Rank: 12  –Rate: 14.9%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

The Philippines is an archipelagic country in Southeast Asia. It is situated in the western Pacific Ocean and consists of around 7,641 islands that are broadly categorized under three main geographical divisions from north to south: LuzonVisayas, and Mindanao. The Philippines is bounded by the South China Sea to the west, the Philippine Sea to the east, and the Celebes Sea to the southwest. It shares maritime borders with Taiwan to the north, Japan to the northeast, Palau to the east and southeast, Indonesia to the south, Malaysia to the southwest, Vietnam to the west, and China to the northwest. The Philippines covers an area of 300,000 km2 (120,000 sq mi) and, as of 2021, it had a population of around 109 million people, making it the world’s thirteenth-most populous country. The Philippines has diverse ethnicities and cultures throughout its islands. Manila is the country’s capital, while the largest city is Quezon City; both lie within the urban area of Metro Manila.

The Philippines is an emerging market and a newly industrialized country whose economy is transitioning from being agriculture-centered to services- and manufacturing-centered. It is a founding member of the United NationsWorld Trade OrganizationAssociation of Southeast Asian Nations, the Asia-Pacific Economic Cooperation forum, the East Asia Summit and a member of the Non-Aligned Movement since 1993. The Philippines’s position as an island country on the Pacific Ring of Fire that is close to the equator makes it prone to earthquakes and typhoons. The country has a variety of natural resources and is home to a globally significant level of biodiversity.

There were 101,688 hospital beds in the country in 2016, with government hospital beds accounting for 47% and private hospital beds for 53%. In 2009, there were an estimated 90,370 physicians or 1 per every 833 people, 480,910 nurses and 43,220 dentists. Retention of skilled practitioners is a problem. Seventy percent of nursing graduates go overseas to work. As of 2007, the Philippines was the largest supplier of nurses for export. The Philippines suffers a triple burden of high levels of communicable diseases, high levels of non-communicable diseases, and high exposure to natural disasters.

There is improvement in patients access to medicines due to Filipinos’ growing acceptance of generic drugs, with 6 out of 10 Filipinos already using generics. While the country’s universal healthcare implementation is underway as spearheaded by the state-owned Philippine Health Insurance Corporation, most healthcare-related expenses are either borne out of pocket or through health maintenance organization (HMO)-provided health plans. As of April 2020, there are only about 7 million individuals covered by these plans.

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

This month’s blog embraces the Philippines, our 71st country-focused blog. Throughout our journey you have inspired and amazed us, touched our hearts and fueled our imaginations. We have explored the breadth of our associations, witnessed the global diversities, similarities, needs, barriers, challenges and resources present within our Preterm Birth community. Kat and I began our journey with eyes wide open, minds full of curiosity, hearts wary yet open, following an unseen but deeply compelling call to serve the Community in some guided capacity.  We always knew we would receive more than we could ever give. We appreciate and thank you for who you are and your presence in our lives. Within your eternal perfection, such goodness, strength and love abide.


Socioeconomic Disparities in Adverse Birth Outcomes in The Philippines

Ryan C.V. Lintao Erlidia F. Llamas-Clark Ourlad Alzeus G. Tantengco Open Access Published: April 10, 2022DOI:https://doi.org/10.1016/j.lanwpc.2022.100453

Kaforau et al. reported the burden of adverse birth outcomes and their risk factors in the Pacific Islands region. Preterm birth prevalence was 13.0%, while low birth weight was 12.0%. Malaria, substance use, obesity, and poor antenatal care were the most significant risk factors associated with adverse birth outcomes.

 The Philippines, a lower-middle-income country in the Asia Pacific, continues to experience challenges in addressing adverse birth outcomes. We share the status and the socioeconomic disparities in adverse birth outcomes in the Philippines.

The latest health survey in 2017 showed a 3.0% preterm birth rate in the Philippines.

 Low birth weight (LBW) incidence was 11.9% in 2020.

 Moreover, in a newborn screening cohort from 2015 to 2016, 13.6% were small-for-gestational age.

 Increased antenatal care utilization, essential newborn care, and kangaroo mother care have decreased adverse birth outcomes and neonatal mortality.

 However, health inequalities prevail in the Philippines.

Despite no difference in LBW incidence between urban and rural areas, regional disparities exist. The national capital region, Metro Manila, had the lowest LBW rate (9.0%), while two regions in the southern Philippines had the highest LBW rates (Davao at 20.0%, and Zamboanga at 21.0%).

 Smokers were more likely to have LBW newborns (21.0%) than nonsmokers (14.0%), agreeing with Kaforau and colleagues findings. A cohort study examining maternal second-hand smoke (SHS) exposure showed significantly lower birth weight in the SHS-exposed group.

Pregnant women exposed to SHS had higher parity, lower educational attainment, and lower monthly household income.

Socioeconomic status and its proxy variables (e.g., educational attainment, household income, and occupation) were shown to affect birth outcomes in the Philippines. LBW incidence decreased with higher maternal educational attainment, with 17.7% of mothers who reached primary school level and 12.5% of mothers who reached college level having LBW newborns. Household wealth was a significant determinant of LBW: mothers in the lowest wealth quintile had higher LBW incidence (16.0%) than mothers in the highest quintile (12.5%).

With increasing socioeconomic inequality exacerbated by the ongoing pandemic, underlying social determinants must be recognized and addressed. We call for more research to investigate the country’s social determinants of adverse birth outcomes, which can be used as the basis for evidence-based policies and health services to improve maternal and neonatal outcomes. We also emphasize the need for good governance, gender equality, and equitable access to women’s and reproductive health services (antenatal care, basic emergency obstetric and neonatal care, and family planning) to reduce widening disparities in adverse birth outcomes.

Source:Socioeconomic disparities in adverse birth outcomes in the Philippines – The Lancet Regional Health – Western Pacific

Magnus Haven – Oh, Jo (Official Music Video)

Premiered Jun 26, 2022  Magnus Haven

Jo is a term of endearment among Kapampangans, which means special someone. So the love song pays tribute to that “Jo” or special someone. A statement of love echoing the romantic joy that that “Jo” brings to her partner’s life.

Pregnancy becomes a more vulnerable time with climate change

Wildfires, natural disasters, rising heat can lead to poor health outcomes for the expectant and their babies – By Katherine Kam – April 11, 2022

In the western United States, where massive wildfires have fouled the air with smoke and hazardous levels of pollutants, Santosh Pandipati, an obstetrician in California, counsels pregnant patients to always check air quality before they venture outside to exercise. “You need to plan your outdoor activities when the air quality is better,” he tells them.

In other parts of the country, where hurricanes and floods have displaced pregnant residents, obstetrician Nathaniel DeNicola has advised patients, including those he saw in New Orleans, to pack a preparedness kit.

In case of evacuation, “they might be away from home for a long time,” he said. DeNicola encourages people to include emergency drinking water, extra supplies of medications and a paper copy of their medical records. “If the power’s out, that’s not typically available” now that most records are electronic, he said.

As scientists study how climate change is affecting human health, pregnant people and their unborn babies are emerging as a vulnerable group.

Those who must evacuate during natural disasters are often extremely distressed and might find their pregnancy health care interrupted. “If you have to flee, how do you make sure you continue to have access to your OB/GYN or to the hospital you plan to deliver in?” said Pandipati, who has seen patients who have escaped wildfires. “If you end up needing to go live with family an hour or two hours away, you have a disruption in care.”

Pregnancy & Parenthood

It doesn’t take a catastrophe to create problems. Ongoing exposure to hot temperatures and air pollution might raise the risk of adverse pregnancy outcomes, such as preterm birth and low birth weight.

About 7,000 California preterm births linked to wildfire smoke risks, study says

Spurred by growing evidence on climate-related effects, Pandipati and DeNicola have tailored their medical advice, not to alarm people, but to prepare them. “The reality is that we need to start telling our patients right now that the climate is changing,” Pandipati said. “We need to empower patients.”

In 2016, the American College of Obstetricians and Gynecologists issued a position statement on climate change, calling it “an urgent women’s health concern and a major public health challenge.

Air pollution and heat exposure

Amid widespread changes wrought in the environment, air pollution and heat exposure have been significantly associated with preterm birth, low birth weight and stillbirth in the United States, according to a 2020 review published in JAMA Network Open. Such exposures are becoming increasingly common, according to the paper.

DeNicola, an obstetrician at the Johns Hopkins Health System in Washington, was one of the review’s co-authors.

Exposure to high temperatures can cause dehydration. During pregnancy, dehydration can lead to the release of oxytocin, a hormone that contributes to labor contractions, he said. “The extreme heat could very well be causing an increase in that mechanism,” DeNicola said. “It’s revved up.”

If labor occurs and a baby is born before 37 weeks, it’s a preterm birth, compared with a normal pregnancy of 40 weeks. Some of these newborns may have immature organ systems and experience trouble with breathing, feeding and regulating body temperature. Long term, premature babies might develop other problems, including learning disabilities and hearing or vision problems. The more premature the baby, the more serious the health risks.

Racial disparities in exposure

In the JAMA study, women of all races were at increased risk for poor pregnancy outcomes when exposed to heat and air pollution, but disparities emerged. Black women consistently had the highest risks of preterm birth and low birth weight, said Rupa Basu, an epidemiologist who also co-wrote the JAMA study. She is chief of the air and climate epidemiology section at the California Office of Environmental Health Hazard Assessment.

Because of historical redlining, higher-risk communities might be exposed to more pollution from sources such as freeways, she said. Residents may also dwell within “heat islands,” urban locations that have higher temperatures than outlying areas. “There’s less green space and more buildings and cement and blacktops to really absorb and retain the heat,” Basu said.

Anecdotally, Pandipati said he has seen the effects of heat waves on his patients, some of whom work in agriculture. He consults on high-risk pregnancies as a maternal and fetal medicine specialist with Obstetrix of San Jose. Some women travel to the Bay Area clinic from as far away as California’s Central Valley.

During one record-breaking heat wave before the pandemic, Pandipati noticed many ultrasounds with low levels of amniotic fluid in the womb — a situation that might require doctors to deliver a baby early. “These were moms who were saying that they don’t always have access to air conditioning, they’re often working more manually, either in agriculture or manual labor-type jobs, not always able to stay hydrated adequately,” he said. “I was starting to wonder, wow, I think this is really from the heat waves that we’re experiencing.”

“We just kept monitoring these pregnancies and then things just turned around and the fluid improved. They turned around as the heat wave dissipated,” he said. “We didn’t have to end up delivering them early.”

Air pollution and poor pregnancies

Air pollution, whether from urban pollutants or wildfires, has also been linked to poor pregnancy outcomes.

Air pollution affects preterm birthrates globally, study finds Wildfire pollution may have contributed to as many as 7,000 additional preterm births in California between 2007 and 2012, according to a study that Stanford researchers published in 2021. Wildfire smoke contains fine particulate matter called PM 2.5, which can enter the lungs and bloodstream to create serious health problems. The researchers hypothesized that wildfire pollution might have triggered an inflammatory response that led to preterm delivery.

Weather disasters and mental health

There’s debate about whether human-caused climate change is producing stronger or more frequent hurricanes. But Hurricane Sandy, which struck New York and New Jersey particularly hard in 2012, offered a glimpse into how such devastating superstorms can place severe stress on pregnant people.

In a 2019 study that looked at pregnancy complications in New York after Sandy, researchers found a heightened risk of problems such as early delivery and mental illness. The latter peaked about eight months after the hurricane. In the aftermath of community disasters, post-traumatic stress disorder, depression and anxiety can develop.

Natural disasters trigger a cascade of health consequences, DeNicola said. While there may not be direct cause and effect on birth outcomes, “a lot of it is considered to be because of the stress of the event, either the stress of evacuation or the stress of difficulty getting potable water, the stress of maybe not having the typical indoor living conditions that you’re expecting,” DeNicola said. “You’re not having heat or not having air conditioning.”

“There are a number of physical stressors and psychosocial stressors that come with bracing for a natural disaster like a hurricane and an evacuation,” he said. “People posit, and I think it’s a reasonable concern, that that all prompts some kind of cascade in pregnancy that creates things like preterm contractions.”

A safer pregnancy

Both obstetricians routinely talk to their patients about air and water.

“You need more hydration in pregnancy in general. A woman’s blood volume will increase roughly 50 percent during pregnancy,” DeNicola said. “That’s a lot of extra volume to maintain, so hydration’s really important anyway. I make the extra point that as the seasons get hotter, which happens more often now, you’ll need even more hydration and you need to be aware of things like preterm contractions that are prompted by extreme heat and dehydration.”

Pandipati said he warns patients to watch out for heat waves and to keep an eye on the air quality index, too.

“Ideally, 1 to 50 is good air quality. If you’re starting to get up into the 50 to 100 range, you need to start modifying your activities, doing less outdoor exercise, not as long, not as hard,” he said. “If you’re already not feeling well, you’re coughing, you already have respiratory illness, you shouldn’t be out there.”

Such illnesses include asthma, respiratory allergies and other chronic lung conditions, Pandipati said.

“By the time the AQI is 100, you need to just exercise indoors,” he said. “You need to plan your outdoor activities when the air quality is better, so usually, very early in the morning.” Air quality over 100 begins to enter the unhealthy range.

During wildfires, those who are pregnant must be especially careful about spending time outside, DeNicola said. “During covid, we all wear masks for everything, so it’s kind of redundant,” he said, “but I do mention that wearing a mask is advised and to really limit outdoor activity.”

Basu, the epidemiologist, has advocated for pregnant people to be included in heat advisories. “There are still a lot of heat advisories that don’t include pregnant women, but include other groups, such as the elderly,” she said. Many heat advisories also mention children, people with illnesses, even pets, but not pregnant people.

A natural experiment

A few pregnant patients have asked DeNicola about environmental concerns, but that small number is increasing, he said.

“I have had patients ask about where they should buy their new home because they heard that if you live near coal power plants, that could create worse air quality,” he said. “I’ve had them say similar things related to homes near a highway.”

Pandipati talks to fellow doctors about slipping climate change into the conversation naturally, for instance, while talking about outdoor exercise or staying hydrated during pregnancy. He tells doctors, “You don’t need to be an expert on climate emissions,” he said. “What you need to understand is that those emissions are leading to environmental changes that are now measurably increasing risks to the patients you care for.”

When DeNicola speaks to health-care professionals, he often mentions “a really strong natural experiment,” he said.

Researchers studied preterm birthrates before and after eight coal and oil power plants in California were retired. When the plants shuttered, pollution levels fell. In the 10 years following the closures, the rate of preterm births in the neighboring communities dropped 27 percent, a larger-than-expected reduction.

“When you knock out air pollution over a good 10-year period, the preterm birthrate dropped in a way that no other intervention can achieve,” DeNicola said. “It gives us a bit of hope.”

Doctors can start discussing climate change with pregnant patients, but in the long run, the solutions are much bigger, Pandipati said. “We need to be ensuring that we are enacting policies that stabilize or improve the environment, that really don’t neglect the science.”

“We’ve got to address the problem at the source,” he said. “That’s the real, ultimate preventive care.”


Chemicals Found in Cosmetics, Plastics Linked to Preterm Delivery

July 14, 2022

THURSDAY, July 14, 2022 (HealthDay News) – Phthalates, chemicals that are typically used to strengthen plastics, are in millions of products people use every day, but a new analysis confirms their link to a higher risk for preterm births.

The largest study to date on the topic analyzed data from over 6,000 pregnant women in the United States to better understand the link between phthalate exposure and pregnancy. It found that women with higher concentrations of phthalates in their urine were more likely to deliver preterm babies. Preterm babies, by definition, are delivered three or more weeks before their due date.

“Having a preterm birth can be dangerous for both baby and mom, so it is important to identify risk factors that could prevent it,” said senior study author Kelly Ferguson, an epidemiologist at the U.S. National Institute of Environmental Health Sciences (NIEHS).

For the study, the researchers pooled statistics from 16 studies conducted across the United States that included data on individual phthalate levels as well as the timing of the mothers’ deliveries, with the data spanning from 1983 to 2018. Approximately 9% (or 539) of the women delivered premature babies, with phthalate byproducts detected in over 96% of those urine samples.

The study, published online July 11 in JAMA Pediatrics, examined 11 different phthalates found in the pregnant women, and discovered that four of them were associated with a 14% to 16% greater probability of having a premature baby. The most consistent exposure was linked to a phthalate found commonly in nail polishes and other cosmetics.

“It is difficult for people to completely eliminate exposure to these chemicals in everyday life, but our results show that even small reductions within a large population could have positive impacts on both mothers and their children,” first study author Barrett Welch, a postdoctoral fellow at NIEHS, said in an institute news release.

The effort could be worth it: Reducing the level of phthalates exposure by 50% could prevent preterm births by 12%, on average, the researchers said. The interventions focused on specific changes, such as choosing phthalate-free personal care products, companies reducing the number of phthalates in their products on their own or changing regulations that would reduce exposure to these chemicals.

In the meantime, the researchers suggested avoiding processed food or food wrapped in plastic, instead opting for fresh, home-cooked meals. They also recommended choosing fragrance-free products, which are lower in phthalates. Limiting the amount of product used can also lower exposure.   More information:

Visit the U.S. Centers for Disease Control and Prevention for more on phthalate exposure.

SOURCE: NIH/National Institute of Environmental Health Sciences, news release, July 11, 2022 https://consumer.healthday.com/b-7-14-chemicals-found-in-cosmetics-plastics-linked-to-preterm-delivery-2657652790.html


Forced Retirement Spotlighted as Risk Factor for Physician Suicide

Also time to do away with the “myth of the never-ill physician,”study author says by Shannon Firth, Washington Correspondent, MedPage Today July 5, 2022

Systemic support systems need to be implemented for physicians to prevent work-related stressors that could lead to suicide, a thematic analysis of 200 physician deaths suggested.

Among physician suicides included in the National Violent Death Reporting System database from 2003 to 2018, six themes were found to precede such deaths, including inability to work due to physical health, substance use, mental health issues, relationship conflicts, legal problems, and increased financial stress, all leading to work-related stress, reported Kristen Kim, MD, of the University of California San Diego, and colleagues.

The results further suggested that suicide risk is associated with premature retirement due to health issues that affect employment, they noted in Suicide and Life-Threatening Behavior.

Among 200 physician death narratives, nearly all that reported earlier-than-expected retirement were linked to a physical ailment, Kim told MedPage Today, including a surgeon with a tremor, a physician with dementia, and a physician with alcohol and prescription drug use problems who had lost hospital privileges.

Investigations by state medical boards, employers, and law enforcement were also common in the narratives, and a re-examination of the data found that a majority of the physicians who died by suicide during the study period were unemployed or “pending job loss and typically not by choice,” the authors noted.

While interpersonal conflicts, including those occurring at work, were common, “strained relationships with family members,” often in the context of a divorce or extramarital affair, were even more common, they added.

The study showed “substantial overlap” with a prior study on job-related problems preceding nurse suicides, with a few exceptions. While nurses experienced difficulty accessing mental health supports and medications following job loss, physicians did not. Furthermore, legal issues were a factor in the physician suicide data but not in the nurse data.

Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” they wrote.

Kim said that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”

To that end, Kim and team offered some anonymous screening tools and “confidential pathways” to treatment, including UC San Diego’s Healer Education Assessment and Referral Program, which links physicians to counseling and outpatient treatment.

In addition, the “Dr. Lorna Breen Health Care Provider Protection Act,” which was signed into law in March, includes funding for hospitals to implement suicide prevention initiatives and to promote help-seeking.

Kim also stressed the urgent need to reform the licensure application process to eliminate “invasive” questions about physicians’ mental health and substance use history, which serve to discourage help-seeking and have unintended consequences for patient care.

For this study, Kim and colleagues used a mixed methods approach combining thematic analysis and natural language processing to develop themes representing narratives of 200 physician suicides included in the National Violent Death Reporting System database from 2003 to 2018.

Of the 200 physicians, mean age was 53, 83.5% were men, 89.5% were white, and 62.5% were married. Over half had mental health problems, 16% had problems with alcohol, 14.5% had other substance use problems, and 22% had physical health problems.

Using natural language processing, the authors confirmed five of the six identified themes — except “incapacity to work due to deterioration of physical health” — which “was likely not identified by natural language processing because physical health issues were described as the various, specific conditions affecting work performance (e.g., back pain, tremor), which were not grouped as a common theme.”

Limitations to the study included the fact that the evaluations were conducted postmortem based on short narratives — usually two paragraphs long — developed following interviews with loved ones.

“We’re using the best available data that we have on the reasons for why they decided to do what they did,” Kim said, but most of the data, with the exception of quotes from suicide notes in the narratives, were not first-hand accounts.

In addition, because most of the physicians in the study were men and white, the results may not be reflective of the work-related stressors of underrepresented minorities.

Furthermore, the database used in the study is voluntary. While the number of states participating rose from six in 2003 to 42 in 2018, including the District of Columbia and Puerto Rico, 10 states still do not report these data.

If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).


Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Front. Pediatr., 23 March 2022

Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

FULL ARTICLE:Frontiers | Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care (frontiersin.org)

Karen M. Puopolo, MD, PhD

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference

Published on Mar 21, 2022 in CHOP News

Children’s Hospital of Philadelphia (CHOP) is proud to announce that Karen M. Puopolo, MD, PhD, a national leader in the field of neonatology, has received the prestigious Pennsylvania Pediatrician of the Year Award from the American Academy of Pediatrics (AAP) after a unanimous selection by the Pennsylvania AAP Governance Committee and Board of Directors. Each year, this prestigious award is granted to a Pennsylvania pediatrician who exemplifies the ideals of the pediatric profession and participates in activities that reflect the foundation of the chapter.

As an attending neonatologist at CHOP and Chief of the Section on Newborn Medicine at Pennsylvania Hospital, Dr. Puopolo has dedicated her career to quantifying the risk for neonatal infection. She developed a clinical tool known as a sepsis calculator to estimate risk at the individual infant level to avoid unnecessary antibiotic use in neonates. This research has drastically changed newborn care in birth hospitals throughout the U.S. and world. 

Most recently, Dr. Puopolo conducted important research related to the COVID-19 pandemic. Dr. Puopolo led efforts of the national AAP Section on Neonatal Perinatal Medicine (SONPM) to draft clinical guidance on the screening and care of COVID-19-exposed and COVID-19-positive newborns.

“The naming of Dr. Puopolo as the PA AAP Pediatrician of the Year highlights her enormous contributions to perinatal health,” said Eric Eichenwald, MD, Chief of the Division of Neonatology at CHOP. “She embodies the AAP’s commitment to recognize women leaders who go above and beyond to provide excellent, evidenced-based care of newborns. What’s more, Dr. Puopolo’s unwavering dedication to advance the care of neonates during the COVID-19 pandemic has been unsurpassed.”

In addition to her clinical work, Dr. Puopolo serves as Associate Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She has authored hundreds of peer-reviewed publications, scientific abstracts, chapters, and editorials. A member of AAP since 1993, Dr. Puopolo has served many roles within the organization, including as a member of the Committee on Fetus and Newborn and on the Editorial Board of NeoReviews and Pediatrics.

Currently, Dr. Puopolo serves as chair for the AAP Southeastern Central Conference on Perinatal Research, where perinatal trainees can present their research and receive high-quality feedback.

CHOP Neonatologist Dr. Karen M. Puopolo Receives PA Pediatrician of the Year Award at 2022 AAP Conference | Children’s Hospital of Philadelphia

Providing A Potential Treatment Option To Infants Where There Is None

Celia Spell   April 21, 2022

A little over 1% of babies born in the U.S. in 2020 fell under the category of very low birthweight, meaning they weighed less than 1,500 grams at birth or 3 pounds, 4 ounces. And considering that the Centers for Disease Control and Prevention says more than 3.5 million babies were born that year, almost 48,500 were considered to be at very low birthweight.

Many of these babies are born premature, at 30 weeks or less, and they have a high chance of having a hemorrhage in their brains shortly after birth, known as a germinal matrix hemorrhage (GMH). Bleeding like this within the substance of the brain is a form of stroke that can lead to a buildup of fluid in the brain known as hydrocephalus – both of which put babies at an increased risk of neurodevelopmental disability, and many don’t survive.

There is currently no medical treatment for GMH, and since these blood vessels are even more delicate when a baby is born prematurely, there is no way to predict or prevent bleeding in the brain after birth.

When Ramin Eskandari, M.D., a pediatric neurosurgeon at MUSC Children’s Health, read about the work that Stephen Tomlinson, Ph.D., vice chair of the Department of Microbiology and Immunology at MUSC, was conducting related to a specific part of the immune system known as the complement system, he thought it might have applications to infants as well.

“We were just having to wait for bad things to happen,” Eskandari said. “And then we had to react to them. We have no treatment for the actual hemorrhage or for preventing the stroke or hydrocephalus that comes after. Tomlinson was looking at adult pathologies in the brain, and we thought it would be a great opportunity to apply his methods to an animal model for premature infants.”

As joint principal investigators for their recent paper in the International Journal of Molecular Sciences, Tomlinson and Eskandari created a mouse model to represent premature infants of very low birthweight and to find treatment options for GMH. Mohammed Alshareef, M.D., a senior neurosurgery resident at MUSC and member of the collaborative lab, discovered that by inhibiting the complement system at a specific site within the brain immediately after a hemorrhage, they could prevent many of the permanent and temporary deficits that accompany hydrocephalus and stroke.

By treating GMH mouse models with the complement inhibitor known as CR2Crry, Tomlinson and Eskandari found improved survival and weight gain, reduced brain injury and incidence of hydrocephalus, and improved motor and cognitive performances in adolescence.

As part of the immune system, the complement system helps antibodies and phagocytic cells activate inflammation and remove microbes and damaged cells from the body, labeling and attacking them. But inflammation activation also leads to the detrimental effects of GMH, and while there is still no way to prevent the initial hemorrhage, Tomlinson and Eskandari are excited about the potential opportunity to prevent the events that occur after the brain bleed.

Cases of GMH are on the rise, and according to Eskandari, this rise is actually due to better care and clinical advancements. With improved prenatal care and better treatment options for premature infants, more babies are surviving being born early. But with more survival, comes higher chances of GMH.

“We’re seeing younger and younger babies viable,” Eskandari said. “I remember when a 23-week-old baby wasn’t viable, and even in the last eight years since my residency, we’re now seeing babies at 20 weeks not only be viable but live full lives and attend school.” It’s these medical advancements that show Eskandari just how important the findings of this study are. And treatment of GMH has the potential to alter an infant’s life course.

Success in inhibiting the complement system has led to a recent boom in research, with over 100 clinical trials currently ongoing, according to Tomlinson. But CR2Crry inhibitor has its own niche. By targeting the therapeutic specifically to the point where the pathology begins, physicians don’t need to knock out the complement system in the entire body, which can lead to increased risk of infections and other immune disorders. They can use less of the inhibitor and target it to a local site, which is safer for patients.

“It’s because this is targeted,” Tomlinson said. “We can actually inject fairly small concentrations directly into the bloodstream to target the injured brain.”

In addition to using the CR2Crry inhibitor to develop a novel therapeutic for premature babies, Eskandari and Tomlinson think it has promise for treating other forms of brain injuries too. “These babies are a really good overall model of how all brain injury could potentially be helped,” Eskandari said. “Having a hemorrhage that leads to stroke and hydrocephalus checks a lot of boxes that we see in many patients.”

Tomlinson’s future research plans include looking at the complement system at different points following an injury in an effort to understand more fully the point at which it becomes part of an injury’s pathology rather than part of its healing process.

Eskandari hopes to host human clinical trials with the human equivalent of the CR2Crry inhibitor at MUSC next. He wants to help his premature patients to live the fullest lives possible. “We want to allow these babies to reach their full potential,” he said.

Source:Providing a potential treatment option to infants where there is none | MUSC | Charleston, SC


It takes a village: NICU parents share their experience as reminder that partners need support, too

Apr 5, 2022

Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner


Some preterm neonatal patients can be discharged from the hospital sooner through the unique Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota.

This one-of-its-kind program in Minnesota allows infants that qualify to receive expert care and monitoring at home through the use of an app on a tablet and a scale. The parent caregiver inputs the baby’s vitals daily, which are then shared and monitored by the baby’s neonatal care team.

The Children’s Minnesota Neonatal Intensive Care Unit (NICU) in St. Paul conducted a pilot study with 20 patients during a one-year period to evaluate how at-home care impacts babies’ ability to learn to feed, rates of breastfeeding and overall patient-family satisfaction. The results of the pilot were overwhelmingly positive and, for one family, meant that a father could spend precious time with his newborn while battling his own illness.

A challenging time

The year of 2021 was a time of mixed emotions for Amanda and Rob Calvin. They were excited to be welcoming their first baby, but Rob was also battling pancreatic cancer. “When we found out about Rob’s diagnosis, he was given one year to live, so we decided to have a child,” Amanda recalled.

The Calvins expected their baby to arrive in early April, but around mid-February, Amanda started having complications from a bleeding disorder she’s had since birth. “My condition had been flaring up with my pregnancy and getting worse to the point where I had to be admitted to the hospital,” Amanda said.

With the pandemic still at its height – and in light of her illness and her husband’s cancer – Amanda had a virtual baby shower from her Minneapolis hospital room. There, she also dealt with another serious health concern called preeclampsia, a severe high blood pressure condition in pregnant women. Amanda had a C-section procedure the day after her baby shower at The Mother Baby Center, a partnership between Allina Health and Children’s Minnesota.

Baby Finn arrived early

On Valentine’s Day 2021, baby Finn entered the world nearly eight weeks early – weighing just 3 pounds and 13 ounces. Finn’s care team rushed the newborn to the NICU at Children’s Minnesota and placed the tiny infant on a breathing machine. Finn spent the next month splitting time between the NICU and the special care nursery.

“I remember all of his caregivers being the most compassionate people and they made sure I knew what was going on,” recalled Amanda, a physician specializing in pulmonary and critical care medicine with HealthPartners Park Nicollet. “I’m an ICU provider and my son was in the ICU. Vital signs for infants are completely different than vital signs for adults. I tried to shut out paying attention to that stuff. There was too much for me to process.”

Time was of the essence

As Finn and Amanda navigated the NICU, Rob continued his fight with pancreatic cancer. “Rob no longer responded to chemo and was about to transition to hospice,” said Amanda. “He was so sick he couldn’t make it to the hospital.”

Preterm babies usually stay in the hospital with their care team until when they would have been full-term to grow, learn how to eat and breathe on their own. But CHAMP allowed Finn to go home a month early. Amanda used the app to stay connected with his care team and took over feeding using a nasogastric (NG) feeding tube that was inserted before heading home.

“It ended up being a major blessing,” Amanda said. “We were stretched thin going back and forth to the hospital. We were making it work. Without this program, we would not have had time together as a family at home in the place where we wanted to be.”

Finn graduated from CHAMP after a week on the special care program. Rob passed away soon after his infant’s graduation. “Rob died six days before Finn’s original due date. Finn got to be home with his dad before he died. I can’t quantify the value of that,” Amanda said while reflecting on her late husband.

Today, Finn is a healthy 1-year-old and meeting or exceeding all of his physical and developmental milestones. “Everybody at Children’s Minnesota went out of their way to make sure Finn was cared for – that we were heard, and they knew what we needed more than we did,” Amanda said while holding back tears. “I can’t thank those people enough. They gave us time we would have never had.”

About CHAMP at Children’s Minnesota

Children’s Home Application-based Monitoring Program (CHAMP) at Children’s Minnesota is the only program of its kind in Minnesota. Before heading home, babies have a nasogastric tube (NG) inserted. Families are provided with a scale and a tablet equipped with a program called Locus, which allows parents to input vitals that are shared with their neonatal team. Families are also trained by the team on proper NG and oral feeding techniques as well as CPR.

To qualify for CHAMP, a newborn must be a current Children’s Minnesota NICU patient, be able to breathe without any respiratory or oxygen support, weigh more than four pounds and consistently gain around 30 grams of bodyweight per day.

“Children’s Minnesota will always strive to pioneer cutting-edge programs that continue to put our patients first and keep families as part of their care team – CHAMP accomplishes all of these goals,” explained Dr. Cristina Miller, medical director of the NICU follow-up clinic at Children’s Minnesota, and founder and director of CHAMP. “Even though the babies who qualify for CHAMP are home, their clinical care team still remains at their bedside virtually to ensure they are growing, healthy and thriving.”

“The first question any parent asks when their child is admitted to the NICU is, ‘When can we go home?’ We’re hoping that this method helps families return to their normal daily lives faster, especially with the additional COVID-19 pandemic restrictions that have been in place,” said Dr. Miller. “But even after the pandemic is over eventually, this could be a game changer.”

Source:Innovative CHAMP program at Children’s Minnesota helps preterm babies go home sooner | Children’s Minnesota (childrensmn.org)

Importance The Of Support For NICU Families

Mar 7, 2020      LivingHealthyChicago

A health complication involving kids can really rock a family’s world- especially when it involves the very youngest in our families. This mother is sharing her family’s story in hopes of raising awareness about the importance of support for NICU families. Plus, we learn about an innovative treatment being utilized to help with a heart health issue that’s more common in premature babies.

Chatting to your premature baby

Talking and listening to children from the moment they are born helps them develop. This is especially true for babies who are born prematurely.

When a child is born prematurely, they might spend some time in the neonatal unit at hospital. Talking to your baby from day one will help the two of you get to know each other. The stimulation of your voice will help your baby develop and bond with you in the early days.

Premature babies will get tired more quickly and sleep more, but there are lots of ways to communicate with your baby such as touch, eye contact and facial expressions are all ways of communicating.

Babies can communicate before they start talking. As soon as your baby is born, they can recognise the sound of your voice.

Tips for talking to your premature baby

  • Kangaroo Care is when your baby is placed skin-to-skin on your chest. The contact will help to form a bond between you. Talk quietly and take time to listen to them – if they make noises try to respond.
  • When you are ready, care staff will support you to do some routine tasks such as nappy changing, tube feeding, or bath time. This is a great time to talk to your baby about what you are doing or sing to them as you are doing it.
  • When your baby is very small, they will like to grasp your finger and enjoy the feeling of your hands on their body.
  • Call them by their name. The sound of your voice will help relax and soothe them.
  • As the weeks go by, your baby will look at you for longer and see your face more clearly. Smile and respond to your baby.
  • It’s never too early to read a story! Choose a baby book and read. Your voice will help your baby relax and fall asleep.
  • Like adults, babies don’t always feel like being sociable. If your baby starts to hiccough, look away or yawn, these are signs they need to rest.


Innovative Music Therapy for the Brain Development of Premature Babies

Apr 3, 2022    HEC Science & Technology

It only takes a few chords to capture Ayla Campbell’s attention. She arrived 16 weeks early, weighing less than two pounds. While staying in MU Health Care’s neonatal intensive care unit, or NICU, Ayla received her first visit from a music therapist Emily Pivovarnik. “Her heart rate would just go down, and her oxygen was going up,” said Angel Campbell, Ayla’s mom. “If someone had told me that this could happen just from singing, I wouldn’t have believed it.” Pivovarnik is a trained music therapist who helps babies eat better, regulate their stress levels and adjust to stimulation. Pivovarnik is part of a team starting a research project to look at the long-term effects of a specific music therapy intervention called multimodal neurological enhancement, or MNE. This therapy combines music, gentle touch and rocking to help a baby’s brain develop. About 135 babies will be involved in the research project. After leaving the hospital, they’ll receive neurodevelopment testing.

Innovative Music Therapy for the Brain Development of Premature Babies – YouTube

Joel Mackenzie used ‘kangaroo care’ to help daughter Lucy, born prematurely. Photo: U. South Australia

Snuggling With Dad: Fathers’ Contact Can Help Preemies Thrive

Ellie Quinlan Houghtaling

THURSDAY, July 14, 2022 (HealthDay News) — Decades of research have shown the power of skin-to-skin contact between preemies and their moms, but would the same technique, dubbed “kangaroo care,” work with fathers?

Yes, claims a new Australian study that found when dads held their premature babies close to their bare chest, they reported feeling a “silent language of love and connection.”

“It’s like when your finger touches a fire, there are receptors there letting you know that it’s hot,” said study author Qiuxia Dong, a nurse and master’s candidate at the University of South Australia. “It’s the same thing [in kangaroo care], when the attachment happens between father and baby or mother and baby, it’s just another reaction.”

First-time father Joel Mackenzie experienced it with his tiny daughter, Lucy, when he was first able to hold her, two weeks into her time in the neonatal intensive care unit (NICU). Mackenzie explained that the NICU experience can be a really isolating one for parents, especially dads who are not often considered by the health care system when it comes to reconnecting with their child after a medical intervention.

