Polyvagal Theory, Community Collaboration, Stories


Preterm Birth Rates – Portugal

Rank: 138 –Rate: 7.7% Estimated # of preterm births per 100 live births (USA – 12 %)
Source: https://www.marchofdimes.org/mission/global-preterm.aspx

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

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

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


TAG: PORTUGALCovid Story 5

Posted on June 13, 2020

Joana Mendes, São Francisco Xavier Hospital, Lisbon, Portugal

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

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

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

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

Source: https://nna.org.uk/tag/portugal/

Violence Against Healthcare Workers: A Worldwide Phenomenon With Serious Consequences

Sandro Vento1*Francesca Cainelli1,2 and Alfredo Vallone3

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


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

Recent Studies

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

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

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


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

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

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

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

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

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

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

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

Source: https://www.frontiersin.org/articles/10.3389/fpubh.2020.570459/full

Self-care during COVID-19

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

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

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

Source: https://www.who.int/pmnch/media/videos/self-care-series/en/


Breastfeeding during COVID-19

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

Is This Normal? How the NICU Impacts Your Emotional Health

by Hand to Hold Staff | Jun 7, 2018

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

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

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

Grief & guilt

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


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

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

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

Anxiety & acute stress

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

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

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

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

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

Post-traumatic stress disorder (PTSD)

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

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

How to get help

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

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

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

3 Resources you should know

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

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

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

Source: handtohold.org/nicu-emotional-health/

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

McGill University Health Centre (MUHC)   Sep 15, 2020


Catching infections in premature babies before they happen using AI


Using Artificial Intelligence to help premature babies stay healthy is the aim of a European research project.… READ MORE : Source:https://www.euronews.com/2020/04/07/c…

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

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


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

Full Article: https://www.nature.com/articles/s41598-020-66231-2

Therapeutic approach of stem cell transplantation for neonatal white matter injury

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

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

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

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


Full Article: http://pm.amegroups.com/article/view/5604/html

Dr. Stephen Porges: What is the Polyvagal Theory

              Apr 23, 2018

                Dr. Stephen Porges explains Polyvagal Theory in his interview with PsychAlive.org.

Learn More about Dr. Porges at https://www.stephenporges.com/


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

2020 Infant Health Policy Summit

Sep 29, 2020

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

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

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

Full Article: http://www.infanthealth.org/summit


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cold storage doesn’t inactivate the virus

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

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

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

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

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

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

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

Source: https://www.sciencedaily.com/releases/2020/08/200811120217.htm

Shining a light on physician suicide

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

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

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

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

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

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

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

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

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

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

Source: https://www.aha.org/news/blog/2020-09-17-shining-light-physician-suicide

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

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: https://www.who.int/pmnch/media/news/2020/covid-improving-adolescent/en/

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

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

Apps to Help Kids and Teens with Anxiety

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

Source: https://www.medicalhomeportal.org/living-with-child/mental-health/apps-to-help-kids-and-teens-with-anxiety

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

Sep 20, 2020 Berna SUPer SURFers

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



Preterm Birth Rates – ROMANIA

Rank: 151Rate: 7.3% Estimated # of preterm births per 100 live births (USA – 12 %)
Source: https://www.marchofdimes.org/mission/global-preterm.aspx

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

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

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


Babies born prematurely can catch up their immune systems

March 9, 2020  Source: King’s College London

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

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

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

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

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

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

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

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

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

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

Source: https://www.sciencedaily.com/releases/2020/03/200309093029.htm

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

Bucharest, 09/09/20.

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

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

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

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

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

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

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

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

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

About the Premature Association

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

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

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

Discriminatory Housing Practices Tied to Premature Births

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: University of California- Berkeley

Source: https://psychcentral.com/news/2020/08/28/discriminatory-housing-practices-tied-to-premature-births/158868.html


Premature baby – Home at last! What next?

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

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

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

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

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



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


Track your preterm baby’s milestones


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


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

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

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

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

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

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


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



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

INHA NICU Milestone Cards  INHA Position Papers  INHA Angel Babies

Link: Global Premature Parent Organisations

WALL OF HOPE – Our Stories (enter link below)


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

9 September 2020

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

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

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

The current COVID-19 pandemic is no exception. 

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

Source: https://www.who.int/news-room/detail/09-09-2020-every-woman-s-right-to-a-companion-of-choice-during-childbirth

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


What is a Neonatal Nurse Practitioner?

Jan 15, 2016

National Association of Neonatal Nurses

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

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

Original Investigation Pediatrics  September 23, 2020

Key Points

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

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

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


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

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

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

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

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

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

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

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

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




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

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

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

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

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

Source: https://www.aappublications.org/news/2018/10/26/obesity-among-former-extremely-premature-infants-from-too-small-to-too-big-pediatrics-10-26-18

Developmental care for little patients FINE trainings in Romania

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

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

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

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

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

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

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

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

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

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

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

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

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

DJI – Delivering the Future of Healthcare

   Feb 12, 2020

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

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

July 29, 2020 Source: University of Warwick

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: https://www.sciencedaily.com/releases/2020/07/200729114730.htm


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

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

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

   Aug 12, 2020  CNBC International TV

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


Young Adults: MentalHealth.gov


Popular APPS:
Calm:      https://www.calm.com/   Sleep more. Stress less. Live better.
Moodpath:    https://mymoodpath.com/en/   Depression & Anxiety

Health Care Providers: National Academy of Medicine

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

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

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

Preterm Birth Parents:

USA: http://www.nationalperinatal.org/

USA Regional Contact Information: https://www.preemiecare.org/supportgroups.htm

UK: https://www.bliss.org.uk/parents/support/impact-mental-health-premature-sick-baby

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

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

Source: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html


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

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

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

Kitesurf Constanta, Romania 15.02.2020 Ep. 2 Plaja 3 papuci

•Feb 18, 2020                                                Kite Inspiration

kitebeginner Prima iesire din 2020. Temperatura apa 7 grade Celsius

Self Empowerment, Trauma Informed Care

Preterm Birth Rates – Samoa

Rank: 181 –Rate: 5.5% Estimated # of preterm births per 100 live births (USA – 12 %)
Source: https://www.marchofdimes.org/mission/global-preterm.aspx

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


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

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



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


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


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


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

Source: https://link.springer.com/article/10.1186/s13006-019-0245-6

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

THANK YOU (Faʻafetai)  

Hinari Access to Research for Health programme

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

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

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

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

Source: https://www.who.int/hinari/about/en/

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

Karen L Weis, USAF, NC, PhDKatherine C Walker, MSN, RNWenyaw Chan, PhDTony T Yuan, PhDRegina P Lederman, PhD, RN, FAANMilitary Medicine, Volume 185, Issue 5-6, May-June 2020, Pages e678– e685, https://doi.org/10.1093/milmed/usz399    Published: 06 December 2019



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

Material and Methods

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


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


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

Source: https://academic.oup.com/milmed/article/185/5-6/e678/5663471


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: https://www.statnews.com/2020/07/13/nicu-both-parents-essential-childs-bedside/

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


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

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

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

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

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


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

NICU: Helping Siblings Cope

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

Northwestern Memorial Hospital – Patient Education – HEALTH AND WELLNESS

What Siblings Need


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


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


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

Behaviors to Watch For

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

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

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

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

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

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

Watch for:

■ Aggressive play or behavior

■ Increased need for attention/clinginess

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

■ Changes in routine (sleeping and eating patterns)

How You Can Help

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

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

Activities to Promote Positive Coping

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

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

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

■ Write a letter to take to the baby.

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

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

Books You Can Read Together

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

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

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

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

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

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

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

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

     chronically ill.

■ “The Kissing Hand” by Audrey Penn

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

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

■ “In My Heart” by Jo Witek

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


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

by Marissa Shapiro Jul. 24, 2020

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

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

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

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

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

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

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

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

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

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

Source: https://news.vanderbilt.edu/2020/07/24/vanderbilt-develops-computational-method-to-explore-evolutions-influence-on-preterm-birth/

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

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

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

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

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

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

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

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

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

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

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


Decolonizing Parents Cuts NICU Staph Transmission Risk

Nicola M. Parry, DVM – January 13, 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

JAMA. Published online December 30, 2019. AbstractEditorial

Source: https://www.medscape.com/viewarticle/923668#vp_2


How Premature Birth Shapes Future Heart Health

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

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

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

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

Source: https://www.aappublications.org/news/2020/07/07/premature-birth-heart-health-pediatrics

Trauma-informed Care in the NICU

Caring Essentials Collaborative, LLC – Mar 9, 2018

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

Premature babies experience high exposure to noise in the incubator

by Medical University of Vienna– JULY 20, 2020

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

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

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

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

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

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

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

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

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

Source: https://medicalxpress.com/news/2020-07-premature-babies-high-exposure-noise.html

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

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


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

Recapitulation: Release your past and reclaim trapped energy

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

8 Self-Empowerment Books to Help You Take Back 2020

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

Peter Daisyme – August 28, 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Feb 10, 2020        Toadstools and Fairy Dust

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

The Samoan Surfers

Apr 27, 2013  Iva Motusaga

The Motusaga Wave Riders




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

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


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

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

Preterm Birth Rates – Chad

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

Source: https://www.marchofdimes.org/mission/global-preterm.aspx



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


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

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

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

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

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

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

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

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

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

Ashley Yeager is an associate editor at The Scientist. Email her at ayeager@the-scientist.com.




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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




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

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

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

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

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

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

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

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

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

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

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

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

Source: https://www.salon.com/2020/07/21/premature-births-have-gone-down-during-the-pandemic–and-doctors-are-baffled-as-to-why/





Effective Communication in the NICU

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


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

Dýrleif Pétursdóttir     https://orcid.org/0000-0002-9757-1373

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



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


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


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


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

Source: https://onlinelibrary.wiley.com/doi/10.1111/apa.15378


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

By Manas Mishra Reuters  Posted June 10, 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




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

02/14/2019 – Dad University

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



Concerns About Preterm Birth Extend to the Last Few Weeks


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

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

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

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

“They’re not done yet, they’re just not done yet,” said Dr. Wanda Barfield, the director of the division of reproductive health at the Centers for Disease Control and Prevention. In that excitement over being able to save the profoundly premature infants, medicine lost sight for a while of the fact that the infants born at 34 and 35 and 36 and 37 weeks gestation “weren’t just little term babies, weren’t mature, had a lot of needs to continue their physiological maturity,” she said.

This led, in some cases, to a rather cavalier attitude toward delivering babies early, even when not medically indicated. But when researchers looked more closely at these “late preterm” infants, they found that they were at increased risk of a whole range of medical problems and developmental issues.

One important result of the research on late preterm infants was that the American College of Obstetricians and Gynecologists recommended strongly against early deliveries, unless they were medically necessary. Between 2007 and 2014, Dr. Barfield said, late preterm births declined, but since 2014, there has been an uptick. “We’re losing ground,” Dr. Barfield said. And there are also concerning disparities with higher rates of prematurity among African-American and Hispanic women.

Dr. Prachi Shah, an associate professor of pediatrics at C.S. Mott Children’s Hospital at the University of Michigan, said, “when we think about the morbidities of preterm birth, most studies have focused on the very preterm infant, less than 32 weeks, less than 28 weeks.” However, she said, from a public health point of view, late preterm births — from 34 to 37 weeks — account for the majority of preterm births — about 70 percent — and for 7 percent of all live births.

The terminology was revised in a 2007 report by the American Academy of Pediatrics: Babies born from 34 to 36 6/7 weeks gestation were classified as “late preterm,” rather than “near term.” Those born from 37 to 38 6/7 weeks are now called “early term” babies, and only those who stay inside for 39 to 40 6/7 weeks are considered full term. Early term infants represent another 26 percent of all live births.

In pediatrics, late preterm infants are now considered an at-risk population. Most immediately, they are at higher risk of medical problems in the newborn period, including poor feeding, dehydration, jaundice and hyperbilirubinemia. They may have trouble maintaining their blood sugar levels, and they may have trouble maintaining their temperatures. They are more likely to be readmitted after they go home from the hospital.

When researchers control for underlying conditions associated with early deliveries, like maternal hypertension or diabetes, late preterm infants are still at higher risk than full-term infants whose mothers have those same problems.

As they grow, the late preterm children are also at increased risk for developmental problems, Dr. Shah said. “Beyond the perinatal period, at a population level, when compared to full-term infants, there is a higher incidence of learning difficulties and minor cognitive and neurologic issues.”

In a recent study, researchers looked at data from a group of almost 6,000 children in New York (the Upstate KIDS cohort, born outside New York City from 2008 to 2010) who were regularly assessed during the first three years of life through parental questionnaires. The researchers also looked to see whether children had been found eligible for early intervention services, which are provided to those with developmental delays.

Edwina Yeung, a senior investigator at the Eunice Kennedy Shriver National Institute of Child Health and Development division of intramural population health research, who was the senior author, said, “We were trying to look at this in a longitudinal way, as a continuum of gestational age.”

Although the most marked risks were found in children born at the lower gestational ages (32 weeks and below), the relationship was consistent: The longer babies stayed in the womb, the less likely they were to show developmental delays on the questionnaires, and to qualify for early intervention services. The late preterm infants were at higher risk than the early term infants, but those born at 37 and 38 weeks gestation were also at higher developmental risk, with a greater likelihood of failing the gross motor and communication domains of the questionnaire. Even 39 weeks was not as good as 40 or 41.

“Nobody doubts that preterm delivery is a problem,” Dr. Yeung said. “The question of interest is in that small window around 40 weeks with term deliveries and early term deliveries.”

Dr. Shah, who was not involved with this study, said, “The key take-home message is that every week seems to make a difference in terms of developmental delay — the earlier you were born, the higher your risk for developmental delay.”

Dr. Shah was the first author of a 2016 study which found that at preschool and kindergarten entry, children born in the late preterm period had lower math and reading scores than children born at term. “Compared to full-term infants, there is an increased risk of developmental vulnerability, but the magnitude of effect is not as great as those born very preterm,” she said.

Still, these are children who should be identified — and helped — before they get to school. “We have missed a window to intervene,” Dr. Shah said. “If we have evidence that there are population-based differences, we should be thinking about them as a vulnerable population that may need targeted surveillance.” It may be important to look closely at which late preterm infants should be monitored most closely, she said, and to consider extending the eligibility for services like early intervention.

In terms of development, Dr. Shah said, many of the risks for late preterm and early term infants seem to be around communication and language delays, and around math. “Every week of intrauterine life makes a difference in these neurodevelopmental processes,” Dr. Shah said. “Even a week early can seem to result in structural changes.”

Dr. Barfield was the co-author of a 2019 update on the late preterm infant from the American Academy of Pediatrics, which emphasizes the importance of strategies for preventing prematurity. The A.A.P. recommends against early discharge for these newborns, and suggests that they come back for follow-up visits after discharge.

They need to be breastfeeding well, and able to maintain their body temperatures. Their families need to be clear on the rules of safe sleep and fully informed about all the other warning signs to watch for, from jaundice to lethargy to breathing problems.

“We need to understand that these babies are premature,” Dr. Barfield said. “Although they may be closer in terms of time, they are still premature infants.”

Source: https://www.nytimes.com/2020/06/08/well/family/premature-babies-preterm-birth-pregnancy-developmental-delays.html



NICU Nurse Adopts Baby She Felt ‘Instant Connection’ With

insidSep 16, 2019

Baby Jackson is the apple of his mom’s eye. The two share a special bond, and the way it came about is even more special. Claire Mills, 25, is a NICU nurse at a hospital in Houston, Texas. When Jackson was born five weeks premature at the same hospital, he quickly became more than Mills’ patient. So when his biological mother worried she couldn’t care for him in the way he deserved, she asked Mills if she would adopt him. She said yes and has been raising the sweet little boy ever since.




Exposure to iodine in the NICU may affect infant thyroid function

HealthDay News – JULY 7, 2020

Exposure to iodine in the neonatal intensive care unit (NICU) may increase a baby’s risk for loss of thyroid function, a new study suggests.

Iodine solutions are often used as disinfectants on the skin before surgical or other medical procedures. Iodine also is given internally for imaging procedures used in infants, researchers explained.

Investigators found higher blood levels of iodine in babies with congenital hypothyroidism (partial or total loss of thyroid function) who had a stay in the NICU. All these infants had normal thyroid function when they went to the NICU.

“Limiting iodine exposure among this group of infants whenever possible may help lower the risk of losing thyroid function,” researcher Dr. James Mills said in a news release from the U.S. National Institutes of Health.


Mills is from the epidemiology branch of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

For babies with congenital hypothyroidism, treatment with thyroid hormone has to start within four weeks after birth or permanent intellectual disability can happen.

For the study, Mills and his colleagues compared iodine levels from more than 900 children with congenital hypothyroidism to more than 900 children who did not have the condition.


Among the kids, 183 were cared for in the NICU. Of these, 114 had congenital hypothyroidism and 69 did not.

Children with congenital hypothyroidism were more likely to have been in a NICU than those without the condition, the researchers found.

When they looked at only kids who had been in the NICU, they found those with congenital hypothyroidism had higher iodine levels than those without the condition.


Higher iodine levels among babies with congenital hypothyroidism and a NICU stay might be linked to exposure to iodine during treatment, although only an association was observed and the research didn’t include information on the infants’ exact medical procedures.

The researchers caution NICU staff not to use disinfectants containing iodine and to avoid exposing babies to iodine unless necessary. Preemie infants absorb iodine more readily through their skin than older infants, they noted.

The report was published July 7 in the Journal of Nutrition.

Source: https://www.upi.com/Health_News/2020/07/07/Exposure-to-iodine-in-the-NICU-may-affect-infant-thyroid-function/3271594154032/



Telehealth helps Mayo Clinic neonatologists better treat newborns in emergencies

The new technology connects on the first attempt 96% of the time, compared with 73% for the previous telemedicine carts; with enhanced monitoring and support, tele-neonatology availability is 99%. By Bill Siwicki -November 06, 2019

The Mayo Clinic in Rochester, Minnesota, implemented tele-neonatology six years ago. Prior to that, Mayo Clinic neonatologists were assisting community hospital care teams via telephone when a newborn required advanced resuscitation or critical care.


“Because we were unable to visually assess the newborn, this limited our ability to closely collaborate with the local team and guide care over the phone,” said Dr. Jennifer Fang, medical director, tele-neonatology, at Mayo Clinic. “This was especially relevant when our neonatal transport team was not present for a high-risk delivery due to weather or geography, and the local team had to resuscitate and stabilize the critically ill newborn independently.”

These challenges prompted Mayo Clinic to develop a tele-neonatology program that allows neonatologists to establish a real-time audio/video telemedicine connection with care teams in community hospitals during these high-risk, low-frequency neonatal emergencies.

The tele-neonatology program is now offered at 19 community hospitals with Level I (well-baby) or Level II (special care) nurseries located in Minnesota and Wisconsin. Mayo Clinic board-certified neonatologists have performed more than 425 tele-neonatology consultations.

“During the initial pilot program, local care teams and neonatologists identified that tele-neonatology was feasible and seemed to improve the quality and safety of care provided to newborns requiring advanced resuscitation,” Fang explained. “However, we also realized that the initial technologies used for our program did not provide the level of reliability and audio/video quality that our program required.”


Previously used telemedicine technologies for Mayo Clinic’s tele-neonatology program had issues with reliability, including ability to establish and maintain a connection for the duration of the tele-neonatology consultation.

For example, when using a consumer-grade wireless tablet with HIPAA-compliant video conferencing software, neonatologists were able to connect on the first attempt during only 70% of consults. Further, 15% of consults were interrupted by an unintended disconnection.

After the initial pilot phase, Mayo Clinic transitioned to a wired telemedicine cart with a hardware CODEC. While this technology improved the ability to connect on first attempt to 83% and reduced dropped connections to 6%, it still did not meet the reliability requirements for tele-neonatology given the emergent, critical nature of the consultations.

“In addition to suboptimal reliability, previous technologies were not meeting provider expectations for audio and video quality,” Fang reported. “When assessing satisfaction with audio/video quality on a 1 (poor) to 5 (excellent) scale, the wireless tablet had a mean rating of 3.3 and 3.2 for video and audio quality, respectively. After transitioning to the wired telemedicine cart, the video and audio quality ratings significantly improved to 4.6 and 4.3, respectively.”

However, users still reported issues with device size and difficulty positioning it in a constricted care environment, lack of mobility due to the wired connection, and audio delay and fragmentation.

“Because reliability and audio/video quality of the previous technologies did not meet our programmatic goals, the Mayo Clinic tele-neonatology program sought a telemedicine product that could provide 99% reliability in rapidly establishing and maintaining a connection, a more responsive remotely controlled camera, seamless high-fidelity audio, and a mobile form factor that fit well into the typical neonatal work space, for example, the labor and delivery room, nursery, and operating room,” Fang said.


There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, InTouch Health, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.


In October 2016, Mayo Clinic’s tele-neonatology program transitioned from a wired telemedicine cart with hardware CODEC to a proactively monitored, fully supported wireless telemedicine product from vendor InTouch Health.

Care teams in the community hospitals activate tele-neonatology when there is a high-risk delivery or a newborn that requires advanced resuscitation. Providers at the community hospital place the wireless telemedicine device at the newborn’s bedside and call Mayo’s Admission and Transfer Center to request a tele-neonatology consult.

A Mayo Clinic neonatologist then establishes a synchronous, audio/video connection with the care team via the telemedicine device in the room. If the newborn requires transfer to Mayo Clinic’s neonatal intensive care unit (NICU), the neonatologist can dispatch the transport team to retrieve the patient as part of the tele-neonatology workflow.


The objective of the Mayo Clinic tele-neonatology study (McCauley et al, Telemed and e-Health, 2019) was to compare the performance of two telemedicine technologies used to provide tele-neonatology consults.

“We hypothesized that the InTouch Health Lite Version 2 telemedicine device (ITH Lite) would provide superior reliability and a higher-quality user experience when compared with a wired telemedicine cart,” Fang said.

“When considering reliability of connection, we demonstrated that the neonatologist was able to connect on first attempt more reliably with the ITH Lite compared with the wired telemedicine cart (96% versus 73% of consults). The improved connection reliability was likely due to proactive monitoring of the device by the vendor and implementation of formal support processes by both the vendor and Mayo Clinic’s Center for Connected Care.”

With enhanced monitoring and support, product availability with the ITH Lite was 99%, Fang added. When compared to the wired telemedicine cart, Mayo Clinic found that a significantly great percentage of incidents were resolved proactively and did not impact patient care when using the ITH Lite (incidents that impacted care, ITH Lite 7% versus wired cart 32%).

The percentage of consults complicated by unplanned disconnections was not significantly different between the two technologies.

“After each tele-neonatology consult, an electronic survey is sent to the community physician and neonatologist,” Fang explained. “Providers rate the technology performance on a 1 (poor) to 5 (excellent) Likert scale. Overall user satisfaction and video quality were not significantly different between the wired cart and the ITH Lite. However, the average audio quality rating was significantly higher for the ITH Lite compared with the wired telemedicine cart: 4.6 versus 4.1.”

This is an important finding because communication is fundamental to a successful newborn resuscitation, and may be even more critical when team members are separated by time and space as is experienced during tele-neonatology consults, Fang explained. To provide high-quality care during neonatal resuscitations, the team needs to share information and communicate intentions and plan of care; for these reasons, exceptional audio quality is imperative during tele-neonatology consults, she added.

“Local providers found the wired telemedicine cart to be bulky and less maneuverable,” Fang reported. “They either had to work around the cart or the neonatologist’s view of the neonate was compromised due to obstruction by the local care team. Comparatively, qualitative data suggested that the ITH Lite was more maneuverable, particularly when moving from one location to another – for example, operating room to nursery.”

Correct positioning of the ITH Lite within the workspace was still important, however, to ensure the neonatologist could secure the necessary view of the neonate, she added.


“The focus of Mayo Clinic’s tele-neonatology program has always been the needs of our neonatal patients, whether they are located in Mayo Clinic Rochester or elsewhere in our region,” Fang said. “By leading with patient care and identifying unmet needs of patients or care teams, organizations can design telemedicine programs that are impactful, effective and highly utilized.”

When developing a tele-neonatology program, the multi-specialty team must consider many factors including service activation and workflow, staff education and training, team building and communication – and the telemedicine technology itself, she advised.

“Our recently published study (McCauley et al, Telemed and e-Health, 2019) focuses on one of these domains, the telemedicine technology,” she said. “We demonstrated that the ITH Lite improved audio quality and ability to connect on first attempt when compared with a wired telemedicine cart. Organizations should consider the reliability of connection, audio/video quality, and fit within the care environment when selecting a technology for their tele-neonatology program.”

In addition, proactive monitoring is broader than hardware and network monitoring, she cautioned. In this study, incidents were not only identified by vendor monitoring of the devices but also during care team and physician training, tele-neonatology simulation sessions, and physician on-call preparation activities.

“When developing a tele-neonatology program,” Fang concluded, “organizations should consider comprehensive support models for incident management and tracking.”

Source: https://www.healthcareitnews.com/news/telehealth-helps-mayo-clinic-neonatologists-better-treat-newborns-emergencies




Is This My Home? A Palliative Care Journey Through Life and Death in the NICU


Abstract – A Case Report


With advancements in neonatology, patients in the neonatal intensive care unit (NICU) are living in the hospital with complex life-limiting illnesses until their first birthday or beyond. As palliative care (PC) becomes a standard of care in neonatology, a level IV NICU developed an interdisciplinary PC team with the mission to ease the physical, mental, and moral distress of the patients, families, and staff. This case report highlights the teamwork and long-term palliative care and ultimately end-of-life care that an infant received by this dedicated NICU palliative care team.

Clinical Findings: 

This case discusses a premature ex-27-week gestation male infant who initially presented to the emergency department at 5 months of age with significant tachypnea, increased work of breathing, and poor appetite.

Primary Diagnosis: 

The primary diagnosis was severe pulmonary vein stenosis resulting in severe pulmonary hypertension.


The severity of the infant’s pulmonary vein stenosis was incurable. He required substantial life-extending surgical procedures and daily intensive care interventions. In addition to his life-extending therapies, the infant and his family received palliative care support by the NICU PC team and the hospital-wide PC team (REACH team) throughout his admission. This was specialized care that focused on easing pain and suffering while also addressing any social/emotional needs in the infant, his family, and in the hospital staff. The PC teams also focused on protecting the families’ goals of care, memory making, and providing a positive end-of-life experience for the infant and his family. The infant’s end-of-life care involved providing adequate pain and symptom management, education, and communication to his family about the dying process and allowing unlimited family time before and after his death.


After 11 months in the NICU and despite aggressive therapies, he required more frequent trips to the cardiac catheterization laboratory for restenosis of his pulmonary veins. He was dependent on iNO to treat his pulmonary hypertension and he continued to require an ICU ventilator. His parents ultimately decided to pursue comfort care. He died peacefully in his mother’s arms.

Practice Recommendations: 

The American Academy of Pediatrics and the National Association of Neonatal Nurses both have statements recommending that palliative care be standard of care in NICUs. Establishing a NICU-dedicated interdisciplinary PC team can improve outcomes for infants and families living in the NICU with complex life-limiting illnesses.

Walters, Aurora RN, BSN, RNC-NIC; Grosse, Jordan RN, BSN, RNC-NIC

Editor(s): Fortney, Christine A. PhD, RN, Section Editor

Advances in Neonatal Care: April 2020 – Volume 20 – Issue 2 – p 127-135 – doi: 10.1097/ANC.0000000000000697

Source: https://journals.lww.com/advancesinneonatalcare/Abstract/2020/04000/Is_This_My_Home__A_Palliative_Care_Journey_Through.7.aspx?context=FeaturedArticles&collectionId=3



Rising Virginia Apgar (1909-1974)

If we neonatologists ever get a patron saint of our own, it will probably be Virginia Apgar. We are reminded of Dr. Apgar’s dedication, wisdom, wit, tenacity, and many contributions to infant care every time we are called to the delivery room to evaluate a baby. Dr. Apgar originally intended to become a surgeon, but to our great good fortune, ended up in anesthesia instead, where she soon turned her attention to the care of mothers and the assessment and resuscitation of newborns. Her elegant paper of 1952 established the scoring system that now bears her name, but she was also famous for her work in the March of Dimes, her love of cars and fast driving, and her construction of her owned stringed instruments — among other things.

