. The act will provide federal funding for mental health education and awareness campaigns aimed at protecting the well-being of health care workers. 

The new law—the first to provide such funding—is named for Lorna Breen, MD, an emergency medicine physician and faculty member at the Vagelos College of Physicians and Surgeons and NewYork-Presbyterian/Columbia University Irving Medical Center who died by suicide in April 2020 at the peak of the first COVID surge. 

“Health care professionals often forgo mental health treatment due to the significant stigma in both our society and the medical community, as well as due to the fear of professional repercussions,” says Angela Mills, MD, chair of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons. “This law will provide much needed funding to help break down the stigma of mental health care, providing education and training to prevent suicide, address other behavioral health issues, and improve well-being.” 

Health care workers have always experienced extraordinarily high levels of stress. To protect their careers, however, most with mental health issues suffer in silence. The COVID pandemic has only intensified the stress and suffering.

Breen’s death highlighted the need to help front-line health care workers cope with the stress of their jobs. 

The goal of the Dr. Lorna Breen Health Care Provider Protection Act is to prevent suicide, alleviate mental health conditions and substance use disorders, and combat the stigma associated with seeking help. It provides up to $135 million over three years to improve mental health and resiliency and train medical students, residents, nurses, and other professionals in evidence-based mental and substance use disorders strategies. 

Grants will go to medical schools, academic health centers, state and local governments, Indian Tribes and Tribal organizations, and nonprofit organizations.

Health care worker stats 

  • One in five health care workers quit their job during the pandemic.  
  • 400 physicians in the United States die by suicide every year.   
  • 60% of emergency doctors feel burned out  


Virtual nursing programs help hospitals overcome staffing shortages and support onsite nurses in providing patient care.

    September 01, 2022

Healthcare organizations across the U.S. are under tremendous pressure as the growing need for nurses outpaces a shrinking workforce. There have been unprecedented challenges from the large, aging baby boomer population. Nurses are also getting older, with a median age of 52 — 4.7 million are projected to retire by 2030.

“None of us are going to have the complement of nurses that we would like to have moving forward, so we have to get creative with the way that we provide care,” says Jennifer Ball, director of virtual care at Saint Luke’s Health System in Kansas City, Mo.

Healthcare systems like Saint Luke’s are increasingly turning to virtual nursing to address the shortage. Virtual nurses work in remote centers with videoconferencing technology to observe and answer questions from patients, speak with family members and ease the burden on bedside nurses by performing tasks that don’t require physical proximity, such as conducting admissions interviews and providing discharge instructions.

“What better way to retain those experienced nurses who might be thinking of retiring or leaving the field early?” Ball says. “It’s a great way to allow them to continue their careers

There has been a 34 percent increase in the number of virtual nursing programs around the U.S. in the past year, says Laura DiDio, principal at research and consulting firm ITIC. The growth was spurred by the pandemic, “but it shows no signs of slowing down,” she adds.

Virtual nurses support bedside nurses in healthcare facilities, but they can also see patients at home using remote monitoring tools to collect clinical data, DiDio says. During the pandemic, virtual nurses used high-definition cameras and tablets to connect patients in isolation with their loved ones. Digital hospice and palliative care ­visits became commonplace.

“You will always have hands-on bedside care. That’s not going away,” Ball says. “But we must expand the types of caregivers that we have. I think virtual nursing is the wave of the future.”

The Technology Behind Virtual Nursing

Virtual nurses typically operate in remote centers manned with fully loaded workstations. At Saint Luke’s, each workstation uses a mix of multiple monitors, including HP monitors, the Epic Monitor dashboard feature and the Teladoc virtual healthcare platform, which includes a microphone, camera and videoconferencing software. Saint Luke’s also uses LogMeIn (now called GoTo) for remote desktop access so that virtual nurses can document as second nurse.

All the technologies used by Saint Luke’s virtual nurses were in use before the program launched. Even the workstations’ 5-foot adjustable desks were repurposed from an older project, Ball says. “We have been really lucky because we didn’t have to start from scratch with new technology,” she adds.