“I felt like I was actively fostering her survival and her development by giving her a cuddle,” said Mackenzie, who was one of 10 dads followed in the study.

The findings were published online recently in the Journal of Clinical Nursing.

One expert in neonatal care described how the bonding process works.

“There are biologic phenomenon that exist that allow babies and their parents to bond, and there are hormones that get released that allow you to fall in love,” explained Dr. Robert Angert, a neonatologist at NYU Langone in New York City. “Those are stimulated by all your senses — your sight, but also your smell and touch. If you cut out some of those senses, you’re going to miss out on those opportunities,” he said.

“On the other side, you have anxiety and stress, and those make it harder to fall in love. As they describe in the article, a lot of parents, particularly non-birthing parents, are stressed and anxious and worried about the well-being of their child, especially a baby who’s in the ICU,” Angert added. “Bringing them together safely and in a way that’s helpful to the baby reduces that anxiety to the parent.”

Research has shown that during kangaroo care, the close contact activates nerve receptors in mammals that increase the production of hormones that lower pain and stress for both babies and parents.

The latest study illustrated that: Many of the fathers described the NICU environment as “overwhelming,” but the ability to hold their children next to their skin fostered strong bonds and relaxed them, which helped build confidence and made them very happy.

“It was palpable how much of an impact it had on her,” Mackenzie said. “Of course, it helped me in bonding with her and helping me understand her and what was good for her as a child, but also as well you could almost tell that she almost drew energy from us. She started to move better, she started to develop faster. I’d see her move better on a day-to-day basis. Eat more, be more responsive. Her eyes would open and move and engage more each time we took her out of the crib.”

Having to separate a newborn from its parent for medical reasons isn’t just traumatic for parents, it can have emotional and developmental impacts on the infant as well.

Angert said that “separation is an incredibly traumatic event in the life of a newborn, and I think we underestimate the impact that that event has on a baby. So we have an opportunity here to restore some of that togetherness, and it’s not without good reason that we’re taking the baby away. We’re saving their life. But it’s also good to think about when we can reestablish contact and allow them to give kangaroo care to their babies.”

Parents who go through the NICU process have no doubts about the efficacy of staying by their child’s side when they’re sick. Mackenzie, whose child will celebrate her first birthday next week, said the bonding made all the difference.

“She still has mild lung disease and chronic cerebral palsy, but [the kangaroo care] part of her NICU experience was definitely a contributing factor to where she is now, I have no doubt about it,” Mackenzie said. “Children who’ve gone through this experience definitely have a better chance of survival in my opinion.”

More information: To learn more about skin-to-skin contact benefits between parents and newborns, visit the Cleveland Clinic.


Occupational Therapy and Infancy: Supporting Families During the Earliest Occupations

Alexis Ferko, B.A., OTS

Occupational Therapy and Infancy: Occupational therapy (OT) is a holistic, client-centered, occupation-based profession focused on assisting individuals to independently participate in daily activities to the best of their ability . Occupational therapy practitioners (OTP) are board certified, have extensive academic training and clinical experience and treat individuals across the lifespan in various settings  while considering the “biological, developmental, and social-emotional aspects of human function in the context of daily occupations”. OTPs utilize the power of occupation to support families and infants in achieving positive outcomes . The first year of an infant’s life is a rapid period of growth; infants are learning how to actively interact with their environment and family system. Occupations of infancy are defined as “any activity or task of value in which the family or setting expects the infant to engage”  including activities of daily living (ADL) like feeding and bathing, health management including social and emotional health promotion and maintenance, rest and sleep, play and social participation . Infants also participate in co-occupations, meaning infants share an occupation with their caregiver; examples such as play and breastfeeding . OTPs also assist families with adapting to new performance patterns including habits, roles, routines, and client factors. OTPs treat infants in settings including hospitals or NICU’s, early intervention (EI), outpatient, and community-based settings. Infants may be referred to OT for concerns with maintaining homeostasis or bonding in the NICU, feeding or sensory concerns, physical development, social-emotional skills, and sleep .

OT in the NICU: Many infants and families have their first experience with OT in the NICU setting. NICU OTPs have extensive knowledge in neonatal medical conditions, development and understand the complex medical needs of infants in this setting . OTPs are members of an interdisciplinary team of professionals including pediatricians, physical therapists (PT), speech-language pathologists (SLP), lactation consultants, respiratory therapists, nurses, midwives, neonatologists, among others. OTPs administer assessments related to sensory processing, motor function, social-emotional development, pain, activities of daily living (ADL), neurobehavioral organization, and environmental screenings to identify and create an appropriate infant and family-centered intervention plan. The primary functions of an OT in the NICU is to focus on developmentally appropriate occupations, maintaining homeostasis (stable vitals, feeding, breathing), self-regulation, sensory development, feeding, motor function, coping and attachment skills, bathing and dressing, and nurturing interactions with caregivers including skin to-skin contact. OTPs utilize various interventions including sensory integration, neurodevelopmental techniques, positioning/handling, infant massage, feeding, bonding, and environmental modifications to minimize stress and overstimulation while in this setting. Therapists must also address the family system by forming a therapeutic relationship with the family. The NICU can cause separation between infant and caregivers especially if there are maternal complications after delivery which can increase stress and instability within the family system . Parent-infant attachments and occupations must be prioritized, including bonding such as skin-to-skin contact, or kangaroo care. Kangaroo care is an essential intervention to support infants in the NICU by having the infant lay on the caregiver’s bare skin. Benefits to this intervention include more stable heart rate, breathing patterns and temperatures, faster weight gain, more successful feeding, and increased bonding. OTPs also consider the Neonatal Integrative Developmental Care Model, meaning therapists are fostering a healing environment in the NICU setting – a setting known to be stressful and overstimulating for infants and their families. Core measures of this model include skin protection, optimizing nutrition, positioning/handling to promote breathing and stability, safeguarding sleep, optimizing nutrition, minimizing stress and pain through environmental and sensory modifications, and partnering with families . Research shows that interventionists who follow this model have better growth development outcomes.

Breastfeeding and Feeding: As of 2020, over 83% of infants are breastfed at some point in their young life. 60% of mothers stop breastfeeding before they intend to stop due to various reasons including latching difficulties, infant weight concerns, lack of work and family support, and concerns with medication while breastfeeding. OT can assist with facilitating breastfeeding which improves parent-infant attachment and bonding and can also reduce postpartum depression . OTPs must consider various aspects of the infant caregiver dyad during breastfeeding including infant arousal state, respiratory ability, overall stability, oral reflexes, oral strength and endurance and caregiver arousal, attention, posture and upper extremity strength, cognition, and cultural values/beliefs related to feeding . It is also important to consider sensory and environmental stimulation, social supports, and bottle/nipple type if the infant is not being breastfed. OTPs can assist breastfeeding caregivers with developing routines and habits to promote breastfeeding and education related to their infant’s hunger and stress cues, positioning, ergonomics, self-regulation, and environmental modifications . Infant interventions include suck training, positioning, and various sensory strategies to promote arousal levels. Environmental and activity modifications include changing the position of feeds, adapting the lighting, touch, sound and using supportive equipment during feeding and adapting the type, thickness or volume of milk and feeding schedule . Feeding is a very important occupation for an infant as it takes up much of their early life and helps facilitate secure attachments to their caregiver as well as promoting self-regulation .

 OT’s Role in Transitioning Home: OT also plays a role in assisting families with the transition from NICU to home. Transition planning begins at NICU admission with OTPs educating families on various interventions and considerations for the infant’s unique medical needs. Upon discharge from the NICU, OTPs may recommend follow-up with EI, outpatient OT or PT, or a feeding clinic to address various concerns including feeding, global developmental delay, ROM or joint limitations, tone management, among others . OTPs also educate families on general infant care like signs of stress and how to relax or calm an infant, feeding strategies, home environment set-up and safe sleep strategies. OTPs also work with lactation consultants to address any concerns or strategies related to breastfeeding.

Early Intervention and Infancy: Infant occupations vary based on family, contextual and cultural factors. OT is a primary service under IDEA Part C and delivers services related to the infant’s individualized family service plan (IFSP) outcomes . Gorga (1989) identified seven areas of occupational therapy treatment practices for infants in EI including motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills and play . OT interventions include handling, positioning, adapting the environment, sensory registration, arousal, attention, emotional regulation, cognition, feeding and play activities like reach and grasp. The American Occupational Therapy Association (AOTA) elaborated on various interventions in early intervention including promoting healthy bonding and attachment, family education and training, adapting tasks and the environment, participation in ADLs, rest and sleep and play related to the infant’s IFSP outcomes.

Conclusion: Occupational therapy practitioners are client-centered, occupation-based and address the infant and their family holistically. Various occupations OTPs can address include feeding, bathing, rest and sleep, health management, play and social participation, among others. Breastfeeding is also an important co-occupation OTPs can address in this setting. OT can also work with the family to promote carryover of strategies, encourage developmental care, and optimize infant well-being in the NICU, EI and home setting. Various professions work with occupational therapists on multidisciplinary, transdisciplinary, and interdisciplinary teams including PT,  SLP, pediatricians, lactation consultants, nursing, midwives, neonatologists, and other specialists. These professions would benefit from working with OT to help increase independence, improve overall well-being and participation in infant and family occupations all of which leads to a greater quality of life for both the infant and family.  Occupational therapists serve a unique role in the neonatal intensive care setting by identifying, promoting, and advocating for developmental care practices that aim to support families in participating in these early occupations.



A Wearable for Monitoring Prenatal Health at Home

An estimated 15 million babies are born prematurely every year, posing a significant risk to both maternal and neonatal health. The EU funded WISH project promotes a novel tool for monitoring the risk of preterm labour at home.

Preterm birth is defined as any live birth before the 37th week of pregnancy and is associated with complications that lead to neonatal and infant mortality. Additionally, premature babies are prone to serious long-term illnesses, lifelong disabilities such as cerebral palsy and respiratory illnesses as well as poor quality of life. Consequently, preterm birth is the cause of great suffering and psychological stress to parents. For further information see the IDTechEx report on Wearable Sensors 2021-2031.

Machine learning to predict preterm birth

Currently, regular medical check-ups and clinical examinations in a hospital setting are the only available solution for expectant women to diagnose preterm labour. However, expecting couples often mistake Braxton Hicks contractions, which occur normally during a healthy pregnancy, as preterm labour contractions. This increases hospital visits and concomitant healthcare costs. To address this issue, the EU-funded WISH project has developed an innovative platform for antepartum maternal and foetal monitoring. “WISH integrates seamlessly into the daily activities of expectant women in a way that will enable remote antepartum monitoring at home,” explains Julien Penders, co-founder and COO of Bloomlife. The WISH system consists of a specifically designed electrode patch, a consumer app, a web-based dashboard and a secure cloud data platform. It measures maternal and foetal health parameters, such as heart rate and uterine activity, through a specific sensor. This real time information is processed using advanced algorithms and machine learning to provide the probability of a woman being in labour.

Clinical validation and prospects

The WISH solution was tested and validated during the project in a two-centre, interventional study on 150 pregnant women. Study participants received a WISH system and were asked to use it at least three nights per week until they gave birth. Results demonstrated that the WISH system had similar accuracy in labour detection with current diagnostic methods used in hospital. “This clearly illustrated the feasibility of applying non-invasive wearable technology at home as an alternative labour management strategy,” emphasises Penders.

Preterm birth is a global health problem and one of the EU healthcare priority areas. The high socioeconomic impact of preterm birth necessitates novel solutions for predicting and prolonging the gestational age at delivery. The WISH project laid the foundation for a new non-invasive approach for preterm labour detection and a much needed tool for high-risk pregnancies. Implementation of WISH is expected to provide essential data for both expectant women and healthcare providers, facilitating more efficient prenatal care across Europe. Importantly, WISH will offer reassurance to women throughout the last stages of pregnancy through the provision of trustworthy information. Future efforts will focus on how to exploit the WISH solution to improve doctor-patient communication, implement preventive actions and timely interventions to reduce preterm births and radically change prenatal care across Europe. Penders envisions pivotal clinical trials will support the CE marking of WISH as a medical device and render it ready for commercialisation.

Source:A Wearable for Monitoring Prenatal Health at Home | Wearable Technology Insights

CDC: Infant outcomes vary by maternal place of birth

JUNE 29, 2022

Maternal characteristics and infant outcomes vary by maternal place of birth, according to a report published in the June issue of Vital and Health Statistics, a publication of the U.S. Centers for Disease Control and Prevention National Center for Health Statistics.

Anne K. Driscoll, Ph.D., and Claudia P. Valenzuela, M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, describe and compare maternal characteristics and infant outcomes by maternal place of birth among births occurring in 2020.

The researchers found that 21.9 percent of women who gave birth in the United States in 2020 were born outside of the United States. Women born in Latin America accounted for 12.0 and 54.9 percent of all women giving birth and those born outside of the United States, respectively, while women born in Asia accounted for 5.9 and 27.2 percent, respectively. Maternal characteristics varied by region, subregion, and country of birth, with the percentage of women giving birth under age 20 higher for women born in the United States (5.0 percent) than for those born in other regions, and obesity rates varying from 10.7 percent for women born in Asia to 38.1 percent for women born in Oceania. Infant outcomes varied by mother’s place of birth, with preterm birth rates varying from 6.90 to 11.43 percent of infants of women born in Canada and Oceania, respectively. Similar variation was seen for low birthweight and neonatal intensive care unit admission rates.

“The characteristics, residence patterns, and infant outcomes of women born outside the United States vary considerably,” the authors write.

Full Article: https://www.cdc.gov/nchs/data/series/sr_03/sr3-048.pdf https://medicalxpress.com/news/2022-06-cdc-infant-outcomes-vary-maternal.html

NICU Lighting Tech Licensed to NASA Spinoff

Post Date: April 11, 2022

Cincinnati Children’s has licensed technology that mimics sunlight in the NICU of the new Critical Care Building to a NASA spinoff, which is marketing a consumer product called the SkyView Wellness Table Lamp.

California-based Biological Innovations and Optimization Systems LLC, or BIOS, focuses on the biological application of LED lighting for people and plants. 

BIOS announced it has licensed the exclusive rights to the violet light technology invented and developed at Cincinnati Children’s, which optimizes light exposures and can influence circadian rhythms, eye development and metabolism.

The violet light technology is a component in the world’s first full-spectrum, tunable lighting system in a neonatal intensive care unit, which was installed in the Critical Care Building that opened on the Burnet Campus of Cincinnati Children’s in November 2021.

Richard Lang, PhD, director of the Visual Systems Group at Cincinnati Children’s, has worked with colleagues for more than a decade to better understand the role that sunlight plays in fetal development. Their discoveries, coupled with growing scientific knowledge about the importance of circadian rhythms to human health, sparked the idea to install lights in the NICU that could provide the full range of wavelengths found in sunlight.

“Our recent discoveries showed that violet light plays a crucial role in normal human physiology,” Lang said. “This prompted us to work with BIOS lighting to deploy a new human-centric lighting technology in our neonatal intensive care unit. We believe everyone can benefit from human-centric lighting.”

The licensing agreement comes in the wake of global studies by researchers into sleep complaints and circadian disturbances observed during the COVID-19 pandemic, BIOS stated. The science behind the company’s biological lighting expertise was first developed for the International Space Station.

“BIOS is committed to creating human-centric lighting designed to promote health and wellbeing,” Robert Soler, a former NASA engineer who is vice president of biological research and technology for Bios, said in a news release. “When the opportunity arose, we were excited to work with Cincinnati Children’s and co-develop new human-centric lighting technology. We now offer this technology in our SkyView Wellness Table Lamp.”

Source:NICU Lighting Tech Licensed to NASA Spinoff | Research Horizons (cincinnatichildrens.org)

Over the past few weeks extreme heat waves have resulted in record breaking temperatures worldwide. Living in London, I witnessed the impact of the 105-degree temperature on the local community, nature parks,  infrastructure, and public transportation. With tube station, railway, and plane shutdowns due to fires and melting roadways it was clear that this was an event that would mark an obvious need to shift towards increased climate action both within the UK and Worldwide. Millions of residents were encouraged to stay home, avoid attending events and work outside of the home and were provided emergency warning resources and information about ways to stay safe. The impact of this recent climate event has now moved along to the Pacific Northwest Region where many of my family members and friends have reported similar disruptions in their communities as consecutive high temperatures throughout the last week of July into August will reach an all-time high.

Climate change has and will continue to impact every community in a variety of anticipated and unexpected ways. Amongst our global neonatal community studies have shown a direct correlation between the effects of rising temperatures and increased risk for preterm labour. For example, a recent 2020 BMJ meta-analysis study found that “the odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. “ (Cherish et al,2020)

Increased research efforts to investigate the impact of climate change on preterm birth rates and outcomes will be instrumental in addressing collaborative solutions to implement preventative interventions and improved care to those negatively impacted as a result of climate change on maternal and neonatal health. As an active community we can do our part to enhance our knowledge and find creative ways to be a part of the solution towards helping to improve our carbon footprint within our communities and homes.

Personally, I believe our global youth have in many ways led the forefront towards addressing climate change. We have included a few engaging videos discussing ways we can help to address climate change and the experiences of young climate activists like Greta and friends who may inspire us to pick up some new habits and get involved in doing our part to bring about the prioritization of climate action to improve the health of our planet and our livelihood now and in the future.


Climate Change for Kids | A fun engaging introduction to climate change for kids

Hey Teachers and Parents! In this video we explore climate change for kids. We learn all about the causes of climate change like the greenhouse effect, fossil fuel burning, farming, and even deforestation and why these are big dilemmas in today’s world. We also cover ways that we can help prevent climate change and be friendlier to our environment including: walking, planting trees, using less electricity and other fun ways. We hope you and your students have fun as they learn about climate change and what we can each do to help planet earth. We also invite you to download our FREE climate change lesson plan (for grades 4-6) that is complete with more content, worksheets, activities for kids, and more!

Greta and eight young activists reveal how the climate crisis is shaping their lives | UNICEF

Nine young activists explain how climate change is affecting their lives and who inspires their efforts to make our planet a better place. Greta Thunberg (Sweden) is joined by Alexandria Villasenor (USA), Catarina Lorenzo (Brazil), Carlos Manuel (Palau), Timoci Naulusala (Fiji), Iris Duquesn (France), Raina Ivanova (Germany), Raslene Jbali (Tunisia) and Ridhima Pandey (India).


Oct 22, 2020

Surfing in the Philippines was not something that we thought about when planning our holiday. Usually you think of Hawaii’s waves and the surf vibe and culture. So when we realized we’d stumbled into Siargao Island the little Hawaii of the Philippines, we knew one of us had to take to the water and try out a surf lesson. As a British family, most of us didn’t grow up around surf culture because of the cold water and weather so we were so happy to do this here in the bath warm pacific ocean. We booked a private lesson with Racel from Makulay Resort Santa Fe in General Luna. It cost 1400 pesos or around £21 for a two hour teaching session, and Racel is actually a professional competing surfer so it felt even better to get our first experience of surfing in the Philippines with him. I stood up multiple times on the board and I highly recommend lessons with Racel if you find yourself on Siargao Island wanting to learn to surf. If this mum can do it, anyone can!

CDC: Infant outcomes vary by maternal place of birth


Tech Emerging, Mortality, FC Care



Rank: 172  –Rate: 6.0%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

Norway, officially the Kingdom of Norway, is a Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of Jan Mayen and the archipelago of Svalbard also form part of Norway. Bouvet Island, located in the Subantarctic, is a dependency of Norway; it also lays claims to the Antarctic territories of Peter I Island and Queen Maud Land. The capital and largest city in Norway is Oslo.

Norway has a total area of 385,207 square kilometres (148,729 sq mi) and had a population of 5,425,270 in January 2022.[14] The country shares a long eastern border with Sweden at a length of 1,619 km (1,006 mi). It is bordered by Finland and Russia to the northeast and the Skagerrak strait to the south, on the other side of which are Denmark and the United Kingdom. Norway has an extensive coastline, facing the North Atlantic Ocean and the Barents Sea. The maritime influence dominates Norway’s climate, with mild lowland temperatures on the sea coasts; the interior, while colder, is also a lot milder than areas elsewhere in the world on such northerly latitudes. Even during polar night in the north, temperatures above freezing are commonplace on the coastline. The maritime influence brings high rainfall and snowfall to some areas of the country.


Norway was awarded first place according to the UN’s Human Development Index (HDI) for 2013. In the 1800s, by contrast, poverty and communicable diseases dominated in Norway together with famines and epidemics. From the 1900s, improvements in public health occurred as a result of development in several areas such as social and living conditions, changes in disease and medical outbreaks, establishment of the health care system, and emphasis on public health matters. Vaccination and increased treatment opportunities with antibiotics resulted in great improvements within the Norwegian population. Improved hygiene and better nutrition were factors that contributed to improved health.

The disease pattern in Norway changed from communicable diseases to non-communicable diseases and chronic diseases as cardiovascular disease. Inequalities and social differences are still present in public health in Norway today.

In 2013 the infant mortality rate was 2.5 per 1,000 live births among children under the age of one. For girls it was 2.7 and for boys 2.3, which is the lowest infant mortality rate for boys ever recorded in Norway.



Ten Years of Neonatal Intensive Care Adaption to the Infants’ Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway

Lene Tandle Lyngstad 1Flore Le Marechal 1Birgitte Lenes Ekeberg1Krzysztof Hochnowski 1Mariann Hval 1Bente Silnes Tandberg1

International Journal of Environmental Research and Public Health  13 May 2022, 19(10):5917
DOI: 10.3390/ijerph19105917 PMID: 35627454 PMCID: PMC9140644


Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support.

Our paper describes how we managed to systematically reorganize the nurse’s workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants’ needs by providing neonatal intensive care with parents as equal partners.

FULL ARTICLE:    http://europepmc.org/article/MED/35627454

Sigrid, Bring Me The Horizon – Bad Life


The RHODĒ Study

Rhode Island Cohort Of Adults Born Prematurely

The Rhode Island Cohort Of Adults Born Prematurely — or “RHODĒ” Study — is a longitudinal study following a group of 215 infants born between 1985-1989 in Rhode Island. The study was previously known as the Infant Development Study. Prior waves of data collection occurred at birth, 1 month, 18 months, 30 months, 4 years, 8 years, 12 years, 17 years, and 23 years of age. The 215 originally enrolled infants represent a wide range of gestational ages, birth weights, and illness severity, and includes both preterm and full-term participants.

In response to an Institute of Medicine recommendation for long-term outcome studies for premature infants into young adulthood, we are currently conducting the tenth wave of the study, with participants aged 30-35 years old.

We are fortunate to have retained 96% of the participant sample between ages 17 and 23 years, and 85% since birth. To our knowledge, this is the only U.S. based study to follow preterm and full-term participants from birth into age 30.

Source: https://www.rhodestudy.com/


‘Smart pacifier’ in development with help from WSU Vancouver researchers:2701:45

Clinical trials are still to come, but the academic group hopes the small medical device eventually replaces blood draws, and a lot of wires and electrodes.

Author: kgw.com  Published: 5:43 PM PDT June 11, 2022 Updated: 5:43 PM PDT June 11, 2022

Comparison of the effect of two methods of sucking on pacifier and mother’s finger on oral feeding behavior in preterm infants: a randomized clinical trial



Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother’s finger on oral feeding behavior in preterm infants.


This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother’s finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother’s finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used.


The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05).


Considering the positive effect of these two methods, especially non-nutritive sucking on mother’s finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit.


EFCNI involved in new study on blood transfusions in preterm babies


Most preterm babies admitted to a Neonatal Intensive Care Unit (NICU) receive blood transfusions. Some neonates, however, receive blood transfusions even though these transfusions may not be necessary, cause side effects or even harm. Therefore, the International Neonatal tranSfusion PoInt pREvalence study (INSPIRE) aims to describe the current state and indications for blood transfusions among preterm babies in Europe.

Although most preterm babies receive blood transfusions in the NICU, there are no international guidelines that have been incorporated into clinical practice, and there is significant variation in blood transfusion practice within Europe. Additionally, high-quality data on neonatal transfusion practice in Europe is lacking. The INSPIRE-study will describe current neonatal transfusion practices within Europe. These results will help to improve practice, develop future clinical studies, and inform guideline writing. Additionally, the results may help to reduce unnecessary transfusions through increased awareness of the proper use of transfusions in this vulnerable patient group.

In collaboration with the Neonatal Transfusion Network (NTN), EFCNI coordinates an international parental advisory board (PAB). The PAB is chaired by EFCNI and meets on a regular basis throughout the duration of the project. Furthermore, EFCNI gives advice and provides input on topics related to ethics and patient information throughout the project.

Ongoing updates on the project can also be found on our project page.


Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Gabriel Fernando Todeschi Variane1,2,3*, João Paulo Vasques Camargo2,4, Daniela Pereira Rodrigues2,5, Maurício Magalhães1,2,6 and Marcelo Jenné Mimica7,8

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

Full Article: https://www.frontiersin.org/articles/10.3389/fped.2021.755144/full

Accuracy and Completeness of Intermediate-Level Nursery Descriptions on Hospital Websites

David C. Goodman, MD, MS1,2,3,4Timothy J. Price, MS1David Braun, MD5,6

JAMA Netw Open. 2022;5(6):e2215596. doi:10.1001/jamanetworkopen.2022.15596

Key Points

Question  How completely and accurately do hospital websites describe their level II special care (ie, intermediate care) nurseries?

Findings  In this cross-sectional study of hospital nurseries (including 1.99 million live births and 268 level II units) in 10 large US states that regulate nursery levels of care, state-designated intermediate (ie, level II) units were inaccurately or incompletely described in 39% and 25% of the hospital websites, respectively. There was substantial and statistically significant variation in rates of incompleteness and inaccuracy across states.

Meaning  These results suggest that hospital websites, often the only source of publicly available information describing a hospital’s neonatal unit, do not provide reliable information for prospective parents, referring physicians, and the public to assess the capacity to care for ill newborns.


Importance  Birth at hospitals with an appropriate level of neonatal intensive care units is associated with better neonatal outcomes. The primary sources for information about hospital neonatal unit levels for prospective parents, referring physicians, and the public are hospital websites, but the accuracy of neonatal unit capacity is unclear.

Objective  To determine if hospital websites accurately report the capabilities of intermediate (ie, level II) units, which are intended for care of newborns with low to moderate illness levels or the stabilization of newborns prior to transfer.

Design, Setting, and Participants  This cross-sectional study compared descriptions of level II unit capabilities on hospital web pages in 10 large states with their respective state-level designation. Analyzed units were located in the 10 states with the highest number of live births in 2019 (excluding states with no level II regulations) and had active websites as of May 2021.

Main Outcomes and Measures  Hospital websites were assessed for whether there was any mention of the unit, the description of the unit was provided, the unit was identified as a level III or both levels II and III, the terms “neonatal intensive care unit” or “NICU” were used without indicating limits in care available or newborn acuity, or the unit was claimed to provide the most advanced level of care.

Results  A total 28 states had no regulation of nursery unit levels; in the 10 large, regulated states, web descriptions of level II units were incomplete for 39.2% of hospitals (95% CI, 33.3%-45.3%) and inaccurate for 24.6% (95% CI, 19.6%-30.2%). Within incomplete descriptions, 2.6% (95% CI, 1.1%-5.3%) of hospitals did not mention an advanced care unit and 22.0% (95% CI, 17.2%-27.5%) identified a level II unit without providing further description. Within inaccurate descriptions, 25.4% (95% CI, 20.3%-31.0%) of hospitals described the unit as a “neonatal intensive care unit” or “NICU” without any qualification and 9.3% (95% CI, 6.3%-13.5%) claimed that the unit provided the most advanced neonatal care or care to the sickest newborns; 3.0% of hospitals (95% CI, 1.3%-6.0%) stated that their unit was level III and 1.5% (95% CI, 0.4%-3.8%) as level II and III. Across states there was substantial variation in rates of incompleteness and inaccuracy.

Conclusions and Relevance  Incomplete and inaccurate hospital web descriptions of intermediate newborn care units are common. These deficits can mislead parents, clinicians, and the public about the appropriateness of a hospital for sick newborns, which raises important ethical questions.



Turns out not where but who you’re with that really matters

Terrie Eleanor Inder   Pediatric Research volume 88, pages533–534 (2020)

An understanding of the impact of the environment, including the new enhanced single-family room (SFR) structure, on outcomes in the preterm infant is critical. The study by van Veenendaal et al. in this edition of Pediatric Research expands on others’ work by analyzing a level II neonatal facility SFR setting and concludes that the SFR environment was associated with lower rates of late onset sepsis, mediated by the lower use of intravenous and central venous catheters. The authors hypothesized that the presence of parents, who know their infants well, may have resulted in less antibiotic treatment for symptoms and signs that were interpreted by less familiar medical caregivers as concerning for late onset sepsis. It is important to note that the definition of “sepsis” included any culture positive infant, independent of treatment, and infants treated for ≥7 days with antibiotics after clinical signs of concern for sepsis with negative cultures.

This study compared two epochs from 2012−2014 and 2017−2018 with 1046 infants who were predominantly level II late preterm infants (<37 weeks’ gestation and hospital stay ≥3 days) with average gestational age of 34−35 weeks. During this time of change to SFR environment, Family Integrated Care (FICare) was also introduced with parents being present to provide most of the care for their infants. Their SFR included a full parent bed for the parent to live and sleep in the room with their infant. The major mediator of the reduction in late onset sepsis, from 9.3% in the open bay to 5.3% in the SFR, was an approximately 50% reduction in vascular lines (peripheral and central) and use of parenteral nutrition. Although the reasons for the reduction in line use remain unclear, the authors hypothesized that the presence of the parents resulted in joint decision making and avoidance of painful procedures—both leading to reduced lines and parenteral nutrition. The authors also report a trend toward higher exclusive breastfeeding at discharge and a shorter length of stay.

Although infection rates in the neonatal intensive care unit have been consistently falling over the last two decades, this study informs us that in a less intensively sick population of infants, the SFR environment may reduce the risk of late onset sepsis. Importantly, they define that the association is mediated by invasive vascular access, which may be avoided with parental engagement. This study did not evaluate early breast milk supply in the new SFR setting, but others have noted in a similarly designed study a significant increase in the availability of human milk in the SFR environment being a key driver of SFR-associated improved neurodevelopmental outcomes.

 In contrast to the current study, a study from a typical larger neonatal intensive care unit setting in Texas, USA, found an increased rate of sepsis documented following their renovation to SFR environment in 2015. They analyzed 9995 encounters in their 90-bed unit, with a trend toward increased sepsis rates in the SFR in the moderately preterm infant (OR 1.33, 95% CI 0.7−3.3) that reached significance in the term/post-term infant (OR 1.79, 95% CI 1.2−3.3). It was noted that the trend was reversed toward lower infection rates in the preterm infants <32 weeks. Their definition of sepsis was based on medical records alone and not as carefully curated as the current study.

Single-family room environments have been noted to have numerous advantages, including enhancing parent−infant closeness and engagement in infant care and improved parental psychological wellbeing with reductions in maternal depression and parental stress in both parents. In these studies, based in Scandinavia, parents in the SFR were present 21 h/day compared with 7 h/day previously in the open bay unit. The SFR environment has also been associated with improved neurodevelopmental outcomes following discharge, with an approximate 3-point advantage in cognitive and language scores on Bayley III at 18−24 months. However, in our own neonatal intensive care unit setting in St. Louis, we documented a negative impact of SFR with lower language scores (−8.3 (95% CI −2.4 to 14.2), p = 0.006) and a strong trend toward worsening motor scores at 24 months follow-up. We attributed this to the sensory isolation within the SFR environment if the parental presence and engagement was low. A subsequent study in the same unit in St. Louis by Dr. Pineda’s team demonstrated that the average presence of parents was higher in the SFR environment at 3.6 h/day compared to 2.4 h/day in the open bay environment. Notably, mothers reported more NICU stress in the SFR environment.

A recent meta-analysis of 13 study populations (n = 4793) concluded that there was no clear difference between room environments in cognitive neurodevelopment on the Bayley Scales of Infant and Toddler Development-III at 18–24 months (680 infants analyzed; mean difference 1.04 [95% CI −3.45 to 5.52], p = 0·65; I2 = 42%). However, the authors did note a lower incidence of sepsis (4165 infants analyzed; 108,035 days in hospital [hospitalization days]; risk ratio 0.63 [95% CI 0.50−0.78], p < 0·0001; I2 = 0%) and higher rates of exclusive breastfeeding at discharge (484 infants analyzed; 1.31 [1.07−1.61], p = 0.01; I2 = 0%) in SFRs than in open bay units. No other differences in neonatal outcomes were noted. This meta-analysis combined Scandinavian, Australian, and USA studies.

Differences in these studies point to a clear explanation—it is “not where but who you’re with that really matters” (the lyrics from “The Best of What’s Around” by the Dave Mathews Band). In the studies documenting benefit from the SFR environment, parental presence is almost universal and routinely >12 h in duration with shared decision making. The current study adds to this literature by documenting that such parental engagement may assist in both prevention of invasive vascular devices, that are associated with increased sepsis, and more informed interpretation of their infant’s clinical signs to better define the risk of sepsis. In the current study, it is not possible to untangle the effects of the SFR from the FICare model, with both promoting the presence and engagement of the family in care decisions. It appears that it is this critical combination that renders the benefits seen in this and other studies of the SFR, predominantly reported from Scandinavia.

In contrast, the studies documenting the adverse effects from the SFR environment, typically studies in the settings of large urban NICUs within the USA, parental presence averaged <4 h/day. Although this was increased compared to the open bay environment, it appeared associated with greater NICU stress in the mothers with both greater adult and infant isolation. Thus, without a structured program of parental support and engagement with their infant and shared decision making, this modest increase in parental presence may not offset the deficit in human language exposure which appears critical during the third trimester for language development.

In conclusion, although much effort has been focused on the room type, it appears more pertinent to ask what is happening in any space in which an infant is being cared for in the neonatal intensive care unit. This appears just as relevant for shorter lengths of stay, as shown by the current study. It is worthy of note that it is common for medical rounds or records to lack any systematic documentation or summary review of the nature of the parent’s presence or engagement, other than to discuss in a socially cursory manner. The SFR encourages greater presence of the parents to be “living” with their infant, enabling a family-centered model of care, with the combination in many studies resulting in reduced sepsis, enhanced human milk production, improved parental mental health and attachment and improved infant neurodevelopmental outcomes. To achieve the presence of parents for >12 h, and ideally 24 h/day, in the setting of the USA will require firm advocacy from the neonatal community as a fundamentally important facet of care. It is no longer “nice to have” but a “necessary element of care” for optimal outcomes. The provision of paid parental leave during the time of an infant’s neonatal intensive care course for both parents should be federally mandated as medically necessary, and we must fight for our infants’ right to their parent’s presence. The SFR environment greatly assists parents and staff with such a model of family-centered care but it is only a facilitator of the true key—the parents.


Preemies at greater risk for mortality in adulthood

By Svein Inge Meland – Published 23.03.2021

*** It’s important to remember that most people who are born prematurely do well, and that treatment and follow-up are constantly improving, says Professor Kari Risnes at NTNU.

The risk of dying from heart disease, chronic lung disease or diabetes in adulthood is twice as high for preemies —premature infants — as for the general population. Even those who were born just two to three weeks before term have a slightly increased risk.

A new study of mortality among young adults who were premature infants includes 6.3 million adults under the age of 50 in Norway, Sweden, Finland and Denmark. Among this group, 5.4 per cent were preemies, or born before term, according to Professor Kari Risnes at NTNU’s Department of Clinical and Molecular Medicine and St. Olavs Hospital.

Researchers used the national birth registers and compared them with the cause of death registers that all Scandinavian countries have.

“We already know that preemies have increased mortality in childhood and early adulthood. Now we’ve confirmed the risk of death from chronic diseases such as heart disease, lung disease and diabetes before the age of 50,” says Risnes.

Normal cancer and stroke risk

The study shows that the risk of preemies dying before the age of 50 is 40 per cent higher than for the population as a whole. Researchers found that the risk of dying for individuals born before full gestation and who have chronic heart disease, lung disease or diabetes is twice that of the population as a whole. However, this group has no increased risk of death from cancer and stroke.

“We were surprised to see that the risk of death was higher even in people who were born as late as weeks 37 and 38, only a few weeks before full gestation. Although the extra risk was only about 10 per cent, this group makes up about 15 per cent of all births, and we have to try to map the causal relationships here,” says the paediatrician.

Findings should be factored in

Risnes believes that the results from the study should be factored in when doctors assess the patient’s risk of disease and their preventive advice for the patient.