Source: http://www.neonatology.org/pinups/apgar.html





Smiling with your eyes: Communication in a face-masked COVID-19 world

Health & WellbeingBy Rich Haridy – July 12, 2020

As the COVID-19 pandemic continues to transform the world, millions of people are suddenly wearing face masks. But for people used to relying on facial expressions to effectively communicate, how are masks changing the way we interact? And what can we do to compensate for losing that all-important smile?

In the late 1960s a psychologist named Albert Mehrabian co-authored two influential studies investigating how important the semantic meaning of words were in regards to how people communicate emotions. Mehrabian ultimately quantified his ideas into a specific ratio, occasionally referred to as the “7:38:55 rule.”

Mehrabian’s rule suggests three elements need to be effectively co-ordinated for the successful communication of feelings or emotion: words, vocal tone, and body language. Breaking down the effect of each of these elements, Mehrabian concluded only seven percent of communication is related to the actual meaning of a given word, while 38 percent relates to tone of voice, and 55 percent is body language (primarily facial).

Mehrabian’s findings have been debated, criticized and misinterpreted over the decades. Whether or not one agrees the efficacy of communication can be reduced to such specifically quantified ratios, the general observation arguably holds strong. Effective communication stems from a congruent combination of factors beyond the specific semantic meaning of words.

So how can we effectively communicate when millions of people are suddenly required to cover two-thirds of their face?

A bigger problem for North America

Stanford psychologist Jeanne Tsai has long studied the relationship between culture and communication. She says, some cultures around the world have more experience negotiating the complexities of communication while wearing facial coverings. East Asians, for example, have long incorporated protective mask wearing into public activities. North Americans, on the other hand, in particular will likely find it very difficult to quickly learn effective communication with masks, Tsai suggests.

“The mouth seems particularly important in the United States partly because mouths are a critical part of conveying big smiles, and for Americans, bigger smiles are better,” says Tsai. “Our work finds that North Americans judge people with bigger smiles to be more friendly and trustworthy. In fact, smiles have an even stronger influence on judgments of friendliness and trustworthiness than more structural facial features associated with race or sex.”

Taking away one’s ability to smile in public settings is challenging enough but it presents particularly unique challenges in cultural contexts with pre-existing racial disparities. In the United States, for example, African American men are already expressing anxiety over being perceived as threatening while wearing face masks. A video from March showing a police officer removing two black men from a Walmart for wearing surgical masks highlighted the unique problems faced by widespread mask wearing in the United States.

“At the very least, I think people will have to learn to smile with their eyes and voices, and to read the eyes and voices of others more,” Tsai suggests.

The Duchenne Smile

In the mid-19th century French scientist Guillaume Duchenne published an iconic book titled Mecanisme de la physionomie Humaine (The Mechanism of Human Facial Expression). Duchenne was fascinated by the relationship between communication and facial anatomy and part of his research focused on the anatomical differences between a real smile and an insincere smile.

He found a simple smile involves the contraction of the zygomatic major muscle. This muscle is basically all one needs to raise the corners of their mouth. However, a truly positive, genuine and exuberant smile also involves contracting the orbicularis oculi muscle.

The orbicularis oculi muscle surrounds the eye and is primarily involved in controlling blinking. However, it also plays a role in smiling by helping raise the cheeks and create a wrinkling around the eyes. At the time, Duchenne suggested this more holistic type of smile could not be faked, and only the “sweet emotions of the soul” could lead to contraction of the orbicularis oculi.

This type of holistic smile became known as the Duchenne Smile. And, although researchers have since discovered the Duchenne Smile can indeed be faked, not everyone can easily fake it, and an exaggerated Duchenne Smile can be an effective signal someone is lying.

Interestingly, researchers have found botulinum toxin, or botox, the neurotoxin used in beauty therapies to paralyze certain facial muscles and slow the development of wrinkles, can also prevent a person from effectively contracting the orbicularis oculi muscle. A 2018 study found botox therapy does prevent a person from performing a Duchenne Smile, which not only stifles their ability to effectively communicate positive emotion, but may even induce depression as forming a facial expression has been found to strengthen the internal embodied feeling of that emotion.

Face masks are not a novel experience for everyone

While many North Americans struggle with communicating effectively in a world of newly masked faces, perhaps the best advice moving forward comes from cultures that have already adapted to this kind of behavior. For many Muslim women around the world, facial coverings, called a niqab, are normal. And both wearers and non-wearers have developed techniques to maintain effective communication.

Samar Al Zayer, a psychologist currently working in Europe, grew up in Saudi Arabia and, although she never wore a niqab, she remembers how facial coverings changed how one interpreted different social cues. Speaking to the BBC, Al Zayer recalls how communication wasn’t necessarily more difficult when one party’s face was covered, but it certainly was profoundly different.

“I would be a bit more aware of their non-verbals, keeping more eye contact to understand how they were feeling, to try and pick up on some sort of emotion,” she says. “I would be more attentive to their tone and hand gestures as well.”

The onus needs to be on both parties to overcome the limitations of communicating while wearing face masks. For those wearing masks, experts recommend using more exaggerated gestures to compensate for the loss of half of one’s face. From expressive eyebrows to a simple thumbs-up, it is suggested people amplify other elements used in communication.

“Over-communicate – use more words than you normally would, and ask more questions, to make sure you’re correctly picking up on the other person’s emotions,” says Al Zayer. “Learn how to use your other senses and body language, too.”

Source: https://newatlas.com/health-wellbeing/smiling-eyes-communication-face-mask-coronavirus/



Masks…. We have to wear them. Why? Because we are smart, caring, socially conscious and efficacious survivors.

Sometimes it’s a challenge….accessing a supply, accessorizing it for the appropriate time and place, keeping one on hand (I mean-face) at all times, and ahhhh flirting? Just kidding…..

We can make wearing a mask fun through individual expression, on-going education, and by cheering our friends and family to partake in mask attire in creative or just plain practical ways. We can choose to shop and frequent business that are invested in our well-being.

I do, despite the bickering  in my head, judge people’s actions when they are not wearing a mask in Public when it is required.  I feel like they are making a pretty strong statement, and not one that values me or others.

Let’s team up and do what we can to slow down this global pandemic. We know what it takes to survive. It takes the love and commitment of others and that is why we are here.


No surfing in CHAD


Climate change is a critical factor in Lake Chad crisis conflict trap -“Shoring Up Stability” report

aJul 15, 2019- ADELPHI

Lake Chad is caught in a conflict trap. It is experiencing one of the world’s worst humanitarian emergencies with an estimated 10.7 million people in need of assistance. Now a new G7 mandated report from the Berlin based think tank adelphi shows, for the first time, how climate change is interacting with the conflict to compound the crisis and sets out how these challenges might be overcome. DOWNLOAD the report here https://www.shoring-up-stability.org The report “Shoring Up Stability” shows that climate change and conflict dynamics create a feedback loop where climate change impacts seed additional pressures while conflict undermines communities’ abilities to cope.

Nature, Dancing and a Cuddle!



Preterm Birth Rates – Colombia

Rank: 114 –Rate: 8.8% Estimated # of preterm births per 100 live births (USA – 12 %)

Source: https://www.marchofdimes.org/mission/global-preterm.aspx

Colombia, officially the Republic of Colombia  is a country largely in the north of South America, with territories in North America. Colombia is bounded on the north by the Caribbean Sea, the northwest by Panama, the south by Ecuador and Peru, the east by Venezuela, the southeast by Brazil, and the west by the Pacific Ocean. It comprises 32 departments and the Capital District of Bogotá, the country’s largest city. With an area of 1,141,748 square kilometers (440,831 square miles), Colombia is the fourth-largest country in South America, after Brazil, Argentina and Peru. It is also the 25th-largest country in the world, the fifth-largest country in Latin America, and the fourth-largest Spanish-speaking country.

The overall life expectancy in Colombia at birth is 74.8 years (71.2 years for males and 78.4 years for females). Healthcare reforms have led to massive improvements in the healthcare systems of the country, with health standards in Colombia improving very much since the 1980s. Although this new system has widened population coverage by the social and health security system from 21% (pre-1993) to 96% in 2012, health disparities persist.

Through health tourism, many people from over the world travel from their places of residence to other countries in search of medical treatment and the attractions in the countries visited. Colombia is projected as one of Latin America’s main destinations in terms of health tourism due to the quality of its health care professionals, a good number of institutions devoted to health, and an immense inventory of natural and architectural sites. Cities such as Bogotá, Cali, Medellín and Bucaramanga are the most visited in cardiology procedures, neurologydental treatmentsstem cell therapyENTophthalmology and joint replacements because of the quality of medical treatment.

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




Cuddling Preemies Kangaroo Style Helps Into Adulthood

By Maggie Fox -Dec. 12, 2016

Cuddling small and premature babies in a style known as “kangaroo mother care” helps them in life decades later, researchers reported Monday.

They found that babies held upright and close to bare skin and breastfed, instead of being left in incubators, grew up with fewer social problems. They were far less likely to die young.

It’s a reassuring finding for parents who may worry that tiny and premature babies are safer in an incubator than in their arms, the team wrote in their report, published in the journal Pediatrics.

Kangaroo mother care was first described in Colombia, and the team of experts there who first showed it was safe did a 20-year follow-up to see how the babies fared as they grew up. They tracked down 494 of the original 716 children who were born prematurely from 1993 to 1996 and randomly assigned to get either kangaroo mother care or standard handling.

“The effects of kangaroo mother care at one year on IQ and home environment were still present 20 years later in the most fragile individuals, and kangaroo mother care parents were more protective and nurturing,” Dr. Nathalie Charpak and colleagues at the Kangaroo Foundation in Bogota, Colombia, wrote in their report.

“At 20 years, the young ex-kangaroo mother care participants, especially in the poorest families, had less aggressive drive and were less impulsive and hyperactive. They exhibited less antisocial behavior, which might be associated with separation from the mother at birth,” they added.

“Kangaroo mother care may change the behavior of less well-educated mothers by increasing their sensitivity to the needs of their children, thus making them equivalent to mothers in more favorable environments.”

Twenty million babies are born at a low birth weight every year around the globe, the World Health Organization reports. The U.S. has one of the highest rates of pre-term and low-weight births — about one in 12 births, according to the March of Dimes.

It defines low birthweight as being when a baby is born weighing less than 5 pounds, 8 ounces.

Most of these small babies are premature and they are at high risk of dying, of developing cerebral palsy, or having learning disabilities, and they can grow up more prone to a range of diseases.

High-tech care can help, but WHO promotes the simpler, low-tech approach alongside modern medical care — or instead of it in some poor settings.

“Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. Its key features are: early, continuous and prolonged skin-to-skin contact between the mother and the baby; exclusive breastfeeding (ideally); it is initiated in hospital and can be continued at home; small babies can be discharged early; mothers at home require adequate support and follow-up,” WHO said.

“It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward with preterm infants.”

And it’s safe, WHO added. “Almost two decades of implementation and research have made it clear that kangaroo mother care is more than an alternative to incubator care.”

Charpak’s team found the babies randomly assigned to get this treatment were 39 percent more likely to live into adulthood. They had stayed in school longer and earned more as adults.

It didn’t work miracles. Children with cerebral palsy were equally likely to have symptoms whether they had the kangaroo care or not, and more than half the people in the entire group needed glasses. The children given standard care had higher math and language scores in school, while IQ levels were about the same in both groups.

But overall, the findings support the benefits of kangaroo mother care, the team concluded.

“Our long-term findings should support the decision to introduce kangaroo mother care to reduce medical and psychological disorders attributable to prematurity and low birth weight,” they wrote.

“We suggest that both biology and environment together might modulate a powerful developmental path for these children, impacting until adult age,” they added.

“We firmly believe that this is a powerful, efficient, scientifically based health intervention that can be used in all settings.”



Kat and I have danced Zumba for the past 13 years and are both certified instructors. Kat teaches several Zumba and Strong Nation (HITT) classes every week.  Zumba founders Alberto “Beto” Pérez (Colombian native), Alberto Perlman, and Alberto Aghion built a worldwide global health and fitness community (180 countries)  that we are grateful to be a part of.  Zumba in the streets? That’s what it’s all about! And our Neonatal Womb Community? We all need to do a little dancing. This pandemic has been challenging and we have a ways to go! Let’s move forward with curiosity, creativity, some crazy footwork and a focus on taking active care of ourselves and each other.

Colombia: Bogota Police help fight corona-virus isolation blues with dance classes

Apr 1, 2020

Colombian national police officers took to Bogota’s streets on Tuesday with loud speakers and dance tunes to encourage citizens to get some exercise and help them get through self-isolation with high spirits. “We are working at the moment on the idea of prevention to help people in everything that relates to tranquility in terms of their spiritual, physical and mental control in relation to the entire quarantine due to COVID-19,” said national police colonel Doris Manosalva. Footage shows police officers coordinating the dance operation before heading out to the streets to dance, calling on people to join them as well as reminding everybody the importance of staying inside. Police officers go to a different area of the city every day to reach as many citizens as possible.


How California Became The Only State To Lower Its Infant Mortality Rate

Here’s how they’re saving the lives of more premature babies.

By Anna Almendrala08/08/2018

California was the only state to significantly reduce the rate of stillbirths and newborn deaths from 2014 to 2016.

In 2014, Dr. Elizabeth Rogers and her colleagues at the UCSF Benioff Children’s Hospital in San Francisco noticed a disturbing trend among the tiniest preemies in their neonatal intensive care unit: a high rate of brain bleeds among these babies born before 28 weeks’ gestation.

Rogers wondered if other NICUs had seen an increase as well or if there was something about her patient population that put them at particular risk.

Intracranial hemorrhages, caused by the rupture of immature blood vessels in the brain, are a major cause of death in very preterm babies, as well as a complication linked to developmental delays and cognitive deficits later in life. Driving down the rate of such complications is one way that hospitals can help reduce the number of early infant deaths.

Compared to other rich countries, the U.S. has unacceptably high rates of perinatal deaths, a category that covers stillbirths and deaths within the first week of life. And the most recent data suggest those numbers are not improving ― except in California. That state was the only one to see a decrease in perinatal deaths from 2014 to 2016, according to a report published Wednesday by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

The reason for California’s success may be a statewide data project that has been gathering information from hospitals for the past two decades. In any other state, Rogers and her colleagues would have struggled to find an answer to her initial question about the prevalence of brain bleeds. But because they were in California, Rogers was able to log into a data dashboard created by the California Perinatal Quality Care Collaborative. The easy-to-use clearinghouse of real-time information from more than 90 percent of California hospitals that treat babies in NICUs let her compare her unit’s outcomes to those at similar units.

What she found shocked her. UCSF was seeing brain bleeds in more than 15 percent of NICU babies, or nearly four times the rate at comparable hospitals of the same size and expertise.

“I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem,’” said Rogers, who is director of the hospital’s intensive-care small-baby program.

Armed with that information, she persuaded hospital administrators to allocate resources to the issue; gathered a group of doctors, nurses, therapists, technicians, janitors and parents to consider what steps to take; and produced a training manual for staffers.

I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem.’ Dr. Elizabeth Rogers

It isn’t clear what causes brain bleeds in premature babies, so Rogers’ group tackled the issue in multiple ways. Starting in 2014, women who went into labor preterm received a shot of steroids to strengthen their babies’ brains. Immediately after birth, the clamping of a preemie’s umbilical cord was delayed 45 seconds, which is known to decrease brain bleeds.

Everyone who interacted with the babies, from X-ray techs to sanitary workers, received training on how to create a calm environment, which included intervening as little as possible and using low voices if they had to speak.

In about three years, UCSF reduced the rate of brain bleeds to 3.8 percent, just a quarter of what it had been and on par with comparable hospitals in the state. This decrease set off a cascade of other positive outcomes. Deaths in the NICU were cut almost in half, dropping from 11.9 percent to 6.8 percent over that time period. Rates of necrotizing enterocolitis ― another common complication among premature babies ― went down as well, which Rogers attributed to the hospital’s increased attention to their littlest patients.

The speed at which Rogers and her team implemented research-based change was remarkable and unusual. It takes an average of 17 years for research data to alter standard medical practice, in part because of entrenched hospital bureaucracies that favor tradition, a systemic reluctance to spend money on monitoring and prevention, and medical staff who may feel competitive and territorial.

Without the initial comparative data, Rogers is convinced she wouldn’t have been able to revamp her NICU’s systems so fast and the rates of hemorrhage would have remained high.

Hospitals in general need to become better at rapidly adjusting and refining their care when it’s lacking or when new research points to a better way of doing things, Rogers argues.

Across the rest of the country, rates of stillbirths and deaths within a week after birth remain at a standstill. In one state, Missouri, the rate has actually gone up since 2014. California has the third-lowest rate, following Washington state and Wyoming.

“To see the results … is a huge reward,” said Rogers. “It’s a huge validation that all of this effort is worth it.”

They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors. Dr. Jeffrey Gould, co-founder of the California Perinatal Quality Care Collaborative

While the larger issue of American infant mortality is now more widely recognized, it wasn’t in the public consciousness 21 years ago when Dr. Jeffrey Gould, then a researcher with the University of California, Berkeley, began to compile a single statewide database of numbers on newborn deaths and complications, paid for by the state.

The project grew as Gould convinced neonatologists, hospitals, insurance payers, public health experts and state agencies that it was in everyone’s interest to share NICU data in real time. With its wealth of information, the California Perinatal Quality Care Collaborative also develops best practice standards and toolkits to help hospitals implement those practices. It periodically launches initiatives aimed at improving care in one particular area, such as breastfeeding in the NICU, using antibiotics and reuniting these vulnerable newborns with their families.

The model of the California Perinatal Quality Care Collaborative has spread across the country, albeit only in recent years. Most states now have some kind of perinatal quality collaborative, but they aren’t created or funded equally. Because California was the first, none of the other state collaboratives has as much data or experience. And though some of them provide education on better practices, they don’t seek to help hospitals implement specific changes ― an aspect of California’s collaborative that makes membership so worthwhile. This means the gains California has seen are not guaranteed in other parts of the country.

Gould, now a professor of neonatal and developmental medicine at Stanford, is especially frustrated that hospitals still hesitate to invest real money in trying to improve the quality of care.

“One of the big drawbacks in this country is that quality improvement is not really seen by hospital administrators as a line item kind of thing,” Gould said. “They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors.”

The annual cost of membership in the California Perinatal Quality Care Collaborative is $13,000 to $15,000, depending on the size of the hospital, and it gives them access to the data dashboard. Participation in each individual initiative is optional and costs an additional fee ― around $8,500 per hospital ― to defray the additional costs for data collection, training and network access.

Meanwhile, the average daily cost of one baby’s care in a NICU is more than $3,000.

More data may ultimately ease this problem too, Rogers said. Besides helping doctors make the case to administrators for more resources for the NICU, as she did, better information leads to more effective and efficient care, which can lead to cost savings.

When a state does decide to invest in improving outcomes for preemies, hospitals may not know where to start. Gould’s suggestion: Use the data to find the low-hanging fruit, and then build on those first successes.

That’s exactly what Rogers is doing. The doctor is now turning her attention to necrotizing enterocolitis, a bacterial infection in the gut that can destroy intestinal walls. As brain bleeds have continued to decrease, necrotizing enterocolitis has become the biggest contributor to preemie deaths in her unit.

Again, armed with data, Rogers convinced the hospital to free up some funding for her unit to take part in the California Perinatal Quality Care Collaborative’s current effort to improve nutrition in NICUs. For premature babies, this boils down to hospital policies that encourage and assist mothers to pump breast milk soon after the baby’s birth ― a difficult task for women who have just experienced a stressful and unexpected early delivery.

Because formula feeding is one of the only consistent risk factors for necrotizing enterocolitis, breast milk ― especially milk produced by the baby’s mother ― decreases the odds that a premature baby will develop the infection. It’s so good for NICU patients, Rogers said, that doctors look at it more like medicine than food.




Brazil changes maternity leave for mothers of premature babies – a step to a fairer and more humane scenario of the labour market for all women 

Brazil (2019): The maternity leave for mothers of premature babies is extended. Last month Brazil’s Supreme Federal Tribunal decided to prolong the period of maternity leave for mothers of premature infants. We talked to Denise Leao Suguitani, founder and executive director  of GLANCE partner parent organisation Brazilian Parents of Preemies’ Association (Prematuridade.com), member of the GLANCE advisory board, about this important adjustment in Brazilian law.

  1. Ms Suguitani, Brazil took another big step to strengthening maternal rights. What brought this change to come?

We, the organized civil society, were finally able to raise awareness for the Brazilian Governments about the challenges prematurity brings along. It seems they have understood the essentiality of protecting motherhood and childhood, especially for more delicate babies like the premature ones. Although the decision is valid only for mothers working on a formal contract, it is a huge step towards a fairer and more humane scenario of the labour market for all women.

  1. Ms Suguitani, your parent organisation spoke to the lawyers who placed the injunction that was eventually approved. What changes for mothers of premature babies in Brazil from now on?

Women in the workforce in Brazil have 120 days of standard maternity leave, which begins on the day of the delivery. From now on, mothers of premature babies can require a new beginning of maternity leave, if their baby needs to be in the hospital for more than two weeks. Once the baby is discharged, the maternity leave with its 120 days starts anew – regardless of how long the baby had to stay in hospital.

  1. The initial decision of Minister Fachin was valid until the Brazilian Federal Supreme Court plenary confirmed the new law, on April 3rd. How do you assess that victory in the Court?

We were really optimistic that the injunction would not be overturned since we have been working for the approval of this law for over 5 years now, dialoguing with politicians and decision makers. It is such a great achievement for the cause of prematurity in our country and a big step for our society.

Ms Suguitani, thank you so much for taking the time to speak with us.

Source: https://www.glance-network.org/news/details/brazil-extends-maternity-leave/



Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the USA Systematic Review

Bruce Bekkar, MD1Susan Pacheco, MD2Rupa Basu, PhD3,4; et alNathaniel DeNicola, MD, MSHP5 – June 18, 2020

Key Points:

Question  Are increases in air pollutant or heat exposure related to climate change associated with adverse pregnancy outcomes, such as preterm birth, low birth weight, and stillbirth, in the US?

Findings  In this systematic review of 57 of 68 studies including a total of 32 798 152 births, there was a statistically significant association between heat, ozone, or fine particulate matter and adverse pregnancy outcomes. Heterogeneous studies from across the US revealed positive findings in each analysis of exposure and outcome.

Meaning  The findings suggest that exacerbation of air pollution and heat exposure related to climate change may be significantly associated with risk to pregnancy outcomes in the US.


Importance  Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country.

Objective  To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth.

Findings  Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The sub-populations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality.

Conclusions and Relevance  This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.


The current climate crisis, also known as climate change or global warming, has been widely recognized as an environmental emergency that threatens many critical resources and protections including sustainable food and water supplies, natural disaster preparedness, and US national security. However, as the World Health Organization and The Lancet Countdown have identified, one of the greatest consequences of climate change is its association with human health.

Specific to women’s health, the American College of Obstetricians and Gynecologists position statement recognizes that “climate change is an urgent women’s health concern as well as a major public health challenge.” The associations of climate change with women’s health have been further outlined to include a wide range of undesirable outcomes, such as worsening of cardiac disease, respiratory disease, and mental health, and exposure to an increasing number of infectious diseases.

These adverse health effects are most consequential to at-risk populations, which include a high number of pregnant women and developing fetuses. The obstetrical literature has included numerous observational studies demonstrating an association between air pollution and heat and increased risk of adverse birth outcomes. Two components of air pollution that are exacerbated by climate change and continued use of fossil fuels are fine particulate matter less than 2.5 μm in diameter (PM2.5) and ozone.

In this review, we assessed the associations between exposure to PM, ozone, and heat and preterm birth, low birth weight, and stillbirth. Although these associations have largely been studied in a global setting, we focused specifically on the US population, in which these exposures are increasingly common.


Scope of Review

For this systematic review, we evaluated evidence of the association between air pollution and heat on the adverse obstetrical outcomes of preterm birth, low birth weight, and stillbirth. The Arskey O’Malley methodologic framework for a scoping review was used.18,19 This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Research Questions

The following specific key questions were addressed in this review. Is prenatal exposure to PM2.5 or ozone associated with increased risk of preterm birth? Is prenatal exposure to PM2.5 or ozone associated with increased risk of low birth weight? Is prenatal exposure to PM2.5 or ozone associated with increased risk of stillbirth? Is prenatal exposure to heat associated with increased risk of preterm birth? Is prenatal exposure to heat associated with increased risk of low birth weight? Is prenatal exposure to heat associated with increased risk of stillbirth?


Studies across diverse US populations were identified that reported an association of PM2.5, ozone, and heat exposure with the adverse obstetrical outcomes of preterm birth, low birth weight at term, and stillbirth. More than 32 million births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. In each analysis of climate change–related exposure and adverse obstetrical outcome, most of the studies found a statistically significant increased risk (Table). The highest number of studies were found for risk of preterm birth (29 studies) and low birth weight (32 studies), whereas limited studies were identified for stillbirth (7 studies) because of the lack of available data for health studies.

Our review contributes the largest number of recent studies (2007-2019) focusing solely on US populations and is the first, to our knowledge, to combine the increasingly common exposures of air pollutants and heat associated with a series of adverse obstetrical outcomes. Our findings are consistent with other review articles that were not included in our analysis (all included non-US participants). Reviews that examined PM2.5 found consistently positive association with preterm birth and low birth weight or continuous birth weight, and 1 systematic review and meta-analysis on stillbirth risk showed elevated effect estimates for both PM2.5 and ozone, although they did not achieve significance. Five reviews that focused on heat exposure found an association with preterm birth in most studies, as did 4 that analyzed low birth weight and 2 analyzing stillbirth risk.

The adverse obstetrical outcomes examined in this study are known to be complex, heterogeneous, and multifactorial in origin; several animal studies suggested that both air pollutant and heat exposure may contribute to adverse obstetrical outcomes. Regarding preterm birth, mechanisms that implicate toxic fine particulates include maternal hematologic transport of inhaled noxious chemicals, the triggering of systemic inflammation, or alterations in function of the autonomic nervous system. Low birth weight may be associated with air pollutants by direct toxic effects from fetal exposure, altered maternal cardiac or pulmonary function, systemic inflammation from oxidative stress, placental inflammation, altered placental gene expression, or changes in blood viscosity; multiple effects may operate simultaneously. Mechanisms for the association of air pollutants with stillbirth may involve alterations in oxygen transport, DNA damage, or placental injury. The cause-specific analysis by Ebisu et al of stillbirths reinforces the apparent association of injury to the fetal-placental unit with air pollutant exposure compared with other possible causes.

Heat exposure may contribute to prematurity through labor instigation from dehydration (via prostaglandin or oxytocin release), from altered blood viscosity, and/or by leading to inefficient thermoregulation; it may also trigger preterm premature rupture of membranes and thus preterm birth during the warm season. Likewise, heat exposure may impair fetal growth by reducing uterine blood flow and altering placental-fetal exchange. Mechanisms associated with elevated temperatures and stillbirth include the initiation of premature labor (as noted above), lowering amniotic fluid volume, damaging the placenta, or causing abruption.

Biologic plausibility is further supported by other recent studies not included in this review. The study by Casey et al of preterm birth rates in California before and after coal power plant closures showed a 27% reduction during the 10-year period after closure. Currie et al found that among 1.1 million live births in Pennsylvania, the risk of low birth weight was higher within 3 km of a fracking site compared with the background risk and increased by 25% within 1 km of a site.

