Rate: 7.4%     Rank: 146Estimated number of preterm births per 100 live births

(USA – 12%)


Switzerland, officially the Swiss Confederation, is a country situated in western, central and southern Europe It consists of 26 cantons, and the city of Bern is the seat of the federal authorities. The sovereign state is a federal republic bordered by Italy to the south, France to the west, Germany to the north, and Austria and Liechtenstein to the east. Switzerland is a landlocked country geographically divided between the Alps, the Swiss Plateau and the Jura, spanning a total area of 41,285 km (15,940 sq mi) (land area 39,997 km (15,443 sq mi)). While the Alps occupy the greater part of the territory, the Swiss population of approximately 8.5 million people is concentrated mostly on the plateau, where the largest cities are to be found: among them are the two global cities and economic centres Zürich and Geneva.


Swiss residents are universally required to buy health insurance from private insurance companies, which in turn are required to accept every applicant. While the cost of the system is among the highest, it compares well with other European countries in terms of health outcomes; patients have been reported as being, in general, highly satisfied with it. In 2012, life expectancy at birth was 80.4 years for men and 84.7 years for women, the highest in the world. However, spending on health is particularly high at 11.4% of GDP (2010), on par with Germany and France (11.6%) and other European countries, but notably less than spending in the USA (17.6%). From 1990, a steady increase can be observed, reflecting the high costs of the services provided. With an ageing population and new healthcare technologies, health spending will likely continue to rise.






Humanitarian Neonatology

Many Swiss neonatologists are involved in humanitarian projects in low and middle income countries. The Swiss Society of Neonatology strongly supports such efforts and therefore has decided set up this platform.

Frequently, these projects remain hidden, unless the topic comes up in a random conversation, revealing common interests and similar problems that are all facing when working in different parts of the world – when in fact, one could benefit from the experience of the other, from their contacts, their achievements and their mistakes.

The goal of this platform is to provide information, to offer opportunities to get involved, to share experiences and find synergies. Neonatologists can present their humanitarian projects and invite other medical professionals to join them in their efforts.

Finally, the Swiss Society of Neonatology has decided to set up an Annual Award Program for Humanitarian Neonatology.  Interested medical professionals can apply for a grant of CHF 5‘000.00.




NEO FOR NAMIBIA Helping Babies Survive is a non-profit organization based in Switzerland that focuses on the implementation of simple medical interventions that are known to improve survival rates of newborn infants.

What we do – Simple interventions will save lives

The founders of NEO FOR NAMIBIA – Helping Babies Survive, Prof. Thomas M. Berger, a Swiss pediatrician, neonatologist and pediatric intensivist and his wife Sabine Berger, a pediatric registered nurse, have visited several sub-Saharan African countries (Ivory Coast, the Gambia, Namibia) in the past years to assess neonatal and pediatric care at various hospitals in these countries.

During these visits, they observed recurrent themes: poor infrastructure related to both high acquisition costs and lack of proper maintenance, unreliable supply chains for spare parts and consumables, and shortage of qualified health care professionals.

They are convinced that simple interventions will have a huge impact; any delay will lead to additional, potentially preventable deaths. The time to act is now!

The activities of NEO FOR NAMIBIA – Helping Babies Survive are officially approved by the Ministry of Health and Social Services and supported personally by the Honorable Minister of Health, Dr. Bernard Haufiku. “I highly appreciate the efforts of NEO FOR NAMIBIA – Helping Babies Survive. I am convinced that the proposed interventions will play an important role in reducing neonatal deaths in the Kavango region of Namibia. Potentially, other regions of this country could benefit from this experience. I can guarantee that the Ministry of Health and Social Services of Namibia will support Prof. Berger and his team”.

NEO FOR NAMIBIA focuses on the following aspects of the care of newborn infants:

  • Provide essential equipment to improve neonatal care (including warming beds, consumables appropriate for the use in newborn infants, monitors, devices for respiratory support)
  • Regular teaching of both physician and nursing staff in basic neonatal care, such as thermoregulation, Kangaroo care, neonatal resuscitation, appropriate use of antibiotics, fluid and nutrition management, respiratory care
  • Develop standard operating procedures (SOPs) together with the local health care professionals
  • Support of local champions (physicians and nurses who will train and supervise their peers)







We value medical and psycho-social research related to preterm birth survivors as they age. 


Abstract: A meta‐analysis of neurodevelopmental outcomes at 4–10 years in children born at 22–25 weeks gestation    Sharon Ding – Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada


To update our meta‐analysis on neurodevelopmental disability rates in children born at 22–25 weeks gestation. The main outcome measure was rates of neurodevelopmental disability in survivors at age 4–10 years.


We used a peer‐reviewed electronic and grey search to identify articles. Two authors independently reviewed cohorts published after May 2012 with: born ≥1995 in a developed nation; assessed at 4–10 years; prospective; >65% follow‐up; definitions for neurodevelopmental disability as per the EPICure cohort; results reported by gestation. We contacted authors for clarification. Random effects meta‐analysis was used to estimate pooled proportions of neurodevelopmental disability. Within each study, the absolute change in proportions with each week was estimated and then pooled.


We reviewed 3980 records; 21 articles were assessed and six were included. With the previous 9 cohorts, the meta‐analysis now contains 15. Rates of moderate‐to‐severe neurodevelopmental disability were as follows: 42% (95% CI 23,64%; I2 0%) at 22; 41% (95% CI 31,52%; I2 20%) at 23; 32% (95% CI 25,39%; I2 45%) at 24; 23% (95% CI 18,29%; I2 60%) at 25 weeks. The analysis shows a significant decrease in risk of moderate‐to‐severe neurodevelopmental disability between each week (8.1% (95% CI −11.8, −4.5%); I2 0%; p < 0.001).


Physicians can use this high‐quality data to support parents during decision‐making.




Platelet Transfusions in Neonates — Less Is More

  • Thrombocytopenia is common in preterm neonates. At some point during their stay in the neonatal intensive care unit, this condition affects up to 73% of infants with a birth weight of less than 1000 g.1 The smallest and most premature infants also have the highest incidence of bleeding; in approximately 30% of neonates born with a weight of less than 1500 g, an intracranial hemorrhage develops, usually in the first week of life.2 Because of the high rates of both thrombocytopenia and bleeding in this population, it has been widely accepted that preterm infants should receive platelet transfusions at higher platelet-count thresholds than those used in older children and adults. However, the specific platelet count below which a platelet transfusion is beneficial has been unknown.
  • Before the trial by Curley and collaborators reported in this issue of the Journal,3 the only randomized trial comparing platelet-transfusion thresholds in preterm neonates had been published 25 years earlier. That trial involved 152 premature neonates who had a birth weight of less than 1500 g and a platelet count of less than 150,000 per cubic millimeter. The neonates were randomly assigned to receive platelet transfusions during the first week of life at a platelet-count threshold of 150,000 per cubic millimeter or to receive no platelet transfusions unless the platelet count was less than 50,000 per cubic millimeter or the neonate had bleeding. The trial showed no significant differences between the two groups in the incidence of the primary composite outcome of new intracranial hemorrhages or worsening of existing intracranial hemorrhages. These results led neonatologists to embrace 50,000 per cubic millimeter as the most frequently used threshold for platelet transfusions in preterm neonates, although limitations in this single randomized trial left room for uncertainty and several unanswered questions, including which transfusion thresholds to use beyond the first week of life and whether platelet counts lower than 50,000 per cubic millimeter were safe in preterm neonates. In the absence of additional trials, surveys and observational studies over the past decade revealed a striking worldwide variability in thresholds for platelet transfusions in neonates.5
  • The trial by Curley et al. was well designed to address critical questions in this field. In this multicenter trial, 660 neonates who had a median gestational age of 26.6 weeks and a median birth weight of 740 g and in whom thrombocytopenia had developed were randomly assigned to receive platelet transfusions at platelet-count thresholds of 50,000 per cubic millimeter (high-threshold group) or 25,000 per cubic millimeter (low-threshold group). The primary outcome was a composite of death or new major bleeding within 28 days after randomization, and bleeding was quantified with the use of a validated neonatal bleeding-assessment tool. A total of 90% of the infants in the high-threshold group and 53% of those in the low-threshold group received at least one platelet transfusion.
  • Surprisingly, infants in the high-threshold group had a significantly higher rate of death or major bleeding within 28 days after randomization than those in the low-threshold group (26% vs. 19%; odds ratio, 1.57; 95% confidence interval, 1.06 to 2.32). In a subgroup analysis, findings were similar in neonates who were born at less than 28 weeks of gestation (the highest-risk group) (Table S4 in the Supplementary Appendix of the article by Curley et al., available with the full text of the article at With regard to secondary outcomes, the incidence of bronchopulmonary dysplasia (defined as dependency on oxygen at 36 weeks of postmenstrual age) was higher among infants in the high-threshold group than among those in the low-threshold group, and rates of major bleeding through trial day 28 were 14% and 11%, respectively.
  • The observation that major bleeding was not more common in the low-threshold group than in the high-threshold group was consistent with previous observational studies showing a poor correlation between the degree of thrombocytopenia and bleeding risk, and it suggests that factors other than the low platelet count account for the high incidence of bleeding among neonates with thrombocytopenia. A total of 37% of infants in the trial underwent randomization on or before day 5 of life, and 59% underwent randomization by day 10, the highest-risk period for bleeding.7 However, 39% of the infants in the trial received one or more platelet transfusions before randomization; this raises important questions about whether the infants received these transfusions during this high-risk period and, if so, for what reasons and at what platelet-count thresholds.
  • The rates of death and bronchopulmonary dysplasia observed to be higher in the high-threshold group than in the low-threshold group also raise obvious questions regarding the mechanisms mediating these adverse effects. Are they related to the presence of adult platelets (which are more reactive than infant platelets) tilting the neonatal primary hemostatic balance toward a prothrombotic state that promotes microthrombosis?8 A previous study that showed increased risks of arterial thrombosis and in-hospital death associated with platelet transfusions among adults with platelet-consumptive disorders provides some support for this hypothesis.9 Or are these adverse events mediated by the increasingly recognized effects of platelets on inflammation,10 a particular concern in neonates with infection, as in approximately 60% of the infants in the trial by Curley et al.?
  • Although the mechanisms underlying the findings are unknown, the trial by Curley et al. is a major advance in neonatal hematology. More than two decades after the first randomized trial comparing platelet-transfusion thresholds in preterm infants, this long-awaited trial provides neonatologists with high-level evidence that should translate into a shift toward restrictive thresholds for prophylactic platelet transfusions in neonates who have not had recent major bleeding (since this trial excluded infants with major bleeding within the previous 72 hours which was either already known or detected on cranial ultrasonography performed within 6 hours before randomization). In clinical practice, recent cranial ultrasonographic findings are not always available when decisions are made regarding platelet transfusions. This raises concerns, particularly for infants during the first week of life. Nevertheless, it is now clear that platelet transfusions may have deleterious effects in preterm neonates, and the evidence from this trial strongly suggests that less is more when it comes to the management of neonatal thrombocytopenia.



Healthy Nurse Healthy Nation Grand Challenge-Leading the Nation’s Journey to Better Health


If all 4 million registered nurses increased their personal wellness and then their families, co-workers and patients followed suit, what a healthier nation we would live in! That is the goal of the Healthy Nurse, Healthy Nation™ Grand Challenge, an initiative to connect and engage nurses, employers, and organizations around improving health in five areas: physical activity, nutrition, rest, quality of life, and safety.

Nurses are less healthy than the average American. Research shows that nurses are more likely to be overweight, have higher levels of stress, and get less sleep. As the largest and most trusted health care profession, nurses are critical to the health of the nation. Healthy nurses are great role models for their patients, colleagues, families, and neighbors.

  1. Register to join “Healthy Nurse, Healthy Nation™ Connect”
  2. Take the health assessment survey and get a heat map of your health risks.
  3. Pick your focus area(s), make a health commitment, and participate in health challenges.

                          Activity   Rest   Nutrition  Quality of life    Safety

  1. Connect with others for support, advice, and share successes.
  2. Repeat the survey annually to see how far you’ve come!


To Join Now:



Working Out And Staying Fit In Medical School and Residency!

Antonio J. Webb, M.D.
       Published on Oct 29, 2017

In this video, Dr. Webb discusses working out and staying fit while in residency.


Antonio J. Webb, M.D.
       Published on Oct 29, 2017

In this video, Dr. Webb discusses working out and staying fit while in residency.





Matt Ryan’s Cause: Care and Support for Preterm Babies and Their Families


November 28, 2018

This Sunday, when the Falcons play the Ravens, you’ll see Matt Ryan wearing a new pair of blue cleats. The March of Dimes, a non-profit that works to support the health of mothers and babies, will be printed on his right shoe; Northside Hospital Miracle Babies, a program to support families of preemies born at the Atlanta hospital, will be printed on the left. Ryan’s cleats will be auctioned off to raise money for both organizations through the NFL’s My Cause, My Cleats platform, but the Falcons quarterback and dad to nine-month-old twin boys also has a very personal reason behind his choice.

It was a Tuesday morning last January, and we were getting ready to the play the Eagles in last year’s divisional round of the playoffs. I was at work, in a normal quarterbacks’ meeting that we have. I had my phone with me, only because I knew my wife, Sarah, had a doctor’s appointment that day.

We’d found out she was pregnant during training camp, and we were both so excited. It was something that we had been trying for, for a long time. And then when we found out she was having twins, that was a special day, too. We were happy and excited and nervous—all of the things that go along with that.

Twin pregnancies are always high-risk, so Sarah was going in for regular doctor’s appointments bi-weekly, if not more, throughout her entire pregnancy. She went in on this Tuesday morning for what was supposed to be a routine check-up. And then she called me and said she was getting admitted to the hospital.

Sarah had a complication with her pregnancy at 24 weeks and five days.

It was around 8:15 a.m. when I got the call, and I left the Falcons facility and stayed at the hospital with her the rest of the day through the next morning. We were just trying to get as much information as we could. It was still so early in her pregnancy. When they talk to you about the percentages of survival with children being born at that gestational age, that’s a scary and terrifying time.

That week before the Eagles game was touch and go. We were unsure as to what was going on, what was going to happen. The game was a huge opportunity for us as a team, and I was excited about that, but obviously I was most concerned with the well-being of my family. You don’t want to leave; you want to be able to be there and support her in any way that you can. We had reassurance from the doctors that things were stable before I left for Philadelphia, and we were lucky that Sarah was able to have family come down to be with her while I was gone.

After we lost to the Eagles, the next five weeks were basically spent at Northside Hospital, in Room D8. Sarah’s mom, Susie, came and stayed with us, and we alternated staying overnight with Sarah. We watched TV, read books, played cards. She and her mom were really into Gin Rummy, and we oddly played a lot of Uno, which was just kind of a brainless way to pass the time. It’s not easy having to be on bed rest, not able to leave a room for six weeks, but not once was Sarah restless or angry or anything like that. She’s incredibly selfless.

The one thing we both learned through this process is that each day that the babies were able to stay inside was huge. So each day that passed, each week that passed, the amount of development for our boys was monumental. We’re so fortunate she was able to keep them in there as long as she did, to give our boys a really good chance. Sarah has an unbelievable strength to her that I knew was there, but when you go through something like that, it opens your eyes to it even more.

Feb. 21 started out like every other day in the hospital. I left to get in a workout, and I got a call in the early afternoon that Sarah was uncomfortable. I went back, and the doctors and nurses got her a little bit more comfortable. We ordered some take-out salads for dinner around 6 p.m. By 7 p.m., she was in labor. I think anybody who has been in the room when children are born knows it’s an unbelievable experience. With our boys being premature, we also had a little bit of a crew in the room. The hospital had a team of five or six nurses and doctors each, waiting to take them up to the neonatal intensive care unit (NICU).

Our boys were born at 30 weeks and six days. Marshall was first, weighing 2 lbs., 15 oz. Seven minutes later, Johnny arrived. He was 2 lbs., 14 oz. They were small, but they were strong. Sarah’s maiden name was Marshall, and John is a family name for both of us. Johnny’s middle name is Matthew, and Marshall’s middle name is Thomas, the same as mine, so it was cool to be able to give each of them each a little bit of my name. Sarah was able to hold both babies, but within about 10 minutes of being born, they were taken upstairs to a different part of the hospital. I went up there, and a different group of doctors were running all kinds of tests.

We were really fortunate to receive the care that we did. While Sarah was in the hospital, she had access to medicines to help prevent premature labor. Our boys were able to get two rounds of steroid injections for their lungs so their breathing was really good when they were born, which was critical in their success. They were able to be taken off breathing assistance within the first week that they were born, which was huge. They were off the high-flow support for their lungs within 10 days or so, though Johnny had to go back on a couple different times. This is one reason why we are supportive of the March of Dimes, because they do so much research into medicines like these that can help moms and babies.

You never really know how things are going to shake out when babies are born prematurely. They give you a window of time that they might need to stay in the NICU if there are no complications, and it’s usually around when they would be born full-term. Part of the reason that Sarah chose Northside Hospital was because of the NICU specifically. It’s widely known as one of the best NICUs in the country. With a high-risk pregnancy with twins, that was something that was really important to us.

It was a stressful time. During the boys’ stay in the NICU, early on there was more restriction on the amount of time they could be outside of the incubator. Once every eight hours for an hour was roughly the amount of time that you could have them out and with you. We got into a pretty good routine of going back three times a day at different shifts so we were able to spend time with them. One of the things they said is best for their development is skin-to-skin contact, so you’d take both of the boys out of the incubator and you would hold them up against your chest. We would read to them a lot, just fill them in about what was going on, talk to them. In the early stages, that was really all we could do.

As they matured in the NICU and they were in open-air cribs, and you could be there whenever you wanted. Sarah was nursing the boys while they were there, and we would bathe them. Our days were spent at their cribside. The boys each had a hotline number, so you could call in overnight and check on how they’re doing. If you woke up during the night. you would call. And you’d call first thing in the morning. You also have that Northside NICU number saved in your cell phone, and they would call you with updates. Any time you would see that number come through, your heart would start racing.

Marshall came home first. He spent five weeks in the hospital and left at 5 lbs, 5 oz. You’re so proud and happy for him to be coming home, but it’s also tough when he’s leaving his brother, and you’re leaving his brother, who still has to be at the hospital. That was a hectic week, trying to take care of Marshall at home and still make sure Sarah was at the hospital as much as she could to help with Johnny. A week later Johnny came home, just a little bit heavier than Marshall. That was a really special day, to have everybody at home together for the first time.

We’re so thankful that our life brought us to Atlanta, and that Sarah’s pregnancy took us to Northside, and for the unbelievable care we got there. Sandy Jun was the main doctor who took care of both of our boys during their extended stay in the NICU, and Gretchen Koontz from Atlanta Maternal-Fetal was Sarah’s doctor during her hospital stay. And then the countless nurses and people who helped us during both the day and night shifts. They are dealing with you in a situation that’s stressful and difficult, and they’re so patient and so good to the children there.

Those were long days, but the time went by quickly. Our boys are nine months old now, and they’re doing awesome. I remember being able to fit them in my hand. They’re getting big now. They’ve been fighters from Day One.

I want other families going through this to know they’re not alone. But we’re also sharing our story to create awareness for finding ways to help babies who are born prematurely and providing our doctors with every opportunity to give these kids the best chance. It’s the first time we’ve supported either of these charities and hospital, but this is just the beginning for us. This is just one small piece of what we plan to do to try and help Northside and the March of Dimes.

I think back to that day in January when Sarah was first admitted to the hospital. That was the scariest time, because we had no idea how things were going to go. All you want to hear is what can be done to help your sons. We want to help other families get the same help we did.


Kathy: Organ donation was not available to me when my son Cruz (Kat’s twin brother) died and I do not know if any of his organs (24 weeks. gestation) would have been viable for donation. I would have pursued donation if that had been an option. Dust in the Wind (Reference song by Kansas – 1998), or life in the wind.  I would choose life!


Of Tragedies and Miracles — Neonatal Organ Donation  NEJM

Beatrice E. Lechner, M.D. – November 29, 2018

Baby K. was born at full term after an uncomplicated pregnancy, with sweet baby thighs, adorable little hands and feet, and a soft crown of wispy hair. But at 5 days of age, rather than snuggling with his mother and breast-feeding, he was lying on a cooling blanket in a neonatal intensive care unit (NICU), attached to a ventilator, monitors, and IV fluids. When his hypothermia therapy for encephalopathy ended that day, he underwent an EEG and an MRI. I’m sure his parents suspected what these tests would reveal, but it broke my heart to have to put their worst fears into words.

Over the years, I’ve had many difficult conversations with parents about devastating test results and the possibility of shifting an infant from curative care to comfort care. Some parents react with denial, some with anger. Others take the initiative in choosing redirection of care, and some quietly acquiesce to my guidance. As the team and I sat down to talk with Baby K.’s parents, I thought I’d seen the full spectrum of possible parental reactions.

But without waiting for my explanations or opinions, Baby K.’s father said something I’d never heard a newborn’s parent say: “We would like to donate his organs.”

Tears erupted from the few eyes in the room that had managed to remain dry.

Then we leapt into action — or tried to. This was my first experience with neonatal organ donation, and I had no idea how rarely that process took place. I was keenly aware that I didn’t know what steps I needed to take, and that nobody else seemed to know either.

The first stumbling blocks we encountered were our own assumption that infants with significant organ injury could not be organ donors and our doubt about whether it was possible to diagnose brain death in a neonate — and if not, whether organs could be donated anyway. We learned that day that some level of injury to organs may be acceptable: neonatal organs are hard to come by, so transplant surgeons make case-by-case decisions based on the condition of both the organs and the recipient. A baby who would otherwise die soon may benefit from a less-than-healthy organ, whereas a baby who is stable may be better off waiting.

As the day stretched into night, I learned that what I’d been taught about neonatal brain death during training was incorrect. I’d believed that brain death can’t be diagnosed in neonates for physiological reasons, but in fact there were simply no well-disseminated guidelines for this age group. The 1981 Guidelines for the Determination of Death covered patients 5 years of age or older, and the 1987 American Academy of Pediatrics (AAP) guidelines expanded the criteria to cover patients as young as 7 days old.

We spent that long night trying to reconcile the fact that the organ bank could not legally accept an organ from a patient who had not been declared dead with the fact that I could not conscionably declare a 5-day-old brain dead because it wasn’t standard practice. We felt that we couldn’t give up until we’d found a solution for Baby K.’s family. They were willing to give so much even as they were losing so much that I could not refuse their gift on the basis of technicalities. As we sat in the team room discussing options with the organ bank coordinator and our hospital risk manager, I remembered Thomas Edison’s famous words: “I have not failed. I’ve just found 10,000 ways that won’t work.”

Then serendipity stepped in. The neonatology fellow on call that night had been a chief resident at a neighboring children’s hospital. Wondering what the pediatric intensive care unit (PICU) at that hospital did in these situations, he contacted the on-call PICU attending. That intensivist happened to be on a committee charged with developing a new pediatric brain-death policy for the PICU, and she had just received a draft of it. She had not yet read it, but she was willing to share it with us. Although it was designed for an older population, the draft policy pointed us toward the AAP guidelines for the determination of brain death in children, an update to the 1987 recommendations that included guidelines on the determination of brain death from birth onward for infants born at 37 weeks’ gestation or later.1 Even the people we’d spoken to at the New England Organ Bank (NEOB) had not been aware of these 2011 guidelines.

Despite the guidelines, pediatricians’ ability to define and apply the concept of brain death leaves substantial room for improvement, so it’s not surprising that cases of neonatal organ donation are rare. Between 1988 and 2013, there was a yearly average of 100 U.S. organ donors under 1 year of age. In the New England region, the average was 1.5 per year, according to the NEOB, and Women and Infants Hospital, home of the only level IV NICU in Rhode Island, had had no organ donations at all between 2000 and 2013. Furthermore, over the previous 28 years, only two neonatal organ donations had occurred in the entire New England region. All of this strongly suggests that before Baby K.’s parents proposed donating his organs, there had never been a neonatal organ donation in the state of Rhode Island.

As my colleagues and I worked to help Baby K.’s parents achieve their goal, I wondered whether neonatal organs are not being donated because NICU physicians are unaware of the donation criteria and so are missing many possible donors or whether there are actually few newborns who meet the criteria. Recent retrospective studies of theoretically suitable cases indicate that though it’s unlikely that a large number of potential donors are being missed, there is room for improvement in physicians’ awareness.3,4

Baby K.’s father asked me why he had to be the one to raise the question of organ donation. I think the complex answer is that we often believe that the family will find the idea too difficult to bear, we may be too uncomfortable ourselves to take the necessary steps, and we may assume that a given newborn wouldn’t qualify as a donor.

Ultimately, the strength that Baby K.’s parents showed launched a cascade of unanticipated good. First and foremost, they saved another baby’s life, thereby “saving another family from the anguish [they] were living through,” as they put it. But they did more than that.

They allowed the NICU team to feel not just the sadness and failure that we experience when a baby dies under our care, but also the comfort of knowing that we were part of something miraculous. Although we could not save our patient’s life, we played at least a small role in saving another baby’s life — and so saw a faint light that we had not seen before. Baby K. and his family reminded us not only that miracles in medicine may sometimes arise out of the deepest tragedies, but also that patients and their families may offer their care providers such profound gifts as humility, strength, and inspiration.

And Baby K. and his parents challenged us to expand our clinical horizons beyond our comfort zone by educating ourselves. They thereby opened the door to future lifesaving donations: we now have a policy for neonatal organ donation and have been teaching our staff and trainees about the process.

During our final family meeting, Baby K.’s parents asked me to raise awareness about neonatal organ donation so that in the future more parents of dying newborns are offered the choice and more babies’ lives can be saved. If we actively screen for qualified donors, perhaps we can avoid missing so many opportunities to turn heartbreaking tragedy into bittersweet success.





Regenerative Therapies for sick term and preterm born infants

Posted on 08 June 2018

An interview with Professor Mario Rüdiger, Professor for Neonatology and Pediatric Intensive Care Medicine, Head of Department at the Neonatal Research Group at the University Hospital Dresden, Germany

photoWhat was the idea behind the planned project?

In the past decades, improvements in feto-neonatal care have significantly reduced mortality. Long-term morbidity however, still represents a major problem. Most prominent disease entities with a feto-neonatal origin are chronic lung disease of preterm infants, sepsis and brain injury. Though affecting hundred thousands of patients every year, these diseases are of little interest to the industry.

Scientific evidence suggests a beneficial effect of regenerative therapies in these disease entities, with the most promising intervention being based on mesenchymal stromal cells (MSC)[1]. Whereas MSC have become standard therapy in some adult diseases, translation into neonatal routine care was hampered by the lack of firstly, a cell product of clinical grade that can be used in newborns and secondly, well-performed clinical studies testing these cells.

That’s where our project offers solutions to overcome these problems.

What are mesenchymal stem cells?

MSC are considered somatic stem cells which possess the potential to adapt to the microenvironment of injured organs and to regulate the healing process by secreting various factors. Therefore, they have also been termed “medicinal signalling cells” which ameliorate severe complications of diseases. MSC will not stay within the host tissue but will disappear after about two weeks. Therefore the risk of potential long-term complications is very low and the cells are considered to be safe.

What will you be doing in the project?

Our group has developed a way to manufacture MSC from the umbilical cord tissue of healthy term born infants in a high quality and has thereby opened a unique chance of successfully transferring MSC-based therapies into neonatal routine.