“Our idea is that we should increase awareness in both the general population and among doctors so that the risk can be reduced. We need to recognize that prematurity is a factor to take into account when assessing risk, just like we do with a family history of heart disease, obesity or smoking,” says Risnes.

“It’s important to be aware of additional factors that increase the risk of cardiovascular disease and diabetes, like high blood pressure, obesity, inactivity and high blood sugar, plus the high levels of all these additional factors that we see more of in premature births,” she says.

Early prevention important

“These diseases are often preventable. Good treatment is important and can often be longterm to maintain a good quality of life and avoid illness and death. We should be identifying lifestyle changes from an early age that reduce the risks, like more physical activity and avoiding obesity and smoking,” says Risnes.

One question still to be answered is whether more premature than full-term infants develop these chronic diseases, or if they are just generally less well equipped to survive the diseases.

“We need to try to address this question in the next round of research. It may be that the diseases crop up earlier in premature babies. We don’t have data on this yet,” Risnes says.

In the 1960s and 1970s, only 20 to 30 per cent of the most premature infants reached 15 years of age. Today, their survival rate is over 90 per cent. This means that the strong ones, the survivors, were preemies in Risne’s study of adults.

“With better neonatal medicine, the proportion of the population born prematurely is growing,” says Risne. She believes it will be important to follow this population closely in terms of risk. In the study, individuals born prematurely around 1980 had a slightly higher risk of cardiovascular disease than those born around 1970.

Not genetics or environment

The study doesn’t indicate that the social status of the mother or conditions of upbringing explain the increased risk of mortality. The researchers compared siblings to find out if the excess mortality was due to genetics or socioeconomic conditions.

“We found that risk of death for these diseases was higher for people born prematurely — preemies — than for their full-term siblings. We concluded that the increased risk can’t be fully explained by genes, which siblings have in common, or by socio-economic conditions and living conditions in childhood,” says Risnes.

Most common diseases

Dying in the first 50 years of life is rare. For 30-year-olds, the risk of dying is one in 1 000 per year, for 50-year-olds the risk rises to two in 1 000. Chronic diseases make up a minor percentage of these deaths. The researchers in the EU study chose to look at cancer, heart disease, stroke, chronic lung disease and diabetes because these are the most common chronic diseases that can be fatal.

In the past, it has been difficult to access other nations’ health databases. Risnes is very happy that such access was possible for this study. Robust results are easier to attain with such a large volume of health data. The findings of the study are consistent between countries.


Recognising a Grandparent’s Journey

FRIDAY, MAY 22, 2020

When a family travels the difficult journey of welcoming a premature or sick baby into the world, it isn’t just the parents or carers who are impacted.

The whole family feels the reality and shares in the emotions of the experience. None more so than grandparents. Grandparents are often an invisible casualty when a birth does not go to plan and ends in an emergency delivery and admission to the NICU. Grandparents are part of a common phenomenon where there’s a double concern for both the newborn grandchild, and their adult child who is managing this stressful event physically, mentally, and emotionally.

While Grandparents are the most common support system for new parents, the hospital restrictions and fragile health of an NICU baby can create an imbalance of involvement and un-involvement, which is often difficult to avoid. Hence, grandparents may require great flexibility to help in other ways.

One common way to help is in the home, attending to the needs of the siblings, and supporting the family’s routine which is a huge and much-needed help. During this time grandparents provide new parents the opportunity to be with their baby and to also be part of the healthcare team. In a way, they become the scaffolding for parents to be in this very important position for the best outcome for their grandchild.

It’s important to also acknowledge the challenges for grandparents of babies in the hospital during COVID-19 who would have no involvement in the NICU and for some, possibly meeting this new baby for the first-time months later, once discharged. The restrictions that are put into place are there to protect the fragile health of the baby as well as protecting this particular age group from entering a building where patients are being treated for the COVID-19 virus. All of those feelings of fear, worry, and uncertainty are shared by the new parents and extended family, however grandparents are unique and medical staff should understand and welcome them in their supportive presence. They are the unsung heroes of this life-changing event.

We are looking for stories from a grandparents perspective, sharing your experience of having a grandchild in NICU or SCN and watching your own child navigate the challenges of such a journey. If you would like to share your story click HERE.


She Had a Preemie — and Then She Started to Ask Important Questions

By Randi Hutter Epstein  & Sarah DiGregorio – Jan. 28, 2020

EARLY:  An Intimate History of Premature Birth and What It Teaches Us About Being Human

Sarah DiGregorio was 28 weeks pregnant when she found out that her baby had stopped growing. Two days later, her daughter, Mira, was delivered via an emergency cesarean section. She weighed 1 pound 13 ounces.

“My body had been trying to kill her,” DiGregorio writes.

“Early” opens like a medical thriller. Newborn Mira is whisked away to a neonatal intensive care unit while her parents are bombarded with statistics, terrified about her future. It closes with Mira, a robust toddler, diving into a pit of foam blocks. This isn’t a spoiler — but the heart of DiGregorio’s illuminating book isn’t just about her family’s journey; it’s an expansive examination of the history and ethics of neonatology.

For most of human history, babies born months too soon were left to die. They were considered less than full-fledged beings, not quite living and therefore not worth saving. Plus, there wasn’t much to be done.

The field of neonatology took off in the second half of the 20th century when a few pediatricians, often against the advice of colleagues, dared to save newborns.

In 1961, Dr. Mildred Stahlman, a Vanderbilt University pediatrician, fitted a premature baby into a miniature iron lung machine. These machines, originally for polio patients, used negative pressure to pull open weak chest muscles to draw air into the lungs. The baby survived. Stahlman then created one of the first neonatal units and trained a cadre of disciples.

By the 1970s, negative pressure machines were replaced with positive pressure ones that worked by inflating the lungs. It was a tricky technique that required threading the tiniest of tubes through the trachea and into the lungs. Dr. Maria Delivoria-Papadopoulos, then a pediatrician at Toronto’s Hospital for Sick Children, was one of the first to try. Seventeen attempts were unsuccessful. Then she saved one baby girl. Her tenacity paved the way for half a million people born prematurely living today.

And yet, DiGregorio reminds us, every advance — every attempt at every advance — brings with it new dilemmas. Such innovations may save a child’s life but can leave them with significant disabilities. A doctor cannot predict how a particular premature baby will fare. Complicating the matter, who’s to say what kind of life is worth fighting for and how much treatment is too much?

In “Early,” we read about neonatologists, bioethicists and parents grappling with the toughest decisions. We meet pediatric palliative care specialists and parents who forgo further treatment and embrace their babies as they die. DiGregorio covers other factors that influence prematurity, such as poverty and racism.

DiGregorio, a food editor and writer, is such a beautiful storyteller, I found myself underlining passages, turning corners of pages and keeping track of the page numbers at the back of the book until I had a hodgepodge of numbers scribbled on top of each other.

She imagines her nonfunctioning placenta as “a beat-up old car, chugging along, belching smoke”; after her emergency C-section, she writes, her body “felt like an empty house that had been vacated in a rush, leaving dirty dishes in the sink.” And later, DiGregorio refers to a 1-year-old as “that sweet spot between baby and toddler.”

By the epilogue, when the narrative returns to DiGregorio’s personal story, readers will appreciate how medicine lurches forward with leaps and mishaps along with the inevitably tense discussions about which path to take and when. All doctors wrestle with these issues, yet they seem particularly poignant when we are dealing with tiny babies. That’s because, as DiGregorio puts it, the field of neonatology has “changed the way we understand what it means to be alive, what it means to be human, and what constitutes a life worth living.”

Randi Hutter Epstein is the writer in residence at the Yale School of Medicine and author of “Aroused: The History of Hormones and How They Control Just About Everything.”

An Intimate History of Premature Birth and What It Teaches Us About Being Human

By Sarah DiGregorio
A version of this article appears in print on Feb. 9, 2020, Page 17 of the Sunday Book Review with the headline: Born Too Soon.


© Provided by The Boston Globe – Brian and Kristen Sardini with Aila at the Brigham and Women’s Hospital.


Laura Crimaldi – The Boston Globe

Brian and Kristen Sardini didn’t expect to become parents in time to mark Mother’s Day and Father’s Day this year. Their first baby was due on July 4.

But little Aila had different plans.

The baby girl was born March 26 during her mother’s 25th week of pregnancy. She weighed just over a pound.

On Sunday, the family will mark Brian Sardini’s first Father’s Day with Aila in the Newborn Intensive Care Unit, or NICU, at Brigham and Women’s Hospital.

“It’s the best Father’s Day gift in the world,” he said Saturday. “I’ve always wanted to be a dad and wouldn’t change anything because Aila’s perfect.”

During her three months in the unit, Aila has made tremendous strides, her parents said. The ventilator and continuous positive airway pressure or CPAP machine that Aila once used for breathing are history. A crib has replaced the isolette where she once spent most of her time. She’s tried out breastfeeding and started wearing clothes from the Preemie Store, which sells “micro” sizes for babies who weigh between 1 and 3 pounds.

On Friday night, Aila tipped the scales at just over 4 pounds. She has a collection of colorful, hand-knitted octopuses, which are used in hospitals to comfort premature babies.

What’s more, her parents have already read her the first four books in the “Harry Potter” series and are now halfway through reading her the fifth book, “Harry Potter and the Order of the Phoenix.”

“We started reading her ‘Harry Potter’ when she was, I think, 3 days old,” said Kristen.

Dr. Elisa Abdulhayoglu, the NICU’s medical director, said she was in the room when Aila was born and watched Brian meet his daughter.

“He bent down, looked at his beautiful little girl, and he said, ‘Yup. I’m a daddy’s girl for sure,’” she said. “It was an absolutely beautiful, beautiful moment.”

Good thing beautiful moments don’t require planning. Four days before Aila was born, Kristen said she had an uneventful appointment with her obstetrician. On the following day, the couple, both 27, planned to go to work and turn in a down payment for their new home in Medway.

But that day, they also went to an ultrasound appointment, and got some troubling news. Kristen had pre-eclampsia and needed to be admitted to the hospital for monitoring. Her routine checkup from the day before was suddenly ancient history.

“I had a totally normal OB appointment. My blood pressure was like 112 over 79. Completely normal. No red flags. Nothing wrong,” she said. “Within 24 hours, I was being sent to the Brigham. That’s how quickly this stuff can happen. And it’s really crazy.”

Kristen credits her husband with getting her through the Cesarean section birth.

“He just really helped me stay calm, and just like he said, focus on the task at hand and just take one thing at a time, and not let myself get lost in in mumbo jumbo of everything,” she said.

Before the birth, the couple said they were warned that their daughter wasn’t likely to cry or move when she was born and they wouldn’t have a chance to cut her umbilical cord.

Once again, Aila had something else in mind. She entered the world kicking, waving, and “crying at the top of her lungs,” her parents said. Brian also got to cut the umbilical cord.

“People say that when you see your child for the first time, it’s just an instant, instant bond and your whole life kind of changes,” Brian said. “As cliché as it sounds, it really is what happens.”

At a gestational age of 25 weeks, Abdulhayoglu said Aila is considered young by preterm standards. The majority of preterm babies born in the United States have reached a gestational age of at least 32 weeks, she said. The Brigham’s NICU cares for preterm babies as young as 22 weeks gestation, though, according to Abdulhayoglu.

In the long-term, she said outcomes are “excellent” for babies born at 25 weeks gestation.

“Parents are the true champions for these tiny, preterm babies, and her parents are amazing,” Abdulhayoglu said. “They’re there every day.”

The couple said they don’t know when Aila will be ready to leave the hospital, but they hope to take her home next month.

On Sunday, the couple said they plan to spend most of the day at the hospital with Aila, reading and snuggling. They heaped praise on the nurses, doctors, social workers, and other Brigham employees who have assisted them during Aila’s hospitalization.

Aila shares a room overlooking a courtyard with six other babies and decorated by her nurses with photographs of her and prints of her feet positioned to look like butterfly wings.

On Mother’s Day, Kristen said her daughter’s nurses gave her a mug that read, “Mom,” with Aila’s handprint in the spot for the letter O.

Kristen said she wants her husband to enjoy his first Father’s Day with their daughter.

“I hope that he just has the best day possible,” she said. “He has 100 percent earned it.”



MRI Detects Atypical Brain Development in Premature Babies By News Release – School of Medicine in Boston

Subtle differences in brain structure can be detected by quantitative MRI (qMRI) in premature babies who later develop abnormalities such as autism or cerebral palsy. The study, published in Radiology, demonstrates the potential for qMRI, which obtains numerical measurements, to help improve outcomes for the growing numbers of people born preterm.

Advances in neonatal care have boosted survival rates for children born extremely preterm, defined as fewer than 28 weeks of gestation. With so many preterm infants surviving, there is interest in understanding the effects of preterm birth on brain development. Research has shown that extremely preterm babies face higher risks of brain abnormalities.

“So much of the maturation of brain occurs during the third trimester when the fetus is in the womb’s nourishing environment,” said study co-author Thomas M. O’Shea, MD, from the University of North Carolina in Chapel Hill. “These preterm babies don’t experience that, so it seems likely that there are alterations in the brain maturation during that interval.”

Dr. O’Shea and colleagues at 14 academic medical centers in the US launched a study 20 years ago to better understand the effects of preterm birth. The study, known as the Extremely Low Gestational Age Newborn-Environmental Influences on Child Health Outcomes (ELGAN-ECHO), evolved over the years to include experts in medical imaging like medical physicist Hernán Jara, PhD, professor of radiology at Boston University School of Medicine in Boston.

For the new study, Dr. Jara, Dr. O’Shea, and other ELGAN-ECHO researchers used qMRI. The noninvasive technique generates rich information on the brain without radiation. The researchers used it to assess the brains of adolescents who had been born extremely preterm.

“Quantitative MRI in a large dataset allows you to identify small differences between populations that may reflect microstructural tissue abnormalities not visually observable from imaging,” Dr. Jara said.

The researchers collected data from MRI scanners at 12 different centers on females and males, ages 14 to 16 years. They compared the qMRI results between atypically versus neurotypically developing adolescents. They also compared females versus males. The comparison included common MRI parameters, or measurements, like brain volume. It looked at less commonly used parameters too. One such example was proton density, a measurement related to the amount of water in the brain’s gray and white matter.

“What we aimed to do with qMRI was establish a biological marker that could help us discern these preterm children who had a diagnosis of disorder from those who didn’t,” said study lead author Ryan McNaughton, MS, a PhD student in mechanical engineering at Boston University.

There was no control group of people born after the typical nine months of gestation. Instead, the researchers used the neurotypically developed children for comparison.

Of the 368 adolescents in the study, 252 developed neurotypically while 116 had atypical development. The atypically developing participants had differences in brain structure visible on qMRI. For instance, there were subtle differences in white matter related to proton density that corresponded with less free water.

“This might be the tip of the iceberg since the amount of free water is highly regulated in the brain,” Dr. Jara said. “The fact that this difference was observed more in females than males may also be related to the known comparative resilience of females as demonstrated in findings from earlier ELGAN-ECHO and other studies.”

The researchers collected umbilical cord and blood samples at the beginning of the study. They plan to use them to look for correlations between qMRI findings and the presence of toxic elements like cadmium, arsenic, and other metals. The power of qMRI will allow them to study both the quantity and quality of myelin, the protective covering of nerves that is important in cognitive development. They also want to bring in psychiatrists and psychologists to relate qMRI findings to intelligence, social cognition and other outcomes.

“This project shows how researchers with different expertise can work together to use qMRI as a predictor of psychiatric and neurocognitive outcome,” McNaughton said.

“The teamwork required to get where we are now is pretty astounding,” Dr. O’Shea added. “I’m really grateful for the families, the nursing coordinators, and everyone else who made this possible.”


Dr. Philip Sunshine, founding father of Neonatology, is turning 90!

Jun 12, 2020

Our beloved Dr. Philip Sunshine, one of the founding fathers of Neonatology, is turning 90 years young! His only birthday wish? To help save more babies.

Fascinated? Learn more about Dr. Sunshine here: https://www.youtube.com/watch?v=h4ZjVfN3u0g

Policy Strategies for Addressing Current Threats to the U.S. Nursing Workforce

List of authors. Deena Kelly Costa, Ph.D., R.N., and Christopher R. Friese, Ph.D., R.N.

The Covid-19 pandemic has made it clear that without enough registered nurses, physicians, respiratory therapists, pharmacists, and other clinicians, the U.S. health care system cannot function. Weaknesses in health care staffing are of particular concern when it comes to the workforce of registered nurses, which could well see a mass exodus as the Covid-19 pandemic eases in the United States and the economy recovers. In a 2021 national survey conducted by the American Association of Critical-Care Nurses, 66% of respondents reported having considered leaving the profession, a percentage that is much higher than previously reported rates. Unsafe work environments — which predated the pandemic — are a key contributor to intentions to leave. Clinicians, health system executives, and policymakers have issued calls to address this crisis, but there has been little in the way of tangible federal or state policy action to prevent workforce losses or to build capacity.

Although it may comfort hospital executives to imagine a post-Covid future in which nurses are again willing to accept positions at local pay scales, such a scenario is unlikely to come about anytime soon. Historically, nurses have reduced their working hours or left the workforce during economic growth periods and returned during recessions, when family incomes fall.1 Nurses may again choose reduced employment as Covid-19 pressures ease and economic conditions improve. Moreover, nurses reported pervasive unsafe working conditions before the pandemic, and during Covid, they have cited a range of stressors and traumatic experiences, including furloughs, a lack of adequate protective equipment, increased violence, excessive workloads, and reduced support services. Pressures on the nursing workforce may therefore only worsen as Covid-19 subsides.

Federal and State Policy Approaches to Supporting Nurse Staffing in the United States.

State and federal policy solutions could prevent workforce losses and increase the supply of nurses (see table). Although there are challenges and opportunities for the nursing workforce throughout health care settings, hospitals are a particularly important area of focus.

Preventing the loss of current nurses is an essential component of shoring up the hospital nursing workforce. We contend that there isn’t a shortage of nurses, but a shortage of hospitals that provide nurses with safe work environments and adequate pay and benefits. At the federal level, the Centers for Medicare and Medicaid Services (CMS) could publish regulations, similar to recently announced policies governing skilled nursing facilities, that specify standards (including maximum patient-to-nurse ratios) for ensuring safe nursing care — and could establish financial penalties for hospitals that violate these regulations. Data supporting increased nurse staffing have been available for decades.2

Another federal strategy centers on investing in reimagined, safer health care systems. Congress could appropriate funds to the Agency for Healthcare Research and Quality to support investigator-initiated grants focused on developing new, scalable care-delivery models that are designed to improve outcomes for patients and clinicians. The National Institute for Occupational Safety and Health could expand testing of protective equipment and strategies for improving health care workers’ well-being. Data are needed on care-delivery models that keep patients safe and on approaches for promoting joy and safety in clinical work.

Regulatory bodies, including CMS and CMS-approved accreditors, such as the Joint Commission, could scale back regulations and standards that add to nursing workloads. Although some regulations were temporarily eased during the pandemic, new rulemaking could eliminate especially burdensome provisions that aren’t essential to patient safety. For example, clinical-documentation burden is a frequently cited source of job dissatisfaction and burnout. Documentation requirements, which are interpreted in various ways by different hospitals, could be minimized to reduce burnout and attrition.

States have more flexibility than the federal government when it comes to enacting legislative and regulatory changes to improve work environments and prevent losses in the nursing workforce. In the absence of federal action in this area, state legislation promoting safer nurse-staffing practices — such as laws establishing mandatory patient-to-nurse ratios — is an evidence-based intervention to support patient safety and reduce the likelihood of nurse departures. Studies have reported improved nurse staffing, improved job satisfaction among nurses, and improved patient outcomes in California after the state enacted legislation prohibiting mandatory overtime for nurses and establishing maximum patient-to-nurse ratios.3 Many U.S. hospitals continue to require nurses to work overtime hours, however, and few have mandated staffing ratios. Legislatures in some states have introduced bipartisan bills similar to California’s law that would restrict mandated overtime and implement maximum staffing ratios. When considered at a national scale, mandated staffing ratios face implementation hurdles, since coordination would be required to distribute the nursing workforce equitably throughout the country. But such policies would most likely prevent workforce losses and boost the number of entrants into the profession.

Policies could also support career development among nurses. Studies have documented the negative effects of Covid-19 on the careers of women in particular. Approximately 90% of U.S. nurses are women, and many of them have faced pressures related to family care during the pandemic, amid school and child-care facility closures. To ease nurses’ household burdens, states could offer loan-repayment programs and offset nursing school tuition debt. They could also provide grants or tax benefits to hospitals offering on-site child care, after-school care, or comprehensive dependent-care programs. Finally, states could offer innovation grants to hospitals to develop safer, more supportive workplaces or fund new initiatives to support on-site graduate-school and professional-development programs designed to retain experienced nurses.

Preventing workforce losses is important, but so is increasing the supply of nurses. The United States lacks access to real-time workforce data and expert guidance for evaluating those data and for advising policymakers on workforce shortages. The National Health Care Workforce Commission was authorized as part of the Affordable Care Act, but Congress never funded it. Appropriating funds for this commission would strengthen the country’s ability to respond to the current threat to nurse staffing and prepare for future ones.

A key factor constraining the supply of nurses derives from structural barriers within nursing education. Being hired as a nursing school faculty member requires having an advanced degree, but expert nurses rarely accept faculty positions because salaries are higher for practice roles. Faculty shortages, among other factors, limit nursing school enrollments; over the past decade, schools turned away between 47,000 and 68,000 qualified applicants annually.4 Federal policies could loosen the nursing bottleneck. For example, policymakers could increase financial incentives to recruit nurse educators, expand nursing school loan-forgiveness programs, fund grants for hospitals and nursing schools to share expert nurses as clinician-educators, and develop a nurse faculty corps program to raise salaries in regions with shortages of nurses. Creative financial incentives, such as tuition-remission programs or programs that provide loans at low interest rates, could encourage prospective students to choose nursing careers. Pipeline programs and partnerships among high schools, technical schools, and universities could permit emergency medical technicians, certified nursing assistants, and armed forces corpsmen or medics to apply clinical work hours toward nursing degrees and qualify for targeted scholarships supported by state or federal funds. Expansion of the CMS Graduate Nurse Education demonstration project could substantially increase the number of qualified nurse practitioners, who could also serve as clinical nursing faculty.

State legislation that eliminates onerous scope-of-practice regulations for advanced practice providers would enable nurse practitioners, including midwives, to practice independently and could increase access to health care. In Michigan, Senate Bill 680 would implement these reforms, thereby allowing nurse practitioners to prescribe tests, medications, and services. This bill could increase the state’s supply of clinicians and potentially attract nurses planning to pursue advanced degrees.

Threats to the nursing workforce aren’t new, and neither are proposals to address them.5 Although policies aimed at individual components of this problem could be helpful, a comprehensive package of federal, state, and local efforts would probably be the most effective approach for averting health care system dysfunction and adverse outcomes. We believe federal and state policies should both prevent the loss of current nurses and increase the supply of nurses. Without timely investments in the nursing workforce, the United States may have enough hospital beds for seriously ill patients, but not enough nurses to deliver essential, safe care.


Skin injuries to babies in neonatal care could be avoided with new splint, trial shows

by Victoria University of Wellington – MAY 26, 2022

A new device to prevent skin injuries to babies in neonatal intensive care units has been successfully trialed in a study led by Dr. Deborah Harris, a neonatal nurse practitioner at Te Herenga Waka—Victoria University of Wellington.

Most babies admitted to hospital need an intravenous drip to deliver fluids and medications, says Dr. Harris. This drip is secured to the baby’s skin using adhesive tape.

“Removing the adhesive tape is painful and can cause skin injuries and scarring. Skin damage also increases the risk of the baby getting an infection and being in hospital longer. We designed a device called a Pēpi Splint that can be used to secure the drip without the need to apply adhesive tape to the baby’s skin,” Dr. Harris says.

A trial of the Pēpi Splint on 38 babies at Wellington Hospital’s neonatal intensive care unit showed it was effective and avoided the skin damage caused by adhesives.

“The Pēpi Splint held the drips secure for 34 of the 38 babies in our trial. In four cases, the splint became loose either because it hadn’t been secured properly or was dislodged when the baby was removed from the cot for breastfeeding.”

Dr. Harris says the results provide support for a larger randomized controlled trial.

“Skin injuries are common in neonatal units and the damage caused to a baby’s skin by adhesive tape can be considerable. Removing the tape has the potential to strip 70% to 90% of a baby’s epidermis. We hope the Pēpi Splint will help reduce these injuries to newborns.”

The splint is made from medical-grade silicon gel and contains an aluminum mesh, allowing it to be molded to the baby’s limb. Adhesive tape is used on the Pēpi Splint itself to secure it to the drip, but tape is not applied to the baby’s skin.

During the trial, modifications were made to the splint to make it easier to use. “After these changes, clinicians involved in the trial reported the splint was easy to apply,” Dr. Harris says.

Most parents supported the device’s use: 52 of 58 (90%) said they would participate in the study again if they had another eligible baby.

The Pēpi Splint, developed in collaboration with a design engineer, can be washed and sterilized for reuse.



Golden Buzzer: Avery Dixon’s Emotional Audition Moves Terry Crews to Tears | AGT 2022

May 31, 2022  –    #AGT #AmericasGotTalent #Auditions

     America’s Got Talent

Grab your tissues; Avery Dixon’s emotional audition might make you cry. Terry Crews was moved to tears when he heard Avery’s sensational saxophone skills and harrowing story about being bullied.

Kat’s Korner

Fellow Warriors and Preemie Parents,

As per the NTNU St. Olay Hospital’s Study, “ the risk of dying before the age of 50 is 40 percent higher for preemies than for the population as a whole. Researchers found that the risk of dying for individuals born before full gestation and who have chronic heart disease, lung disease, or diabetes is twice that of the population as a whole.” These findings provide valuable information in regard to the morbidity risk of preemie infant survivors and highlight the need for further research. 

Increased diagnosis and early detection of disease conditions that preemie survivors are more prone to experience are critical as our rate of survival is improving and more of us are thriving well into adulthood. While research efforts to improve outcomes, reduce mortality and enhance care for neonates have drastically improved over the past 50 years, few studies have investigated long-term outcomes, health disparities, and the impact of the life-long physical and psychological impact of being premature among the adult population. We need to establish specialist education/credentialing that support workforce opportunities to partake in diagnostics, treatment, research and  development aimed at addressing adult care for preemie infant survivors.

As a community that makes up 11-12% of the global population, we can connect and engage with each other as preemie survivors, promote collaboration between all members of our community, and actively advocate for change in the clinical management of preemie infant survivors to include long-term and specialized care.

If you or someone you know is interested in learning more about ways to connect with our adult preemie community a great resource is the Adult Preemie Advocacy Network, sharing safe space communication platforms for preemie survivors and opportunities to participate in research activities, and partake in advocacy activities to support our resilient community. Check out this great resource below-


Surfing Under the Northern Lights w/ Mick Fanning | Chasing the Shot: Norway Ep 1

Mar 20, 2017



Japan is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the north toward the East China Sea and Taiwan in the south. Japan is a part of the Ring of Fire, and spans an archipelago of 6852 islands covering 377,975 square kilometers (145,937 sq mi); the five main islands are HokkaidoHonshu (the “mainland”), ShikokuKyushu, and Okinawa. Japan is the eleventh most populous country in the world, as well as one of the most densely populated and urbanized. Japan is a great power and a member of numerous international organizations, including the United Nations (since 1956), OECDG20 and Group of Seven. Although it has renounced its right to declare war, the country maintains Self-Defense Forces that rank as one of the world’s strongest militaries. After World War II, Japan experienced record growth in an economic miracle, becoming the second-largest economy in the world by 1972 but has stagnated since 1995 in what is referred to as the Lost Decades. As of 2021, the country’s economy is the third-largest by nominal GDP and the fourth-largest by PPP. Ranked “very high” on the Human Development Index, Japan has one of the world’s highest life expectancies, though it is experiencing a decline in population. A global leader in the automotiverobotics and electronics industries, Japan has made significant contributions to science and technology. The culture of Japan is well known around the world, including its artcuisinemusic, and popular culture, which encompasses prominent comicanimation and video game industries.

The level of health in Japan is due to a number of factors including cultural habits, isolation, and a universal health care system. John Creighton Campbell, a professor at the University of Michigan and Tokyo University, told the New York Times in 2009 that Japanese people are the healthiest group on the planet. Japanese visit a doctor nearly 14 times a year, more than four times as often as Americans. Life expectancy in 2013 was 83.3 years – among the highest on the planet. 

A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. Japan had the highest level of expected human capital among the 20 largest countries: 24.1 health, education, and learning-adjusted expected years lived between age 20 and 64 years.

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


Rank: 175  –Rate: 5.9%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)


Resilience is at the core of each and every Neonatal Womb Warrior/Preterm Birth Community member. We have all been challenged and have responded with such great love, commitment, and to the best of our abilities.

From the perspective of a parent who has experienced the death of a preemie baby, and the rigorous commitment it took to support the ultimate well-being of a surviving preterm birth twin, the needless death of our children due to war, school shootings in the USA, lack of adequate healthcare in many global communities, including the USA, the challenges we face as we are called to navigate pandemics and global warming calls my heart to weep at times and my soul to act.

Now more than ever, we have an opportunity in our lives to step in and focus our energies on building strong and resilient solutions that protect, heal, and empower our mutual wellness through collaborative innovation. Together we can engage in creating new systems and resources to act, not react, to the issues heavily impacting our world.

The first step towards effective collaboration with our Pre-term Birth Community and the Global Community starts with a look within. As we look into our individual personal internal habitat in order to develop and secure a solid foundation to carry with us, we acknowledge our personal responsibility and ability to empower our personal well-being and to establish and maintain trust within.

The more we each seek our own health and happiness, the stronger the world becomes. Start with you and yours. Each one of us is called to travel a unique path. Follow your guidance, embrace your journey. Your happiness and well-being itself are transformative. Ultimately, action based on a foundation of love will prosper and triumph. Kathy, Kat and Gannon (the other cat).

The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future

Tetsuya Isayama Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan Correspondence to: Tetsuya Isayama, MD, MSc, PhD. Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan. Email: isayama-t@ncchd.go.jp. Submitted Apr 10, 2019. Accepted for publication Jul 08, 2019.

Abstract: There is a wide variation in neonatal mortality rates across regions and countries. Japan has one of the lowest neonatal mortality rates in the world; in particular, the mortality rate of extremely preterm infants (i.e., those born before 26 weeks of gestation) is much lower in Japan than in other developed countries. In addition, Japan has low incidences of intraventricular hemorrhage, necrotizing enterocolitis, and late-onset sepsis, a very high incidence of retinopathy of prematurity, and a relatively high incidence of chronic lung disease. In Japan, general perinatal medical centers (PMCs), which are PMCs that offer the highest levels of care, are required to have an obstetric department with maternal-fetal intensive care units as well as a neonatal or pediatric department with neonatal intensive care units (NICU), in order to promote antenatal rather than neonatal maternal transfer of high-risk cases. The limit of viability of extremely preterm infants is 22 weeks of gestation, and approximately half of them are estimated to receive active resuscitation. The clinical management of extremely preterm infants in Japan are characterized by (I) circulatory management that is guided by neonatologist-performed echocardiography, (II) relatively invasive respiratory management, (III) nutritional management, which entails the promotion of breast milk feeding, early enteral feeding, routine glycerin enema, and the administration of probiotics, (IV) neurological management by means of minimal handling, sedation of ventilated infants, and serial brain ultrasounds, and (V) infection control with the assistance of serial C-reactive protein (CRP) monitoring. Thus, this review provides a brief description of the development of neonatology in Japan, introduces the unique features of Japanese clinical management of extremely preterm infants, and overviews their outcomes.


Source: https://tp.amegroups.com/article/view/27505/24536


this music video!

Novelbright – 愛とか恋とか [Official Music Video]

#Novelbright #愛とか恋とか #関水渚 2,332,778 views  Premiered Apr 22, 2022

Affordable, Lightweight, Neonatal Incubators – mOm Incubators#HeroSeries

Apr 20, 2022  Innovate UK KTN

15 million babies are born prematurely every single year, and of that about 7% don’t make it due to poor healthcare. Decreasing infant mortality rates by addressing accessibility issues is at the heart of what they do at mOm incubators. CEO and product designer of mOm incubators James Roberts is rethinking the way neonatal healthcare is delivered. Their neonatal incubator is a unique solution that contrasts traditional incubators in that it is a 20 kg portable, collapsible, and accessible solution that provides flexibility to medical staff, allowing them to provide the necessary care to infants whenever and wherever it is needed, in any environment and even during transportation. As any traditional incubator, mOm incubators provide a high spec thermally stable and safe environment for premature infants. However, these particular incubators run on 100 watts in steady state, making them very energy efficient and thus have a low carbon footprint. Innovate UK’s Sustainable innovation Fund allowed the company to perform a usability study to gather data and detailed feedback on how to improve the performance of the incubator. The fund also allowed the company to test their product in a clinical setting for the first time. This technology can benefit thousands of premature babies not only throughout the UK but internationally, changing the landscape for neonatal care on a global scale through a high-tech and sustainable solution.

When a mom and baby are cuddling, talking and cooing warmly with each other, making eye contact, listening and responding to each other, they are influencing the very physiological functions that underlie their health.

Relational Health Through the Lens of Emotional Connection

February 17, 2022

“Toxic stress” as a concept has gained a firm foothold in our health discourse and even crossed over into the mainstream. That’s because we can so clearly see the physiological and behavioral effects it is having on our children. 

But what do we do about it? And how do we shift our attention from merely identifying toxic stress as a problem to buffering it? How do we build healthy, resilient children and families?

The American Academy of Pediatrics released a policy statement last year that says the answer lies in fostering relational health between children and adults in pediatric primary care practice. 

But how we foster relational health remains up for interpretation. As the policy statement reports, many pediatric and early childhood professionals have long recognized the vital importance of the parent-child relationship, and yet “the elemental nature of relational health is not reflected in much of our current training, research, practice, and advocacy.” 

From our perspective here at the Nurture Science Program, there are three central reasons relational health has not become an integral component of pediatric care. 

1. Relational Health is still largely considered psychological. 

2. Most existing relational health screens look separately at parent or child, take time, and are difficult to code.

3. Within existing frameworks, such as attachment theory, each individual develops a fixed attachment style, which means it does not change. Early intervention then becomes the only hope for the developing child.

Through our lens and work on autonomic emotional connection, we hope to provide a practical, scalable solution. 

1. Relational health is biological, physiological, and interpersonal. 

Over decades of research we have uncovered that there is something happening between mother and infant when they get emotionally connected—not just in the brain, but on a deep body-to-body level, which is where we can observe and measure it. That is why we call it autonomic emotional connection. 

The autonomic nervous system is the nervous system that modulates our stress response; it makes our hearts beat and lungs breathe without our having to think about it; these processes regulate our emotional behavior. When mom and baby are emotionally connected on the autonomic level, they are actually regulating each other’s heart rates and hormones and positively affecting each other’s stress responses. In other words, when a mom and baby are cuddling, talking and cooing warmly with each other, making eye contact, listening and responding to each other, they are influencing the very physiological functions that underlie their health. 

It sounds strange, I know. We don’t think of things like cuddling and cooing as science—but they are behavioral manifestations of essential physiological and biological processes happening between two bodies. 

And the impacts these behaviors have on our physiology are profound. Through our randomized control trial of Family Nurture Intervention (FNI) in NICU, we found that engaging mothers and children in autonomic emotional connection dramatically improves babies’ development, sleep, stress resilience, attention, cognitive, learning, and language scores. Mothers also saw improved mental health and lower cardiac risk. Five years later, both mother and child still had better physiological regulation and stress resilience (which is important when we’re worried about the effects of toxic stress). 

Once parent-facing professionals can understand that relational health produces physiological outcomes  and observable behaviors—rather than being an ephemeral concept—they can seamlessly integrate relational health observation into an office visit where they are already checking vital signs and motor skills. 

All they need is a brief observational tool that evaluates parent and child in relationship with each other. 

2. To measure relational health, we need to observe parent and child interacting with each other face-to-face. 

Unlike existing relational health screens that only look at the child or the parent, the Welch Emotional Connection Screen (WECS) focuses on the behaviors between parent and child. It is a quick (20-30 second), easy to use, non-invasive, validated screen that a parent-facing professional can employ while observing a mother and infant interacting face-to-face with the child on the parent’s lap. 