This review revealed a disproportionate effect on populations defined as pregnant women with certain medical conditions or specific race/ethnicities. Women with asthma may be particularly susceptible to adverse outcomes, such as preterm birth and stillbirth, in association with PM2.5 exposure during gestation. Among racial/ethnic groups, our findings suggest that black mothers are at greater risk for preterm birth and low birth weight. Social determinants of health, including residence in urban areas with higher exposure to air pollutants and long-term high levels of stress, are known to contribute to adverse obstetrical outcomes. A recent study from California suggested that PM2.5 exposure alone was associated with an equivalent amount of the racial disparity (black vs white) in preterm birth rates as did other demographic and social factors. Our research suggests that these environmental exposures further exacerbate that background risk and could be included among these social determinants.

Regarding both air pollutant and heat exposure, associations with adverse birth outcomes were found across the continental US. For example, studies on air pollution and low birth weight found an association in 19 states in the Northeast (10), Southeast (5), Midwest (2), Mountain (1), and West (1) regions. California, known for both high temperatures and unhealthy particulate and ozone levels, was included in the greatest number of studies showing a positive association (13), followed by Massachusetts (6), Georgia (5), and Florida (4). The exposures are complex; even within 1 state, the weather patterns, geography, and urbanization may create zones with widely different pollution risks, as shown by Tu et al in Georgia.

Future research is needed to further identify at-risk populations, high-exposure geographic areas, and effects of seasonality. This ongoing research may be enhanced by improved geographic information systems that can be mapped onto existing US public health data-banks such.


This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US. It appears that the medical community at large and women’s health clinicians in particular should take note of the emerging data and become facile in both communicating these risks with patients and integrating them into plans for care. Moreover, physicians can adopt a more active role as patient advocates to educate elected officials entrusted with public policy and insist on effective action to stop the climate crisis.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260


Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep

Fulmer, Megan BSN, RN-NIC; Zachritz, Whitney MSN, CPNP-BC, RN; Posencheg, Michael A. MD

Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC, Section Editor

Advances in Neonatal Care: June 2020 – Volume 20 – Issue 3 – p 229-232



Although the incidence of sudden unexplained infant deaths has decreased over time with the use of safe sleep practices, one area that remains unclear is the safety of hats during infant sleep.


Decrease the risk of overheating or suffocation by removing NICU infants’ hats during sleep without increasing the relative risk of hypothermia during transition to an open crib.


Removal of hats for routine thermoregulation, beyond the initial infant resuscitation and stabilization of NICU infant was implemented in 2015. Retrospective chart audits were conducted on all NICU infants between February 2015 and December 2016. Hypothermia (≤ 97.6°F) data during transition to an open crib was collected. Exclusion criteria included concurrent diagnosis of: sepsis, hyperbilirubinemia, congenital anomaly inhibiting infants thermoregulation and noncompliance with unit guideline for weaning infant to open crib.


Over 18 months, 2.7% of infants became hypothermic (≤ 97.6°F) during transition to open crib, requiring return to isolettes.

Implications for Practice: 

Hats were found to be unnecessary in maintaining thermoneutrality after weaning infants to an open crib in our NICU. By avoiding the use of hats in an open crib, it’s possible infants will avoid overheating and a risk of suffocation, creating a safer sleep environment.

Implications for Research: 

The removal of hats during sleep to promote infant health should be considered for all infants.




Premature Baby Makes Full Recovery After Experimental Coronavirus Treatment | NBC News NOW

newsJun 22, 2020

Born premature at just 27 weeks, one baby is finally on his way home after battling both sepsis and COVID-19. NBC News’ Helena Humphrey spoke with the baby’s mother about his 47-day battle.



Preemie Parent Perspective: Addressing Health Equity and Cultural Competency in the NICU

Jenné Johns, MPH

In 2016, I published Once Upon A Preemie, a first- of its kind children’s book written to comfort parents of premature infants during their journey through the Neonatal Intensive Care Unit (NICU). During my journey, I discovered that reading to my micropreemie was the one activity as a mother that I could offer my son that helped normalize my overwhelming and traumatic NICU experience. During our nearly three-month stay in the NICU, I read to my son every day as research studies suggest that reading stimulates healthy brain development in preemies, and also helps to form a bond between parent and baby. Many of the bedtime stories that we read ended with a parent tucking the child into bed at home with Mommy and Daddy. That wasn’t our reality for three months. There were no books about us. Little did I know that in publishing my deepest emotions carried during and post NICU would lead me to become an author and speaker, but also an advocate and advisor for the needs of preemie parents, especially African Americans. As the mother of a micro-preemie and miracle baby born at 26 weeks and weighing 1 lb 15.3 ounces, I found myself advocating for his needs as I knew his life depended on it. Despite my 10-year career working to eliminate racial and ethnic disparities in health care, nothing prepared me for the heart-wrenching experience of my son’s premature birth. “Disparity” became real for me as my son joined the ranks of the nearly 500,000 premature babies born in the United States, nearly half to African American and Hispanic mothers. It was through this dual role that I experienced the NICU, one as a vulnerable micro-preemie mother, and the other as a health equity professional.

At birth, my son required life-saving medical interventions; oxygen, photo-therapy lights, feeding tubes, a heart monitor, medication, vitamins, and even caffeine. Over our nearly three-month stay in the NICU, I traveled through snowstorms and blizzards, to parent and nurture my baby. I only missed three days (two due to inclement weather and one self-care day). A typical day in the NICU lasted from 7 am until midnight, with many breaks to pump breast milk. My lactation consultant promised that my breast milk was liquid medicine. Midway through our NICU journey, I had to return to work, unlike many of my new NICU parent friends who were Caucasian. My advocacy skills were tested daily, as his life depended on how well I could speak “neonatology” language, I had to be his voice and articulate his needs. This was challenging because, after all, “I’m just a Mom,” an African American Mom, and not a doctor.

As a mother, my NICU journey was traumatic and filled with a sea of emotions, including fear, anxiety, helplessness, and isolation. Much of which NICU parents are facing due to the current COVID-19 pandemic. Many of my fears, concerns, and feelings of isolation were due to the NICU environment, which was not as culturally friendly and supportive, as I assumed it would be. I’m being generous by saying there was little cultural diversity; it was dismal at best. There were times when the lack of cultural sensitivity and bedside manner caused more pain than my son’s actual health status, and it made me very uncomfortable because as the end of each night, I had to trust my most prized possession with nurses and doctors who I did not always trust. Another challenge I faced as an African American preemie parent, was that although our larger hospital system had active and robust NICU parent support groups, these resources were not made available at the smaller hospital where I delivered my son. This hospital served more African American and lower-income families than the other hospitals. Many of the parents I developed a relationship with, felt as if our socio and emotional needs did not matter and were oftentimes dismissed because of this missing resource.

Lastly, I experienced inconsistent positive communication and relationships with many of the NICU staff. Although I now believe that all of the members of my son’s care team, held his safety and the quality of care they delivered to him with the utmost regard, our daily communication and interaction lacked humility, respect, and sensitivity. I will admit, I was not always the easiest or most cheerful mother to deal with, I now believe, that with trauma-informed and implicit bias training among hospital staff, the professional staff would have been better equipped to communicate and support my delicate and fragile nature.

Overall, a good deal of our NICU experience was positive; some experiences left permanent and negative memories that, to this day, cannot be erased. As much as I tried checking my professional credentials at the door before entering the NICU, my interactions with the NICU staff begged, yelled, and warranted us to have those tough cultural sensitivity conversations. Not in a negative way, but as an opportunity for forming better communication, respect, and, most importantly, trust. In my professional view, the NICU is a microcosm of the larger hospital system on steroids, particularly NICU’s serving low income and racially, ethnically, and linguistically diverse populations. Health disparities impacting the NICU are also a reflection of a larger hospital ecosystem. Below are my preemie parent and professional recommendations for integrating health equity and cultural competency in the NICU:

1. Prioritize health equity and cultural competency as strategic priorities and goals. Establishing opportunities for integrating and addressing health equity in short and long terms strategies ensures layers of accountability, allocation of funding, measurement, and documentation of outcomes. One example of an important health equity priority includes staff diversity. Peer-reviewed studies have shown that cultural congruence among patients and providers yields better health outcomes, better communication, and trust.

2.Make health equity, cultural competency, and implicit bias training mandatory for all NICU Staff. Participating in an annual training program is a great start to begin addressing and delivering equitable care to all NICU families. However, one-time training is not sufficient. Integrating health equity and implicit bias content into clinical rounds, staff development, and training opportunities are critical to reducing racial and ethnic disparities in the NICU.

3.Communicating in lay terms should be standard in every NICU. Literacy and health literacy levels are important considerations for family-centered and culturally appropriate care in the NICU. Regardless of one’s educational level, the NICU terminology is overwhelming and confusing for a new parent entering the NICU. Literacy and health literacy considerations are also important factors for families who are limited or non-English speaking. Break the communication barriers by speaking the same language and utilizing interpreters even if everyone speaks English. I had a great deal of respect and appreciation for the NICU staff who used lay terms and avoided NICU jargon when communicating with me. In time, I began understanding the NICU language; however, that wasn’t my job as a preemie parent. Preemie parents should be made to feel as comfortable speaking and interacting with NICU staff regardless of their literacy and health literacy levels.

4.Partner with parents to address the cultural competency, spiritual diversity, and unconscious biases that exist in the NICU. Listen to the voices of parents with multicultural backgrounds to be more sensitive to racial, ethnic, language, income, education, transportation, and spiritual needs. Encourage preemie parents to speak up. Staff should value their input. Allow parents to give their insights on their baby’s health status, and any gut feelings they may have about a diagnosis or new development. This is extremely important for minority parents who assume their voice and parental role is undervalued.

5.Engage and establish culturally congruent NICU family supports. Many minority parents may not immediately express a need for mental or emotional help while in the NICU for fear of being labeled. Where and when possible, make culturally congruent resources available to support these parents, even if the supports are outside of the NICU.

6.Make digital technology and virtual solutions available to parents with transportation, competing work schedules, or other barriers to delivering care to their preemies. This is most critical during the current COVID season, where parental fears and social distancing may prohibit them from visiting their baby. Creating safe opportunities for parents to connect with their babies is vital bonding via smart devices or other safe technology solutions.



Coastal Sunrise Father dances on TikTok for his son in NICU

3waveWSAV3 – Feb 5, 2020




Using Neonatal Intensive Care Units More Wisely for At-Risk Newborns and Their Families

DeWayne M. Pursley, MD, MPH1,2John A. F. Zupancic, MD, ScD1,2   June 18, 2020

Escalating US health care expenditures, including estimates that 20% to almost 50% of these costs involve processes, products, and services that do not improve outcomes, have brought renewed attention to the need to improve value in health care.1 Among the 6 waste categories outlined by Berwick and Hackbarth, there has been considerable focus on opportunities to reduce overtreatment, “the waste that comes from subjecting patients to care that… cannot possibly help them… rooted in outmoded habits, supply-driven behaviors, and ignoring science.”

Neonatal intensive care unit (NICU) services are at particularly high risk of overuse. Hospital and professional services reimbursements, reflecting the acute and highly technical nature of intensive care, are favorable and remain closely linked to admission volume and patient days in most regions. Both a legacy of intervention and a fear of litigation in caring for an at-risk population can also contribute to ineffective testing and treatments. The neonatology community is, however, starting to recognize the potential for improving care and controlling resource utilization. A 2015 study describing a systematic process to identify ineffective or harmful neonatal tests and treatments yielded a “Choosing Wisely Top Five” list in part to guide these efforts. In recent years, the neonatal care value literature has evolved to also focus more broadly on trends relating to NICU utilization—specifically, increasing admission rates and longer lengths of stay.

In the study by Braun et al,3 investigators from Kaiser Permanente share a population-based study describing a decline in NICU utilization—both admission rates and patient days—during a 9-year period. This is an important study, as it describes a trend that is counter to several recent reports of unexplained increasing NICU utilization, particularly for more mature and higher birth-weight infants, using a clinical rather than administrative data set. It is also important because the results may have been associated with several intercurrent performance improvement initiatives. Kaiser Permanente is a large, integrated health care system with a diverse population and a population-based financial payment structure and is in many ways uniquely suited (and motivated) to undertake a project to identify and characterize potential approaches to safely reduce neonatal care that is costly, may be ineffective, separates families, and is potentially harmful. The authors used a risk-adjustment model to ensure that the improvements were associated with postnatal care practices and not with changes in case mix reflecting patients less in need of acute neonatal care. They were also careful to include balancing measures, such as readmission and mortality, among the outcomes. Also important is the residual practice variation, which may hint at future opportunities for reduction in NICU utilization.

In the study by Braun et al, 12% of more than 300 000 liveborn infants were admitted to the NICU. Contrary to public perceptions of NICUs as prematurity colonies, more than two-thirds of these admissions were infants born after 34 weeks gestational age with birth weights more than 2000 g. The risk-adjusted NICU admission rate, accounting for socioeconomic, prenatal, and delivery room variables to control for independent factors that might affect admission or length of stay, decreased 25% over the study period to 10.9% of births, with 92% of the decline represented by infants with greater gestational age and higher birth weights. Importantly, these changes occurred without evidence of higher 30-day readmission or mortality rates.

There are compelling reasons that these results might not have been a random occurrence, as the health care system’s clinical leadership had implemented several concurrent performance improvement initiatives associated with decreased NICU admissions. A revised policy raised the threshold for NICU admission by lowering the gestational age (<35 weeks) and birth weight (<2000 g) for which well-appearing preterm infants were routinely admitted. A decision support tool based on individual infant estimates of early onset sepsis risk was introduced to guide laboratory testing and empirical antibiotic treatment. Finally, obstetric policies to decrease the rate of nonmedically indicated deliveries before 39 weeks of gestation and to reduce nonmedically indicated nulliparous, term, singleton, and vertex cesarean births were introduced.

The findings by Braun et al3 stand in contrast to a national trend documented in a 2015 population-based study. In that study using a public data set, birth-weight–specific NICU admission rates of US neonates were examined over a 6-year period (2007-2012). During this time, despite adjustment for maternal and neonatal characteristics, NICU admissions increased by 23%. These increases were generally represented by larger and less premature infants, such that by the end of the study period, most NICU admissions were for infants with birth weight more than 2500 g.

Although not population-based, observations by NICU member collaboratives, such as the California Perinatal Quality Care Collaborative and the Vermont-Oxford Network, have documented substantial variations in NICU admission and length-of-stay profiles. One California Perinatal Quality Care Collaborative study from 2018 observed that 79% of NICU admissions in 2015 were among infants born at or after 34 weeks gestation, while 10% of infants with 34 or more weeks gestation were admitted to the NICU. Schulman et al5 documented a 40-fold variation among member hospitals in the proportion of NICU admissions meeting high acuity definitions. In a Vermont-Oxford Network6 study involving approximately 500 000 infants hospitalized for nearly 10 million days in 381 NICUs from 2014 to 2016, 74% of NICU admissions were infants at 34 or more weeks gestation and only 15% of admissions met high acuity criteria. The proportion of admissions, patient days, high acuity, and short stays varied significantly both within and between different NICU types.

The origins of NICUs go back a half century, and NICUs have contributed substantially to reductions in US infant mortality during this time, a period during which rates of prematurity and low birth weight have actually increased. In 1967, the infant mortality rate was 22.4 per 1000 live births.  Fifty years later, in 2017, the rate had declined to 5.8 per 1000 live births, a remarkable 74% reduction. Neonatal intensive care is highly effective and has achieved these outcomes and corresponding reductions in morbidity by mitigating the effects of prematurity, congenital anomalies, and pregnancy and perinatal complications. In the early days, NICUs were in short supply and public health entities mobilized to develop regionalized perinatal systems to ensure that obstetric and neonatal patients at high risk had access to specialized services when indicated. As the neonatology workforce and NICU bed capacity increased, hospitals and hospital systems, seeking to become full-service systems, contributed to deregionalization, and there was increasing reliance on economic forces to regulate growth and distribution. In some areas, infants at high risk were distributed more broadly, including to smaller, lower-level units, resulting in less favorable outcomes. Because NICUs are high-margin services, there are significant pressures to expand capacity and maintain volume. This can lead to overuse, including more frequent admission of infants at low risk or a failure to focus sufficiently on care practices that could potentially reduce demand.

There is a cost to these practices. Although NICUs are effective, they are also expensive. Health care system costs are largely borne by government and business, and unwarranted increases may potentially compromise funding of other essential services. Importantly, there may be hidden financial harms for families as well, including costs associated with transportation or lost work days. There are also risks. Short NICU stays by infants at low risk may interfere with breastfeeding, expose them to infection, or increase antibiotic exposure. Additionally, family-infant separation may contribute to emotional risk.

It is not clear that increases in short term, low acuity, and high gestational age and birth-weight NICU admissions have benefited these infants and their families. In fact, the study by Braun et al suggests that it may be possible to reverse these trends without compromising and even potentially enhancing care. Rigorous adoption of evidence-based clinical practices, such as use of early onset sepsis decision support and obstetric policies to reduce non-medically indicated early deliveries and low-risk cesarean delivery rates is a start. There is also a need to examine the opportunities demonstrated by the enormous variation in NICU utilization and in specific NICU practices. These include gestational age thresholds for NICU admission; preferred sites of clinical evaluation, intravenous placement, and antibiotic administration for well-appearing infants with sepsis risk; preferred sites for monitoring and treatment and guidance for length of treatment for opiate withdrawal; and duration of apnea monitoring of preterm infants nearing discharge.

Neonatal intensive care is one of the major achievements of the last half century, and it has resulted in substantial reductions in mortality and long-term morbidity that benefit infants at high risk, including those born to mothers at substantial social risk. If the neonatology community is to successfully achieve the Triple Aim goal for neonatal intensive care—improved neonatal health, better family experience, and reduced cost—we must intensify efforts to learn how to use NICUs more wisely.

Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.5693

Corresponding Author: DeWayne M. Pursley, MD, MPH, Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (dpursley@bidmc.harvard.edu).

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767254


Why The Trauma Parents Experience In The NICU Follows Them Home


Parents who’ve spent time in the neonatal intensive care unit (NICU) carry anxiety with them even after their baby is released.

The NICU’s constant barrage of doctors and beeping monitors is traumatic — and that trauma lingers.

Kepley Wakefield approaches life with typical 13-month-old vigor. A lot of smiling, excellent crawling acceleration and a fair amount of shrieking.

Her parents Courtney and Hollis Wakefield cherish her. They were by her side for each of the 95 days Kepley spent in the NICU.

“I had some bleeding at 21 weeks. So at that point, they put me on bed rest and we were having really difficult conversations,” Hollis said. “Viability is considered 24, so we had like two-and-a-half or three weeks to get through — which was a really, really scary time.”

Giving Birth At 24 Weeks

Hollis knew her pregnancy was going to be high risk. She was a 39-year-old cervical cancer survivor, so she and her wife had a plan for early labor. Even they weren’t prepared for delivery at 24 weeks, five days. But that’s when Kepley arrived, at 1 lb 10 ounces. The NICU team braced the Dallas couple for a long and frustrating road.

“They told us it would be like a roller coaster,” Hollis said. “They were like it’s going to be, you know, minute-to-minute some days. It’s not a straight line at all.”

Kepley started out in the NICU at UT-Southwestern’s Clements University Hospital, but eventually moved to the higher level NICU just down the road at Children’s Medical Center in Dallas. She was on a ventilator for three months.

When she was discharged, she still was tiny not even five pounds. She still needed supplementary oxygen and had weekly doctors appointments. Courtney says the stress from the NICU followed them home.

“I’m anxious all the time,” she said. “I have said, I have not been myself since Kepley was born.”

At-Home Risks

Because Kepley was born so early, her lungs weren’t fully developed. And because a ventilator helped her breathe for so long, those tiny lungs were also damaged. So even though Kepley is now thriving, flu season is a real threat. Her parents second guess every public outing, even quick trips to the store.

“And you’re thinking, do we risk it? Are we both going to be home where one of us could stay home?” Courtney said. “Just kind having to deal with that, even just for day-to-day tasks that we might normally bring a baby to. We’re having to kind of think twice.”

That’s not an overreaction. Doctors say catching a respiratory virus like RSV or the flu might put a premature baby right back in the hospital, which could re-traumatize those parents who’ve already spent time in the NICU.

Dr. Rashmin Savani is the chief of neonatal medicine at Children’s Health and UT Southwestern. He says even just the noise of endlessly beeping NICU monitors can overwhelm parents.

“The medical team and the nursing team they’re phenomenal, they understand what all these beeps are and when to respond, when to not respond.” Savani said. “But the family is bombarded with this sort of cacophony of alarms that are all designed to say ‘hey, pay attention to me.’ But for the family, it’s really scary.”

Children’s Health has a support crew in place to handle everything but the medicine. Every family has access to a team that includes a social worker, a psychologist and a chaplain.

‘Cutting The Umbilical Cord The Second Time’

Dr. Savani says Children’s Health also has a team devoted to helping a family transition to home — learning the ins and outs of complicated equipment and medication, as well as making sure the house is set up for a preemie, without the constant surveillance of doctors and nurses.

“And I actually call it you’re cutting the umbilical cord the second time,” he said. “And it’s a very scary thing for parents to go through.”

Hollis and Courtney Wakefield have been there. And while some things about caring for a preemie are old hat by now, they say some of those visceral NICU memories will never fade. There’s a visual reminder in the house too — a strand of colorful beads, so long it could wrap around Kepley’s tiny waist a dozen times. Courtney says each bead stands for something different Kepley went through in the NICU, for example: blood draws, surgeries and overnight stays.

One day, Kepley might decide to hang these beads on the wall — a memento of her earliest triumph.

For now though, she’s happy to use them as a teething toy.

Source: https://www.keranews.org/post/why-trauma-parents-experience-nicu-follows-them-home


Cultura de surf hecho en Chocó – Surf culture made in Chocó

  Apr 10, 2017

Nestor Tello, Termales, Chocó, Colombia, 2015. Directed by Guillaume Parent y Sina Ribak Suport: masartemasaccion.org Fundación Buen Punto: clubdesurfdelchoco.com In this mini video series we meet with some persons from the Colombian Chocó region who live on the Pacific Coast, south of Nuquí. In Chocó exists a big contrast between the wealth of natural resources and the few opportunities of what we call development for its population. Same as in many rural areas in Colombia, corruption and violence are reality. Nevertheless, the visitor experiences an impression of freedom, tranquility and solidarity. Here, you (re-)connect with nature – you almost dissolve into it – and you feed on the philosophy and dreams of the Chocó people.



We need these articles to inspire, guide and support our precious community


Survival of the littlest: the long-term impacts of being born extremely early


Babies born before 28 weeks of gestation are surviving into adulthood at higher rates than ever, and scientists are checking in on their health.

Amber Dance- NEWS FEATURE  – 02 JUNE 2020


Scientists are watching out for the health of adults born extremely premature, such as these people who took part in a photography project. Credit: Red Méthot

They told Marcelle Girard her baby was dead.

Back in 1992, Girard, a dentist in Gatineau, Canada, was 26 weeks pregnant and on her honeymoon in the Dominican Republic.

When she started bleeding, physicians at the local clinic assumed the baby had died. But Girard and her husband felt a kick. Only then did the doctors check for a fetal heartbeat and realize the baby was alive.

The couple was medically evacuated by air to Montreal, Canada, then taken to the Sainte-Justine University Hospital Center. Five hours later, Camille Girard-Bock was born, weighing just 920 grams (2 pounds).

Babies born so early are fragile and underdeveloped. Their lungs are particularly delicate: the organs lack the slippery substance, called surfactant, that prevents the airways from collapsing upon exhalation. Fortunately for Girard and her family, Sainte-Justine had recently started giving surfactant, a new treatment at the time, to premature babies.

After three months of intensive care, Girard took her baby home.

Today, Camille Girard-Bock is 27 years old and studying for a PhD in biomedical sciences at the University of Montreal. Working with researchers at Sainte-Justine, she’s addressing the long-term consequences of being born extremely premature — defined, variously, as less than 25–28 weeks in gestational age.

Families often assume they will have grasped the major issues arising from a premature birth once the child reaches school age, by which time any neuro-developmental problems will have appeared, Girard-Bock says. But that’s not necessarily the case. Her PhD advisers have found that young adults of this population exhibit risk factors for cardiovascular disease — and it may be that more chronic health conditions will show up with time.

Girard-Bock doesn’t let these risks preoccupy her. “As a survivor of preterm birth, you beat so many odds,” she says. “I guess I have some kind of sense that I’m going to beat those odds also.”

She and other against-the-odds babies are part of a population which is larger now than at any time in history: young adults who are survivors of extreme prematurity. For the first time, researchers can start to understand the long-term consequences of being born so early. Results are pouring out of cohort studies that have been tracking kids since birth, providing data on possible long-term outcomes; other studies are trialing ways to minimize the consequences for health.


These data can help parents make difficult decisions about whether to keep fighting for a baby’s survival. Although many extremely premature infants grow up to lead healthy lives, disability is still a major concern, particularly cognitive deficits and cerebral palsy.

Researchers are working on novel interventions to boost survival and reduce disability in extremely premature newborns. Several compounds aimed at improving lung, brain and eye function are in clinical trials, and researchers are exploring parent-support programmes, too.

Researchers are also investigating ways to help adults who were born extremely prematurely to cope with some of the long-term health impacts they might face: trialing exercise regimes to minimize the newly identified risk of cardiovascular disease, for example.

“We are really at the stage of seeing this cohort becoming older,” says neonatologist Jeanie Cheong at the Royal Women’s Hospital in Melbourne, Australia. Cheong is the director of the Victorian Infant Collaborative Study (VICS), which has been following survivors for four decades. “This is an exciting time for us to really make a difference to their health.”

The late twentieth century brought huge changes to neonatal medicine. Lex Doyle, a paediatrician and previous director of VICS, recalls that when he started caring for preterm infants in 1975, very few survived if they were born at under 1,000 grams — a birthweight that corresponds to about 28 weeks’ gestation. The introduction of ventilators, in the 1970s in Australia, helped, but also caused lung injuries, says Doyle, now associate director of research at the Royal Women’s Hospital. In the following decades, doctors began to give corticosteroids to mothers due to deliver early, to help mature the baby’s lungs just before birth. But the biggest difference to survival came in the early 1990s, with surfactant treatment.

“I remember when it arrived,” says Anne Monique Nuyt, a neonatologist at Sainte-Justine and one of Girard-Bock’s advisers. “It was a miracle.” Risk of death for premature infants dropped to 60–73% of what it was before.

Today, many hospitals regularly treat, and often save, babies born as early as 22–24 weeks. Survival rates vary depending on location and the kinds of interventions a hospital is able to provide. In the United Kingdom, for example, among babies who are alive at birth and receiving care, 35% born at 22 weeks survive, 38% at 23 weeks, and 60% at 24 weeks.

For babies who survive, the earlier they are born, the higher the risk of complications or ongoing disability (see ‘The effects of being early’). There is a long list of potential problems — including asthma, anxiety, autism spectrum disorder, cerebral palsy, epilepsy and cognitive impairment — and about one-third of children born extremely prematurely have one condition on the list, says Mike O’Shea, a neonatologist at the University of North Carolina School of Medicine in Chapel Hill, who co-runs a study tracking children born between 2002 and 2004. In this cohort, another one-third have multiple disabilities, he says, and the rest have none.

“Preterm birth should be thought of as a chronic condition that requires long-term follow-up,” says Casey Crump, a family physician and epidemiologist at the Icahn School of Medicine at Mount Sinai in New York, who notes that when these babies become older children or adults, they don’t usually get special medical attention. “Doctors are not used to seeing them, but they increasingly will.”

Outlooks for earlies

What should doctors expect? For a report in the Journal of the American Medical Association last year, Crump and his colleagues scraped data from the Swedish birth registry. They looked at more than 2.5 million people born from 1973 to 1997, and checked their records for health issues up until the end of 2015.

Of the 5,391 people born extremely preterm, 78% had at least one condition that manifested in adolescence or early adulthood, such as a psychiatric disorder, compared with 37% of those born full-term. When the researchers looked at predictors of early mortality, such as heart disease, 68% of people born extremely prematurely had at least one such predictor, compared with 18% for full-term births — although these data include people born before surfactant and corticosteroid use were widespread, so it’s unclear if these data reflect outcomes for babies born today. Researchers have found similar trends in a UK cohort study of extremely premature births. In results published earlier this year, the EPICure study team, led by neonatologist Neil Marlow at University College London, found that 60% of 19-year-olds who were extremely premature were impaired in at least one neuropsychological area, often cognition.