Based on that technique, we, the MASC-collaboration will establish the prerequisites for getting the MSC licensed for chronic lung disease of preterm infants. Therefore, we will conduct four clinical trials in Europe, Canada and the USA. The results from these trials will then be analysed together in a meta-analysis based on single patient data.

Furthermore, we will investigate prospectively further applications of MSC in newborns, focusing on brain-injury, sepsis and on the patient/parent perspective.

What is the aim of the “MASC-n-EU” project?

The European MASC-collaboration dedicates its effort with the “MASC-n-EU” project (“MSC to Ameliorate Severe Complications in Newborns in Europe”) to introduce umbilical cord-MSC-based therapy into neonatal care, with a special focus not only on treating but also preventing diseases originating in the feto-neonatal period. By providing a medicinal product specifically developed for the use in newborns we are addressing a great need and will improve the health of children in Europe.

Which professional areas will be involved?

The European MASC-collaboration dedicates the combined expertise and enthusiasm of leading scientists, clinicians, patient organisations, regulatory authorities and industry to make MSC-based regenerative therapies an integral part of clinical routine in newborns. Thereby, the European collaboration is embedded in a strong international network of experts, ensuring the success and sustainability of the project.

Thank you Prof. Rüdiger, for giving us insights into this innovative project.

[1] multipotent stromal cells that can differentiate into a variety of cell types.





16 Apps and Websites to Help Young Adults Stay

Healthy and Fit

Millennials and young adults are taking care of themselves. Using apps and websites to enhance their healthy lifestyles is an obvious choice for this tech-loving generation.

We reviewed the 16 recommended APPS and all will appeal to many of us for varying reasons. We found the APPS listed below especially interesting!

7 minute workout

The 7-minute workout uses the exerciser’s body weight to create exercises that build strength and muscle, rather than having to go to a gym or use equipment. While the app is free, some of the programs need to be purchased, most for a nominal fee.

Couch to 5K (C25K)

C25K takes couch potatoes and exercise slackers and slowly moves them from sitting to running a 5K (3 miles). The time period for this evolution is 2 months, and there’s a strong, supportive community available online for those in the program.* Tailored for first time runners

Map My Fitness

If your young adult runner is a traveler, Map My Fitness is a handy tool to help him or her find the best and most convenient running routes in cities around the world, and it syncs to other fitness apps to keep track of miles run and calories burned.


Rise is a weight loss program that is Tailored to the individual, backed by scientific research, focuses on healthy living and uses daily accountability to keep clients on track. Also unique to Rise is their photo-based communication between user and coach/trainer. With an emphasis on helping busy people stay on track, Rise is popular with millennials who are on the go and working long hours.




My Beloved Warriors: This month’s blog marks our three year anniversary of exploring, looking at, listening to, communicating with and immersing ourselves in our very large, diverse, and wonderful preterm birth community. The communities we have explored instruct and humble us to our core. You and I are survivors; our community has provided us with critical support and we will all work to understand, assess and treat our future health and wellness needs. Many of us have been reliant on the support of others to sustain our lives in very unique ways. For some of us taking on the responsibilities of caring for our own health and wellness needs may be quite daunting. When I look at the world at large I see humanity in need of collaboration. I am a recipient of so many gifts and I ask myself what will I contribute?  The beauty of looking at the whole world through the eyes of a preterm birth survivor is that I am transformed on a regular basis through exposure to our amazing preterm birth community in  every part of the world. Recently, I have become increasingly aware of how large our community is, and how our health and well-being is affected by the global community at large. Developing countries have taught us every bit as much as the so-called developed nations.  Maternal and infant health and mortality are not dependent on a nation’s net worth, but rather on that nation’s values, wisdom, humanity and vision.

I am sharing the article below because although in the USA preterm birth survivors themselves currently represent an estimated 9-12% of the infant/youth and young adult population we need to consider not only our prematurity-specific healthcare needs but the general healthcare issues confronting youth and young adults in our local nation as we are a part of that family as well.

So let’s put our phones away when we drive, call an Uber if tired or intoxicated, educate ourselves regarding guns and gun control, recognize and take appropriate action if we suspect a friend who seems to be depressed may cause harm to themselves or others. My Mom says, “Dead kids aren’t fun kids”. She would know… Let’s live with joy, connect with love and collaborate with curiosity and intelligence.

eat.jpgThe Problem for Children in America

  • Edward W. Campion, M.D.

Children in America are dying or being killed at rates that are shameful. The sad fact is that a child or adolescent in the United States is 57% more likely to die by the age of 19 years than those in other wealthy nations. In 2016, there were more than 20,000 deaths of Americans 1 to 19 years of age. Physical injury accounted for 61% of this tragic total. As the Special Report by Cunningham et al.2 in this issue of the Journal documents, America’s children and adolescents are at far higher risk for death than are youth in other developed countries such as England, Sweden, and Australia.

The death of a child is a crime against nature. These tragedies leave enduring pain and may be the most stressful thing that can happen to parents and siblings. The devastated families take no comfort from the fact that childhood deaths are now far less common than they were in centuries past. In recent decades, there has been progress, but the United States is clearly not effectively protecting its children.

The problem is not deficiencies in medical care; it is the high rate of lethal traumatic injury. Firearm injury, the second leading cause of death, is only a minor contributor to childhood mortality in other developed countries. Cunningham et al. report that in 2016, children and adolescents in the United States were more than 36 times as likely to be killed by gunshots as their counterparts in other high-income countries. The grim statistics include suicides, which occur mainly in adolescents and which accounted for 35% of firearm-related deaths and 13% of all deaths among children and adolescents in 2016.

The largest single cause of child and adolescent deaths is motor vehicle crashes, which account for 20% of such deaths. In 2016, the U.S. rate of death from motor vehicle crashes (5.21 per 100,000 children and adolescents) was more than triple that in other developed countries, a finding consistent with other international comparisons. There has been substantial improvement in this rate over the past 20 years in this country, mainly thanks to safety engineering in car construction and road design. However, between 2013 and 2016, mortality from car crashes increased, most likely owing to the distracting and dangerous use of cellphones by both drivers and pedestrians. This is an area in which tougher laws and enforcement can save lives, but perhaps new technological solutions will be necessary to help keep eyes on the road rather than on small screens.

The biggest barrier to preventing the many deaths from injury is the sense of helpless inevitability conveyed by the word “accident.” Car crashes and lethal gunshots are not random results of fate. Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma. Strong leadership by the medical and public health communities is needed. Education, awareness, and very feasible interventions can help protect children and adolescents from the six top causes of death from trauma, namely those related to motor vehicles, firearms, suffocation, drowning, drug overdose or poisoning, and fire or burns. Our country has led the way in so much medical research, but the facts summarized by Cunningham et al. reveal a need to invest far more in research on the prevention of the injuries that threaten the lives of children and adolescents.

Progress will not be easy. The approach to this underrecognized public health problem has to be social as well as technological, and the risks are highest in areas of poverty and social isolation. Essential medical care should be guaranteed for every child in the country. That care needs to include access to the social supports and mental health services that promote health and safety and save lives. Such a commitment would be an investment in the next generation that can promote family stability and healthy development while reducing the underlying causes of trauma and violence. Laws and programs are also urgently needed to improve gun safety, and these initiatives need the support of those on all sides of the contentious political debates about guns. Here, the medical community is in the best position to take the lead. The guiding principle should be to save the lives of children.

We are living in a divisive era in which there are few areas of consensus and agreement. Perhaps one of the few core beliefs that all can agree on is that deaths in childhood and adolescence are tragedies that we must find ways to prevent. Shouldn’t a child in the United States have the same chance to grow up as a child in Germany or Spain or Canada? We ought to be able to agree that in a country with America’s wealth and resources, children should have the opportunity to live, play, and grow to become adults.


World’s Most Extreme Nighttime Stunts in Switzerland!

surf.jpgdevinsupertramp   Published on Nov 17, 2017- Lume Cube, creator of The World’s Most Versatile Light, brought some of the world’s greatest athletes to Interlaken, Switzerland to step out of their comfort zones and into the night!




Vietnam, Resources, Progressive Preemie Families


Vietnam, officially the Socialist Republic of Vietnam, is the easternmost country on the Indochina Peninsula. With an estimated 94.6 million inhabitants as of 2016[update], it is the 15th most populous country in the world. Life expectancy has risen by two years for males and females in Vietnam between 2000 and 2012. This is half of the average rise in life expectancy for other parts of the world during the same time period.

Malnutrition is still common in the provinces, and the life expectancy and infant mortality rates are stagnating. In 2001 government spending on health care corresponded to just 0.9 percent of gross domestic product (GDP). Government subsidies covered only about 20 percent of health care expenses, with the remaining 80 percent coming out of individuals’ own pockets.


Estimated Preterm Birth RatesBorn Too Soon

Vietnam: Rate: 9.4%     Rank: 103 Global Average: 11.1         USA: 12.0




WHO-recommended newborn care cuts life-threatening infections by two thirds   15 January 2019

A study in Viet Nam by the World Health Organization (WHO) shows that hospitals can reduce life-threatening infections in newborns by over two thirds and admissions to the neonatal intensive care unit (NICU) by one third by implementing Early Essential Newborn Care (EENC).

Published in EClinicalMedicine (The Lancet journal focused on clinical and public health research), the study titled “Early Essential Newborn Care is associated with reduced adverse neonatal outcomes in a tertiary hospital in Da Nang, Viet Nam: A pre-post intervention study” presents evidence that EENC strengthens health workers’ skills and improves care. These lead to increased rates of skin-to-skin contact and exclusive breastfeeding, and significant reductions in hypothermia, sepsis and NICU admissions.

“A newborn dies every 2 minutes in this Region, but full implementation of EENC could prevent up to half of these deaths,” explained Dr Howard Sobel, Coordinator for Reproductive, Maternal, Newborn, Child and Adolescent Health in WHO’s Western Pacific Region and co-author of the study.

Other studies in Asia have shown that health worker practices around birth are often outdated and harmful, leading to increased risks for babies of sepsis (a dangerous infection in the bloodstream), hypothermia (dangerously low body temperature) or death. Despite the availability of knowledge and tools, the quality of care can be compromised by the lack of clear policy guidelines, availability and allocation of staff, supportive work environments, and other issues.

EENC is a package of simple, evidence-based clinical care practices recommended by WHO. It focuses on improving the quality of care during and immediately after birth. Central to EENC is the “First Embrace” – a prolonged skin-to-skin cuddle between mother and baby, which allows proper warming, feeding and umbilical cord care. Key actions include: thorough drying; immediate skin-to-skin contact; clamping the cord after pulsations stop; cutting the cord with a sterile instrument; and initiating exclusive breastfeeding when the baby shows feeding cues, such as drooling, tonguing, rooting and biting of their hand.

Aside from the bond it fosters, the First Embrace helps transfer warmth, placental blood, protective bacteria, and through colostrum (the first breast milk) essential nutrients and immune cells to protect from infection. All babies can benefit, including those born preterm, sick or by caesarean section.

Study findings

The Da Nang Hospital for Women and Children in central Viet Nam, where about 14 000 babies are born every year, implemented EENC through on-the-job coaching of staff on appropriate childbirth and newborn care in 2014 and 2015. A quality improvement approach was subsequently implemented to address factors such as local policies, organization of work spaces, health worker roles, sequencing of tasks, and availability of supplies and equipment.

“EENC has transformed the care that babies receive in our hospital. The package of procedures is practical, and it can be implemented anywhere,” said Dr Hoang Tran, Deputy Director, Da Nang Hospital for Women and Children.

The study compared live birth outcomes and NICU admissions in the 12 months before and after EENC was introduced. Data revealed that, after EENC implementation, sepsis cases fell by two thirds (from 3.2% to 0.9% of babies born in the hospital), NICU admissions fell by one third (from 18.3% to 12.3%), and hypothermia cases fell by one quarter (from 5.4% to 3.9% of babies admitted to the NICU).

Before EENC was introduced, skin-to-skin contact was not practised. Babies born vaginally were routinely separated from their mothers for at least 20 minutes, and those delivered by caesarean section for 6 hours or more. After implementation of EENC, 100% of babies received immediate skin-to-skin contact regardless of route of delivery.

The percentage of babies in the NICU born preterm (less than 37 weeks of gestation) or with low birthweight (less than 2.5 kilograms) receiving “kangaroo mother care” increased by 15% after EENC was introduced. Kangaroo mother care – continuous skin-to-skin contact for more than 20 hours per day, early and exclusive breastfeeding, and close monitoring of illness – reduces newborn deaths by up to half.

With EENC, the rate of exclusive breastfeeding in the NICU almost doubled. Exclusive breastfeeding is when a baby receives breast milk only – no formula, water or anything else. WHO and UNICEF recommend this as the ideal way to feed babies for their first 6 months. These improvements occurred during the study period despite a significant increase in the proportion of babies born by caesarean section and with low birthweight, which are barriers to breastfeeding.

Direct and indirect savings

The study also found additional benefits of EENC for hospitals and families. As a result of increased breastfeeding, parents of babies in the NICU and those on the postnatal ward spent 78% and 96% less on infant formula, respectively. Families also saved money thanks to shorter hospital stays and less time off work. As a result of reduced NICU admissions, the hospital saved more than US$ 300 000 and reduced staff workload. There was also reduced antibiotic use.

“The findings of our study are relevant way beyond Viet Nam. All hospitals – in rich and poor countries alike – can learn from this experience to improve newborn health. I’ve seen harmful practices across more than 20 low- and middle-income countries. Our job is to help health authorities, doctors, nurses and midwives replace those practices with evidence-based ones. We know that EENC works. We now need to finish the job and make it available to every mother and newborn across the Region,” Dr Sobel added.


US opposition to UN breastfeeding resolution defies evidence and public health practice

Date: Jul 09 2018 – Contact: David Fouse, 202-777-2501

Statement from Georges Benjamin, MD, Executive Director, American Public Health Association

Washington, D.C., July 9, 2018 – “We are stunned by reports of U.S. opposition to a resolution at the World Health Assembly this spring aimed at promoting breastfeeding. According to news stories, U.S. officials attempted to block a resolution encouraging breastfeeding and warning against misleading marketing by infant formula manufacturers.

“Fortunately, the resolution was adopted with few changes, but it is unconscionable for the U.S. or other government to oppose efforts that promote breastfeeding. The consequences of low rates of breastfeeding are even greater for the health of children in resource-poor countries.

“Breastfeeding is one of the most cost-effective interventions for improving maternal and child health. Breastfeeding provides the best source of infant nutrition and immunologic protection. Babies who are breastfed are less likely to become overweight and obese, and have fewer infections and improved survival during their first year of life. Breastfed infants often need fewer sick care visits, prescriptions and hospitalizations. In addition maternal bonding is increased, a benefit to both mother and child.

“The scientific evidence overwhelmingly supports breastfeeding and its many health benefits for both child and mother. The American Public Health Association has long supported exclusive breastfeeding for the first six months and continued breastfeeding through at least the first year of life. APHA also strongly supports policies that encourage breastfeeding at home, maternity hospitals and birth centers and the workplace, and help identify women most in need of support of breastfeeding practices.

“In cases where mothers are unable to breastfeed, there are evidence-based solutions to protect the mom and ensure the baby thrives. The solution to malnutrition and poverty is not infant formula, but improved economic development and access to domestic and international nutrition and food programs.”

APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a nearly 150-year perspective and brings together members from all fields of public health. Learn more at


Aspirin for all pregnant women may reduce preterm birth

Bob Kronemyer Jul 9, 2018

Growing evidence that aspirin can prevent preterm birth (PTB) was presented at the 3rd European Spontaneous Preterm Birth Congress in Edinburgh, Scotland. Adding to data later this summer will be results from an open-label randomized, controlled trial (RCT) of low-dose aspirin with early screening for preeclampsia and growth restriction.

A review of the current evidence and perspective on its clinical implications were presented by Fionnuala McAuliffe, MB BCh BAO (Honours) DCH MD FRCPI, FRCOG FRPI. Dr. McAuliffe is principal investigator of the RCT and chair and professor of obstetrics and gynecology at University College Dublin in Ireland. The trial is an acceptability and feasibility study of low-risk women taking aspirin and their compliance and scheduled to be published in BMJ Open.

Addressing the Congress attendees, she said that “a number of studies point to the effectiveness of aspirin taken by pregnant women. At the moment, the data shows that aspirin reduces preeclampsia and preterm birth in women who are at risk for preeclampsia.”

In the United Kingdom, aspirin is often prescribed to prevent preeclampsia, but not as often in the United States. “Aspirin reduces both preeclampsia and preterm deliveries in women at risk for preeclampsia,” Dr. McAuliffe said. “If preeclampsia is reduced, then preterm birth is also reduced…You could argue that it might simply be cheaper to give everyone aspirin rather than trying to figure out if a certain individual is at risk of pre-eclampsia or not by conducting expensive blood and ultrasound tests in early pregnancy,” she said.

Aspirin is an antiplatelet agent that improves blood flow and vascular formation in the placenta by reducing the thromboxane and increasing the vasodilator prostacyclin. “Preeclampsia, of course, is a disease of the placenta that results from a placenta not developing properly from very early in pregnancy,” Dr. McAuliffe explained. “The association between preterm birth and preeclampsia is strong. If a woman develops preeclampsia prior to 37 weeks, she will need to deliver because of the risk to her health.”

As for safety, many studies conclude that aspirin has no adverse fetal sequelae in doses less than 150 mg per day and that aspirin does not increase the risk of congenital malformations. However, one study found that vaginal bleeding is more common: 3.9% for low-dose aspirin versus 1.3 for placebo.

The data to support aspirin date back more than 10 years, showing that the drug reduces risk of PTB by 7% to 14%. “This is robust data compiled from more than 40,000 women at risk of preeclampsia,” Dr. McAuliffe said. “The question then becomes can we extrapolate the data to all pregnant women?”

Dr. McAuliffe cited examples of women who are given aspirin only during a follow-up pregnancy after experiencing preeclampsia during their previous pregnancy. “These women are concerned that they were not offered aspirin to begin with,” she said. “Thus, there is interest in offering aspirin to all pregnant women.”

However, currently there is no concrete evidence that aspirin reduces the rate of preeclampsia in low-risk women.

Numerous studies of women who are at risk for preeclampsia show a risk reduction with daily aspirin, with a decrease in preeclampsia ranging from 17% to 24%, a decrease in PTB of between 8% and 14% and a reduction in small for gestational age (SGA) spanning from 10% to 20%.

Specifically, a multicenter, randomized placebo-controlled trial of low-dose aspirin (80 mg) to prevent recurrent preterm labor in 406 women found that incidence of PTB < 37 weeks’ gestation was reduced by 35%, as reported in BMC Pregnancy and Childbirth in 2017.

Similarly, for the same gestation period, incidence of PTB fell by 20%, according to a study of 11,920 nulliparous mothers in seven low- and middle-income countries who were given aspirin supplementation during pregnancy, again as reported in BMC Pregnancy and Childbirth in 2017.

Dr. McAuliffe was co-author of a viewpoint in the American Journal of Obstetrics and Gynecology in 2016 that posed the question: Should we recommend universal aspirin for all pregnant women? In support of the proposal, the authors listed efficacy in at-risk women, safety, cost and international impact. “Aspirin is incredibly inexpensive,” Dr. McAuliffe said. “It can be easily stored at room temperature, so potentially there is a huge international impact.”

Two reasons against the recommendation are lack of evidence of efficacy in low-risk women and potential side effects.

The trial of aspirin to prevent preeclampsia (TEST), for which Dr. McAuliffe is the principal investigator, was carried out at two hospitals in Ireland to determine if low-risk, first-time mothers would be interested in taking aspirin during pregnancy and actually adhere to the protocol of once-daily aspirin (75 mg).


Of the 1,054 eligible women approached to participate in the study, 52.8% agreed. And of the 179 women who were randomized to take aspirin, 96% complied with the protocol. “In the United States, the dose is quite similar at 80 mg,” Dr. McAuliffe noted. When study patients were asked if they would be willing to take aspirin during a subsequent pregnancy, 92.5% of those who took aspirin and 91.5% of those who did not said yes.

A separate study conducted by Dr. McAuliffe and colleagues, which has been submitted for publication, is a cost-effectiveness analysis of aspirin in 21,641 low-risk nulliparous women in Ireland. The economic analysis compared universal aspirin to a Fetal Medicine Foundation screening test and then offering aspirin to those who screened positive.

“We found that it was less expensive to give everyone aspirin rather than detecting within the population those who are at risk of preeclampsia, and then prescribing low-dose aspirin,” Dr. McAuliffe said.

The universal aspirin net savings was estimated as roughly $1.8 million, whereas universal screening and treatment tallied about $1.7 million annually for Ireland. “These data, if extrapolated to the United States, would amount to very considerable savings,” Dr. McAuliffe said.

However, before recommending universal aspirin, “we need to research and further consider the consequences,” Dr. McAuliffe said. “But it is important to start that conversation. I am cautiously optimistic that both clinicians and patients may embrace aspirin for all pregnant women.”



Managing Low Birth Weight in Rwanda

Posted July 25, 2018

“It would have been very painful and harmful if we had lost our firstborn,” Laurence Uwamahoro says as she breastfeeds her newborn son.

Laurence lives in Murehe, a rural region of eastern Rwanda, with her husband, Jean d’Amour Nduwimana, and their newborn, Yvan. Jean d’Amour sits next to his wife as she breastfeeds, continually smiling at his son.

“We have to keep enjoying our union,” he says of life with their new son. “We would have been narrating a very sad story, but it didn’t happen.”

The story of this new family began two months after Laurence and Jean d’Amour married, when a test confirmed Laurence’s pregnancy. But as the couple began enthusiastically preparing for birth, Laurence felt increasingly ill. She sought care at the nearest health center, but continued to worsen until she was six months pregnant – and felt the symptoms of her labor beginning.

“On my way to the hospital, my mind was elsewhere. I was only thinking of funeral ceremonies, because I had no hope that my baby could survive,” Laurence says. By the time she arrived at the health center, her membranes had prematurely ruptured and she was bleeding – signs of placenta abruption.

She soon delivered a very premature Yvan. Weighing only 800 grams (1.7 pounds) at birth, he met the World Health Organization’s definition as “extremely low birth weight” (less than two pounds, three ounces). The nurses who helped Laurence deliver immediately transferred both mother and baby to Kibungo Hospital to receive higher-level care only available in the hospital’s neonatal unit.

Thankfully, Laurence and Yvan were received at Kibungo Hospital by MCSP-trained nurses and midwives, who confidently continued their care. In collaboration with the Rwanda Ministry of Health, Rwanda Biomedical Center, and national professional associations (including the Rwandan Pediatric Association), MCSP is improving the capacity of the country’s health care providers to manage the acute care needs of babies like Yvan through on-site trainings and clinical mentorship.

Kibungo Hospital’s neonatal ward staff had benefited from multiple weeks of targeted MCSP training on Basic Emergency Obstetric Care and Essential Newborn Care, after which a mentor had visited each trainee bi-monthly for several months to ensure they were applying their new skills correctly. These efforts are part of MCSP’s overarching capacity building strategy for Rwanda, which uses clinical training to address the leading causes of death for children under five and pregnant women. To date, the Program has trained more than 12,000 doctors, nurses, midwives, lab technicians, and community health workers from 16 districts in areas such as infection control, resuscitation, and newborn treatment protocols.

One such provider is Midwife Christine Mujawimana, who used her new skills to continue Yvan’s treatment for three months, as his weight steadily rose to 2 kilograms (4.4 pounds). “That was my first time I received such a low weight baby,” she said. “But with the training from MCSP, we all felt confident that Laurence’s baby had to survive.”

The care Yvan required to survive was extensive, but the trained hospital staff was up to the task. After placing him in an incubator, they began implementing Yvan’s treatment according to national neonatal protocols: administering intravenous fluids, diagnosing and treating an infection with antibiotics, giving him a blood transfusion due to anemia and phototherapy for jaundice, and placing him on a Continuous Positive Airway Pressure machine for respiratory distress syndrome.

They also knew to give him expressed breast milk by nasogastric tube. Thanks to their MCSP training, the hospital’s providers learned to use this method for all low birth weight babies who lack a sucking reflex – typically those who weigh less than 1.5 kilograms (3.3 pounds) at birth. Later, when babies acquire a sucking reflex, the providers know to encourage breastfeeding and supplementation with expressed breast milk using a feeding cup (until breastfeeding alone meets a baby’s needs).

After stabilizing Yvan, the staff taught Laurence how to hold him in Kangaroo Mother Care. This continuous skin-to-skin contact not only keeps low birth weight babies warm, it also increases their nutrition by promoting frequent and exclusive breastfeeding.

Three weeks after he was discharged from the hospital, Yvan’s weight had increased to a stable 3 kilograms (6.6 pounds). Laurence and Jean d’Amour were thrilled! And as their concerns about their son’s weight faded, they finally began to enjoy parenthood as they imagined it when Laurence was first pregnant.

“Our baby is healthier now. We thank all the nurses and everybody who played a big role in having our baby survive,” Jean d’Amour says.

Written by Evariste Bagambiki, MCSP Communications Assistant, Rwanda
(with support from Ingabire Muziga Mamy, MCSP Communication Specialist, Rwanda)




My Neonatal Story – From a Novice to Advanced Neonatal Nurse Specialist

My story started seven years ago when I graduated from nursing school as a general nurse at the University of Rwanda in 2011. Shortly afterwards, I was appointed by Ministry of Health to work at the Rwanda Military Hospital (RMH) and when I arrived at the hospital I was allocated to work in the Neonatal Unit. It was not my choice to work in the Neonatal Unit. My preference was to work with adults and not neonates, but it was an order and I had to follow it.

I was terrified to work in the neonatal unit! I did not have any prior knowledge or skills to care for neonates. I did not get any neonatal training course during my nursing studies and it was my first time to enter a neonatal unit. So when I entered the neonatal unit, every thing was new to me. There was no identified person in charge of my orientation or an orientation program for new graduates. Instead, I was given the task to read the National Neonatal Guidelines; though I could not understand all the content. The senior nurses on the unit were too busy and did not have time to train me. However, I did my best to learn some neonatal skills from senior nurses, though due to the staff shortage I only had two weeks orienting to the neonatal unit.

Consequently, every single day spent on the neonatal unit was filled of worries, as my lack of neonatal knowledge and skills made me fearful to be alone monitoring the neonates. I hated lunchtimes as someone had to stay on the unit mentoring neonates and I did not like being that one nurse left behind by myself.

After one year of working in the neonatal unit, I had the first opportunity to be trained in neonatal resuscitation, though the expression, “the more you know, the more you fear” suddenly applied to me. After the training, I realized that my skills were harmful to neonates rather than helpful. I was saddened to realize that I had spent the whole year on neonatal unit without knowing how to hold the Ambubag and mask, and to provide positive pressure ventilation to the neonate. I could not stop blaming myself, thinking about all the neonates I had seen dying and perhaps with good skills I may have been able to save them.

A few months later in 2012, I had the opportunity to meet a neonatal nurse from the USA who came as a mentor at RMH as part of the Human Resources for Health (HRH) program. I was most fortunate to work with Vicky Albit a neonatal nurse. It was through her mentorship that enhanced my abilities and confidence to care for neonates. Since then, caring for neonates has become my passion!

My hospital organized a critical care workshop for nurses who wanted to work in neonatal and adult intensive care units, which were new services to the hospital. Selected nurses had intensive care courses and neonatal courses during a three-week period. After the workshop, only five nurses were interested in working in the Neonatal Intensive care unit (NICU) and they were sent for four-weeks training at King Faisal Hospital (KFH), the only hospital in Rwanda with a NICU. For the first time, I saw a neonate on mechanical ventilation. I was afraid to touch the baby, but through help with my mentor, I was taught how to care for a neonate on mechanical ventilation. Even though the clinical placement was brief, I gained the knowledge and skills to care for very sick neonates.