The WECS organizes the visible behaviors of their relationship into the following four domains:

  • Mutual Attraction (Do mom and baby want to be close to each other?)
  • Vocal Communication (Is their vocal tone warm and engaging?)
  • Facial Expressiveness (Are they trying to communicate using their faces?)
  • Reciprocity (Are they sensitive to each other’s expressed emotions? Do they follow-up with each other?)

In clinical research, pairs who exhibit all of the above receive a high WECS score. And in mother-baby pairs with high WECS scores, we see improved neurobehavioral outcomes, both short and long-term. 

In widespread practice, a parent-facing professional can use the WECS, even without formally scoring it, to help identify the families that can most benefit from support. 

3. Emotional connection is a state not a trait. 

The fact that emotional connection is a state between two people and not a trait of just one person is the most hopeful takeaway from our work. It means we are not fully “baked” with a maladaptive attachment style based on whether our needs were met in childhood. It means your toddler with behavioral problems is not destined to always have behavioral problems. No matter our age or life experience, we can enter into a state of emotional connection and share its health benefits. 

Fortunately, the very same behaviors that the WECS observes can also be used to get two people connected—by conditioning the underlying physiological mechanisms of relational health. The context is still sensory—physical touch, eye contact, vocal communication—but the activity is emotional expression. 

In a pediatric primary care setting, the intervention is brief: emotional exchange between parent and child, with the child sitting on the parent’s lap. Parents respond to a prompt on an emotional topic (such as “tell your child the story of how you picked their name,” or “tell your child the story of their birth”), in their primary language. The prompt works when it elicits deep emotional expression from the parent.

During FNI (an intervention used in extreme cases, such as preterm birth), mothers are guided through what we call calming cycles. A nurture specialist prompts mothers to express their feelings to their babies while engaging their senses (e.g. skin-to-skin, making eye contact, etc). This emotional expression engages the child’s orienting reflex, and often prompts some kind of response (their oxygen saturation may go up or they may look at their mom for the first time). This cycle continues as parent and child move from mutual states of distress to mutual states of calm. Once calm and connected, we can see evidence that their physiological co-calming mechanism (what we call co-regulation) is in effect. Any further nurturing interactions between them will continue to strengthen and condition that mechanism. 

We hypothesize that the mechanism of co-regulation underlies and facilitates all of the physiological improvements, developmental gains, and emotional and mental well-being we see in our results. And because emotional connection and co-regulation feel good, moms and babies will continue to do these sensory and emotional activities, not because they have been told to, but because they want to. That may be part of why mothers and children show physiological benefits related to stress resilience (HRV) even 5 years after the intervention.

It’s Time for a Paradigm Shift

The quality of our relationships can alter the landscape of our physical and mental health, lifelong. Relational health, it turns out, is an absolutely essential part of our wellbeing, and we can foster it by looking through the lens of autonomic emotional connection. 

When we do so, we will see that relational health is behavioral and can be observed; its impacts are physiological and can be measured; and it is a state that we move in and out of with our loved ones throughout our lifetimes. The reason to start early, and to target the mother-infant relationship as a mediator of positive effects on relational health, is not merely to prevent later problems, it is to experience maximum benefit at every stage of our lives. 

This paradigm shift would necessarily impact the way that health conditions are viewed and treated: by creating environments and relationships capable of fostering the growth and health we all deserve.

Disseminating these tools and practices to researchers, clinicians, and parent-educators has the potential to help children and their families experience deep autonomic emotional connection with each other—opening the door to intergenerational health and thriving.

Source: https://nurturescienceprogram.org/relational-health-through-the-lens-of-emotional-connection/


When can babies go home from the NICU

Jul 5, 2020   The NICU Doc

Do you want to know when can babies go home from the NICU? You have been in the NICU for days, weeks, sometimes even months and you are SO CLOSE! Find out what things need to happen for your baby to be discharged from the NICU. How can you best prepare to be ready for the day of discharge. What actually happens the day of discharge? The NICU Doc will go over the things that your baby and you need to be doing to be ready for discharge. And also, I will go over the events of the day of discharge.

*Disclaimer: Although I work in an academic institution and unless stated, the videos posted are of my sole creation. Any opinions, comments, or postings are not a representation or a reflection of our institutions. **Any medical advice or topics discussed are NO substitute for your physician’s advice and care. Actions taken on advice from the videos are done so at your own risk.

CPR Training of Parents of Preterm Babies before Discharge – Experience from a Tertiary Care NICU

Mathew Jisha, MBBS, DNB, Nagar Nandini, MBBS, DCH, DNB, Rajagopal Kumar Kishore, MBBS, DCH, MD, FIAP, DCH, MRCP, FRCPCH, FRCPI, FRACP, FNNF, MHCD


Objectives: To evaluate the feedback of CPR training given to parents of preterm babies discharged from the NICU.

Methods: This was a retrospective study conducted using a questionnaire sent to parents of preterm neonates admitted to a neonatal intensive care unit (NICU) from January 2007 to May 2020. All parents of newborns under 30 weeks gestation who survived to discharge were considered eligible. Parents were given CPR training on a manikin by a Neonatal resuscitation provider (NRP) certified doctor. Babies less than 30 weeks were sent home with a disposable bag and mask after the training of the parents. The responses thus received were analysed.

 Results: We analysed data from 60 responses (48.3%). 85% of the parents were given one-on-one training, the rest as classroom training. 68.3% felt that the addition of video demonstrations would be beneficial. 95% of parents said that the training helped increase their confidence in taking care of their babies. 78% felt it did not add to unnecessary parental anxiety. 5 babies received CPR at home, and all were told that the home CPR was successful on assessment at the hospital after the episode. 65% felt a repeat training would be helpful. All the parents educated about CPR opined that this training is essential for discharge preparation.

Conclusion: We conclude that parental CPR training backed by video demonstration prior to the instructor-led session and followed by repeat training after 3 months is desirable in the holistic care of preterm babies post-discharge.

Key Message – Routine CPR education of parents of preterm neonates, backed by video demonstration and repetition of training after 3 months is desirable; it improves the confidence of parents and reduces anxiety in the care of their premature infants.

Introduction: Cardiopulmonary resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating. Around the turn of the 20th century, preterm infants were discharged only when they achieved a certain weight, typically 2000 gm(5lb). Studies have shown that preterm neonates can be sent home earlier without adverse health effects based on physiologic criteria rather than body weight. Evidence has shown that preterm neonates with low birth weight who require neonatal intensive care experience a much higher rate of hospital readmission and sudden deaths during the first year after birth than healthy term infants. The most important predictor of infant survival from an acute life-threatening event (ALTE) is the time from cardiopulmonary arrest to resuscitation. More so in neonates, this is the case, who are likely to suffer a respiratory arrest that responds quickly to resuscitation. This emphasizes the importance of systematic preparation for discharge and good follow-up thereafter of high-risk preterm neonates to reduce the chances of such life-threatening events.

Preterm neonates should demonstrate some physiologic competencies before being discharged from the hospital. These include oral feeding sufficient to support appropriate growth, thermoregulation in a home environment, and sufficiently mature respiratory control. The first two are usually achieved around 34-36 weeks’ postmenstrual age, but the maturation of respiratory control to the point that allows safe discharge may occasionally take up to 44 weeks’ postmenstrual age. Infants born as very or extremely preterm and have a prolonged and complicated stay in the hospital tend to take longer to achieve these competencies. But they may be discharged home much earlier if they exhibit thermostability and reasonable weight gain, as plotted on the Fenton’s growth chart. NICU graduates are discharged when they satisfy the above criteria. Their parents have demonstrated the necessary skills to provide all care components at home, including CPR should the need arise.

At the time of discharge, most parents lack confidence and are anxious about their capability to handle the babies at home. Hence, we thought that our intervention of training parents of neonates born at home. Hence, we thought that our intervention of training parents of neonates born < 34 weeks would help in the holistic care of these babies, including handling emergencies at home post-discharge. Many studies have emphasized that pre-discharge infant cardiopulmonary resuscitation training is essential or highly desirable. As shown by literature, it is a routine pre-discharge requirement in most developed countries, but this training is not reported or published in our country. Based on our hospital protocols, we initiated this training at its inception 13 years ago. We wanted to review our data over these years to see if it has made an impact or a difference.

Materials and methods:  This retrospective study was conducted at a tertiary care neonatal intensive care unit in India from January 2007 to May 2020. Informed consent for the survey was taken, and the Institutional Review Board approved the study. Initially, only parents of babies less than 30 weeks gestation were being given the training to perform CPR; however, since December 2019, due to a change in the unit protocol, all parents of babies with gestational age less than 34 weeks were admitted to the NICU were trained and included in the study. Babies (less than 30 weeks initially and less than 34 weeks later), deceased, and babies more than these respective gestational age groups were excluded. Parents of these babies were given CPR training (AHA NRP guidelines) in a language they could understand using a manikin, on the day of the transfer to wards or discharge from the NICU, by an NRP-certified doctor who is recertified every 2 years. The training included a brief description of CPR, when it needed to be initiated, and the steps of CPR, and ended with a physical demonstration of the same on a manikin. Parents were also given a chance to practice the steps on the manikin. Each session lasted around 20 minutes. At no additional cost, a new disposable self-inflating bag and mask were procured for each of these neonates and sent home at discharge after their parents underwent CPR training. The authors prepared a questionnaire/survey in English or the local language on request, with 22 questions. Parents were first called and spoken to and were then messaged a web link to complete this survey. All parents had access to the internet and the necessary device. The data from the survey was later analysed and reported.

Results:  During the study period, parents of 126 preterm babies were trained, out of which parents of 84 neonates were attempted to be contacted. The overall response rate to the survey was 71.4%, as shown in Figure 1. We analysed the data of 60 responses we received, and the following results refer to only those that participated in the survey. 46.6% of the babies were between 32-34wks as seen in Table 1. 27 were twins (with one survivor of a pair), and the rest were singleton babies. 85% of the parents were given one-on-one training, the rest as classroom training; however, only 23% of these parents perceived that classroom training may be better than one-on-one training. A majority of 95% found that the training given was easy to follow, and 68.3% thought that providing a video demonstration and one-on-one training would be more helpful. Bag and mask were used in 58% for demonstration. Only manikins with the demonstration of mouth-to-mouth breathing and chest compressions were used for the rest. 63.3% of parents thought it would be good to use a bag and mask for training. Of the total number who responded, 92% understood in what way CPR helped babies in an acute life-threatening event. 90% of them felt that they could identify when their babies required CPR.

Most parents (95%) said that the training helped increase their confidence in taking care of their babies. 78% felt it did not add to unnecessary parental anxiety. 5 babies received CPR at home. Of these babies, 3 received CPR in the first week after discharge and 2 after a month since discharge from the hospital, as shown in Table 2. 4 recovered from the episode quickly following home CPR. All parents correctly followed the steps as they had been advised to initiate CPR according to the assessment at the hospital after the episode. These parents, who found themselves in a situation that needed CPR, felt that they could execute it as taught. 67% of parents said that after three months, they could still recollect the steps of CPR taught during the training session. The need for repetition of training was felt by 65%, and they opined that it should be conducted after a time interval of 3 months since the last session. All 60 parents educated on CPR thought that this training is an essential part of discharge preparation.

Discussion: The American Heart Association (AHA) educates more than 9 million persons annually about CPR. Parents need to be trained in infant CPR. In the United States, 2230 infants (<1 yr. of age) died of sudden infant death syndrome (SIDS) in 2005, making it the third leading cause of death there. Drake et al. found that parents considered CPR a priority when asked to rank discharge teaching topics in order of importance.

We chose to do this study as CPR training is an important aspect of pre-discharge preparation for parents of preterm babies, as has been shown previously. Still, it is not routinely being done in most hospitals in our country, as evidenced by the lack of literature on the same. We hypothesised that getting feedback from parents who had received training in infant CPR would give us an overview of the effectiveness and scope for improvement of what we consider an essential practice.

Conventionally, CPR is taught using a combination of didactic instruction and hands-on practice, followed by a written test. Most of our parents had one-on-one training sessions, occasionally a group training. It was a manual demonstration, and in response to the questionnaire, parents did express that a video-backed demonstration would be more helpful. Brannon et al. used an instructional video as an adjunct to the instructor-led demonstration. The group concluded that CPR is a psychomotor skill, so learning it requires more than just acquiring knowledge. Practice with a manikin is essential to ensure competence. An effective video instruction, while most likely cannot totally replace an instructor-led class, could be helpful in learning infant CPR. A literature review by Parsons et al. opined that teaching infant CPR to parents of high-risk neonates is considered beneficial in decreasing mortality. However, the evidence for this is very limited. The overall trend is supportive of CPR training. It increases parental confidence and decreases anxiety levels. Parents’ memory of knowledge regarding CPR decreases over time. Our survey also showed similar findings. At discharge, the training did seem to have boosted their confidence in taking care of their newborn, and it did not add to the overall anxiety among most parents. In those instances where CPR was required at home, parents could resuscitate and then bring their infant to the hospital for continuing care. It was heartening to learn that the training was hugely successful, considering that most parents had understood when to use CPR and how it helps resuscitate. The aim is to increase this to 100%. Parents of one baby who required home CPR could not self-assess the effectiveness of CPR given. Henceforth, our training should also focus on educating parents on assessing the baby post-resuscitation. All parents were given adequate pre-discharge teaching regarding other aspects of their preemies’ care and the resuscitation training that we provided. Wintch et al. showed that 80% of their subjects who required CPR post-discharge survived complete resuscitation efforts after full cardiopulmonary arrest and were neurologically intact. In all of our 5 babies who required home CPR, parents had correctly followed the steps as they had been advised to initiate CPR as per the post-resuscitation assessment done once they reached the hospital.

The AHA gives CPR training kits to parents of high-risk neonates at discharge at a nominal fee. Providing these kits to carry home may also be useful. Hence, we also provide a complimentary manual resuscitator kit with masks of two sizes to parents of those born <30 wks., and neonates born at 30-34 weeks who are discharged after a very stormy course in NICU.

The inability to retain learned CPR skills has been researched. Studies have documented deficits in retention and performance skills beginning as early as 2 weeks after initial instruction, with continued deterioration up to one year later. The peak incidence of SIDS occurs between 1 and 4 months of age, so long-term retention of infant CPR skills is critical. Therefore, it has been reported that 3 to 6 months after initial instruction is the optimal timeframe for recertification. Most of our parents, too, felt the need for a repeat training session 3 months after the first one.

The limitation of this study was the sample size, which could have been better. The contact details of many parents were either changed or unavailable. There is also an element of recall bias as the survey was conducted after a long time for some. One of the main reasons for more responses from parents in recent years was a better recall. As it was a retrospective study, contacting and convincing parents to take the survey was arduous. Not all parents agreed to participate. Some did not receive phone calls and some responded by saying they were busy and would not be able to complete the survey. Also, during the study period, there was a change in unit protocol, and parents of all preterms, 34 wks. were being trained instead of those only <30 wks.  as was done previously. We noticed that there were babies in the gestational age group of 30-34weeks who had episodes of apnoea at home and thereby changed the Unit protocol to include these parents to improve outcomes in these babies. The study’s strengths were the simplicity of the survey method used and the number of responses we received, considering that the oldest of the babies whose parents responded was born 13 years ago.

Conclusion:  Our study shows that parental CPR education seems to have improved their confidence in the care of these preemies and has not added to general parental anxiety. All parents also agreed that it is an essential step in the pre-discharge planning of preterm babies. Parental CPR training backed by video demonstration before the instructor-led session and followed by repeat training after 3 months is vital in the holistic care of preterm babies post-discharge and is highly recommended at all centres catering to this major subgroup of neonates admitted to the NICU.

*** Access in-person and online training through numerous resources worldwide- Ask your health care provider



Day in the life of a DOCTOR: Shadowing NICU NURSE PRACTITIONER (ft. premature babies)

Violin MD

Babies born at 22 weeks (5.5 months) can survive!! Join me in the largest NICU in Canada and learn about the lifesaving treatments for premature babies! I’ll be shadowing Nikki, a nurse practitioner who works in the neonatal ICU. Plus you’ll meet baby Kalani who was born at 23 weeks and her mother, Paola.

Still a Preemie

The National Coalition for Infant Health explains why all preemies — regardless of how prematurely they’re born or what challenges they face — deserve proper care and appropriate health coverage.

The National Coalition for Infant Health explains why all preemies — regardless of how prematurely they’re born or what challenges they face — deserve proper care and appropriate health coverage.

The science of nurturing and its impact on premature babies

May 31, 2017  

A long-term study on helping preterm babies, using the simplest of interventions, is showing signs of promise. In part two of our story, William Brangham explores the study’s outcomes, as well as questions about the complex past of the doctor behind it.


Preterm birth and Kawasaki disease: a nationwide Japanese population-based study

Published: 08 October 2021



Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases. However, the risk of preterm children developing Kawasaki disease remains unknown. In the present study, we investigate whether preterm birth increased the morbidity of Kawasaki disease.


We included 36,885 (34,880 term and 2005 preterm) children born in 2010 in Japan. We examined the association between preterm birth and hospitalization due to Kawasaki disease using a large nationwide survey in Japan.


In log-linear regression models that were adjusted for children’s characteristics (sex, singleton birth, and parity), parental characteristics (maternal age, maternal smoking, paternal smoking, maternal education, and paternal income), and residential area, preterm infants were more likely to be hospitalized due to Kawasaki disease (adjusted risk ratio: 1·55, 95% confidence interval: 1.01–2.39). We then examined whether breastfeeding status modified the potential adverse effects of preterm birth on health outcome. Preterm infants with partial breastfeeding or formula feeding had a significantly higher risk of hospitalization due to Kawasaki disease compared with term infants with exclusive breastfeeding.


Preterm infants were at a high risk for Kawasaki disease, and exclusive breastfeeding might prevent this disease among preterm infants.


  • Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases, however, the risk of preterm children developing Kawasaki disease remains unknown.
  • This Japanese large population-based study showed that preterm infants were at a high risk for Kawasaki disease for the first time.
  • Furthermore, this study suggested that exclusively breastfeeding might prevent Kawasaki disease among preterm infants. Full Study available.

Source: https://www.nature.com/articles/s41390-021-01780-4

Relationships between overwork, burnout and suicidal ideation among resident physicians in hospitals in Japan with medical residency programmes: a nationwide questionnaire-based survey

2022 Mar 10;12(3):e056283. doi: 10.1136/bmjopen-2021-056283.Masatoshi Ishikawa 1 2


Objectives: This study examined the relationships between overwork, burnout and suicidal ideation among resident physicians working in hospitals throughout Japan.

Design: A nationwide, questionnaire-based survey.

Setting: Participating hospitals (n=416) were accredited by the Japanese Medical Specialty Board to offer medical residency programmes in 19 core specialties. Surveys were conducted in October 2020.

Participants: Valid responses were obtained from 4306 physicians (response rate: 49%).

Outcome measures: Items pertaining to the Japanese Burnout Scale, depressive tendencies and suicidal ideation were included in questionnaires. Multiple regression analyses were performed: suicidal ideation was the response variable; sex, age, core specialty, marital status, income, weekly working hours and workplace (ownership, number of beds, number of full-time physicians and regional classification) were explanatory variables.

Results: Regarding the Japanese Burnout Scale, the highest score was recorded for ‘sense of personal accomplishment’, followed by ’emotional exhaustion’ and ‘depersonalization’. Increased emotional exhaustion and depersonalisation were associated with longer working hours, but there was no such trend for sense of personal accomplishment. Depressive tendencies and suicidal ideation were noted in 24.1% and 5.6% of respondents, respectively. These percentages tended to increase when respondents worked longer hours. Several factors were significantly associated with suicidal ideation: female sex (reference: male, OR: 2.08, 95% CI: 1.56 to 2.77), ≥12 million yen income (reference: <2 million yen, OR: 0.21, 95% CI: 0.05 to 0.79), ≥100 working hours/week (reference:<40 hours/week, OR: 3.64, 95% CI: 1.88 to 7.04) and 600-799 hospital beds (reference: <200 beds, OR: 0.23, 95% CI: 0.07 to 0.82).

Conclusions: Many Japanese residents demonstrated a tendency to experience burnout and suicidal ideation. Female sex, low income, long working hours and insufficient hospital beds were associated with suicidal ideation. To ensure physicians’ health and patients’ safety, it is necessary to advance workstyle reform for physicians.

<a href=”http://Abstract Objectives: This study examined the relationships between overwork, burnout and suicidal ideation among resident physicians working in hospitals throughout Japan. Design: A nationwide, questionnaire-based survey. Setting: Participating hospitals (n=416) were accredited by the Japanese Medical Specialty Board to offer medical residency programmes in 19 core specialties. Surveys were conducted in October 2020. Participants: Valid responses were obtained from 4306 physicians (response rate: 49%). Outcome measures: Items pertaining to the Japanese Burnout Scale, depressive tendencies and suicidal ideation were included in questionnaires. Multiple regression analyses were performed: suicidal ideation was the response variable; sex, age, core specialty, marital status, income, weekly working hours and workplace (ownership, number of beds, number of full-time physicians and regional classification) were explanatory variables. Results: Regarding the Japanese Burnout Scale, the highest score was recorded for ‘sense of personal accomplishment’, followed by ’emotional exhaustion’ and ‘depersonalization’. Increased emotional exhaustion and depersonalisation were associated with longer working hours, but there was no such trend for sense of personal accomplishment. Depressive tendencies and suicidal ideation were noted in 24.1% and 5.6% of respondents, respectively. These percentages tended to increase when respondents worked longer hours. Several factors were significantly associated with suicidal ideation: female sex (reference: male, OR: 2.08, 95% CI: 1.56 to 2.77), ≥12 million yen income (reference: <2 million yen, OR: 0.21, 95% CI: 0.05 to 0.79), ≥100 working hours/week (reference:<40 hours/week, OR: 3.64, 95% CI: 1.88 to 7.04) and 600-799 hospital beds.)

Source: https://pubmed.ncbi.nlm.nih.gov/35273058/

Protecting workers’ health and safety: Online training resources at your fingertips

28 April 2022

Everyone deserves to work in a place that is healthy and safe. Each year on 28 April, we celebrate World Day for Safety and Health at Work to raise awareness of this right and the steps we can take to ensure it is a reality for workers across the globe.

Training is key. Nearly half of the world’s population works. Providing workers with the latest occupational health and safety knowledge can help protect them from work-related injuries, diseases and deaths. This is especially important during public health emergencies like the COVID-19 pandemic.

Workplaces have played an important role in both the spread and mitigation of COVID-19. Health workers of all kinds have been particularly affected by the pandemic. Not only have they been sick, they have suffered adverse effects of prolonged use of personal protective equipment, fatigue and mental health problems, violence and harassment and exposure to hazardous disinfectants.

The pandemic has stimulated many work settings around the world to expand telework and hybrid work arrangements. All these can impact the health, safety and wellbeing of workers.

So the World Health Organization (WHO) is offering free online courses on these topics on its OpenWHO.org learning platform. Materials are available in multilingual and low-bandwidth formats to maximize access.

WHO has also collaborated with partners like the International Labour Organization (ILO) on additional training materials to protect health workers and responders and prepare workplaces for future health emergencies. To access these learning resources, please visit the links below.

  • Healthy and safe telework (OpenWHO): This course provides guidance to teleworkers and their managers on protecting and promoting health and wellbeing while teleworking.
  • All-Hazard Rapid Response Teams Training Package (WHO Health Security Learning Platform): The all-hazard Rapid Response Teams Training Package is a structured comprehensive collection of training resources and tools enabling relevant training institutions to organize, run and evaluate face-to-face training for Rapid Response Teams tailored to country specific needs.
  • HealthWISE – Work Improvement in Health Services (ILO/WHO publication): HealthWISE is a practical, participatory quality improvement tool for health facilities. The HealthWISE package consists of an Action Manual and a Trainers’ Guide to combine action and learning. Topics include occupational safety and health, personnel management and environmental health.



New Survey Shows That Up To 47% Of U.S. Healthcare Workers Plan To Leave Their Positions By 2025

Jack Kelly   Senior Contributor  Apr 19, 2022

The Covid-19 pandemic unleashed wave after wave of challenges and feelings of burnout for United States healthcare workers, and unless changes are made to the industry, nearly half plan to leave their current positions, according to a new report examining the work environment and industry’s future for clinicians.

Elsevier Health, a provider of information solutions for science, health and technology professionals, conducted its first “Clinician of the Future” global report. It revealed current pain points, predictions for the future and how the industry can come together to address gaps—including that 31% of clinicians globally, and 47% of U.S. healthcare workers, plan to leave their current role within the next two to three years.

Dr. Charles Alessi, chief clinical officer at Healthcare Information and Management Systems Society (HIMSS), said, “As a practicing doctor, I am acutely aware of the struggles today’s clinicians face in their efforts to care for patients.” Alessi continued, “This comprehensive report from Elsevier Health provides an opportunity for the industry to listen—and act—on the pivotal guidance given by those on the frontlines. I commend this important initiative and look forward to next steps in supporting our doctors and nurses.”

In the new report from Elsevier Health, published two years after the Covid-19 pandemic began, thousands of doctors and nurses from across the globe revealed what is needed to fill gaps and future-proof today’s healthcare system. The comprehensive “Clinician of the Future” report was conducted in partnership with Ipsos and uncovered how undervalued doctors and nurses feel, as well as their call for urgent support, such as more skills training—especially in the effective use of health data and technology—preserving the patient-doctor relationship in a changing digital world and recruiting more healthcare professionals into the field. The multiphase research report not only understands where the healthcare system is following the Covid-19 pandemic, but where it needs to be in 10 years to ensure a future that both providers and patients deserve.

Jan Herzhoff, president at Elsevier Health, said, “Doctors and nurses play a vital role in the health and well-being of our society. Ensuring they are being heard will enable them to get the support they need to deliver better patient care in these difficult times.” Herzhoff added, “We must start to shift the conversation away from discussing today’s healthcare problems to delivering solutions that will help improve patient outcomes. In our research, they have been clear about the areas they need support; we must act now to protect, equip and inspire the clinician of the future.”

There has never been a greater need for lifting the voices of healthcare professionals. The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past 10 years, with many saying their jobs have gotten worse.

The “Clinician of the Future” report includes a quantitative global survey, qualitative interviews and roundtable discussions with nearly 3,000 practicing doctors and nurses around the world. The data helps shed light on the challenges impacting the profession today and predictions on what healthcare will look like in the next 10 years, according to those providing critical patient care.

According to the report, 56% of respondents said that there has been growing empowerment amongst patients within the last 10 years, as people take charge of their health journeys. When referring to soft skills, 82% said that it’s important for them to exhibit active listening and empathy to the people they serve. Furthermore, nearly half of clinicians cite the allocated time they have with patients as an issue, as only 51% believe that the allotted time allows them to provide satisfactory care.

To ensure a positive shift moving into the future and to fill current gaps, clinicians highlight the following priority areas for greater support:

  • Clinicians predict that over the next 10 years “technology literacy” will become their most valuable capability, ranking higher than “clinical knowledge.” In fact, 56% of clinicians predict they will base most of their clinical decisions using tools that utilize artificial intelligence. However, 69% report being overwhelmed with the current volume of data and 69% predict the widespread use of digital health technologies to become an even more challenging burden in the future. As a result, 83% believe training needs to be overhauled so they can keep pace with technological advancements.
  • Clinicians predict a blended approach to healthcare with 63% saying most consultations between clinicians and patients will be remote and 49% saying most healthcare will be provided in a patient’s home instead of in a healthcare setting. While clinicians may save time and see more patients, thanks to telehealth, more than half of clinicians believe telehealth will negatively impact their ability to demonstrate empathy with patients they no longer see in person. As a result, clinicians are calling for guidance on when to use telehealth and how to transfer soft skills like empathy to the computer screen.
  • Clinicians are concerned about a global healthcare workforce shortage, with 74% predicting there will be a shortage of nurses and 68% predicting a shortage of doctors in 10 years’ time. This may be why global clinicians say a top support priority is increasing the number of healthcare workers in the coming decade. Clinicians require the support of larger, better-equipped teams and expanded multidisciplinary healthcare teams, such as data analysts, data security experts and scientists, as well as clinicians themselves.

“While we know that many nurses are leaving the profession due to burnout, we also know that the pandemic has inspired others to enter the field because of a strong desire for purposeful work,” said Marion Broome, Ruby F. Wilson professor of nursing at Duke University’s School of Nursing. “We must embrace this next wave of healthcare professionals and ensure we set them up for success. Our future as a society depends on it.”

Looking To The Future

“Ultimately, we asked clinicians for what they need, and now it’s our responsibility as a healthcare industry to act,” said Dr. Thomas “Tate” Erlinger, vice president of clinical analytics at Elsevier Health. “Now is the time for bold thinking—to serve providers and patients today and tomorrow. We need to find ways to give clinicians the enhanced skills and resources they need to better support and care for patients in the future. And we need to fill in gaps today to stop the drain on healthcare workers to ensure a strong system in the next decade and beyond.”

Source: https://www.forbes.com/sites/jackkelly/2022/04/19/new-survey-shows-that-up-to-47-of-us-healthcare-workers-plan-to-leave-their-positions-by-2025/?sh=1b883b0b395b


Artificial Intelligence Getting Smarter! Innovations from the Vision Field

Posted on February 8th, 2022 by Michael F. Chiang, M.D., National Eye Institute

One of many health risks premature infants face is retinopathy of prematurity (ROP), a leading cause of childhood blindness worldwide. ROP causes abnormal blood vessel growth in the light-sensing eye tissue called the retina. Left untreated, ROP can lead to lead to scarring, retinal detachment, and blindness. It’s the disease that caused singer and songwriter Stevie Wonder to lose his vision.

Now, effective treatments are available—if the disease is diagnosed early and accurately. Advancements in neonatal care have led to the survival of extremely premature infants, who are at highest risk for severe ROP. Despite major advancements in diagnosis and treatment, tragically, about 600 infants in the U.S. still go blind each year from ROP. This disease is difficult to diagnose and manage, even for the most experienced ophthalmologists. And the challenges are much worse in remote corners of the world that have limited access to ophthalmic and neonatal care.

Artificial intelligence (AI) is helping bridge these gaps. Prior to my tenure as National Eye Institute (NEI) director, I helped develop a system called i-ROP Deep Learning (i-ROP DL), which automates the identification of ROP. In essence, we trained a computer to identify subtle abnormalities in retinal blood vessels from thousands of images of premature infant retinas. Strikingly, the i-ROP DL artificial intelligence system outperformed even international ROP experts [1]. This has enormous potential to improve the quality and delivery of eye care to premature infants worldwide.

Of course, the promise of medical artificial intelligence extends far beyond ROP. In 2018, the FDA approved the first autonomous AI-based diagnostic tool in any field of medicine [2]. Called IDx-DR, the system streamlines screening for diabetic retinopathy (DR), and its results require no interpretation by a doctor. DR occurs when blood vessels in the retina grow irregularly, bleed, and potentially cause blindness. About 34 million people in the U.S. have diabetes, and each is at risk for DR.

As with ROP, early diagnosis and intervention is crucial to preventing vision loss to DR. The American Diabetes Association recommends people with diabetes see an eye care provider annually to have their retinas examined for signs of DR. Yet fewer than 50 percent of Americans with diabetes receive these annual eye exams.

The IDx-DR system was conceived by Michael Abramoff, an ophthalmologist and AI expert at the University of Iowa, Iowa City. With NEI funding, Abramoff used deep learning to design a system for use in a primary-care medical setting. A technician with minimal ophthalmology training can use the IDx-DR system to scan a patient’s retinas and get results indicating whether a patient should be sent to an eye specialist for follow-up evaluation or to return for another scan in 12 months.

Many other methodological innovations in AI have occurred in ophthalmology. That’s because imaging is so crucial to disease diagnosis and clinical outcome data are so readily available. As a result, AI-based diagnostic systems are in development for many other eye diseases, including cataract, age-related macular degeneration (AMD), and glaucoma.

Rapid advances in AI are occurring in other medical fields, such as radiology, cardiology, and dermatology. But disease diagnosis is just one of many applications for AI. Neurobiologists are using AI to answer questions about retinal and brain circuitry, disease modeling, microsurgical devices, and drug discovery.

If it sounds too good to be true, it may be. There’s a lot of work that remains to be done. Significant challenges to AI utilization in science and medicine persist. For example, researchers from the University of Washington, Seattle, last year tested seven AI-based screening algorithms that were designed to detect DR. They found under real-world conditions that only one outperformed human screeners [3]. A key problem is these AI algorithms need to be trained with more diverse images and data, including a wider range of races, ethnicities, and populations—as well as different types of cameras.

How do we address these gaps in knowledge? We’ll need larger datasets, a collaborative culture of sharing data and software libraries, broader validation studies, and algorithms to address health inequities and to avoid bias. The NIH Common Fund’s Bridge to Artificial Intelligence (Bridge2AI) project and NIH’s Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD) Program project will be major steps toward addressing those gaps.

So, yes—AI is getting smarter. But harnessing its full power will rely on scientists and clinicians getting smarter, too.

Source: https://directorsblog.nih.gov/2022/02/08/artificial-intelligence-getting-smarter-innovations-from-the-vision-field/

MaineHealth Innovation: Augmented Reality for Neonatal Resuscitation

Jan 26, 2022           MaineHealth

Helping newborns in distress is the goal of Augmented Reality Technology for Medical Simulation (ARTforMS) – an immersive experience that layers AR over traditional manikins. Learn how MaineHealth Innovation is supporting pediatric hospital medicine and critical care experts, Dr. Mary Ottolini and Dr. Michael Ferguson, as they continue leading a pilot with the software application at Maine Medical Center and throughout the MaineHealth system.

Association of Prenatal Exposure to Early-Life Adversity With Neonatal Brain Volumes at Birth

Original Investigation   Pediatrics   April 12, 2022

Regina L. Triplett, MD, MS1Rachel E. Lean, PhD2Amisha Parikh, BS3; et alJ. Philip Miller, AB4Dimitrios Alexopoulos, MS1Sydney Kaplan, BS1Dominique Meyer, BS1Christopher Adamson, PhD5,6Tara A. Smyser, MSE2Cynthia E. Rogers, MD2,7Deanna M. Barch, PhD2,8,9Barbara Warner, MD7Joan L. Luby, MD2Christopher D. Smyser, MD, MSCI1,7,9

Author Affiliations Article Information

JAMA Netw Open. 2022;5(4):e227045. doi:10.1001/jamanetworkopen.2022.7045

Key Points

Question:  Is prenatal exposure to maternal social disadvantage and psychosocial stress associated with global and relative infant brain volumes at birth?

Findings:  In this longitudinal, observational cohort study of 280 mother-infant dyads, prenatal exposure to greater maternal social disadvantage, but not psychosocial stress, was associated with statistically significant reductions in white matter, cortical gray matter, and subcortical gray matter volumes and cortical folding at birth after accounting for maternal health and diet.

Meaning:  These findings suggest that prenatal exposure to social disadvantage is associated with global reductions in brain volumes and folding in the first weeks of life.


Importance:  Exposure to early-life adversity alters the structural development of key brain regions underlying neurodevelopmental impairments. The association between prenatal exposure to adversity and brain structure at birth remains poorly understood.

Objective:  To examine whether prenatal exposure to maternal social disadvantage and psychosocial stress is associated with neonatal global and regional brain volumes and cortical folding.

Design, Setting, and Participants:  This prospective, longitudinal cohort study included 399 mother-infant dyads of sociodemographically diverse mothers recruited in the first or early second trimester of pregnancy and their infants, who underwent brain magnetic resonance imaging in the first weeks of life. Mothers were recruited from local obstetric clinics in St Louis, Missouri from September 1, 2017, to February 28, 2020.

Exposures:  Maternal social disadvantage and psychosocial stress in pregnancy.

Main Outcomes and Measures:  Confirmatory factor analyses were used to create latent constructs of maternal social disadvantage (income-to-needs ratio, Area Deprivation Index, Healthy Eating Index, educational level, and insurance status) and psychosocial stress (Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Everyday Discrimination Scale, and Stress and Adversity Inventory). Neonatal cortical and subcortical gray matter, white matter, cerebellum, hippocampus, and amygdala volumes were generated using semiautomated, age-specific, segmentation pipelines.