Such disabilities can impact education as well as quality of life. Craig Garfield, a paediatrician at the Northwestern University Feinberg School of Medicine and the Lurie Children’s Hospital of Chicago, Illinois, addressed a basic question about the first formal year of schooling in the United States: “Is your kid ready for kindergarten, or not?”

To answer it, Garfield and his colleagues analysed standardized test scores and teacher assessments on children born in Florida between 1992 and 2002. Of those born at 23 or 24 weeks, 65% were considered ready to start kindergarten at the standard age, 5–6 years old, with the age adjusted to take into account their earlier birth. In comparison, 85.3% of children born full term were kindergarten-ready.

Despite their tricky start, by the time they reach adolescence, many people born prematurely have a positive outlook. In a 2006 paper, researchers studying individuals born weighing 1,000 grams or less compared these young adults’ perceptions of their own quality of life with those of peers of normal birth-weight — and, to their surprise, found that the scores were comparable. Conversely, a 2018 study8 found that children born at less than 28 weeks did report having a significantly lower quality of life. The children, who did not have major disabilities, scored themselves 6 points lower, out of 100, than a reference population.

As Marlow spent time with his participants and their families, his worries about severe neurological issues diminished. Even when such issues are present, they don’t greatly limit most children and young adults. “They want to know that they are going to live a long life, a happy life,” he says. Most are on track to do so. “The truth is, if you survive at 22 weeks, the majority of survivors do not have a severe, life-limiting disability.”


But scientists have only just begun to follow people born extremely prematurely into adulthood and then middle age and beyond, where health issues may yet lurk. “I’d like scientists to focus on improving the long-term outcomes as much as the short-term outcomes,” says Tala Alsadik, a 16-year-old high-school student in Jeddah, Saudi Arabia.

When Alsadik’s mother was 25 weeks pregnant and her waters broke, doctors went so far as to hand funeral paperwork to the family before consenting to perform a caesarean section. As a newborn, Alsadik spent three months in the neonatal-intensive-care unit (NICU) with kidney failure, sepsis and respiratory distress.

The complications didn’t end when she went home. The consequences of her prematurity are on display every time she speaks, her voice high and breathy because the ventilator she was put on damaged her vocal cords. When she was 15, her navel unexpectedly began leaking yellow discharge, and she required surgery. It turned out to be caused by materials leftover from when she received nutrients through a navel tube.

That certainly wasn’t something her physicians knew to check for. In fact, doctors don’t often ask if an adolescent or adult patient was born prematurely — but doing so can be revealing.

Charlotte Bolton is a respiratory physician at the University of Nottingham, UK, where she specializes in patients with chronic obstructive pulmonary disease (COPD). People coming into her practice tend to be in their 40s or older, often current or former smokers. But in around 2008, she began to notice a new type of patient being referred to her owing to breathlessness and COPD-like symptoms: 20-something non-smokers.

Quizzing them, Bolton discovered that many had been born before 32 weeks. For more insight, she got in touch with Marlow, who had also become concerned about lung function as the EPICure participants aged. Alterations in lung function are a key predictor of cardiovascular disease, the leading cause of death around the world. Clinicians already knew that after extremely premature birth, the lungs often don’t grow to full size. Ventilators, high oxygen levels, inflammation and infection can further damage the immature lungs, leading to low lung function and long-term breathing problems, as Bolton, Marlow and their colleagues showed in a study of 11-year-olds.

VICS research backs up the cardiovascular concerns: researchers have observed diminished airflow in 8-year-olds, worsening as they aged, as well as high blood pressure in young adults. “We really haven’t found the reason yet,” says Cheong. “That opens up a whole new research area.”

At Sainte-Justine, researchers have also noticed that young adults who were born at 28 weeks or less are at nearly three times the usual risk of having high blood pressure. The researchers figured they would try medications to control it. But their patient advisory board members had other ideas — they wanted to try lifestyle interventions first.

The scientists were pessimistic as they began a pilot study of a 14-week exercise programme. They thought that the cardiovascular risk factors would be unchangeable. Preliminary results indicate that they were wrong; the young adults are improving with exercise.

Girard-Bock says the data motivate her to eat healthily and stay active. “I’ve been given the chance to stay alive,” she says. “I need to be careful.”

From the start

For babies born prematurely, the first weeks and months of life are still the most treacherous. Dozens of clinical trials are in progress for prematurity and associated complications, some testing different nutritional formulas or improving parental support, and others targeting specific issues that lead to disability later on: underdeveloped lungs, brain bleeds and altered eye development.

For instance, researchers hoping to protect babies’ lungs gave a growth factor called IGF-1 — which the fetus usually gets from its mother during the first two trimesters of pregnancy — to premature babies in a phase II clinical trial reported in 2016. Rates of a chronic lung condition that often affects premature babies halved, and babies were somewhat less likely to have a severe brain hemorrhage in their earliest months.

Another concern is visual impairment.

Retina development halts prematurely when babies born early begin breathing oxygen. Later it restarts, but preterm babies might then make too much of a growth factor called VEGF, causing over-proliferation of blood vessels in the eye, a disorder known as retinopathy. In a phase III trial announced in 2018, researchers successfully treated 80% of these retinopathy cases with a VEGF-blocking drug called ranibizumab, and in 2019 the drug was approved in the European Union for use in premature babies.

Some common drugs might also be of use: paracetamol (acetaminophen), for example, lowers levels of biomolecules called prostaglandins, and this seems to encourage a key fetal vein in the lungs to close, preventing fluid from entering the lungs.

But among the most promising treatment programmes, some neonatologists say, are social interventions to help families after they leave the hospital. For parents, it can be nerve-racking to go it alone after depending on a team of specialists for months, and lack of parental confidence has been linked to parental depression and difficulties with behaviour and social development in their growing children.

At Women & Infants Hospital of Rhode Island in Providence, Betty Vohr is director of the Neonatal Follow-Up Program. There, families are placed in private rooms, instead of sharing a large bay as happens in many NICUs. Once they are ready to leave, a programme called Transition Home Plus helps them to prepare and provides assistance such as regular check-ins by phone and in person in the first few days at home, and a 24/7 helpline. For mothers with postnatal depression, the hospital offers care from psychologists and specialist nurses.

The results have been significant, says Vohr. The single-family rooms resulted in higher milk production by mothers: 30% more at four weeks than for families in more open spaces. At 2 years old, children from the single-family rooms scored higher on cognitive and language tests. After Transition Home Plus began, babies discharged from the NICU had lower health-care costs and fewer hospital visits — issues that are of great concern for premature infants. Other NICUs are developing similar programmes, Vohr says.

With these types of novel intervention, and the long-term data that continue to pour out of studies, doctors can make better predictions than ever before about how extremely premature infants will fare. Although these individuals face complications, many will thrive.

Alsadik, for one, intends to be a success story. Despite her difficult start in life, she does well academically, and plans to become a neonatologist. “I, also, want to improve the long-term outcomes of premature birth for other people.”



Cloud Surfing Roldanillo, Colombia in a Paraglider

Jan 30, 2017 Jonathan Kelley

Cloud Surfing Roldanillo, Colombia in a paraglider in January 2017



Climate Migrants, Microfluidic Systems, GoMo



Rate: 14% Rank 24 Global Average 11.1%

Bangladesh  is the eighth-most populous country in the world, with a population exceeding 161 million people. In terms of land mass, Bangladesh ranks 92nd, spanning 147,570 square kilometres (56,980 sq mi), making it one of the most densely-populated countries in the world. Bangladesh shares land borders with India to the west, north, and east, Myanmar to the southeast, and the Bay of Bengal to the south. It is narrowly separated from Nepal and Bhutan by India’s Siliguri Corridor, and from China by the Indian state of Sikkim, in the north, respectively. Dhaka, the capital and largest city, is the nation’s economic, political and cultural hub. Chittagong, the largest sea port, is the second largest city. With numerous criss-crossing rivers and inland waterways, the dominant geographic feature of Bangladesh is the Ganges delta, which empties into the Bay of Bengal with the combined waters of several river systems, including the Brahmaputra river and the Ganges riverHighlands, with evergreen forests, cover the northeastern and southeastern regions, while the country’s biodiversity comprises a vast array of plants and wildlife, including the endangered Royal Bengal tiger, which is the national animal. The seacoast features the world’s longest natural sandy beach in Cox’s Bazar as well as the Sundarbans, which is the world’s largest mangrove forest.

Healthcare facilities in Bangladesh are considered less than adequate, although they have improved as poverty levels have decreased significantly. Findings from a recent study in Chakaria (a rural Upazila under Cox’s Bazar District) revealed that the “village doctors”, practicing allopathic medicine without formal training, were reported to have provided 65% of the healthcare sought for illness episodes occurring within 14 days prior to the survey. Formally-trained providers made up only four percent of the total health workforce. The Future Health Systems survey indicated significant deficiencies in the treatment practices of village doctors, with widespread harmful and inappropriate drug prescribing. Receiving health care from informal providers is encouraged.

Malnutrition has been a persistent problem in Bangladesh, with the World Bank ranking the country first in the number of malnourished children worldwide. More than 54% of preschool-age children are stunted, 56% are underweight and more than 17% are wasted. More than 45 percent of rural families and 76 percent of urban families were below the acceptable caloric-intake level.

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

Born on Time: Fathers Clubs in Bangladesh

planPlanCanadaVideos   Jun 4, 2019

The Born on Time project educates communities on the risk factors of preterm birth. The risk of preterm birth can be decreased by addressing unhealthy lifestyle factors and harmful gender discriminatory behaviors such as: heavy workloads for mothers, domestic violence, and child, early and forced marriage. Born on Time Fathers Clubs encourage male engagement in birth preparedness, safe pregnancy and delivery, and in preterm birth prevention. See how Born On Time supported Abdur take part in a Fathers Club in Bangladesh, transforming local gender roles and teaching dads to put family first.





One-fifth of babies born premature in Bangladesh

Published at 10:47 pm November 16th, 2019
Bangladesh has managed to curb the premature deaths in recent years, according to the United Nations (UN).

Although the deaths caused by communicable diseases have decreased over the past years, the death of premature babies is still a concern for the authorities.

Even a few years ago, Bangladesh was a country where communicable diseases were responsible for the death of many newborn babies. But with the recent awareness programs by different organizations, about how to take care of neonates, mortality rate of infants from communicable diseases have decreased noticeably.

When asked, DGHS officials said more than 3 million children are born every year in Bangladesh, and very few die of communicable diseases.

Though, death from premature birth now tops the list. Out of 3 million children born every year in Bangladesh some 0.6 million are born premature, and out of that 0.6 million premature births 20,000 infants die, said UN.

According to 2018 UN estimation, the newborn mortality rate in Bangladesh is 18 per 1000 infants.

Dr Shamim Jahan, director of Health, Nutrition & HIV/AIDS, Save the Children, said the number has decreased in comparison to 2016 as 23620 infants died due to premature birth that year.

Experts opinion

The UN estimation said that complications of premature birth is the cause for it to top the list of infant deaths.

Experts opined that this situation has not been addressed for a long time, resulting in such number of deaths in the country.

Though, experts themselves are still unaware of the real reason as to why premature birth tops the list for infant mortality.

Professor Dr Begum Sharifun Nahar, head of Neonatology department of Sir Salimullah Medical College and Mitford Hospital, said “A premature child do not live for long, as most of the time the infant’s vital organs are not completely developed, and they suffer from lung problems, which leads to breathing issues. In conjunction with low birth weight, feeding disorders and hypothermia causes the death of premature infants. But she added that many of these issues can be avoided if people are more aware of the procedure, and the baby is taken care of by proper doctors, and nurses who have good knowledge about premature birth related issues, she added.


A miracle touch keeps child breathing without stress

When Popy (25) became pregnant for the second time, her family became very cautious, as she went through a miscarriage two years back.

She was married at the age of 20 and when she first conceived at 22. In her second pregnancy she was supposed to give birth to twins.

But her joy turned into tears, as the low birth weight caused death to one of her children ten days after their birth on October 29, following their premature birth weight of only 1500 grams. The babies had breathing difficulties along with other health hazards.

Her child was given treatment at NICU of Mitford Hospital, and later given to her as part of KMC.

“You can’t explain the feelings of its breath, when it takes its food from you. It seems like the world started living on my chest,” Popy told the reporter.

Professor Dr Begum Sharifun Nahar said KMC, a method of contacting a skin–to–skin contact between a mother and her newborn facilitating frequent or exclusive breastfeeding, and early discharge from the hospital has been effective in reducing the risk of mortality among preterm, and low birth weight infants.

“KMC helps the children to be stress free, and easiest breast feeding process. We have witnessed that the child going through KMC treatment have good growth, more sleep, less infections, and control temperature lessening chances of hypothermia,” she said.

Dr Shamim Jahan director – Health, Nutrition & HIV/AIDS, Save the Children said:  “As part of their objectives to make Bangladesh controlling deaths from premature birth, Save the Children is providing assistance in capacity building, establishing a monitoring system, and by providing technical assistance to the government for effective implement of KMC.”

Government initiatives to end premature birth

Dr Shamim Jahan said Bangladesh is at the seventh position among the top 10 countries with the largest numbers of preterm births, and deaths.

In the course of changing paradigm of diseases that are causing neonatal deaths, without controlling premature deaths, achieving SDGs new global target to end preventable newborn, and child deaths by 2030 (SDG 3.2) would never be possible, he said, adding that the theme for World Prematurity Day 2019 has put forth our course of action rightly — ‘’Born Too Soon: Providing the right care, at the right time, in the right place.”

Recognizing premature birth and death as a matter of concern, Dr Shamsul Haque, line director of Mother Neonatal Care and Adolescent Health (MNC&AH) under Directorate General of Health Services (DGHS) said, under the fourth sectoral program DGHS has established some 42 Special Care Newborn Units (SCANU) in tertiary, and district level hospitals.

Besides, as part of keeping the child alive, government has taken KMC as a trusted way, and have already established 132 centres in tertiary, district, and upazila level government hospitals. Besides, the private hospitals have also been asked to use the method.

The government started the programme (January 2017-June 2022) with an aim to reduce the newborn mortality rate to under 12 per 1,000 live births by 2030.

Directorate General of Family Planning (DGFP) and Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare are implementing the programme at a cost of around Tk 422 crore.

To meet the manpower problem, necessary training is being provided to pediatric specialists, and nurses in the hospitals, as many as they can. So that, wherever the doctors are transferred, they could continue the process.

“The government has planned to establish SCANU in every district, and all the upazila would have the facility of KMC treatment within 2022,” the line director stressing the need for creating awareness among rural people regarding premature births.

About KMC he said it is a very low cost treatment, and costs almost nothing. Besides, it takes only Tk 85,000 to set up a two bed unit.

The early result of KMC methods has made them hopeful of the fact that it would play a key role in preventing premature birth, and infant death in the country within the timeline they targeted, he added.

Source: https://www.dhakatribune.com/bangladesh/2019/11/16/one-fifth-of-babies-born-premature-in-bangladesh


Rohingya Refugee Children Are in Desperate Need of Help

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Perinatal health of refugee and asylum-seeking women in Sweden

2014–17: a register-based cohort study

Published:  04 July 2019   Can Liu, Mia Ahlberg, Anders Hjern, Olof Stephansson

European Journal of Public Health, Volume 29, Issue 6

Source: https://doi.org/10.1093/eurpub/ckz120



An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.


Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.


Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).


Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.

Source: https://academic.oup.com/eurpub/article/29/6/1048/5528507


Taking care of premature babies with Kangaroo Mother Care

UNICEF Bangladesh   Sep 1, 2019

Learn how to take care of premature babies with Kangaroo Mother Care




Successfully leveraging mobile technology to reduce preterm births

A maternal population risk study

Mary E. Cramer PhD, RN, FAAN – Elizabeth K. Mollard PhD, APRN‐NP – Amy L. Ford DNP, RN –  Kevin A. Kupzyk PhD, Fernando A. Wilson PhD

In Nebraska, nearly half of the counties on average – mostly rural – have a higher percentage of preterm births than the March of Dimes national average of 8.1%. Many of these rural counties are home to 30% or more soon-to-be mothers who receive inadequate prenatal care. Access to prevention and resources are rural barriers in Nebraska that contribute to preterm births.

Through a pilot study conducted under the direction of the University of Nebraska Medical Center (UNMC) and with funding from Blue Cross Blue Shield of Nebraska, we sought to positively impact these issues within Nebraska’s prenatal patient population. GoMo Health collaborated with Dr. Amy Ford and Dr. Mary Cramer from UNMC to develop a program with specialized content to help reduce preterm births.


Objectives: (1) Assess feasibility of a smartphone platform intervention combined with Community Health Worker (CHW) reinforcement in rural pregnant women; (2) Obtain data on the promise of the intervention on birth outcomes, patient activation, and medical care adherence; and (3) Explore financial implications of the intervention using return on investment (ROI).

Sample: A total of 98 rural pregnant women were enrolled and assigned to intervention or control groups in this two‐group experimental design.

Intervention: The intervention group received usual prenatal care plus a smartphone preloaded with a tailored prenatal platform with automated texting, chat function, and hyperlinks and weekly contact from the CHW. The control group received usual prenatal care and printed educational materials.

Measurements: Demographics, health risk data, interaction with platform, medical records, hospital billing charges, Client Satisfaction Questionnaire‐8, satisfaction comments, and the Patient Activation Measure.

Results: A total of 77 women completed the study. The intervention was well‐received, showed promise for improving birth outcomes, patient activation, and medical care adherence. Financial analysis showed a positive ROI under two scenarios.

Conclusions: Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at‐risk population to appreciate the impact of the intervention.

Source: https://gomohealth.com/resource/unmc/


New preclinical study shows promise for treating necrotizing enterocolitis

Reviewed by James Ives, M.Psych. (Editor)May 6 2020

Necrotizing enterocolitis (NEC), a rare inflammatory bowel disease, primarily affects premature infants and is a leading cause of death in the smallest and sickest of these patients. The exact cause remains unclear, and there is no effective treatment.

No test can definitively diagnose the devastating condition early, so infants with suspected NEC are carefully monitored and administered supportive care, such as IV fluids and nutrition, and antibiotics to fight infection caused by bacteria invading the gut wall. Surgery must be done to excise damaged intestinal tissue if the condition worsens.

A new preclinical study by researchers at the University of South Florida Health (USF Health) Morsani College of Medicine and Johns Hopkins University School of Medicine offers promise of a specific treatment for NEC, one of the most challenging diseases confronting neonatologists and pediatric surgeons.

The team found that inhibiting the inflammatory and blood-clotting molecule thrombin with targeted nanotherapy can protect against NEC-like injury in newborn mice.

Their findings were reported May 4 in the Proceedings of the National Academy of Sciences.

Our data identified the inflammatory molecule thrombin, which plays a critical role in platelet-activated blood clotting, as a potential new therapeutic target for NEC. We showed that anti-thrombin nanoparticles can find, capture and inactivate all the active thrombin in the gut, thereby preventing or reducing the small blood vessel damage and clotting that accelerates NEC.”

Samuel Wickline, MD, Study Co-Author and Professor of Cardiovascular Sciences, Morsani College of Medicine. Dr Wickline is also the director of the USF Health Heart Institute.

PNAS paper’s senior author is Akhil Maheshwari, MD, professor of pediatrics and director of neonatology at the Johns Hopkins University School of Medicine.

Before joining Johns Hopkins Medicine (Baltimore) in 2018, Dr. Maheshwari’s group at USF Health was the first to demonstrate that platelet activation is an early, critical event in causing NEC, and therapeutic measures to block these platelets might be a new way to prevent or reduce intestinal injury in NEC.

The nanotherapy platform created by Dr. Wickline and USF Health biomedical engineer Hua Pan, PhD, delivers high drug concentrations that specifically inhibit thrombin from forming blood clots on the intestinal blood vessel wall without suppressing the (clotting) activity needed to prevent bleeding elsewhere in the body.

This localized treatment is particularly important for premature infants, Dr. Wickline said, because the underdeveloped blood vessels in their brains and other vital organs are still fragile and susceptible to rupture and bleeding.

For this study the researchers used a model they created — infant mice, or pups, induced to develop digestive tract damage resembling human NEC, including the thrombocytopenia commonly experienced by premature infants with NEC.

Thrombocytopenia is characterized by low counts of blood cell fragments known as platelets, or thrombocytes, which normally stop bleeding from a cut or wound by clumping together to plug breaks injured blood vessels.

The molecule thrombin plays a key role in the bowel inflammation driven by overactive platelets. While investigating role of platelet depletion in NEC-related thrombocytopenia, the USF-Johns Hopkins researchers were surprised to find that thrombin mediates platelet-activated blood clotting early in the pathology of NEC-like injury – before bacteria leaks from inside the gut to circulating blood or other organs.

This clotting clogs small blood vessels and restricts blood flow to the inflamed bowel. Eventually, the lining of the damaged intestinal wall can begin to die off.

The investigative therapy essentially works “like a thrombin sponge” that is exponentially more potent than current agents used to inhibit clotting, Dr. Wickline explained. “It literally puts trillions of nanoparticles at that damaged (intestinal wall) site to sponge up all the overactive thrombin, which tones down the clotting and inflammation processes promoted by thrombin.”

“We are so excited about finding this new way to attenuate intestinal injury in NEC,” Dr. Maheshwari said.

The same approach has also been shown in preclinical studies to inhibit the growth of atherosclerotic plaques and certain kidney injuries without causing systemic bleeding problems. Dr. Wickline added. “The nanoparticles can be tailored to other inflammatory diseases highly dependent on thrombin for their progression.”

The study authors conclude that their experimental targeted treatment for NEC merits further evaluation in clinical trials.

Source: University of South Florida (USF Health)

Journal reference: Namachivayam, K., et al. (2020) Targeted inhibition of thrombin attenuates murine neonatal necrotizing enterocolitis. Proceedings of National Academy of Sciences.

Source: doi.org/10.1073/pnas.1912357117.


Climate change is causing an increase in preterm births: Study


Myupchar Dec 12, 2019

With the change in climate, the emergence of vector-borne diseases (insects-bearing diseases) like dengue and chikungunya, has spiked. This is subsequently leading to more than 7 lakh deaths annually.

That’s just the beginning though. The increase in temperature directly affects health by compromising the body’s ability to regulate its internal temperature. With the inability to control the internal temperature of the body, we become more prone to a cascade of illnesses like heat cramps, heat exhaustion, heatstroke, and hyperthermia during extreme heat and hypothermia and frostbite in extremely cold temperatures.

And now we find that climate change is having an insidious effect on pregnant women.

Studies have claimed that, with the rise in temperature, the cases of preterm delivery have increased. Any birth that occurs at least three weeks before the due date is considered by doctors to be a premature delivery. Some of the complications that this could lead to are slow weight gain, immature lungs, poor feeding, etc.

Heat and preterm labour

Long span research was conducted by Alan Barreca, an associate professor at UCLA’s Institute of Environmental Sustainability, and economist Jessamyn Schaller of Claremont McKenna College in a two-decade window, i.e., from 1969 to 1988, to find out the link between the change in temperature and preterm deliveries.

The researchers found that when the temperature exceeded or reached 32.2ºC (90ºF), the premature birth rate per 100,000 women increased by 0.97. It was also noted that on days when the temperature was hot but not extreme, the premature births increased by 0.57.

They further concluded that with an increase in temperature, the gestation period was decreased by two weeks. The gestation period is the time period of 40 weeks that it takes for fetal development, starting right from the conception till the day before the delivery.

Across the entire 20-year period of the study, around 25,000 infants were born prematurely every year, leading to the loss of more than 150,000 gestational days, all because of exposure to an exceptionally hot environment.

Another long span study was conducted by scientists led by Dr Lyndsay A. Avalos in Northern California for a time window of 14 years, i.e., between January 1, 1995, to December 31, 2009, to investigate the impact of apparent temperature on spontaneous preterm delivery.

Dr Lyndsay concluded the research by stating that with the increase in temperature by 10 °F (5.6 °C) during warm seasons, the cases of spontaneous preterm delivery increased by 11.6%.

All the preterm deliveries in this study took place between 28 and 37 weeks of gestational period, instead of 40.

The uncertain reason

Scientists have not been able to find the exact cause, but have laid down some possible reasons that could lead to premature labour:

  • Scientists believe that due to the increased heat, the mother could have cardiovascular stress that in turn could trigger the body to go into labour early.
  • The second theory proposed by the scientists is that the high temperatures could trigger an increase in the levels of the hormone oxytocin, which plays a role in inducing labour.
  • The third theory stated that because of the hot temperature the mother might unable to sleep properly. This could increase the chances of preterm labour and preeclampsia (complication in pregnancy marked with high BP) in the mother.

The alarming situation

It’s time to realize that climate change is real. And not only is it adversely affecting the environment but it has serious health implications as well, especially for the coming generation.

For more information, please read our article on Preterm Labour.

Source: https://www.firstpost.com/health/climate-change-is-causing-an-increase-in-preterm-births-study-7773851.html


Microfluidic Systems for Sweat Analysis and Neonatal Care

newsApr 24, 2020: In this interview, Professor John Rogers talks to News-Medical Life Sciences about his research and work in developing biocompatible electronics and microfluidic systems with skin-like properties.

Biological systems are traditionally mechanically soft however modern electronic and microfluidic technologies are rigid, meaning the layouts are completely different. Eliminating this mismatch will create huge opportunities in man-made systems that can be used for diagnostics, therapeutics and in clinical and healthcare. Can you tell us about the new opportunities these man-made systems will create?

There are all kinds of interesting and compelling opportunities that could come from thinking about how to reformulate the kinds of systems that form the core foundations of devices that you see in consumer gadgetry, so computer chips, integrated circuit chips that are flat and rigid and planar, into forms that are more naturally biocompatible – compatible with the soft surfaces of the human body.  And integrated circuits are not the only kind of man-made technology that has those kinds of physical characteristics and geometrical shapes.

You see the same type of thing in optoelectronic devices, lab-on-a-chip type technologies and microelectromechanical systems. The goal behind our research, and that of a growing community of researchers, is to create new ideas in material science and manufacturing, mechanical engineering and electrical engineering that will allow us to reformulate those sorts of technologies, without sacrificing the performance or capabilities, into platforms with geometries and mechanical properties that are inherently biocompatible and can be interfaced with soft tissue systems — the skin, the brain, the heart, the peripheral nervous system, the bladder, and the kidneys. And the idea is to develop those technologies into system that can ultimately enhance human health and extend life.

Can you tell us more about these ‘biocompatible’ electronic and microfluidic systems with skin-like physical properties?

The skin-like devices that we have developed are specifically designed to interface with the skin and to use the skin as a window for measuring clinical-grade physiological status parameters associated natural processes of the human body. For example, looking at cardiac activity, respiratory activity, flow properties associated with blood through near-surface arteries and veins; to reproduce what’s done in the hospital, but in platforms that can be worn continuously for wireless streaming of data outside of the hospital in the home setting, to develop a deep foundational basis of information on health status. This information can be used with artificial intelligence algorithms to assess a person’s well-being at any given moment and to make predictive assessments of health trajectories over time. This kind of personalized, digitally oriented model for healthcare enabled by these kinds of skin-like platforms will be a very powerful way that healthcare will evolve into the future for reduced costs and improved outcomes.

You presented the Wallace. H. Coulter Lecture this year at Pittcon 2020 in Chicago. What did you discuss in your talk?

In this talk, I will focus on skin-interfaced systems, devices that provide not only this electronic monitoring functionality but those that also embed tiny networks of microchannels. The microchannels along with very small reservoirs and valves that are designed to capture sweat that is pumped to the surface of the skin through the Eccrine glands and the connective ducts for capture and analysis of biomarkers in sweat.

Sweat is a relatively under-explored but very potentially important class of bio-fluid that could provide information content to substitute for blood draws. The idea is to use sweat and the noninvasive ability to collect sweat to do biochemical based assessments of health status to complement the sort of physics-based measurements that we can achieve with our electronic devices.