After the clinical placement at KFH, we were ready to open our NICU at RMH. We had more training sessions on medical equipment to use in our NICU including monitors, incubators, radiant warmers, CPAP machines, ventilator machines, syringe pumps, infusions pumps, ABG machine and others. At the opening of our NICU, I was given the hard task of unit manager of the new service and worked with my mentor to create clinical guidelines, protocols and policies. I faced many challenges to mange our new four- bed capacity NICU with shortages of trained staff, and lack of essential consumables and drugs. In addition, it was hard for the hospital administration to understand the needs of the new NICU in terms of nurses, consumables and drugs.

I remember how we prepared to receive our first NICU patient; we were ready with the medical equipment, drugs, nursing team and doctors. After many efforts to save the first patient – who was in septic shock with severe neonatal sepsis – the patient died. I remember how disappointed and discouraged I felt after that first attempt ended in failure. I was wrong to think that by having a NICU we would be able to provide life-saving care to all babies.

After the opening of our NICU, I worked with the neonatal nurse for another two months and I did my best to learn as much as I could, as I was the one now mentoring my colleagues. I could not imagine how we would be able to take care of the very sick neonates without our mentor. I had to take hold and control of everything; supervising and mentoring both the experienced and new nurses on the unit. A few days after our mentor had left RMH, a nurse who was caring for a sick neonate on mechanical ventilation called me, “Chief, please come and help me with the endo-tracheal tube as it is not well fixed and may displace easily.” I responded to the nurse, but I was terrified as I was not good at taping the ETT. But I said to myself, I have done this with my mentor, so I have to do it. I helped the nurse secure the ETT and we did it well. I was forced to do many skills because I was the assigned leader.

Even though I was considered to be the one with knowledge and skills in our NICU, I felt a gap in my training and I wished I could go to university to study neonatology. I had a role model in mind; I wanted to be like Vicky Albit the HRH neonatal nurse that I had met. After two years of leading our NICU, I finally had the opportunity to be in the first cohort of the Master’s of Science of Nursing – neonatology track – at the University of Rwanda.

It was not easy to study in the masters program; as I had to go to school three days a week and work four days a week. Though I was now a bedside nurse taking care of neonates in the NICU and no longer dealing with unit manager responsibilities. It was difficult balancing the demands of school, work, and family, but nothing could stop me! I was truly committed and I wanted to become a neonatal nurse. After two years of working hard, I graduated with a Master’s of Science in Nursing, in the specialty track of Neonatology. I am proud to be a neonatal nurse; I have gained a lot of knowledge and skills from school and the experiences of working in the NICU.

I have returned to the NICU unit manager position at RMH, where we still have the four- bed capacity due to limited medical equipment, with only two working CPAP machines and two ventilator machines. Our NICU is always full and we have a high demand for NICU services.

We face many challenges including lack of trained health care providers. There is only one neonatologist in the country; unfortunately he does not work at RMH, though I wish I could work with him.

The care that we provide to our neonates is limited as many times we have low or lack resources in our clinical settings. I see babies who could have been saved with surgical interventions, if we had more surgical resources. I see babies who died after surgery because of poor post-surgical management, such as lack of total parenteral nutrition. I see many preterm babies who died because they needed advanced therapy like surfactant. I see babies who died because they needed antibiotics that were not available or the family could not afford them. I see babies who died because of limited medical equipment such as ventilators or CPAP machines.

To work and manage a NICU in a resource-limited country is not easy; each day we struggle to give the best care we can to our neonates. The flowing is an example of our on-going situation.

A preterm baby who recovered well in the NICU post CPAP progressed to Kangaroo Mother Care (KMC). All of the NICU team was happy for such an achievement and I was happy to see the mother holding the baby in KMC. The following morning I entered the unit to see the nurses doing resuscitation and I was shocked to see that the baby that they were resuscitating was our KMC baby. I remained calm and quiet, and did not ask how the baby had gone in to respiratory failure. I was busy thinking ahead about the possibility of a ventilator machine, as we only had two and they were being used.

Neonates are amazing. The baby was moving the limbs, but without any spontaneous breathing needed intubation, as well as a ventilator machine. When I looked around I saw the baby’s mother in tears and I remembered how happy she was the previous day holding her baby. Then the on-call pediatrician notified me that King Faisal Hospital, the other hospital with ventilator machines, had no available machines for our KMC baby. The pediatrician advised me to inform the family that we did not have a ventilator machine and that we were going to discontinue positive pressure ventilation. It was a very sad situation to let a baby die because we did not have a ventilator machine. I told the pediatrician that we would find a ventilator machine for our baby. We had two machines in our NICU that were not in use because they were lacking spare parts. I was thinking that with the help of a biomedical technician we could find a working machine. I was trying to assemble the necessary equipment, when I saw the baby’s mother in tears. I did not want to face her, but I did, and I told her that we were doing everything possible to find a ventilator machine that could help her baby breathe. During that time of comfort, she wiped her tears and told me that she trusts us.

While we waited for the biomedical technician to come, I instructed the resident Pediatrician to intubate the baby for better ventilation. I was confident that we would have a working ventilator machine soon. The nurses on the ward alternated doing hand ventilation. After two hours the biomedical technician had repaired one machine and we put the baby on. The baby was doing well on the ventilator machine and all the team was happy. Unfortunately, the machine only worked for about four hours, when a nurse told me, “Your machine crashed, it’s no longer ventilating the baby.” I was very sad as the nurse said, “YOUR machine crashed;” it was my responsibility to find another machine. The remaining machine was missing some spare parts that had been requested, but not yet delivered. In the meantime, I pushed the chief of biomedical services to do all he could to get the missing spare parts; it took more hours to get the spare parts and to repair the machine. Finally, the machine was repaired, and the baby was put on the machine again. The day was full of stress with many ups and downs, but finally ended well with success. The following days, I was happy to see the baby improving and to see the mother joyful once again. The baby had a quick recovery; was discharged from the NICU and is now doing well in KMC.

To be a neonatal nurse is not only delivering routine nursing care to sick neonates, it is going that extra mile (kilometer) and being present for babies and their families in NICU. In my daily activities, I am supportive of families that are worried about the outcome of their sick babies and I grief with families when we cannot save a baby. I feel happy when a baby recovers and graduates from the NICU; by either going to KMC in neonatal unit or going home. I work with a formidable team of nurses and midwives, who have not had the same opportunities as me to study neonatal, but they work hard day and night, and are dedicated to the care of neonates.

They are enthusiastic and willing to learn and I wish that they could all have an advanced neonatal course.

We have many challenges as nurses and midwives trying to establish a professional neonatal career path as it is still under development in Rwanda; there is no clear scope of practice, and even the MScN neonatal degree is not yet recognized by all Rwanda institutions. I am a member of the newly formed Rwanda Association of Neonatal Nurses (RANN). It is a new association, but I have a strong conviction that it will go far to promote a neonatal professional career and will undoubtedly improve neonatal outcomes in Rwanda.

I am working at a national referral hospital in Rwanda, one of the best neonatal units in the country, though our level of care is limited. I know the evidence based practice and I wish I could see and learn from other NICUs, both in resource-limited countries and high-income countries, where they use advanced technologies and practice. I will never be discouraged because I know that one day neonatal care will be a priority in my country and that we will have a high standardized NICU with well-trained health care providers and enough advanced medical equipment to save more lives.

This blog is cross-posted from the COINN website. This blog is also part of the HNN collection, Telling Your Story: transforming care for small and sick newborns. If you have a story to share about transforming care for small and sick newborns, send a 300-600-word blog about your experience or research to



Decision-making at the limit of viability: Differing perceptions and opinions between neonatal physicians and nurses

RESEARCH ARTICLE-Open Access   Decision-making at the limit of viability: differing perceptions and opinions between neonatal physicians and nurses Hans Ulrich Bucher1*, Sabine D. Klein1, Manya J. Hendriks1,2, Ruth Baumann-Hölzle3, Thomas M. Berger4,Jürg C. Streuli2, Jean-Claude Fauchère1and on behalf of the Swiss Neonatal End-of-Life Study Group

Abstract Background: In the last 20 years, the chances for intact survival for extremely preterm infants have increased in high income countries. Decisions about withholding or withdrawing intensive care remain a major challenge in infants born at the limits of viability. Shared decision-making regarding these fragile infants between health care professionals and parents has become the preferred model today. However, there is an ongoing ethical debate on how decisions regarding life-sustaining treatment should be reached and who should have the final word when health care professionals and parents do not agree. We designed a survey among neonatologists and neonatal nurses to analyze practices, difficulties and parental involvement in end-of-life decisions for extremely preterm infants. Methods: All 552 physicians and nurses with at least 12 months work experience in level III neonatal intensive care units (NICU) in Switzerland were invited to participate in an online survey with 50 questions. Differences between neonatologists and NICU nurses and between language regions were explored. Results: Ninety six of 121 (79%) physicians and 302 of 431(70%) nurses completed the online questionnaire. The following difficulties with end-of-life decision-making were reported more frequently by nurses than physicians: insufficient time for decision-making, legal constraints and lack of consistent unit policies. Nurses also mentioned a lack of solidarity in our society and shortage of services for disabled more often than physicians. In the context of limiting intensive care in selected circumstances, nurses considered withholding tube feedings and respiratory support less acceptable than physicians. Nurses were more reluctant to give parents full authority to decide on the course of action for their infant. In contrast to professional category (nurse or physician), language region, professional experience and religion had little influence if any on the answers given. Conclusions: Physicians and nurses differ in many aspects of how and by whom end-of-life decisions should be made in extremely preterm infants. The divergencies between nurses and physicians may be due to differences in ethics education, varying focus in patient care and direct exposure to the patients. Acknowledging these differences is important to avoid potential conflicts within the neonatal team but also with parents in the process of end-of-life decision-making in preterm infants born at the limits of viability.




The Power of Breast Milk in the NICU (Full)

Medela US – Published on Nov 20, 2017

For premature babies, breast milk is more than food – it’s medicine. See how it’s transforming lives in the NICU.

Breastfeeding a Boon to Preemies’ Hearts: Study

Improvements seen in function and size 20 years later – By Alan Mozes – HealthDay Reporter

TUESDAY, June 14, 2016 (HealthDay News) — Breast-feeding premature babies appears to increase the likelihood that those infants will have healthier hearts in young adulthood, new research suggests.

The finding was based on an analysis involving just over 200 men and women in their early- to mid-20s. It suggests that premature infants fed just breast milk during infancy ultimately have better heart volume and overall function compared to preemies raised on formula or a mixture of formula and breast milk.

“It was completely unknown that breast milk would provide this particular protective effect on the development of the heart in babies born preterm,” said study author Paul Leeson. He’s the clinical director of the Cardiovascular Medicine Division of the Cardiovascular Clinical Research Facility at the University of Oxford, in England.

“We suspected it might, but were surprised by the size of the effect,” he added.

The study authors pointed out that premature babies often go on to develop long-term heart abnormalities. Those can include small heart chambers, thicker heart walls and impaired heart function. The first few months of life are considered a critical period in terms of development of the heart, the researchers said.

To see what effect breast-feeding during infancy might have, the researchers followed 102 people born preterm in the 1980s who were part of a larger study on feeding regimens. At the time, half of that group was assigned to receive breast milk, while the other half was given formula. Ultimately, 30 were fed solely breast milk, while 16 were given “nutrient-enriched” formula only during early postnatal life.

They were compared with another 102 people born full-term from the same time period.

The researchers conducted heart testing when all the participants were between 23 and 28 years old.

As expected, participants who were born premature had reduced heart volume and function compared with those carried to term. But those born premature and fed exclusively with breast milk had greater heart volume than preemies fed only formula.

The study only found an association between heart health and breast milk. And, the impact of breast milk appeared to be incremental. That meant that those whose feeding mix included more breast milk than formula ended up with greater heart volume and better functioning hearts than those whose diets included more formula. What we have now found is that, although exclusive breast milk does not alter the wall thickness, it does mean the hearts of adults who were born preterm get closer in size to those of adults born at term and the function of their hearts is better,” Leeson said.

Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City, said “the benefits [of breast milk] for premature infants are enormous.” Wu was not involved with the study.

“In the short term, there are protective antibodies and the production of important gut flora,” she said. “In the long term, breast-feeding improves heart structure and function.”

But at the same time, Wu added that “breast-feeding can be a challenge for moms with premature infants.”

“Due to Newborn and Infant Critical Care Unit admissions and longer hospital stays, breast-feeding can be difficult to initiate and maintain,” she said. “Extra support and lactation consultations are needed.”

The study was published online June 14 in Pediatrics.  WebMD News from HealthDay




Bonding With Your NICU Baby

green.jpgMountainStar Health Published on Nov 30, 2016

Christine Van Orden is a Registered Nurse in the NICU at Eastern Idaho Regional Medical Center, and shares what you can do to bond with your NICU baby.


Parents’ Hearts Melt Seeing 6-Year-Old Boy Give Preemie Baby Brother Skin-To-Skin  1010 Wins Published on Jul 25, 2018

After years of asking his parents for a baby brother, Mikey finally got his wish. And this photo of him cuddling little Jake is melting hearts. Mikey’s parents Jessica and Michael had complications arise during the pregnancy. Little Jake was born premature at 30 weeks and weighed just one pound, 12 ounces and was only 12-inches-long. He spent over two months in the NICU.



Impact of preterm birth on parental separation: a French population-based longitudinal study


Objective The objective of this study was to investigate both the effects of low gestational age and infant’s neurodevelopmental outcome at 2 years of age on the risk of parental separation within 7 years of giving birth.

Design Prospective.

Setting 24 maternity clinics in the Pays-de-la-Loire region.

Participants This study included 5732 infants delivered at <35 weeks of gestation born between 2005 and 2013 who were enrolled in the population-based Loire Infant Follow-up Team cohort and who had a neurodevelopmental evaluation at 2 years. This neurodevelopmental evaluation was based on a physical examination, a psychomotor evaluation and a parent-completed questionnaire.

Outcome measure Risk of parental separation (parents living together or parents living separately).

Results Ten percent (572/5732) of the parents reported having undergone separation during the follow-up period. A mediation analysis showed that low gestational age had no direct effect on the risk of parental separation. Moreover, a non-optimal neurodevelopment at 2 years was associated with an increased risk of parental separation corresponding to a HR=1.49(1.23 to 1.80). Finally, the increased risk of parental separation was aggravated by low socioeconomic conditions.

Conclusions The effect of low gestational age on the risk of parental separation was mediated by the infant’s neurodevelopment.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.


EDUCATIONAL NEONATAL WOMB COMMUNITY RESOURCES                                     MANDATE: Maternal and Neonatal Directed Assessment of Technology                             The Mandate Approach and Goal


Team members include RTI economists, epidemiologists and engineers, as well as consultants and subcontractors, including Dr. Robert Goldenberg, an obstetrician with broad clinical and research experience in low-resource settings and Dr. Alan Jobe, a neonatologist with extensive research experience in newborn health. MANDATE also utilizes input from key frontline practitioners in India and sub-Saharan Africa.

MANDATE included an Advisory Group with expertise in maternal and neonatal health, technology development and implementation, modeling, and philanthropy.

MANDATE includes an interactive, computer-based, quantitative model that compares the potential number of lives saved across maternal and neonatal technologies. Users can identify and isolate the potential impact of a technology by patient category, region, and setting. The tool is available for public use free of charge.



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Resources for: Researchers, Publishers, Librarians, Educators/Trainers, Healthcare Professionals, Public

Products and Services: PubMed/MEDLINE. MeSH. UMLS. Medline Plus. LocatorPlus, Digital Collections



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Gregg Braden and Bruce Lipton speak on The Truth, The Journey Within

Gregg Braden & Bruce Lipton speak on the science of the mind-heart connection. Modern science shows that the human heart creates the single most powerful electrical field in the human body, about 60-100 times more powerful than the human brain.


Did my entrance into the world, my subsequent heart surgery, my preemie experiences, the amazing healers that touched my soul  guide my path towards becoming a surgeon? How do I know this path is the right one for me?

I know this path is right direction at this time because on this path my heart expands and the beat of my heart excites me and carries me forward into the  mystery that awaits. I feel passion and a yearning to serve.

This past weekend on my way to cadaver anatomy lab I ran into a professor/surgeon who was stuck in the hallway (he forgot his access card in his office and was locked in). This doctor whom I had not met previously  is involved in the type of surgical care systems work that captures my attention. The meet-cute was a reminder to me that no meeting is accidental, and mindfulness and presence allows us to connect in wonderful mysterious ways.

Kiteboarding Trip in Vietnam-Windsurfing also Filmed by DGapone






Born Too Soon – Preterm Birth Rates

Rate: 11.5     Rank: 66

(USA Rate: 12.0%     Rank: 54)


Afghanistan officially the Islamic Republic of Afghanistan, is a landlocked country located within southcentral Asia. Afghanistan is bordered by Pakistan in the south and east; Iran in the west; Turkmenistan, Uzbekistan, and Tajikistan in the north; and in the far northeast, China.

Afghanistan is a unitary presidential Islamic republic with a population of 31 million, mostly composed of ethnic Pashtuns, Tajiks, Hazaras and Uzbeks. It is a member of the United Nations, the Organisation of Islamic Cooperation, the Group of 77, the Economic Cooperation Organization, and the Non-Aligned Movement. Afghanistan’s economy is the world’s 108th largest, with a GDP of $64.08 billion; the country fares much worse in terms of per-capita GDP (PPP), ranking 167th out of 186 countries in a 2016 report from the International Monetary Fund.

Health in Afghanistan is unsatisfactory but slowly improving. The Ministry of Public Health oversees all matters concerning the health of Afghanistan’s population. According to the Human Development Index, Afghanistan is the 15th least developed country in the world. Its average life expectancy at birth is reported at around 60 years. The country’s maternal mortality rate is 396 deaths/100,000 live births and its infant mortality rate is 66 to 112.8 deaths in every 1,000 live births.

There are over 100 government-run and private or internationally-administered hospitals in Afghanistan. The most advanced medical treatments are available in Kabul. The French Medical Institute for Children and Indira Gandhi Children’s Hospital in Kabul are the leading children’s hospitals in the country. The Kabul Military Hospital and the Jamhuriat Hospital are two of the popular hospitals in the country. In spite of all this, many Afghans still travel to Pakistan and India for advanced treatment



Our Focus for this blog is PREVENTION

Global prevention of preterm birth, maternal and infant mortality. Preventing/reducing PTSD for survivors, families and providers. Preventing and reducing health care provider shortages.



The Improvement of Health Care in Afghanistan – June 2016

Since 2002, the improvement of health care in Afghanistan has been great. According to USAID, “9 percent of Afghans lived within a one-hour walk of a health facility.” Today, over 50 percent of the population has access to a health care facility, the infant and child mortality rates have decreased and maternal mortality rates have declined as well.

The country’s turbulent history, filled with war and internal strife, has contributed a deteriorated health care system. The old Taliban regime stifled access to adequate medical facilities and professionals. With the help of groups like UNICEF, WHO and USAID the Afghan people are seeing tremendous progress within their country.

On May 16, 2016, a campaign to vaccinate every child under five years of age for polio was launched.

Afghanistan and Pakistan are the only two countries still struggling against the illness. According to WHO, the campaign could put an end to the disease in the next few months.

This is just one example of the efforts being made to improve health care in Afghanistan. U.S. support in the country has also led to success in fighting tuberculosis. Data from 2012 reports daily TB treatments to have a 91 percent success rate.

Women’s health has improved immensely over the last decade. With the help of the U.S. government, more trained midwives were available in Afghanistan. As a result, by 2010, 60 percent of women had care prior to birth. This is an enormous step forward from 2002 when only 16 percent had this same access.

Despite its progress, the country still has a long journey ahead in improving the health care system. According to the Thomas Reuters Foundation, nearly 1.2 million Afghans have been internally displaced.

These individuals have little to no access to healthcare, which is a major problem as they also struggle for food and clean water. Violence against medical facilities has not helped the issue either. In 2015, 42 people were killed in a Doctors Without Borders hospital in Kunduz.

Increased foreign aid and peace efforts are necessary to solve the health care crisis in Afghanistan. This will involve supporting organizations already involved in the country as well as increased pressure on foreign governments for humanitarian action.

Saroja Koneru



Bringing health care to Afghanistan’s vulnerable women


Published on Mar 12, 2014


Improving women’s access to medical care is helping reverse troubling trends in Afghanistan, one of the world’s most dangerous places to bear children.


The high price of premature births

Caitlin Mullen, Bizwomen contributor -Nov 6, 2018   bizwomen – The Business Journals

A March of Dimes report card shows the preterm birth rate has worsened from the previous year in 30 states.

As the country’s preterm birth rate rises again, health professionals and organizations say they’re taking steps to address issues like inequitable access to prenatal care.

The March of Dimes premature birth report card notes the rate of premature births rose to 9.9 percent in 2017 in the U.S, up from 9.8 percent in 2016. In looking at all 50 states, the District of Columbia and Puerto Rico, the maternal and infant health nonprofit reports the rate has risen for the third year in a row.

“Premature birth and its complications are the largest contributors to infant death in this country and globally,” per the report card. November is Prematurity Awareness

Earlier this year, Johns Hopkins University researchers reported that American babies are 76 percent more likely to die before turning one than babies in other wealthy countries like Canada, France or Japan, per Vox.

March of Dimes reports high stress levels can cause a baby to be born premature — earlier than 37 weeks — or a baby that weighs less than 5.5 pounds, and those born too small or too soon face greater risk for other health problems. An American Academy of Pediatrics study has found children born prematurely face higher risk of hospitalizations, doctor visits, and societal costs down the road.

Reasons for preterm birth can vary, but March of Dimes points to inequities in quality health care across the country; rates are higher in poverty-stricken communities.

Race, too, plays a part from the womb. Women of color are 50 percent more likely to deliver a preterm baby, and babies of color experience a 130 percent higher death rate than white infants, the report states.

In the past few years, racial disparities have worsened, NPR reports. Chronic stress from racism may be to blame: research has shown it’s connected to a greater risk of preterm birth among black women.

Giving birth prematurely brings greater risks for moms, too. Mothers of babies born prematurely experience a high rate of postpartum depression, and researchers now recognize the experience associated with having a baby receive care in a NICU can lead to post-traumatic stress disorder, per The Atlantic.   

“The experience of the neonatal intensive-care unit, the birth of a premature baby — it’s a very different kind of trauma from what we call single-incident trauma, like someone in a car accident or even a sexual assault,” Dr. Richard J. Shaw, psychiatry and pediatrics professor at Stanford University’s Lucile Salter Packard Children’s Hospital, told The Atlantic.

The monetary cost of preterm birth is another blow. One study found preterm births cost employer-sponsored health insurance plans $6 billion. Even after insurance coverage kicks in, parents might be on the hook for hundreds of thousands of dollars. 

The March of Dimes report card showed the preterm birth rate had worsened from the previous year in 30 states. Mississippi and Louisiana were the states with the highest rates, at 13.6 percent and 12.7 percent. Vermont, with a rate of 7.5 percent, was the only state to receive an A grade.

Among the country’s cities with the highest number of births, Irvine, Calif., had the lowest rate — 5.5 percent — while Detroit had the highest, at 14.5 percent.

But progress was made in some states, with efforts like greater collaboration among March of Dimes, state officials and health care providers in Rhode Island; addressing issues like smoking and early elective deliveries in Raleigh, N.C.; and tailored programs like group prenatal care in Knox County, Tenn. Each location saw its preterm birth rate drop.

Group prenatal care may be making a difference in South Carolina, too. Per Vox, infant deaths there have dropped 28 percent since 2005, and experiments like Dr. Amy Crockett’s — holding large group appointments where women receive prenatal care — could be a contributing factor.

Women who’ve gone through these appointments are less likely to have premature babies, Vox reports, and appreciated that the group appointments offered a bit of community with women in the same situation.

“South Carolina has absolutely been at the forefront, from a state perspective. I think they do serve as a model for what can be done nationwide,” Jessica Lewis, Yale University infant health researcher, told Vox.



The availability, well-being, safety and development of our Neonatal Womb/Preterm Birth Community healthcare partners must be a community priority. Our access to healthcare is critical to the health and vitality of our community.


Violence against health workers

Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression. Most violence is perpetrated by patients and visitors. Also in disaster and conflict situations, health workers may become the targets of collective or political violence. Categories of health workers most at risk include nurses and other staff directly involved in patient care, emergency room staff and paramedics.

WHO, ILO, ICN and PSI jointly developed Framework guidelines for addressing workplace violence in the health sector to support the development of violence prevention policies in non-emergency settings, as well as a questionnaire and study protocol to research the magnitude and consequences of violence in such settings. For emergency settings, WHO has also developed methods to systematically collect data on attacks on health facilities, health workers and patients.



Attacks on Health Care in Afghanistan: January 2018 – October 2018

We are sharing this article/data to represent an example of healthcare targets of collective or political violence. Violence and lack of healthcare access significantly traumatizes our neonatal womb/preterm birth community globally, increasing preterm birth rates and infant and maternal mortality.

Map from World Health Organization, US Agency for International Development, Health Cluster Published on 20 Oct 2018



Taking steps to prevent violence in health care workplace

We are sharing this article as an example of healthcare targets perpetrated by patients and visitors.

06/14/16  amy    Amy Farouk

A new report by the AMA Council on Science and Public Health responds to increasingly common violence directed at physicians and other health care professionals where they work, looking at the trends in violence, solutions that have been tested and barriers to addressing the problem. The AMA adopted policy to help prevent violent acts in the health care setting.

An unacceptable hazard of the job

The U.S. Bureau of Labor Statistics reports that workplace assaults from 2011 to 2013 were 23,540-25,630 annually, with upwards of 70 percent occurring in health care and social service settings. Health care workers are three to four times more likely than other private sector employees to sustain injuries that involve days of work missed.

“Emergency department, mental health and long-term care providers are among the most frequent victims of patient and visitor attacks,” the report said. “A nationwide survey of emergency medicine residents and attending physicians found that 78 percent of respondents had reported at least on workplace violence act in the previous year, and 21 percent had reported more than one type of violent act.”

Addressing violence: Barriers and steps

One of the biggest obstacles to fully understanding the scope of the problem and taking corrective action is the fact that many incidents go unreported. “Reasons for not reporting can be as simple as health care workers not knowing what constitutes an act of workplace violence or a reporting process that is too cumbersome and time consuming,” the report said. “Other reasons for not reporting include a perception that workplace violence is ‘normal’ or a part of the job, fearing the response they may receive when reporting these events (blaming the victim), and lacking support from leadership to encourage reporting.” Some hospitals and health systems are taking steps to prevent violence, according to the report. They range from more traditional facility safety to more clinical approaches. Henry Ford Hospital in Detroit, for instance, has installed metal detectors at its entrances to prevent people from bringing weapons into the buildings. In the first six months of screening, the hospital confiscated 33 handguns, 1,324 knives and 97 chemical sprays.

The Veterans Health Administration, meanwhile, flags patient records to help clinicians and others identify patients who may pose a threat to themselves or others. Patients are flagged in tiers, one for those who are high risk for violent or disruptive behavior based on a history of violence and credible threats, and another for patients with other high-risk factors, such as drug-seeking behavior, a history of wandering or spinal cord injuries.