Results:  A total of 280 mothers (mean [SD] age, 29.1 [5.3] years; 170 [60.7%] Black or African American, 100 [35.7%] White, and 10 [3.6%] other race or ethnicity) and their healthy, term-born infants (149 [53.2%] male; mean [SD] infant gestational age, 38.6 [1.0] weeks) were included in the analysis. After covariate adjustment and multiple comparisons correction, greater social disadvantage was associated with reduced cortical gray matter (unstandardized β = −2.0; 95% CI, −3.5 to −0.5; P = .01), subcortical gray matter (unstandardized β = −0.4; 95% CI, −0.7 to −0.2; P = .003), and white matter (unstandardized β = −5.5; 95% CI, −7.8 to −3.3; P < .001) volumes and cortical folding (unstandardized β = −0.03; 95% CI, −0.04 to −0.01; P < .001). Psychosocial stress showed no association with brain metrics. Although social disadvantage accounted for an additional 2.3% of the variance of the left hippocampus (unstandardized β = −0.03; 95% CI, −0.05 to −0.01), 2.3% of the right hippocampus (unstandardized β = −0.03; 95% CI, −0.05 to −0.01), 3.1% of the left amygdala (unstandardized β = −0.02; 95% CI, −0.03 to −0.01), and 2.9% of the right amygdala (unstandardized β = −0.02; 95% CI, −0.03 to −0.01), no regional effects were found after accounting for total brain volume.

Conclusions and Relevance:  In this baseline assessment of an ongoing cohort study, prenatal social disadvantage was associated with global reductions in brain volumes and cortical folding at birth. No regional specificity for the hippocampus or amygdala was detected. Results highlight that associations between poverty and brain development begin in utero and are evident early in life. These findings emphasize that preventive interventions that support fetal brain development should address parental socioeconomic hardships.


Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies

Momma1,  Ryoko Kawakami2, Takanori Honda3, Susumu S Sawada2

Correspondence to Dr Haruki Momma, Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; h-momma@med.tohoku.ac.jp


Objective: To quantify the associations between muscle-strengthening activities and the risk of non-communicable diseases and mortality in adults independent of aerobic activities.

Design: Systematic review and meta-analysis of prospective cohort studies.

Data sources: MEDLINE and Embase were searched from inception to June 2021 and the reference lists of all related articles were reviewed.

Eligibility criteria for selecting studies: Prospective cohort studies that examined the association between muscle-strengthening activities and health outcomes in adults aged ≥18 years without severe health conditions.

Results: Sixteen studies met the eligibility criteria. Muscle-strengthening activities were associated with a 10–17% lower risk of all-cause mortality, cardiovascular disease (CVD), total cancer, diabetes and lung cancer. No association was found between muscle-strengthening activities and the risk of some site-specific cancers (colon, kidney, bladder and pancreatic cancers). J-shaped associations with the maximum risk reduction (approximately 10–20%) at approximately 30–60 min/week of muscle-strengthening activities were found for all-cause mortality, CVD and total cancer, whereas an L-shaped association showing a large risk reduction at up to 60 min/week of muscle-strengthening activities was observed for diabetes. Combined muscle-strengthening and aerobic activities (versus none) were associated with a lower risk of all-cause, CVD and total cancer mortality.

Conclusion: Muscle-strengthening activities were inversely associated with the risk of all-cause mortality and major non-communicable diseases including CVD, total cancer, diabetes and lung cancer; however, the influence of a higher volume of muscle-strengthening activities on all-cause mortality, CVD and total cancer is unclear when considering the observed J-shaped associations.

Source: https://bjsm.bmj.com/content/early/2022/01/19/bjsports-2021-105061

How to Tap Into Your Joy

By Emily Madill, Contributor

Author and Certified Professional Coach Sep. 20, 2017, 12:52 PM EDT

“Whether you think you can, or you think you can’t– you’re right”. ― Henry Ford

I love this quote, I believe it applies to so much in life. There is no doubting perception is powerful. What could be added to the above quote, is that regardless of what we think, the object of our heart’s desire is always right here  whether or not we think it exists.

In relation to joy, this is wonderful news because it speaks to the idea that the experience of joy is always available to us. It’s not something we have to tirelessly search for or jump through hoops to arrive at. Rather, it’s something we can access right now in this very moment, if we choose.

If that seems like it’s too easy to be true, try these 5 added tips and see if they may help you tap into your joy.

1. Listen for Joy

The fast track way to accessing our personal joy is to be still and quiet enough to hear our unique inner voice and spirit. Often the outside noise drowns out the wise voice within is. When we give ourselves the space to really listen, it becomes very clear our joy is right below the surface just waiting to play. When we listen, our joy will show us the way.

2. Keep Joy Simple

Joy is not complicated and neither is accessing it. We don’t need to read endless books, listen to podcasts and spend copious amounts of money searching for joy. It’s much easier to take the simple route. Sometimes it’s a matter of reminding ourselves we are all worthy and capable of experiencing joy, it’s as simple as knowing our joy lives within us.

3. Just Be Joy

I love the idea that in order to have something — whether it’s love, peace, joy etc. that we must first be the very thing we are wanting. If we want joy, we can start by ‘being joy’. We can be joyful in our thoughts, the words we speak, our interactions with others and our overall demeanor. We humans are blessed to have the creative license to actually try on and be whatever it is we most want — that’s amazing!

4. Laugh Your Way to Joy

Laughing is powerful. Laugh at yourself, laugh with a friend, laugh with your pet. Whatever you do, be sure to laugh as often and as loud as you can. It’s nearly impossible to not feel joy when you are midway through a belly laugh with happy tears streaming down your cheeks. Laughter is a gift that’s available to us all the time. There isn’t a limit to how often we can bust a gut. The more we laugh, the greater sense of joy we feel and spread out into the world.

5. See Joy

If you want to prove to yourself that joy exists everywhere, all the time, see what happens when you start looking for the evidence of it. Try it out for a day, I dare you. When we start seeing joy in the faces of people around us and the pure magnificence of our surroundings, we experience a deep feeling of joy within ourselves. Breathe it all in. Give yourself the gift of becoming an expert at finding joy in the most mundane and simplest places. You may be surprised to see how much joy exists in our world, and even more so in recognizing it’s always present within you.


After a week of working hard on studies and research I decided to take a break this weekend to escape London and visit the coastal city of Brighton. Taking the time to try new things, explore new places and go on an adventure even for a day is something that can bring great joy in our lives. Having the opportunity to explore the seaside, swim in the Atlantic ocean and enjoy my first proper English fish and chips was a delight. Finding balance and slowing down to enjoy the simple moments in life is empowering and instrumental in helping us build our relationship to better know ourselves and positively grow our friendships with others.

Kanoa Igarashi 🇯🇵 is bringing surfing home to Japan!

Jul 23, 2021  Olympics

Kanoa Igarashi is a Japanese-American surfer who has competed professionally worldwide since 2012. He was the youngest rookie on the World Surf League Championship Tour in 2016 and collected more Round One wins than any other surfer. He talks to the Olympic Channel about going all-in, pressure, what the Olympics symbolise, and more. Enjoy watching this interview with Kanoa Igarashi!

Crisis, Coalitions, Shinrin-Yoku

Serbia, officially the Republic of Serbia, is a landlocked country in Southeast Europe, at the crossroads of the Pannonian Plain and the Balkans. It shares land borders with Hungary to the north, Romania to the northeast, Bulgaria to the southeast, North Macedonia to the south, Croatia and Bosnia and Herzegovina to the west, and Montenegro to the southwest, and claiming a border with Albania through the disputed territory of Kosovo. Serbia has a population of roughly 7 million inhabitants. Its capital Belgrade is also the largest city.

Serbia is an upper-middle income economy, ranked 64th in the Human Development Index domain. It is a unitary parliamentary constitutional republic, member of the UN, CoE, OSCE, PfP, BSEC, CEFTA and is acceding to the WTO. Since 2014, the country has been negotiating its EU accession, with the aim of joining the European Union by 2025. Serbia formally adheres to the policy of military neutrality.

The country provides universal health care and free primary and secondary education to its citizens. The healthcare system in Serbia is organized and managed by the three primary institutions: The Ministry of Health, The Institute of Public Health of Serbia “Dr Milan Jovanović Batut” and the Military Medical Academy. The right to healthcare protections is defined as a constitutional right in Serbia. The Serbian public health system is based on the principles of equity and solidarity, organized on the model of compulsory health insurance contributions. Private health care is not integrated into the public health system, but certain services may be included by contracting.



UNICEF delivered a life-saving machine for newborns

A valuable donation to the Institute for Health Care of Children and Youth of Vojvodina provided by Delhaize Serbia

Belgrade, 4 November 2021

The Institute for Health Care of Children and Youth of Vojvodina from Novi Sad received today a therapeutic hypothermia device for asphyxiated newborns, provided by the Delhaize Serbia company as part of the So Small They Could Fit Inside a Heart campaign.

The therapeutic hypothermia device for asphyxiated newborns is intended for treating babies who suffered oxygen deprivation during birth. This device prevents brain damage in these babies by applying a modern controlled cooling method and is worth2,419,000 dinars.

“This valuable device is used for applying a proven therapeutic method in preventing brain damage in newborns, thus saving lives of asphyxiated babies. In the previous period, the Institute received valuable equipment from UNICEF, which helped equip the Institute. However, in order to reach the highest standards in developmental care, professional support we receive from UNICEF experts and partners is equally important. I would also like to thank the Delhaize Serbia company, which provided funds for the purchase of this life-saving device. UNICEF is our reliable partner that knows that many newborn babies need daily support of the health care system, regardless of the crisis, and we are grateful for it,” stated the Director of the Institute, Doc. Dr. Jelena Antić.

In Serbia, 65 thousand children are born every year, 4000 of whom are premature babies, and every day seven new babies require some form of urgent support. Premature birth is responsible for more than 60% of infant deaths in Serbia. The So Small They Could Fit Inside a Heart campaignwas launched by UNICEF late last year in order to provide additional equipment for neonatal units in Serbia, which will also contribute to reducing the mortality of premature babies in the country.

“The Institute for Health Care of Children and Youth in Novi Sad provides care to the most vulnerable babies from all over Vojvodina. For years, it has ensured that every newborn child gets the highest quality support in order to survive and thrive. The Institute is a good-practice example in the country when it comes to the provision of family-oriented developmental care, which also includes conditions for the continuous and irreplaceable contact between mum or dad and baby from the first days of baby’s life.

This is one of the few institutions in Serbia that has managed to preserve this practice during the pandemic, which opens up opportunities for us to jointly support other neonatal intensive care units in Serbia to persist in that endeavour. Maintaining the highest standards of child health care, despite the challenges imposed by the COVID19 pandemic, is a common priority, and we would like to thank Delhaize Serbia for providing the funds to support the most vulnerable, but also the bravest among us, who fight like true “little giants”, said Jelena Zaganović Jakovljević, UNICEF Early Childhood Development Specialist.

The COVID-19 epidemic has also been affecting pregnant women, newborns and children lately, so it is particularly important to invest efforts in adequate treatment of the infected and combating the epidemic, which is not sparing the youngest either. UNICEF has supported the equipping of neonatal units in Serbia, so that the most vulnerable among us, prematurely born babies and ill newborns, are given adequate support to survive and thrive. Starting from 2017, UNICEF has invested a total of 59,628,463 dinars in modernising the operation of the neonatal service in Serbia. The So Small They Could Fit Inside a Heart campaign was supported by the Ministry of Health of the Republic of Serbia.

“Delhaize Serbia has recognised UNICEF as the right partner and supported the modernisation of neonatal units in Novi Sad and Kragujevac, because we are aware of how important it is to help the most vulnerable babies that are also affected by the Corona virus crisis. Helping such small babies to get a chance at life is a reflection of our belief that help should be provided to those who need it most,” said Milica Popović, Corporate Communications Manager at Delhaize Serbia.

In all Maxi, Mega Maxi, Tempo and Shop&Go stores across Serbia, customers have the opportunity to round their bill up to the amount they wish, and in this way support the provision of equipment to neonatal units in our country.

Delhaize Serbia donated a total of 200,000 euros to UNICEF for equipping neonatal units in our countryFrom this donation, another therapeutic hypothermia device for asphyxiated newborns will be provided to the Kragujevac Neonatal Care Centre, which will also receive the first ambulance for prematurely born and ill newborn babies. Since the start of the campaign, this is the largest private sector donation in the So Small They Could Fit Inside a Heart campaign.


Coalition for Preemies – We Help Polish Parents of Preemies and Rescue Ukrainian NICUs

Maria Katarzyna Borszewska-Kornacka, MD, Elzbieta Brzozowska, Adriana Misiewicz, Joanna Nycz

Coalition for Preemies is an organization operating in Poland for ten years – initially as a social movement that brought together people and institutions working for the health of premature babies in Poland, and from 2019 as a Foundation.

The goals of the Foundation have been unchanged for many years – to work for the smallest of the youngest – premature babies and their parents. Our goal is education – starting with the health of pregnant women and preventing premature births, ending with the health of premature babies, their development, and rehabilitation. We reach out to parents of premature babies to help them care for their premature babies and to the general public to help them understand that a premature baby is the most vulnerable person who needs our help. Nobody who has not encountered a premature baby in their environment knows what complications the baby and its loved ones face and how much effort is needed to ensure healthy development.

During the pandemic, we got involved with an international campaign initiated by EFCNI #zeroseparation. It aimed to restore the possibility of visiting preemies in neonatal departments for their parents. In Poland, as part of the #zeroseparation campaign, we included parents of preemies in the group “zero” for vaccination against COVID-19 – the group that could be vaccinated first together with medical staff. We wanted parents of premature babies to be protected from the virus as soon as possible and to be able to visit their children in hospitals. It was possible thanks to the immediate decision of the Ministry of Health after we sent a request on this matter.

In 2021, we launched advice for parents of premature babies with specialists as part of the “Ask for a premature baby” campaign – it consists of a telephone conversation or via online communicators. Parents can talk to a neonatologist, psychologist, pediatric neurologist, lactation consultant, and physiotherapist.

Currently, we are involved in helping premature Ukrainian babies. Together with the Neonatus Foundation, the Tęczowy Kocyk Foundation, and the blogger MatkoweLove, we organized a fundraiser. With the collected money, we finance the purchase of the necessary equipment and medicines for Ukrainian neonatal units and transport the equipment to the neediest hospitals in Ukraine. The President of our Foundation- prof. Maria Katarzyna Borszewska-Kornacka is in constant contact with the national consultant for neonatology in Ukraine, and therefore we know what their needs are. First shipments of medical equipment, drugs, and milk were sent to Lviv, Kyiv, Charkov, Brovary, Ivano-Frankovsk, and Dniepro.

It is possible to donate to the Coalition for Preemies Foundation: https://www.koalicjadlawczesniaka.pl/numer-konta-fundacji-koalicja-dla-wczesniaka-i-dane-do-przelewow-z-zagranicy/

We have also started the “Package for a Newborn” campaign, the purpose of which is to equip Ukrainian babies born in Warsaw with necessities such as clothes for newborns, sizes 50-68, including bodysuits, rompers, socks, hats, nipples, small toys, cosmetics, and hygiene articles.

We also plan to prepare a warehouse of clothes/things useful for newborns, which will be issued in response to the specific needs of single Ukrainian mothers in Poland. From the warehouse, mothers will be able to receive rockers, carriers, scarves for carrying babies, prams, changing mats, bathtubs, and breast pumps.

Since the outbreak of war, we have had over a dozen requests to help in transferring newborns from Ukraine to Poland.

Initially, there were babies of US and UK citizens born in Ukraine, followed by several neonatal transfers or personal admissions of Ukrainian newborns from the border zone brought personally by parents.

Our triage center has different scenarios comprising both stabilization and subsequent transfer to different Polish neonatal/pediatric centers and diagnostic and treatment approaches on site.

Requests regarding medical transfers of premature babies were formulated predominantly by aid organizations, governmental or family activities, and not specifically by medical referrals.

Recently we have received several inquiries about the possibility of admission of newborns/small infants with chronic and/or rare genetic problems. Until now, the utility of the database created for the quick electronic exchange of medical data regarding the transfer of newborns from Ukraine to Poland seems suboptimal as there was perhaps no need for such transfers on a larger scale.

Further information can be found on the Foundation website: Source:https://www.koalicjadlawczesniaka.pl/aktualnosci/

Serbia to Use Cash to Boost Birth Rate, Avert Population Decline

By Misha Savic  November 24, 2021

Serbia will triple a cash incentive to parents for their first-born child and prop up support for bigger families to fight a crippling demographic decline, President Aleksandar Vucic said.

“We’re vanishing as a nation,” the Balkan country’s leader told reporters on Wednesday as he announced tripling the one-time incentive for mothers for their first child to 300,000 dinar ($2,862) as of January. Serbia will also increase its existing cash and other support to families to have and raise more children, he said.

The plan comes as Vucic, whose party and allies control an absolute majority in Serbia’s parliament, is gearing up for general elections expected in the spring. Mainstream opposition parties boycotted a previous ballot in 2020 but are likely to challenge Vucic’s dominance in the race that will also include his job.

The average monthly net wage equals $616 in the nation of 6.9 million. The population is falling by around 30,000 a year amid a low birth rate and emigration. The median age is almost 43 years, among the highest in Europe. 

Serbia’s current birth rate of 1.5 needs to go up to at least 2.15 just to maintain the current population size, Vucic said.

Additional steps will help young people to stay in colleges and universities even if they become parents while studying, he said. The government is weighing giving grants to young couples of as much as $22,000 to help them buy their first home and start a family, he said.

“We’re getting older and older, and our economic progress will depend on how we ensure the nation’s progress with the demographic measures,” Vucic said. 


Ukraine crisis: Premature babies born into war as deliveries forced to take place in hospital basement

I’m incredibly sad,’ doctor says, ‘babies are going to die because they cannot live in these conditions’

As women are forced to give birth in the basements of hospitals in war-torn Ukraine, health officials have raised fears that not all newborn babies can survive in such conditions.

Devastating images coming out of the Eastern European nation show the makeshift wards being used after medical staff work tirelessly to convert basements of maternity hospitals – all the while, using them as bomb shelters.

Most at risk are premature babies, who require special medical attention in their first few days, weeks or even months of life.

More than 1,000 babies are born in Ukraine per day, according to data from research platform Macrotrends. Of those, around 100 will need some form of neonatal intensive care.

Footage from one perinatal care unit in Kyiv, published by ITV News, showed parents and their

At one point, a man is filmed attending to a tiny baby in an incubator.

The machine beeps momentarily as he reaches for some medical equipment, then the clip cuts to night time where nurses and parents can be seen sat underneath what looks like the building’s water or gas pipes.

Speaking to the broadcaster, Dr Olena Kostiuk, a neonatologist associate professor in Ukraine’s capital city, described how the basement unit was set up in just a few days.

“It’s usually a technical room for water, for electricity and heating… never, never, ever is this space used in this way,” she said. “Very sick babies, babies which we cannot move… they permanently live in the basement.”

Pregnant women and newborn babies in the basement of a maternity hospital converted into a medical ward, and used as a bomb shelter during air raid alerts in Kyiv.

Clearly frustrated, and upset, Dr Kostiuk said plainly that “babies are going to

“I’m incredibly sad,” she added, “for myself the biggest problem is, I don’t know when it’s going to finish and how long our pregnant women, our babies delivered in a basement, our babies have no normal support.”

Over in the city of Zhytomyr, as reported by The Independent earlier today, staff of the maternity ward at Pavlusenko hospital – all taking cover under Russian missile fire – helped a pregnant woman who had started giving birth on the floor of the bomb shelter after the shock of a nearby explosion sent her into labour.

Medical workers show a newborn baby to a woman who gave birth in a maternity hospital basement converted into a medical ward in Mariupol, Ukraine

It came after an airstrike in the city on Tuesday which struck a military base just 200 metres away from the hospital, seriously damaging multiple wards.

Among those worst hit was the maternity wing, where 45 women and 15 newborn babies were being cared for at the time. All were subsequently evacuated to the basement, where they remain.

The Russian strike on Zhytomyr, in Ukraine’s northwest, also hit a residential area and killed at least two people, emergency services said afterwards.

Dr Cora Doherty, a neonatologist speaking on behalf of the British Association of Perinatal Medicine (BAPM), said she had seen the footage from Kyiv’s perinatal centre and was concerned the babies’ care was being compromised.

“We know that if babies do not get the proper care around the time at birth, that particularly if they’re ill, there is an increased risk of death in those babies,” she told ITV News.

And she added: “That’s essentially the, you know, the future denigrate generation there. So, it is really, really important that we support both these mothers and their babies in their plight.”

Four “loud explosions” were heard in the centre of Kyiv late on Wednesday night, with the Kyiv Independent taking to Twitter to advise its readers to take cover in their “nearest shelter” at around

It came as Russian troops appeared to take “complete control” of Kherson, the first major city to be captured during Vladimir Putin’s war.

Igor Kolykhayev, Kherson’s mayor, said in a Facebook post on Wednesday that the Black Sea port had been lost.

He urged the Kremlin’s soldiers not to shoot at civilians and publicly called on Ukrainians to walk through the streets only in daylight and with no more than one other person.

Cars will only be allowed to enter the city to bring food and medicine and other essentials. They must drive at minimum speed and be prepared to stop to be searched by Russian troops, he said.

Mr Kolykhayev added: “Ukrainian flag above us. And to keep it the same, these requirements must be met. I have nothing else to offer yet.”



Oct 21, 2021      IDJVideos.TV

Official music video for “Ti Meni, Ja Tebi” by Aleksandra Mladenović and Nenad Manojlovi


SHEA NICU White Paper Series: Practical approaches for the prevention of central line-associated bloodstream infections\

Pediatrics AUTHOR: SHEA PUBLISHED:MARCH 4, 2022 CURRENT – CLABSI, Clinical Practice, Guidelines, Immunocompromised Patients, Infection Prevention


This document is part of the “SHEA neonatal intensive care unit (NICU) white paper series.” It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: “Practical approaches to Clostridioides difficile prevention” published in August 2018 and “Practical approaches to Staphylococcus aureus prevention,” published in September 2020.


American Nurse Journal/Cedars-Sinai Hospital: Fostering nurse-physician collaboration

February 1, 2022

Author(s): Sarah Low, MSN, RN, OCN, CMSRN; Emily Gray, MSN, RN-BC; Amanda Ewing, MD, FACP; Patricia Hain, MSN, RN-BC, NE-BC, FACHE; and Linda Kim, PhD, MSN, RN, PHN, CPHQ


Eat, Sleep, Console Approach

A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome

Grisham, Lisa M. NNP-BC; Stephen, Meryl M. CCRN; Coykendall, Mary R. RNC-NIC; Kane, Maureen F. NNP-BC; Maurer, Jocelyn A. RNC-NIC; Bader, Mohammed Y. MD

Advances in Neonatal Care: April 2019 – Volume 19 – Issue 2 – p 138-144

doi: 10.1097/ANC.0000000000000581



The opioid epidemic in the United States has resulted in an increased number of drug-exposed infants who are at risk for developing neonatal abstinence syndrome (NAS). Historically, these infants have been treated with the introduction and slow weaning of pharmaceuticals. Recently, a new model called Eat, Sleep, Console (ESC) has been developed that focuses on the comfort and care of these infants by maximizing nonpharmacologic methods, increasing family involvement in the treatment of their infant, and prn or “as needed” use of morphine.


The purpose of this evidenced-based practice brief was to summarize and critically review emerging research on the ESC method of managing NAS and develop a recommendation for implementing an ESC model.


A literature review was conducted using PubMed, Cochrane, and Google Scholar with a focus on ESC programs developed for treating infants with NAS.


Several studies were found with successful development and implementation of the ESC model. Studies supported the use of ESC to decrease length of stay, exposure to pharmacologic agents, and overall cost of treatment.

Video Abstract Available at:



Acknowledging and Supporting NICU Moms this Mother’s Day

Leah Sodowick, B.A., Pamela A. Geller, Ph.D., Chavis A. Patterson, Ph.D.

Each year on the second Sunday in May, people across the United States and around the globe honor and celebrate mothers (Our use of the term “mothers” includes anyone who identifies as a mother, grandmother, gestational parent, or caregiver.) on Mother’s Day. This holiday is full of joy, celebration, pride, and gratitude for many. There may be hugs, handmade and store-bought cards, photos posted and shared on social media, breakfast in bed, family gatherings, flower bouquets, and tokens of appreciation. Mother’s Day can be challenging and emotionally fraught for some, including mothers with an infant hospitalized in a neonatal intensive care unit (NICU). With the help of NICU staff and providers, mothers can anticipate and cope with the challenges and emotions that they may experience this Mother’s Day, on May 8th. This article will discuss the emotions and challenges NICU mothers may experience on the holiday and suggest ways to acknowledge, support, and celebrate NICU mothers and caregivers.

Parents in the NICU may grieve the loss of anticipated postpartum plans and experiences, such as caring for and bonding with their baby at home. Mothers in the NICU may also grieve the loss of expected holiday events and experiences (1). Grief is one of the many normal and common reactions NICU parents may have. On Mother’s Day and the days surrounding this holiday, mothers in the NICU may feel disappointed, disheartened, and sorrowful if their expectations, visions, and anticipations for Mother’s Day do not match their current reality—one that is often characterized by long hours at their baby’s bedside and concern and worry about their baby’s health and survival. Current realities may also involve difficult decision making about treatment options and endof-life care. NICU parents may be juggling multiple responsibilities, such as caring for older children and work. Parents may also experience physical separation from their baby when the gestational parent is recovering from childbirth, the baby is in an isolette, the baby is undergoing a surgical procedure, or when parents leave the hospital to go home or to their temporary residence. Furthermore, by spending time in the NICU, mothers may miss traditional family gatherings and their usual Mother’s Day celebrations (1). Not being present for these events may exacerbate feelings of isolation as many families begin to reunite after separations due to COVID-19 restrictions.

Some mothers in the NICU may have difficulty or delays in forming their maternal identity due to limited opportunities for caregiving and interacting with their infant, shared caregiving responsibilities with NICU staff providers, disrupted mother-infant bonding, perceived lack of control, and increased psychological distress (2–5). Difficulty or delays in forming maternal and parental identity are part of an array of normal reactions and experiences that a parent may have. In a qualitative examination of NICU mothers’ perceptions of the development of their maternal role in the context of NICU, the thematic analysis revealed that some respondents characterized themselves as mothers only while they were in the NICU; they reported not feeling like mothers when they left the hospital because they were not with their babies or serving as a primary caretaker (3). Researchers have found that mothers’ perceived loss of parental role was one of the most stressful aspects of their infant’s NICU hospitalization (6,7)predictors, and child outcomes associated with NICU-related stress for mothers of infants born very preterm (VPT. For mothers in the NICU who have not yet fully developed their maternal identity or perceive a loss of their parental role, Mother’s Day may feel conflicting and isolating. Of note, mothers in the NICU who have experienced neonatal losses or are anticipating and planning for neonatal loss may experience an intensification of grief and have particularly difficult emotional experiences on Mother’s Day.

We encourage NICU staff and providers to thoughtfully acknowledge and celebrate mothers and caregivers in the NICU this Mother’s Day. Listed below are some suggestions:

Acknowledge Mother’s Day Staff and providers can communicate their acknowledgment of Mother’s Day, even when it may not be a “happy” Mother’s Day for mothers and other caregivers in the NICU. If this is the case, instead of wishing mothers a “happy” Mother’s Day, one can express, “I am thinking about you today on Mother’s Day.”

Validate and reflect emotions – NICU staff and providers can help mothers and caregivers cope with emotions that may arise during this holiday by validating and reflecting on mothers’ expressed feelings. Offering opportunities for parents to share their feelings by asking open-ended questions about how they are feeling and allowing time to listen to the responses can be very empowering for parents. Responding with statements that validate their experience also can be very helpful. For example, one could respond to a mother who expresses grief about the loss of expected Mother’s Day experiences by stating, “it makes sense why you would feel especially sad and disappointed today.”

Provide opportunities for caretaking – If possible, NICU staff and providers can find ways for parents to interact with their babies more on Mother’s Day. For example, mothers could be encouraged to take on a meaningful hands-on caretaking task, like feeding or bathing their baby or changing a diaper. Mothers also can be encouraged to engage in skin-to-skin care.

Encourage mothers to communicate with their babies – On Mother’s Day, NICU mothers can communicate and bond with their babies by reading them a book, story, or poem. Mothers could write and share a personal letter to their babies about their love, their family, and what it means to be their mother. Mothers may also wish to sing to their babies.

Praise mothers’ efforts to care for their babies – On Mother’s Day (and regularly), NICU staff and providers are encouraged to acknowledge and praise mothers’ efforts to care for their babies in the NICU. A simple phrase like “you are doing a great job” can be meaningful and impactful to mothers who may be lacking confidence and feeling uncertain about their maternal role.

 Encourage mothers to attend parent support groups – NICU staff and providers can encourage mothers to attend parent support groups on Mother’s Day. Peer sharing of positive and negative maternal experiences in NICU support groups can strengthen social relationships and networks, provide therapeutic benefits, foster feelings of safety and comfort, and encourage parent advocacy (3,9). On Mother’s Day, NICU parent support groups can feature topics related to Mother’s Day. Mother’s Day themed activities, such as scrapbooking, crafting, and even expressive writing or journaling that allow for both positive and adverse feelings can also be incorporated.

Create cards or keepsake gifts for mothers – There are several ways Mother’s Day can be celebrated in the NICU. One way to celebrate the holiday is for NICU staff to take a photo of each baby or each mother with their baby and put it inside of a card that can be placed by the baby’s bedside. Staff may also wish to create small keepsake gifts for mothers. At Denver Health Medical Center, NICU nurses make keychains to give to each mother (8). Each keychain contains a photo of the mom with their baby. Provide scent cloths for mothers Small pieces of soft fabric with the baby’s and the mother’s familiar scent can bring comfort to mothers and babies and help facilitate bonding. The cloth can be placed in the baby’s be against the mother’s skin to absorb scent and then exchanged. The scent cloths can even be shaped like hearts.

 Enlist volunteer assistance from past NICU graduate families – Staff and providers can consider enlisting volunteer assistance from past graduate families of the NICU to help support and celebrate mothers in the NICU on Mother’s Day (1). Former NICU mothers and caregivers with first-hand lived experience and expertise could write cards with encouraging and supportive messages to current NICU mothers and assist with running parent activity groups. It is important to remember that each mother in the NICU will experience Mother’s Day differently, and some families may not be open to celebrating or participating in Mother’s Day activities.

As a final note, we would like to acknowledge NICU staff, providers, and readers this Mother’s Day. We recognize those who are mothers, grandmothers, and caregivers. We recognize those who have or have had infants hospitalized in the NICU. We recognize those who have lost children and those who have lost mothers. We recognize those with strained relationships with their mothers, those with strained relationships with their children, those who have chosen not to be mothers, and those who are yearning to be mothers. We honor you all and wish you a peaceful Mother’s Day.


Timely examination can save premature babies from permanent blindness

By Muhammad Qasim     April 20, 2022

Rawalpindi : Over eighty-five per cent of premature babies who weigh less than 1.5 kilograms at the time of birth have a high risk of developing the disorganised growth of retinal blood vessels, which can cause vision problems including permanent blindness.

Babies born prematurely, before 266 days, have many obstacles to overcome in their first fragile weeks, one of which is eye development that can be resolved through screening and surgical procedures to help avoid serious eyesight problems like vision impairment and blindness.

Chief Consultant and Head of Retina Department at Al-Shifa Eye Hospital Dr Nadeem Qureshi said this while talking to the media persons. He said that the blood vessels of the retina develop three months after conception and complete their growth at the time of normal delivery. If an infant is born prematurely, eye development can be disrupted, as the smaller a baby is at birth, the more likely that baby is to develop difficulties, he said.

Using excess oxygen to treat premature babies in the hospitals stimulates abnormal vessel growth in the eyes, with the smallest and sickest having the highest risk of devastating effects of Retinopathy of Prematurity (ROP), he said.

He added that studies have shown that keeping the oxygen saturation at a lower level from birth can reduce the rate of advanced ROP, a blinding eye disorder.

All parents must include a vision screening in their list of baby check-ups between six and twelve months of age as every premature infant deserves the constant attention of an ophthalmologist because of his or her increased risk for eye misalignment, amblyopia, and the need for glasses to develop normal vision.

Dr Qureshi said that Al-Shifa Eye hospital has already signed MoUs with Fauji Foundation Hospital, Combined Military Hospital, and Benazir Bhutto Hospital to treat newborns with vision complications.

Al-Shifa Eye Hospital is the only facility in the SAARC region and among few in the world having the latest equipment and excellent skills to treat newborns having vision complications, he claimed. So far, the trust has treated around 6000 infants in the last seven years and the number is bound to increase as the awareness grows, he said.

He added that we are here to provide free guidance to all the state-owned and private healthcare facilities, including those in other countries, to help save thousands from plunging into darkness for life. The Retina Department of Al-Shifa Hospital has 12 surgeons, assisted by trainees, and it performs Retinal OPD, lasers, injections and surgery every day of the week, said Dr Qureshi.

Average OPD at the Retina Department is 215 patients per day, average lasers are 35 per day, average injections are 50 per day and on average 25 surgeries are conducted daily, he added. A retinal surgery costs around Rs95 thousand, but 75 per cent of patients are treated free of cost, he said.

Source:Timely examination can save premature babies from permanent blindness (thenews.com.pk)

UCSF NICU-How To Do A Swaddled Bath

(Spanish subtitles)

197,922 views   Nov 28, 2018

UCSF Benioff Children’s Hospital Oakland

Watch the dramatic moment a preemie leaves his tubes behind and starts a new life (VIDEO)


Paola Belletti – published on 09/14/17aa

Ward Miles Miller’s scary and moving first year of life was captured by his father.

Ward Miles Miller was born on July 20, 2012 — three months early. Fear and anxiety initially overshadowed (but didn’t suffocate) his parents’ joy and hope. The story of Ward’s first year of life is a beautiful, moving, and dramatic one, as told through the video and photos taken by his father Benjamin.

Little Ward received all the medical support possible and necessary until he was able to go home safely; he spent 107 days in the hospital, most of them in an incubator. His mom and dad, Lindsay and Benjamin Scott, are devoted and loving parents who fought for Ward and celebrated every ounce he gained as a milestone.

Today, Ward is navigating the stormy waters of life in a vessel that is stronger and more stable every day.


Association of Abnormal Findings on Neonatal Cranial Ultrasound With Neurobehavior at Neonatal Intensive Care Unit Discharge in Infants Born Before 30 Weeks’ Gestation

JAMA Netw Open. 2022;5(4):e226561. doi:10.1001/jamanetworkopen.2022.6561

Original Investigation –  Pediatrics April 8, 2022

Key Points

Question  What is the association between neonatal cranial ultrasound findings and neurobehavioral examination at term-adjusted age?

Findings  In this cohort study of 675 infants born before 30 weeks’ gestation, abnormal findings on cranial ultrasound were associated with decreased tone, poor regulation of attention, and movement outcomes as the infants matured to term-adjusted age.

Meaning  Among very preterm infants, abnormal findings on cranial ultrasound identifiable in the first 14 postnatal days were associated with neurobehavior outcomes at or near term-equivalent age and could be used to help counsel and educate parents as well as inform treatment strategies for therapy service in the neonatal intensive care unit and after discharge.


Importance  Cranial ultrasound (CUS) findings are routinely used to identify preterm infants at risk for impaired neurodevelopment, and neurobehavioral examinations provide information about early brain function. The associations of abnormal findings on early and late CUS with neurobehavior at neonatal intensive care unit (NICU) discharge have not been reported.

Objective  To examine the associations between early and late CUS findings and infant neurobehavior at NICU discharge.

Design, Setting, and Participants  This prospective cohort study included infants enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study between April 2014 and June 2016. Infants born before 30 weeks’ gestational age were included. Exclusion criteria were maternal age younger than 18 years, maternal cognitive impairment, maternal inability to read or speak English or Spanish, maternal death, and major congenital anomalies. Overall, 704 infants were enrolled. The study was conducted at 9 university-affiliated NICUs in Providence, Rhode Island; Grand Rapids, Michigan; Kansas City, Missouri; Honolulu, Hawaii; Winston-Salem, North Carolina; and Torrance and Long Beach, California. Data were analyzed from September 2019 to September 2021.

Exposures  Early CUS was performed at 3 to 14 days after birth and late CUS at 36 weeks’ postmenstrual age or NICU discharge. Abnormal findings were identified by consensus of standardized radiologists’ readings.

Main Outcomes and Measures  Neurobehavioral examination was performed using the NICU Network Neurobehavioral Scale (NNNS).