At Atrium Health in North Carolina, patient rooms use one of two setups to enable observation for its virtual nursing program to support newer nurses. New facilities are designed with audio and video capabilities, so the push of a button calls the virtual nurse, who appears on screen. Older facilities use wheeled poles with mounted cameras, speakers, microphones and monitors. Atrium Health uses the Caregility telehealth platformCerner cameras and software, and Microsoft Teams.

Vanderbilt University Medical Center in Nashville, Tenn., uses mobile devices with audio and video capabilities for its “virtual sitter” program, which allows nurses to monitor multiple patients at once. “They kind of look like a robot that you would see in a cartoon,” Karen Hughart, senior director of nursing informatics at VUMC, says of the devices.

VUMC’s virtual sitter program launched in 2019, when a dramatic increase in patients needing observation — those at risk of falls or other types of harm — coincided with Nashville’s booming economy, making it difficult to hire entry-level patient-care attendants.

“Sometimes, patients just need somebody to redirect them if they start to get out of bed because they’re confused,” Hughart says. “We’re not relying on patients to press their call bell. There’s somebody available to monitor them to determine if the patient needs immediate assistance, and they’re notifying the patient’s bedside nurse directly instead of waiting until the patient has had a bad outcome.”

Virtual sitters, who use 24-inch Dell monitors to observe patients centrally, can even use recorded messages from family members to reorient patients. “Sometimes a voice that they recognize is more effective with redirecting their behaviors,” Hughart adds.

The pandemic placed stressors not only on practicing nurses but also on those in training. “Nursing school students didn’t get the same experience that some of us more seasoned nurses have because their clinical rotations were cut short,” says Becky Fox, Atrium Health’s vice president and chief nursing informatics officer.

Health systems like Atrium and Saint Luke’s assigned experienced virtual nurses to mentor recent graduates. They can walk bedside nurses through procedures, interact with the care team on rounds and even listen in on a patient’s lungs via a remote stethoscope, Fox says.

“Imagine you’re a new graduate, and you’re concerned that your patient is taking a turn for the worse. It helps knowing that you’ve got someone on screen who has your back,” she adds.

Atrium Health has seen call bell volumes go down while patient satisfaction scores have risen, Fox says. It also saw a decrease in the number of rapid response team calls, in which the whole care team rushes to a patient’s bedside amid a crisis, because virtual nurses can spot problems before they escalate.

The organization was already using video capabilities in other areas, such as translators and disease education specialists, to help nurses manage patients’ care. Atrium Health expects the use of video capabilities to develop further.

At VUMC’s virtual sitter program, Hughart sees similar potential. It’s currently in use only in the adult hospital, but VUMC would like to expand virtual care capabilities. Some vendors provide not only the equipment to support such programs, but also the virtual nurses themselves, she adds.

“That’s very attractive to us right now,” Hughart says, “because like a lot of other facilities, we’re struggling to keep pace with the demand for nurses.”

Saint Luke’s has seen many benefits from its virtual nursing program. Patients always have immediate access to someone, and bedside nurses have help with time-consuming tasks, such as ordering meals for patients and completing quality checks.

“Care is delivered on time, and everything is double- and triple-checked,” Ball says. “It allows for a more efficient hospital stay.”

Other staff, such as pharmacists and social workers, have expressed interest in using the virtual center. The four smaller critical-access hospitals in the Saint Luke’s network have already installed virtual care equipment in their rooms to gain greater access to specialists throughout the system. For instance, a diabetes education specialist can now meet with a patient in one location through the videoconferencing tools, and then 30 minutes later, meet with another patient who’s two hours away.

“I think there will be a lot of ways to use this technology in the future, and we’re probably not even aware of everything we can do,” Ball says. “This is an opportunity for us to provide more holistic care to all patients.”


The purpose of the virtual nurse is to work alongside the bedside nurse, but that’s often easier said than done.

“Early on, nursing staff would get frustrated because they felt they either weren’t warned soon enough or they were being interrupted every five minutes to check on patients,” says Hughart. It took months of repeated education and meetings to work through ongoing problems.