Physicians call for enforced standards

Delegates at the 2016 AMA Annual Meeting adopted policy that calls on all parties to take an active approach to increase the safety of health care workers:

  • New policy calls on the Occupational Safety and Health Administration to develop and enforce a standard addressing workplace violence prevention in health care and social service industries.
  • The AMA will encourage Congress to provide additional funding to the National Institute for Occupational Safety and Health to further evaluate programs and policies to prevent violence against health care workers, and asks the National Institute for Occupational Safety and Health to adapt the content of their online continuing education course on workplace violence for nurses into a continuing medical education course for physicians.
  • The AMA is urging all health care facilities to adopt policies to reduce all forms of workplace violence and abuse; develop reporting tools that are easy for workers to find and complete; make prevention training courses available; and include physicians in safety and health committees.
  • Updated policy also encourages physicians to take an active role in their safety by participating in training to prevent and respond to workplace violence threats, report all incidents of workplace violence and promote a culture of safety within their places of work.

“As violent incidents continue to plague hospitals, emergency departments, residential care settings and treatment centers, we must do everything we can to protect the health and well-being of our health care workers,” AMA Board Member William E. Kobler, MD, said in a news release. “We urge the federal government to develop and enforce a federal standard for health care employers to help shield health care workers from workplace violence.”



Why Physicians Are More Burned Out Than Ever

liz.pngElizabeth Métraux -Dec 7, 2018

I sat knee to knee with a nurse practitioner at a school-based clinic in rural Ohio. Choking back tears, she described a patient she couldn’t get out of her head: a middle-school girl, accompanied by her mother and a social worker. Just days prior, the girl was dropped off at her father’s home for the weekend. Before the promised Friday night football game, she discovered him unconscious on the bathroom floor. Within the hour, paramedics were laying a sheet over his body. Another victim of an opioid overdose in a region of the country that has been devastated by the epidemic.

That was only part of the story.

As I spoke with the NP, she described the girl entering the exam room, listless and distant. Mom was shouting at the social worker and insisting it was a “good thing” the girl’s father was “finally” out of the picture. Her daughter would get over it, she said.

The NP noticed the girl furiously scratching the back of her head. She lifted the girl’s hair to examine her scalp.

Lice. Hundreds of nits covered the girl’s head, with spots rubbed raw and scabbed over. She had likely had them for weeks, maybe longer. The girl looked down at her feet in shame. Her mother, picking up on the encounter, eyed her daughter with disgust.

“And just like that,” the NP said, “the mother left. She just left. She couldn’t stand to look at her own daughter.” She began to cry.

“How do you process that?” I asked.

What we’re witnessing isn’t a failure to thrive in America’s clinics; it’s a failure to act in America’s communities.

Through sobs, she said she doesn’t. It just stays with her. For herself and colleagues like her — soldiers in the trenches of our nation’s health care system — she says, “It hardens us all. It’s the poverty and the brokenness and the addiction and the inequity and the hate. But what can we do? The public won’t act, so we have to.”

Her story is no different than hundreds I’ve listened to over the course of the year — along the southern border, in community health centers, in prisons, on Native American reservations, in the hallways and exam rooms of some of the most esteemed academic medical centers in our country.

I listened to these stories as part of my work with Primary Care Progress, a national nonprofit working to strengthen primary care teams and clinicians. As I spoke with several health care providers about the realities of their work, I expected to hear the usual concerns: the rise of the electronic medical record, cumbersome administrative burdens, the frenetic pace and long hoursThese pain points certainly came up.

What I didn’t expect to discover, however, was our own central role — my role as a patient and member of the public — in so much of their professional trauma. Burnout is a real issue, and we’re contributing to it.

It’s easy for those of us on the outside the burnout epidemic to wonder why professionals so skilled at healing seem unable to heal themselves. Indeed, who among us doesn’t feel overworked and undervalued?

But there’s something deeply disturbing about this growing crisis in medicine. What we’re witnessing isn’t a failure to thrive in America’s clinics; it’s a failure to act in America’s communities.

Take, for example, the brutal shooting in Thousand Oaks, California, this past November. In a hospital waiting room, a trauma surgeon changed her bloodied scrubs. She stood in front of a bathroom mirror to rehearse the name of a victim so she didn’t accidentally say the name of the one she worked on an hour earlier. Then, donning her starched white coat and well-trained detachment, she met with the family to notify them that their 22-year-old son was dead. Her team had done all they could. She was sorry. Later that day, she mourned the deaths. Alone.

Days later, a row between the National Rifle Association and health care professionals ensued over the NRA’s remarks that doctors should “stay in their lane” when it comes to gun violence. Providers hit back with a powerful, viral social media campaign to draw attention to their critical role in treating victims of gun violence.

While the NRA and clinicians nationwide debated the issue, an important point was missing from the dialogue: Gun violence shouldn’t have to be physicians’ responsibility; preventing it should be in the public’s responsibility.

Yet there are countless ways in which we — the public — abdicate that responsibility, instead putting the onus on clinicians to treat victims of our hate, our neglect, and our bigotry. Community health workers offer care in homeless encampments and outpatient drug treatment facilities nationwide. Nurses treat thousands of children in detention facilities on America’s southern border. Health care providers work with millions of incarcerated men and women in our country’s overcrowded prisons.

At a recent visit to a community health center in suburban Seattle, I asked a group of doctors to share the best part of their week. One clinician noted that after days of negotiating with a local power company, she was able to get her patient’s electricity turned back on. “It was important,” she said, “because she’s on medication that requires refrigeration.” Another glowed when talking about the clinic’s new food pantry that had opened to serve its food-insecure patients.

All that is laudable — and an absolute travesty. It’s a sobering testament to the fact that America is content to neglect social and structural determinants of health.

William Osler famously remarked, “Listen to your patients; they’re telling you their diagnosis.” We also need to listen to our clinicians. Story by story, they’re telling us that our nation is in crisis.

Those of us who aren’t in clinics or emergency rooms every day can look away when we see injustice. Health care professionals don’t have that luxury. While they’re checking their clothes to make sure there’s no visible blood before they break the news to a family, the rest of us listen to so-called experts tell us it’s “too soon” to address gun reform in the wake of another mass shooting. While an oncologist tries to figure out how to treat a mother’s cancer when she can’t afford her medications, policymakers explain why it would be imprudent to tackle health care coverage or rising prescription costs.

Our health care providers don’t get to turn a blind eye to symptoms of America’s divisions and inactions. They also don’t get to decide who deserves treatment. The victim or the shooter. The immigrant or native born. The nationalist or the progressive. For clinicians, they’re all patients. But health care professionals do suffer the consequences of inaction.

William Osler famously remarked, “Listen to your patients; they’re telling you their diagnosis.” We lso need to listen to our clinicians. Story by story, they’re telling us that our nation is in crisis. Too many people are dying too unnecessarily from too many treatable conditions by too many factors that we can control.

Sure, no one likes the electronic medical record. But that’s not at the heart of burnout. Inaction is driving our collective burnout — not just in health care, but in all care. Again and again, providers across the country are put in a position of saying, “We did all we could.”

They may have done all they could, but the rest of us haven’t.

Why should the public care about the well-being of a well-heeled workforce? Because when the problem is on us, so is the solution. Instead of asking physicians if they’re burned out, let’s start asking: Did we do all we could to heal our nation? Maybe then we can be a part of healing the healers.

A special thanks to Dr. Krisda Chaiyachati for your important contribution to this piece.



Reducing Health Care Burnout: Preventive Tips for Organizations & Caregivers

Working in the healthcare industry can be both gratifying and challenging. The unrelenting chronic stress of being exposed to life and death issues, long hours and loads of work can progressively evolve into burnout. If fact, the odds are pretty high that burnout will affect every healthcare professional at some point in their career. Burnout is defined as the consequence of mental and physical exhaustion that is caused by stress resulting in depersonalization and a profound decrease in personal accomplishment.

Working in this high-stress industry can become emotionally draining, especially when hospitals are understaffed; the caregiver can begin to experience emotional exhaustion, and fatigue. All of this can lead caregivers to an emotional detachment from their work and to begin to see patients as objects, thereby reducing the safety and quality of care provided.

According to a study by NSI Nursing Solutions, the average national turnover rate among all hospital healthcare workers is 16.5%. And the costs are high:

  • Each additional percentage point increase in turnover can cost the average hospital another $359,650
  • It takes hospitals between 36 to 97 days to hire a replacement for an experienced RN
  • The average cost of turnover for a bedside RN ranges between $44,380 and $63,400To prevent burnout, employers should create a culture that sustains resilience and supports employee wellbeing. It’s important to take the time to identify the signs and symptoms of burnout, some of which may include:
  • Chronic emotional and physical fatigue
  • Reduced feelings of sympathy or empathy
  • Poor work-life balance
  • Depersonalization
  • Hypersensitivity or complete insensitivity to emotional material
  • Withdrawal from friends, family, and other loved ones
  • Loss of interest in activities previously enjoyed
  • Feeling blue, irritable, hopeless, and helpless
  • Changes in sleep patterns
  • Getting sick more often
  • Irritability3,4

How Organizations Can Prevent Burnout

As a healthcare employer, there are things your organization can do to help your providers stay healthy and succeed:

Take an active role: Know your employees’ concerns – Provide a forum for feedback and address problems before they get to a unrecoverable level.

Encourage breaks: Taking breaks helps employees walk away from stress ensuring that the staff is not overworking themselves to the point of burnout.

  • Support healthy habits: Implementing health and wellness programs can be invaluable and they don’t have to cost a lot money to be effective. Include healthy recipes in your newsletters, sponsor workout classes, create a relaxation room, or offer meditation classes.5

How Caregivers Can Prevent Burnout

As a caregiver, adopting healthy behaviors can prevent compassion fatigue and burnout:

Take Time to Care for Yourself

Practicing good self-care will significantly help your resilience and reduce your vulnerability to stress.

  • Balanced, healthy diet
  • Regular exercise
  • Routine schedule of restful sleep
  • Balance between work and personal life
  • Drink alcohol in moderation

Adopt Positive Coping Strategies

Positive coping strategies can be used at work or at home to help ease your response to stressful situations.

  • Deep breathing
  • Meditation
  • Taking a walk
  • Talking with a friend
  • Relaxing in a hot bath

If you still feel that you are not getting enough out of mindful techniques, and are still feeling emotionally vulnerable, chronically stressed and overwhelmed, seek help. Seeing a therapist can help you process your feelings and put things in better perspective, which can help you successfully implement the strategic techniques that will help you move toward a healthy work-life balance.





Omega-3 Fatty Acids May Reduce Risk of Premature Birth

11/17/18 – By Traci Pedersen

Expectant women who increase their intake of omega-3 long-chain polyunsaturated fatty acids can reduce the risk of premature birth, according to a new study published in the Cochrane Review.

“We know premature birth is a critical global health issue, with an estimated 15 million babies born too early each year,” said Associate Professor Philippa Middleton from Cochrane Pregnancy and Childbirth and the South Australian Health and Medical Research Institute (SAHMRI).

“While the length of most pregnancies is between 38 and 42 weeks, premature babies are those born before the 37-week mark — and the earlier a baby is born, the greater the risk of death or poor health.”

Infants born prematurely are at greater risk of a range of long-term conditions including visual impairment, developmental delay and learning difficulties.

Middleton and a team of Cochrane researchers have been looking closely at long-chain omega-3 fats and their role in reducing the risk of premature births; particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) found in fatty fish and fish oil supplements.

For the study, they reviewed 70 randomized trials and found that for pregnant women, increasing the daily intake of long-chain omega-3s:

  • lowers the risk of having a premature baby (less than 37 weeks) by 11 percent (from 134 per 1,000 to 119 per 1,000 births);
  • reduces the risk of having an early premature baby (less than 34 weeks) by 42 percent (from 46 per 1,000 to 27 per 1,000 births);
  • lowers the risk of having a small baby (less than 5.5 pounds or 2,500g) by 10 percent.

“There are not many options for preventing premature birth, so these new findings are very important for pregnant women, babies and the health professionals who care for them,” Middleton says.

“We don’t yet fully understand the causes of premature labor, so predicting and preventing early birth has always been a challenge. This is one of the reasons omega-3 supplementation in pregnancy is of such great interest to researchers around the world.”

This review was first undertaken back in 2006. At that time, the researchers had concluded there wasn’t enough evidence to support the routine use of omega-3 fatty acid supplements during pregnancy. Over a decade later, however, this updated review concludes that there’s high quality evidence for omega-3 supplementation to be used as an effective strategy for preventing preterm birth.

“Many pregnant women in the UK are already taking omega-3 supplements by personal choice rather than as a result of advice from health professionals,” Middleton said.

“It’s worth noting though that many supplements currently on the market don’t contain the optimal dose or type of omega-3 for preventing premature birth. Our review found the optimum dose was a daily supplement containing between 500 and 1000 milligrams (mg) of long-chain omega-3 fats (containing at least 500mg of DHA) starting at 12 weeks of pregnancy.

“Ultimately, we hope this review will make a real contribution to the evidence base we need to reduce premature births, which continue to be one of the most pressing and intractable maternal and child health problems in every country around the world.”





At GAPPS, we want to recognize parents whose lives have been impacted by losing a baby to stillbirth or caring for a premature baby. Preterm birth and stillbirth impact the lives of parents, families, and infants all over the world, regardless of geography or socioeconomic status, and it is our goal to better understand the causes of preterm birth and stillbirth and ways to prevent them. This work is dedicated to parents dealing with the loss of a baby through stillbirth, and to those struggling to care for premature infants.

We recognize the profound pain and loneliness of grieving parents and extend our sincerest sympathy. There are many organizations available to help parents navigate loss, connect with others and move forward with their lives, as well as support for parents of premature babies. Explore these resources for more information.

Below are some additional links to organizations with information that may be useful for those caring for preterm newborns or dealing with the loss of a baby.

First Candle

First Candle is one of the nation’s leading nonprofit organizations dedicated to safe pregnancies and the survival of babies through the first years of life. Their current priority is to eliminate stillbirth, Sudden Infant Death Syndrome and other Sudden Unexpected Infant Deaths through research, education, and advocacy programs.

International Stillbirth Alliance

The International Stillbirth Alliance is a nonprofit coalition of organizations dedicated to understanding the causes of and working on the prevention of stillbirth. Their mission is to raise stillbirth awareness, promote global collaboration in the prevention of stillbirth, and to provide appropriate care for parents who have lost a baby to stillbirth.

SANDS: Stillbirth & Neonatal Death Society (UK)

SANDS supports anyone affected by the death of a baby, works in partnership with health professionals to improve the quality of care and services offered to bereaved families, and promotes research and changes in practice that could help to reduce the loss of babies’ lives.

The Tears Foundation

The TEARS Foundation is a non-profit organization that seeks to compassionately assist bereaved parents with the financial expenses they face in making final arrangements for their baby who has died.

March of Dimes

March of Dimes helps moms have full-term pregnancies and focuses on researching problems that threaten babies’ health.

Hayden’s Helping Hands

Hayden’s Helping Hands is a non-profit foundation that assists Oregon and Washington families after the birth of a stillborn baby by paying for a portion or all of their hospital delivery medical expenses.





Psychologist Sue Makarchuk with Alberta Health Services interacts with Anna Strachan, 2, who needed a dose of caffeine as a preemie to help her breathe. Photos by Riley Brandt, University of Calgary

New study shows premature babies’ developing brains benefit from caffeine therapy

December 12, 2018 – By Pauline Zulueta, Cumming School of Medicine

UCalgary’s Abhay Lodha shows early caffeine treatment of premature babies born less than 29 weeks’ gestation has no long-term negative effects on brain development. Calgary mom Avril Strachan says she’s pleased to learn the results of the study as her daughter, Anna, was treated with caffeine.

For many, starting the day off with caffeine from a cup of coffee is a must. In neonatal intensive care units, or NICUs, premature babies born under 29 weeks are given a daily dose of caffeine to ensure the best possible start to life. A new study by University of Calgary researchers shows the earlier the dose of caffeine can be given, the better.

“Caffeine is the most commonly used drug in the NICU after antibiotics,” says Dr. Abhay Lodha, MD, associate professor in the departments of paediatrics and community health sciences at the Cumming School of Medicine and staff neonatologist with Alberta Health Services (AHS). “It’s important that we understand the long-term effects of caffeine as a treatment and ensure these babies are not only surviving, but have quality of life down the road.”

Born prematurely at 27 weeks at the Foothills Medical Centre, Kyle and Avril Strachan’s baby, Anna, was given caffeine to help her breathe and to boost lung function.

“The doctors told us, with premature babies, their brain hasn’t developed quite enough to let them do all the things their bodies should be doing on its own, like breathing,” says mom Avril. “In the first few weeks, when Anna was feeding, she would slow down or even forget to breathe. This would cause her heart to slow and for her to not get enough oxygen.”

To help her breathe more easily, Anna needed a continuous positive airway pressure, or CPAP, machine to deliver constant airflow to her lungs.

A 2014 study by Lodha showed starting caffeine therapy within two days after birth shortened the amount of time babies needed to use ventilators. It also reduced the risk of bronchopulmonary dysplasia (BPD), a form of chronic lung disease caused by damage to the lungs from use of a ventilator. What was not known was how that dose of caffeine affected brain development.

Lodha collaborated with researchers from the Universities of British Columbia, Montreal, Toronto and Mount Sinai Hospital in Toronto to analyze data from 26 NICUs across Canada. They found early caffeine treatment has no long-term negative effects on neurodevelopment, and is actually associated with better cognitive scores, and reduced odds of cerebral palsy and hearing impairment. The findings are published in Pediatrics.

The team examined data from followup assessments conducted at age 18 to 24 months. During these followups, children were assessed for their cognitive, language and motor development using the Bayley Scales of Infant and Toddler Development, a standardized scoring system to assess developmental functioning in infants and toddlers.

“We look at how children are constructing their understanding, such as solving simple problems or figuring out three-dimensional objects and toys,” says Dr. Dianne Creighton, PhD, research assistant professor in the Department of Paediatrics and retired psychologist with AHS. “We also assess how the little ones are able to understand simple words, or recognize the name of a picture, as well as their motor skills like climbing, crawling, balance and co-ordination.”

Lodha says it’s believed that caffeine may increase the growth of dendrites, the small branches of a neuron that receive signals from other neurons. “Caffeine may also improve better lung stretch and expansion, cardiac output and blood pressure in premature infants, which improves oxygen supply throughout the body and brain, reducing the duration of mechanical ventilation and the risk of chronic lung disease and injury on the developing brain.”

Now two years old, Anna has completed multiple followup assessments and is participating in dance classes, gymnastics lessons and swimming like a fish, says her mom.

“She’s very mechanical. She likes to build things, take it apart and figure out how it works,” Avril says. “It’s wonderful to know that the caffeine treatment has no adverse effects and that if researchers are getting positive findings, it should continue to be the standard of care for premature babies. In that case, I think parents would have no hesitation in having caffeine as part of their child’s treatment.”

This study was conducted with data from the Canadian Neonatal Network and the Canadian Neonatal Follow-up Network, which is supported by the Maternal-Infant Care Research Centre at Mount Sinai Hospital. Abhay Lodha and Dianne Creighton are associate members of the Alberta Children’s Hospital Research Institute.





As the New Year approaches and we create our lives with vitality and curiosity one of the most important things we can choose to do daily is to connect with Source and engage in peaceful connections within and throughout. May Peace be with us as we journey.





The Honest Guys – Meditations – Relaxation


Afghani Pro Surfer Afridun Amu


Afridun Amu was the first Afghan athlete to internationally represent Afghanistan in surfing. He participated in the International Surfing Association World Surfing Games in Biarritz, France in May 2017. Amu also won the first official Afghan surfing championship (men) in 2015 in Ericeira, Portugal. He is the reigning Afghan surf champion.

Amu was born in Kabul, Afghanistan on June 23, 1987. He spent his childhood in Moscow, Russia, where his father worked as a diplomate. His family moved to Germany as political refugees in 1992. He graduated in law, cultural science and design thinking. He works as an expert in Constitutional law at the Max Planck Foundation for International Peace and the Rule of Law and is a lecturer on Design thinking at the Hasso Plattner Institute.


Published on May 23, 2017

At 29, surfer Afridun Amu is thrilled to be participating in his sport’s world championships in Biarritz, and even more so to be representing his native country: land-locked Afghanistan. A political refugee, Amu grew up in Germany, and hopes his performance this week might help people to see his country differently.

Antenatal Counseling, Dental Health, Nurse Notes




Poland, officially the Republic of Poland, is a country located in Central Europe. It is divided into 16 administrative subdivisions, covering an area of 312,696 square kilometres (120,733 sq mi), and has a largely temperate seasonal climate. With a population of approximately 38.5 million people, Poland is the sixth most populous member state of the European Union. Poland’s capital and largest metropolis is Warsaw.

Poland’s healthcare system is based on an all-inclusive insurance system. State subsidised healthcare is available to all Polish citizens who are covered by this general health insurance program. However, it is not compulsory to be treated in a state-run hospital as a number of private medical complexes exist nationwide.

All medical service providers and hospitals in Poland are subordinate to the Polish Ministry of Health, which provides oversight and scrutiny of general medical practice as well as being responsible for the day-to-day administration of the healthcare system. In addition to these roles, the ministry is tasked with the maintenance of standards of hygiene and patient-care.



Born Too Soon – Preterm Birth Rates

Rate: 6.7%     Rank: 157

(USA Rate: 12.0%     Rank: 54




Preemies often face dental complications related to their premature birth and related treatment. Enamel defects and palette formation (in older preemie survivors) are issues we address in our blog this month. We wonder how we as a Family may be able to reduce preterm birth globally (including countries like the USA where maternal morbidity and preterm birth rates are high) through the effective use of group preterm birth care.

Newborn & Infant Nursing Reviews

Dental Outcomes of Preterm Infants

Diane L. Eastman, MA, RN, CPNP Enamel Defects NAINR. 2003;3(3)

Enamel defects are a well-studied complication of prematurity. Enamel is a hard tissue that once formed, unlike bone, does not remodel. For that reason, insults during enamel development are permanent on the tooth surface. Dental enamel formation begins during the second trimester of pregnancy and is complete by about 18 years of age. The major portion of the newborn’s stores of calcium and phosphorus are accumulated in the third trimester of pregnancy. Therefore, an ELBW infant will not have accumulated these stores. Enamel hypoplasia is defined as “deficient quantity of enamel resulting from developmental aberrations, and may occur in the form of pits, grooves, or larger areas of missing enamel.” Enamel opacity is defined as a qualitative change in the translucency of the enamel.

The common medical complications of premature infants including surfactant-deficiency respiratory distress syndrome, asphyxia and hypoxia, hypocalcemia, renal immaturity, feeding difficulties, and infection are just some of the problems that may affect enamel formation. The biochemical cause of enamel hypoplasia is not fully understood, but growing evidence indicates it is strongly linked to calcium homeostasis. There are several studies that suggest a direct relationship between enamel hypoplasia in primary teeth and neonatal hypocalcemia. There are numerous pre- and postnatal problems that cause hypocalcemia in the newborn. The more premature and the lower the birth weight, the more problems with calcium homeostasis. Maternal diabetes mellitus, placental insufficiency, often related to preeclampsia, and maternal deficiency of dietary calcium and vitamin D are all in utero factors. Traumatic delivery, asphyxia, cerebral injury, and prematurity itself with deranged calcium metabolism are perinatal factors that contribute to hypocalcemia. Additional contributors to hypocalcemia include hypoxia, sepsis, and hyperbilirubinemia.

The prevalence of enamel defects ranges from 43% to 96% of VLBW infants. Seow et al reported a direct relationship between birth weight and gestational age with the greatest prevalence of enamel defects occurring in the lowest birth weight group. The clinical significance of enamel defects is not only esthetic, although these teeth can appear cream colored, yellow, or brown. Enamel hypoplasia is linked to plaque accumulation, dental caries, and in more severe cases, with space loss and malocclusion. In a longitudinal study by Lai et al[5] there was a significant association with enamel defects and dental caries in the VLBW group that was noted on exams of the children at 44 and 52 months of age. The most dental caries were observed in those children who had both enamel hypoplasia and opacity.

Enamel defects have also been identified in the permanent dentition of children born prematurely. Pimlott et al[4] found enamel hypocalcification in at least one maxillary permanent incisor in 58% of the 106 VLBW infants examined; however, the other permanent teeth were not examined. Seow matched 55 VLBW and 55 normal birth weight (NBW) controls at a mean age of 7.7 years for defects in enamel of permanent incisors and molars. The VLBW group had a higher percentage of enamel defects in the permanent molars (21% v 11%) and permanent lateral incisors (12% v 0%) compared with controls. Most of the defects were enamel opacities. Aine et al matched 32 preterm to 64 control children. The prevalence of enamel defects in preterm compared with control children was higher in both primary (78% v20%) and permanent (83% v 36%) dentitions. Because the permanent teeth are believed to begin mineralization a few months after the preterm birth, it is hypothesized that persistent metabolic disturbances affect the mineralization and calcium homeostasis of the first few permanent teeth.

Enamel defects can be both generalized or localized. Generalized defects are symmetrically distributed and likely caused by systemic illnesses associated with prematurity. As mineral stores in the preterm infant are depleted, calcium and phosphorus entering the developing tooth is insufficient for enamel formation. This theory is supported by a study of preterm children who had neonatal rickets secondary to severe osteopenia. In the study, every child with rickets also had severe enamel hypoplasia. A later study by the same investigators[14] demonstrated that all preterm children with enamel hypoplasia also had decreased cortical mineralization of the humerus. This study demonstrated a direct relationship between enamel hypoplasia and diminished bone mineral stores.

Trauma may also cause some enamel defects. Controlled studies by Seow et al demonstrated that children who had been orally intubated and required mechanical ventilation had more enamel defects on the left maxillary teeth (63% v 40%) compared with nonintubated children. A Swedish study of full-term infants who were intubated in the neonatal period demonstrated similar results of more defects on the left side. The process of laryngoscopy would account for this primarily left side defect. Inadvertent force is often placed on the left side as the laryngoscope is pushed more to that side to allow room to insert the orotracheal tube along a groove in the right side. Although the tube itself has been considered to be the cause of the trauma, the tube would likely cause more even distribution of force to both right and left sides.


tech.poland    Moms.poland

Group prenatal care reduces preterm birth and low birth weight

Posted October 12, 2018

Researchers at Yale School of Public Health have found that group prenatal care for expecting mothers reduces the risks for preterm birth and low birth weight. The findings are published in the Journal of Women’s Health.

This study, conducted in collaboration with Vanderbilt University Medical Center, examined over 9,000 women and found that women who received either Centering Pregnancy or Expect With Me group prenatal care compared to traditional one-on-one care.

Researchers found that group prenatal care patients had a 37 percent lower risk of having a preterm birth and a 38 percent lower risk of having a low birth weight baby than women receiving traditional one-on-one care. Better attendance at the group visits also resulted in more pronounced benefits. Women with five or more group prenatal care visits had a 68 percent lower risk of having a preterm birth and a 66 percent lower risk of having a low birth weight baby than their peers receiving traditional care.

These findings come from the largest study comparing group prenatal care to traditional one-on-one care, to date.

“The health benefits of group prenatal care are enormous,” said Jessica Lewis, deputy director of pregnancy research at Yale School of Public Health and a co-author of the study. “Preterm birth and low birth weight are the second leading causes of infant mortality in the US, and cost more than $38 billion dollars per year.”