What sparked your interest in ‘soft’ materials?

My core expertise is in electronic materials, and I like to think about novel electronic materials in the context of technologies with capabilities that go beyond what is currently supported with conventional sorts of electronic materials. We got our start in this area thinking about flexible displays, so paper-like displays that could replace the kind of liquid crystal and organic light-emitting diode displays that you see in consumer devices today. So, thinking about thin paper-like systems, lightweight, mechanically rugged, capable of rolling up in storage when they’re not being used. And so that was interesting for us for a while, and it remains a major focus at most large display companies.

I happened to be giving a talk at the University of Pennsylvania on that kind of technology. It turned out that a couple of curious neuroscientists were in the audience and they came up to me after the talk and asked whether we could take those kinds of flexible electronic devices and put them on the brain to study the electrical activity of the brain. That was the first suggestion that these kinds of devices could be brought to bear to important problems in human health and in research around the fundamental mechanisms that govern the behavior of living systems. That interaction catalyzed a whole new set of research opportunities for us and it has been a sustained area of activity now in the group for the last 10 years.

What extra levels of functionality do soft electronics provide? How were they discovered?

Soft electronics allow you to intimately and persistently integrate advanced biosensors, radios, stimulators, microprocessors and digital memory technologies with the human body, in ways that go far beyond what’s possible with conventional wearable technologies that you see on the market today. Commercial devices are dominated by bulky, clunky pieces of electronics, loosely strapped to the body, typically at the wrist. That kind of technology approach can allow you to measure certain parameters, qualitative assessments of health and wellbeing, you can count steps, you can get a rough estimate of heart rate, but those are parameters that physicians can’t readily interpret and act upon.

What we’re thinking about is the next generation of wearable technology that integrates more intimately with the body, almost serving as a second skin that laminates in a physically imperceptible way on the surface of your actual skin. Almost like a temporary tattoo or a bandaid to provide ICU grade measurements of health status to allow physicians to, at a very detailed level, track health progression over time, not in an episodic way, which is currently the way that measurements are made when a patient comes to a hospital or a clinic. But now thinking about those same types of measurements performed continuously and I feel that it’s going to open up new frontiers to think about how to manage health conditions and to promote healthy living as well.

What ‘skin-like’ physical properties do biocompatible electronic and microfluidic systems have?

We target a set of physical properties that are precisely matched to the skin itself. The skin stretches somewhat, it can flex and bend and wrinkle, it has certain thermal characteristics, it has a whole set of properties, water permeability characteristics as well, thermal. And we try to embody those exact skin-like properties into electronic devices. And that’s the trick and the centroid of the research that we’ve been doing over the last decade or so. You think about a silicon-based integrated circuit, the mechanical properties are a million times different than those of the skin. So, there’s a huge chasm and a gap there. It’s perfectly flat, it really can’t conform to a natural curvature and the sort of sub-millimeter scale texture associated with the skin. So we try, to the best of our ability, to take a collection of materials and build them into an electronic system that has the same type of functionality you achieve with a silicon-based electronic platform today, but with mechanical properties, geometrical features that precisely match those of the skin.

The goal is to develop almost like a second skin that interfaces directly and naturally with your natural skin so you can wear these devices for long periods of time without even realizing they’re there because they’re matched to the skin. You don’t have a physical sensation that they’re there. And we think that that’s not just a convenience, that’s an essential characteristic of the devices because if they can’t be worn in a comfortable way that doesn’t introduce irritation at the surface of the skin, then nobody will wear the devices. The patient compliance will be unacceptably low.

That’s the goal around engineering and it turns out that with a few relatively simple ideas, we can get very close. The thickness of these devices is thinner than the epidermis, the mechanical properties almost precisely matched, the overall thermal mass is almost the same, there’s no thermal load as a result.

Could you name some of the main advantages of using soft, skin-like electronics over using conventional hospital apparatus?

What’s used in hospitals today, are primarily biosensors that are attached to the surface of the skin just with adhesive tapes. They connect via hard wires to external boxes of electronics that do all the data acquisition and storage and processing. And that works fairly well for an adult patient who’s in a hospital bed and not moving around a lot.

The wires, however, even in that kind of scenario, create a pretty serious inconvenience and in many cases, they frustrate basic operations in clinical care, surgical operations are confounded by the presence of the wires.

The idea is to go to a platform that gets rid of the wires, so it’s wireless. And the forces that are inevitably imparted through the wires to the interface between the biosensors and the skin also go away, we can get away with an adhesive that has an adhesive strength to the skin that’s a factor of 10 or a hundred times lower than that which is required for the wired based devices. And the consequence of that is that you end up with a much more comfortable interface to the skin and one that is much less prone to create skin irritation.

In the context of almost all sorts of hospital practice in terms of monitoring, these kinds of skin-like or band-aid-like devices represent an important advantage, but if you take a look at probably the most extreme scenario where those wires are problematic, it’s what you encounter in the neonatal intensive care unit.

If you consider what’s done with premature babies, they have to be monitored for all vital signs, at clinical grade quality 24/7, because they’re in a very fragile health status, but their skin is also very fragile. They don’t accommodate these strong adhesive tapes very effectively. The wires are not just a nuisance, now they frustrate the natural motions of the baby. They frustrate the ability of the parents to interact with the baby as well because you have to manage the wires.

A lot of the work that we’ve done so far is focused on that use case as the most compelling opportunity for these kinds of technologies. We’ve done a lot of work in the NICU facility at Lurie Children’s Hospital in Chicago. We tested out the devices on about a hundred neonates who’ve come through the hospital and we’ve shown equivalency in the measurements made with our wireless skin-like devices to those determined with the conventional wired based devices and external boxes of electronics.

In fact, those platforms are now deployed at scale in Africa through funding from the Gates Foundation and the Save The Children Foundation, because in the developing world there are no monitoring capabilities at all. The idea is to kind of leapfrog the old-style wired based devices, go straight to wireless and provide improved capabilities in healthcare in that context of neonatal, pediatric, maternal and fetal health.

Another application of biocompatible electronic systems is in sport and fitness research. Why is sweat an important bodily fluid to be looked at?

Sweat, in the context of athletics, athletic performance, fitness, and general well-being is sort of low hanging fruit in terms of how to think about sweat as a biofluid, that can characterize health because it’s very clear that sweat loss can lead to dehydration.

In fact, maintaining optimal sports performance requires optimal hydration management. If you go into a training scenario or you enter an athletic competition, you want to keep your body at an optimally hydrated state. So, the ability of these skin interfaced microfluidic devices to continuously monitor sweat loss locally — and that local measurement correlates to full body sweat loss — can inform an athlete precisely how much water they need to drink in order to replenish the lost water through the sweating process.

But not only that, we can also measure the electrolyte concentration in sweat – a quantity that varies depending on the individual, their genetic background, their racial background, their dietary habits, all sorts of things. So the devices measure not only sweat loss but electrolyte loss as well. In this way, they allow you to replenish not only the lost water but also the lost electrolytes so you can maintain not only perfect hydration, but you can also maintain perfect electrolyte balance as well.

For competition at the highest levels, a few percentage improvements that can result from that data-driven hydration management can be very important. We have a partnership with Gatorade, and as you might imagine that kind of capability is touching on their core product, to distribute these devices to athletes, both pro athletes and youth athletes as well, to maintain better performance and also to avoid things like cramping and injuries that can also result from poor hydration management.

Nanotechnology has become an increasingly investigated area within the science industry, also having many applications within medicine. How does nanotechnology take part in your research?

Nanotechnology is important for us, but it’s not necessarily the end goal. We’ll use nanotechnology where it makes sense. We’re focused at the system level and how you can achieve novelty in devices and construction can yield data streams that are a direct benefit for health or fitness or sports.

But nanotechnology specifically does come into play, in a pretty simple way if you think about it. A silicon wafer has a certain set of mechanical properties that are defined by the silicon itself, but also by the geometry of the wafer. It’s fairly thick, it’s about a millimeter in thickness, half a millimeter in thickness or so and it’s partly because of that thickness that the silicon wafer cannot be bent without fracturing the material. Nanotechnology comes into play then because reducing the thickness of the silicon imparts a flexibility to the silicon just due to elementary bending mechanics. So a 2 x 4 you can’t bend that. You can bend a sheet of paper. It’s the same materials just by virtue of the fact that the paper’s really thin compared to the 2 x 4 that you can bend it.

The same principles apply to silicon. We deploy silicon in nano-scale forms rather than in wafer-based forms. If you take the thickness of a wafer, half a millimeter, and you shrink that down to a hundred nanometers, the flexibility improves by a factor of 1012 or something like that. It’s absolutely transformative in terms of the way you think about the material. That’s how nanotechnology enters the systems that we’re interested in, it allows us a straightforward route to make a material like silicon flexible and skin-compatible ultimately.

If this continued research is carried out into the field of biocompatible electronic and microfluidic systems, where could this take us?

The skin interfaced devices represent the most immediate opportunity because they’re minimally invasive. It’s very easy to get approvals for using these devices on human patients. They can easily be removed if any kind of adverse effect develops, although we haven’t seen that. It’s a straightforward and natural starting point for bio-integrated electronics, as the skin as an interface, at least for use in humans. We do a lot, however, with implantable systems, primarily in animal model studies as a predicate to eventually moving into use in humans.

The frontier for us is in taking the design principles that we’ve proven out for skin interface devices and deploying the same technology on the brain or the heart to allow similar types of functionality but in the context of internal organs. Electronically enhanced organ health is the way you can think about it. So devices that wrap the outside surface of the heart have the ability to monitor basic cardiac function, but also with the capability to deliver stimulus, therapeutic stimulus, as an advanced type of pacemaker, but one that’s distributed around the outside surface of the heart. The same types of possibilities are present in the context of brain disorders as well. So I think moving these devices from the skin to internal organs in the body is a huge area of opportunity.

What is next in your research into soft, skin-like electronics?

Exploring more deeply the value and information content embedded in sweat. Sweat has not been nearly as thoroughly explored as blood or interstitial fluid as a biofluid that contains biomarkers of relevance to health status.

There’s some work to be done there, but the area is opening up because now we have microfluidic devices that allow us to capture very small, but pristine quantities of sweat that can be used for very precise chemical analysis and correlation ultimately to blood.

It’s a technology-enabled opportunity in studies of human physiology and basic biological questions around how sweat relates to blood. And if you can establish those correlations, then I think sweat becomes a compelling way to make a biochemical assessment of health that avoids the need to do a blood draw.

Can you tell us why you come to Pittcon?

There is an amazing collection of people who are interested in topics very similar to those that represent core activities in my own research group. There is a huge synergy and resonance between my interests and the topics that are covered at Pittcon. It’s also comprehensive. It’s a very large meeting with all the key experts and so it’s kind of a one-stop shop for work in this area. I think it’s a fantastic event and I’ve been to this meeting many times in the past.

What do you expect to achieve this year at Pittcon?

I’ll be delivering this special lecture at Pittcon and I expect, as occurs many times, that I’ll be able to strike up some conversations and seed some areas for collaboration. Conferences for me are successful if I make new connections and meet new people and maybe open up new opportunities for research.

Why are events like Pittcon important for your research but also important for the analytical chemistry industry?

The exchange of ideas is incredibly important as a catalyzing aspect of how science works. It’s very important to share insights and ideas. A conference of this type provides an excellent platform for doing that, and so I think it helps everyone. It helps the whole community and helps society in a sense because it just accelerates progress in research.

Source: https://www.news-medical.net/news/20200424/Microfluidic-Systems-for-Sweat-Analysis-and-Neonatal-Care.aspx




Cuddler to the Rescue! Meet NYP’s “Grandma Cuddler”

nypNew York-Presbyterian Hospital Published on Apr 20, 2018                                      Visit https://healthmatters.nyp.org for more about ‘Grandma Cuddler’ and other inspiring stories.


Preterm Birth a Key Risk Factor for Development of Childhood Depression

psyc.Publish Date October 4, 2018 The study investigators observed that low level of urbanization was associated with a lower risk for depression.

Children born preterm may have an increased risk for depression compared with children born full-term, according to study results published in the Journal of Affective Disorders.

Researchers analyzed data from 21,478 preterm children and 85,903 full-term children born between 2000 and 2010 who were included in the Taiwan National Health Insurance Research Database. The mean ages of the preterm children and full-term children were 9.72 and 9.88 years, respectively.

Evaluation of the study population found that preterm birth was the key risk factor for depression.

The risk of depression among preterm children was 2.75 times higher than that seen in full-term children (95% CI, 1.58–4.79; P <.001). Depression rates in full-term children were 0.37, compared with 1.01 in preterm children, per 10,000 person-years. In female preterm children, incidence of depression was 3 times higher compared with full-term children. Preterm children whose parents had blue-collar occupations had a risk for depression 3.4 times higher than full-term children in the same demographic. Preterm children whose parents had occupations other than blue-collar positions had a 6.06-fold higher risk for depression compared with full-term children in the same demographic (blue-collar occupations: 95% CI, 1.04–11.15; P <.05; other occupations: 95% CI, 1.71–

Researchers conclude that “findings of the present study suggest that preterm infants have a significantly higher risk of depression in adolescence compared with full-term infants.” They note that limitations of the study include lack of maternal demographic data and emphasize the need for healthcare providers to recognize the potential for depression in children born prematurely.


Chiu TF, Yu TM, Chuang YW. Sequential risk of depression in children born prematurely: A nationwide population-based analysis J Affect Disord. 2018; 243:42-47. doi: 10.1016/j.jad.2018.09.019

Source: https://www.psychiatryadvisor.com/home/depression-advisor/preterm-birth-a-key-risk-factor-for-development-of-childhood-depression/


Mayo Clinic Minute: 5 signs your teenager is battling depression

mayo.clinicMay 8, 2018: It’s no secret that teenagers can be moody, but research shows that ongoing moodiness often is far more serious. Dr. Janna Gewirtz O’Brien, a Mayo Clinic pediatrician, says teen depression is much more common than most people realize.


GAPPS seeks to improve birth outcomes worldwide by reducing the burden of premature birth and stillbirths. We are working to close the knowledge gap in understanding the causes of preterm birth and stillbirth and collaborating to implement evidence based interventions to improve birth outcomes.

Parent Support

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.

Source: https://firstcandle.org/

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.

Source: https://www.stillbirthalliance.org/

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.

Source: https://www.sands.org.uk/

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.

Source: https://thetearsfoundation.org/

March of Dimes

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

Source: https://www.marchofdimes.org/

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.

*** With our record-breaking success from very generous donors, we will continue to accept applications for financial assistance to ALL states within the United States.

Source: https://www.haydenshelpinghands.com/



*** We heartthis infographic!

kid Illustrative Neonatology 

Praveen Chandrasekharan : An infographic application, this provides easy to understand illustrations on some of the common and rare pathophysiology in neonatal perinatal medicine. It is designed and made available for download at no cost in handheld devices to be used as a ready reckoner for all.

Download APP Here: https://apps.apple.com/us/app/illustrative-neonatology/id1220324936


Attenuated brain responses to speech sounds in moderate preterm infants at term age.

Dev Sci. 2020 May 16     François C1, Rodriguez-Fornells A2,3,4, Teixidó M3, Agut T5,6, Bosch L3,6,7.

Abstract: Recent findings have revealed that very preterm neonates already show the typical brain responses to place of articulation changes in stop consonants, but data on their sensitivity to other types of phonetic changes remains scarce. Here, we examined the impact of 7-8 weeks of extra-uterine life on the automatic processing of syllables in 20 healthy moderate preterm infants (mean gestational age at birth 33 weeks) matched in maturational age with 20 full-term neonates, thus differing in their previous auditory experience. This design allows elucidating the contribution of extra-uterine auditory experience in the immature brain on the encoding of linguistically relevant speech features. Specifically, we collected brain responses to natural CV syllables differing in three dimensions using a multi-feature mismatch paradigm, with the syllable /ba/ as the standard and three deviants: a pitch change, a vowel change to /bo/, and a consonant Voice Onset Time (VOT) change to /pa/. No significant between-group differences were found for pitch and consonant VOT deviants. However, moderate preterm infants showed attenuated responses to vowel deviants compared to full-terms. These results suggest that moderate preterm infants’ limited experience with low-pass filtered speech prenatally can hinder vowel change detection and that exposure to natural speech after birth does not seem to contribute to improve this capacity. These data are in line with recent evidence suggesting a sequential development of a hierarchical functional architecture of speech processing that is highly sensitive to early auditory experience.

Source: https://pubmed.ncbi.nlm.nih.gov/32416634/


Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults

Kara N. Goss, MD1,2Kristin Haraldsdottir, PhD1,3Arij G. Beshish, PhD1; et alGregory P. Barton, PhD1,4Andrew M. Watson, MD5Mari Palta, PhD6,7Naomi C. Chesler, PhD1,6,7,8Chris J. Francois, MD8,9Oliver Wieben, PhD4,8,9Marlowe W. Eldridge, MD1,3,8

JAMA Cardiol. Published online May 20, 2020. doi:10.1001/jamacardio.2020.1511

Key Points

Question  What are the consequences of premature birth for later cardiac structure and function?

Findings  In this cardiac magnetic resonance imaging–based cross-sectional cohort study, adolescents (n = 20) and young adults (n = 38) born moderately to extremely preterm (≤32 weeks) demonstrated statistically significantly smaller biventricular cardiac chamber size and lower biventricular mass compared with 52 age-matched participants who were born at term. Cardiac function was preserved, with a hypercontractile strain pattern in adults.

Meaning  Adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size with preserved function, notably without a hypertrophic response, which may contribute to their increased lifetime cardiovascular risk.


Importance  Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood.

Objective  To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI).

Design, Setting, and Participants  This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019.

Exposures  Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g.

Main Outcomes and Measures  Main study outcomes included MRI measures of biventricular volume, mass, and strain.

Results  Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely.

Conclusions and Relevance  In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.

Source: https://jamanetwork.com/journals/jamacardiology/article-abstract/2766286


Our Feelings are Valid, Too: How Emotional Labor Affects the NICU Nurse

By Victoria Lemme, BSN RN

NANN Footprints: Stories from the NICU April 2020

To many, I have the best job in the world. I see babies take their first breaths, first baths, first bottles; but I also see the lasts for some. I am a Neonatal Intensive Care Unit nurse and yes, I have the best and worst job all wrapped up into one. I may appear put together on the outside, but on the inside, there are emotions begging to be recognized because my feelings are valid, too.

When I chose to become a nurse, I knew that I would have to contend with extenuating circumstances that often led to death. What I did not know but have come to realize is that behind the calm and collected persona of a nurse is someone who has feelings, too. Although the physical labor of working with infants is significantly less than that of working with adults, the emotional labor of building unforgettable relationships with families and babies, regardless of whether I’ve met them for a moment or had the opportunity to spend months with them, is everlasting.

Emotional labor has been defined as “the labor that requires one to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others- in this case the sense of being cared for in a convivial and safe place” (Cricco-Lizza, 2014). For those unfamiliar with the NICU environment, I encourage you to look up what the typical bedside of a neonate looks like. From ventilators and IV poles to alarming monitors, the NICU is anything but calming to new parents. This is where we as nurses come into play. We are the calm in the storm, or so we think we must be.

I vividly remember the night I lost my first patient. I walked into the unit at the start of my shift expecting my usual assignment to see that I was assigned to one baby. I walked over to the bedside to see two parents staring in at their little girl while her day nurse stared at her monitor as the baby’s oxygen saturations were in the 60s. My immediate thought was, “Why is nobody doing anything?” As I received report, I came to realize that there was not much more humanly possible to do to help this tiny girl. I felt broken for this family knowing that they would not be able to take their baby girl home but despite my feelings, I had to be the calm in the storm for them.

Right before the shift was over, I handed the precious baby girl to her mother as support was withdrawn. I fought back my tears in front of the family because I felt selfish making this moment about my emotions. When the day nurse arrived, we walked the family to a private room to spend their lasts moments with their baby. As the door shut, I began to break down.

There are still days that I believe that I am not entitled to my feelings. I’ve been asked “Are you sure this is the right job for you?” and for a moment I actually question it. I stumbled upon the article, “The Need to Nurse the Nurse: Emotional Labor in the Neonatal Intensive Care” by Roberta Cricco- Lizza and for once I felt my emotions were validated. It’s okay to be sad and angry. It’s okay not to bottle those feelings up. The emotional burden of working in the NICU is one that can no longer be ignored.

Here are a handful of quotes from fellow nurses, from the article and in my workplace, that resonated with me:

“We are always on stage in the unit…the nurse had to expend considerable emotional labor to maintain a ‘happy face’ persona, but they believed that this helped the families feel safe and calm.” (Cricco-Lizza, 2014)

“There are days your heartstrings are pulled to the point of breaking. Tears flow for babies and moms and families who don’t get a chance to feel the love a child can help grow. Sometimes I feel angry, too, for an innocent baby who wasn’t given a fair chance at life.” (M. Ouellette, 2020)

“Sometimes leaving work at work can be difficult, but realizing you did everything you could during your shift for the baby and the family is all you can do.” (S. Kaminski, 2020)

If there’s any one thing a nurse can take away from this, I want it to be that you don’t always have to put on your brave face to mask your emotions. Speak out, tell your truth and you will find that you are not alone in how you feel. Before we are healthcare professionals, we are human, and our feelings are valid too.

References: Cricco-Lizza, R. (2014). The Need to Nurse the Nurse. Qualitative Health Research24(5), 615–628. doi: 10.1177/1049732314528810- Kaminski, S (2020). Personal Interview – Ouellette, M (2020). Personal Interview

Source: http://nann.org/publications/april-2020-footprints

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Helping a friend struggling with depression: Tips from

Dr. Randy Auerbach

Dr. Randy Auerbach, Associate Professor at Columbia Psychiatry, gives some tips on how to help a friend struggling with depression. Break the silence and be the one to prevent suicide. The National Suicide Prevention Lifeline (1-800-273-8355) provides 24/7, free and confidential support and prevention and crisis resources for people in distress.


kats.korner (2)


Blue economies or water-friendly urban planning in Bangladesh, perhaps soil improvement and water management in Ethiopia? So many possibilities… I wonder what kinds of innovations we Warriors may generate as we face the challenges calling us into action.

Climate change drastically effects our global preterm birth community. In the video below Dr. Oppenheimer shares interesting perspectives of the why and how we may choose to prepare locally and globally in order to proactively respond as climate change rearranges our world. While progressive communities committed to protecting our planet and humanity take scientifically supported measures to reduce the effects of climate change we question if anything can be done to create sustainable economies to support and harness the capacities migrant/refugee populations have to share.


Refugees Are Fleeing Climate Change

yearsJan 31, 2020   The YEARS Project

Tens of millions of people could be displaced by climate change by the end of this century. Climate scientist Michael Oppenheimer explains why that matters, why he supports the right to migrate, and what governments need to do to prepare.


Dennis Sundström   Aug 6, 2019 : A short movie from my trip to Cox’s Bazar, Bangladesh. Thanks to everyone that made the trip unforgettable!

Covid-19, a collective technological journey



Preterm Birth Rates – Iceland

Rank: 167–Rate: 6.5% Estimated # of preterm births per 100 live births (USA – 12 %)

Iceland is a Nordic island country in the North Atlantic, with a population of 364,134 and an area of 103,000 km (40,000 sq mi), making it the most sparsely populated country in Europe. The capital and largest city is Reykjavík. Reykjavik and the surrounding areas in the southwest of the country are home to over two-thirds of the population. Iceland is volcanically and geologically active. The interior consists of a plateau characterised by sand and lava fieldsmountains, and glaciers, and many glacial rivers flow to the sea through the lowlands. Iceland is warmed by the Gulf Stream and has a temperate climate, despite a high latitude just outside the Arctic Circle. Its high latitude and marine influence keep summers chilly, with most of the archipelago having a polar climate.

Health: Iceland has a universal health care system that is administered by its Ministry of Welfare paid for mostly by taxes (85%) and to a lesser extent by service fees (15%). Unlike most countries, there are no private hospitals, and private insurance is practically nonexistent. A considerable portion of the government budget is assigned to health care,  and Iceland ranks 11th in health care expenditures as a percentage of GDP and 14th in spending per capita. Overall, the country’s health care system is one of the best performing in the world, ranked 15th by the World Health Organization. According to an OECD report, Iceland devotes far more resources to healthcare than most industrialised nations. As of 2009, Iceland had 3.7 doctors per 1,000 people (compared with an average of 3.1 in OECD countries) and 15.3 nurses per 1,000 people (compared with an OECD average of 8.4). Icelanders are among the world’s healthiest people, with 81% reporting they are in good health, according to an OECD survey.



Our focus in this month’s blog will highlight some of the unique challenges our preterm birth community faces during the current Covid-19 pandemic.

Big  THANKS  to our essential workers and community members who are respecting and following local Covid-19 protocols/orders. Together we are saving lives.  Here in Seattle, WA. King 5 News staff working from their homes remind us that although times are tough, together we can get through this. Through their Neighbors Helping Neighbors virtual stories King 5 staff show us that it is heroic to not only care about others but to act accordingly. You are likely sharing similar do-good stories within your local communities.  People everywhere are connecting with respect and kindness while offering diverse and creative ways to pitch in for our mutual good. We see through responsible media-sharing that as a community we are resilient and adaptable as we quickly learn to educate ourselves and our children using  our in-home technology and resources. We have immersed ourselves in creating home offices, learning new software programs, and changing the ways we work in order provide meaningful services and goods.  We are learning to cook and bake at home, and we have had time to garden, read, make home improvements and opportunity to ponder things that have special personal meaning in our lives! We will look back at this time with sorrow, gratitude, joy and relief.  We may be thinking about how we can use this time to manifest our dreams moving forward. We will be stronger, more educated, with renewed clarity about the power of human kindness and our global and local reliance on each other.

i.5From our third floor window, while a very inspired woodpecker hammers our wood/concrete siding in order to mark his territory, we greet you with our love, gratitude, and very best wishes!

Mothers and Fathers kept from seeing their premature babies due to Covid-19 – ITV News

ITV News

The Covid-19 pandemic has led to time between babies and parents being rationed. In some cases, this means new mothers and fathers are having to wait days – and in some cases weeks – to see their newborns on the neonatal ward. Health officials say the strict measures are in place to protect babies born prematurely from the risk of infection. ITV News spoke to some of the parents who were forced to stay away from their ill newborns.

An Iceland Preemie Innovation

The company name Róró originates from the Icelandic word “ró” which means calmness and comfort. Róró is dedicated to helping babies and their caregivers feel better. It was founded in 2011 around a single idea: to make a product for babies that imitated closeness when their parents needed to be away. Indeed, the idea of the Lulla doll was born when our friend had her baby girl prematurely and had to leave her alone in the hospital every night for two weeks.


Lulla doll is a soother and sleep companion for preemies, babies, toddlers and beyond. It imitates closeness to a caregiver at rest with its soft feel and soothing sounds of real-life breathing and heartbeat. Lulla plays for 12 hours to provide comfort all night long. The doll is machine washable and comes with 2 AA batteries.

Watch How the Lulla Doll Works



COVID-19 and the NICU Balancing Safety and Care

I dedicate this column to the late Dr. Andrew (Andy) Shennan, the founder of the perinatal program at Women’s College Hospital (now at Sunnybrook Health Sciences Centre). To my teacher, my mentor and the man I owe my career as it is to, thank you. You have earned your place where there are no hospitals and no NICUs, where all the babies do is laugh and giggle and sleep.

“There is no evidence of vertical transmission of novel coronavirus between mother and baby at this time. Infants born to COVID-19 infected mothers have not tested positive for the disease, nor has novel coronavirus been found in amniotic fluid or breast milk.”  Rob Graham, R.R.T./N.R.C.P.

One cannot watch television or pick up a newspaper without being bombarded with COVID-19 stories and information. In our lifetimes, we haven’t seen anything like this; while the adult world is the focus of this pandemic, we in the NICU must contend with the risks associated with parental involvement in the care of their babies.