Results  Among the 704 infants enrolled, 675 had both CUS and NNNS data (135 [20.0%] Black; 368 [54.5%] minority race or ethnicity; 339 [50.2%] White; 376 [55.7%] male; mean [SD] postmenstrual age, 27.0 [1.9] weeks). After covariate adjustment, lower attention (adjusted mean difference, −0.346; 95% CI, −0.609 to −0.083), hypotonicity (mean difference, 0.358; 95% CI, 0.055 to 0.662), and poorer quality of movement (mean difference, −0.344; 95% CI, −0.572 to −0.116) were observed in infants with white matter damage (WMD). Lower attention (mean difference, −0.233; 95% CI, −0.423 to −0.044) and hypotonicity (mean difference, 0.240; 95% CI, 0.014 to 0.465) were observed in infants with early CUS lesions.

Conclusions and Relevance  In this cohort study of preterm infants, certain early CUS lesions were associated with hypotonicity and lower attention around term-equivalent age. WMD was associated with poor attention, hypotonicity, and poor quality of movement. Infants with these CUS lesions might benefit from targeted interventions to improve neurobehavioral outcomes during their NICU hospitalization.

Full Article:


Can a new effort end ‘equipment graveyards’ at neonatal ICUs?

By Catherine Cheney /09 September 2021

Just outside of San Francisco, product engineers at a manufacturer and supplier of health technologies are hard at work on devices to save newborn lives in settings far different from this bayside facility.

The 3rd Stone Design warehouse features a display of lifesaving technologies for newborns, including a continuous positive airway pressure — or CPAP — machine that the team helped develop.

The company is part of a global coalition of organizations working to get such devices to babies in low-income countries, where they confront inequity from the moment they’re born. The coalition is called Newborn Essential Solutions and Technologies, or NEST360, and it targets neonatal intensive care units.

Infants born in sub-Saharan Africa or Southern Asia are 10 times more likely to die during the first month of life compared with those born in high-income countries, due in part to a lack of access to medical devices. About 75% of babies born prematurely can be saved with the right medical care.

“People who come up with product ideas are not the same people who figure out how to sell something, and the people who figure out how to sell it are not the same people who figure out how to service it.”

But when health facilities end up with devices that are not designed with their constraints in mind — or when staffers lack training in using these tools and there are no plans to fix products when they break — potentially lifesaving technologies can end up in what are often called medical equipment graveyards.

NEST360, which aims to reduce newborn mortality in sub-Saharan African hospitals by 50%, is trying to change that. It’s taking what it describes as a “holistic approach” to neonatal care — distributing newborn health technologies, educating clinicians and technicians on how to maintain these tools, and supporting local innovators to build the technologies that work best for their contexts.

The coalition launched in 2019, with an initial focus on Malawi, Kenya, Tanzania, and Nigeria. From the beginning, NEST360 has said there is a need for not just low-cost technology but high-quality distribution. With assistance from 3rd Stone Design, which helped develop a new nonprofit called Hatch Technologies, NEST360 may have found the end-to-end solution for distribution that it sought.

Hatch provides distribution and support services for devices designed for newborn care units in sub-Saharan Africa. And partners involved in NEST360 say they hope it can serve as a model for ensuring medical equipment reaches low birth weight and premature babies in time to save their lives.

Steve Adudans, Kenya country director at the Rice360 Institute for Global Health Technologies — which is also part of the NEST360 partnership — has seen many examples of donated medical devices piling up instead of being used in neonatal ICUs.

“We need to bury the medical equipment graveyards,” he said during an online webinar on innovations in newborn health in Africa organized by The Elma Philanthropies, one of NEST360’s funders. “That’s what NEST is about.”

The NEST360 bundle of technologies includes 18 medical devices focused on areas including temperature stability, respiratory support, and neonatal jaundice treatment. Each of them meets target product profiles for newborn care in low-resource settings developed by NEST360 in partnership with UNICEF.

Many of the NEST360 technologies that meet these operational and performance characteristics were developed by innovators focused on low-resource settings, where it is often impossible to repair products made by corporations that impose restrictive warranties, lock their software, and limit access to spare parts.

But these devices cannot fulfill their vital potential when they are introduced into a broken system, Adudans said.

NEST360 needed a solution to get products from manufacturers to distributors to facilities in the countries where it works. That’s where Hatch Technologies comes in.

Often, nations with the highest rates of neonatal mortality receive donated equipment that fails when placed in environments with unreliable electricity, temperature variation, and too much dust and dirt.

Bottom of Form

But even when countries can procure medical supplies, they often don’t know which devices would work best for their settings. So they end up with cheap devices that break because they are poor quality or high-end ones that never get fixed because maintenance is too expensive, said Dick Oranja, CEO at Hatch Technologies.

Based in Nairobi, Kenya, Hatch Technologies launched in March 2020 with a mission to transform the way newborn care devices are distributed, supported, and used in Africa. To date, Hatch has helped NEST360 distribute almost 2,000 pieces of equipment reporting over 95% functionality, meaning they are working as they should. It is starting with support from the same backers as NEST360 but is an independent nonprofit that could continue to seek support elsewhere.

Hatch uses asset tracking — with a bar code-type sticker on each of its products — to follow each shipment from the initial logistics and warehousing to shipment and ultimately the use of the device.

“Distributors will mention they provide a level of service. They have to assure their customers. But the truth of the matter is distributors do not offer targeted service,” Oranja said. “We measure customer service parameters a routine medical equipment manufacturer will not measure.”

Beyond delivering medical devices, Hatch installs the equipment, trains staffers, and stops by to see how the technology is working, based in part on its measure of the functional status of the equipment — meaning whether it is being used as intended or at all.

A number of supply chain bottlenecks prevent newborn health products from reaching babies in low-income countries during critical moments of life and death.

“People who come up with product ideas are not the same people who figure out how to sell something, and the people who figure out how to sell it are not the same people who figure out how to service it and support it,” Robert Miros, CEO at 3rd Stone Design, told Devex.

That reality is part of what led 3rd Stone Design to work with partners to develop Hatch Technologies.

NEST360’s expanded model, which includes Hatch, reflects a growing understanding that no matter how innovative medical devices are, they are only one part of the solution to saving newborn lives. The other crucial piece is distribution.

Hatch Technologies began after Miros and his colleagues formed a task team to brainstorm the effort together with other NEST360 partners and funders. They drew on the expertise of 3rd Stone Design’s Danica Kumara, a director of product management who formerly worked on medical device efforts in Southeast Asia, and Vikas Meka, a senior product manager who was formerly a senior adviser on global health innovation at the U.S. Agency for International Development.

Now that NEST360 has launched in four African countries, it intends to demonstrate a path to scale across the continent, said Rebecca Richards-Kortum, director at the Rice360 Institute for Global Health Technologies, during the webinar.

But what turned the tide on newborn survival in the United States and the United Kingdom was a network of neonatal ICUs — “a regional system with people and products that are ready to help babies,” she said.

So as NEST360 partners with Hatch Technologies to bridge the gap from manufacturers to distributors and ensure that lifesaving medical devices can reach health care facilities, it is also calling for stronger hospital systems for newborn care.


The transition to the artificial uterus should be as natural as possible. Photo: Bart van Overbeeke

Without gasping for air safely in the artificial womb

   APR 07, 2022

An artificial uterus significantly increases the chances of survival for extremely premature babies. That is why researchers at TU Eindhoven are doing a lot of research on this topic. One of the biggest challenges  is preventing the fetus from breathing oxygen just after birth, because that is harmful to the not yet mature alveoli. The solution? A wound spreader, coupling elements and a biobag filled with amniotic fluid.

The development of the artificial uterus has accelerated in recent years, not least because of the Perinatal Life Support partnership, which includes TU Eindhoven. According to Professor Frans van de Vosse (Professor of Cardiovascular Biomechanics within the Faculty of Biomedical Technology) and Guid Oei (Gynecologist and part-time Professor within the Faculty of Electrical Engineering), within ten years it should be possible to significantly increase the chances of survival and quality of life of extremely premature babies via a so-called incubator 2.0.


In the Netherlands alone, 700 children are born extremely prematurely each year – between 24 and 28 weeks. Almost half die, while a large proportion retain permanent health problems because organs have not yet matured. “Think of lung problems or brain damage,” clarifies Frank Delbressine (Assistant Professor of Industrial Design). “We want to increase both the life chances and the quality of life of newborn babies with an artificial uterus.”

Delbressine is the supervisor of PhD student Juliette van Haren. Together with a group of Industrial Design students, she is concerned with, among other things, the way in which childbirth should take place. One of the biggest challenges is to prevent the fetus from gasping for air just after birth (in this case by caesarean section). The birth procedure to the artificial uterus should be as natural as possible, which is why Van Haren is developing a safe way for the premature baby to be transferred from the natural uterus to the artificial uterus.


“We want to prevent the fetus from breathing oxygen, because the alveoli are not yet mature and can be damaged. A 24-week-old baby belongs in an artificial amniotic fluid environment, and we’re trying to mimic that. The transition from the real uterus to the artificial one must occur in a way that the baby barely notices, both physically and mentally, that he or she is being taken to a different location,” explains Delbressine.

The principle works as follows: a so-called wound spreader holds open the wound created by the C-section, after which a biobag filled with artificial amniotic fluid is attached to the wound spreader via a connector. The baby can then be carefully transferred to the artificial uterus at the correct temperature via a glove in the biobag. 

Delbressine: “A filled biobag may sound crazy or disrespectful at first, but this is exactly how the fetus is ‘wrapped up’ in the womb as well, we are trying to imitate that as real as possible.”

The baby can be carefully transferred to the artificial uterus via the biobag at the correct temperature, through a glove.


The system that Van Haren is currently developing consists of several components. Think, for example, of a mechanism that supports the doctor during transfer, as the combination of fetus and fluid can become quite heavy.

Of all these parts, the wound spreader is already in medical use and therefore clinically certified. The rest of the system is completely new and must go through a rigorous clinical approval process. Delbressine: “That’s logical, what we are doing is brand new. Pioneering. It will therefore be years before we can actually start using this system.”

The two are in close contact with the working field, such as specialists from the Máxima Medical Center in Eindhoven. Van Haren: “It’s a nice interaction, we get a lot of feedback from doctors. They have the medical knowledge, we know how to design systems.”


There is a lot involved in developing the artificial uterus itself. Elements must be taken into account that you might not immediately think about at first. Delbressine: “At 24 weeks, the senses are still developing, and babies are sensitive to light, sound and vibrations. The impulses they receive in the natural womb we try to imitate in the artificial womb. The senses need to be stimulated, but in such a way that the brain can handle it. This is still work in progress”

There is still a lot of work to be done before the system can actually be used. We’re talking years. For Delbressine and Van Haren, no problem. Their driving force is in helping children. Van Haren: “Improving the lives of premature babies and increasing their chances of living a beautiful life, that’s what we ultimately do it for.”


Perinatal Life Support is a larger partnership that conducts research into a ‘Perinatal Life Support’ system. Partners are TU/e, the universities of Aachen and Milan, and the companies LifeTec Group and Nemo Healthcare. In 2024 the European funding (from Horizon 2020) ends, then the prototype of the artificial uterus must be ready. After that, the preclinical and clinical tests and the certification process will start.


Nature: free, accessible, healing

Forest Bathing | Shinrin-Yoku | Healing in Nature | Short

Learn how to create healing experiences in nature for yourself and your loved ones. Visit the link for a course on Shinrin-yoku / Forest bathing. Learn calming nature meditations, forest bathing exercises, and mindfulness activities that reconnect us with nature and ourselves. Please share the forest calm and spread some healing.

City Dweller? You can do this!


We’re Going On A NATURE HUNT

Nov 24, 2020    Stories For Kids

Come join in the adventure of a nature hunt. This book is written by Steve Metziger and illustrated by Niki Sakamoto. Thanks for listening!

Medical empirical research on forest bathing (Shinrin-yoku): a systematic review



This study focused on the newest evidence of the relationship between forest environmental exposure and human health and assessed the health efficacy of forest bathing on the human body as well as the methodological quality of a single study, aiming to provide scientific guidance for interdisciplinary integration of forestry and medicine.


Through PubMed, Embase, and Cochrane Library, 210 papers from January 1, 2015, to April 1, 2019, were retrieved, and the final 28 papers meeting the inclusion criteria were included in the study.


The methodological quality of papers included in the study was assessed quantitatively with the Downs and Black checklist. The methodological quality of papers using randomized controlled trials is significantly higher than that of papers using non-randomized controlled trials (p < 0.05). Papers included in the study were analyzed qualitatively. The results demonstrated that forest bathing activities might have the following merits: remarkably improving cardiovascular function, hemodynamic indexes, neuroendocrine indexes, metabolic indexes, immunity and inflammatory indexes, antioxidant indexes, and electrophysiological indexes; significantly enhancing people’s emotional state, attitude, and feelings towards things, physical and psychological recovery, and adaptive behaviors; and obvious alleviation of anxiety and depression.


Forest bathing activities may significantly improve people’s physical and psychological health. In the future, medical empirical studies of forest bathing should reinforce basic studies and interdisciplinary exchange to enhance the methodological quality of papers while decreasing the risk of bias, thereby raising the grade of paper evidence.


Windsurfing Serbia Surduk 2020 50 kts

lunelun – Dec 8, 2020 un
Windsurfing in Serbia on Danube river. Wind 50 kts, sales 3.7-4,7 m2, boards 74-100l.

Provider Crisis, Nurse Needs, WHO

Costa Rica officially the Republic of Costa Rica is a country in Central America, bordered by Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, the Pacific Ocean to the southwest, and maritime border with Ecuador to the south of Cocos Island. It has a population of around five million in a land area of 51,060 km2 (19,710 sq mi). An estimated 333,980 people live in the capital and largest city, San José, with around two million people in the surrounding metropolitan area.

The sovereign state is a unitary presidential constitutional republic. It is known for its long-standing and stable democracy, and for its highly educated workforce. The country spends roughly 6.9% of its budget (2016) on education, compared to a global average of 4.4%. Its economy, once heavily dependent on agriculture, has diversified to include sectors such as finance, corporate services for foreign companies, pharmaceuticals, and ecotourism. Many foreign manufacturing and services companies operate in Costa Rica’s Free Trade Zones (FTZ) where they benefit from investment and tax incentives.

Costa Rica provides universal health care to its citizens and permanent residents. Both the private and public health care systems in Costa Rica are continually being upgraded. Statistics from the World Health Organization (WHO) frequently place Costa Rica in the top country rankings in the world for long life expectancy. WHO’s 2000 survey ranked Costa Rica as having the 36th best health care system, placing it one spot above the United States at the time. In addition, the UN (United Nations) has ranked Costa Rica’s public health system within the top 20 worldwide and the number 1 in Latin America.

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


Our blog this month is focused on the Global Healthcare Workforce Shortage Crisis.

Kat and I would not be writing this blog were it not for the life-saving care she received by skilled healthcare providers at and after her birth. Each and every one of you who has experienced a preterm birth knows the value of care access. Our healthcare provider workforce deserves our attention and support.

The Global Healthcare Workforce Shortage Crisis pre-existed the Covid pandemic. The pandemic has severely impacted the shortage of healthcare providers and the further development of the healthcare workforce. The need for healthcare access has substantially increased due to provider shortages, delayed medical assessment and care, postponed access to “elective” surgeries, fear of seeking treatment due to Covid exposure risks, worsening of untreated conditions, and mental health barriers resulting from the stresses the pandemic has created in our lives. 

Preterm birth accounts for 11-12% of the global births at large and connected to our preemie  survivors is a much larger population of family members, healthcare providers, teachers, scientists, community members, employers and so on that also have a critical need for healthcare access. We are and will continue to be significantly impacted by our lack of access to healthcare provider care, and it is absolutely vital that all of us have access to healthcare services that are not limited to pharmaceutical options. We must protect, value, and build our healthcare workforce by making becoming a healthcare provider affordable, accessible, safe, humane, attractive, and available to all economic classes in order to build a healthy, vital, educated, effective and sustainable healthcare workforce that represents our populations at large.

Investing in our Healthcare Workforce is essential. Thank you for supporting our healthcare workforce in ways that are meaningful to you and impactful to our Preterm Birth Family.

Elsevier Health’s first “Clinician of the Future” global report reveals current pain points, predictions for the future and how the industry can come together to address gaps

New York, March 15, 2022

“There has never been a greater need for lifting the voices of healthcare professionals. The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past 10 years, with many saying their jobs have gotten worse. One in three clinicians are considering leaving their current role by 2024, with as many as half of this group in some countries leaving healthcare entirely. This comes on top of the existing global healthcare workforce shortage, where clinicians continue to experience severe levels of fatigue and burnout since COVID-19 was declared a pandemic”.

Full Article : https://www.elsevier.com/about/press-releases/corporate/doctors-and-nurses-worldwide-point-to-roadmap-to-future-proof-healthcare

The Play’s the Thing for Nurses Coping with Pandemic’s Sting

— How the age-old themes of a Greek tragedy can spark new conversations

by Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today March 23, 2022

Last Thursday, Amy Smith, MS, APRN, took part in a virtual reading of Sophocles’ ancient Greek tragedy “Antigone.” But the production wasn’t ordinary theater.

Smith and more than 3,000 attendees sat in on a Zoom webinar of “The Nurse Antigone” as part of a new effort to help frame and spark discussions about the challenges faced by nurses, especially during the pandemic.

“Antigone” is a famed Greek tragedy for a reason. Its young titular heroine risks her life to stand up for what she believes is right, and the play focuses on her quest to properly bury and mourn her deceased brother. Many themes from the play resonate with nurses, especially today.

Smith, who acted in the performance as part of the chorus, said that she feels many nurses who took park in the inaugural event “saw in Antigone the kind of anguish that a lot of people felt when we were in the middle of the pandemic, especially in the hospital setting.”

Nurses were “unable to get past one horrible tragedy when the next person would code, or the next person would come in,” Smith said. It’s “this concept of delayed healing.”

After her own experience with the production, Smith, director of the Sexual Assault Nurse Examiner (SANE) Program at the Hofstra Northwell School of Nursing and Physician Assistant Studies, told MedPage Today that she believes many other nurses will want to take part.

The production was one of 12 that have been scheduled over the coming year. Though “The Nurse Antigone” features headliners such as author Margaret Atwood, and actresses Tracie Thoms and Taylor Schilling, in addition to a chorus comprised of working nurses, the performance itself is hardly the main event.

That’s according to Bryan Doerries, artistic director for Theater of War Productions, which for the past 14 years, has produced community-focused theater projects designed to address public health and social justice issues.

“The performance is the table dressing for the conversation that follows it,” Doerries told MedPage Today.

Some of the themes present in “Antigone” that resonate with the nurse workforce today include deferred grief, moral injury, structural violence and misogyny, as well as women speaking out and living up to standards of care, he said.

“Talking about these things requires energy, and sometimes nurses who are overworked don’t have the energy … the play provides the energy,” Doerries said.

The actors commit emotionally to the material, so that the nurses can then follow them, he explained.

Though each event is expected to be different and yield varying discussions due to the unique makeup and interpretation of each audience, the general format will remain the same, Doerries said.

The chorus of the play is performed by nurses, who are joined by a community panel, also comprised of nurses, after the reading to respond to what they heard that spoke to them, he said. There are then a series of questions posed to the audience and a discussion of themes important to nursing. The performance itself runs about 45 minutes, and the discussions that follow consist of about 15 minutes for the community panel and about 1 hour for the audience discussion.

“We’re not asking people to agree,” Doerries said. And “it’s not therapy, to be clear.”

“The point is that, once people have walked through the door of this project, the hope is that they may be open to walking through the other door to healing,” he said.

Cynda Rushton, PhD, RN, lead nursing advisor on the project, concurred.

“The use of the Greek tragedy, particularly ‘Antigone,’ seemed like a really important way to engage nurses to explore their experiences during the pandemic — and before the pandemic — and to create a space where we could really honor their challenges and sacrifices,” Rushton said.

Rushton, professor of clinical ethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, said that, as a nurse herself, she “feels very committed to helping our profession heal.”

In addition to connecting nurses with each other, another goal of the production is to “invite the public to bear witness to the experiences of nurses,” Rushton said.

Theater of War Productions, the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and the Resilient Nurses Initiative – Maryland, have partnered to co-present “The Nurse Antigone.” The production is supported by the Laurie M. Tisch Illumination Fund, and the theater’s digital programming is provided, in part, by The Andrew W. Mellon Foundation.

All of “The Nurse Antigone” events are free and have unlimited capacity, Doerries said.

The next event is scheduled for April 21, and is being hosted by the Greater NYC Black Nurses Association.

“It’s not therapy, but it is therapeutic,” Smith said of “The Nurse Antigone.” “Certainly it was for me, and I hope other people felt that as well.”

Added benefits of the production include helping others to feel like they’re not alone in their experiences, and making difficult discussions easier to have, she noted.

“The reason that the themes keep recurring is because nobody talks about it,” Smith said.


Preterm Birth and Low Birth Weight

Health at a Glance: Latin America and the Caribbean 2020 (Book)

Globally, preterm birth (i.e. birth before 37 completed weeks of gestation) is the leading cause of death in children under 5 years of age, responsible for approximately 1 million deaths in. In almost all countries with reliable data, preterm birth rates are increasing. Many survivors of preterm births also face a lifetime of disability, including learning disabilities and visual and hearing problems as well as long-term development (WHO, 2018).

In LAC, most countries are near the regional average of 9.5% of births being preterm. Colombia is the only country significantly above average with near 15% of preterm births, followed by Brazil with 11%. The lowest rates were observed in Cuba (6%) and Mexico (7%) Most LAC countries rates are lower than the global rate, but there are opportunities for further improvements through interventions such as a national focus on improved obstetric and neonatal care, and the systematic establishment of referral systems with higher capacity of neonatal care units and staff and equipment (Howson, Kinney and Lawn, 2012). On average, 10 new-borns out of 100 had low weight at birth across LAC countries. There are very significant differences between countries in the region, ranging from a low 5% in Cuba and 6% in Chile, to the highest rate of 23% in Haiti, followed by Guyana with 16%.

Low birth weight has decreased an average of 0.4 percentage points in LAC26 countries in the 2000-15 period, suggesting that, overall, the region still has room for improvement in regards to this indicator. Chile, Brazil, Venezuela and Costa Rica are the only LAC countries to have increased low birth weight new-borns, while the largest reduction happened in Surinam, Guatemala and Honduras with more than 1 percentage point of decrease between 2000 and 2015.

Antenatal care can help women prepare for delivery and understand warning signs during pregnancy and childbirth. Higher coverage of antenatal care is associated with higher birth weight in LAC countries, suggesting the significance of antenatal care over infant health status across countries . However, the correlation does not apply equally in all countries. For instance, Trinidad and Tobago and Barbados report to have 100% and 98% of at least four antenatal care visits, but their low birth weight prevalence is 12%, over the LAC average of 10%. This might be explained partly by a low quality of care in their antenatal care visits. On the other hand, countries like Grenada, Paraguay and Bolivia show an antenatal care coverage below the LAC24 average of 87%, but also a low birth weight prevalence of 7-9%. Some of the differences between countries can be attributed to cultural practices and preferences, such as different approaches to privacy or perceptions about what antenatal and postnatal care entail.

Preterm birth can be largely prevented. Effective interventions to reduce preterm births include smoking cessation, progesterone supplementation, cervical cerclage, preterm surveillance clinics and screening, diagnosis and preparation, corticosteroids, magnesium sulphate, and tocolysis (Osman, Manikam and Watters, 2018). Most of these exist in several LAC countries and could be further developed. In addition, three-quarters of deaths associated with preterm birth can be saved even without intensive care facilities. Current cost-effective interventions include kangaroo mother care (continuous skin-to-skin contact initiated within the first minute of birth), early initiation and exclusive breastfeeding (initiated within the first hour of birth) and basic care for infections and breathing difficulties (WHO, 2018), all of which can also be scaled up in LAC countries.

Source: https://www.oecd-ilibrary.org/sites/53620b68-en/index.html?itemId=/content/component/53620b68-en

COVID-19: Health workers face ‘dangerous neglect’, warn WHO, ILO

21 February 2022

Health teams worldwide need much safer working conditions to combat the “dangerous neglect” they have faced during the COVID-19 pandemic, the UN health and labour agencies said on Monday.

Approximately 115,500 health workers died from COVID-19 in the first 18 months of the pandemic, linked to a “systemic lack of safeguards”, they noted. 

In a joint call for action from the World Health Organization (WHO) and the International Labour Organization (ILO), the UN bodies insisted that the coronavirus crisis had contributed to “an additional heavy toll” on health workers. 

“Even before the COVID-19 pandemic, the health sector was among the most hazardous sectors to work in,” said WHO’s Maria Neira, Director, Department of Environment, Climate Change and Health. 

Physical injury and burnout 

“Only a few healthcare facilities had programmes in place for managing health and safety at work,” Dr. Neira continued. “Health workers suffered from infections, musculoskeletal disorders and injuries, workplace violence and harassment, burnout, and allergies from the poor working environment.”  

To address this, WHO and ILO have released new country guidelines for health centres at national and local levels. 

“Such programmes should cover all occupational hazards – infectious, ergonomic, physical, chemical, and psycho-social,” the agencies noted, adding that States that have either developed or are actively implementing occupational health and safety programmes in health settings had seen reductions in work-related injuries and absences due to sickness and improvements in the work environment, productivity and retention of health workers. 

Workers’ rights 

“Like all other workers, should enjoy their right to decent work, safe and healthy working environments and social protection for health care, sickness absence and occupational diseases and injuries,” insisted ILO’s Alette van Leur, Director, ILO Sectoral Policies Department. 

The development comes as the agencies indicated that more than one-in-three health facilities lack hygiene stations at the point of care, while fewer than one-in-six countries had a national policy in place for healthy and safe working environments within the health sector. 

“Sickness absence and exhaustion exacerbated pre-existing shortages of health workers and undermined the capacities of health systems to respond to the increased demand for care and prevention during the crisis,” said James Campbell, Director, WHO Health Workforce Department.  

“This guide provides recommendations on how to learn from this experience and better protect our health workers.” 

Source: https://news.un.org/en/story/2022/02/1112352

Debi Nova, Pedro Capó – Quédate (Official Video)


Premiered Nov 21, 2019                    Debi Nova


When the Brain Sees a Familiar Face

Los Angeles, Mar 18, 2022

Cedars-Sinai Investigators Show How the Action of the Eye Triggers Brain Waves to Help Remember Socially Important Information.

In a study led by Cedars-Sinai, researchers have uncovered new information about how the area of the brain responsible for memory is triggered when the eyes come to rest on a face versus another object or image. Their findings, published in the peer-reviewed journal Science Advances, add to scientific understanding of how memory works, and to evidence supporting a future treatment target for memory disorders.

While vision feels continuous, people move their eyes from one distinct spot to another three to four times per second. In this study, investigators found that when the eyes land on a face, certain cells in the amygdala, a part of the brain that processes social information, react and trigger memory-making activity.

“You could easily argue that faces are one of the most important objects we look at,” said Ueli Rutishauser,  PhD, director of the Center for Neural Science and Medicine at Cedars-Sinai and senior author of the study. “We make a lot of highly significant decisions based on looking at faces, including whether we trust somebody, whether the other person is happy or angry, or whether we have seen this person before.”

To conduct their experiments, the investigators worked with 13 epilepsy patients who had electrodes implanted in their brains to help determine the focus of their seizures. The electrodes also allowed investigators to record the activity of individual neurons within the patients’ brains. While doing so, the researchers tracked the position of the subjects’ eyes using a camera to determine where on the screen they were looking.

The researchers also recorded the study participants’ theta wave activity. Theta waves, a distinct type of electrical brain wave, are created in the hippocampus and are key in processing information and forming memories.

Investigators first showed study participants groups of images that included human and primate faces and other objects, such as flowers, cars and geometric shapes. They next showed participants a series of images of human faces, some of which they had seen during the first activity and asked whether or not they remembered them.

The investigators found that each time participants’ eyes were about to land on a human face—but not on any other type of image—certain cells in the amygdala fired. And every time these “face cells” fired, the pattern of theta waves in the hippocampus reset or restarted.

“We think that this is a reflection of the amygdala preparing the hippocampus to receive new socially relevant information that will be important to remember,” said Rutishauser, the Board of Governors Chair in Neurosciences and a professor of Neurosurgery and Biomedical Sciences.

“Studies in primates have shown that theta waves restart or reset every time they make an eye movement,” said Juri Minxha, PhD, a postdoctoral scholar in neurosurgery at Cedars-Sinai and co-first author of the study. “In this study, we show that this also happens in humans, and that it is particularly strong when we look at faces of other humans.”

Importantly, the researchers showed that the more quickly a subject’s face cells fired when their eyes fixed on a face, the more likely the subject was to remember that face. When a subject’s face cells fired more slowly, the face they had fixed on was likely to be forgotten.

Subjects’ face cells also fired more slowly when they were shown faces they had seen before, suggesting those faces were already stored in memory and the hippocampus didn’t need to be prompted.

Rutishauser said these results suggest that people who struggle to remember faces could have a dysfunction in their amygdala, noting that this type of dysfunction has been implicated in disorders related to social cognition, such as autism.

“If theta waves in the brain are deficient, this process triggered by the amygdala in response to faces might not take place,” Rutishauser said. “So restoring theta waves could prove to be an effective treatment target.”

The study was funded by National Institute of Mental Health Grands number R01MH110831 and P50MH100023, National Science Foundation Grant number 1554105, National Institute of Neurological Disorders and Stroke Grant number U01NS117839, a Center for Neural Science and Medicine Fellowship and European Research Council Grant number 802681.



On parenting preemies: Gratitude, fear and a lingering sense that nothing is in your control

By Anna Nordberg  March 9, 2020

My son was born at 8:15 a.m. on Halloween, a long, skinny four pounds and crying in great angry gulps. With a kindness I’ve never forgotten, the anesthesiologist leaned down and said to me, “A lot of full-term babies don’t even sound that loud.”

The doctors laid my baby on my chest in his footprint-patterned swaddle, and for a moment he stopped crying. Then he was whisked away to the neonatal intensive care unit and I didn’t see him for 30 hours.

That’s how my life as a parent started.

In the United States, 10 percent of babies, or more than 380,000 a year, are born premature, before 37 weeks of gestation. The majority will need time in the NICU, meaning parents are shut out from many of the rituals surrounding a birth. You don’t leave the hospital with your child. Grandparents and friends can’t hold your newborn.

Now that my son is 7 and my daughter is 5 (she was born 19 months later, also premature), I think about how much support our family received in those early weeks, but how little guidance there was about how the experience could impact us over time. I wonder if who I am as a mother was influenced by that early start.

I interviewed parents of preemies, and while each experience was different, there were many consistent themes. Here are some of their stories.

The delay of grief

More than a year after my son was born, one of my closest friends had a placenta abruption and delivered her son at 34 weeks. She called me while I was in the car, and I tried to be as calm and loving as possible. Afterward, though, I pulled over in a parking lot and starting sobbing. My hands were shaking.

I cried with a force I’d never felt when my own pregnancy was going off the rails and all my focus had been on my baby. Until that morning, I hadn’t realized that my son’s premature birth, which I’d filed away as a bumpy start to an otherwise normal parenting journey, had imprinted in my brain like a trauma.

Other mothers said it was not until they had a full-term child that they fully processed their grief. “I didn’t really have a sense of loss or understand what I had missed until I had my son,” says Ame McClune, whose twin girls were born at 24 weeks and required feeding tubes and full-time nursing care for several years. “With my twins, I took it in stride because it was all I knew. Now, here was a baby I could hold and breast-feed and cuddle. I loved it. I had no idea.”

Teira Gunlock, whose daughter Lake was born at 29 weeks when Gunlock developed severe preeclampsia, was diagnosed nine months later with PTSD. “While everything worked out, it was a traumatic experience,” says Gunlock, who for six days had not been able to see her baby. “It makes me emphasize my daughter’s emotional health and growth in my own parenting more than I likely would have.”

Taking setbacks in stride, supercharged gratitude

At some point in everyone’s parenting journey, things don’t go according to plan. But preemie parents get that message early.

“Nothing is a crushing blow,” McClune says. Instead, when there are challenges, she just thinks, “Okay, how do we deal with this?”

In my experience, it was freeing to step off the hamster wheel of worry over milestones, because my children weren’t going to hit any of them. Instead, the NICU distilled things: Are we healthy? Are we happy(ish)? Are we okay? Given the anxiety many parents have over their children’s accomplishments, that perspective can feel like a gift.

Preemie parents also occupy a strange space between intense thankfulness and the early recognition that things can go wrong. In the NICU, most parents understand that there are babies in more precarious positions that their own and are sensitive to that.

The experience also yields daily opportunities for gratitude — to the nurses and doctors caring for your child; to the progress your baby is making; to the much-anticipated car-seat day when you get to take your baby home.

“I think about how lucky we are that both my daughter and my wife survived, and that hits me hard sometimes,” says Michael Zimmer, Gunlock’s husband. “We benefited from scientific advances that stemmed from a lot of tragedy in the past. That provides perspective — our daughter, and my wife, frankly — have a chance at life they might not have had 50 or even 25 years ago.”

Danger ahead

If having a preemie makes you more resilient as a parent, it can also put you in a defensive crouch, waiting for the other shoe to drop.

When we brought my son home from the NICU after two weeks, my husband and I felt the normal terror of first-time parents with our own, special terror thrown in. He had been hooked up to monitors and cared for by professionals since he was born. Once he was home, though, he had to rely only on our loving, possibly incompetent care. That first night, my husband slept on the floor next to the bassinet while I feverishly pumped milk.

Gunlock and Zimmer spent the first year on high alert after their daughter had a choking episode in the NICU, and then again a few days after she came home.

Several parents told me that the strengths of the NICU — the care your baby receives; the nurses you learn from — can also feel like a weakness when you leave, because you think you will never measure up. That fades over time, outweighed by the support and confidence you built during those early weeks, but a tiny part of you always remains on alert.

Naming the sadness

All these years after my children were born, I still feel sad my body didn’t get them over the finish line. Not guilty, not angry, just sad. Is this normal? Is this weird? I don’t know.

I regret that I never got those final weeks of nesting, that I missed my baby shower, that I never felt a contraction. To many people, I’m sure that skipping labor twice makes me lucky. But it feels strange.

Stacey D. Stewart, chief executive of the March of Dimes, a nonprofit that works to improve maternal and infant health outcomes and supports more than 50,000 families a year who are in the NICU, says there needs to be more attention given to the impact the experience has on parents’ mental health.

“You’re pregnant and then one day you’re not, sooner than it was supposed to happen,” she says. “There’s a lot of anxiety and grief and helplessness and fear. It takes an immense emotional toll.”

It can also be very isolating. “I found it incredibly lonely,” says Kate Bosanquet, who had her daughter at 31 weeks. “I missed out on most of my prenatal classes, and while my group was very sweet and continued to meet, we weren’t having the same shared experiences you hope for.”

It doesn’t help that the entire baby industrial complex caters to parents of full-term babies. There’s the books and websites telling you your baby should be doing things months before she will. The carrier that requires your child to be a monstrous eight pounds. The email updates that continue to cheerfully inform you about the progress of your pregnancy when your baby is already out in the world. It can all hurt. One mother told me she wished there was a switch to turn off all the marketing and email that assumed she’d delivered full-term. (March of Dimes has a My NICU Baby app for parents of premature and full-term babies that started out in the NICU.)

And yet many of us hope and believe that these birth stories will become a source of strength for our children.

When my son was in kindergarten and it was his turn to be “Friend of the Week,” he shared that he weighed four pounds at birth, telling his class he “surprised us” seven weeks early. To him, it was an interesting fact and also, I think, a small source of pride.

It should be. Preemie babies, and their parents, have to come so far. I hope that every mom and dad who started out that way — confused, scared, fierce, loving — feels pride in their parenting. They’ve earned it.

Source: https://www.washingtonpost.com/lifestyle/2020/03/09/parenting-preemies-gratitude-fear-lingering-sense-that-nothing-is-your-control/

Determinants of mothers knowledge about breastfeeding in neonatology intensive care

A SyllaA SanaS NaniS HassouneM LehlimiA BadrS HajjajiM ChemsiA HabziS Benomar

European Journal of Public Health, Volume 31, Issue Supplement_3, October 2021, ckab165.285, https://doi.org/10.1093/eurpub/ckab165.285

20 October 2021



Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. In Morocco the BF rate decreased from 51% to 27,8% between 1992 and 2011. The breast feeding rate in neonatal intensive care unit (NICU) is lower 12,4%. Studies showed if we improve the mothers knowledge, the BF practice rate increase in NICU. We aim to determine associated factors of mothers knowledge about BF in NICU of Ibn Rochd teaching hospital in Casablanca (Morocco).