Group prenatal care typically brings together 8 to 12 women for 2-hour long sessions on the same schedule as traditional prenatal care. Each patient gets a brief one-on-one check-up and then most of the time is spent in a facilitated discussion on the topics of pregnancy and childbirth. Women receive 20 hours of care over the course of a pregnancy, compared to 2 hours in traditional care.

Groups are led by prenatal care providers, who offer education and support, while working to increase patient engagement. Expect With Me includes a social media platform, where women can continue to access resources, track their health metrics and connect with other moms and providers between visits.

Previous studies of group prenatal care have primarily focused on young, low-income, minority women. The study provides evidence that group prenatal care sharply reduces adverse birth outcomes for a diversity of women, said lead author Shayna Cunningham, Ph.D., research scientist at Yale School of Public Health. “We need to expand access to group prenatal care for all women to improve outcomes and eliminate health disparities.” “Future analyses will aim to understand the mechanisms by which group prenatal care results in better outcomes,” Cunningham said.





Antibiotic use in preemies and premature brain development are important issues that are currently the focus of significant scientific research. In the article about antenatal counseling John Lantos MD drew us in with this proposal “Three factors suggest that it may be time to revisit the norms that govern conversations between doctors and parents who are facing the anticipate birth of a baby who is extremely premature”.

What are the risks of antibiotics in premature babies?

By Preeti Paul – June 16, 2018

A recent article in Science evaluated the risks of overusing antibiotics in premature babies and provided insight into their safe and effective use.

Premature babies, also known as preemies, enter the world many weeks before full-term babies. Preemies need special care and are kept in neonatal intensive care units (NICUs) in hospitals. Infection is a threat to a premature baby’s life and doctors usually prescribe antibiotics to prevent or treat infections. In fact, antibiotics are the most common medicines used in the NICUs. It is customary to use antibiotics for preemies, sometimes even when there is no evidence of an infection.

In recent years, some doctors and researchers are becoming more conscious of using antibiotics for newborns. Many studies suggest that using antibiotics in preemies is associated with health problems such as asthma, obesity, and autoimmune disorders later in life.

A recent article in the Science magazine brings our attention to the seriousness of the risks associated with the use of antibiotics in preemies. The article discusses the work done by neonatologist Josef Neu and microbiologist Gautam Dantas, who have been working to understand the dangers of antibiotic overuse. Neu and Dantas advocate for the intelligent use of antibiotics, especially in premature babies.

The dangers of antibiotics –

Premature babies are at risk of infections such as sepsis and strep B. Undoubtedly, antibiotics help keep them alive. However, a blanketed prescription of antibiotics for all preemies is not the correct approach.

Many studies show that antibiotics wipe out a baby’s developing gut microbiome. The gut bacteria influence the health of an individual in many ways. An unhealthy balance of the gut microbiome is related to certain diseases, nutritional status, and immune function.

The researchers found that preemies who were given antibiotics had ten-fold fewer species of bacteria in the gut, compared to babies born at full-term. A less diverse microbiome means a higher likelihood that bad bacteria will over colonize in the gut. In addition, antibiotics kill the good bacteria in the gut resulting in an imbalance in the microbiome makeup.

Antibiotic use leads to resistant bacteria –

Researchers conducted DNA sequencing studies on all the bacteria present in the stool of preemies. The results showed that most of the bacteria found in the babies’ gut were very close to the ones found in hospitals. These bacteria were resistant to all the commonly used antibiotics because when antibiotics are used for someone who does not need them, there is a risk of developing bacteria that grow resistant to these antibiotics. Therefore, the gut of the preemies on antibiotics becomes the breeding ground of antibiotic-resistant microorganisms.

Scientists also found that over time, the use of antibiotics can increase a baby’s risk of getting fungal infections, late-onset sepsis, and necrotizing enterocolitis, a deadly intestinal disorder.

Can antibiotics for babies be avoided? –

Preventing the vulnerable preemies from life-threatening infections is the main responsibility of the doctors. However, the effect of antibiotics on the gut microbiome of babies is a cause for concern. The scientists have put forward some suggestions to change the trend of antibiotic overuse.

Neonatologist Karen Puopolo recently developed an algorithm based on gestational age, infant’s clinical exam, and maternal risk factors to screen for serious infections in a newborn. This tool has helped reduce the percentage of full-term babies given antibiotics.

In preemies, however, the method of delivery, whether vaginal or C-section, may help to distinguish a high risk or a low risk of infection in the baby because C-section does not expose the baby to bacteria in the birth canal. Another way to reduce antibiotic overuse is developing better tests for infection diagnosis that, unlike blood culture, are quick and sensitive to indicate an infection.

Preemies in the years to come –

A healthy gut microbiome plays a vital role in diverse functions such as synthesizing vitamins and strengthening immune systems. Microbiologist Dantas traced the gut microbiome of preemies long after they left the hospital. He found that babies who left with poor gut microbial ecosystem are able to develop diverse gut microbiome in the years to come, but he suggests that these babies are not able to catch up to have the same healthy microbiome as that of full-term babies.

This difference might explain why early use of antibiotics is associated with certain health conditions such as obesity, asthma, and autoimmune disorders. Moreover, the antibiotic-resistant bacteria stay in the gut of the preemies long after they leave the NICU, putting themselves and others around them at risk.

Future research should focus on developing safer antibiotics for preemies –

Antibiotics can help save babies’ lives but antibiotics also give them a lifetime of poor health. The gut microbiome is an important part of a healthy body and plays a critical role in many important functions. The make-up of the gut microbiome is affected by many genetic and environmental factors, such as the use of antibiotics.

Awareness and understanding of the impact of antibiotics, especially on premature babies, may change the trend of customary use of antibiotics.  Additionally, developing antibiotics that are safe and effective for the little patients should be considered as the next steps for future research.

Written by Preeti Paul, MS Biochemistry Reference: Broadfoot, Marla. Too many antibiotics can give preemies a lifetime of ill health, Science Apr 5, 2018.




Antenatal – definition:Antenatal care is a form of health service provided to a woman throughout pregnancy to ensure a safe gestation and childbirth, and prevent complications to the mother and the baby.


What is the Purpose of Antenatal Counseling?

John D. Lantos, MD-PlumX Metrics     Children’s Mercy Kansas City, Missouri

In this volume of The Journal, Kharrat et al report the results of a systematic review designed to explore parental expectations and preferences regarding communication and decision-making for infants born extremely premature.  I’d like to highlight 2 important points from their paper. The first focuses on the main findings of their review. In 19 published articles that met their inclusion criteria, they found, unsurprisingly, that parents want information about anticipated chances of survival and about long-term prognosis. More surprisingly, unlike many doctors, parents did not usually think of these conversations as ones about whether or not to provide neonatal intensive care unit care and life support. Instead, parents wanted this information to help them prepare to participate in the care of their babies. They were dissatisfied when information was exclusively negatively framed. They did not want to be reminded repeatedly of the potential for neurodevelopmental disability. Emphasizing such information made parents distrust physicians.

Parents want healthcare professionals to be sensitive, compassionate, and attentive to their goals.

These findings should come as no surprise to any health professional who has worked with parents facing the birth of a baby who is extremely premature. Parents in this situation want what patients and family members want in any similar situation—compassion, sensitivity, honesty, and hope. We know from studies of communication in other situations that physicians who are more optimistic and patient-centered care are perceived as trustworthy and compassionate.

Often, however, antenatal counseling (ANC) does not give parents what they say they want. Instead, for doctors, the goal of ANC is to offer the parents the opportunity to make an informed choice about foregoing intensive care. To achieve that goal, doctors try hard to honestly communicate pessimistic information. Thus, doctors’ goals for ANC may be fundamentally at odds with parents’ goals.

The roots of this mismatch can be understood by examining the history of our current approach to ANC. Kharrat et al refer, indirectly, to that history by limiting their analysis to articles published after 1990 because, as they say, “Our publication date cut off was guided by the 1990 seminal publication on family centered neonatal care by Harrison.” They thus rightly highlight the outsized role that Harrison’s critiques of neonatology played in reshaping the norms of communication about outcomes and complications for babies born premature.

Harrison wrote a guidebook for parents of preemies. In writing that book, she had many conversations and correspondences with parents of preemies. She came to the conclusion that doctors often withheld information from parents about infants’ poor prognosis. She wrote, “In medical situations involving very high mortality and morbidity, great suffering, and/or significant medical controversy, fully informed parents should have the right to make decisions regarding aggressive treatment for their infants.” For parents to be fully informed, they “must have available to them the same facts and interpretation of those facts as the professionals.” She believed that, if given this information, many parents would choose to forego intensive care and, instead, allow their babies to die. She further believed that this would spare many families the burdens and suffering that she associated with raising a disabled child.

There is a certain irony in the fact that Ms. Harrison’s own experiences with neonatal intensive care unit care did not seem consistent with her critiques. That history is worth highlighting because, in many ways, her actual experiences may be more typical than the types of experiences she feared and tried to prevent. As a result, her recommended approach to ANC may not reflect what most parents actually want.

In 1975, Ms. Harrison was 28 weeks pregnant with her first baby when she developed fever and back pain. She was diagnosed with listeriosis. Her son Edward weighed 1275 g at birth.  His prognosis was not good. His father recounted that the neonatologist was completely honest and told him, “Don’t even hope. He has seven major conditions, any one of which would be of serious concern.” Mr. and Ms. Harrison tearfully made the decision to turn off the respirator. But Edward did not die. He grew up to be, according to his father, “A major joy to Helen and me…a delightful human being who plays music for himself all day, sings, dances, and reads Dr. Seuss books out loud with heavy intonations.” Edward also had significant disabilities. Over his childhood, he had 20 surgeries.

The groundbreaking paper that Harrison wrote did not seem to reflect her own experiences or those of her family. The Harrison family was given bad news about their baby straightforwardly. They engaged in a process of shared decision-making. As it turned out, the prognosis that they were given was not unduly optimistic. It was unduly pessimistic. When life support was removed, their baby survived. Nevertheless, Harrison’s critiques of neonatologists for withholding information struck a nerve. Her suggested remedies have been widely adopted as the preferred approach to ANC.

But perhaps they are not the best approach. Three factors suggest that it may be time to revisit the norms that govern conversations between doctors and parents who are facing the anticipate birth of a baby who is extremely premature. First, and most importantly, the study by Kharrat et al suggests that current approaches do not reflect the preferences of most parents. Many parents find that negatively framed information undermines trust and interferes with compassionate care. Instead, they prefer optimistic or hopeful messages, ones that acknowledge and even anticipate the possibility of good outcomes as well as bad ones. Such messages can be given without being dishonest. They only require that doctors discuss the range of possibilities and outcomes for babies who are premature.

A second important factor that might lead us to re-evaluate the purpose of ANC is that it is often undertaken in contexts in which parents do not really have choices. The studies reviewed by Kharrat et al focus on counseling for parents whose babies were expected to be born between 22 and 26 weeks of gestation. Today, in most centers in the US, there is no choice for babies born at 24-26 weeks. The American Academy of Pediatrics strongly recommends treatment for babies born at 25 weeks and greater.7 Recently published data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network show that neonatologists follow these recommendations. At 24 weeks and greater, virtually every baby receives active treatment. Parental preferences, then, guide treatment decisions only at only at 22 and 23 weeks. Treatment for more mature babies is guided by the principle of the child’s best interest. Nevertheless, it is likely that parents of all babies whose birth is expected to be between 22 and 26 weeks routinely receive ANC. If there are no choices to be made, it is unclear what the purpose of such counseling should be.

Even when there are choices to be made, there are problems with antenatal discussions that focus on giving quantitative information about the probabilities of different outcomes. One problem is that the prognosis changes with each passing day, and it is difficult to predict when any woman will deliver. Most women who receive ANC because they are at risk of giving birth prematurely do not, in fact, go on to give birth between 22 and 26 weeks of gestation. In 1 study, about 75% of the pregnant women who were counseled antenatally did not deliver their baby in this gestational age window.  Even for those who did, the information given when they were at 22 or 23 weeks would no longer be accurate or relevant if they delivered at 25 weeks.

Finally, we also know now that doctors do not all give parents the same information. Stokes et al studied ANC and found that, for a specific baby, 12 different neonatologists gave 13 unique numeric estimates of the probability of survival. The estimates ranged from 3% to 50%. There is even more variation in prognostic estimates by doctors of different specialties.

The goal of ANC, as proposed by Harrison and as implemented by many doctors, is for doctors and parents to decide together whether to provide intensive care treatment or, instead, to provide palliative care only with the goal of keeping the baby comfortable during the dying process. Two implicit assumptions in this approach are that a decision must be made before birth and that that decision will be irreversible. But neither of these assumptions is true. Perhaps a better approach would be to counsel with a goal of conveying the uncertainties inherent in the situation and to prepare parents for the idea that they may face a series of decisions after their baby is born and doctors have a chance to assess the baby. As shown in the studies reviewed by Kharrat et al, this approach seems to be what most parents want.

In implementing this approach, doctors should strive to understand what parents want. To do that, they would need to do less talking and more listening. Given a chance, parents will tell us a lot about their hopes, fears, values, and preferences. They will ask questions that will reveal what they want to learn and need to know. By such careful, active listening, doctors will be in a better position to individualize their discussions and respond to each family’s needs. That would be a truly family-centered approach to ANC.


Poland.lab         science.poland

Premature brains develop differently in boys and girls

September 19, 2018     Summary: Brains of baby boys born prematurely are affected differently and more severely than premature infant girls’ brains.

Brains of baby boys born prematurely are affected differently and more severely than premature infant girls’ brains. This is according to a study published in the Springer Nature-branded journal Pediatric Research. Lead authors Amanda Benavides and Peg Nopoulos of the University of Iowa in the US used magnetic resonance imaging (MRI) scans as part of an ongoing study on premature babies to examine how the brains of baby boys and girls changed and developed.

The researchers took high-quality MRI scans of the brains of 33 infants whose ages were corrected to that of one year. The sample included babies who were carried to full term (at least 38 weeks) and preterm (less than 37 weeks). The scans were analyzed in conjunction with information gathered from questionnaires completed by the infants’ mothers and other data collected when they were born.

“The window between birth and one year of age is the most important time in terms of brain development. Therefore studying the brain during this period is important to better understand how the premature brain develops,” explains Benavides.

Brain measurements taken from the MRIs showed that even at this very young age, there are major sex differences in the structure of the brain, and these are independent of the effects of prematurity. Brain tissue is divided into cerebral gray matter which includes regions of the brain that influence muscle control, the senses, memory, speech and emotion, and cerebral white matter which helps to link different parts of grey matter to each other. While boys’ brains were overall larger in terms of volume, girls had proportionately larger volumes of gray matter and boys had proportionately larger volumes of white matter. These same sex differences are seen in children and adults, and therefore document how early in life these differences are seen.

In regard to the effects of prematurity, the researchers found that the earlier a baby was born, the smaller the overall cerebral volume. However, the effect of prematurity on the specific tissues was different depending on a baby’s gestation age in conjunction with its sex. The earlier a baby boy was born, the lower the researchers found his cortex volume (gray matter) to be. The earlier a baby girl was born, the lower was the volume of white matter in her brain. Overall, although the effects of prematurity were seen in both boys and girls, these effects were more severe for boys.

According to the research team, it is well known that male fetuses are more vulnerable to developmental aberration, and that this could lead to other unfavorable outcomes. Findings from the current study now add to this by showing how the brains of baby boys born too early are affected differently to that of baby girls.

“Given this background, it seems likely and even expected that the effects of prematurity on brain development would be more severe in males. The insults to the premature brain incurred within the first few weeks and months of life set the stage for an altered developmental trajectory that plays out throughout the remainder of development and maturation,” says Nopoulos.




Breast feeding and brain development, nurses sharing…

10 Notes from NICU Nurses to

Parents of Premature Babies

“Never underestimate the strength and resiliency of babies.”

nurse.poland                                       music.npte.png

Every year 15 million babies around the world are born preterm, before 37 weeks of gestation. Premature birth is the leading cause of infant death in the U.S. and even if a woman does ‘everything right’ during pregnancy, there’s still a risk. However, technological advancements and growing expertise about prematurity are increasing preterm babies’ chances of survival. Over the last 10 years, the smallest baby saved has improved from 550 to 350 grams, and the youngest baby saved has improved from 26 to 22 weeks.

Every year 15 million babies around the world are born preterm, before 37 weeks of gestation. Premature birth is the leading cause of infant death in the U.S. and even if a woman does ‘everything right’ during pregnancy, there’s still a risk. However, technological advancements and growing expertise about prematurity are increasing preterm babies’ chances of survival. Over the last 10 years, the smallest baby saved has improved from 550 to 350 grams, and the youngest baby saved has improved from 26 to 22 weeks.

The Pulse asked Neonatal Intensive Care Unit (NICU) Nurses for notes that they would share with parents who are currently in the NICU. Here are their words of wisdom and encouragement.

1. “Don’t ever be afraid to ask questions. There is no such thing as a stupid question. You know your baby the best.”-Cheryl Cavallaro, NICU Nurse

2. “It’s important to include the extended family members for the health of your baby and extended family. Try Facetime or Skyping with family members from the unit. Post updates and photos on social media or through the clinical blog, CaringBridge.                   – Joyce Abrames, NICU Nurse

3.“Don’t try to compare your experience (or your baby’s) to anyone else’s. Take each new milestone or victory and celebrate it with all you have. Those little victories will get you through. Spend all the time you can with your baby – bond, learn and love. Finally, be kind to yourself, and practice self-care whenever you can. You can do this.”-Morgana Jokiel, NICU Nurse

4. “There are good days and bad days. It will feel like a roller coaster, and you’ll have to be patient. Ask a lot of questions. If you don’t understand something, ask.”                    -Mary Jane Stover, NICU Nurse

5. “Once you have a premature baby, you enter a world you never knew existed. The surprising result is that you will meet a group of people you will never forget for the rest of your life. We will always be there to get you through. You are not alone.”              -Rebecca LaClair, NICU Nurse

6. “Remember that your love for your baby (or babies!) is the most important things you can bring 100% of the time, and don’t forget its incredible power. Your infant can feel that, even in the smallest touch.”-Alissa Ray, Clinical Nurse

7. “You will never be alone on this journey. Your family is surrounded by caring and dedicated professionals who will listen to your concerns, cry with you during difficult times, hold your hand, and make you understand that whatever it takes, we are in this journey together to make sure that your precious one will get the best care ever.”    -Liberty Abelido, Nurse Manager

8. “Parents need to take time to care for themselves so that they are better able to provide care for their baby. Talk to your baby. Touch them. They relax and are better able to cope with the environment because they will hear a familiar voice and that provides a sense of security.”-Tarisai Zivira, NICU Nurse

9. “Every day may be so different from the next. Keep your eye on the goal–your baby’s safety, health, and happiness. Babies are so much smarter, stronger and braver than we can imagine. They let us know when they are ready to go home with you. ”                   -Clara Song, Faculty Neonatologist

10. “Never underestimate the strength and resiliency of babies. Preterm, ill, congenital anomalies or whatever condition brings them into the NICU, they are still sweet babies that ENDURE and give something to their parents and families, no matter how small…HOPE! Take that hope and bring good energy to your baby every time you visit.”       -Donna Dichirico, Nurse




Breast milk helps in brain development in premature babies

Published on Sep 22, 2018: New Delhi, Sep 23 (ANI): Breast milk sure has a lot of health benefits for babies. According to a new research, babies born before their due date show better brain development when fed breast milk rather than formula milk. Premature birth has been linked to an increased possibility of problems with learning and thinking skills in later life, which are thought to be linked to alterations in brain development. Experts say that helping mothers to provide breast milk in the weeks after giving birth could improve long-term outcomes for children born pre-term. Studies have shown that pre-term birth is associated with changes in the part of the brain’s structure that helps brain cells to communicate with one another, known as white matter. Researchers at the University of Edinburgh studied MRI brain scans from 47 babies from a study group known as the Their world Edinburgh Birth Cohort. The babies had been born before 33 weeks gestation and scans took place when they reached a term-equivalent age, an average of 40 weeks from conception. The team also collected information about how the infants had been fed while in intensive care – either formula milk or breast milk from either the mother or a donor. Babies who exclusively received breast milk for at least three-quarters of the days they spent in the hospital showed improved brain connectivity compared with others. The effects were greatest in babies who were fed breast milk for a greater proportion of their time spent in intensive care. The study appeared in the Journal of NeuroImage.



Our Neonatal Womb family needs innovation and a scientific effort to identify and treat hearing deficits in preterm birth survivors. We are excited to learn that EFCNI is unique and progressive within the Neonatal Womb community in efforts to research and provide support to preterm birth survivors into their adulthood.


plos  Published: September 14, 2017

Hearing impairment in premature newborns—Analysis based on the national hearing screening database in Poland

Katarzyna Wroblewska-Seniuk , Grazyna Greczka, Piotr Dabrowski, Joanna Szyfter-Harris, Jan Mazela

Abstract – Objectives

The incidence of sensorineural hearing loss is between 1 and 3 per 1000 in healthy neonates and 2–4 per 100 in high-risk infants. The national universal neonatal hearing screening carried out in Poland since 2002 enables selection of infants with suspicion and/or risk factors of hearing loss. In this study, we assessed the incidence and risk factors of hearing impairment in infants ≤33 weeks’ gestational age (wga).


We analyzed the database of the Polish Universal Newborns Hearing Screening Program from 2010 to 2013. The study group involved 11438 infants born before 33 wga, the control group—1487730 infants. Screening was performed by means of transient evoked otoacoustic emissions. The risk factors of hearing loss were recorded. Infants who failed the screening test and/or had risk factors were referred for further audiological evaluation.


Hearing deficit was diagnosed in 11% of infants ≤25 wga, 5% at 26–27 wga, 3.46% at 28 wga and 2–3% at 29–32 wga. In the control group the incidence of hearing deficit was 0.2% (2.87% with risk factors). The most important risk factors were craniofacial malformations, very low birth weight, low Apgar score and mechanical ventilation. Hearing screening was positive in 22.42% newborns ≤28 wga and 10% at 29–32 wga and in the control group.


Hearing impairment is a severe consequence of prematurity. Its prevalence is inversely related to the maturity of the baby. Premature infants have many concomitant risk factors which influence the occurrence of hearing deficit.



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.

We bring together parents, healthcare experts from different disciplines, and scientists with the common goal of improving long-term health of preterm and newborn children. Our vision is to ensure the best start in life for every baby. With our activities we want to reduce preterm birth rates, ensure the best possible treatment, care, and support and to improve the long-term health of preterm infants and newborns with illnesses.


Research on European Children and Adults born Preterm (RECAP preterm)

Background: from data collection to data sharing

The overall aim of the EU-funded research project RECAP preterm is to improve health, development, and quality of life of children and adults born very preterm (VP) or with a very low birth weight (VLBW):

  • VP: less than 32 weeks of gestation
  • VLBW: less than 1500 g
  • Core steps – RECAP preterm will…
  • The innovative element of RECAP preterm is to provide the bridge from data collection to data sharing: the members aim to establish a digital platform for harmonizing and exploiting data of European cohort studies with babies, children, and adults born preterm as well as Nordic registry data. This broadened data basis shall ensure improved understanding, diagnosis and evidence-based, personalized prevention of mental and somatic disorders that are associated with preterm birth. Long term effects of different treatments, especially the use of (off-label) medication applied for these patients are meant to be analyzed by combining adult cohorts with available data from preterm babies. By developing mHealth applications, the cohort participants shall be encouraged to sustainably collect follow-up data (mHealth/mobile health = the use of information and  communication technology for collecting health data, delivery of healthcare information, monitoring of patient vital signs, and telemedicine).
  1. create a sustainable data platform of national and European cohorts of VP/VLBW children and adults to optimise the use of population data for research and innovation in healthcare and policy (view more)
  2. develop hypothesis-driven research on health status and medical care of VP/VLBW children and adults that builds on the unique opportunities provided by the larger sample sizes of combined cohorts and the added value of their geographic and temporal diversity
  3. integrate exchange with various stakeholders to disseminate results and to translate them into evidence-based care and policy (e.g. obstetricians, neonatologists, paediatricians, psychologists, psychiatrists, other healthcare providers, educators, scientists, economists, policy planners, health insurance companies, and patient and parent groups).
  4. emphasise patient and public involvement in order to reflect real-world needs

Next steps for 2018-

  • Finalise first version of stakeholder map
  • Start planning of winter school 2020
  • Verbalise the upcoming research findings in order to make them easier to understand for non-expert target groups like the general public or parents and patients
  • Conceptualise a meeting bringing together RECAP preterm researchers and representatives of national parent organisations to exchange on the project.

The RECAP preterm consortium-

RECAP preterm brings together European child to adult cohorts and a group of highly experienced organisations. The expertise of the partners covers a wide and complementary range of fields, including life course epidemiology, methodology, neonatology, paediatrics, early-life stressors, non-communicable disease research, epigenomics, economics, psychology, and mental health as well as e-learning technologies, eHealth/mHealth applications, communication, dissemination and project management.




YOUTUBE: Image video of the European Standards of Care for Newborn Health Project by EFCNI –Published on May 22, 2017

European Standards of Care for Newborn Health is an interdisciplinary European collaboration to develop standards of care for key topics in newborn health. The project brings together more than 220 healthcare professionals of different professions, parent representatives and selected industry specialists, from more than 35 countries. The focus of the project is the treatment and care of preterm and ill newborn babies in hospital and as they grow up. The project was initiated by the European Foundation for the Care of Newborn Infants. View more about the project at





Growing up as a young child I experienced bullying likely as a result of my (much) smaller than average stature and jack-o-lantern smile. Due to my intubation as a preemie my oral cavity and jaw developed differently, creating a deeply indented palate and a very cute but wildly crooked smile.

Between 1st and 2nd grade I was consistently taunted by kids on the playground for my pearly whites. One particular boy physically assaulted me daily and organized a group of boys to chase me. When I came from school with gravel and bark embedded in my skin my Mom told me to fight back. Permission given, I took matters into my own hands (literally).   Eventually though, due to lack of  school support (bullying was allowed back in the day),  I choose to transfer to an alternative elementary school.

I began wearing  braces at age 8,  complete with a stellar set of head-gear to reset my jaw and to support the big smile I have today.  Like most kids with braces the comments of having a metal mouth quickly became a background noise norm. It wasn’t until I was 16 years old that I got my braces off, although I wore a retainer until last year. In reflection, I realize I was very fortunate that my mom was able to provide me with dental care and braces.  Having my teeth straightened has impacted my daily life in a very positive way. I can enjoy eating without the anxiety of being awkward in my eating habits due to the large unorderly spaces between my teeth and silent fear of rude commenters. Braces helped my confidence in smiling at/with others and in conversing comfortably in social situations.

Learning about how life as a preterm birth survivor may impact dental and oral health outcomes of patients is fascinating  to me. Dental health is a critical component of experiencing health in life. My hope is that with current dental health research families of preterm birth babies and preterm birth survivors themselves may become aware of the ways their dental development may be impacted. I also hope that attention to dental outcomes in preterm birth patients may aid in bridging the gaps that may exist between the dental and medical fields so that collaborative measures may be taken to aid in the research, understanding, innovation, and collaboration of pediatric related medical and dental care of preemies. Furthermore, as our current healthcare system does not offer adequate dental coverage as a critical component of healthcare I hope that current research findings may aid our healthcare community in pushing for better oral care coverage and acknowledging that dental care is a critical part of overall health,  not just for preemies but for people in general.