There is no evidence of vertical transmission of novel coronavirus between mother and baby at this time. Infants born to COVID-19 infected mothers have not tested positive for the disease, nor has novel coronavirus been found in amniotic fluid or breast milk. While this is ostensibly good news, it must be tempered with the fact that this is a hitherto unknown pathogen and that while our knowledge base is growing daily, there is still much we don’t know. It is my opinion that one cannot be too cautious dealing with COVID-19; better to modify the policy as evidence becomes available than to wait for evidence to form policy. Unfortunately, the latter approach has been most common and has likely led to the explosion in cases outside the Wuhan epicentre.

Many hospitals have prohibited visitors during this crisis. This approach is certainly prudent given the increasing evidence of asymptomatic transmission but may not be in the best interests of the neonatal population. Regardless, in Toronto, there are discrepancies between institutions. (A copy of Toronto’s guideline is attached. NOTE: this is an example and not intended as medical advice or protocol). A previous column (December 2019) discussed the relationship between respiratory care and neurodevelopmental outcome, including the benefits of direct parental involvement and kangaroo care. The clear benefits of parental contact must be weighed against the risks to the baby and those who care for it. The unit in which I am employed has limited visitation to one parent at a time. Overnight stays are permitted, parents are forbidden to leave the NICU area until leaving the hospital, and face masks must be worn at all times.

The major concern when breastfeeding an infant of a COVID-19 infected mother or symptomatic parent under investigation is twofold: prevention of transmission to the infant and protection of those charged with the infant’s care. It is not breastmilk that is of concern, rather the potential infection of others via droplet. The safest approach here is to have parents wear masks to reduce the chance of droplet exposure during breastfeeding; however, the utility of regular surgical masks in preventing transmission of COVID-19 is questionable. The same applies to kangaroo care since exposure is identical. During skin to skin contact, consideration may be given to having the involved parent thoroughly clean the area of contact in addition to routine hygiene. Ideally those entering the room of a COVID-19 infected patient should wear a properly fitted N-95 mask,  but the international breakdown of our supply chain has resulted in an acute shortage of PPE; thus surgical masks are being used as a substitute. There is much debate over the utility of these masks to protect caregivers but increasing evidence in their ability to reduce transmission.

The best way to contain an outbreak like this is to test and isolate. China and South Korea have amply demonstrated the efficacy of this approach. However, a combination of reagent supply shortage and a concurrent shortage of swabs (ironically mostly manufactured in Italy) have made this impossible as the pandemic spread to the rest of the world, and the fact that the number of infections outside the epicentre now greatly outnumber those within is a testament to the necessity of testing. Given the possibility of asymptomatic transmission, it would behoove us to assume infection in all until proven otherwise and act accordingly. This is a case of what we don’t know can indeed hurt us.

The risks associated with aerosol-generating medical procedures are well known, particularly in the adult population. It stands to reason that a premature infant generates less aerosol than an adult; however current guidelines call for the infant of a confirmed or suspected parent to be treated in the same manner as an adult patient. Compounding this is the unusually high viral titre with COVID-19 infection, potentially making droplets more likely to lead to infection.

In the adult population, when mechanical ventilation is required, lower tidal volumes (3-6mls/kg) and higher PEEP has been recommended, although recent anecdotal reports from the front lines are less clear. (These anecdotal reports are coming from Twitter® posts from ER physicians on the front line and as such do not constitute evidence). A letter to the editor of The American Journal of Respiratory and Critical Care Medicine, March 2020, suggests a different approach. One that is echoed by other anecdotal reports and describes an atypical ARDS picture associated with COVID-19. In this case, it is not a lack of recruitment that is the problem but rather uneven ventilation/perfusion matching. (10) HFO is potentially more prone to aerosol generation, and if used, airborne precautions are advised. (11) (This is an excellent reference for the management of all COVID-19 patients.) A filter on the expiratory limb of any ventilated patient may be considered provided it does not interfere with the normal operation of the machine and are changed in accordance with the manufacturer’s recommendations.

It is perhaps fortunate we have little data regarding neonatal infection with COVID-19. It seems that mechanical ventilation for symptomatic positive infants may only be required for other reasons (i.e., extreme prematurity as the limited number of cases seen thus far have not required intubation) and that neonates exhibit the same relatively mild symptoms of older children.(12) Recent reports of 2 infants succumbing to COVID-19 in the U.S. may be a harbinger of things to come.(13) It is my sincere hope this is not the case. Perhaps the most significant risk NICU staff face for infection are each other. Given the increasing rate of community-acquired infection and asymptomatic transmission, we are at the same or greater risk than the general population. Fomites are a known source of transmission (particularly plastic and stainless steel). (14) We are all potentially exposed this way, particularly when using public transit as grab bars, and handles are all made of plastic and stainless steel. The importance of meticulous, regular hand hygiene, and avoidance of touching the face cannot be emphasised enough.

The concept of social distancing is difficult to achieve in the NICU environment due to the necessity of close contact during procedures and the proximity of workstations. Staff are well-advised to wear face masks at all times as a matter of policy to mitigate the risk of infection. Patient assignments should be such that staff can be stationed as far away from each other as is practically possible. COVID-19 doesn’t discriminate based on credentials!

This pandemic will affect all of us one way or another. As NICU caregivers, we may be at reduced risk relative to our adult colleagues; however, as the crisis worsens, some of us may be seconded to adult areas. Now would be a good time for those assigned exclusively to the NICU to brush up on adult ventilation protocols. The Toronto Centre for Excellence in Mechanical Ventilation provides an excellent resource.

As evidence is gathered, the guidelines and recommendations we practice under are subject to change. Given limited numbers (although still increasing exponentially), the fact that there is presently no evidence to suggest vertical transmission or risks associated with breastmilk, for example, doesn’t necessarily mean risks do not exist. Healthy, younger patients are dying from COVID-19. While the mean age of infection is 45 years, the mortality rate for those <60 is approximately 0.32% compared to 6.4% in those >60 and 13.4% in those >80. (16) 0.32% seems pretty small, but this represents a 3-fold increase over that of seasonal flu in the general population.(17) We’re all playing Russian roulette; the only difference is the number of bullets in the gun. I, for one, prefer not to play.

Finally, while high-frequency jet ventilation (HFJV) is commonly used in the NICU setting, there is currently no commercially available adult jet ventilator in North America. There are a few machines available in Toronto cobbled together in labs at the University of Toronto years ago. These have been used as a last-ditch effort when other modes have failed. The Oscillate study of conventional (CV) vs. high-frequency oscillation (HFO) ventilation in adult respiratory distress syndrome (ARDS) found HFO detrimental, but similar research on HFJV has not been performed.(18) The benefits of HFJV in the neonatal population may well apply to the adult population; the high mortality rate from ARDS surely should provide an incentive to its study in this population. Now seems to be a good time.

I have been asked to explore the possibility of using the LifePulse HFJV machine in larger patients. I shall keep readers apprised of any progress in that regard. We are facing the challenge of our careers and, indeed, our lives. The world is counting on us. Please, everyone, take care of yourselves and each other. While always important, it is now more so than ever. References: 1. https://www.frontiersin.org/articles/10.3389/ fped.2020.00104/full 2

Source: https://www.cdc.gov/coronavirus/2019-ncov/



A digital response to help ensure safer childbirths during COVID-19

A new initiative launched today by Maternity Foundation, University of Copenhagen and Laerdal Global Health in collaboration with International Confederation of Midwives (ICM) and UNFPA, the UN sexual and reproductive health agency, uses a digital tool to equip midwives in low-resource settings to protect themselves, mothers and newborns from the Coronavirus and to ensure that women continue to receive respectful quality of care during pregnancy and childbirth. During the current COVID-19 pandemic, women everywhere will continue to get pregnant and give birth. In low-resource countries and in humanitarian settings affected by conflict, pregnant women, new mothers, newborns and the health personnel providing them care face great risks in the new reality brought by the virus. Health systems are facing enormous pressure with lack of staff, resources and training to take necessary preventative measures against the virus. Midwives and other skilled health personnel providing care during childbirth need immediate support and tools to be able to still provide quality maternal care in the light of the pandemic. A new digital tool launched today aims to do just that.

In response to the global COVID-19 pandemic, Maternity Foundation, University of Copenhagen, and Laerdal Global Health in collaboration with International Confederation of Midwives (ICM) and UNFPA have partnered up to develop and disseminate an immediate and digital response for healthcare personnel – particularly midwives – to protect themselves, women and newborns from COVID-19.

The coalition is launching tools for capacity building and training for midwives through the Safe Delivery App, a mobile application developed by Maternity Foundation and University of Copenhagen, which provides visual, clinical and practical guidance on how to handle the most common childbirth complications. Through the Safe Delivery App, midwives can now get key information, animated video instructions, and check lists as well as guided training to support them to limit the spread of COVID-19 in the health facilities, including information on infection prevention, breastfeeding and vertical transmission.

The Safe Delivery App is a free application that is already being used by midwives and other skilled health personnel providing care during childbirth in over 40 countries worldwide. Thereby, the partners are leveraging an existing platform that is already reaching thousands of frontline health workers. All current users of the App will receive a pop-up message creating awareness about the new module and the importance of taking pre-cautions during COVID-19. It works offline once downloaded, making it easy to use in remote settings without a stable internet connection. The new COVID-19 content in the App is available in English as of today and will be available in French in a near future. The content of the Safe Delivery App is updated according to WHO standards and guidelines.

Laerdal Global Health has 10 years of experience of simulation-based training for midwives and other health care providers in low resource settings through the Helping Mothers Survive and Helping Babies Survive training programmes, implemented in over 80 countries. The current collaboration on merging scenarios for simulation into the Safe Delivery App will expand use of the App and support training in an efficient way, supporting the midwives where they are working.

In Moshi in northern Tanzania, senior nurse midwife at Mawenzi Regional Hospital Anne Shuma and her colleagues have just been introduced to the new COVID-19 module in the Safe Delivery App. The hospital is one of the hospitals in the country selected for receiving COVID-19 patients, and preparations are in full motion to prepare isolation centers, so they are ready when the first cases arrive. In the first week of April alone, they had 50 deliveries in the hospital.

“Going through the Safe Delivery App and the COVID-19 module made us realise that we were not prepared to receive pregnant women with suspected COVID-19. Immediately, we prepared a delivery kit and brought it to the isolation center and prepared a cube where suspected cases can give birth. We have now developed checklists based on the content in the App, so we are ready for when suspected cases come. It’s a very helpful tool for us midwives in an outbreak like this. It takes a concrete case and gives guidelines that are aligned with our national guidelines; procedures for handwashing and how to handle personal protective equipment. The App has opened our minds, we’re prepared now”, says Anne Shuma, who will spend the next weeks training fellow midwives and nurses in nearby clinics and hospitals to use the Safe Delivery App in their preparations for the COVID-19 response.

Dr. Natalia Kanem, Executive Director UNFPA: “The enormity of the COVID-19 crisis and its consequences is testing us all. As essential frontline health care workers, midwives must be protected and prioritized so that they can continue providing quality care to women and their newborns during the pandemic. UNFPA is pleased to collaborate with the Maternity Foundation, Laerdal, ICM and the Government of Denmark in developing innovative online resources to support midwives and other maternity care providers working in the field. These new digital tools will enable them to access the latest evidence-based approaches to care delivery in the context of COVID-19.”

Dr. Sally Pairman, CEO of the International Confederation of Midwives: “Midwives everywhere are frontline health care professionals in the face of the coronavirus, providing essential care to pregnant women and their babies during the childbirth continuum, despite the risk this presents to their own health. Many midwives have never had to work in pandemic situations before, and for everyone the coronavirus is new. In speaking with our Midwives’ Association members, we’ve been saddened by news of midwives dying from Covid19, simply because they were not adequately protected from the virus or did not have proper information on how to protect themselves. It’s essential that midwives and all other health professionals providing maternity care can access up-to-date and evidence-based advice on the changes they need to incorporate into their practice to keep women and their babies, and themselves, as safe as possible. The new modules in the Safe Delivery App will help guide midwives everywhere with advice they can count on.”

Chairman of Laerdal Global Health Tore Laerdal: “Our mission has always been helping save lives and now it has come even closer. During these extraordinary days, we work even harder towards our mission. There are hundreds of thousands of health workers who heroically continue to work through challenging situations and are in need of all the support we can offer. We hope our manikins and simulation solutions will be the helping hand that will support them in providing safe and respectful care.”CEO of Maternity Foundation, Anna Frellsen: “The direct and indirect consequences caused by the covid-19 pandemic can be fatal for mothers and newborns in many parts of the world. The Ebola outbreak in West Africa in 2013-16 showed a dramatic increase in maternal deaths because the health system was under too much pressure to fight the pandemic to also provide quality care. In a situation like this we need to respond fast and we need to do it together. By building on an existing digital platform and our global partners’ strong channels, we are now availing essential clinical guidelines instantly to midwives, even in some of the most vulnerable settings.”

How to download the Safe Delivery App

  • Search for Safe Delivery App in Google Play or App store
  • Click Download – the App is free of charge
  • Open the App and select language version – the COVID-19 content is in the global English version
  • If you already have the Safe Delivery App on your phone, update it and the COVID-19 module will appear in the global English version

The full Infection Prevention video can be found here.

Source: https://www.healthynewbornnetwork.org/news-item/a-digital-response-to-help-ensure-safer-childbirths-during-covid-19/



Vulnerable babies are being separated from their families because of corona virus

i.10Published on Apr 19, 2020

Babies born sick and premature are being separated from their families because of hospital restrictions put in place during the corona-virus outbreak. Some hospitals are only allowing one parent to visit at a time and it’s even more difficult for siblings to meet their new relative.



Doctors are pessimistic about premature babies. Despite the evidence, we all are.

We tend to view them as “miracle babies,” or as the result of medical hubris.

By Sarah DiGregorio – Sarah DiGregorio is the author of “Early: An Intimate History of Premature Birth and What it Teaches Us About Being Human.” Feb. 21, 2020

In 2014, I was 28 weeks pregnant and sitting in a hospital bed, my husband beside me. My placenta was failing; to survive, our daughter would need to be delivered soon. She was smaller than average for this stage, an estimated 1.75 pounds.

The neonatal intensive-care unit (NICU) dispatched a neonatology fellow to help us understand what this meant. He started with our baby’s brain. When she was born, it might bleed, putting her at risk of death or cerebral palsy. Her lungs: They would certainly be immature, and she would probably have some degree of respiratory distress syndrome. Her heart might have a hole in it that would fail to close. Her intestines might develop an infection, possibly fatal, in which lengths of the bowel die. In the long term, premature babies are much more likely to experience developmental delays — the doctor guessed that our daughter had about a 50 percent chance of having a disability of some kind. She might lose some IQ points as a result of being premature, he added. The message was clear: Being born early was very, very bad, and our baby was likely to be fundamentally damaged, even in ways we would never definitively know.

It’s important that parents have the facts, and our doctor wanted us to know something true: Being born prematurely can affect a child’s health in many ways, and some of those complications can be fatal. The information he recited was medically accurate, though he probably inflated the likelihood of disability. (One benchmark is that, among babies born at 25 weeks, 13 percent develop a profound neurodevelopmental disability, and 29 percent develop a moderate one, according to data from the National Institute of Child Health and Human Development.)

The doctor’s laundry list also missed something important, something we really needed to hear at the time: The majority of babies born early, even very early, survive in good health. Their weeks, months and years ahead will not be easy. But there is also plenty of evidence for optimism.

Health-care providers have a well-documented and surprisingly durable pessimism about preemies. A 1994 survey in the American Journal of Obstetrics and Gynecology showed that doctors significantly underestimated their survival rates and overestimated their long-term disability rates. More than a decade later, a Pediatrics study of physicians, nurses and nurse practitioners echoed those findings, and showed that learning the true rates made doctors more likely to recommend resuscitation in theoretical borderline cases. Doctors are much sunnier about other patients: Research shows that internists and intensive-care unit physicians accurately assess the survival chances of adult patients admitted to the ICU.

This professional pessimism is matched by a broader cultural ambivalence. Our feelings about preterm infants are powerfully fraught. They suggest the thinness of the line between life and death; they symbolize the heights of human capability and the perils of going too far. We have two common narratives about premature infants: inspirational “miracle baby” stories and warnings of medical hubris. Record-setting “micro-preemies” who “defy the odds” and “fight for their lives” are regularly featured in tabloids and local TV broadcasts. Meanwhile, a 2017 Maclean’s article wondered, in the case of a very early birth, “to what extent should we intervene to prevent nature from taking that life before it becomes fully viable and conscious?” A Bloomberg Businessweek article, “Million-Dollar Babies,” asked, “Is there such a thing as too young?” Perhaps the general hand-wringing over such efforts made AOL’s chief executive blame the expensive medical care of “distressed babies” when he cut employee retirement benefits in 2014.

Our fascination with premature infants has always contained starry-eyed optimism about what could be done for them, along with uncertainty about whether the results were “worth” those efforts. That conflict goes back to the invention of the incubator in the 1880s, as Jeffrey Baker writes in “The Machine in the Nursery.” The medical establishment was slow to adopt the technology: The machine was expensive, and the value of the lives saved was seen as dubious. At the time, “Better Baby” contests were wildly popular, grading children on pseudoscientific traits like head measurements and awarding prizes to the “fittest” (i.e. large, able-bodied babies of white European heritage). Eugenicists argued that premature babies weren’t meant to survive; they would become a drain on society. The Buffalo Medical Journal wondered “whether the race as a whole does not suffer from the preservation of these weaklings to perpetuate their kind.” As a result, incubators remained a curiosity, touring world’s fairs and popping up in Coney Island as a boardwalk sideshow. People paid to gawk at preemies in their warm, glass-fronted boxes — they were objects of voyeuristic amazement, inspiring both hope and horror.

Even as cultural attitudes have progressed, some anxiety remains, often rooted in fears of disability. The 1985 book “Playing God in the Nursery” warned of “the dismal fate of a disturbing number of ‘salvaged’ babies’ ” who go on to lead “pathetic lives.” Two neonatologists called on fellow physicians to reexamine these beliefs in the Journal of Perinatology in 2013: “For the case of the preterm newborn, in particular, there may also be a sense that she is still ‘not meant to be here,’ ” they wrote. “If she survives with significant disability, the physicians might perceive that: But for our actions, there would be no disabled child.” The worry about gratuitous intervention, present in many medical decisions, seems especially acute when it comes to these patients.

All preterm babies are at increased risk for neurodevelopmental and learning disabilities when compared with term babies; the earlier the birth, the higher and more severe the risk. But these blanket assessments elide the fact that “disability” includes a whole range of experiences. Rigorous quality-of-life studies have found that as extremely premature babies grow into young adults, they rate their own health-related quality of life just as highly as a control group born at term. That includes former preemies who have a significant disability, such as cerebral palsy, vision problems or hydrocephalus — outcomes that providers seem to view more negatively than parents do. Neonatal providers often think that serious disabilities following from premature birth are worse than death, one study published in the Journal of the American Medical Association found. Most parents of babies born under 2.2 pounds feel differently — as do the grown ex-preemies themselves.

The truth is that the successful treatment of premature babies is one of the great triumphs of modern medicine. Before the widespread adoption of the incubator (and back when babies were usually studied by weight rather than gestational age), an 1883 study found, only about 35 percent of babies born under 4.4 pounds survived. But it isn’t just the incubator: With the subsequent development of respiratory support, intravenous nutrition and a host of other treatments, outcomes have improved dramatically. Infants born at the edge of viability, between 22 and 25 weeks, do, unfortunately, face substantial risk of death. But the vast majority of premature babies — more than 80 percent — are born after 32 weeks, and those born at 26 weeks and above are now quite likely to survive. According to the most recent available data from the Centers for Disease Control and Prevention, 87 percent of infants born at 26 weeks survive, and outcomes improve with each week of development.

Health-care providers are uniquely positioned to reframe our understanding of premature birth. They can answer parents’ questions, rather than leading with negative (and often hypothetical) predictions, and they can ground the discussion in the latest research. That evidence-based optimism might seep into the wider conversation. At the very least, it would make a difference to families, whose numbers are growing: More than 1,000 babies are born prematurely in the United States every day, and that figure has been rising for the past four years.

Families of premature babies are often deeply grateful to the providers who saved their children’s lives, and I am no exception. The doctor who recited that laundry list may have just been following hospital protocol. He probably had the best intentions; he may have been trying to manage his own emotions and expectations. But our counseling session hit me so hard not just because it laid out all the worst-case scenarios: It also seemed to say that my daughter would not have a wide-open future. She would forever be measured against an ideal that she was born short of and could never grow into.

And yet, in the time since, I have never wished my daughter, now age 5, were different. I speak from a position of tremendous luck: Her IQ is “normal,” whatever that means; she has a pulmonologist monitoring her persistent asthma and receives physical and occupational therapies for minor motor delay. Some of her fellow former preemies have fewer challenges; others have far more. But I don’t contemplate who she may have been, and I can’t wish away those difficulties without, in some real sense, wishing her away, exactly as she is.

We have a powerful collective fantasy of newborn perfection. We associate babies with possibility; we believe they could grow up to be anything, do anything. The truth is that no one, anywhere, has unlimited potential, not even at the very start of their life. But that fantasy can lend early births an unnecessarily tragic aspect — a sense of brokenness, of damage, even before parents have a chance to hold their infants. And often, we have plenty of reason to hope.

Source: https://www.washingtonpost.com/outlook/doctors-are-pessimistic-about-premature-babies-despite-the-evidence-we-all-are/2020/02/20/c4cefe50-4c44-11ea-9b5c-eac5b16dafaa_story.html



Does COVID-19 affect pregnancies?

UW Medicine – Mar 24, 2020

Much is still unknown about the virus that causes COVID-19. Dr. Kristina Adams Waldorf, professor of obstetrics and gynecology at University of Washington School of Medicine, shifted her lab’s focus to research what effects the virus may have on a pregnancy or a newborn. Scientists are investigating such questions as whether the infection can affect a fetus’ growth or whether it heightens the risk for preterm birth, stillbirth, and other conditions. This kind of research can help determine clinicians’ responses to pregnancies that also involve COVID-19.




Will Simplifying the Finnegan Neonatal Abstinence Scoring Tool Improve Outcomes for Infants With Opioid Exposure?

Ju Lee Oei, MD1,2; Trecia Wouldes, PhD3

It has been known for decades that opioid withdrawal in neonates has the potential to be fatal. Unfortunately, newborn withdrawal symptoms can be nonspecific, and identifying and differentiating infants with drug withdrawal from those with other illnesses, such as infection or neurologic problems, can be difficult, especially when maternal history is not forthcoming. Loretta Finnegan and colleagues devised the 21-point Finnegan Neonatal Abstinence Scoring Tool (FNAST) in 1975 based on observations of 55 full-term infants with narcotic exposure who were born at the Philadelphia General Hospital. The neonates were all admitted to a nursery and scored every hour for the first 24 hours, then every 2 hours on day 2, and then every 4 hours after that. They were formula fed and treated with a repertoire of agents that are no longer used as first-line treatments, including phenobarbital, paregoric, chlorpromazine, and diazepam. The FNAST is now the most widely used tool to screen, assess, and treat infants suspected of having drug withdrawal, but it is notoriously difficult to administer and is fraught with subjective differences.

In the study by Devlin et al, the authors attempted to shorten and simplify the FNAST by incorporating observational data from several infant cohorts (N = 424), including infants who did not require medications for neonatal abstinence syndrome (NAS). They dichotomized items that were previously expressed in grades of severity and removed items that were not observed frequently or were extremely heterogeneous, including convulsions, high-pitched crying, and hyperactive reflexes. The result was an assessment scale made up of 8 items, from which scores of 4 and 5 yielded closest agreement with FNAST treatment thresholds of 8 and 12, respectively (weight κ = 0.55; 95% CI, 0.48-0.61).

The simplicity of this tool is attractive. However, before it can be embraced in clinical care, several questions remain to be answered. First, only 1 score was used to determine treatment. Withdrawal symptoms typically evolve as the infant ages, and whether the associations between the 8 chosen items and NAS remain consistent with time needs to be assessed. The rare or uncommon items, such as seizures, were removed, but this may have limited the ability of the scale to detect severe but rare manifestations of withdrawal that require urgent treatment rather than continued observation. Critical events, such as seizures, may not have been common in the cohort studied by Devlin et al4 because the infants, unlike historical examples, were already monitored and treated preemptively with supportive care.

Nevertheless, the most significant knowledge gaps with the use of this and other scales is the lack of information regarding long-term outcomes. No prospective, well-controlled longitudinal studies have been conducted to associate prenatal drug exposure as well as assessment and treatment for NAS with later neurodevelopmental outcomes. Every single drug that causes NAS and every single medication that is used to treat withdrawal is neurotoxic. For example, opioids interfere with neurotransmitter homeostasis, promote cell death by apoptosis, and reduce brain growth and neuronal differentiation.5 Conversely, without treatment, severe withdrawal could lead to serious complications, such as dehydration, malnutrition, seizures, and even death.

Certainly, the work of Devlin et al highlights that much more needs to be known about how an infant responds postnatally to intrauterine drug exposure and the optimum screening, diagnostic, and treatment strategies. Perhaps the ultimate goal should not be to decide whether to treat an infant with medication but to prevent poor outcomes, including neurologic harm and death. Adopting simple measures will only be effective if they are systematically accepted by clinicians, parents, guardians, and caretakers, which is often not the case. For example, standardized protocols for identifying and treating women with opioid use disorder and for assessing and treating infants at risk of NAS have been shown to be beneficial in reducing length of hospitalization and rates of NAS treatment even without changing assessment scales.

Finally, we need to acknowledge that infants, especially those affected by multiple drugs, may need more than 1 type of assessment. The FNAST was based on infants withdrawing from narcotics, most notably heroin and methadone. Today, pregnant women with a drug use disorder usually use multiple drugs, which may obfuscate the clinical presentation of the infant. Incorporating items from other scales, such as the NICU Network Neurobehavioral Scale, which incorporates physiological parameters with interactive capabilities in an assessment method, may provide useful diagnostic information even for infants without opioid exposure and may even prognosticate not only for the short term but also, importantly, for longer-term outcomes.

Published: April 8, 2020. doi:10.1001/jamanetworkopen.2020.2271

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2764194


Advanced Wireless Neonatal Body Monitors to Improve Outcomes

Babies that end up in the neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) are monitored via a complex collection of sensors, each of which has a wire connected to a patient monitor. While necessary, all this technology makes it difficult for parents to bond with their children and for clinicians to access their patients.

Northwestern University engineers have developed flexible, wireless sensor patches that are able to collect the same vital signs as wired devices while offering an entire set of additional capabilities that existing commercial devices lack.

The new sensors are able to track the heart rate, respiration rate, temperature, and blood oxygenation as well as conventional sensors, and they also allow for monitoring of body movement and orientation, recording heart sounds, crying, and other audio biomarkers, and even provide a pretty accurate estimate of systolic blood pressure.

The sensors are powered by internal batteries and are pretty cheap to manufacture, and so should be applicable for use in low resource areas and varying clinical settings. Additionally, the same sensors can be used to monitor pregnant women and potentially hospitalized adults as well.

Following comprehensive testing at two hospitals in Chicago, the results of which have just been published in journal Nature Medicine, the sensors are already being evaluated for use on newborns in a hospital in Kenya and one in Zambia.

Source: https://www.medgadget.com/2020/03/advanced-wireless-neonatal-body-monitors-to-improve-outcomes.html




At Mayo Clinic, Bringing Neonatologists to the Point of Care with Telemedicine

The health system has co-developed a tele-neonatology program designed to close a gap in care that has existed when neonatologists aren’t physically available.

Rajiv Leventhal– Oct 29th, 2019

According to researchers at the Rochester, Minn.-based Mayo Clinic, 10 percent of all newborn infants will require assistance at birth, while approximately 1 in 1,000 newborns will require advanced resuscitation after delivery—an intervention after a baby is born to help it breathe and to help its heart beat.

When these high-risk deliveries occur in a local referral center, such as the aforementioned Mayo Clinic, newborn outcomes can be optimized under the care of a multidisciplinary team that has frequent experience with neonatal resuscitation.