Saint Luke’s holds joint training sessions with virtual and bedside nurses so they can learn to collaborate as a team, says Ball.

Here are a few lessons on how to build a successful virtual nursing program:

1. Involve everyone — from clinical staff to IT and quality assurance — from the start.

2. If possible, start in a new facility. “There are always challenges when you go into an existing unit and change the culture,” Ball says.

3. When hiring, look for experienced nurses with strong communication skills.
“You want knowledgeable staff because you’re looking to them to do the teaching and the education for the patients,” Ball adds.

4. Make sure buildings have adequate wireless bandwidth. “We have to continue expanding capacity and building in redundancy to keep up,” Hughart says.

5. Focus on the communication workflows between unit-based nursing staff and staff who monitor patients virtually, Hughart adds. For the technology to have maximum impact, those using it must understand its capabilities and limitations, and there must be collaboration between the onsite and virtual teams that centers patient care.

6. Build strong device support processes, with quick turnaround on repairs for critical equipment, says Becky Fox, vice president and chief nursing informatics officer for Atrium Health.

7. Don’t be afraid to change workflows when starting new programs. “The best ideas on paper don’t always work in real life,” Ball says.


How do children develop after being born very preterm? Four likely outcomes

Children born very preterm can be divided into different subgroups, each with a different profile of developmental outcomes.

   Washington, DC June 28, 2022

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that, among very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits.

Children born very preterm, that is, after a pregnancy duration of less than 32 weeks, have a higher risk for difficulties during development than peers who are born after a normal pregnancy duration. What kind of difficulties and to what degree, however, varies strongly from child to child. Nevertheless, very preterm born children are usually considered as one group. According to new research, this assumption is unjustified.

Researchers from the Obstetrical, Perinatal and Pediatric Epidemiology Research Team at Inserm and the French National Institute for Health and Medical Research followed the development of 2,000 very preterm born children from all over France from birth until the age of 5.5 years. Their findings suggested that the population of very preterm born children could be divided into four subgroups, each with a different profile of developmental outcomes.

Almost half of the children (45%) belonged to a subgroup of children who had no difficulties and functioned at similar levels as their full-term born peers. However, 55% of the children belonged to one of three subgroups with suboptimal developmental outcomes. The first subgroup consisted of children who primarily had difficulties in motor and cognitive functioning, whereas a second group of children primarily had difficulties in behavior, emotions, and social relationships. A small subgroup of children had more severe impairments in all domains of development.

“Very little is known about the specific needs of subgroups of very preterm born children,” said lead author Sabrina Twilhaar, PhD. “Our study is the first large-scale study to distinguish very preterm born children based on their profile of outcomes across multiple important developmental domains. After all, how children function in everyday life is not determined only by their IQ or behavior. We now have a better understanding of which difficulties are prominent in different subgroups and which difficulties often occur together. This is important information for the development of targeted interventions.”

The researchers were also interested to know the predictors of these developmental outcomes. They found that children in the three subgroups with suboptimal outcome profiles were more often boys or had parents with a lower level of education or with a non-European migration background. Children who were diagnosed with prematurity-related lung disease (i.e., bronchopulmonary dysplasia) also had a higher risk for suboptimal developmental outcomes.

New insights are highly needed for very preterm born children. Preterm birth rates are increasing as are survival rates, especially among the most immature infants who have the highest risk for impairments. Thus, the number of very preterm born children with impairments growing up in our societies is rising. These impairments generally persist when children get older and there is currently little evidence in support of interventions that meaningfully improve long-term outcomes. These insights may be used to tailor support programs to the specific needs of subgroups of children to improve their effectiveness.

Dr. Twilhaar: “Instead of taking a one-size-fits-all approach, the findings emphasize the importance of taking individual differences much more into account. The average of the population is not representative of the individual children that it consists of. Moving forward, we should thus aim to understand how certain combinations of difficulties arise in specific groups of children, whereas others encounter no difficulties at all. This will aid the development of interventions that are tailored to the actual needs of individual children and target co-occurring problems, but also programs and policy to promote positive development in all children.”