         Kitesurfing Jastarnia, Poland 2017

Marcin Bachrynowski Published on Sep 13, 2017-Summer holiday in Jastarnia with a lots of kiresurfing. Letnie wakacje w Jastarnii z pływaniem na kitesurfingu








  • Preterm birth rate – 6.5 births <37 weeks per 100 live births)
  • (Preterm birth rate – USA – 12 per 100 births)
  • Ranking: 166


Israel, officially the State of Israel, is a country in the Middle East, on the southeastern shore of the Mediterranean Sea and the northern shore of the Red Sea. It has land borders with Lebanon to the north, Syria to the northeast, Jordan on the east, the Palestinian territories of the West Bank and Gaza Strip to the east and west, respectively, and Egypt to the southwest. Health care in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli citizens are entitled to basic health care as a fundamental right.



Hadassah nursing students, 1948

Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim (קופת חולים – “Sick Funds“) which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance.[1] In a survey of 48 countries in 2013, Israel’s health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51.[2] In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings[3] and ranked eighth in terms of life expectancy.



7 November, 2017

Tiny patients with big problems are now being treated in the new Neonatal Intensive Care Unit (NICU) at Hadassah Hospital Ein Kerem—the first of its kind in Israel.

The newest addition to Hadassah’s Neonatology Department, located in the Charlotte R. Bloomberg Mother and Child Center, the innovative NICU combines advanced technology with private rooms and dedicated multidisciplinary health care professionals, including a nutritionist and physical therapist. Most babies admitted to the NICU are premature, have low birth rates, and/or special conditions that need immediate specialized care. Typically, they are so small you could hold each one in your palm–if they weren’t attached to so many tubes and life-saving devices.

Let’s meet a few:

In Baby Room One, there is a baby boy that has no name yet; he is too sick to undergo a circumcision ceremony where he will finally get his name. His parents, in their forties, waited a long time to get the news that his mother was pregnant. And with twins! His brother is home from the hospital, but this other twin has a faulty connection between his esophagus and trachea. Air flows into his stomach instead of his lungs. This baby needs surgery, and a consultation for his heart and skeletal problems that are often linked to this esophageal problem. His distraught parents are counting on Hadassah’s team of experts to bring him through.

In Baby Room Two, there is a baby girl–the fourth child of a young religious family. Everything seemed fine during the pregnancy, but the nurses in the hospital where she was born noticed a blue tinge. She was rushed to Hadassah Ein Kerem where she was stabilized and will undergo heart surgery. Her parents are counting on Hadassah to bring her through.

In Baby Room Three, there is a baby girl from the Palestinian Authority, who was born with a vascular problem called “Vein of Galen Malformation.” Misshapen arteries in her brain are connected directly with veins, instead of capillaries, which help slow blood flow. This causes a rush of high-pressure blood towards her little heart and lungs. She has already had three brain catheterizations by Hadassah experts. Her parents are counting on Hadassah to bring her through.

The new eight-bed NICU doesn’t just provide space and protection from infection to these at-risk newborns. It also allows parents to be integral parts of their care, explains NICU Director Prof. Smadar Eventov-Friedman. “Bonding with a sick infant is crucial,” says Prof. Eventov-Friedman. “Parents need to be close at hand for feeding and bathing and to become part of the baby’s care from the beginning.” Therefore, in addition to the complex machinery, such as mechanical ventilators and monitors for every life function, there’s an easy chair for mom and dad plus a small refrigerator to store supplements for the baby.

When Prof. Eventov-Friedman was a medical student, she relates, few of these babies would have had a chance of surviving. But the huge leaps in neonatal care have enabled sophisticated interventions that save babies’ lives and give them quality of life. “A child born with low weight or the need for surgical or subspecialist intervention has as good a chance of survival at Hadassah as in any top medical center in the world,” she says.

Hadassah’s Neonatology Department includes well-baby care and two intensive care units—the other, at Hadassah Hospital Mount Scopus. Close to 13,000 babies were born at Hadassah last year. While the vast majority are healthy and go home in two days, because Hadassah is a referral center for high-risk pregnancy, there is a spiraling need for intensive care, explains Dr. Benjamin Bar-Oz, head of the Neonatology Department.



Yom Kippur fast doubles risk of early birth, study finds.

By ANDREW TOBIN, 30 September 2014 – Research gives backing for recommendation against fasting while pregnant, despite stricter Orthodox Jewish guidelines

Fasting on Yom Kippur while pregnant may trigger early birth, according to a new Israeli study — providing the first clear evidence against doing so.

In the retrospective cohort study of 725 deliveries in Israel on Yom Kippur over 23 years, Jewish women were twice as likely as others to have their babies early, the study found. Premature babies are at elevated risk for various health problems and for death.

Jews are religiously obligated to fast on Yom Kippur, which falls this year on Friday night and Saturday, considered the holiest day on the Jewish calendar. Pregnant women are included in this, but if a doctor gives them a pass, they can eat and drink a bit.

Still, many pregnant Jewish women at least partially refrain from eating or drinking during the 25 hour period, according to their religious beliefs.

Although doctors often advise their patients not to fast while pregnant, the recommendation is not supported by clear evidence or by official medical guidelines. The large cross-sectional study, published in The Journal of Maternal-Fetal & Neonatal Medicine this month, adds empirical weight to recommending leniency on the matter.

“We found that during the Day of Atonement, Jews had twice as many preterm deliveries. And I’m not talking about one year, I’m speaking about the whole study period,” said Prof. Eyal Sheiner, an obstetrician and gynecologist at Ben-Gurion University of the Negev and at Soroka Medical Center in Beersheba, who led the study. “This is the first evidence based study to support our recommendation (to pregnant women) not to fast on Yom Kippur.”

Sheiner’s post-doctoral students Dr. Natalie Shalit and Dr. Roy Shalit co-authored the study.

Soroka Medical Center is the largest hospital in southern Israel. About half of the patients who give birth at the hospital are Jewish, and about half are Bedouin. Sheiner noticed a boost in deliveries every year on Yom Kippur in the obstetrics and gynecology department he heads.

To investigate why, he matched data on deliveries at the hospital from 1988 to 2012 with the Jewish calendar. Of the mothers, 388 were Jewish and 357 were Bedouin. Forty-seven, or 6.3 percent, of the births were premature, or earlier than 37 weeks after conception. Data analysis revealed that the Jewish mothers were twice as likely as their Bedouin counterparts to give birth early on Yom Kippur.

The difference remained significant after controlling for other factors that could explain early birth — the mother’s age, previous early delivery, and problems with fetal development. Significantly — looking at the day exactly a week before Yom Kippur each year, Sheiner found no significant difference in early births between the two groups of mothers.

Several previous studies showed an increase in labor and in deliveries on Yom Kippur and on the following day, but none of them specifically addressed early birth. Sheiner said that since many pregnant Jewish women do not fast completely or at all on Yom Kippur, the risk of a 25 hour fast may be even greater than is reflected in the study.

Babies born prematurely are at increased risk of complications at birth, and the risks rise according to how early a baby is born. Seventy-five to 80 percent of babies who die at birth are born early. They are also more likely to develop cerebral palsy, impaired cognitive skills, sensory, dental, behavioral and psychological problems, and chronic health issues later in life.

“The best incubator for the first 37 weeks is the uterus,” said Sheiner.

The relationship between early delivery and fasting is not well understood. The leading theory is that fasting increases the thickness of the blood, which promotes the secretion of a hormone shown to induce contractions of the uterus.

Sheiner said dehydration and stress are both risk factors for early delivery. The first thing he says doctors at his hospital do when a woman comes in with preterm contractions is to hydrate her. He said he will continue advising women to take a break from the Yom Kippur fast when they are pregnant, especially now that he’s armed with the numbers to support his recommendation.




Authors Paula Quigley Submitted by HNN Admin Partners – London School of Hygiene & Tropical Medicine (LSHTM) MARCH Centre for Maternal, Adolescent, Reproductive and Child HealthInternational Stillbirth AllianceHealth Partners International

Pregnant women in rural communities across Africa face enormous challenges in accessing appropriate health care. Often there are few healthcare providers available locally with the appropriate skills needed for managing complications that may arise during the pregnancy or birth.i But there are also other barriers at community level, including a lack of household funds, limited transport options to reach the health facility, lack of social support for the family or limited knowledge and awareness of danger signs in pregnancy. These barriers combine to result in higher rates of maternal and neonatal mortality and stillbirths among these populations and health systems are struggling to cope.

However, in Zambia some communities are rising to the challenge. Building on an existing government initiative of community volunteers – the Safe Motherhood Action Groups (SMAGs) and supported initially with funding from UK aid and subsequently from Comic Relief – a UK-based charity, communities established their own response systems to address their many barriers. These were identified locally by ordinary community members and volunteers, in collaboration with traditional leaders, the district health teams, local health facility staff and community facilitators. The design process ended with a bespoke action plan for each community, led by the community volunteers. The two programmes, Mobilising Access to Maternal Health Services in Zambia or MAMaZ and MORE MAMaZ, operated between 2010 and 2016. An empowerment approach mobilised the communities around a maternal and newborn health (MNH) agenda and built local capacity to act. Figure 1 outlines the elements of the approach.


The Volunteer Training uses a simple and effective methodology:

  • The training content is based on issues and challenges defined by the community
    • Innovative teaching methods are used to train community volunteers (SMAGs)
    • Training methods are appropriate in low literacy setting (body tools and songs)
    • Training methods empower and encourage sharing of problems and action planning
    • Volunteers are given time to practice and internalise the training (no need for training manuals)
    • Training is followed up with coaching and mentoring support

Volunteers (SMAGs) then facilitate the establishment of the community-owned responses – figure 2 shows the range of community responses and figure 3 indicates the effectiveness of the training approach:


Community volunteers infographic-

The results achieved by the programme provide robust evidence of the effectiveness of the approach. Critical MNH indicators improved significantly more in the intervention sites compared to control sites – see figure 4.iv Although the programme did not measure mortality or stillbirth rates, it is highly likely that the improved access to essential services also had an impact on health outcomes. In all the intervention communities there was a strong perception that fewer mothers and babies were dying than before. In addition, the approach is sustainable (as shown by the high volunteer retention rates), builds community capacity and agency, particularly for women, and is socially inclusive. Such approaches can contribute to developing strong people-focused health systems that build upwards from the community.

About the Author-Paula Quigley is a medical doctor with an MPH focused on maternal and child health and over 27 years of international experience in health programme design, management, implementation and evaluation. She works with DAI Global Health (now incorporating Health Partners International) as the technical lead for reproductive, maternal, newborn, child and adolescent Health. She is also a member of the Stillbirth Advocacy Working Group (SAWG) co-chaired by the International Stillbirth Alliance and London School of Hygiene & Tropical Medicine. MAMaZ and MORE MAMaZ were implemented by a consortium comprising Development Data, Disacare, Transaid and Health Partners International (now part of DAI Global Health).




We were researching best apps for Preterm Birth/Maternal/ NICU nurses and discovered this interesting Abstract regarding an IFDC Mobile App.

Elsevier – Article history: Available online 7 December 2017 abstract – Journal of Neonatal Nursing 24 (2018) 48e54

Innovations: Supporting family integrated care J. Banerjee* , A. Aloysius, K. Platonos, A. Deierl IFDC Core Group, Neonatal Unit, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, United Kingdom

Integrated family delivered care mobile app: The IFDC mobile app is freely available for both mobiles and tablets from both Apple Appstore for iOS * Corresponding author. E-mail address: (J. Banerjee). Contents lists available at ScienceDirect Journal of Neonatal Nursing journal homepage: 1355-1841/© 2017 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. Journal of Neonatal Nursing 24 (2018) 48e54 devices and Google Playstore for Android devices for any parents around the world who are in need of information around neonatal care of their sick preterm infant. The App was funded by the Imperial Health Charity

Family integrated care is delivered in a supportive environment where parents are supported with education and competency based training and the neonatal unit policies and guidelines are conducive to providing such care and nurturing such approach. Use of digital technology has revolutionised and shaped the modern world. Use of mobile-based application can help parents to develop their knowledge and confidence; cameras and videos can help parents to stay in touch with the vulnerable infants even when they are not next to their loved ones. In this article we glance through the innovative ways of breaking through the barrier of staff and parent education, communication and access of the parents to the cotside using innovative ideas and digital technologies. © 2017 Neonatal Nurses Association.

Conclusion: There is growing evidence that FIC is the most efficient way of providing high quality care to the parent-baby-unit across neonatal services. But initiating FIC in neonatal units requires parental and staff training and a neonatal environment conducive in providing FIC. Current lack of resources within NHS and stretch in the capacity of the services requires innovative approaches to make this a reality. The Imperial IFDC mobile application can help to provide parental education and training as a basis of the competency based training programme for FIC. The parents gain confidence and knowledge empowering them to be an integral part of their infant’s care giving team. Simple modification of the neonatal unit environment is one of the key elements to successful FIC in the neonatal units. Use of 24/7 seamless parental access to the cotside reduces anxiety and stress and increase parental satisfaction. This may require some adjustments such as providing parents with fingerprint entry or access cards; and use of headphones could be an innovative way to allow parents to be at the cotside without impairing patient confidentiality. Bite size teaching enables the staff to be trained at bedside without taking them out of their clinical duties. We strongly believe that even when the neonatal service is stretched to its limits, the use of innovative approaches to parent and staff education and perhaps making some minor modifications to allow parental access will help FIC flourish in the neonatal units across the UK.



LIFE: Neonatal Resuscitation Training (ETAT+ NR)

Nuffield Department of MedicineEducational

Learn the ETAT+ guidelines on how to resuscitate a newborn baby who is born not breathing in this exciting 3D simulation training app. Navigate around a virtual reality hospital, find the equipment you need and quiz yourself with interactive quizzes, multiple-choice questions (MCQs) and perform simulated procedures. Example and APP Link below-

App Link-

Neonatal Intensive Care Unit for Self Learning

Knowledge Revolution INC.Education

With this app you can learn on the Go, Anytime & Everywhere. The learning & understanding process never been so easy like with our 5 study modes embedded in this app.
This app is a combination of sets, containing practice questions, study cards, terms & concepts for self learning & exam preparation on the topic of Neonatal Intensive Care Unit. This app is also suitable for students, researchers, resident, doctors, Anatomy & physiology specialists, nurses and medical professionals and of course Medical lecturers, teachers and professors.

App Link:


robs.isrealNeonatal Intensive Care Unit for Self Learning

Knowledge Revolution INC.Education

With this app you can learn on the Go, Anytime & Everywhere. The learning & understanding process never been so easy like with our 5 study modes embedded in this app.
This app is a combination of sets, containing practice questions, study cards, terms & concepts for self learning & exam preparation on the topic of Neonatal Intensive Care Unit. This app is also suitable for students, researchers, resident, doctors, Anatomy & physiology specialists, nurses and medical professionals and of course Medical lecturers, teachers and professors.

App Link:




LATE PRETERM BIRTH: Born preterm but not treated in the NICU? Even if preterm birth babies don’t require neonatal intensive critical care, they may face health challenges. Those challenges can extend through childhood into adulthood. Kat and I have had many conversations with late term preemie parents regarding their individual challenges caring for and identifying and gaining medical support and information that they understand, trust and find empowering.


The National Coalition for Infant Health is a collaborative of more than 180 professional, clinical, community health, and family support organizations focused on improving the lives of premature infants through age two and their families. NCfIH’s mission is to promote lifelong clinical, health, education, and supportive services needed by premature infants and their families. NCfIH prioritizes safety of this vulnerable population and access to approved therapies

Born between 34 and 36 weeks’ gestation? Just like preemies born much earlier, these “late preterm” infants can face: Jaundice – Feeding issues – Respiratory problems

And their parents, like all parents of preemies, are at risk for postpartum depression and PTSD.

Born preterm at a “normal” weight? Though these babies look healthy, they can still have complications and require NICU care. But because some health plans determine coverage based on a preemie’s weight, families of babies that weigh more may face access barriers and unmanageable medical bills.

ARTICLE: NEONATOLOGY TODAYtwww.NeonatologyToday.nett September 2018

Dear Colleagues, We have all heard it. “But, she is so big, how can she be a preemie?” Premature babies are not just those that are admitted to the NICU. About 4 million babies are born each year in the United States. Of these, roughly half a million babies are born prematurely (<37 weeks) each year. Today, close to 1,500 babies in the United States (over 1 in 10) will be born prematurely (1-2). Some babies are very small or sick and are admitted to the NICU. However, a lot more preemies are admitted to couplet care with mom in her room. Family and friends expect that the baby will come home with the mom. The baby starts to have feeding problems in the hospital. Then, the bilirubin goes up and phototherapy is started. Despite never entering the NICU, this late premature baby may not go home for a week or more. The mom and dad are frantic. Mom wants to breastfeed, but she has to go to the hospital each and every time she wants to feed her baby. She was given a breast pump prior to discharge, but the pump is not the same hospital grade pump that she used in the hospital. Her friends reassure her that it is okay to just give the baby formula. Meanwhile, without mom’s breastmilk, the baby receives formula feeds, spits up more frequently, and is having trouble gaining weight. Mom is distraught. She has not been able to bond with this baby the way she did with her first child. She is frequently sad. Her family does not understand. “What is there to be upset about? It is not like your baby is really sick?” The obstetrician wants to help. Mom is not going to breastfeed. So she gives her an anti-depressant.

By day three, the insurers are calling. One calls the clinician and asks why this 2500 gram baby is still not discharged home. Another in utilization review calls the father at work and explains how the policy will not cover a well baby hospital stay past three days. “The family will be responsible for all of the costs from now on.”

The parents speak with the clinician and an agreement is made to take the baby home with close follow up. The baby was started on a fortified infant formula to improve weight gain in the hospital. On the way home, the parents stop at the store to pick up the new formula. The supermarket doesn’t have it, nor the drugstore neither the large wholesale store. One of their friends suggests goat’s milk, another had good results with hemp milk. Two weeks later, the parents finally have an appointment with the pediatrician. Unfortunately, the pediatrician is not doing well baby checks that day, and instead, the baby is seen by someone who does not know the baby’s history. He re-assures the parents and explains that there should be no differences between this baby and their first child. Five minutes later, the parents are checking out.

Across from them, another mom is bringing in her baby for an emergent visit. The baby is coughing and looks sick. Mom is worried, but she remembers what the doctor said. The parents go home. Although their baby has not regained birthweight, they are satisfied. Mom cannot remember discussing her concerns about prematurity or whether hemp milk should be used exclusively. Two days later, the baby is stick with a cold. Mom is concerned. The baby’s chest seems to be bouncing off the bed. Dad and mom go to the urgent care at 3 AM. The ER doctor starts an IV and broad spectrum antibiotics. Mom is crying; dad is stoic. They admit the baby to the general pediatrics ward. The nurse tells mom that her baby has Respiratory Syncytial Virus or RSV. The insurer is calling again. He wants to know why the baby is re-admitted to the hospital. The parents are despondent. No one seems to understand. “Is this what it is going to be like forever, what went wrong?” The answer is not always obvious. This baby is still a preemie.

Not every premature baby goes to the NICU. Some have feeding problems, jaundice, and respiratory problems. Some spend weeks in the hospital. Some have lifelong health problems. And some are disadvantaged from birth. All preemies face health risks, all deserve appropriate health coverage, and all need access to proper health care. The National Coalition for Infant Health has created a new infographic designed to bring these concerns to light. The full graphic panel is on the facing page. Please download it from our website and share it with a colleague, friend, or parent of a preemie.

The National Coalition for Infant Health VALUES-

Safety. Premature infants are born vulnerable. Products, treatments and related public policies should prioritize these fragile infants’ safety.

Access. Budget-driven health care policies should not preclude premature infants’ access to preventative or necessary therapies.

Nutrition. Proper nutrition and full access to health care keep premature infants healthy after discharge from the NICU.

Equality. Prematurity and related vulnerabilities disproportionately impact minority and economically disadvantaged families. Restrictions on care and treatment should not worsen inherent disparities.

Mitchell Goldstein, MD Medical Director National Coalition for Infant Health




            Miracle Babies

Applified Marketing GroupHealth & Fitness

Download the #1 NICU resource app for FREE!

App Features:

Free printable PDF of “Guide and Journey Through the NICU” book by Sean Daneshmand, MD & Susan Kylee Newman, MSN, RN, NNP-BC-

Miracle Monday inspirational quotes can be delivered to your phone every Monday to help you feel more empowered as a NICU parent.

Kangaroo Care tab provides information and advice on skin-to-skin contact with your baby

Breastfeeding tab gives you information and advice on breastfeeding your NICU baby during your hospital stay and after you bring them home

NICU Glossary provides definitions of the most used terms in the NICU (With a search bar for ease of access)

Read inspirational family stories about miracle babies just like yours! There is also a questionnaire you may fill out if you would like your miracle to be in the spotlight. It is a great way to help lift other mothers up.

MBMD is a resource center built by professionals who know and understand your NICU struggles and would like to help you by providing articles, blog posts, podcasts, and more!

Free relaxing music player

So Much More!!!



IFDC Integrated Family Delivered Neonatal Care project video

YOUTUBE-Published on Jan 12, 2017

Integrated Family Delivered Care – This video was created by the Neonatal team (Imperial College NHS Healthcare Trust, London, UK) for our quality improvement program. Our Integrated Family Delivered Care project aim to help families with babies treated in our NICU via parent engagement and education. Along thins program an App was developed for IOS and Android which can be downloaded and used for free. The project is funded by Imperial Healthcare Charity.



“Imagination is more important than knowledge.” Albert Einstein “The only real valuable thing is intuition.”




The Lancet publishes important new study showing success of model of care in our NICU                                                By Corporate Communications | Feb 8, 2018 |

A new study by Mount Sinai neonatologist Dr. Karel O’Brien, and principal investigator, Dr. Shoo Lee, Chief of Pediatrics, published in the prestigious journal The Lancet Child & Adolescent Health shows that the Family Integrated Care (FICare) model of treating the tiniest and most fragile babies in Mount Sinai’s Newton Glassman Charitable Foundation Neonatal Intensive Care Unit helps improve the well-being of both children and parents. Family Integrated Care actively involves parents in the care of their newborns, including giving oral medicine, feeding, taking their temperatures and taking part in ward rounds.

The study, which involved 26 NICU units in Canada, Australia and New Zealand which had adopted the model of care developed at Mount Sinai Hospital by Dr. Lee, showed improved weight gain among preterm infants, better breastfeeding and reduced parental stress and anxiety compared to standard care.

“How care is provided to the family, not just the infant, has a positive effect on the wellbeing of both infant and family,” says Dr Karel O’Brien, who leads the Family Integrated Care Program at Mount Sinai. “Weight gain, breastfeeding and reduced parental stress and anxiety are all associated with positive neurodevelopmental outcomes, suggesting that integrating parents into the care of infants at this early stage could potentially have longer-term benefits.”

Mount Sinai supports parents in spending six hours a day, at least five days a week with their babies by providing them with a rest space and sleeping room, comfortable reclining chairs at the bedside and nurses trained in family support.

At 21 days, infants in the FICare group had put on more weight and had higher average daily weight gain (26.7g vs 24.8g), compared to the standard care group. Additionally, parents in the FICare group had lower levels of stress and anxiety, compared to the standard care group. Once discharged, mothers were more likely to breastfeed frequently (more than 6 feeds a day), compared to the standard care group (70% vs 63% ).There were no differences in rates of mortality, duration of oxygen therapy or hospital stay.

“Parents are too often perceived as visitors to the intensive care unit. Our findings challenge this approach and show the benefits to both infants and their families of incorporating parents as key members of the infant’s health care team, and helping parents to assume the role of primary caregiver as soon as possible,” says Dr O’Brien.

“The results of this trial are encouraging indeed. Not only is this an example of innovative care developed here in our hospital, it is an exceptional example of how a good idea can be shared across the country and around the world,” says Dr. Lee. “This was truly a collaborative effort with participating NICUs, parents, and the whole care team.”

When Amy, a new mother of twins found herself in the NICU with babies born at 23 weeks, 5 days, she felt scared and overwhelmed by how fragile the babies were. Today, still in the NICU for almost three months, she has found comfort in being part of the Ficare model of care. “It really allowed me to feel like a mother.  Being with my babies all day, I know instinctively if something is wrong or what they need, and can report that to the doctors and nurses.  They are getting stronger and stronger every day, and this model of care has made me believe that when I bring them home, I’ll be able to confidently care for them.”


See the Study     arrow.isreal.png


Positioning NICU Patients with The Zaky






What Trauma Taught Me About Resilience Charles Hunt

ted.isrealTEDx Talks    Published on Nov 18, 2016

That resilience is one of the most important traits to have, is critical to their happiness and success, & can be learned.



Second Step – Session 2 – Regression Therapy

The abyss of repressed feelings and visceral knowing is not as dark as it once was.  I would like to say that in one session my repression and anxiety were enlightened and released and my healing is complete, but that is not the case, nor did I anticipate it would be….

My next session with Lillian was booked about three weeks after the first appointment. During the two hour session Lillian used multiple modalities (past life regression, birthing therapy preparation, hypnotherapy, etc.) to identify closed and to carefully open new doors within the inner realms of my being. There were moments during treatment I experienced strong fear and anxiety, a desire to run, excruciating pain on my left side, sadness, grief and guilt. Lillian moved slowly and expertly directed me back into my body when my soul stood a little too far outside. Trust in my therapist was my anchor. Lillian’s use of hypnotherapy to conclude the session provided me with a process that brought me fully into the present feeling exhausted but safe. I agreed to a journaling process on a daily basis (a few minutes per day is all my busy work and school schedule can handle at this time) until our next session as we approach the rebirthing process more fully.

Therapy for me is a journey of surrender and trust. I do not know where I am going in therapy but I trust it will lead me to increased freedom and wholeness. My experience of heightened anxiety may be due in part to how my birthing experience and the loss of my twin brother at birth traumatically impacted my life journey. It seems to me that sub-consciously a part of my cellular, visceral and physiological body has been aware of the trauma. As an adult pursuing full vitality I am seeking greater self-awareness so that I may better heal myself and increase my ability to connect with others.

What I want most to share with you today in my journey is this: go forward on your journey with faith in your heart, curiosity in your eyes, resilience in your spirit, warmth in your voice, and an out-stretched hand to our Warrior family.


Tribe without Borders: Israel | EP 1

Matador Network Loading…Published on Mar 16, 2018

The first in a two-part series, Tribe without Borders: Israel follows 5 young women from 5 different backgrounds on a journey through the Middle East. Here in Tel Aviv they connect with the next generation of surfers to promote peace and stoke.

Courage, WhatsAPP, Cord Milking




  • Home of Christiaan Barnard, Nelson Mandela, Dave Matthews, Desmond Tutu
  • Preterm birth rate – 8 (births <37 weeks per 100 live births)
  • Preterm birth rate – USA – 12 per 100 births


South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. South Africa is the largest country in Southern Africa and the 25th-largest country in the world by land area and, with close to 56 million people, is the world’s 24th-most populous nation. South Africa is a multiethnic society encompassing a wide variety of cultures, languages, and religions. Its pluralistic makeup is reflected in the constitution‘s recognition of 11 official languages, which is the fourth highest number in the world. Since 1994, all ethnic and linguistic groups have held political representation in the country’s democracy, which comprises a parliamentary republic and nine provinces. South Africa is often referred to as the “rainbow nation” to describe the country’s multicultural diversity, especially in the wake of apartheid. The World Bank classifies South Africa as an upper-middle-income economy, and a newly industrialised country. South Africa is still burdened by a relatively high rate of poverty and unemployment, and is also ranked in the top 10 countries in the world for income inequality. In South Africa, private and public health systems exist in parallel. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population use the private system and are far better served. About 79% of doctors work in the private sector.