Conversely, if a similar high-risk delivery occurs in a community hospital, the local providers may face unique challenges when responding to delivery room emergencies, Mayo Clinic researchers pointed out. As such, the health system recently co-developed a Newborn Resuscitation Telemedicine Program (NRTP) in collaboration with telehealth solutions company InTouch Health.

At Mayo Clinic, the organization’s main hub in Rochester has Level III and Level IV regional NICUs (neonatal intensive care units)—Level IV being the highest level of neonatal care—but there are also 10 Mayo Clinic health system sites that range from having just Level 1 well baby nurseries up to Level II intermediate specialty care nurseries. On top of that, Mayo Clinic has eight emergency departments (EDs) that are a part of either critical access hospitals or standalone EDs where there are no labor or delivery services, explains Beth Kreofsky, operations manager for the new tele-neonatology program at Mayo Clinic.

“So when mothers present to these sites, they may not always have access to a neonatologist. Six years ago, our team identified—with the assistants of our Mayo Clinic health system pediatric teams and family medicine providers—that there was a need to have a neonatologist available for assistance at the bedside in critical care situations where newborn resuscitation was needed,” Kreofsky recalls.

This disparity based on birth location was what motivated Christopher E. Colby, M.D., chair of neonatal medicine at Mayo Clinic’s Rochester campus to explore the use of telemedicine for newborn resuscitation, according to health system officials who noted that Dr. Colby’s first consultation was for an extremely preterm baby with an unknown gestational age due to limited prenatal care.

In this scenario, the local physician was unsure if the newborn was viable and if resuscitation was indicated. After examining the baby via video, Dr. Colby determined the neonate was likely 26 to 28 weeks gestation and proceeded to guide the resuscitation and stabilization. After a short time in the Mayo Clinic NICU, the baby was transferred back to the local Level II nursery. From there, the healthy infant was discharged home, health system officials explained.

The telemedicine program that has now been established enables nine board certified Rochester-based neonatologists to consult with local care teams in 10 health system sites. Prior to using telemedicine, only 43 percent of newborns in Mayo Clinic health system sites had access to a neonatologist if they required advanced resuscitation, officials pointed out, and as Kreofsky explains it, in these situations, local care teams would activate Mayo Clinic’s transport services and be asked to connect by phone to a neonatologist to assist in the service.

“Now we have added the video component onto that workflow so our neonatologists can see what the infants look like and what the physician at the local hospital is seeing, and can then provide appropriate recommendations. This is [compared with the prior approach of] not being able to see what’s going on and conducting what essentially [amounted] to a phone consult,” Kreofsky says.

This can be especially beneficial in rural settings where neonatal resuscitations are typically attended by general pediatricians or family practitioners. “While clinicians may have completed Neonatal Resuscitation Program training, knowledge and technical skills decline within four to six months, if not used regularly. Maintaining high proficiency in the face of low volumes presents inevitable challenges for rural providers. Telemedicine serves as a mechanism to address barriers in access to subspecialty care, support neonatal resuscitation in remote sites, and improve care for critically ill outborn neonates,” Kreofsky and her Mayo Clinic colleagues wrote in a study that evaluated the tele-neonatology program.

The study also examined the effectiveness of two telemedicine technologies used to provide NRTP consults: the InTouch Health Lite device compared with a wired telemedicine cart. As Kreofsky explains, if a mother needs to be moved to a different room, say for a C-section, the wired cart solution requires unplugging the device and removing it from the wall to a place where a network jack could be found. And if the physician gets disconnected during that transition, he or she would have to reconnect once the network is reestablished on that device.

But the InTouch technology, on the other hand, allows the physician to stay connected as the patient is being transitioned, meaning the transition is “more seamless and you don’t have to worry about unplugging anything or reestablishing connections in this scenario,” says Kreofsky.

Kreofsky also clarifies that when a tele-neonatology  service does occur, neonatologists are able to partner with the local family medicine physician and pediatrician to assist with guidance and recommendations, but it’s the bedside physician who is still in control of all the care that’s happening on site. “So while a neonatologist cannot physically get their hands on a patient, he or she can assist with recommendations on how neonatal resuscitation program standards are followed throughout a resuscitation,” Kreofsky explains.

During the 20-month study period, 118 NRTP consultations were performed across Mayo Clinic sites, resulting in:

  • 96 percent first connection attempt rate—the ability of the device to connect to the network on the first try.
  • 93 percent incident resolve rate—the ability of the provider to easily resolve any issues with the device before patient care is impacted.
  • Results of the NRTP device can be compared to a traditional wired cart, which saw a 73 percent connection attempt rate and a 68 percent incident resolve rate.

Kreofsky also notes that more recent satisfaction survey results found that 99 percent of the local care teams who have been surveyed agreed that they would use tele-neonatology again and would recommend  it to others. Further, 100 percent of Mayo Clinic’s local care teams surveyed agreed that the consulting neonatologist provided, brief, clear, and specific information for the team, and worked collaboratively with them locally via telemedicine.

According to Jennifer L. Fang, M.D., with neonatal medicine at Mayo Clinic in Minnesota, the next step is to study the impact telemedicine has on the quality of newborn resuscitations. “While we and our colleagues in the health system believe telemedicine is improving delivery room care, we need to design a study to better answer that question,” she said.

Source: https://www.hcinnovationgroup.com/population-health-management/telehealth/article/21112281/at-mayo-clinic-bringing-neonatologists-to-the-point-of-care-with-telemedicine



A simple solution for healthier premature babies?

bCBC News: The National –  Published on Feb 12, 2018

Is there a simple solution to improve the health of premature babies? A new Canadian-led study suggests there is. The study’s results showed that by simply getting a premature baby’s parents involved in the care process sooner, the baby gained 15 per cent more weight. There was also another effect — the parents also showed less stress.



Kat has been teaching virtual fitness classes from home during Covid-19 Stay at Home restrictions. Kat’s voice was significantly impacted from long term intubation as a 24 week micro-preemie. Back in 1991 the intubation equipment was quite large and the roof of her mouth is a deep cavern. Her voice is smokey in her normal tone and she is often asked if she is a smoker (she is not). Kat has always had difficulty talking loudly and she will not be pursuing a singing career. I stay upstairs while she teaches her classes and have had the opportunity to re-notice how challenging it is for her to shout out directions and encouragement while teaching HITT fitness (Strong Nation) classes throughout each 60 minute session. This is not a big problem that needs fixing, just an interesting preemie outcome. I wish I would have been more aware of this impairment issue when Kat was a kid and her coaches yelled at her to yell louder!

Voice Abnormalities and Laryngeal Pathology in Preterm Children

Anne Hseu  1 Nohamin Ayele  1 Kosuke Kawai  1 Geralyn Woodnorth  1 Roger Nuss  1

PMID: 29962214 DOI: 10.1177/0003489418776987


Introduction: The prevalence of voice abnormalities in children born prematurely has been reported to be as high as 58%. Few studies have examined these abnormalities with laryngoscopic or videostroboscopic findings and characterized their laryngeal pathologies.

Objective: To review voice abnormalities in patients with a history of prematurity and characterize the etiology of their voice problems. A secondary objective is to see if there is a correlation between the findings and the patient’s intubation and surgical history.

Methods: A retrospective chart review was conducted of all preterm patients seen in voice clinic at a tertiary pediatric hospital. Demographic data, diagnoses, and office laryngoscopies were reviewed as well as any speech therapy evaluations and/or medical and surgical treatments.

Results: Fifty-seven patients were included. Mean age at presentation was 5.1 (±4.3) years. Mean gestational age was 27.8 (±3.7) weeks. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) perceptual evaluations included a mean overall dysphonia severity of 46.6 (±24.2). Patients who had undergone prolonged intubation (⩾28 days) in the NICU or had prolonged NICU stays (>12 weeks) had significantly higher overall dysphonia severity scores. Thirty-three patients with vocal fold hypo- or immobility had significantly greater voice deviance in breathiness, loudness, and overall severity compared to those without vocal fold immobility. Of all patients, 35% were recommended surgical intervention and 49% voice therapy.

Conclusion: Intubation greater than 28 days and prolonged NICU stays are associated with more severe dysphonia in premature patients. There should be a low threshold for clinical evaluation of dysphonia in this unique patient population. ***Dysphonia= impairment of the voice

Source: https://pubmed.ncbi.nlm.nih.gov/29962214/



Covid-19: A Collective Hero’s Journey Dr. Arielle Schwartz

Posted on March 28, 2020 by Arielle Schwartz

“Covid-19 has led many of us around the world to experience feelings of shock and confusion. This collective crisis has disrupted our orientation to the world as we have known it. We have been thrust into a process of self-discovery and a requisite redefining of our lives. It is impossible to go back to the old ways of living.” ~Dr. Arielle Schwartz

American mythologist, Joseph Campbell (2008), describes personal transformation as a hero’s journey. The hero must enter the darkness, face challenges, slay the dragon, retrieve the treasure, and emerge stronger. Here, we understand that challenging life events can serve as a call to enter the hero’s journey. You may feel as though you have been thrown into an abyss. The dragons you must slay are the inner demons. You walk into the darkness in order retrieve the treasures that exist within you, such as inner strength, wisdom, and hope. You emerge with an enhanced sense of meaning and purpose, which become the gifts that you have to offer to the world.

A Collective Hero’s Journey

Campbell described the hero’s journey as a “monomyth,” which serves as a blueprint for many of our fairytales, books, and movies. The monomyth is described as a cycle that begins with a phase of freedom and innocence. This period of ease is tragically disrupted by a crisis that sends the hero into exile.

Here we are. There is no turning back. Covid-19 has changed our world. But, we are in this together. To overcome the challenges that are set before us, we must seek out resources needed to face our fears and inner demons. We must go within to gather our strength and to rise up in the midst of crisis. We are being asked to become the best version of ourselves.

This doesn’t mean that we won’t feel pain. Attending to our sadness, anger, fear is the path forward. Attend with love. Reach out…we are not meant to move through this alone. Perhaps, that is part of the lesson. We are a collective. We are deeply connected to each other. We are here to give and receive from each other.

Crisis as Catalyst

Perhaps our current world crisis has been the catalyst. Or, maybe your hero’s journey began long ago as a result of childhood trauma. No matter the origin, a hero’s journey can guide our process by encouraging us to transform our pain into a source of wisdom.

You might have uncomfortable places that you don’t like to acknowledge or feel. As a result, you might want to reject the call to enter the hero’s journey. The desire to avoid peering into the darkness is normal. It is human instinct to move away from pain. However, learning to turn toward discomfort is necessary and important. Even though you might want to run away, explore the resources that help you to step forward toward the discomfort. Remote psychotherapy, online support groups, journaling, time in nature, or mindful embodiment practices can all help you lean into discomfort at a pace that is right for you.

Living in Two Worlds

The challenge set before us is to learn to live in two worlds—that is, to maintain a connection to our inner, spiritual self while simultaneously living in the outer world. This dual connection helps us learn to live on a threshold where we can acknowledge our pain as a source of compassion.

At times, we might wonder how to live in a world that has betrayed us and that could betray us again. We grow by increasing our ability to hold the complexity of the human experience. This world contains experiences of harm and loss; however, this is also a world of love and care.

Transformed by a hero’s journey, we have an opportunity to grow ourselves into mature adults, capable of holding complex feelings and ideas in a world that can cause harm. There is a great maturity in being able to hold the truth that hurtfulness and happiness can coexist around and within you. We can learn to hold dichotomies, polarities, and contradictions. Experiences of pain are an inevitable part of life; opening our hearts involves the risk of pain. However, life can have excruciatingly painful moments and still be magnificently beautiful. Living on the threshold allows us to walk through the world with an effortless grace that emanates from within.

Emerging into Wholeness

Walk slowly and gently as you face your fears.

In time, we can all learn to trust our capacity to enter the darkness and return to the light. Successfully navigating the hero’s journey gives us the opportunity to discover that we are more powerful than we previously realized.

As a result, the here’s journey allows us to feel more grounded, real, and whole because – in truth – this transformation is about revealing who we truly are.

Together, let us remember that there is an inseparable relationship between our own personal happiness and the wellbeing of others.

Source: https://drarielleschwartz.com/covid-19-a-collective-heros-journey/#.XpjBAEBFxhE

(Kathy) I spent time with Joseph Campbell at Esalen Institute (late 1970’s/early 1980’s). His informal meal gatherings were enlightening and soul-challenging. He was an understated yet powerful speaker who mastered the dynamics of human behavior, subconscious motivations and pathways to transformation. Who in your life inspires transformation?



Covid-19 requires that we look beyond our preterm birth community this month into our broader communities so we can all be empowered through our shared resources and information. How Covid-19 will affect maternal outcomes and our preterm birth communities will be somewhat identified over time. Please reach out to your local healthcare providers for guidance and support and consider reviewing fluid resources such as WHO regarding Covid-19 pregnancy and childbirth information:                   Source: https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-and-pregnancy-and-childbirth

Communities worldwide are navigating with limited resources the creation/expansion of medical, social, economic, governing, inter-governmental, technological, educational, interpersonal and personal best practices to maximize the health and wellness of their community members, patients, essential workforce and healthcare/wellness providers. The global health care provider shortage crisis is now critically exacerbated by our global pandemic experience.

Providing communities with factual, science-based information and resources is a critical component in building trust and reducing fear during crisis in a society that has access to multiple “news” resources at their fingertips. Addressing and advancing mental health holistically in our communities strengthens our ability to save lives, limit loss, and prevents fear-based violence. Media that offers not only factual information but also provides a community with guidelines for engaging in meaningful action supports mental wellness during times of crisis.

THANK YOU to the media members who have reached out to challenge us, give our actions meaning and power, who have focused on what good we can accomplish together while building hope and expressing our fears and gratitude.

As time transpires and we are able to review pertinent essential data including community engagement strategies, socioeconomic factors, local and global resources we will have an opportunity to build better societal strategies to serve our diverse communities. Borders do not exist for climate change and environmental disasters or for pandemic types of     human-centric challenges. Technology has the capacity to collect, provide, analyze, and disperse critical data that through collaboration and intent will allow all of us to respond to our personal, community, and global health care challenges with effective, fluid, time-sensitive, immediate and long-term action based planning.

It is essential that we work together in order to support and empower a healthy and sustainable planet. Covid-19 offers, and in some ways forces us to see in action the possibilities positive collaborative engagement provides. Our thanks to all of you who are choosing to stay informed, conduct your lives with intelligence and humane purpose, who live with integrity and a vision of good. Together we can create a safer, life affirming, dynamic and responsible global/local community for all.

Under An Arctic Sky – Official Trailer #1

Jan 17, 2017

With three hours of light each day, brutal winter storms and freezing temperatures, Iceland is far from the ideal surf trip. However, this didn’t stop photographer Chris Burkard and filmmaker Ben Weiland from rounding up a crew of surfers to seek out unknown waves in the islands remote north… all during the worst storm to hit Iceland’s shores in 25 years.






Preterm Birth Rates – Nicaragua

Rank: 105 –Rate: 9.3% Estimated # of preterm births per 100 live births (USA – 12 %)

Source: https://www.marchofdimes.org/mission/global-preterm.aspx

The Nicaraguan government guarantees universal free health care for its citizens. However, limitations of current delivery models and unequal distribution of resources and medical personnel contribute to the persistent lack of quality care in more remote areas of Nicaragua, especially amongst rural communities in the Central and Atlantic region. To respond to the dynamic needs of localities, the government has adopted a decentralized model that emphasizes community-based preventive and primary medical care.

Source: https://en.wikipedia.org/wiki/Nicaragua#Healthcare


Nicaragua is a country in crisis, and the press has been diminished by the current government.  We were not able to access current news related to our preterm birth community in Nicaragua.  To our brothers and sisters in Nicaragua we send our Love N.heartand Respect for our Neonatal Womb/preterm birth community members and hold your well-being and health in our collective consciousness.

Our goal this month is to provide time sensitive information relevant to our Global/local preterm birth community focused on supporting our preterm birth families, health care providers and community members. Wishing us all health, wellness, hope and love.



Pregnant and worried about the new corona virus

Home » Harvard Health Blog » Pregnant and worried about the new coronavirus?Harvard Health Blog Posted March 16, 2020, 2:30 pm , Updated March 18, 2020, 10:14  Huma Farid, MD – Contributor   Babar Memon, MD, MSc – Contributor

COVID-19, the disease caused by a new coronavirus, has rapidly spread globally. The World Health Organization recently labeled COVID-19 a pandemic. Many of my pregnant patients have expressed concerns, both for themselves and their babies, about the impact of COVID-19 on their health. To answer often-asked questions about pregnancy and the new coronavirus, I’ve teamed up with my husband, an infectious disease specialist and internist. Together, we reviewed the extremely limited data available to provide evidence-based responses below.

Pregnancy and the new coronavirus

As you probably know, the virus spreads through respiratory droplets sent into the air when a person who has COVID-19 coughs or sneezes. It may also spread when someone touches a surface infected by a person who has the virus.

What can I do to protect myself against catching the new coronavirus?

The most important step is to practice excellent hand hygiene by frequently washing hands with soap and water for 20 seconds. Avoid touching your eyes, mouth, and nose. You should also avoid large gatherings. Social distancing is important to limit the spread of the virus. If you have a mild cough or cold, stay at home and limit exposures to other people. Sneeze and cough into a tissue that you discard immediately, or into your elbow, to avoid making others sick. Hydration and adequate rest also are important in maintaining the health of your immune system.

As a pregnant woman, what is my risk of becoming very ill from COVID-19?

Given that this is a novel virus, little is known about its impact on pregnant women. At this point, experts think that pregnant women are just as likely, or possibly more likely, than the general public to develop symptoms if infected with the new coronavirus. Current information suggests symptoms are likely to be mild to moderate, as is true for women (and men) in this age range who are not pregnant.

If I am pregnant and have COVID-19, does this increase the risk of miscarriage or other complications?

There does not appear to be any increased risk of miscarriage or other complications such as fetal malformations for pregnant women who are infected with COVID-19, according to the Centers for Disease Control and Prevention (CDC). Based on data from other coronaviruses, such as SARS and MERS, the American College of Obstetricians and Gynecologists notes that pregnant women who get COVID-19 may have a higher risk for some complications, such as preterm birth, but the data are extremely limited and the infection may not be the direct cause of preterm birth.

If I get sick from the new coronavirus, what is the risk of passing the virus onto my fetus or newborn?

A study of nine pregnant women who were infected with COVID-19 and had symptoms showed that none of their babies were affected by the virus. The virus was not present in amniotic fluid, the babies’ throats, or in breast milk. The risk of passing the infection to the fetus appears to be very low, and there is no evidence of any fetal malformations or effects due to maternal infection with COVID-19.

I tested positive for COVID-19. Can I breastfeed my baby?

Currently, there is no evidence of the virus in breast milk. Given that the virus is spread through respiratory droplets, mothers should wash their hands and consider wearing a face mask to minimize infants’ exposure to the virus.

Can I travel for my baby-moon?

We recommend avoiding all travel at this time, given the concerns that the virus could be widespread, and the uncertainty for travel restrictions (see CDC travel advisories).

Should I reschedule my baby shower because of the new coronavirus?

While a baby shower is a joyous and important occasion, public health agencies such as the CDC recommend social distancing to limit the spread of the virus. Particularly in large gatherings, the risk of possible exposure and infection is quite high. We recommend limiting social gatherings at this time.

What should I do if I have a fever or cough, have traveled from a country in which the virus is widespread, or have been in contact with a person confirmed to have COVID-19?

Every hospital has specific rules for the best way to handle these situations. The first step is to call your doctor’s office to inform them of your symptoms, travel, or contact with someone who has a confirmed case of COVID-19. Do not simply go to your doctor’s office. It is very important to limit the spread of the virus. Particularly if you have symptoms, it is best to call your doctor first to determine whether you need testing and/or to come in for evaluation.

I am worried that doctors, even obstetricians, will be diverted in an emergency setting and may not be available when I am delivering. Will that be the case?

At this time, there is no plan for any other doctors to be pulled from their regular duties to staff other parts of the hospital. Obstetrics is an essential component of health, and it is unlikely that an ob/gyn will not be present at the time of your baby’s birth. Ask your health care team about this.

For more information about the new coronavirus and COVID-19, please see Harvard Health Publishing’s Coronavirus Resource Center.

Source: https://www.health.harvard.edu/blog/pregnant-and-worried-about-the-new-coronavirus-2020031619212?utm_campaign=shareaholic&utm_medium=email_this&utm_source=email]

Is it ethical to recruit doctors from countries with physician shortages?

cjWendy Glauser  2019 May 6; 191(18): E512–E513.

To help address its physician shortage, Nova Scotia is recruiting doctors in the UK.

As Nova Scotia looks to the United Kingdom for doctors, and Britain comes under fire for importing more doctors than it trains, health human resource experts are calling for ethical and local solutions to Canada’s physician shortage.

Staff from the Nova Scotia Office of Immigration, the Nova Scotia Health Authority and the College of Physicians and Surgeons of Nova Scotia recently traveled to four cities in England and Scotland to meet with 36 doctors interested in working in the province. The Nova Scotia Office of Immigration launched a fast-track immigration stream for recruiting and processing doctors last year, according to Lynette MacLeod, a media relations adviser for the office.

Meanwhile, the UK is facing its own physician shortage. According to data from the General Medical Council, 53% of new physician hires at the National Health Service (NHS) come from another country, up from 39% in 2015. Simon Stevens, head of the NHS, called on Britain to stop “denuding low-income countries of health professionals they need.” Most of the recruits come from eastern Europe and India.

Ivy Bourgeault, who holds the Canadian Institutes of Health Research Chair in Gender, Work and Health Human Resources, says it is “not ethical” to recruit from the UK. “They have incredible shortages of GPs … this is being exacerbated by Brexit,” she says.

In Nova Scotia, however, the focus is on the shortage at home. Grayson Fulmer, senior director of medical affairs for the Nova Scotia Health Authority, pointed out that 5% of Nova Scotians are in need of a family doctor. “Just as Nova Scotian physicians are lured to other work environments for competitive offerings, we have a duty to our population to provide access to health care wherever possible,” Fulmer wrote in a statement. “This is a timely and complex issue.”

With 25% of its doctors educated abroad, Nova Scotia’s foreign-trained doctor ratio is in line with Ontario and other provinces. (In Saskatchewan, meanwhile, 50% of doctors are foreign-trained). Overall, data from the Canadian Medical Association show that, in 2018, around 26% of doctors working in Canada were trained abroad. That percentage has held steady over the last decade. Many come from low- and middle-income countries.

“Our dependency ratio on foreign-trained doctors hasn’t really shifted. It’s built into the body and soul of the Canadian health system,” says Ronald Labonté, a Canada Research Chair in Contemporary Globalization and Health Equity. “Under that sort of circumstance, I think Canada has a larger moral obligation to … make sure there are adequate resource transfers to lower- or middle-income countries.”

Numerous suggestions have been floated about how high-income countries could compensate lower-income countries for the brain drain, such as increasing foreign aid, but none have been adopted. Labonté proposes that income tax gathered from doctors from nations with severe physician shortages could be funnelled back to their home countries. No matter how compensation is structured, it should be invested in these countries’ health systems, Labonté argues, to address the common “push factors” that cause doctors to leave — namely, that they are underpaid and working in under-resourced health systems.

Bourgeault says Canada should be taking steps internally to solve its physician distribution and supply issues. “We need to be doing better at health workforce planning, which we are pathetic at,” she says. “It’s inexcusable, that as a high-income country that has invested millions in data on the patient side, we don’t invest the money [to gather and analyze] the data on the health workforce side.”

In addition to better health workforce planning, Canada should focus on increasing rural training opportunities, streamlining processes for licensure in multiple provinces, exploring how to “bring Canadian physicians back” if they are practising abroad, and better utilizing nurse practitioners and physician assistants, Bourgeault suggests.

She adds that recruiting abroad is typically not an effective measure to fill needs in rural areas in the long term. A 2012 study found that a majority of international medical graduates practising in Newfoundland left the province after gaining full licensure. “You have to look at the broader ethics of recruiting, and most people don’t,” says Bourgeault, who estimates that Canada saves about $1 million in training costs for each foreign-trained physician hired.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509029/



Heatwaves Linked to Greater Risk of Preterm Births

By Traci Pedersen  Associate News Editor   Last updated: 26 Feb 2020

A new study reveals that heatwave exposure during the week before birth is strongly linked to an increased risk of preterm delivery — the hotter the temperature or the longer the heatwave, the greater the risk. In particular, longer duration heatwaves are associated with the highest risk of a preterm birth.

“We looked at acute exposure to extreme heat during the week before birth, to see if it triggered an earlier delivery,” said first author Sindana Ilango, a Ph.D. student in the Joint Doctoral Program in Public Health at the University of California (UC) San Diego and San Diego State University. “We found a consistent pattern: exposure to extreme heat does increase risk. And, importantly, we found that this was true for several definitions of “heatwave”. The findings are published in the journal Environment International.

“We knew from previous studies that exposure to extreme heat during the last week of pregnancy can accelerate labor,” said senior author Tarik Benmarhnia, Ph.D., assistant professor of epidemiology at UC San Diego School of Medicine and Scripps Institution of Oceanography.

“But no one had tried to figure out exactly what kinds of conditions could trigger preterm births. Is it the temperature? Is it the combination of the temperature and the humidity? Is it the duration of the heatwave? It’s important to ask these questions to know when we need to intervene and inform pregnant people to stay inside and stay cool.”

Preterm birth is defined as birth before 37 weeks of pregnancy, which typically lasts at least 40 weeks. Early birth can cause a variety of health problems in infants, from respiratory and cardiac ailments and difficulty controlling body temperature to increased risk for brain hemorrhages and long-term health concerns such as cerebral palsy, mental health issues, learning difficulties, and vision and hearing problems.

“Identifying risk factors that can contribute to increased preterm birth rates is an important piece of improving birth outcomes,” Ilango said. While previous studies of this kind have been conducted in other countries, including Canada, China, and Australia, this is the first of its kind to be completed in the United States.

The new study also incorporated information about ambient humidity into the data, which affects the “feels like” temperature in a region.

“In coastal California, due to climate change, we’re seeing more humid heat waves,” said Benmarhnia. “Humid air holds heat longer, which can keep temperatures high overnight, contributing to longer heatwaves. This could be important for the recommendations given to pregnant people — it might not be enough to stay inside just during the day, we might have to think about what to do for night temperatures, too.”

The research team used data collected by the California Department of Public Health that included information about every single birth in the state of California between 2005 and 2013, comprising nearly 2 million live births during the summer months. Then they categorized individuals based on their zip code and compared the birth outcome data to environmental records for that area at the time the woman went into labor.

“California is an interesting region for this study because it has a very diverse population spread across a wide variety of microclimates, providing a lot of variation in the data to help us tease apart the relationship between high temperatures and preterm birth rates,” said Benmarhnia.

The researchers found that while the baseline rate of preterm birth was around 7 percent of all pregnancies, under the most conservative definition classifying a heatwave (an average maximum temperature equal to or greater than the 98th percentile, averaging 98.11 degrees and lasting at least four days), the risk of preterm birth was increased by 13 percent.

While the results were in line with the researchers’ hypothesis, “it was surprising how strong the trend was,” said Ilango. “It was so clear that as temperature and duration of a heatwave went up, so did the risk of preterm birth.”

“We were also surprised to note that the duration of the heatwave seems to be more important than the temperature threshold,” added Benmarhnia. “We thought that temperature would matter the most, but it turns out that it has more to do with how long you’re stuck with the high temperatures rather than how hot it is outside.”

These findings could be used for directly informing recommendations for families faced with high temperatures in their region, as communities use regional weather trends to determine how they define a heatwave and when to issue warnings for pregnant people to stay in air conditioned spaces.

Source: University of California- San Diego https://psychcentral.com/news/2020/02/26/heatwaves-linked-to-greater-risk-of-preterm-births/154502.html


How to protect your family’s mental health in the face of corona virus disease (COVID-19)

A conversation with adolescent psychology expert Dr. Lisa Damour.