Copies of this paper are available to credentialed journalists upon request; please contact the JAACAP Editorial Office at or +1 202 587 9674. Journalists wishing to interview the authors may contact E. Sabrina Twilhaar, PhD; e-mail:


Osteopathic Manipulative Treatment in Neonatal Intensive Care Units

Cicchitti, L.; Di Lelio, A.; Barlafante, G.; Cozzolino, V.; Di Valerio, S.; Fusilli, P.; Lucisano, G.; Renzetti, C.; Verzella, M.; Rossi, M.C. Osteopathic Manipulative Treatment in Neonatal Intensive Care Units. Med. Sci. 20208, 24.


The aim of this study was to assess the impact of osteopathic manipulative treatment (OMT) on newborn babies admitted at a neonatal intensive care unit (NICU). This was an observational, longitudinal, retrospective study. All consecutive admitted babies were analyzed by treatment (OMT vs. usual care). Treatment group was randomly assigned. Between-group differences in weekly weight change and length of stay (LOS) were evaluated in the overall and preterm populations. Among 1249 babies (48.9% preterm) recorded, 652 received usual care and 597 received OMT. Weight increase was more marked in the OMT group than in the control group (weekly change: +83 g vs. +35 g; p < 0.001). Similar trends were found in the subgroup of preterm babies. A shorter LOS was found in the OMT group vs. the usual care group both in overall population (average mean difference: −7.9 days, p = 0.15) and in preterm babies (−12.3 days; p = 0.04). In severe preterm babies, mean LOS was more than halved as compared to the control group. OMT was associated with a more marked weekly weight increase and, especially in preterm babies, to a relevant LOS reduction: OMT may represent an efficient support to usual care in newborn babies admitted at a NICU.



Using AI to save the lives of mothers and Babies

Thought Leaders -Patricia Maguire-Professor of Biochemistry-University College Dublin As part of our SLAS Europe 2022 coverage, we speak to Professor Patricia Maguire from the University College Dublin about their AI_PREMie technology and how it can help to save mothers and babies lives.

Please could you introduce yourself and tell us what inspired your career in artificial intelligence (AI)?

My name is Patricia Maguire, and I am a professor of biochemistry at University College, Dublin (UCD). Four years ago, I was appointed director of the UCD Institute for Discovery, a major university research institute in UCD, and our focus is cultivating interdisciplinary research. In that role, I first became excited by the possibilities of integrating AI into my research.

AI has seen increased attention in recent years, especially concerning its adoption in healthcare settings. Despite this, obstacles still need to be overcome before it is commonplace within research. What do you believe to be some of the biggest challenges surrounding the adoption of AI in clinical settings?

I think there are two major obstacles to adopting AI in healthcare. The first is that when it comes to the actual deployment of that AI in a clinical setting in the real world, there is a significant gap from that lab-based tech development to getting it deployed in the clinic and operationalized there. The second is that once that AI is operationalized, the frontline staff may have difficulty adopting it. Staff are going to be really busy, and their time is valuable. We need to offer them practical solutions that give them reliable results that augments their clinical decision-making.

You are currently the director of the ConwaySPHERE research group at University College Dublin. Please could you tell us more about this research group and its missions?

I co-direct the UCD Conway SPHERE Research Group with my hematology colleagues, Professor Fionnuala Ní Áinle and Dr. Barry Kevane. Our mission is to understand and help diagnose inflammatory diseases, and we work together as a group of clinicians, academic staff, and scientists, collaborating both nationally and internationally. For AI-PREMie it is a truly transdisciplinary team that we have brought together– encompassing clinicians and frontline staff from the three Dublin maternity hospitals. In doing so, we have covered 50% of all births in Ireland. We have brought these hospitals together with a host of scientists from across University College Dublin and data scientists from industry, namely the SAS Institute and Microsoft. The whole AI-PREMie team’s mission is to get this prototype test to every woman who needs it worldwide because we believe we will save lives.