A cross-sectional study was conducted between 04 January and 23 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan mothers who can practice the BF presents during the study period. We used face to face interview using questionnaire. A scoring system from 0 to 16 points was used to measure the knowledge. The student, ANOVA, Mann-Whitney-Wilcoxon, Kruskal Wallis, Pearson and spearman correlation tests were used to test association between BF and potential associated factors. Associated factors with p ≤ 0.05 were considered as determinants of BF. Data were analyzed using R 3.6.3.


We included 111 mothers. The mean score of knowledge was 10.38 ± 2.31. Associated factors with BF knowledge were: healthcare staffs support (yes mean score =11.06 and no = 9.72; p = 0.002); getting prior information about BF (yes mean score =10.53 and no = 9; p = 0.012). The knowledge increase with age of mother (correlation coefficient = 0.26; p = 0.005) and parity (correlation coefficient = 0.30; P = 0.001).


Mothers and specifically younger primiparous should receive more attention from training program and healthcare staffs in NICU to improve the knowledge and practice of BF.

Key messages

  • we can enhance significantly the survival and health of newborn hospitalized in NICU by simple actions as advices, encouragement toward the newborn mothers to improve their knowledge about BF.
  • Healthcare staffs and facilities have to be the teachers and school about breast feeding.


Your Premature Baby’s Sense of Vision

Babies born preterm (before 37 weeks) are still developing their sense of vision.  Babies born before the age of 32 weeks are unable to limit the amount of light entering their eyes even when their eyes are closed.  It is therefore important to protect premature babies from bright lights.

Effects of Vision on your Baby

  • Babies born at term have a preference for looking at faces.  Older premature babies too can fixate on your face briefly if you are holding them closely (approximately 25-30cm or 10-12 inches from your face), as they are very near sighted at this stage.
  • Your baby is likely to have an incubator cover over their incubator whilst in intensive care.  This reduces their exposure to bright light and aims to recreate the conditions of the womb.  As your baby matures these incubator covers are pulled back.
  • It is important that you enjoy your baby.  Talk to them, smile, be expressive; your baby learns from watching your facial expressions.

Source: https://www.nhsggc.org.uk/kids/resources/health-a-z-resources/premature-baby-sense-of-vision/

March of Dimes/Signs of Preterm Labor


Risks of Delays in Emergency Neonatal Blood Transfusions Highlighted in New Safety Report

Priscilla Lynch    March 04, 2022

New recommendations on emergency neonatal blood transfusions have been issued by the Healthcare Safety Investigation Branch (HSIB) following a number of serious adverse outcomes including brain injury and death following delays in such transfusions.

Concerns around emergency neonatal blood transfusions were highlighted in 22 of the HSIB’s maternity investigation programme reports between 2018 and 2021.

This latest HSIB national investigation explored issues influencing timely administration of blood transfusion to newborn babies following acute blood loss during labour and/or delivery. Delays in the administration of a blood transfusion in this scenario can result in brain injury caused by lack of oxygen to the baby’s brain.

Whilst it is rare, and there is a gap in data on incidences of neonatal blood transfusion delays, the impact can be significant. As a reference event, the HSIB investigation examined the experience of a couple, Alex and Robert, whose baby, Aria, was born by emergency caesarean section following an acute blood loss, and sadly died.

Specifically, the investigation examined communication between the different medical teams involved in the care of women/pregnant people and their babies during labour and birth; and national guidance for medical staff on when to consider the option of a blood transfusion for a newborn baby.


The HSIB’s investigation found that administration of a blood transfusion as part of resuscitation requires a number of preparatory steps, including collecting the blood and undertaking various checks before using it, which can cause delays in emergency situations. Inclusion in resuscitation training of a prompt for clinicians to consider the need for a transfusion, and to prepare for it if appropriate, may help reduce any delay, the HSIB said.

The investigation also found that involving members of neonatal teams in multidisciplinary training in maternity units is not routine. Standardising their inclusion in such training would promote a shared understanding of relevant clinical information and ways of working, the HSIB advised.

The HSIB’s final report made two key safety recommendations which focus on training between multidisciplinary maternity and neonatal teams, and through the Newborn Life Support training course.

  1. HSIB recommends that NHS Resolution, working with relevant specialities through the clinical advisory group, amends the maternity incentive scheme guidance for year five to include the neonatal team as one of the professions required to attend multi-professional training.
  • HSIB recommends that the Resuscitation Council (UK)’s Newborn Life Support training course highlights that neonatal resuscitation teams should consider fetal blood loss in the event of neonatal resuscitation that includes chest compressions. In addition, this consideration should be included in the guidance to support the newborn life support algorithm.

Investigator’s View

Commenting on the report’s findings, Melanie Ottewill, National Investigator at HSIB, said: “The need for blood transfusions during resuscitation is rare, but the impact of a delay can be devastating as we heard from Alex and Robert, Aria’s parents.

“Our report forms an important piece of literature in an area with limited research and can support any future work that explores safety issues relating to neonatal blood transfusions.

“The aim is that our safety recommendations can raise awareness of the issue and prompt clinicians to consider the option of a blood transfusion in the early stages of resuscitation.”

Previous Concerns

previous report by the HSIB identified a key safety risk in maternity care relating to delays to intrapartum intervention once foetal compromise is suspected.

The report was compiled by the HSIB after a review of 289 of its maternity investigations into intrapartum stillbirths, neonatal deaths and potential severe brain injuries, which found that in 14.9% of the cases the delay was a contributory factor.

Source: Risks of Delays in Emergency Neonatal Blood Transfusions Highlighted in New Safety Report (medscape.com)

Acknowledging Stigma and Embracing Empathy When Treating Neonatal Opioid Withdrawal Syndrome – Episode 106


In this episode Kenneth Zoucha, MD, FAAP, a recognized leader in addiction medicine for the state of Nebraska, talks about the stigmas around substance use disorder and Neonatal Opioid Withdrawal Syndrome. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Tamela Milan-Alexander, MPPA, about her history with opioid use disorder, which led to a high-risk pregnancy, and her subsequent advocacy for mothers and their babies.

PEDIATRICS ON CALL Acknowledging Stigma and Embracing Empathy When Treating Neonatal Opioid Withdrawal Syndrome – Ep. 106


Residency Is Broken. We’re Unionizing to Fix It.

More fair working conditions and pay are long overdue

by Dipavo Banerjee, DO, MS, and Pratiksha Yalakkishettar, MD – March 19, 2022

On its website, UMass Memorial Health states that the hospital system was created to “make health and healthcare available to everyone.” This mission is made possible by the “people of UMass Memorial Health” and their “relentless pursuit of healing in all its forms.”

As frontline resident physicians who work day in and day out to care for patients at UMass Memorial, this mission is also at the core of our values. That’s why we are bargaining for our first union contract: In order to ultimately improve residency for ourselves, those that come after us, and the people of central Massachusetts who need quality healthcare most. But unfortunately, since the bargaining process began this fall, the hospital system’s leaders have not been as responsive to our proposals as we would have hoped.

A Wave of Resident Physician Organizing

While the COVID-19 crisis dramatically exacerbated issues UMass residents face, our struggle to make ends meet and stay well during residency is nothing new. Before the pandemic, we came together and started the process of unionizing with the Committee of Interns and Residents (CIR/SEIU) to gain a voice at the table where we could better advocate for ourselves and our patients. When the pandemic struck, securing better conditions became even more urgent, as the inequities in our healthcare system were laid bare — and in light of the rapid changes that left residents scrambling to keep up within traumatizing and sometimes dangerous practice conditions.

UMass residents are not alone. In just the past few weeks, hundreds of frontline physicians at Stanford University Medical Center, the University of Vermont Medical Center, and the University of Southern California-Keck recently demanded union recognition with a supermajority of support — a landmark residents and fellows celebrated at UMass not too long ago. In labor organizing, this means over 65% of the bargaining unit voted to unionize, but so far, all of these employers have refused to voluntarily recognize their union. This refusal then forces workers to move to an arduous National Labor Relations Board (NLRB) election process, which can draw out for months and creates an array of complications. (Residents at nearby Greater Lawrence Family Health Center recently won their union through an NLRB election).

Importantly, establishing a union is only the first step. Next, the workers who are organizing must prepare to negotiate with management to approve a collective bargaining agreement, which is a contract between the workers and the organization or company that sets pay, benefits, and other conditions over a period of time. Although we have been organizing for years at UMass, our union protections won’t truly be secure until we sign our first contract.

At the Top of Our List of Demands

Among the most important demands in our contract negotiations with management is the pay we need to live and work in an area with an increasing cost of living. Currently, UMass resident physicians are barely making the state minimum wage when our hours are considered. But so far, UMass has denied residents the basic ask of a fair wage. Instead, they’ve made only a meager wage proposal that fails to keep pace with the cost of living in Worcester — where the main UMass Memorial campus is located — while continually refusing to acknowledge several of our proposals. However, this disregard is perhaps unsurprising given how undervalued resident physicians’ labor is nationwide, a fact reflected in everything from our pay and working conditions to the gaps in our labor protections and benefits.

During residency, many of us are working to establish ourselves in a new location, while in some cases starting families or bringing families with us. We must stretch our dollars to cover the cost of essentials, from rent to childcare to gas to groceries. According to RentData.org, the fair market rent for a two-bedroom apartment in Worcester was $1,450 per month in 2021, which is more expensive than 96% of areas the site calculates. At the same time, the average student loan debt for graduating physicians is almost a quarter of a million dollars.

It is disheartening, to say the least, that the hospital system has so far refused to give us what we need after all we’ve sacrificed during this global catastrophe. We have worked sometimes to the point of physical and emotional exhaustion while witnessing far too many patient deaths during multiple COVID-19 surges.

Working Conditions Impact Patient Care and Health Equity

This pandemic has made it clearer than ever that resident physician well-being and patient care are inseparable. UMass Memorial residents are willing to work 80 hours per week because we know exceptional care is critical to community well-being, but we are significantly underpaid for doing so. A meaningful pay increase and adequate health and leave benefits would mean that we would be able to better focus on caring for our patients without burning out or completely neglecting our families and our own well-being.

Fair pay and benefits for residents is also a matter of health equity. Currently, residency at UMass is unaffordable, which limits who can come work and train here. UMass Memorial cannot claim to care about the most vulnerable communities in Massachusetts while helping to entrench inequities during residency. Through our union, we hope to foster a more diverse body of residents within the historically oppressive systems of healthcare — starting with UMass.

Hospitals Must Respect Resident Physicians’ and Fellows’ Labor Power

The surge in resident physician and fellow organizing around the country shows it is long past time for hospitals like UMass Memorial Health to respect the labor power of residents — first by recognizing our unions and then by agreeing to contracts that reflect the importance of our work and patient well-being. Graduate medical education should not be a burden on would-be physicians. At UMass Memorial, we hope to ultimately make residency more sustainable financially and otherwise, so we can continue to provide the highest quality care to our communities without burning out.

We won’t stop fighting until UMass agrees to invest in its future physician workforce and to treat us with the respect and dignity we deserve. Our families can’t wait — and neither can the communities in Massachusetts who need quality healthcare the most.

Source: Residency Is Broken. We’re Unionizing to Fix It. | MedPage Today Residency Is Broken. We’re Unionizing to Fix It. | MedPage Today

Difficult Times Without Easy Solutions: Nurses Want to Be Heard!

Annette M. Bourgault, PhD, RN, CNL, FAAN Editorial February, 2022

Crit Care Nurse (2022) 42 (1): 7–9. https://doi.org/10.4037/ccn2022577

Many articles have been written during the COVID-19 pandemic about the serious workplace and personal issues experienced by nurses. Although I have mentioned some of these struggles in previous Critical Care Nurse (CCN) editorials, I have not dedicated a full column to the deplorable situation in which so many nurses find themselves. I mistakenly assumed readers were overloaded with pandemic-related information and aware that many organizations are advocating on behalf of nurses to improve the environment and overall working conditions. I now realize that many nurses at the bedside are justifiably concerned that your voices are not being heard.

A national US survey of critical care nurses reported physical and emotional symptoms of exhaustion, anxiety, sleeplessness, and moral distress.1  Working conditions have become increasingly demanding during the pandemic, patient acuity is high, the nursing shortage continues, nurse-to-patient ratios regularly exceed recognized standards, nurses are working extreme amounts of overtime, and many nurses have seen too much death, feel disrespected and undervalued, and are frustrated that they cannot provide the level of excellent care required for positive patient outcomes. In other words, many of you are working in unhealthy and unsafe work environments.

Nurses’ Reality

Nurses are angry. I hear you and I hear your pain. As a nurse, I share your deep concerns about the future of nursing. As Editor of CCN, I recognize the importance and privilege of having a national platform to call for positive change for all critical care nurses.

I should explain one of the realities of publishing, however. Early in the pandemic, I often sat down to write these editorials thinking the worst of the pandemic might be over by the time my words were printed. It is clear now that we will not be out of this mess by the time this editorial goes to press. A recent quote I encountered resonated with me: “Any effort to predict a future course beyond 30 days relies on pixie dust for its basis.” To meet deadlines for print, I am typically writing editorials 3 to 4 months before the final version will be seen by readers, leaving me to guess what lies ahead. Sometimes I miss the mark.

Thus far, COVID-19 waves have fluctuated throughout the country with respect to timing and impact. During various waves of the pandemic, we hoped for a final resolution. While our government instructed the vaccinated public to resume elements of usual life, the work environment for nurses and other health care providers continued to worsen. Nurses in one state might be breathing easier and hoping the pandemic was ending while nurses in another city or state might be experiencing a huge influx of acutely ill patients and worsening work conditions. Each wave came and went leaving more destruction in its path. Some of our international readers experienced virus-related surges before their arrival in the United States. Due to geography and other variables, some of the situations I discuss may not apply to all readers in all places at all times, and sometimes I may overgeneralize about your experience.

Our System Needs an Overhaul

One thing is clear: many critical care nurses have been working in unfathomable work environments that appear to be worsening. A major overhaul of acute and critical care nursing is needed. Nurses have told us loud and clear that they do not want to be heroes—you want a healthy, sustainable work environment. You are willing to work hard, but you also need time to care for yourselves. You deserve the simple things that other professions take for granted, such as having time to eat a meal or empty your bladder during a shift. You deserve to be fairly compensated for the difficult work you perform. You deserve to work in a healthy work environment that supports you and allows you to provide expert nursing care to the best of your ability.

In the spirit of the American Association of Critical-Care Nurses (AACN) Healthy Work Environment standards, health care organizations must strive for skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.  As the health care system is revamped, it is critical to ensure that adequate support and leadership are provided not only for bedside nurses,  but the entire team, including nurse managers.  Strong consideration should be given to other supportive roles such as clinical nurse specialists, whose engagement in patient care has been associated with improved patient outcomes and decreased cost.

No Easy Answers

This editorial does not contain answers to fix our broken health care system; there are no easy answers. Major changes will take time, not only to create a system that works for all, but to create changes that are sustainable. Across the globe, nursing associations, hospitals, schools of nursing, and others are working to make substantive changes to acute and critical care nursing practice. They also are exploring how we train new nurses and looking to models that have worked in other health care disciplines. Frontline nurses have been involved in many of these initiatives. Your input is important to help create a system that works for you.

Many nurses I talk to believe we already had a nursing crisis before the pandemic. Now we have a crisis on steroids. Our nursing shortage was exacerbated by the pandemic, and the current situation is unsustainable. If changes are not made quickly, we risk losing more nurses, including experienced, expert nurses. Intensive care unit nurse and advocate Sandy Summers expressed this well: “Without nurses, an ICU bed is just a bed.”  Obviously we cannot continue to work within this broken system; radical and meaningful change is needed. Many are trying to develop innovative ways to provide safe nursing care to acute and critically ill patients and their families.

A number of solutions have been implemented and others are under development. Some institutions have reduced documentation requirements to free up nursing time for direct patient care, which is a great example of de-implementation to remove or revise current practices to free up valuable nursing time.  There may be other opportunities to de-implement tradition-based practices that are not evidence based. Also, other practices or tasks that do not require critical thinking or high levels of nursing skill might be delegated to trained assistants.

Team nursing models are being used to manage increasing workloads with fewer registered nurses.9  In some cases, one nurse leads a team of nurses and/or health care providers from other disciplines to care for critically ill patients. I have heard stories of patient care being provided by student nurses, medical residents, and other allied health professionals. Although such solutions are intended to support nurses, they risk increasing nurse workload and stress depending on how thoughtfully they are implemented.

Although travel nurses and military nurses are being used to fill some of our patient care needs, this situation is not sustainable either. Some of you have reported working with travel nurses who have no experience caring for critically ill patients. This type of situation places additional burdens on the entire team, including local intensive care unit nurses and the nurse manager, not only to help the travel nurse become familiar with the local work environment and policies, but to become familiar with safe, evidence-based critical care nursing. The additional discrepancy in financial compensation between travel nurses and local nurses has become another great source of frustration.

Giving Nurses a Voice

Internationally, organizations such as Johnson & Johnson have been working with nurses and others to create a more sustainable workforce. Here at home, AACN has worked tirelessly throughout the pandemic to advocate for nurses, beginning with a board member’s visit to the White House in March 2020 to brief officials and the Coronavirus Task Force, demand safe work environments, and advocate for adequate personal protective equipment for frontline health care workers.

AACN also has launched campaigns, educational efforts, and well-being resources during the pandemic to provide various opportunities to improve working conditions and to give nurses a voice. Here are examples:

  • An online portal for nurses to share stories in writing or through use of video
  • The Hear Us Out Campaign to encourage vaccination in an unthreatening way
  • Healthy Work Environment resources including implementation of a fifth national survey to capture nurses’ feedback during the crisis and recommend strategies for action 
  • A national staffing initiative co-led with the American Nurses Association to identify lasting solutions to chronic challenges to provide for safe and appropriate nurse staffing in the future
  • Partnerships on the American Nurses Foundation’s Nurse Well-Being Initiative  and the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience
  • Relationships with organizations such as the Office of the Surgeon General to ensure that your voices are heard at high-profile tables of influence

Nurses collectively have a powerful voice and want to be heard. You want employers, administrators, policy makers, government, nursing associations (including AACN), schools of nursing, the public, and other stakeholders to recognize that your current work situation is unhealthy and unsustainable. We cannot afford to lose more nurses, but we also cannot continue to expect nurses to work within this broken health care system without meaningful change.

In closing, I strongly echo the sentiments expressed by Sandy Summers and others: “We must treat nurses as a vital resource.” Nurses want to be heard. They want ACTION and they need it NOW!

Source: https://aacnjournals.org/ccnonline/article/42/1/7/31660/Difficult-Times-Without-Easy-Solutions-Nurses-Want


Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway

T Tingleff,Å Vikanes,S Räisänen,L Sandvik,G Murzakanova,K Laine

First published: 14 November 2021 https://doi.org/10.1111/1471-0528.17013



To assess the association between preterm first birth and preterm second birth according to gestational age and to determine the role of placental disorder in recurrent preterm birth.


Population-based registry study.


Medical Birth Registry of Norway and Statistics Norway.


Women (n = 213 335) who gave birth to their first and second singleton child during 1999–2014 (total n = 426 670 births).


Multivariate logistic regression analyses, adjusted for placental disorders, maternal, obstetric and socio-economic factors.

Main outcome measures

Extremely preterm (<28+0 weeks), very preterm (28+0–33+6 weeks) and late preterm (34+0–36+6 weeks) second birth.


Preterm birth (<37 weeks) rates were 5.6% for first births and 3.7% for second births. Extremely preterm second births (0.2%) occurred most frequently among women with an extremely preterm first birth (aOR 12.90, 95% CI 7.47–22.29). Very preterm second births (0.7%) occurred most frequently after an extremely preterm birth (aOR 12.98, 95% CI 9.59–17.58). Late preterm second births (2.8%) occurred most frequently after a previous very preterm birth (aOR 6.86, 95% CI 6.11–7.70). Placental disorders contributed 30–40% of recurrent extremely and very preterm births and 10–20% of recurrent late preterm birth.


A previous preterm first birth was a major risk factor for a preterm second birth. The contribution of placental disorders was more pronounced for recurrent extremely and very preterm birth than for recurrent late preterm birth. Among women with any category of preterm first birth, more than one in six also had a preterm second birth (17.4%).


Increased Severe Neonatal Hyperbilirubinemia During Social Distancing

By Sara K. Berkelhamer, Department of Pediatrics, University of Washington, Seattle
Feb 21, 2022

As a neonatologist, I was concerned about an apparent increase in the number of neonates being readmitted to the hospital with severe hyperbilirubinemia during the COVID-19 pandemic and social distancing mandate. I envisioned that the postpartum social support provided by visiting family and friends was being disrupted, impacting successful breastfeeding and the recognition of jaundice in infants. I was also worried about inadequate access to professional support coupled with apprehension to seeking medical care. As severely elevated bilirubin levels can impact an infant’s neurodevelopment, early identification and intervention (including feeding supplementation, lactation support, and phototherapy) is key to avoiding both long-term sequelae and hospitalization. Therefore, there was a need to explore if an increase in severe hyperbilirubinemia cases was truly occurring, if these cases represented more severe disease, and if risk factors could be identified to guide targeted counseling and closer follow up.

For a paper published in the Journal of Paediatrics and Child Health, my colleagues and I aimed to determine rates of severe hyperbilirubinemia admission during social distancing in comparison to historical norms. A retrospective chart review identified all readmissions for hyperbilirubinemia between January 2018 and April 2020 in Western New York. Our study team collected both maternal and infant data as well as details on the infant’s admission to the hospital and clinical course. Infants were categorized according to the period of hospital admission, which was characterized as pre-pandemic or control. In addition, 19 outpatient clinics were surveyed regarding lactation support.

Rates of Readmission Nearly Tripled

While rates of readmission for hyperbilirubinemia nearly tripled during early social distancing mandates, we found that there was no change in the severity of disease as determined by signs of dehydration, rates of suspected sepsis, peak bilirubin levels, duration of phototherapy, rates of bilirubin above exchangeable levels, use of IV immunoglobulin or exchange transfusion, and length of hospital stay.

Mothers who had infants readmitted during social distancing were observed to be younger than mothers of infants readmitted before the pandemic (25.8±3.3 vs 31.3±4.7 for COVID-19 and controls, respectively), with rates of primiparity and exclusive breastfeeding higher than national norms, but not significantly higher than controls in the cohort (62.5% vs 37.0% for primiparity; 87.5 % vs 81.5 for breastfeeding). A survey of outpatient clinics in the region identified limited options for access to lactation support via telemedicine; of the 19 clinics surveyed, only six offered a telemedicine option for lactation support.

Greater Access to Virtual Lactation Support Needed

To our knowledge, this is first study to examine increased rates of readmission for hyperbilirubinemia during the stay-at-home mandate. Our data supported our hypothesis that social distancing impacted access to healthcare, critical social support, and utilization of services for at-risk cohorts, which included young, primiparous women who breastfeed.

Based on our observations, there is a critical need for proactive identification and monitoring of at-risk mother-infant dyads during recurrent COVID-19 surges, not only during the postpartum period in the hospital but after discharge into the community. Our data further advocates for greater expansion of access to virtual lactation support, an option that has grown exponentially for physician visits during the pandemic.

Going forward, we would like to see more research on the design and application of remote lactation support, as well as on the clinical and cost efficacy of these programs. As our data represents a regional experience, we would welcome a secondary analysis comparing severity of disease in cases of hyperbilirubinemia that occurred before and during COVID-19 and the demographics associated with at-risk populations.

Source:increased-severe-neonatal-hyperbilirubinemia-during-social-distancing (physiciansweekly.com)

Building Baby Brains With smallTalk: From Foreign Language Learning at Home to Bridging Gaps in the NICU

January 28, 2022   Jessica Nye, PhD

The best language learners on the planet are children — especially babies. Your brain is most active in creating the language center of your brain, connecting neurons and creating the highways and pathways for processing language, during infancy. In fact, language learning begins in utero. The developing brain of a fetus starts to wire language circuitry around the speech sounds and rhythms of its mother’s voice. This process accelerates when a baby is born.

The brain does more language-associated wiring during the first year of life than any other time in a person’s life. These brain changes occur rapidly as a result of exposure to adult voices speaking to the baby in “infant-directed speech,” characterized by a higher pitch and more melodic, emotional tones.

Ohio-based startup smallTalk (formerly Thrive Neuromedical) is developing the SmallTalk™ platform to enrich the neurological development of babies who don’t have regular, consistent access to their parents’ voices. smallTalk has licensed technology developed at Nationwide Children’s Hospital that delivers recorded voices to infants via devices intended for use in the neonatal intensive care unit (NICU) and at home. These devices support critical brain development for language.

Around 10% of all infants spend some amount of time in the NICU, where they may be exposed to more passing adult speech and sounds of alarms and machinery than infant-directed speech during critical periods for language-associated brain development. This lack of exposure to infant-directed speech may, in part, be responsible for the documented association between NICU care and developmental language delays.

At Nationwide Children’s, where the average stay in the NICU exceeds 100 days, researchers developed and studied an infant-safe, unibody, Bluetooth-enabled speaker device to increase babies’ exposure to their caregivers’ voices with the appropriate sound characteristics to provide a clinical, therapeutic effect. The speaker can easily fit into an incubator and uses technology and volumes that is safe for babies and their sensitive ears.

Beginning this year, nurses and therapists in the NICU will be able to use a specially designed iPad application to help parents or caregivers record lullabies, songs or stories. Playlists of these recordings can be transferred wirelessly to egg-shaped speaker devices placed with the babies in the NICU and played for them several times each day.

The technology has also led to the development of an innovative foreign language learning product, the smallTalk Egg™, designed to help parents plan expose their babies to foreign language learning before age two.

“This is the only time of life when language learning actually helps babies brains develop differently. Infants in bilingual or multilingual household environments develop much broader speech sound recognition capabilities. By 1 or 2 years of age, they’re able to hear and verbalize more speech sounds and adapt to those languages very quickly,” says Dean Koch, CEO of smallTalk.

Infants can be exposed to these songs and stories passively, but studies have shown the most effective changes to the brain occur during interaction. Because the smallTalk Egg™ comes with a sensor device which fits into three different commercially available types of pacifiers, infants can request additional content by sucking on their pacifiers during 20-minute educational sessions. As the infant sucks, they are rewarded with 10 seconds of the foreign language lullaby, which then fades away. The baby recognizes this contingency quickly and will happily engage for a 20-minute learning session.

“Our research on brain imaging and how babies process speech sounds found that 20 sessions of 10-20 minutes over a month or month and a half is all that’s required to make a real, lasting, positive brain change,” says Koch.

The smallTalk Egg™, which will also be available this year, will allow parents and caregivers to bring this brain-enhancing technology into their homes. Currently, content is available in seven languages for use on the smallTalk Egg™, and there are plans to expand to include more languages spoken around the world.

Source: https://pediatricsnationwide.org/2022/01/28/building-baby-brains-smalltalk/

Discover Your Learning Style


In this video, you’ll learn more about the different types of learning styles, to see which one works best for you!  Visit https://www.gcflearnfree.org/ to learn even more.

Traditionally western academic institutions have not adequately developed teaching methods that are geared towards visual, kinesthetic, and combined learning styles. The world is composed of people with diverse, meaningful, and valuable learning styles. Often academic teaching, testing, and programming is aimed towards auditory learning. I propose that we transition from labeling students as “learning disabled” and focusing on the possibility that our education systems are teaching disabled. We can do better.


4/10/2020  by  Surfing Republica


Ideal; Preemie Life Course

Uzbekistan, officially the Republic of Uzbekistan, is a double-landlocked country in Central Asia. It is surrounded by five landlocked countries: Kazakhstan to the northKyrgyzstan to the northeastTajikistan to the southeastAfghanistan to the southTurkmenistan to the south-west. Its capital and largest city is Tashkent. Uzbekistan is part of the Turkic languages world, as well as a member of the Organisation of Turkic States. While the Uzbek language is the majority-spoken language in Uzbekistan. Islam is the predominant religion in Uzbekistan, most Uzbeks being Sunni Muslims.

Uzbekistan is a secular state, with a presidential constitutional government in place. Uzbekistan comprises 12 regions (vilayats), Tashkent City and one autonomous republic, Karakalpakstan. While non-governmental human rights organisations have defined Uzbekistan as “an authoritarian state with limited civil rights”, significant reforms under Uzbekistan’s second president‘s administration have been made following the death of the first president Islam Karimov. Owing to these reforms, relations with the neighbouring countries Kyrgyzstan, Tajikistan and Afghanistan have drastically improved. A United Nations report of 2020 found much progress toward achieving the UN’s sustainable development goals.

In the post-Soviet era, the quality of Uzbekistan’s health care has declined. Between 1992 and 2003, spending on health care and the ratio of hospital beds to population both decreased by nearly 50 percent, and Russian emigration in that decade deprived the health system of many practitioners. In 2004 Uzbekistan had 53 hospital beds per 10,000 population. Basic medical supplies such as disposable needlesanesthetics, and antibiotics are in very short supply. Although all citizens nominally are entitled to free health care, in the post-Soviet era bribery has become a common way to bypass the slow and limited service of the state system. In the early 2000s, policy has focused on improving primary health care facilities and cutting the cost of inpatient facilities. The state budget for 2006 allotted 11.1 percent to health expenditures, compared with 10.9 percent in 2005.


Rank: 118  –Rate: 8.7%   Estimated # of preterm births per 100 live births 

(USA – 12 %, Global Average: 11.1%)

The World Community has experienced increased chaos and stress these past few years, and our community members further impacted by war and climate disasters face escalating healthcare disparity and preterm birth influences. Access/exposure to media provides the opportunity to see for ourselves the challenges our Neonatal Womb Warrior/Preterm Birth community members face globally.  We have the ability to impact change. No matter how big or small our efforts seem, each and every effort to provide support and manifest positive change is both acknowledged and appreciated. Thank you. Kathy and Kat.

We need to talk about prematurity

São Paulo Ambulatory in Brazil carries out pioneering work in nurturing care for preterm infants.

By Emilia Afrange  Last updated: October 6, 2021 Date created: September 24, 2021

                                   International Psychology

The issue of premature births is a global and growing public health concern. Stressing its importance, the United Nations Sustainable Development Goals aim to reduce the rate of global maternal mortality to less than 70 deaths per 100,000 live births by 2030 (United Nations, 2015).

Prematurity is the main cause of neonatal mortality (children up to 28 days old) and infant mortality (children under 5 years old) worldwide and a relevant cause of serious morbidity, associated with long hospital stays in the Neonatal Intensive Care Unit (World Health Organization, 2019)

The sequelae of prematurity are not limited to the period immediately after birth. Premature birth survivors can face adverse health consequences throughout their lives, creating a significant burden for their families and society. Coming into the world before 37 weeks of gestation, or even earlier, can determine the baby’s biopsychosocial development, since biological birth and psychological birth do not coincide (World Health Organization, 2019)

Premature births are a serious issue in Brazil

“Born in Brazil” is a national survey on labor and birth, coordinated by the Sergio Arouca National School of Public Health (ENSP), linked to the Oswaldo Cruz Foundation (Fiocruz). The survey reveals that the rate of prematurity in the country reached 11.5%, almost twice the rate observed in European countries, with 74% of these babies being late preterm (between 34 and 36 weeks of gestation).

More recent information (2014), from the Information System on Live Births (Sinasc) and the Ministry of Health, indicate a prematurity rate in the country corresponding to 12.4% of live births. According to the general coordinator of the study, Maria do Carmo Leal, PhD, “prematurity is the biggest risk factor for the newborn to get sick and die, not only immediately after birth, but also during childhood and adulthood. The damage goes beyond the field of physical health and reaches the cognitive and behavioral dimensions, making this problem one of the greatest challenges for contemporary public health” (Oswaldo Cruz Foundation, 2011/12).

Between October 2016 and June 2019, the Brazilian Association of Parents, Families, Friends and Caregivers of Premature Babies (2019) conducted a survey with 2,900 families of premature babies. The objective was to identify possible actions to provide benefits to aid families with premature babies in the country.  Among the results, it was highlighted that the average period of hospitalization of premature babies in the NICU was 51 days; 63.7% of the babies were hospitalized for more than 60 days and 26% of them stayed between two and five months.

Care for infants born prematurely and their families in Brazil

In the city of São Paulo (SP), the Preterm Outpatient Clinic of the Escola Paulista de Medicina (EPM), of the Federal University of São Paulo (Unifesp), is a national reference in the care of children and adolescents born preterm. Since its foundation, in 1981, it has followed an efficient nurturing care model.

We work with four affiliated hospitals (Hospital São Paulo, Hospital Municipal Vereador José Storopolli, Hospital Estadual de Diadema e Hospital Geral de Pirajussara), which together register approximately 800 premature births/month. Currently, around 900 children and adolescents are being monitored at the Ambulatory. The Premature Clinic offers medical and multidisciplinary care to children and adolescents born prematurely until they reach 20 years of age.

Children born prematurely also receive support for medical treatment, and their families receive social assistance aiming at improving their health and quality of life from the ‘Instituto do Prematuro – Viver e Sorrir,’ founded in 2004 and, since then, a partner of the Clinic (Instituto do Prematuro, 2018).

Children born prematurely and their families also require psychological support. In 2007, the Psychology area at the Premature Outpatient Clinic was created, a unique experience in Brazil. A team of psychologists and psychotherapists support the psycho-emotional health of the premature baby and the mother/caregiver, stimulating the physical and emotional development of the infant, aiding the construction of the loving and empathetic mother/child bond, and supporting the multidisciplinary team helping the family.

Incoming patients are first separated into Operational Groups to address common themes that aim at the psychic expansion, e.g., narrating their anguishes and difficulties while discovering ways of dealing with them – sometimes even in a playful and grateful way. The Operational Groups are as follows:

  • Guidance Group with mothers and children from 0 to 3 years old.
  • Operational Group of mothers and children from 4 to 7 years old.
  • Operational Group of mothers and children from 8 to 10 years old.
  • Operational Group with teenagers.
  • Operational group of caregivers.

Psychological interventions are then created, which can consist of:

  • Psychological screening to verify the patient’s needs and to which type of care s/he should be referred.
  • Individual psychological care.
  • Play therapy.
  • Psychiatric referral.
  • Group service.

Periodically, meetings are held with the specialists from the Outpatient Clinic and with the EPM resident physicians, in order to promote the quality and improvement of the therapeutic practice, according to the modules created by the physician and psychoanalyst Michael Balint, MD, MS (1984).

In this way, we are able to provide an innovative system of psychological support to address the needs of children born prematurely and their families.


Improving mother and child health in Aral Sear are: Baby Gulnara’s story

UNICEF Uzbekistan-  03 February 2022

Gulnara was born after only 30 weeks of gestation. She weighed just 1,000 grams. After two months in an incubator at the Neonatal Intensive Care ward of the Nukus City Perinatal Center, she weighs 2.450 kilograms.

Gulnara’s mother was admitted with a history of miscarriage. She suffered from multiple health conditions which led to premature labor. The head of the department, Dr. Kahramon Kabulov, who performed an emergency cesarean section to assist with Gulnara’s birth, explained that Gulnara would have had slim chances for survival just a few years before. Thanks to the up-to-date, evidence-based advanced newborn care resuscitation protocols recommended by WHO and UNICEF, and the latest equipment and upgraded infrastructure, maternity staff can now save Gulnara and the other babies who are born preterm.

In 2019, within the framework of the ‘Improving Quality of Perinatal Care Service to Most Vulnerable Mothers and Newborns’ Programme, UNICEF and UNFPA had assisted three perinatal facilities in Karakalpakstan (in Nukus City, Kungrad, and Beruniy) to enhance the capacity of neonatologists, obstetricians, and resuscitation specialists to strengthen staff capacities, through comprehensive training and support. UNICEF and UNFPA have also equipped the perinatal center’s new Neonatal Intensive Care Unit with the latest medical equipment such as ventilators, oxygenators, laryngoscopes, and training equipment. Today all premature babies that come through the perinatal center have a real chance of survival.

At the Neonatal Intensive Care Unit, little Gulnara is getting better every day. She can now see lights and hear sounds and uses her strength to drink her mother’s breastmilk. Once she reaches 2.5 kilograms, she will be released to go home. Her parents have been trained on how best to care for her and are looking forward to her arrival at home.

UNICEF and UNFPA significantly contributed to the Government’s efforts to improve the quality of perinatal services in the Kungrad and Beruniy districts and Nukus City. Since the project started, 21% of all mothers and newborns in Karakalpakstan (more than 12,000 mothers and 12,000 newborns) have benefited from upgraded infrastructure and improved quality of care at the target perinatal centers.

A significant reduction in early neonatal mortality has been achieved in all three target facilities on average by 22%. It is expected that the target perinatal centers will extend their specialized service to mothers and newborns from the neighboring districts.