Parents and children are facing major life disruptions with the outbreak of coronavirus disease (COVID-19). School closures, physical distancing, it’s a lot to take in and it’s difficult for everyone in the family. We sat down with expert adolescent psychologist, best-selling author, monthly New York Times columnist and mother of two Dr. Lisa Damour to learn more about how families can support each other and make the most of this new (temporary) normal.

UNICEF: How can teenagers and parents take care of their mental health during the coronavirus disease (COVID-19) outbreak?

Dr. Damour: The first thing that parents can do is actually to normalize the fact that they [teenagers] are feeling anxious. Many teenagers have the misunderstanding that anxiety is always a sign of mental illness when in fact, psychologists have long recognized that anxiety is a normal and healthy function that alerts us to threats and helps us take measures to protect ourselves. So it’s very helpful for teenagers if you say, “You’re having the right reaction. Some anxiety right now makes sense, you’re supposed to feel that way. And that anxiety is going to help you make the decisions that you need to be making right now.” Practicing social distancing, washing your hands often and not touching your face — your anxiety will help you do what needs to be done right now, so that you can feel better. So that’s one thing we can do.

Another thing we can do is actually help them look outward. Say to them, “Listen, I know you’re feeling really anxious about catching coronavirus, but part of why we’re asking you to do all these things  — to wash your face, to stay close to home — is that that’s also how we take care of members of our community. We think about the people around us.” And then give them further things to do that may be of help: perhaps dropping off food to people in need or going shopping for them or figuring out what areas of our community need support and doing things to support the people around them while maintaining social distance. Finding ways to care for others will help young people feel better themselves. And then the third thing to help with anxiety is to help young people find distractions. What psychologists know is that when we are under chronically difficult conditions — and this is certainly a chronically difficult condition that’s going to go on for a while — it’s very helpful to divide the problem into two categories: things I can do something about, and then things I can do nothing about. There’s going to be a lot in that second category right now, where kids are going to have to live with a pretty difficult situation for a while. Researchers have found that finding positive distractions can help us deal with that second category: we do our homework, we watch our favourite movies, we get in bed with a novel. That is a very appropriate strategy right now. There’s probably a lot to be said for talking about coronavirus and anxiety as a way to seek relief, and there is also a lot to be said about not talking about it as a way to seek relief. Helping kids find that right balance will make a big difference.

UNICEF: On distractions, it’s going to be tempting for a lot of teenagers to bury themselves in screens right now. How can parents and teenagers best handle that?

Dr. Damour: I would be very up front with a teenager and say, “Okay, you and I both know you’ve got a heck of a lot of time on your hands, but you and I both know that it’s not going to be a good idea to have unfettered access to screens and/or social media. That’s not healthy, that’s not smart and it may amplify your anxiety. We really don’t think you having a social media free-for-all is a good idea under any condition. So the fact that you’re not in school and your time isn’t being taken up by classes doesn’t necessarily mean that all of that time should be replaced with social media.” But I think you just say that in a very up-front way which acknowledges that, naturally, there’s no way that the time spent in school will be entirely replaced with being online. And then ask the teenager, “How should we handle this? What should our plans be? What do you propose in this new normal or new short-term normal. Your time is no longer structured in the ways you’re accustomed to, come up with a structure and show me the structure that you have in mind, and then we can think it through together.”

UNICEF: Is structure key to maintaining a sense of normalcy?

Dr. Damour: Kids need structure. Full stop. And what we’re all having to do, very quickly, is invent entirely new structures to get every one of us through our days. And so I would strongly recommend that parents make sure that there’s a schedule for the day, that there’s a plan for how time will be spent — and that can include playtime where kids can get on their phones and connect with their friends, which of course they’re going to want to do. But it also should have technology-free time, time set aside to help with making dinner, time to go outside. If you can be outside you should. We need to think about what we value and we need to build a structure that reflects that, and it will be a great relief to our kids to have a sense of a predictable day and a sense of when they’re supposed to be working and when they get to play. I would say for kids under the age of 10 or 11, the parent should come up with a structure and then negotiate from there with their child and see if there’s any feedback that makes good sense. For children 10 and 11 or older, I would ask the child to design it — and give them a sense of the kinds of things that should be part of that structure, and then work with what they create.

UNICEF: What tips would you give parents who are building a structure for younger children?

Dr. Damour: I think we have to recognize that younger kids actually do sit in class for periods of the day and tolerate the interruptions and annoyances of a lot of kids around them, and they won’t have to tolerate those when they’re at home. Which is to say that I don’t think we should underestimate their ability to work in a focused way from home. That said, every family knows their child best and it may be ideal, depending on who is supervising them (I realize that not every parent is going to be home to do this), to structure their day so that all of those things that need to get done get done before anything else happens: All of their schoolwork, all of their chores, all of their have-to-do activities versus get-to-do activities. For some families, doing that at the start of the day will work best for kids. Other families may find that it works well to start the day a little bit later, to sleep in, to enjoy a longer breakfast together, and then get rolling at 10 or 11 in the morning. Every family gets to do it their own way. I also want to add something that some people may be reluctant to voice: We’re stuck with this, so to the degree you can enjoy it — you should. If this means you’re making pancakes as a family for breakfast and that is something that was never a possibility on a normal school day and that’s something that makes everybody happy, enjoy that.

Here’s the bottom line: Kids need predictability — as much predictability as you can offer in a situation like this. So don’t wake up every day and figure out the schedule. Try a schedule, or maybe try a provisional one for a week as a family and then review it at the end of the week.

We should remember that they are the passengers in this and we are driving the car.”

UNICEF: How important is a parent’s own behaviour in a time of crisis?

Dr. Damour: Parents, of course, are anxious too and our kids know us better than we know ourselves. They will take emotional cues from us. I would ask parents to do what they can to manage their anxiety on their own time – to not overshare their fears with their children. That may mean containing emotions, which may be hard for parents at times especially if they’re feeling those emotions pretty intensely. I would want for parents to find an outlet for their anxiety that’s not their children. We should remember that they are the passengers in this and we are driving the car. And so even if we’re feeling anxious, which of course we will be, we can’t let that get in the way of them feeling like safe passengers in our car.

UNICEF: Should parents ask their children how they’re feeling on a regular basis or does that bring up more feelings of anxiety?

Dr. Damour: I think it depends on the kid. Some kids really keep to themselves and so it may be valuable for a parent to say, “How are you doing?” or “What are you hearing?” Other kids are going to be talking and talking and talking about it. The way we want to approach these things is to find a good balance between expression and containment. You want some expression and feeling, especially at a time when we should expect kids to have some pretty intense feelings, but you also want those emotions to feel contained. So if your kid is high on expression, you’re going to work on containment, if your kid is high on containment you’re going to help them with a little bit of expression.

UNICEF: Children may worry about catching the virus, but not feel comfortable speaking to their parents about it. How should parents approach the topic with them?

Dr. Damour: Parents should have a calm, proactive conversation with their children about the coronavirus disease (COVID-19), and the important role children can play in keeping themselves healthy. Let them know that it is possible that [you or your children] might start to feel symptoms at some point, which are often very similar to the common cold or flu, and that they do not need to feel unduly frightened of this possibility. Parents should encourage their kids to let them know if they’re not feeling well, or if they are feeling worried about the virus so that the parents can be of help. Adults can empathize with the fact that children are feeling understandably nervous and worried about COVID-19. Reassure your children that illness due to COVID-19 infection is generally mild, especially for children and young adults. It’s also important to remember that many of the symptoms of COVID-19 can be treated. From there, we can remind them that there are many effective things we can do to keep ourselves and others safe and to feel in better control of our circumstances: frequently wash our hands, don’t touch our faces and engage in social distancing.

UNICEF: There’s a lot of inaccurate information about corona virus disease (COVID-19) out there. What can parents do to help counter this misinformation?

Dr. Damour: Start by finding out what they are hearing or what they think is true. It’s not enough to just give your kid facts. If your child has picked up something that is inaccurate or picked up news that is not correct they will combine the new information you give them with the old information they have into a sort of Frankenstein understanding of what’s going on.  So ask them, “What are you hearing? When you see kids on social media or when you were last at the playground, what was being said?” Find out what they already know and start from there in terms of getting them on the right track. From there, adults should strongly encourage kids to trust and use reliable sources [such as UNICEF and the World Health Organization’s websites] to get information, or to check any information they might be getting through less reliable channels.

>> Get the latest information and tips to protect you and your family against the virus.

When it comes to having a painful feeling, the only way out is through.”

UNICEF: How can parents support their children who are experiencing disappointment due to cancelled events and activities?

Dr. Damour: Let them be sad and don’t try to guilt them out of it. Don’t say, “Other people have this worse than you.” Now your kid feels sad and guilty! That doesn’t make it better. Say to them, “You are having the right reaction. This really stinks. You’re not going to get to be with your friends. You’re not going to get to spend spring on college campus. You’re not going to get to go to this convention that you spent six months preparing for.” In the scope of an adolescent’s life these are major losses. And the other thing adults have to remember is we’ve never seen anything like this, and we’ve been around for a long time. They’ve never seen anything like this and they’re much younger. The disruption of four months in the life of a 14-year-old is a very great percentage of their time they remember being alive. This is bigger for them than it is for us.

A year in a teenager’s life is like seven years in an adult’s life. So, we have to have really high empathy for how big these losses feel. This is their one high school graduation for their whole life, this was their one sophomore spring on campus for their whole life. These are large-scale losses. Even if they’re not catastrophic, they’re really upsetting and rightly so to teenagers. So I would ask parents to expect and normalize that teenagers are very sad and very frustrated about the losses they are mourning and all kids are mourning losses right now. I happened to be around six teenagers yesterday who were leaving school who were deeply sad, and I said, “Go be sad. This is really yucky and this stinks, and you have every right to be sad.” When it comes to having a painful feeling, the only way out is through. When we allow people to feel sad, they usually feel better faster. So, empathy, empathy, support, support. Our kids deserve it. Our job as adults is to provide it. They’re having the right reaction. This is not what any of us would want.

UNICEF: What recommendations do you have for teenagers who are feeling lonely and disconnected from friends and activities?

Dr. Damour: This is where we now may appreciate social media in a whole new way! While adults can have such a jaundiced view of adolescents and social media, teenagers want to be with their friends. Under social distancing conditions: tada! They can be with their friends! Further, I would never underestimate the creativity of teenagers. My hunch is that they will find ways to play with one another online that are different from how they’ve been doing it before. And so I would not hold a dim view of all social media right now. I would just make sure that it’s not a wall-to-wall experience for kids because that’s not good for anybody.

UNICEF: What are some of the outlets teenagers can use to work through these difficult feelings and take care of their mental health?

Dr. Damour: I think every kid is going to do this in a different way. Some kids are going to make art, some kids are going to want to talk to their friends and use their shared sadness as a way to feel connected in a time when they can’t be together in person. Some kids are going to want to find ways to get food to food banks. I would just say know your kid, take your cues from your teenager, and really think a lot about balancing talking about feelings with finding distractions and allow distractions when kids need a relief from feeling very upset.

UNICEF: Some children are facing abuse at school or online around the coronavirus outbreak. What should a child do if they are experiencing bullying?

Dr. Damour: Activating bystanders is the best way to address any kind of bullying. Along these lines, all parents should tell their children that if they witness bullying, they should reach out to the victim or find an adult who can help.

UNICEF: How can parents make the most of the situation?  If you’re able to be with your kids, how can you have fun together while you’re stuck at home?

Dr. Damour: In our house — I have two daughters — we’ve decided that we are going to have a dinner team every night. We’re going to create a schedule of who’s in charge of dinner and sometimes it’ll be me and my spouse and sometimes it’ll be me and one of my daughters. We’ll mix it up in pairs, and my older daughter is a teen and my younger daughter is elementary-school age, so there will be nights where the two girls are in charge of things. And so, we rotate who is in charge of making dinner for the family. We often don’t get the time to make dinner as a family. We don’t usually have the time in the day to enjoy cooking together, so we’re doing that.

I have been making a list of all of the things I want to do with myself: the books I want to read and the things that I’ve been meaning to do — I’ve been meaning to teach my younger daughter how to knit and she’s been asking, so if she’s still interested we’ll be knitting! We’re thinking about having a movie night every three or four nights and we were thinking that the dinner team gets to choose the movie. Every family has their own rhythm and culture and the challenge right now is to invent structures — to pluck them out of thin air. But we can do that, and it’s what our kids need.

Source: https://www.unicef.org/coronavirus/how-protect-your-familys-mental-health-face-coronavirus-disease-covid-19





Coronavirus – Risks for preterm born infants: An interview with Professor Doctor Christoph Bührer

Posted on 09 March 2020

The Coronavirus disease (COVID-19) and its distribution is on everyone‘s lips and speculations run high. Especially older people and persons with a pre-existing medical condition appear to be develop a serious illness more often than others (WHO). This might leave parents-to-be, parents of preterm born infants and former preterms worrying. We talked to Professor Doctor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin about the risks he sees for unborn babies, preterm born infants and preterm born adults.

Professor Bührer, can corona virus pass from pregnant woman to her unborn infant?
At present, the most likely mode of transmission in all newborn infants with COVID-19 infection analysed so far is postnatal transmission. No case of intrauterine transmission has been documented. This do not exclude the possibility that transmission before birth may happen, but it is very unlikely.

What kind of risk of corona infection do you see for preterm born infants?
Infants, as compared to adults, have a much lower risk of getting infected with the new corona virus. Moreover, they are also less likely to develop symptoms. In China, only 9 infants less than 1 year of age were identified by early February 2020, at a time when the total number of infected people had already risen to more than 50,000. None of the infants with a positive test result was seriously ill, none of them was admitted to an intensive care unit. At present, there is no specific data for preterm infants available. As manuscripts on the epidemiology of COVID-19 are published at high speed, there is reason to assume that infants, both term and preterm, are just not the prime target of this virus. If a COVID-19 infection turns into pneumonia, preterm infants with bronchopulmonary dysplasia should be expected develop more serious symptoms (such as shortness of breath, increased rates of breathing, or poor oxygenation) than those with healthy lungs, so they would be more likely to be tested for COVID-19. However, there is lack of reports on COVID-19 ravaging preterm infants which is rather reassuring.

Is the risk of an infection higher for a preterm born adult?
If a COVID-19 infection turns into pneumonia, anybody with a chronic lung condition (such asthma, cystic fibrosis, or former preterm infants who had bronchopulmonary dysplasia) will have more trouble coping with the disease. These people may need more medical help than somebody who is completely healthy. As COVID-19 and flu (notably H1N1) have a similar attack rates, adults and adolescents born very preterm are advised to get vaccinated against influenza.

We would like to thank Prof Bührer for taking time to give this interview.

Note: To avoid infection with COVID-19 it is advisable to frequently wash your hands. If you want to promote handwashing in your organisation, find useful materials such as posters, flyers and colouring pictures at: www.efcni.org/activities/campaigns/wash-your-hands/

Source: https://www.efcni.org/news/coronavirus-risks-for-preterm-born-infants-an-interview-with-professor-doctor-christoph-buhrer/



World Prematurity Day 2019: How Fathers Can Take Care of Wife and Preemie

You need to comfort and support your baby and your partner and realize that you’re making a difference. Remember, the father can connect with the newborn from the very beginning.

News18.com  Updated: November 17, 2019, 11:20 AM IST

As a father, you are the first point of contact for the doctors after the birth of your baby. You are the first to learn about your premature baby’s condition and inform your partner, friends and family about the same.

The father can connect with the newborn from the very beginning. It has been found that men experience a surge in “bonding” hormones around the time their children are born. The earlier you hold your premature baby and engage in her care, the more likely you’re to feel satisfaction, affection and love for your baby. No wonder why they say, it’s an evolutionary response to turn men into dads!

You’re a vital member of the team at the Neonatal, Intensive Care Unit, that’s working to make your baby stronger. Being a NICU dad can be difficult but that’s when you need to step up and do all the things proactively. You need to comfort and support your baby and your partner and realize that you’re making a difference. The more time you spend in the NICU, the better it is for your child’s development.

Remember to take kangaroo care which is a simple act of spending a lot of time with your baby, wherein you maintain a constant skin to skin contact and constant communication with them. It is important to talk to the preemie as it aids in the development of their cognitive faculties. Know that your baby recognizes your voice and touch. According to American Academy of Pediatrics, skin-to-skin or kangaroo contact improves infant’s respiratory patterns and increases the rate of infant’s ideal weight gain.

It is important to being hands on with the daily care. You want to be involved in feeding, changing nappies or settling your baby which helps create one-on-one time with your baby.

Premature babies can get stressed easily and signs such as heart rate and oxygen levels are an indication of the same. You can always check with the nurse on what you can do.

Amidst all this, it’s normal and understandable to feel lost or stretched between responsibilities at home which includes looking after other children, hospital and work. Your needs can sometimes get forgotten too, with family and hospital staff focusing on your premature baby and your partner.

You may be undergoing a plethora of emotions; sometimes anxiety and fear and other times overwhelming love and pride. You and your partner may experience the same feelings but not always at the same time. Key is to be patient and to reassure her, help with the demand of pumping milk and praise her for her efforts.

It therefore becomes important to take some time out to spend with your partner. Couples therapy is a way to go about it. Couples should make it a point to spend time with each other as it not only strengthens their bond but also helps the baby to become accustomed to both the parents. If you’re in the NICU, it can also help your partner feel more confident about the situation. Your support can be of encouragement to her, for her well-being and mental health.

(Dr Preeti Gangan, IBCLC certified consultant, Pediatrician)




Preterm babies are more likely to be diagnosed with reactive attachment disorder

Date: March 12, 2020 Source: University of Turku


Premature birth, low birth weight, and neonatal intensive care are associated with the risk of being diagnosed with reactive attachment disorder (RAD). The disorder causes problems in emotional bonding, social interaction, and expression of emotions, and it can lead to severe and expensive consequences later in life. The disorder will impair child’s social interactions and it is connected with later child protection issues, psychiatric and substance use disorders, and social exclusion.

A new study by the Research Centre for Child Psychiatry of the University of Turku, Finland, suggests that premature babies have the risk of reactive attachment disorder that can impair child’s ability to function in normal situations and their social interactions and it is connected with later child protection issues, psychiatric and substance use disorders, and social exclusion.

“The study showed that children’s risk of being diagnosed with reactive attachment disorder increases by three times if their gestational age at birth is less than 32 weeks. The risk was twofold if the birth weight was less than 2.5 kilos, or if the newborn required monitoring in a Neonatal Intensive Care Unit, says lead author,” researcher Subina Upadhyaya.

The results acknowledged parental age and psychiatric and substance abuse diagnoses, and mother’s socioeconomic status and smoking. Therefore, the association between attachment disorder and early preterm birth is not due to differences in these parental background or lifestyle differences between the diagnosed and the control group.

This is the first population study to report perinatal and obstetric risk factors for RAD. Previously, the research group discovered an association between parental mental health diagnosis, parental substance abuse and RAD.

Results support family-centered treatment

According to Professor in Child Psychiatry Andre Sourander from the University of Turku, the results benefit the planning of preventive and early mental health services.

“The fact that premature birth is so strongly associated with reactive attachment disorder is an important finding. It indicates that family-centered support of early parent-infant interactions and need for care should be taken into account when treating premature babies, says Sourander,” who led the study.

Sourander says that most of the children in the study were born in the 1990s and early 2000s. Treatment practices have changed since then in many countries.

“The management of premature infants should be multidisciplinary and personalised. Parent-infant interaction and family-centered care have recently received attention, and the care of premature infants has become increasingly comprehensive. The practice of skin-to-skin care is increasingly becoming popular worldwide. Early parental-infant closeness should be encouraged in centers that care for preterm infants.

“In the future, it is important to determine whether the independent relationship of prematurity to RAD has decreased as treatment practices have changed,” Professor Sourander concludes.

All the children who were born in Finland between 1991-2012 and diagnosed with RAD were included in the study. There were a total of 614 cases and 2423 controls. The study was part of Inequalities, Interventions, and New Welfare State research flagship funded by Academy of Finland.

Source: https://www.sciencedaily.com/releases/2020/03/200312101031.htm





More internationally educated nurses in hospitals may result in a stable nursing workforce

Having more nurses trained outside of the United States working on a hospital unit does not hurt collaboration among healthcare professionals and may result in a more educated and stable nursing workforce, finds a new study by researchers at NYU Rory Meyers College of Nursing published in the journal Nursing Economic$.

Internationally educated nurses–who receive their primary nursing education outside of the country where they currently work–have become an important part of the nursing workforce in many countries. In the U.S., recruiting internationally educated nurses has been used to address nursing shortages. While the true number of internationally educated nurses in the U.S. is difficult to capture, it is estimated that 5.6 to 16 percent–or 168,000 to 480,000–of the country’s more than 3 million nurses were educated in another country.

Internationally educated nurses often face challenges when transitioning to practice in the U.S. because of cultural, language, and healthcare system differences. While internationally educated nurses can help mitigate nursing workforce shortages, there is little research on their impact on quality of care and patient outcomes, and the findings have been mixed.

In this study, the researchers looked at the proportion of internationally educated nurses on hospital units and evaluated whether this affects collaboration among health professionals and other factors of hospital units. They used 2013 survey data from the National Database of Nursing Quality Indicators, analyzing responses from 24,045 nurses (2,156 of whom were trained outside the U.S.) working on 958 units across 160 U.S. acute care hospitals. Collaboration on a unit was measured using a nurse-nurse interaction scale and a nurse-physician interaction scale.

The researchers found having more internationally educated nurses did not lead to decreased collaboration among nurses and between nurses and physicians. This is important because collaboration among healthcare professionals is a fundamental aspect of quality work environments and can result in positive patient outcomes and satisfaction.

Interestingly, units with higher proportions of internationally educated nurses had notable differences, including factors that could both help and hurt patient care. For example, units with more internationally trained nurses had nurses with higher levels of education, which may be because internationally educated nurses are more likely to have a baccalaureate degree in order to qualify for and pass the U.S. nursing licensure exam.

“Research shows that having more nurses with bachelor degrees improves patient safety, so it is possible that internationally educated nurses are contributing to improved health outcomes,” said Ma.

Units with more internationally trained nurses also had less turnover, as these nurses are likely to stay in a job longer than their U.S.-educated peers.

“In other words, units with more internationally educated nurses have a more stable nursing workforce. Not only can lower turnover rates reduce recruiting and hiring expenses, but they are also linked to fostering collaborative environments among nurses,” said Ma.

In contrast, units with more internationally trained nurses had worse nurse staffing levels or higher patient-to-nurse ratios, despite these nurses being recruited to address shortages. Worse staffing levels have been shown to hurt collaboration and could potentially worsen patient outcomes.

The researchers note that hospitals and nurse recruitment agencies can play important roles helping to integrate internationally educated nurses into the U.S. workforce–for instance, providing training on the basics of the U.S. healthcare system, creating peer mentoring programs, and running workshops on culture, communication, and teamwork.

“Given the ongoing nursing workforce shortage, especially in rural areas, nurse managers and hospital administrators should not be reluctant to hire qualified internationally educated nurses to fill vacancies,” said Ma. “In addition, nurse managers and peer nurses should recognize the contributions of their internationally educated colleagues, who are part of more stable, educated nursing teams. Recognizing the value of individual nurses can lead to a healthy work environment and workforce, which contributes to high quality patient care and outcomes.”

Source: https://www.news-medical.net/news/20200218/More-internationally-educated-nurses-in-hospitals-may-result-in-a-stable-nursing-workforce.aspx?utm_source=news_medical_newsletter&utm_medium=email&utm_campaign=nursing_newsletter_9_march_2020



Severe BPD Ventilator Strategies: A Quick Guide

Prevention of bronchopulmonary dysplasia (BPD) is a primary focus of treatment when an infant is born preterm. An infant who needs ventilator support does best with low tidal volumes and short inspiratory times to try and prevent lung injury during the acute course of lung disease.

However, once lung injury has occurred and the patient is diagnosed with BPD, some patients are still taken care of as if they have acute lung disease, says Leif Nelin, MD, chief of the Division of Neonatology at Nationwide Children’s Hospital and a founder of the national Bronchopulmonary Dysplasia Collaborative. In fact, ventilator strategies and settings must change dramatically after severe BPD is established. The collaborative has published a review of best practices for the interdisciplinary care of children with severe BPD, and included recommendations for ventilator and gas exchange strategies. This chart provided is a guide, adapted from those recommendations and current clinical practice at Nationwide Children’s Hospital.

This chart, adapted from the Bronchopulmonary Dysplasia Collaborative, shows the differences in strategies between the first week of life, when prevention is the goal, and later, when severe BPD has been established ENTER HERE: https://www.nationwidechildrens.org/for-medical-professionals/tools-for-your-practice/connect-with-nationwide-childrens/pediatrics-online/severe-bpd-ventilator-strategies


Babies born prematurely can catch up their immune systems, study finds

by King’s College London – March 9, 2020

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

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

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

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

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

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

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

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

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

Source: https://medicalxpress.com/news/2020-03-babies-born-prematurely-immune.html



Emotional First Aid for Those on the Front Lines of COVID-19

By Nicholette Leanza, MEd, LPCC-S    Last updated: 31 Mar 2020

The stress that COVID-19 has placed on our health care workers is immense. Exhaustion, frustration and feeling overwhelmed has become a daily norm for many of our beloved medical professionals who are on the frontlines fighting COVID-19. Hospitals struggle to find space to help those with the virus while at the same time continuing to care for all their other patients too. “All hands on deck” is not just a term used for a crew of a ship but can now also be used for a crew of a hospital.

During this very difficult time, it’s more important than ever that we take care of our doctors, nurses and other health care professionals as we battle this pandemic. Since these are unprecedented times, typical stress management techniques are not enough to help these caring professionals deal with their stressful jobs. They need an emotional first aid kit to promote a resilient mindset as they battle this devastating virus.

Here are some emotional first aid tips to help those on the front-lines battling COVID-19:

You are not alone.

At times, it can feel like a lonely and uphill battle fighting COVID-19, especially after a long and grueling shift. Remember you are not alone; you are part of a medical team and system fighting this pandemic and can also feel confident that your loved ones and your community are behind you in this fight. The duty to care and to protect others is probably part of what drives you to get up and go to work every day, but just remember you are not doing it alone. You are part of a band of brothers and sisters combatting this virus. We are truly all in this together.

Compassion for Yourself

It’s more important than ever to remember to be kind to yourself during this challenging time. You are dealing with frustration and grief everyday especially as we continue to understand and get ahead of this virus.

You are probably surrounded by the virus every moment of your day as you care for your patients at work and then come home where your loved ones are talking about it as well. You may not even be able to escape it as the media inundates us with information about COVID-19 throughout the day. The ultimate compassion you can show yourself is to soothe your stress in whatever way that works best for you.

Find moments throughout your day where you take a mental break and decompress. Self-care is key! Sleep, hydrate, exercise, connect with family/friends, play video games, watch Netflix. Pamper yourself. Don’t forget to enjoy your pets, they miss and love you too.

Know Your Worth

You may already know that you do a very important job but now more than ever, you will be a part of history as we battle this epic virus. You are brave and courageous. You persevere even when you’re so exhausted both mentally and physically. Be proud of the work you do each day and who you are. Society salutes you and stands behind you and let this be the motivation that helps keep you going.

Know that this is not going to last forever.

There are so many unknowns related to COVID-19 which is what instills a lot of collective anxiety but do know that this pandemic will end. There will be a point when we will be able to breathe easier and slow down. We will have learned so much not just about COVID-19 but about ourselves and our resilience as a species on this planet. We may only initially remember the dire effects of the pandemic, such as the grief and loss it brought to us, the loss life as well as the limits to our freedom as we abided by the safety measures to contain the virus. But do believe that ultimately, we will prevail as we always do to overcome hardship as a collective human spirit.

Please use this emotional first aid kit as a tool for yourself as you care for those with COVID-19. Please remember to be grateful for your team as you are not alone in this fight, to be compassionate and gentle with yourself as you are such an important soldier in this battle that will not last forever because we will win the