We note and appreciate the efforts of many Nations World-Wide working together to bring universal healthcare to our global population and our Neonatal Womb community members!


High Aspirations for Universal Healthcare in South Africa

On 21 June 2018, the Minister of Health published the draft National Health Insurance Bill, 2018 (NHI Bill) for public comment. The NHI Bill aims to enable access to free, universal, high-quality healthcare for all, by creating a single national health insurance fund; and would centralise procurement of medical supplies by the State.


Mobilizing Tech for Moms: MomConnect in South Africa

Published on Jun 11, 2018- Through programs like MomConnect in South Africa, Johnson & Johnson uses mobile technology to reach 6 million moms in 10 countries with health information provided by BabyCenter.

MomConnect: Fostering a long-term, supportive dialogue with mothers in South Africa

As patient groups go, pregnant women and new mothers are among the most motivated. They’re eager for information on how to care for themselves and their children, and quick to take action to ensure their children have the best start in life. But in some low-income countries around the world, accessing high-quality health information at exactly the right time is not always easy. Recognizing the role a mobile phone could play in reaching expectant and new mothers, Johnson & Johnson made a commitment to Every Woman Every Child in 2010 to work with partners to reach women in six countries with evidence-based messages to motivate behavior change, and increase the likelihood that women would seek out antenatal health services.

Eight years after the initial Johnson & Johnson commitment, three of the six country programmes (Bangladesh, India, and South Africa) have reached more than a million mothers each.

How did this happen?

MomConnect, South Africa’s national mobile messaging service, is a useful case study. It has had a true commitment to universal coverage right from the start, and currently reaches over 60% of all eligible pregnant women in the country through over 95% of public clinics – the highest population coverage of any program of its kind in the world. The program is managed by the South African National Department of Health, with a diverse range of funding, technology, health and research organizations at the table.

To encourage uptake, BabyCenter collaborated with local partners to create messages that were carefully targeted to be relevant to the mother’s pregnancy stage or baby’s age. Messages were designed to have a warm, culturally-sensitive and relatable tone, and to provide parenting support and content to promote bonding, alongside more technical health promotion messages.

There have been several key elements to MomConnect that have made scale possible:

  1. It is accessible through all mobile phones. It uses the most simple USSD and SMS mobile technologies – despite their high costs at scale – to ensure that no mother is excluded because of the kind of phone she has. But as user habits have changed, MomConnect has also recently expanded to include WhatsApp as a richer and more affordable messaging platform.
  2. The messaging engages and empowers users, fostering a relationship of trust with the service and the health system. In a sample of 2000 women, 98% found the messages helpful, 77% felt better prepared for delivery, 81% shared their messages with family and friends, and 70% wanted more messages per week.
  3. It has had critical public-sector ownership. Private funders, with a larger appetite for risk, have contributed upfront investment and technical know-how to get MomConnect started, but only in the context of strong public leadership and an enabling policy environment.
  4. It can be adapted over time. The platform has been built with open architecture and open standards so that new features and functionality of increasing complexity can be added to engage new partners and users over time.
  5. It integrates supply and demand. The service doesn’t just push out messaging, but enables two-way interaction between the pregnant mother and the health system through phone-based surveys and a helpdesk. This enables real-time data collection on user knowledge, attitudes, practices, and experiences of service delivery to inform health care improvements.

With a technology platform now reaching over a million active users, MomConnect made it possible to bring direct messaging to mothers across the country with a flip of a switch during South Africa’s recent Listeriosis outbreak. MomConnect’s critical challenge remains long-term sustainability. Beyond maintaining its existing digital infrastructure, it needs to be agile to evolve in line with the technology landscape and the habits and needs of its users.

It will always need some degree of private funding for innovation, and it is critical that an ecosystem of funders and partners stay the course to collectively refine and augment this important public good for collective impact.

You can learn more about MomConnect in South Africa by reading this commentary  and this article in the British Medical Journal.

  • Download PDF
  • Full Text


MomConnect & WhatsApp

Published on Jan 22, 2018-Animation shared at CES 2018 on the innovation behind the South African Department of Health’s MomConnect and NurseConnect platforms.

Association of Gestational Age at Birth With Symptoms of Attention-Deficit/Hyperactivity multimedia icon



Questions  Is the association between gestational age at birth and symptoms of attention-deficit/hyperactivity disorder the same at 5 and 8 years of age, and are there possible sex differences in the associations?

Findings  In this population-based cohort study of 113 227 children that used a sibling comparison approach to adjust for confounding, an association was found between early preterm birth (gestational age <34 weeks) and symptoms of attention-deficit/hyperactivity disorder in preschool and school-age children.

Meaning  The findings illustrate potential gains of reducing preterm birth and the importance of providing custom support to children born preterm to prevent neurodevelopmental problems.


Importance  Preterm birth is associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD); however, it is unclear to what extent this association can be explained by shared genetic and environmental risk factors and whether gestational age at birth is similarly related to inattention and hyperactivity/impulsivity and to the same extent in boys and girls.

Objectives  To investigate the association between gestational age at birth and symptoms of ADHD in preschool and school-age children after adjusting for unmeasured genetic and environmental risk factors.

Design, Setting, and Participants  In this prospective, population-based cohort study, pregnant women were recruited from across Norway from January 1, 1999, through December 31, 2008. Results of a conventional cohort design were compared with results from a sibling-comparison design (adjusting for genetic and environmental factors shared within families) using data from the Norwegian Mother and Child Cohort Study. Data analysis was performed from October 1, 2017, through March 16, 2018.

Exposures  Analyses compared children and siblings discordant for gestational age group: early preterm (delivery at gestational weeks 22-33), late preterm (delivery at gestational weeks 34-36), early term (delivery at gestational weeks 37-38), delivery at gestational week 39, reference group (delivery at gestational week 40), delivery at gestational week 41, and late term (delivery after gestational week 41).

Main Outcomes and Measures  Maternally reported symptoms of ADHD in children at 5 years of age and symptoms of inattention and hyperactivity/impulsivity at 8 years of age. Covariates included child and pregnancy characteristics associated with the week of delivery and the outcomes.

Results  A total of 113 227 children (55 187 [48.7%] female; 31 708 [28.0%] born at gestational week 40), including 33 081 siblings (16 014 female [48.4%]; 9705 [29.3%] born at gestational week 40), were included in the study. Children born early preterm were rated with more symptoms of ADHD, inattention, and hyperactivity/impulsivity than term-born children. After adjusting for unmeasured genetic and environmental factors, children born early preterm had a mean score that was 0.24 SD (95% CI, 0.14-0.34) higher on ADHD symptom tests, 0.33 SD (95% CI, 0.24-0.42) higher on inattention tests, and 0.23 SD (95% CI, 0.14-0.32) higher on hyperactivity/impulsivity tests compared with children born at gestational week 40. Sex moderated the association of gestational age with preschool ADHD symptoms, and the association appeared to be strongest among girls. Early preterm girls scored a mean of 0.8 SD (95% CI, 0.12-1.46; P = .02) higher compared with their term-born sisters.

Conclusions and Relevance  After accounting for unmeasured genetic and environmental factors, early preterm birth was associated with a higher level of ADHD symptoms in preschool children. Early premature birth was associated with inattentive but not hyperactive symptoms in 8-year-old children. This study demonstrates the importance of differentiating between inattention and hyperactivity/impulsivity and stratifying on sex in the study of childhood ADHD.

Helga Ask, PhD1; Kristin Gustavson, PhD1,2; Eivind Ystrom, PhD1,2; et al Karoline Alexandra Havdahl, PhD1,3; Martin Tesli, MD, PhD1,4; Ragna Bugge Askeland, MSc1; Ted Reichborn-Kjennerud, MD, PhD1,5

Author Affiliations Article Information

  • 1Norwegian Institute of Public Health, Oslo, Norway
  • 2Department of Psychology, University of Oslo, Oslo, Norway
  • 3MRC Integrative Epidemiology Unit, Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, United Kingdom
  • 4NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
  • 5Institute of Clinical Medicine, University of Oslo, Oslo, Norway

JAMA Pediatr. 2018;172(8):749-756. doi:10.1001/jamapediatrics.2018.1315



Delayed cord clamping and cord-blood milking are proactive medical procedures offering hope for more effective preterm delivery methodology. If shown to be effective over time, these procedures could impact preterm birth babies in a positive way world-wide.   😊

we.s.africaNeonatal Research Institute at Sharp Mary Birch Hospital for Women & Newborns  WebsEdgeHealth Published on Apr 24, 2018

Experts at Sharp Mary Birch Hospital for Women and Newborns established the Neonatal Research Institute (NRI) to identify and disseminate the latest evidence-based best practices for newborn care. Sharp Mary Birch is the busiest maternity hospital in California, with a baby born every hour on average. That volume provides doctors and researchers with a unique opportunity to create a strong research infrastructure that will yield meaningful breakthroughs. Already, breakthroughs related to cord-blood milking and delayed cord clamping have shown improvements in brain, lung, and heart function for newborns. Now the NRI is building for the future with a clinic that will track the health outcomes of its patients through childhood, demonstrating the long-term benefits of interventions which can be initiated in the first moments of life.

BLOG:   Born Too Soon in a Country at War. Their Only Hope? This Clinic.

This baby girl has stopped breathing. She was born prematurely and is only 3 weeks old. Her mother, Restina Boniface, took her to the only public neonatal clinic in South Sudan. The country is one of the toughest places in the world for newborns with health problems to survive.

Ten feet away sits a donated respiratory machine that could save the baby. But lacking a critical part, it goes unused.

The doctor tries to resuscitate the baby for several minutes. Finally, she begins breathing on her own.

One in 10 babies brought to this clinic will die, most from treatable conditions. But many mothers have nowhere else to go.

South Sudan, the world’s youngest nation, is in the midst of a humanitarian crisis. A brutal civil war has drained the economy. As hospitals closed, doctors were forced to flee. Inside the clinic, many babies remain nameless. Their mothers know they may not make it. “Our mothers here, they come for help,” said Rose Tongan, a pediatrician. “And you pity them. You can’t do anything.”

Electricity cuts out for days at a time.

There is no formula for the premature babies, no lab for blood tests, no facility for X-rays.

There are no beds for breast-feeding mothers. They must sleep outside, where they are at risk of infection and vulnerable to assault. “I feel like: What can I do?” Dr. Tongan said.

Hellen Sitima’s 3-day-old daughter is sick. “When we get home, then that’s the time to name the baby,” she says.

Dr. Tongan has no access to lab tests, but she determines that Ms. Sitima’s baby has a respiratory infection.

The infection clears, and Ms. Sitima takes her daughter home. She names her Gift.

Ms. Boniface’s baby, who was resuscitated earlier, died in the clinic. She was never named.

Kassie Bracken is a video journalist for The New York Times, and Megan Specia is an editor on the International Desk. They were 2018 fellows with the International Women’s Media Foundation’s African Great Lakes Reporting Initiative.

Source: do we help preterm birth partners in countries at war? Human Security, physician/health care provider access and simple, effective, portable resources are things to consider.

mOm – The Inflatable Incubator CBS News Report

Published on Jun 3, 2016 – James Roberts explain how the mOm incubator came to fruition


Consuming fish may reduce premature birth risk

August 3, 2018DayAfter

Eating fish or taking a fish oil supplement may reduce the risk of preterm birth among pregnant women with low level of omega-3 fatty acids, a new study has found.

The findings indicated that pregnant women who had low plasma levels of long chain n-3 fatty acids — found in fish oil — in their first and second trimesters were at a significantly higher risk of preterm birth as compared with women who had higher levels of these fatty acids.

The researchers suggest that low concentrations of certain long chain fatty acids — eicosapentaenoic acid and docosahexaenoic acid (EPA+DHA) — may be a strong risk factor for preterm birth.

“At a time when many pregnant women are hearing messages, encouraging them to avoid intake of fish altogether due to mercury content, our results support the importance of ensuring adequate intake of long chain omega-3 fatty acids in pregnancy,” said lead author Sjurdur F. Olsen from the Harvard T.H. Chan School of Public Health in Boston.

Preterm birth is a leading cause of neonatal death and is associated with cognitive deficiencies and cardiometabolic problems later in life among survivors.

For the study, published in the journal EbioMedicine, the research team examined 96,000 children in Denmark through questionnaires and registry linkages.

They also analysed blood samples from 376 women who gave premature birth (prior to 34 weeks of gestation) between 1996 and 2003 and 348 women who had a full-term birth.

All of the women gave blood samples during their first and second trimesters of pregnancy.

The analysis of the blood samples showed that women who were in the lowest quintile of EPA+DHA serum levels — with EPA+DHA levels of 1.6 per cent or less of total plasma fatty acids — had a 10 times higher risk of early preterm birth when compared with women in the three highest quintiles, whose EPA+DHA levels were 1.8 per cent or higher.

Women in the second lowest quintile had a 2.7 times higher risk compared with women in the three highest quintiles.


It is often difficult to know how to interact with a preemie parent or family member. Congratulating the preemie parents/family on the birth of their child, acknowledging their losses, concerns and the courage their journey requires, listening, helping out at their home, sitting in silence with them are actions preemie parents may truly appreciate. The preterm birth journey is unpredictable, often leaving friends and family feeling awkward and without behavioral guidelines.

Funny Things People Say To Mums Of Premature Babies

YouTube  · 6/9/2015 by Channel Mum


Our environment has a significant impact on preterm birth, offering us the opportunity to invest in preterm birth prevention in many innovative and financially beneficial ways.

Closing coal, oil power plants leads to healthier babies

Mind & body, Research, Science & environment By Robert Sanders, Media relations| May 22, 2018/May 23, 2018

Shuttering coal- and oil-fired power plants lowers the rate of preterm births in neighboring communities and improves fertility, according to two new University of California, Berkeley, studies.

The researchers compared preterm births and fertility before and after eight power plants in California closed between 2001 and 2011, including San Francisco’s Hunters Point plant in 2006.

Overall, the percentage of preterm births – babies born before 37 weeks of gestation – dropped from 7 percent in a year-long period before plant closure to 5.1 percent for the year after shutdown. Rates for non-Hispanic African-American and Asian women dropped even more: from 14.4 percent to 11.3 percent.

Preterm births, which can often result in babies spending time in a neonatal intensive care unit, contributes to infant mortality and can cause health problems later in life. The World Health Organization estimates that the cost of preterm births, defined as births between 32 and 37 weeks of gestation, accounts for some $2 billion in healthcare costs worldwide.

The 20-25 percent drop in preterm birthrates is larger than expected, but consistent with other studies linking birth problems to air pollution around power plants, said UC Berkeley postdoctoral fellow Joan Casey, the lead author of a study to be published May 22 in the American Journal of Epidemiology.

Another paper published May 2 in the journal Environmental Health used similar data and found  that fertility – the number of live births per 1,000 women – increased around coal and oil power plants after closure.

“We were excited to do a good news story in environmental health,” Casey said. “Most people look at air pollution and adverse health outcomes, but this is the flip side: We said, let’s look at what happens when we have this external shock that removes air pollution from a community and see if we can see any improvements in health.”

Retiring fossil fuel power plants

The findings, she said, could help policy makers in states like California more strategically plan the decommissioning of power plants as they build more renewable sources of energy, in order to have the biggest health impact.

“We believe that these papers have important implications for understanding the potential short-term community health benefits of climate and energy policy shifts and provide some very good news on that front,” said co-author Rachel Morello-Frosch, a UC Berkeley professor of environmental science, policy and management and of public health and a leading expert on the differential effects of pollution on communities of color and the poor. “These studies indicate short-term beneficial impacts on preterm birth rates overall and particularly for women of color.”

In a commentary accompanying the AJE article, Pauline Mendola of the Eunice Kennedy Shriver National Institute of Child Health and Human Development said: “Casey and colleagues have shown us that retiring older coal and oil power plants can result in a significant reduction in preterm birth and that these benefits also have the potential to lower what has been one of our most intractable health disparities. Perhaps it’s time for the health of our children to be the impetus behind reducing the common sources of ambient air pollution. Their lives depend on it.”

The researchers compared preterm birth rates in the first year following the closure date of each power plant with the rate during the year starting two years before the plant’s retirement, so as to eliminate seasonal effects on preterm births. They also corrected for the mother’s age, socioeconomic status, education level and race/ethnicity.

Dividing the surrounding region into three concentric rings 5 kilometers (3 miles) wide, Casey delved into state birth records to determine the rate of preterm births in each ring.

Those living in the closest ring, from zero to 5 kilometers from the plant, saw the largest improvement: a drop from 7 to 5.1 percent. Those living in the 5-10 kilometer zone showed less improvement. Those living in the 10-20 km zone were used as a control population. They also considered the effects of winds on preterm birth rates, and though downwind areas seemed to exhibit greater improvements, the differences were not statistically significant.

As a control, they replicated their analysis around eight power plants that had not closed, and found no before-versus-after difference, which supported the results of their main analyses. There did not appear to be any effect on births before 32 weeks, which Casey said may reflect the fact that very early births are a result of problems, genetic or environmental, more serious than air pollution.

Casey noted that the study did not break out the effects of individual pollutants, which can include particulate matter, sulfur dioxide, nitrogen oxides, benzene, lead, mercury and other known health hazards, but took a holistic approach to assess the combined effect of a mix of pollutants.

“It would be good to look at this relationship in other states and see if we can apply a similar rationale to retirement of power plants in other places,” Casey said.

Other co-authors of the AJE paper are Deborah Karasek, Kristina Dang and Paula Braveman of UC San Francisco, Elizabeth Ogburn of the Johns Hopkins University Bloomberg School of Public Health in Baltimore and Dana Goin of UC Berkeley.

This research was supported by the UC San Francisco California Preterm Birth Initiative, which is funded by Marc and Lynne Benioff. Additional support was provided by grants from the National Institute of Environmental Health Sciences (K99ES027023, P01ES022841, R01ES027051) and the U.S. Environmental Protection Agency (RD-83543301).


Domestic Violence is a factor that increases preterm birth rates, and is a preterm birth factor we can change together. Investment in the prevention of preterm birth should always be a primary objective.

Domestic Violence Statistics (USA-2017)

  • Every 9 seconds in the US a woman is assaulted or beaten.
  • Around the world, at least one in every three women has been beaten, coerced into sex or otherwise abused during her lifetime. Most often, the abuser is a member of her own family.
  • Domestic violence is the leading cause of injury to women—more than car accidents, muggings, and rapes combined.
  • Every day in the US, more than three women are murdered by their husbands or boyfriends.


Domestic Violence Can Double Risk of Preterm Birth

Physical injuries and inadequate maternal care lead to serious complications-

  • January 13, 2017   By
  • A study out of the University of Iowa revealed what most of us could have already guessed—domestic violence during pregnancy puts both mom and baby at increased risk for serious health problems. Published this past March in BJOG: An International Journal of Obstetrics and Gynaecology, the results show intimate partner violence during pregnancy is “significantly associated with” preterm birth (before 38 weeks) and low birth weight, finding that women who endured abuse while pregnant were almost twice as likely to deliver their babies preterm.
  • Trauma to a woman’s abdomen, as well as sexual abuse, may increase the risk of spontaneous abortion, preterm delivery, low birth weight or neonatal death, say researchers, but the risks aren’t limited just to those abused physically. Adverse birth outcomes are also linked to increased stress, inadequate nutrition and prenatal care, and negative maternal behavior. This could include smoking, drinking or not sleeping, says family practice doctor and American Academy of Family Physicians Board Chair, Wanda Filer, MD.
  • “Different people cope differently with stress,” says Filer. Being stressed, drinking, smoking and not staying active can cause high blood pressure, which can have negative implications on the health of the placenta, she says. After 20 weeks, high blood pressure could lead to a condition called preeclampsia, which can cause serious damage to the mother-to-be’s organs, such as the brain and kidneys. While this condition is rare, roughly affecting only about 5 percent of pregnant women, it can lead to more serious complications such as seizures. This is classified as eclampsia, a condition which can be fatal.
  • Other complications of high blood pressure during pregnancy include placental abruption—an emergency condition in which the placenta detaches from the uterus prematurely—as well as low birth weight and an increased risk of C-section birth.
  • The National Institutes of Health (NIH) estimates abusers target more than 300,000 pregnant women in the U.S. each year, adding that the number may be even higher than that given the reluctance of survivors to disclose abuse, especially during pregnancy.
  • This, combined with the fact that the NIH also lists homicide as one of the leading causes of death of pregnant women (Filer says she believes it is the leading cause of death, though research varies), means women with abusive partners who become pregnant should be aware that their lives are in danger in more ways than one.
  • “When a woman is pregnant, she is developing a relationship with, and focusing on, this new baby. And as we know, the abuser wants the focus on him,” says Filer. “My suspicion is the abuse escalates to turn the focus back on the abuser. It’s a way to exert control.”
  • Filer has been an outspoken advocate for more domestic violence training among medical professionals for the last 25 years. Luckily, she believes there have been significant improvements in the screening process of pregnant women by their medical staff to ask about domestic violence in the home.
  • “Twenty-five years ago, it [screening] was non-existent. Now, it’s routine. I have seen a better interface between domestic violence shelters and the medical community.” In Pennsylvania, where Filer practices, she says it’s not uncommon for domestic violence shelters to come into medical practices and do hour-long presentations on the victim services they offer.
  • What You Can Do
  • It is always your call whether or not to reach out for help, and when, as a survivor of abuse. Only you know when it’s safe to do so. However, if you’re looking for a window to reach out to an advocate, consider doing it during one of your prenatal appointments when your partner is either not with you, or not in the room, suggests The National Domestic Violence Hotline. You can ask your doctor or nurse if you can call a local shelter or national crisis hotline from the safety of their office.
  • Also make sure to inform your doctor of any injuries or health concerns you have as a result of the abuse. This includes physical injuries, high stress levels or a lack of access to proper prenatal care, such as if your abuser is preventing you from eating healthy, sleeping or otherwise taking care of yourself. Full disclosure of any health concerns will give your baby the best chance for proper medical care.  



This post discusses the therapeutic treatment of preverbal trauma. Sometimes the most persistent PTSD symptoms are connected to events for which you have no clear memory. This might be the case if you were told that your life is the result of an unwanted pregnancy, if you endured medical complications around your birth, if you grew up neglected, or if you suffered from child abuse.

In addition to these early memories, some people are unable to remember traumatic events that occurred later in life. This is because traumatic stress can impair brain structures involved with memory. I refer to these as nonverbal trauma memories.

Preverbal trauma and nonverbal trauma memories typically do not have associated words or a clear and coherent story. In contrast, they might come in the form of flashes of images, disconnected fragments, or uncomfortable physical sensations with no known cause.

Most importantly, you might ask whether healing is possible if you are unable to remember these traumatic events?

“In my experience, memory retrieval is not always possible. Moreover, many therapists do clients a disservice when they make memory retrieval the focus of therapy. However, there is hope—you can heal whether or not you remember your preverbal trauma.”
-Dr. Arielle Schwartz
                                                         Regaining Emotional Control

Babette Rothschild, trauma expert and author of The Body Remembers vol. 2 (2017), writes “Loss of control is at the core of PTSD.” This statement is a firm reminder that an essential component in healing trauma involves reclaiming a sense of control in your life, now. The first stage of trauma treatment is stabilization which involves successfully managing symptoms of traumatic stress such as anxiety, panic attacks, dissociation, or somatic distress.

When you are no longer overwhelmed by your trauma memories you can cultivate the freedom to live the life you want now.

Since preverbal memories are often related to very young time in your life, healing involves building resources in the here and now and can help you compassionately attend to the pain from your past. Resources for trauma recovery including reclaiming a sense of safety, grounding, and containment.

Memory Retrieval or Trauma Recovery?

Once you have access to resources, you might choose to work with the sensations, emotions, or memory fragments associated with preverbal trauma and nonverbal memories.  However, it is important to be cautious when working with preverbal and nonverbal memories as these fragments and sensations do not necessarily represent an exact replay of original events.

Traumatic experiences are stored with emotional information disconnected from contextualizing information. When we remember any memory, we are almost always inserting new information related to our present state of mind and environment. This is especially true for preverbal and nonverbal memories because the original experience is lacking essential details. As human beings, we are storytellers and we will fill in missing elements of memories—we have a fundamental need to develop a narrative that is consistent with our current beliefs and sense of self.

The goal of therapy for preverbal trauma and nonverbal memories is not memory retrieval. Sometimes memories arise spontaneously; but, even in such moments we must uphold that memory is vulnerable to influence.

In contrast, the goal of therapy is trauma recovery in which you actively distinguish the past from the present, develop a sense that you are at choice about how to respond to your world now, and experience of yourself as a resilient.

Healing preverbal trauma involves working with any present symptoms of anxiety, panic attacks, dissociation, or somatic distress. It is common to feel nauseous, numb, foggy, fatigued, or disconnected when preverbal or nonverbal trauma memories arise. Therefore, healing requires the careful guidance of a well-trained therapist, using fine-tuned approaches such as EMDR Therapy, somatic psychotherapy, and Parts Work therapy. Throughout the process, you learn to become highly descriptive of your somatic experience, work through “stuck” sensations in your body, and attend to unmet childhood needs from your past as a resourced adult in the present.

Again, and it is worth reiterating, the outcome of successful trauma treatment is to recognize that the trauma is in the past…and that it is over.





I am walking the path of a preterm birth survivor…. At 27 years of age repressed feelings are knocking at my door.

First Step -Regression Therapy

Following months of seeking to identify a therapist to best meet my needs I discovered a hopeful match. And she was great!

I was genuinely afraid of stepping into the dark abyss of repressed feelings and visceral knowing. My love for my preterm brothers and sisters inspired me to move forward with courage and resolve. The therapist offered numerous healing modalities and I choose regression therapy to begin this part of my wellness adventure.

Lillian (not her actual name) welcomed me with a broad smile, bright blue eyes, and open arms directing me into a sacred healing space. Completed patient paperwork in hand, Lillian conducted a comprehensive interview while preparing me to enter the mysteries of my deeper, fuller self. During the long session, we meditated, explored my birth story, loss of my twin, heart surgery and my NICU experiences. At times during the session I experienced strong physical pressure and pain, changing breathing patterns, but I contained my emotions (a clear indication of my defensiveness). At times Lillian expertly changed the course of our journey to compliment my readiness to move further into my past. The session ended with a review of the healer’s prescription (journaling), a plan for our next session, and a discussion of potential side effects of treatment.

One week post-session following periods of head, back, shoulder, lung, and chest pain, unanticipated waves of emotion, fatigue followed by sporadic energy bursts I am feeling a little more free, a bit more aware of triggers, and relief that I choose to confront my fears and to seek wholeness. I remain focused on learning to feel safe in my body and with others. I am learning to recognize my feelings and to “sit with” uncomfortable emotions. This step , the first of many, is filled with compassion for myself and others. I travel, not alone, but with you in my heart.

Love, Kat

Faces of Africa : Surfers not Street Children

  • This long video is inspirational, educational, heart-warming, raw and well-worth watching.
  • CGTN Africa – Published on Mar 31, 2015

South Africa has hundreds of children living rough on the streets, many spiralling into crime and suffering from the effects of addiction. Eighteen year old Ntando Msibi has gone from street kid to surfing star with many awards to his name. He was helped to this path by the Durban charity, Surfers Not Street Children and credits them with rescuing him from the harshness of life on the streets. Amongst its many programmes aimed at getting street children get back into society, it is surfing that has proven the biggest hit leading to the transformation of lives that many had given up on and has become a new wave of change with young black surfers succeeding in a sport once known for the whites.