You are giving a talk at SLAS Europe 2022 titled ‘AI_PREMie: saving lives of mothers and babies using AI.’ What will you be discussing in this talk, and what can people expect?

I will discuss our project AI-PREMie, which brings together cutting-edge biochemical, clinical, and machine learning expertise. By bringing them together, we have developed a new prototype test for risk stratification in preeclampsia.

As demonstrated in your latest research, AI-PREMie can accurately help to diagnose preeclampsia, a serious complication affecting one in ten pregnancies. What are the benefits of accurately diagnosing preeclampsia not only for the women and their babies but also for healthcare settings?

Fifty thousand women and 500,000 babies are lost to preeclampsia every year, and an additional 5 million babies are born prematurely – sometimes very prematurely – because of preeclampsia. It is easy to see how devastating preeclampsia is as a disorder: it affects our most vulnerable in society, their whole families, and their whole communities. If we can diagnose preeclampsia in a much timelier manner, we can deliver efficient, effective healthcare that can have a massive impact on the societal good. Not only will this allow us to prevent premature births, but we can also save lives.

What are some of the benefits of using AI tools such as AI_PREMie in diagnosis compared to current diagnostic methods?

There have been no significant advances in preeclampsia diagnosis. We are still using screening tests that were introduced decades ago. We look at high blood pressure, and we look at protein in the urine when we are screening these women, and sometimes these metrics do not predict the outcome. There is simply no test available to tell a clinician that a woman has preeclampsia. There is also no test to predict how that preeclampsia will progress. This means there is no test to tell a clinician or a midwife when to deliver that baby. AI-PREMie, our prototype test, will hopefully be able to not only diagnose preeclampsia but also predict the future in a sense and tell the clinician the best time to deliver that baby – because every day in utero for that baby counts.

Are you hopeful that with continued innovation within the artificial intelligence space, we will see more clinical practices turning to this technology to help aid healthcare? What would this mean for global health?

The field of AI is moving so fast, and healthcare is trying to keep up with it. I do see a future where our healthcare information will be available to us much like our banking information is securely, maybe even on our mobile phones, and that way, we can move global health to treat disease to a status where we predict disease and prevent disease.

Do you believe that AI_PREMie could also be applied to other clinical diagnoses? What further research would need to be carried out before this could be possible?

The patented biomarkers underlying AI PREMie are derived from the information stored within the platelet of sick, pregnant women, and we have studied that information or that ‘cargo’ stored within the platelet. We know that this is a marker – a form of a barcode – of the health status of an individual. In our lab, we are currently looking at this cargo in other diseases involving inflammation and vascular dysfunction concerning the platelet. Right now, we have projects ongoing on multiple sclerosis, cancer-associated thrombosis, and also COVID-19 to look to see if we can find new biomarkers in the platelets for these diseases.

Are there any particular areas where you are excited to see AI incorporated within the life sciences sector?

We have shown in our project that incorporating AI into data-driven life sciences projects has the potential to be truly transformative. If you look at what is available now, eye diseases can be detected using neural networks of three-dimensional retinal scans, but also in critical care, there are now sepsis warnings based on AI, which has dramatically reduced the number of deaths from sepsis in these hospitals. The potential is just so exciting.

What’s next for you and the ConwaySPHERE research group?

Next year, excitingly, we are planning to take AI PREMie across Ireland – so we want to increase the recruitment and data collection across Ireland and grow the group even more.


Golden Hour Education, Standardization, and Team Dynamics: A Literature Review


The “golden hour” is the critically important first 60 minutes in an extremely low birth weight neonate’s life that can impact both short- and long-term outcomes. The golden hour concept involves several competing stabilization priorities that should be conducted systematically by highly specialized health care providers in both the hospital and transport settings for improvement in patient outcomes. Current literature supports utilizing an experienced team in the golden hour process to improve patient outcomes through standardization, improved efficiency, and positive team dynamics. Although a variety of teaching methods exist to train individuals in the care of extremely low birth weight infants, the literature supports the incorporation of low- or high-fidelity simulation-based training. In addition, initial and ongoing educational requirements of individuals caring for a golden hour-eligible infant in the immediate post-delivery phase, as well as ongoing care in the days and weeks to follow, are justified. Instituting standard golden hour educational requirements on an ongoing basis provides improved efficiency in team function and patient outcomes. The goal of this literature review was to determine whether implementation of golden hour response teams in both the inpatient and transport setting has shown improved outcomes and should be considered for neonatal intensive care units admitting or transporting golden hour eligible infants.

Doak, Alyssa, BSN, RNC-NIC, C-NPT, C-ELBW | Waskosky, Aksana, DNP, APRN, NNP-BC


Maternal, Infant, and Child Health Outcomes Associated with the Special Supplemental Nutrition Program for Women, Infants, and Children

A Systematic Review


The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve maternal and child health outcomes. In 2009, the WIC food package changed to better align with national nutrition recommendations.


To determine whether WIC participation was associated with improved maternal, neonatal–birth, and infant–child health outcomes or differences in outcomes by subgroups and WIC enrollment duration.

Data Sources:

Search (January 2009 to April 2022) included PubMed, Embase, CINAHL, ERIC, Scopus, PsycInfo, and the Cochrane Central Register of Controlled Trials.

Study Selection:

Included studies had a comparator of WIC-eligible nonparticipants or comparison before and after the 2009 food package change.

Data Extraction:

Paired team members independently screened articles for inclusion and evaluated risk of bias.

Data Synthesis:

We identified 20 observational studies. We found: moderate strength of evidence (SOE) that maternal WIC participation during pregnancy is likely associated with lower risk for preterm birth, low birthweight infants, and infant mortality; low SOE that maternal WIC participation may be associated with a lower likelihood of inadequate gestational weight gain, as well as increased well-child visits and childhood immunizations; and low SOE that child WIC participation may be associated with increased childhood immunizations. We found low SOE for differences in some outcomes by race and ethnicity but insufficient evidence for differences by WIC enrollment duration. We found insufficient evidence related to maternal morbidity and mortality outcomes.


Data are from observational studies with high potential for selection bias related to the choice to participate in WIC, and participation status was self-reported in most studies.


Participation in WIC was likely associated with improved birth outcomes and lower infant mortality, and also may be associated with increased child preventive service receipt.


On National Child Day, meet clean water activist Autumn Peltier | CBC Kids News

Nov 20, 2020      CBC Kids News#NationalChildDay#CleanWater#Indigenous

You know something’s wrong when a child speaks up. That’s how Autumn Peltier, a 16-year-old from Wiikwemkoong First Nation in Ontario, framed her fight for clean drinking water in Canada’s Indigenous communities. The teen, who’s originally from Manitoulin Island but currently living in Ottawa, told CBC Kids News she’d rather spend her free time doing normal kid stuff. Instead, she’s making speeches on the international stage about the fact that some Canadians don’t have access to clean water. “Water is a basic human right. Everyone deserves access to clean drinking water, no matter what our race or colour is or how rich or poor we are,” Autumn said. Autumn seized the opportunity to share that message with the world when she addressed the United Nations in 2018 and again in 2019. In 2019, she was also named chief water commissioner by the Anishinabek Nation, which means she speaks on behalf of 40 First Nations in Ontario. As of October, more than 40 Indigenous communities in Canada had boil water advisories in place, which means residents have to boil their water before it’s safe to drink. During the federal election campaign in 2015, Prime Minister Justin Trudeau promised to get rid of all boil water advisories in the country by March 2021. Now leaders in many of those communities are saying Trudeau’s government won’t meet that deadline. In October, the prime minister said more than 100 boil water advisories have been lifted since that promise was made, and his government continues to work “very hard” to reach its goal. As for Autumn, she said the idea that time is running out “keeps me up when I can’t sleep at night.” Click play to watch Autumn tell her story in her own words. CBC Kids News is a website for kids, covering the information you want to know. Real Kids. Real News. Check it out at

Cat Video! Here’s looking at you, kid!