***Ntando Msibi became a Pro Surfer in 2016


Passion, Focus, Floating Docs



Biodiversity, the Panama Canal, and Birding panama.tucan.jpg … Oh, Panama…………

March of Dimes  

Panama Preterm Birth Rate: 8.1 (Global 11.1, USA 12%)   Country Ranking: 123 (USA 54)

Panama, officially the Republic of Panama is a country in Central America, bordered by Costa Rica to the west, Colombia to the southeast, the Caribbean Sea to the north and the Pacific Ocean to the south. The capital and largest city is Panama City, whose metropolitan area is home to nearly half the country’s 4 million people. Panama’s politics take place in a framework of a presidential representative democratic republic, whereby the President of Panama is both head of state and head of government, and of a multi-party system. Executive power is exercised by the government. Legislative power is vested in both the government and the National Assembly. The judiciary is independent of the executive and the legislature.

Healthcare in Panama is provided through a system through the government and a private sector. The public sector is funded through the Ministry of Health and the social security System. Problems with the public health care system are in the countryside where lack of funding creates a shortage of beds for their number of patients. The majority of doctors prefer to live in Panama City where there are higher patient loads and more economic opportunity.


global community (1)


Let’s Get Ready to  celebrate World Prematurity Day on November 17, 2018. World Prematurity Day is observed on November 17th each year to raise awareness of preterm birth and the concerns of preterm babies and their families worldwide. In 2014 world renown photographer Anne Geddes created the video and a striking picture of a premature infant to acknowledge and celebrate World Prematurity Day.

Anne Geddes, Photographer, March of Dimes Volunteer                                         Published on Oct 1, 2014 Anne Geddes, one of the world’s most widely respected photographers, for her tireless efforts on behalf of babies worldwide,” says March of Dimes President Dr. Jennifer Howse. “Her work will help focus attention on the critical work needed to give all babies a healthy start in life.”

Progressive intentions, strong collaboration, access to pertinent data bases, hard work, and focus on maternal and child health and well-being have created amazing medical care advancements in Panama! Remarkable Improvements in Maternal and Child Health Care in Panama’s Rural Areas

December 14, 2015

Since 2008, Panama has delivered basic health services to nearly 180,000 beneficiaries per year from rural non-indigenous areas through mobile health teams. Despite the difficulties, results are remarkable: pregnant women receiving prenatal controls rose from 20% to 86%, children below 1 year with complete vaccination scheme rose from 26% to 96%, and professionally assisted delivery increased from 6% to 92%.

Challenge: Although Panama achieved important health outcomes (under 5 mortality declined from 34 to 20 deaths per 1,000 births between 1990 and 2004) and devoted a substantial amount of its GDP to health expenditures (7.7 percent in 2004), well above the regional average of 6.5 percent, inequality in the health sector persisted. Due to geographical, financial and cultural barriers to access key preventive services for mothers and children, poor rural households experienced lower health outcomes. For instance, immunization rates increased for the non-poor but decreased between 4 and 5 percentage points in poor households (except for the anti-tuberculosis vaccine BCG).

Solution : In 2008, the Minister of Health (MOH), with IBRD’s Project support, decided to introduce the Health Protection for Vulnerable Populations program (PSPV, for its Spanish acronym) to deliver a package of basic health services to poor non-indigenous populations in rural areas. In order to deliver the package of health services, the MOH signed performance agreements with local MOH teams and private sector organizations. These agreements were based on capitated payments and a results-based financing approach, innovative methodologies introduced by the Bank.

Results: According to audited data for the Project, nearly 180,000 beneficiaries per year living in non-indigenous rural areas received regular access to a basic package of health services through the mobile health teams financed by IBRD. The following results were achieved:

  • Percentage of pregnant women with at least 3 prenatal controls increased from 20% (2010) to 86% (2014);
  • Percentage of children below 1 year with a complete vaccination scheme for their age increased from 26% (2010) to 96% (2014);
  • Percentage of women delivering children with the assistance of trained personnel from MOH increased from 6% to 92%.

In addition:

  • 54% and 78% of individuals diagnosed with diabetes and hypertension, respectively, received prescribed drugs according to MOH’s protocols:
  • 100% of Panama’s health regions completed the survey and mapping of human resources, equipment and infrastructure:
  • 100% of Panama’s health regions are using an automated monitoring and information system for assessing achievement of results of primary health care providers.

Bank Group Contribution-

  • IBRD total investment: US$40.00 M.
  • Government of Panama total investment: US$ 16.30 M.

Partners: The Project was implemented with a strong partnership among IBRD, the Financial and Administrative Health Management Unit –UGSAF – from the MOH, MOH Regional Offices, and private sector providers.

Moving Forward : The Inter-American Development Bank stepped up its support to Panama’s effort to reach the remote rural areas following the conclusion of IBRD’s Project in 2014.

There is a new IBRD Project under preparation to continue supporting Panama to address its inequality challenge in the health sector. The new project focuses on the inclusion of indigenous people from the “comarcas”, in line with the World Bank and Panama Country Partnership Framework.



FLOATING DOCTORS: What is a mobile clinic?




PsychCentral  By: Traci Pedersen

Parents of Early Preemies More Likely to Worry About Grown Kids

Even after very preterm babies have grown well into adulthood, their parents still tend to worry more about them compared to parents of full-term babies, according to a new analysis conducted by researchers at the University of Warwick and University Hospital Bonn.

According to the World Health Organization, an estimated 15 million babies are born preterm (before 37 week so of gestation) and this figure is rising. Premature birth is the number one cause of death in young children, with most preterm-related deaths occurring in babies who were born very preterm (at 31 weeks or less).

Those who survive may spend weeks or months in the hospital and may face lifelong problems such as cognitive disabilities, respiratory problems, visual and hearing problems, digestive problems, and cerebral palsy.

For the study, the researchers compared the perception of parents whose children were born very preterm with a control group born at term. They also analyzed the opinions of the children.

“Previous work from Canada had suggested that the health-related quality of life of preterm born individuals may decrease as they reach adulthood. However, this study found while quality of life improves for term born adults it remains lower for preterm born participants,” said first author Nicole Baumann, a doctoral student who worked with Professor Dieter Wolke at the University of Warwick’s department of psychology.

The researchers interviewed the parents of 260 individuals born very preterm or with very low birth weight, as well as the parents of 229 individuals born full term. They also interviewed the children themselves at age 13 and then as adults at age 26. The data was gathered as part of the prospective Bavarian Longitudinal Study which began in Germany in 1985.

The researchers looked at health-related issues such as vision, hearing, speech, emotion, dexterity and pain. They asked questions relating to these such as “Are you able to recognize a friend on the other side of the street?” and “Are you happy and interested in life?”

The findings revealed that adult children whose parents were more worried about them having a lower quality of life, did indeed experience more periods of unemployment, were more often the recipients of social benefits, had fewer friends, and were less likely to be with a partner.

There is a positive element to the study, however, in that the findings indicate that preterm participants don’t believe that their health-related quality of life gets worse between age 13 and 26, even though their parents believe the quality does diminish, particularly in pain and emotion.

The study is published in the journal Pediatrics.  Source: University of Warwick



Kathy on Parent Worry and Grown Preterm Birth Survivors-

Kathy: Straight -up: I worry differently about Kat’s health than I do about the health of my  other adult children. At a deep primitive level, my body associates a feeling of helplessness related to Kat’s health even though I have been very proactive in supporting her wellbeing. The preterm birth experience is often traumatic to the infant and their caregivers/family. When a person experiences trauma, anxiety and worry are generated in unique whole-body fashion, where cellular experience and intelligence, not thinking and language, are major players. My anxiety following the death of Kat’s twin, her long term ICU stay and ongoing health issues solidly changed my breathing patterns and level of anxiety for many years. However, once she was weaned off of the steroids (one year of age), I did not hold Kat back from experiencing a full life.

Not letting worry run the show takes action, commitment and faith. Research regarding the medical and psychological challenges and associated treatment strategies for adult preemie survivors is just beginning to develop. With what we know now, heart, lung, pre-verbal  PTSD are just a few of the issues preterm birth survivors may experience. Kat is currently exploring some health care issues that may be preterm birth related. My anxiety is due in part to the fact that foundational resources for information, guidance, prevention, diagnoses and effective treatments are not defined for the preterm birth survivor community.

Now is the time to focus research efforts on evaluating and understanding preterm birth survivor needs specific to the population. As we know, globally an estimated 11% of the population experiences preterm birth. A functional medical platform for adult preterm survivor health is only beginning to be explored and defined. Within this expansive preterm birth community, the need,  research potential, and opportunity to create better health within our community is abundant. As Global community members we do have access to the  foundational concepts of cultural, spiritual and general health and wellness that may support our basic health needs (nutrition, exercise, stress reduction, sleep, etc.). In countries that provide universal health care, we note that preterm birth rates and maternal mortality are generally lower.

 I still worry, so I mediate, and I let go, because I meditate, and my worry becomes curiosity, so I research, which increasingly opens my eyes to the Neonatal Womb community, our Global family, so I can take productive action to counter the worry and hopefully give back to the community that empowered Kat to live. I firmly believe in the scientific principles of quantum physics/mechanics and manifestation (what you see is what you get).  Within this process, our journey, with commitment I choose to see our Neonatal Womb Community experiencing increased support, health, and wellness.

out of box


Healthcare Informatics  February 19, 2018 by the Editors of Healthcare Informatics

Innovator Awards Program 2018: Semifinalists

Duke University School of Medicine (Durham, N.C.)   A NICU discrete event simulation model

Duke’s neonatal clinicians care for more than 800 babies each year in the Duke Neonatal Intensive Care Unit (NICU). Although the majority do well, about 40 babies do not survive. How could they improve outcomes and save lives? Duke’s neonatal research team partnered with analytics company SAS to create an analytics-based model of Duke Children’s Hospital’s Level IV neonatal intensive care unit. The result was the creation of a discrete event simulation model that closely resembled the clinical outcomes of Duke’s training unit, which was validated using data held back from the original model, which also closely tracked actual unit outcomes.

The model uses a vast resource of clinical data to simulate the experience of patients, their conditions and staff responses in a computerized environment. It creates virtual babies experiencing care within a simulated NICU environment, including virtual beds staffed by virtual nurses. The research team attests that they cannot find any evidence of discrete event simulation modeling being used in a NICU setting, making this a first in neonatal care.

SOURCE: spectrum disorder and prematurity: towards a prospective screening program.

By:  Rev Neurol. 2018 Mar 1;66(S01):S25-S29.03/01/18 Hernandez-Fabian A1,2,3, Canal-Bedia R1,3, Magan-Maganto M1,3, de la Fuente G2,3, Ruiz-Ayucar de la Vega I2,3, Bejarano-Martin A4,3, Janicel-Fernandez C1,3, Jenaro-Rio C1,3.Abstract in English, Spanish


The prevalence of autism spectrum disorders (ASD) reported in current studies in risk groups such as preterm or low birth weight infants is higher than in the normal population. This fact has led to the increase in recent years of screening studies that investigate possible risk factors for ASD in preterm newborns and their developmental trajectory.


To present the results of the main screening studies of preterm newborns in order to propose screening recommendations for this population at risk.


The results of the studies presented suggest the possibility that the trajectory of socio-communicative and behavioral development of preterm infants differed from what was expected if their birth had occurred at term. This supports the fact that screening programs are carried out based on developmental surveillance and that it is advisable to use screening tools adapted to this population at risk.


Premature children are a risk group that shows differential characteristics for the screening of ASD.



pills.panama.pngSuccess of blood test for autism affirmed   

Science Daily – News-from research organizations                                                                  First physiological test for autism proves high accuracy in second trial                          Date: June 19, 2018  Source: Rensselaer Polytechnic Institute

Summary: One year after researchers published their work on a physiological test for autism, a follow-up study confirms its exceptional success in assessing whether a child is on the autism spectrum. A physiological test that supports a clinician’s diagnostic process has the potential to lower the age at which children are diagnosed, leading to earlier treatment. Results of the study, which uses an algorithm to predict if a child has autism spectrum disorder (ASD) based on metabolites in a blood sample, published online today, appear in the June edition of Bioengineering & Translational Medicine.


global partners


The art of focus a crucial ability | Christina Bengtsson | TEDxGöteborg                Published on Feb 9, 2017 -How do you bring out the best in yourself? According to Christina Bengtsson –Swedish world champion in precision shooting – the answer lies in the word “focus”. It is a phenomenon she has spent her whole career exploring and she warns us that part of the next generation may not possess this. (The Art of Focus,2017)

You may wonder why we address healthcare provider wellness in our blog, and the reasons are pretty straight forward. We are experiencing a critical health care provider shortage globally. 11% of newborns are born prematurely. Our community includes Labor and Delivery, NICU specialists/Neonatologists, Nurses, Health Care Technicians, Therapists, Emergency Medicine, Family/General Practice, Community Health Care Workers, Psychologists, and so on. All community members including our health care providers need access to personal and occupational healthcare resources. We must create systems that attract, develop, train, employ, retain and continue to educate our provider family.


The Atlantic   Rena Xu   May 11, 2018

The Burnout Crisis in American Medicine: Are electronic medical records and demanding regulations contributing to a historic doctor shortage?


During a recent evening on call in the hospital, I was asked to see an elderly woman with a failing kidney. She’d come in feeling weak and short of breath and had been admitted to the cardiology service because it seemed her heart wasn’t working right. Among other tests, she had been scheduled for a heart-imaging procedure the following morning; her doctors were worried that the vessels in her heart might be dangerously narrowed. But then they discovered that one of her kidneys wasn’t working, either. The ureter, a tube that drains urine from the kidney to the bladder, was blocked, and relieving the blockage would require minor surgery. This presented a dilemma. Her planned heart-imaging test would require contrast dye, which could only be given if her kidney function was restored—but surgery with a damaged heart was risky.

I went to the patient’s room, where I found her sitting alone in a reclining chair by the window, hands folded in her lap under a blanket. She smiled faintly when I walked in, but the creasing of her face was the only movement I detected. She didn’t look like someone who could bounce back from even a small misstep in care. The risks of surgery,

I called the anesthesiologist in charge of the operating room schedule to ask about availability. If the cardiology department cleared her for surgery, he said, he could fit her in the following morning. I then called the on-call cardiologist to ask whether it would be safe to proceed. He hesitated. “I’m just covering,” he said. “I don’t know her well enough to say one way or the other.” He offered to pass on the question to her regular cardiologist.

A while later, he called back: The regular cardiologist had given her blessing. After some more calls, the preparations were made. My work was done, I thought. But then the phone rang: It was the anesthesiologist, apologetic. “The computer system,” he said. “It’s not letting me book the surgery.” Her appointment for heart imaging, which had been made before her kidney problems were discovered, was still slated for the following morning; the system wouldn’t allow another procedure at the same time. So I called the cardiologist yet again, this time asking him to reschedule the heart study. But doctors weren’t allowed to change the schedule, he told me, and the administrators with access to it wouldn’t be reachable until morning.

I felt deflated. For hours, my attention had been consumed by challenges of coordination rather than actual patient care. And still the patient was at risk of experiencing delays for both of the things she needed—not for any medical reason, but simply because of an inflexible computer system and a poor workflow.

Situations like this are not rare, and they are vexing in part because they expose the widening gap between the ideal and reality of medicine. Doctors become doctors because they want to take care of patients. Their decade-long training focuses almost entirely on the substance of medicine—on diagnosing and treating illness. In practice, though, many of their challenges relate to the operations of medicine—managing a growing number of patients, coordinating care across multiple providers, documenting it all. Regulations governing the use of electronic medical records (EMRs), first introduced in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, have gotten more and more demanding, while expanded insurance coverage from the Affordable Care Act may have contributed to an uptrend in patient volume at many health centers. These changes are taking a toll on physicians: There’s some evidence that the administrative burden of medicine—and with it, the proportion of burned-out doctors—is on the rise. A study published last year in Health Affairs reported that from 2011 to 2014, physicians spent progressively more time on “desktop medicine” and less on face-to-face patient care. Another study found that the percentage of physicians reporting burnout increased over the same period; by 2014, more than half said they were affected.

To understand how burnout arises, imagine a young chef. At the restaurant where she works, Bistro Med, older chefs are retiring faster than new ones can be trained, and the customer base is growing, which means she has to cook more food in less time without compromising quality. This tall order is made taller by various ancillary tasks on her plate: bussing tables, washing dishes, coordinating with other chefs so orders aren’t missed, even calling the credit-card company when cards get declined.

Then the owners announce that to get paid for her work, this chef must document everything she cooks in an electronic record. The requirement sounds reasonable at first but proves to be a hassle of bewildering proportions. She can practically make eggs Benedict in her sleep, but enter “egg” into the computer system? Good luck. There are separate entries for white and brown eggs; egg whites, yolks, or both; cage-free and non-cage-free; small, medium, large, and jumbo. To log every ingredient, she ends up spending more time documenting her preparation than actually preparing the dish. And all the while, the owners are pressuring her to produce more and produce faster.

It wouldn’t be surprising if, at some point, the chef decided to quit. Or maybe she doesn’t quit—after all, she spent all those years in training—but her declining morale inevitably affects the quality of her work.

In medicine, burned-out doctors are more likely to make medical errors, work less efficiently, and refer their patients to other providers, increasing the overall complexity (and with it, the cost) of care. They’re also at high risk of attrition: A survey of nearly 7,000 U.S. physicians, published last year in the Mayo Clinic Proceedings, reported that one in 50 planned to leave medicine altogether in the next two years, while one in five planned to reduce clinical hours over the next year. Physicians who self-identified as burned out were more likely to follow through on their plans to quit.

What makes the burnout crisis especially serious is that it is hitting us right as the gap between the supply and demand for health care is widening: A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040. While it might be tempting to point to the historically competitive rates of medical-school admissions as proof that the talent pipeline for physicians won’t run dry, there is no guarantee. Last year, for the first time in at least a decade, the volume of medical school applications dropped—by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, we may be short 100,000 physicians or more by 2030.

Some are trying to address the projected deficiency by increasing the number of practicing doctors. The Resident Physician Shortage Reduction Act, legislation introduced last year in Congress, would add 15,000 residency spots over a five-year period. Certain medical schools have reduced their duration, and some residency programs are offering opportunities for earlier specialization, effectively putting trainees to work sooner. But these efforts are unlikely to be sufficient. A second strategy becomes vital: namely, improving the workflow of medicine so that physicians are empowered to do their job well and derive satisfaction from it.

Just as chefs are most valuable when cooking, doctors are most valuable when doing what they were trained to do—treating patients. Likewise, non-physicians are better suited to accomplish many of the tasks that currently fall upon physicians. The use of medical scribes during clinic visits, for instance, not only frees doctors to talk with their patients but also potentially yields better documentation. A study published last month in the World Journal of Urology reported that the introduction of scribes in a urology practice significantly increased physician efficiency, work satisfaction, and revenue.

Meanwhile, there’s evidence that patients are more satisfied with their care when nurse practitioners or physician assistants provide some of it. This may be because these non-physicians spend more time than doctors on counseling patients and answering questions. In a perfectly efficient division of labor, physicians might focus on formulating diagnoses and treatment plans, with non-physicians overseeing routine health maintenance, discussing lifestyle changes, and educating patients on their medical conditions and treatment needs. Fortunately, over the next decade, employment of nurse practitioners and physician assistants in the United States is expected to grow by more than 30 percent; that compares with overall expected job growth of just 7 percent.

Yet the solution to health care’s labor problem isn’t simply to hire more staff; if not done right, that could make coordination even more cumbersome. A health-care organization’s success, in the years ahead, will depend on its success at delegating responsibilities among physicians and non-physicians, training the non-physicians to do their work independently, and empowering everyone—not just doctors—to shape a patient’s care and be accountable for the results.

Technology can make doctors’ lives easier, but also a lot harder. Consider the internet: It’s made information infinitely more attainable, but it takes time to find what one needs and to filter the accurate material from the inaccurate. The same goes for medicine. Technologies such as telemedicine, which allows for online doctor visits, can make health care more accessible and effective. But the use of EMRs, which is now federally mandated, is frequently cited as one of the main contributors to burnout. EMRs are often designed with billing rather than patient care in mind, and they can be frustrating and time-consuming to navigate. One attending doctor I know, tired of wading through a morass of irrelevant information, writes notes in the electronic chart but in parallel keeps summaries of his patients’ medical histories on hand-written index cards.

One can imagine a better EMR system, built around what health-care providers need. Today, in the absence of more effective tools, medical colleagues rely on email to coordinate patient care—or phone, as in the case of my kidney patient. But email chains can get buried in an inbox, and phone calls are rarely practical for coordinating between more than two people at a time. Neither mode of communication gets linked to a patient’s record, which means work is at risk of either getting lost or being replicated. But what if we were to integrate a tool into the electronic record that made clear what a patient’s active medical issues were, assigned responsibility to providers for overseeing those issues, and helped them to coordinate with each other? A dynamic EMR that didn’t just give physicians more information, but also helped them to prioritize, share, and act upon that information, would be far more useful than what currently exists.

As the world changes—as populations grow and technology advances—it is becoming essential that the workflow of medicine change alongside it. Fortunately for the patient with the failing kidney, the anesthesiologist was willing to get creative. Despite being unable to book the surgery, he unofficially reserved a slot for her and made the rest of his staff aware. The patient underwent the procedure the next morning, followed by her previously planned heart study. Everything worked out in the end. But I couldn’t help thinking: It shouldn’t be this hard to do the right thing.



Charter on Physician Well-being

  • 04/17/18 – Larissa R. Thomas, MD, MPH1; Jonathan A. Ripp, MD, MPH2; Colin P. West, MD, PhD3,4
  • 1Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
  • 2Departments of Medicine, Geriatrics and Palliative Medicine, and Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
  • 3Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
  • 4Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
  • 2018;319(15):1541-1542. doi:10.1001/jama.2018.1331

Dedication to serving the interest of the patient is at the heart of medicine’s contract with society. When physicians are well, they are best able to meaningfully connect with and care for patients. However, challenges to physician well-being are widespread, with problems such as dissatisfaction, symptoms of burnout, relatively high rates of depression, and increased suicide risk affecting physicians from premedical training through their professional careers. These problems are associated with suboptimal patient care, lower patient satisfaction, decreased access to care, and increased health care costs.



We really appreciated the perspective and heart shared by this wonderful NICU Nurse!

NICU Twins Born At Memorial Hospital West Reunite With Nurse Who Took Care Of Them For Five Weeks   Memorial Healthcare System  Publish ed on Jul 28, 2017   Maureen Laighold, RN in the NICU at Memorial Hospital West, reminisces with Jennifer and her daughters about the care they received from the Neonatal ICU team and the lifelong friendship they all now share.


Kat’s Corner     IMG_0270

Frustration, anger, insight and guided creativity, an undeniable need to contribute and a passionate love and concern for the Global Neonatal Womb (pre-term birth community) were the dynamics that birthed the Neonatal Womb Warriors blog in February, 2016. Here’s what happened…..

As my volunteer NICU experience progressed a NICU Nurse Manager approached me about joining the NICU Advisory Board as a volunteer and NICU Grad representative. After gaining more information about the purpose of Advisory Boards, I agreed to join the council and felt honored to be a part of this aspect of the NICU. I was informed that I was the  first NICU grad to serve on the Board. Initially, intimidated and awkward in the company of Medical Directors, Nursing, Physician, Resident and Therapist staff and parents who had children born in the NICU, I was mentored to provide appropriate input, to listen, learn and contribute. With the guidance of two important mentors I quickly understood the level of responsibility associated with serving on the Board and gained confidence to become more engaged in our monthly meetings. I also experienced tension from some of the staff and parents whom questioned my ability to contribute valuable input to our initiatives. Over time this dynamic transformed with some Board members, and I felt increasingly supported by the Mom’s serving on the board,  most of whom were also healthcare professionals. As both a NICU grad and child of a NICU parent I was very interested in learning from the mothers and medical providers on our council. There were no NICU fathers present on the Board at that time. The Board focused on the care and needs of the mothers and patients. The trauma experienced by the fathers/other parent, caregivers, and healthcare staff was not generally addressed.  After serving on the Advisory Board for a two-year period the Board underwent significant management changes, and new Federal regulations were being implemented for the management of Medical Advisory Boards nationwide. I was informed that my two year service on the Board was completed and would not be extended. Based on the fact I was neither a NICU parent or provider I was dismissed.

When one door closesclosed.door.panama.jpg , another opens open.door.panama

Have you ever felt agitated, inspired, empowered by a personal perception of injustice or disrespect?  I am the person who suffered the preterm birth trauma, and I am the recipient of the life-saving care provided by broad community efforts that kept me alive.  I am the adult survivor whose life is profoundly affected by the preterm birth experience. I have a Voice and I will be heard. The belief that because a person does not have language means that no experience took place is beyond antiquated and is completely false. The perspective that because the NICU or preterm birth baby survived is good enough in itself, and that the preterm birth experience ends at the conclusion of critical care is at best naïve, and at the worst, incomplete and destructive. My return to the NICU awakened me on a very visceral level to an ongoing need and opportunities for healing. Each patient, family member, disgruntled parent and provider I engaged with revealed that the opportunities for wellness did not end for community members when a baby was discharged.

My Mom and I had worked diligently to identify a platform for a foundation to contribute to the NICU/preterm birth community but found that the resources she had been denied as a NICU parent were increasingly developing and made available to NICU travelers locally. We searched to identify ways we could meaningfully contribute to the Neonatal Womb community despite the fact that we did not have great financial abundance. Shortly following my dismissal from the Board, we discussed the impact we felt the lack of wisdom, education, and common sense leading to the denial of the worth of the preterm birth grad perspective potentially had on the Neonatal Womb community, and how the support, well-being, and availability of healthcare providers also represented a serious exclusion.  We began to see how large the Community was as a whole and how many people worldwide shared the preterm birth journey, and noted that they were often not well connected or adequately supported. We continued to ask for guidance in our creative efforts to contribute. Late one night, my Mom was on her computer working when she was guided to consider starting a blog focused on representing the preterm birth grad community while identifying and including all community members. Although we really didn’t know what a blog was, we agreed to pursue this course of action with curiosity and openness in order to create for ourselves and others new perspectives for experiencing and understanding the preterm birth  journey globally while providing a Voice to the preterm birth survivors whom we call Neonatal Womb Warriors.

11% of the total human population are “Warriors”. Imagine how expansive our global Neonatal Womb community including all of our members is! Warriors,  OUR VOICES MATTER! Research, in the very early stages due to the recent and increasing survival rates of preterm birth babies, tells us that we may have healthcare concerns such as PTSD, heart, lung and other medical issues that may require attention as we age. Our lives are creating the need for more research and we serve as the foundational resource for providing research and for developing treatment.

I experience my fear of speaking-up at times as a call for healing within myself. Rejection, not being seen or valued hurts. Fear challenges us to choose Love. I am motivated to choose Love.  WARRIORS, stand with me! Together we can impact our personal journeys, influence NICU culture, shape the methods of care, push for new frontiers of Neonatal Developmental Research, and expand the healing of NICU Grads and those NICU Grads to come! We all have a unique story of hope that is of value to our Neonatal Community. We – YOU – deserve to be recognized!

Ofer Yakov : GoPro – Wet Dream – Costa Rica & Panama Published on Jun 23, 2016 –    “From the day I started surfing I knew it was a matter of time before I’ll fly for a surfing trip overseas. I met up with some good friends and we planned our first surfing trip together. Magical destinations were suggested and at the end we decided firmly: Costa Rica- Panama!”(Yakov, GoPro-Wet Dream,2016)