Source: https://www.unicef.org/uzbekistan/en/maternal-and-child-health-in-aral-sea-region

Keeping up with technology and terminology ….. Next up: Deep Learning

What is Machine Learning?

822,603 views – Aug 24, 2017 Google Cloud Tech

Got lots of data? Machine learning can help! In this episode of Cloud AI Adventures, Yufeng Guo explains machine learning from the ground up, using concrete examples.

Ziyoda va Ulug’bek Rahmatullayev – Tor ko’cha

835,425 views              Jan 3, 2022

Gravens By Design: What the Ideal NICU Would Look Like

Robert D. White, MD Director, Regional Newborn Program Beacon Children’s Hospital

It is sometimes hard to imagine the ideal NICU – the concept is still evolving, so there is no one available to visit, and even the elements of what could be optimal are evolving. For example, if this exercise were undertaken a few decades ago, it would be difficult to imagine what the digital transformation might permit – and even now, we cannot predict its full potential. Still, the effort seems worthwhile, not only for those who will soon be building a NICU that will have to meet the needs and expectations of its inhabitants for the next 20-30 years but also for those who cannot rebuild soon but could undertake an interim facelift that would be of value to all its constituents.

A NICU should be welcoming to families.

 This concept has many elements, starting even before one enters the hospital doors. It is usually easy to find the hospital, especially in the digital age, but there are often many places to park and enter the massive complex where most higher-level NICUs are located. Few people will say that finding their way from the street to the NICU is easy; it is hardest for young parents or other family members coming from an outlying community – often at night and almost always under stressful conditions. Proper signage on the street, at the preferred entrance, and through the hallways can greatly facilitate this first encounter. Written directions, both on paper and a hospital website, can also be helpful and allay anxiety even at the start of the journey.

Many hospitals have a foreboding “front door” because of where they are located, how old they are, and their restrictions to entry, but once one reaches the entrance to the NICU, none of these should be factors. The entrance should be well-lit with an attractive color scheme and devoid of stern signage. An individual to welcome and direct families and visitors should always be available. The décor should have more in common with a hotel lobby than an ICU – spacious, relaxing, and, where appropriate, informative. Both signage and artwork should reflect the diversity of cultures served by the NICU and should address parents as members of the care team rather than as visitors.

This paper is not intended to explore the operational aspect of the ideal NICU, but these are immensely important to how families can be made to feel welcome. I have vivid memories of an old NICU in Madrid where several mothers sat in a circle rocking their premature infants while talking and singing together – a stark contrast to most similar NICUs in much wealthier countries I have seen that were largely devoid of parents and dominated by the sights and sounds of technology. The Madrid parents were made to feel welcome not by the physical environment but by the policies of the NICU, and they, in turn, made it more welcoming to every new family.

The NICU should only separate babies from their parents under the most extreme circumstances.

 There is now abundant evidence of the value of early and extensive intimate contact of a baby with its parents and the safety of single-family rooms. There is no evidence that separating babies from their mothers for extended periods in the first days of life benefits either baby or parent. The ideal NICU would provide space and caregivers for all mothers after their delivery except for those who require highly specialized care. Likewise, accommodation would be provided for fathers or other support persons that will be sufficient for their comfort over extended periods.

A NICU should present sights and sounds to all inhabitants that are nurturing rather than stressful.

There was a point in the early NICU days when audio alarms and bright lights were imperative, but we have known how to minimize these stressors for decades now. Most alarms can be transmitted electronically and visually, a technique learned in every other part of the hospital and adopted in some NICUs as early as the 1980s but has only recently achieved widespread acceptance and is still not a reality for some NICUs. Similarly, there was a time before the advent of transcutaneous oximetry when constant bright lights were needed to assess skin color and perfusion. However, the pendulum swung to a constantly dim environment based on the premise that this was the expected environment in utero and, therefore, safer and less stressful for premature infants. This belief has persisted long after it was disproven (1); it is past time for the pendulum to swing back to a middle ground where babies are presented with a circadian rhythm for lighting while still protected from direct light sources.

Adult caregivers and families need appropriate lighting as well. Lighting should be of sufficient intensity and the proper spectrum to provide a circadian and alerting stimulus for caregivers (2) and a welcoming signal to families. In contrast, lighting levels and spectrum at night will minimize melatonin suppression in caregivers while still supporting alertness.

Daylight and views of the outside world and nature provide a substantial psychological benefit to many adults. However, most NICUs will not have an opportunity to improve access to these features until new construction occurs because of the misguided belief in past years that because babies did not need access to daylight, their caregivers and families did not need it either. The ideal NICU will provide windows in almost all spaces where adults spend extended periods during the day. Even hallways should have a window on at least one end rather than closing off that vista by making an office a little larger or for storage space. In the meantime, attention to the visual environment remains even more important. The walls of NICUs have the potential to be palettes conveying subtle messages through artwork, photos, and stories of NICU grads. Even ceilings and floors have been used creatively to provide additional opportunities for the eye to find the color, whimsy, distraction, and information.

Sound control has been difficult to achieve in many NICUs, even after monitor alarms were tamed. For many NICUs, there are still too many sources of noise and too few sound-absorbing surfaces. There are now alternatives to the hard flooring that transmits and reflects the sound of everything that moves across it, for example. All surfaces should absorb more noise than they generate. HVAC systems were often designed in an era when high airflow was recognized as valuable but not understood as an important source of ambient noise, above which all other desirable sounds such as voices and even monitor alarms must be heard. Design or redesigning these HVAC systems to be quiet and where air can be extensively cleaned and filtered are overdue for many NICUs.

Infection control can be improved in most NICUs.

Nosocomial infection continues to be a frustratingly common complication of neonatal intensive care. Something as basic as a handwashing sink is often designed to fail and, even when welldesigned, can be misused in a way that contributes to ongoing contamination of NICU surfaces. The ideal NICU will have sinks readily accessible in all patient care and support areas; these sinks should be hands-free, large enough for cleaning hands and forearms, have drains that are offset from the faucets, rims that do not permit objects to be placed on them (and thereby contaminated), splash guards to protect adjacent areas from splatter, quiet paper towel dispensers, and should be handicapped-accessible.

Among new sanitizing techniques being explored, ultraviolet light in the UV-C spectrum has been demonstrated to reduce bacterial and viral presence in circulating air and on certain devices, including hand-held communication devices. There is also increasing evidence that UV-A can be used to reduce contamination of surfaces in occupied spaces (3).

Support spaces should provide respite and support for families and caregivers.

In many NICUs, support spaces for caregivers and families are cramped and windowless. These spaces would be large and relaxing in the ideal NICU with abundant daylight and access to an outdoor garden. Likewise, there would be smaller individual spaces that provide privacy and an opportunity to nap, pray, exercise, or do yoga.

The patient care space should be a home away from home for those families who desire it and those babies for whom it is appropriate.

This principle comes with qualifiers. Babies whose families rarely interact with them may benefit from being in a shared space with other such babies. A few families prefer being in a space where their baby can be easily seen by caregivers, although this often is based on a misunderstanding of how little we can tell about a baby when we are not directly at the bedside and how much we depend on monitors to provide us information about a baby’s status. Most families, though, appreciate a space they can call their own with comfortable seating, a private sleep surface and shower, a refrigerator, and the opportunity to personalize the space with decorations suitable for the baby and the season. Even in a more open setting, parents should have the opportunity for privacy, especially for breastfeeding and skin-to-skin care and space to store their personal belongings.

The ideal NICU should look better than the day it opened.

To some extent, this is an unreachable goal – walls will get nicked, floors will get stained, equipment will look worn. However, accumulating items in hallways and on counters and signs taped to walls or doors is not inevitable. Instead, it is tolerated mainly by people who get desensitized to its presence and forget that for families in this crucial moment, it announces a lack of attention to details and cleanliness that we would not tolerate in other public venues or indeed in our own homes if we were expecting visitors. It is a rare NICU that cannot find ways to enhance its appearance from time to time with upgrades as mundane as light bulbs with a warmer spectrum or as heart-warming as a piece of art from a graduate or the child of a staff member. Likewise, if allowed, families and staff can transform a patient care area from a sterile medical unit to something that feels more like home.


The proactive approach to mother-infant dyads at 22-24 weeks of gestation: Perspectives from a Swedish center

Johan Ågren    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden


The care of infants born at the lowest extreme of gestation requires dedication, skill, and experience. Most centers apply a selective approach where intensive care at these gestational ages is being offered to a varying proportion of infants depending on the views and experiences of the medical community, the individual physician, and the parents. Consequently, the outcomes differ dramatically with survival rates at 22-23 weeks ranging from 0 to greater than 50%. This paper presents the approach in a center with a long tradition of providing a comprehensive and uniformly active care to all mother-infant dyads from 22+0 weeks of gestation. Important features outlined include prenatal maternal referral and transfer, delivery room management, and initial intensive care.

Full Article/PDF: https://reader.elsevier.com/reader/sd/pii/S0146000521001506?token=B5AD098B8AEB9D5919C458B4CCF3C20E76E11BEA54DE5F07A5224485F86A29707C6DB08D3049A1707894F425ED3E7814&originRegion=us-east-1&originCreation=20220220175145

Thin Endometrium, PCOS, and Risk for Preterm Birth, Low Birthweight Infants

Jessica Nye, PhD – January 26, 2022

Women underwent controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or progestin for pituitary suppression. Hormone therapy cycle or ovulation induction cycle for endometrial preparation. 

Among pregnant women with polycystic ovary syndrome (PCOS), decreased endometrial thickness (EMT) was associated with increased risk for preterm birth (PTB), low birthweight (LBW), and small-for-gestational age (SGA) infants. These findings were published in Frontiers in Endocrinology.

Health records of women (N=1755) who had PCOS and a singleton livebirth after frozen-thawed embryo transfer (FET) between 2009 and 2019 at the Shanghai Ninth People’s Hospital in China were retrospectively reviewed for the study. Prior to pregnancy, the women underwent controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or progestin for pituitary suppression. All women underwent hormone therapy cycle or ovulation induction cycle for endometrial preparation.

Of the entire cohort of 1755 women with PCOS, 10.5% had EMT of £8 mm, 78.6% had EMT of >8-13 mm, and 10.9% had EMT of >13 mm EMT.  The 3 EMT categories were classified as “thin”, “intermediate” and “thick”, respectively, for this study. Patients in these 3 EMT cohorts were aged mean 29.9±3.3, 30.0±3.5, and 30.1±3.5 years; body mass index (BMI) was 23.44±3.70, 23.45±3.85, and 24.02±4.26 kg/m2; and 37.5%, 29.6%, and 25.0% had PCOS without any other fertility issues, respectively.

The patients differed significantly for gravidity and endometrial preparation regimen (both P <.001) among the thin, intermediate, and thick EMT categories. No significant differences in pregnancy complications were found on the basis of maternal age, BMI, parity, or other factors.

For neonatal outcomes, thin EMT associated with increased PTB (13.6% vs 9.3% vs 3.6%; P =.003), lower birthweight (mean, 3260.1 g  vs 3314.6 g vs 3443.3 g; P =.004), LBW (9.2% vs 5.6% vs 2.1%; P =.010), lower birthweight Z-score (mean, 0.33 vs 0.39 vs 0.61; P =.006), and SGA (9.2% vs 4.3% vs 1.6%; P =.001) compared with the intermediate and thick EMT cohorts, respectively.

Using multiple logistic regression models for the same 3 groups, researchers discovered that a 1 mm decrease of EMT led to a 9% decrease ([adjusted odds ratio] 1.09, 95% CI, 1.00-1.19, P = .053), 14% ([aOR]1.14, 95% CI, 1.02-1.38, P=.002), and 22% ([aOR]1.22, 95% CI, 1.07-1.38] P= .003) led to a greater likelihood of developing PTB, LBW, and SGA, respectively.

Researchers acknowledged their study was limited by not adjusting for variants of PCOS or metabolic patterns before pregnancy. Only frozen-thawed embryo transfer (FET) cycles were included in the analysis, so generalization of the study findings should be done with caution.

“Our study demonstrated that decreased EMT was an independent risk factor for PTB, LBW, and SGA in PCOS,” the researchers concluded. “This novel finding suggests that EMT may be applied as a simple indicator of neonatal complications among women with PCOS.”


Huang J, Lin J, Xia L, et al. Decreased endometrial thickness is associated with higher risk of neonatal complications in women with polycystic ovary syndrome. Front. Endocrinol. 2021;12:766601. doi:10.3389/fendo.2021.766601

Thin Endometrium, PCOS, and Risk for Preterm Birth, Low Birthweight Infants – Endocrinology Advisor

Health Equity and Cultural Competency in the NICU: Challenges and Solutions

Jan 28, 2021 National Association of Neonatal Nurses

In this Bonus General Session from 2020 NANN Virtual, Jenne Johns, MPH, takes listeners through an educational and empowering journey to encourage the delivery of high quality and equitable care to all preemie families, regardless of race, language, and socioeconomic status.

We are excited to see the emphasis and progression of efforts towards developing and conducting research that may build a foundation for understanding and addressing the unique needs of preemies as they navigate their FULL life journeys.

Addressing Preterm Birth History With Clinical Practice

Recommendations Across the Life Course

Michelle M. Kelly, PhD, CRNP, CNE, Jane Tobias, DNP, CPNP-PC, & Patricia B. Griffith, MSN, CRNP, ACNP-BC


Preterm birth is defined as birth before the completion of 37 weeks of gestation (World Health Organization, 2018). Worldwide, preterm birthrates range from 5% to 18% (Synnes & Hicks, 2018), and two-thirds of all preterm births occur without an identifiable cause (Ferrero et al., 2016). Over the past decade, despite increased attention to perinatal management, the United States’ preterm birthrate hovered steadily at just below 10% (Martin, Hamilton, Osterman, Driscoll, & Drake, 2018). Advances in perinatal and neonatal management such as prenatal steroids, exogenous surfactant, and advanced respiratory management resulted in preterm birth survival rates in developed countries of 90% to 95% (Philip, 2005; Raju, Buist, Blaisdell, Moxey-Mims, & Saigal, 2017a).

Stable preterm birthrates and high survival rates combine to ensure that preterm born infants will reach adolescence and adulthood in significant numbers such that every health care provider, regardless of specialty, is caring for a patient who was born preterm.

Long-term health outcome research of preterm birth survivors has shown that preterm birth has implications for individual health throughout the life course (Raju et al., 2017a). The National Institutes of Health in The Adults Born Preterm: Epidemiology and Biological Basis for Adult Outcomes (Raju et al., 2017b) calls for an increase in awareness of and education for health care providers regarding the long-term health outcomes of preterm birth survivors. Health care providers report limited knowledge and training related to preterm birth survivors’ life course outcomes (Kelly & Dean, 2017; Luu, Rehman Mian, & Nuyt, 2017; Raju et al., 2017b). Limited content addressing preterm birth survivors’ life course health outcomes is evident in commonly used pediatric-focused textbooks (Kelly & Michalek, 2019).

Current recommendations from the American Academy of Pediatrics, specific to children born preterm, focus on the immediate newborn period and the high-risk infant referral to developmental follow-up (American Academy of Pediatrics Committee on Fetus and Newborn, 2008). Most preterm births occur between 32 and 36 weeks of gestation and subse- quently require limited neonatal intensive care unit (NICU) intervention and are often discharged without significant peri- natal complications. Therefore, many children born preterm are not included in high-risk developmental follow-up pro- grams and are not deemed appropriate for early intervention.

Problem Statement

No formal recommendations or guidelines exist regard- ing preterm birth implications across the life course despite the proliferation of long-term outcome research published in the last decade and the National Institutes  of Health call for increased attention to an individual’s preterm birth history (Raju et al., 2017b). Just as obesity was identified as a risk for coronary artery disease in 1998 (Mitchell, Catenacci, Wyatt, & Hill, 2011), it is time for the health care community to recognize preterm  birth history as an independent risk for developmental and educational success, as well as noncommunicable cardiovascular and respiratory diseases. Recommenda- tions for addressing preterm birth  history  throughout the life course are essential to improving health care pro- vider knowledge, and through their implementation, improving the health of those born preterm.

Following an extensive review of the literature (Kelly & Griffith, 2020a; Kelly & Griffith, 2020b), a set of recommendations for pediatric and adult primary care providers were developed that incorporate findings from national and international meta-analyses, systematic reviews, executive summaries, and professional guide- lines. There is no specific phenotype of the individual born preterm; however, those born preterm experience common chronic childhood and adult conditions at an increased incidence (Kelly, 2018). Initially, those born preterm may not vary from the typical developmental course or raise significant concerns over health or development. However, children born preterm benefit from high-quality and comprehensive interventions and special educational accommodations to promote literacy, numeracy, and life skills (Msall, Sobotka, Dmowska, Hogan, & Sullivan, 2018). The following guidelines aim to enhance the identification of those born prematurely, empower health care providers to employ familiar screening strategies, and advocate for mitigations strategies with anticipatory guidance and health promotion.


Review of Literature

In anticipation of developing these evidence-based recommendations, the authors undertook an extensive review of the existing preterm birth survivor outcome literature. The literature reviewed in preparation for the coalescing of these recommendations included meta-analyses or systematic reviews identified through a systematic search in PubMed, CINAHL, PsychInfo, and Cochrane databases, with assistance and input from a medical librarian. Including only meta-analyses or systematic reviews, umbrella reviews are designed to provide a broad picture of the research base (Aromataris et al., 2015) and may be used to inform practice guidelines or to highlight known strengths or gaps in an area of research or practice (Cantrell, Franklin, Leighton, & Carl- son, 2017). Search terms included: (“Premature birth” OR “Preterm” OR “Preterm infant” OR “Infant, premature, extremely premature”) AND (Adolescen* OR Adult) AND (“Outcome” OR “Outcome assessment” OR “Outcome assessment healthcare” OR “Outcome and process assessment” OR “Prognosis” OR “Long-term adverse effects”). Additional filters included systematic review, meta-analysis, Cochrane review, and review. Search years were from 2010 to 2019 for the school-age review and from 2010 to 2018 for the adolescent and adult review. The methodologic qual- ity of all reviews was assessed using the Joanna Briggs Insti- tute Critical Appraisal Checklist for Systematic Reviews and Research Synthesis (Aromataris et al., 2020).

These findings were published as two umbrella reviews, one focused on  adolescents and  adults  (Kelly  & Griffith, 2020a) and the other focused on school-aged children (2−12 years of age; Kelly & Griffith, 2020b). Additional details of the umbrella review methodology and search parameters are available in the publications (Kelly & Griffith, 2020a; Kelly & Griffith, 2020b). The review of school-aged outcomes included 29 reviews: 14 meta-analyses, eight systematic reviews, and seven described as both meta-analysis and systematic review (Kelly & Griffith, 2020b). The adolescent and adult outcomes include 16 reviews: five meta-analyses, five systematic reviews, and five described as both meta-analysis and systematic review, and one comprehensive review (Kelly & Griffith, 2020a). The researchers also explored literature published between the umbrella reviews publications the development of these recommendations (from 2018 to 2020) to ensure a comprehensive literature review.

Development of Recommendations

Following the extensive review of the literature, the researchers coalesced the currently available research, formal and gray literature (manuals, guidelines, curricula, and recommendations) into clinical practice recommendations. The set of recommendations aims to guide the primary care provider to elicit, understand, and incorporate a patient’s pre- term birth history across the life course. Thirty-six meta- analyses, systematic reviews, guidelines, and recommendations were incorporated into the preterm birth history recommendations (see Table 1).

The recommendations were organized into patient care categories: assessment and diagnosis, prevention and management, and referral and treatment. Assessment and diagnosis recommendations focus on identifying a pattern of risk and recognizing the relative importance that risk confers to individual health. Prevention and management recommendations address the importance of surveillance, anticipatory guidance, and patients and family education. This process should begin at birth, continue through adolescence, and into the transferal of care to the adult provider. Because of the importance of prevention and management in health care, categories were further separated into general recommendations, cardiovascular surveil- lance, and pulmonary surveillance. Referral and treatment recommendations focus on a process that ensures the necessary connections are made, and the patient is partnered with the appropriate health care team to recommend treatment plans for supportive resources. Proper screening and identification may mitigate potential medical and psychological challenges that will affect the patient’s quality of life.

The American Association of Critical-Care Nurses’ level of evidence grading system was used to assess the literature supporting the recommendations (Peterson et al., 2014). Twenty-two references were level A (meta-analysis), one was level B (well-controlled studies), 10 were level C (systematic and integrative reviews), and three-level D (peer-reviewed standards). Table 1 includes the recommendations and the references that support the specific recommendations, with the American Association of Critical-Care Nurses grading. Tables 2−4 highlight the relevant findings from each study and reference. It is important to note that the recommendations are not dissimilar to guidelines for full-term children. Rather they address the importance of recognizing preterm birth as a portion of a patient’s history that increases their risk for commonly occurring conditions.

Health care provider feedback was solicited to help refine and validate the recommendations. Specifically, the feedback was solicited from physicians and nurse practitioners practicing in neonatology, pediatric primary care, pediatric specialty care, and family medicine. The initial e-mail listing was sent to numerous contacts of the researchers across several states and health systems. Responses were anonymous, and participants were asked to share the guidelines with other health care provider colleagues. Literature suggests that most practicing physicians and nurse practitioners would not be familiar with the long-term outcome literature (Kelly  & Dean, 2017; Raju et al., 2017b), so efforts were made to facilitate a review of the supporting literature. Recruitment e-mails and recommendation documents included embedded hyperlinks of the literature used to support each recommendation. Respondents were asked to review the literature before completing the evaluation survey. Respondents were asked to report the level of agreement with each recommendation and the feasibility of implementation in practice. Open-ended comment sections were included following each patient care category and after reviewing the entire set of recommendations.

The research plan was evaluated and deemed an exempt study by the Villanova University Institutional Review Board.

Results from Review of Literature

Conditions experienced by preterm birth survivors after the NICU are not unique to the preterm birth phenomena. In an exploration of the 2011−2012 National Sur- vey of Children’s Health data, the six most commonly occurring chronic health conditions in children were the same in full-term and preterm groups (Kelly, 2018), yet the preterm group experienced these conditions more often. Aylward (2005) described these conditions experienced by those born preterm as low severity, high-frequency conditions. The adult outcome literature supports similar patterns, that preterm birth survivors experience these conditions, whether in childhood or adulthood,  with increased frequency. Because most adult patients do not share or are not asked about their preterm birth his- tory, such conditions are not attributed to being born early.

Tables 2−4 present the findings that support the preterm birth history recommendations. The findings from the literature may be summarized in a few key points.

Preterm birth history increases an individual’s risk for:

1.Impaired school performance related to math, spelling, reading, receptive language, and decreased executive function (cognitive flexibility, working memory, and verbal fluency).

2.Behavioral and mental health concerns including depression, anxiety, and attention deficit hyperactivity disorder.

3.Cardiovascular disease, specifically hypertension, which poses an increased risk for females.

4.Pulmonary disease, specifically wheezing, asthma, and reduced lung capacity. This risk exists even for those without a history of bronchopulmonary dysplasia.

5.Motor delay, visuomotor integration disorders, and coordination impairment.

Results From External Review of Preterm Birth History Recommendations:

From the approximately 75 initial e-mail addresses, 28 respondents completed the evaluation survey (response rate of 37%). Responses were excluded if less than 25% of the survey was completed (n = 10 surveys). There were some items skipped on the survey, resulting in variation in responses per item from a maximum of 28 responses to a minimum of 20 responses. Agreement and feasibility per- percentages, as reported, are listed in Table 1.

There was an overwhelmingly positive response to the recommendations in both agreement and feasibility. Only two recommendations resulted in less than 85% agreement; both items related to screening for metabolic syndrome. There was an 83% agreement with the recommendation for monitoring of body fat mass at annual visits. There was a 78% agreement with screening to include fasting glucose, serum insulin levels, and lipid profile. Although some respondents disagreed with the recommendation, both were deemed feasible by 95% of respondents, suggesting that it could be accomplished without a significant burden to the patient, provider, or practice. None of the respondent’s feedback suggested significant adjustments to the individual recommendations.

Respondents shared suggestions for implementing the recommendations, including programming a hard stop in the electronic medical record for recording preterm birth history.

Respondents’ feedback related to implementation focused on the basic availability of necessary equipment such as appropriately sized blood pressure cuffs for all ages and sizes. Adherence to current American Academy of Pediatrics Guidelines for cholesterol screening was asserted. Respondents agreed with the recommendations and the need for avoidance of air and environmental toxins. Related to respiratory conditions, implementation recommendations included a call for upstream interventions to reduce overall air and environmental toxins.

Others shared concerns for implementation related to the availability of community support and patient resources varying by geographic region, which leads to difficulty in helping families in resource-poor areas. Concerns were raised regarding the accessibility and feasibility of lifestyle modification recommendations in patients without necessary resources. Respondents encouraged referrals to special infant care clinics, yet this is only available in some regions and typically only until 2 years of age. Others questioned if providers should reflexively screen all children born preterm for autism spectrum disorders or recommend starting elementary education with individualized education plans. Access to services and the importance of communication with the school system was represented in this response: “Access to services is often the biggest hurdle, as the PCP for a child/teen, supporting their needs in school is essential; however, much of those decisions are based upon the district.” Further concerns were related to the systemic racism and inherent inequities that contribute to preterm birth rates.

Recommendations related to metabolic syndrome risk had the lowest agreement percentages; 83% for monitoring body fat at annual visits and 78% for fasting glucose, serum insulin levels, and lipid profile screenings. One participant questioned the need for annual invasive testing. Other participants voiced concerns about the early onset of metabolic syndrome and obesity in preterm birth survivors and supported the recommendations suggesting that these were interventions currently being implemented in their practice. This response represented the recognition of the importance of weight gain early in the preterm birth survivor’s life and the difficulty in discussing obesity: “When preterm infants have struggled to gain weight, I think it’s really hard to discuss watching child’s weight post-discharge.”

Several agreed that premature birth should be a history feature that follows the patient into adult care. One pediatric provider shared:

I believe my practice is very good with identifying the needs for babies born prematurely. I also believe that for most this history does follow with them throughout their stay in pediatric practice. We do have diagnosis on their problem lists, but after they transition out, I do not know how the adult world cares for these patients or if they recognize that there are developmental or psychological issues created from prematurity.


Although the researchers attempted to coalesce the most recent publications and findings related to broad outcomes for individuals born preterm, some cohorts analyzed in meta-analyses were born before the 1990s when exogenous surfactant became available and mechanical ventilation techniques improved considerably. It is important to recognize the heterogenicity of preterm birth outcomes and the varied proximal and distal protective factors that may alter those outcomes.


This set of preterm birth history recommendations is the first comprehensive document to advocate for universal recognition and appreciation of life course health risks related to an individual’s preterm birth history. These recommendations advocate a paradigm shift toward proactive intervention, rather than the reactive practice of waiting for children to fail to meet specific milestones or begin to show comorbid tendencies. The recommendations acknowledge the need for early identification, intervention, and family support for not just the most vulnerable infants but for all who were born before the completion of 37 weeks of gestation. It is with conscious intent that the authors make recommendations for surveillance and referral rather than for specific interventions. Each individual must be evaluated and managed as dictated by the specific features of their strengths and limitations.

Healthcare providers caring for an individual born pre-term should not assume that preterm birth concerns are left in the NICU or resolve at 2 years of age. Assumptions that individuals born preterm had the benefit of neonatal follow-up or even coordinated primary care on the basis of preterm birth status should not be made. Boone, Nelin, Chisolm, & Keim (2019) found that 47% of preterm participants lacked a medical home. The evidence for creating recommendations specific to individuals with a history of preterm birth through the life course is well established. However, dissemination directed at concrete ways to improve patient care has been limited.

The research aimed to coalesce the best available evidence to guide the development of initial recommendations. It is hoped that increased attention to potential risks will result in improved outcomes and decreased noncommunicable risk-based conditions in adulthood. With any new set of recommendations, there may be unanticipated risks. The increased provider attention to potential risk could result in perceptions of vulnerability in the patient or family. To balance this risk, the researchers support providers addressing preterm birth history in the same manner a family history of heart disease is addressed. Recognize it as a risk, advocate for lifestyle modifications that mitigate the risk, and intervene as necessary.

The patient care recommended is not vastly different from that provided to children born at term. Rather, the usual practice would be enhanced by a recognition of the potential increased risks. Health care providers should focus on facilitating chronic disease prevention by promoting healthy lifestyles and recommending early and continued support services for psychosocial and neurodevelopmental difficulties (Luu et al., 2017; Nuyt et al., 2017; Raju et al., 2017a; Raju et al., 2017b). Cardiovascular and pulmonary risk are discrete conditions with well-recognized management. It is important to highlight the psychological and behavioral conditions that may accompany preterm birth history. Behavioral and mental health are critical to development and transition to adulthood. Recognition and the early support of patients with these conditions are essential.

The implementation of these recommendations may look different in each practice setting. Resources are necessary to enact these recommendations fully. Geographic variation related to access to services will challenge an already stressed system. Concrete recommendations such as changing patient intake forms and built-in data entry requirements for electronic health records are a start. Further research will be required to evaluate implementation strategies and best practices.

The preterm birth history recommendations should continue as adolescents transition to adult health care. Respondents verbalized a lack of knowledge regarding adult provider preparedness in recognizing the implication of pre-term birth history. Recognition of the hypertension risks for adults with preterm birth history may mean intervening earlier with medications to decrease stroke risk. By developing practice recommendations supported by the evidence, there is a mechanism to increase provider awareness and subsequently improve physical and mental health outcomes. Increasing awareness through current and future health care provider education is imperative in bridging this gap (Kelly & Dean, 2017; Kelly & Michalek, 2019) and decreasing the challenges associated with the transference of care (Fernandes et al., 2010). Education is just one area of focus; advocacy and support of community resources must also be addressed. As noted by the respondents, there is a discrepancy in access to appropriate and necessary services that will require a collective approach in ensuring equity in obtaining the necessary community resources.


Through an in-depth review of literature and contributions from health care experts in pediatric and adult care, evidence-based recommendations were made that will assist in transformational health care for children, adolescents, and adults with a preterm birth history. The goal of these recommendations is the mitigation of chronic health sequelae throughout the life course. The researchers recognize that further investigation into the education and training of adult health care providers related to the implication of preterm birth history is warranted. The first step in reducing the potential for chronic health sequelae is incorporating the question, “Were you born preterm?” into all patient health histories and appreciating the implications of a positive response.

Preemie Triplets Overcome the Odds

August 7, 2020UVM Health Network Logo

They are miracle micro-preemies triplets Cian, Declan and Rowan DeShane, survivors of extremely premature deliveries whose birthdays span not just different days and months, but two different years and decades.

Cian was born first on Dec. 28, 2019. At just 22 weeks, 6 days, he was one of the youngest infants to arrive at UVM Medical Center’s Neonatal Intensive Care Unit (NICU). He weighed only 1.08 pounds, not much more than a 16-ounce bottle of soda.

On Jan. 2, 2020 – five days later – Cian’s identical twin brother, Declan, was born. He weighed 1.47 pounds. Within moments, the boys’ sister, Rowan, entered the world at 1.08 pounds.

Remarkably, each made it through the natural birth process. “When my water broke, I burst into tears because I didn’t think they could survive being born so early. I thought it was all over,” says their mom, Kaylie, who had worked with a fertility clinic to get pregnant.

Life-Saving Interventions

To put the DeShane triplets’ very early births into perspective, a baby is considered full-term at 39 weeks. The World Health Organization defines preterm as babies born before 37 weeks of pregnancy. Less than 32 weeks is defined as “very preterm” and at or under 25 weeks is “extremely preterm.” Until the past year or so, health care organizations like UVM Medical Center did not attempt high-tech intensive medical interventions to resuscitate infants born at 23 weeks or less because their survivability rate was so low and the and the list of diseases and disabilities so long for those infants who lived.

“Every organ and system in these extremely low birth-weight babies is ill-prepared to meet the world,” explains Roger Soll, MD, a neonatologist at UVM Medical Center and the  H. Wallace Professor of Neonatology at the Larner College of Medicine. He says there isn’t any one breakthrough that accounts for his team’s recent successes with extremely preterm babies.“ We’ve perfected our team approach to an optimal system of care, starting with maternal-fetal medicine during the pregnancy and delivery, and continuing to the NICU where respiratory therapists, nurse practitioners and nurses all work together to provide round-the-clock care.”

Hannah Jackman, RN, has a vivid memory of the day Cian was born. “It seemed like there were dozens of healthcare workers in the delivery room, all in yellow gowns, awaiting three tiny triplets. I was one of them, and I remember my heart feeling like it was leaving my chest as I watched Cian’s parents sob and pray,” she says. “I wanted a miracle for this family so badly.”

For Kaylie and her husband, Brandon, the decision was easy. They told the medical team: “Do everything to save them.”

Cian was immediately intubated. Declan and Rowan were both septic at birth and given intravenous antibiotics. The infants were placed in incubators, wires connecting them to monitors so caregivers could keep track of their temperatures, heart rates and breathing. Tubes delivered medicines and fluids to their tiny veins. Pulse oximeters measured the oxygenation of their blood.

Despite the tangle of equipment, mom and dad were encouraged to hold their infants skin-to-skin. During the triplets’ months-long stay in the NICU, the couple made certain one of them was there every day. They each spent weeks at a time at the Ronald McDonald House while the other tended to their two older children at home three hours away in Norwood, N.Y. When visitors were restricted to one parent per pediatric patient due tothe COVID-19 pandemic, the couple joked that they had more than enough babies to be allowed in the NICU together on weekends.

“We were already in survival mode when COVID hit, so it was just one more thing,” Kaylie says. “We were already washing our hands constantly and being especially careful to keep them safe from any germs.”

It Takes a Team

The infants had their own primary nurses assigned to them during every shift of every day. This consistency of care meant that every potential problem was noticed and immediately attended to.

After Cian’s birth, nurse Jackman signed up to be his primary nurse during her 12-hour day shifts.

“I got to spend four months caring for this tiny but mighty human, watching in amazement as he overcame obstacle after obstacle.” Hannah Jackman, RN,University of Vermont Medical Center.

“It is a relationship like no other – these parents are trusting you with their newborn. Advocating for Declan became my biggest priority,” says Julia Watsky, RN, one of the trio of primary nurses dubbed the “dream team” who worked the night shift on Sundays, Mondays and Tuesdays. “I learned every aspect of Declan’s care – from how he liked to be positioned to knowing when

One night Ashley Ostler, RN, noticed that the normally lively Rowan was hardly reacting to her.

“Rowan is typically a sweet, feisty lady. She is not exactly patient and she makes her demands known,” observes Ostler. “She often made me laugh late at night because she really does know how to push your buttons while melting your heart with her adorable little face.”

When Rowan went limp and her abdomen became distended, Ostler rightly suspected she had developed a common but serious intestinal disease called necrotizing enterocolitis, or NEC, which required many interventions until she stabilized.

Cian also developed NEC and, at one point, his parents were asked to create an end-of-life plan. “That taught me to never think we were out of the woods,” Kaylie says.

Lindsey Flanders, RN, remembers the night when Cian’s oxygen needs kept climbing until he reached 100 percent and couldn’t go any higher. “Knowing Cian, I knew this wasn’t his norm and that he needed additional support to bring his oxygen requirement back down.” He was started on nitric oxide to relax the vessels in his lungs and that did the trick.

After 106 days in the NICU, Declan, nicknamed “the Chunkster” because he was the heaviest of the bunch, was the first to go home on April 17. “It was truly a bittersweet moment” says nurse Watsky, who made certain to be there to say goodbye to Declan, even though it was her day off. “After seeing him grow from just over 1 pound, to learning how to eat, how to breathe on his own, and so much more in between – I was so proud of him,” she says.

“Rockstar Rowan” went home on April 30. And firstborn Cian finally joined the rest of his family on May 4. “I’m so proud of the chubby, feisty, blue-eyed, beautiful boy he is,” nurse Jackman says.

The triplets left the NICU with respiratory support and monitors but eating all of their foods without issue. As of July 15: Cian was 13 pounds, 1 ounce; Declan was 14 pounds, 11 ounces; and Rowan was 10 pounds. They are hitting all of their milestones — babbling, cooing, laughing, smiling and rolling over.

The DeShanes’ relationship with UVM Medical Center is far from over. They make regular visits to see a pediatric pulmonologist and ophthalmologist. And neonatologist Deirdre O’Reilly, MD, director of UVM Medical Center’s Neonatal Medical and Developmental Follow-up Clinic, will see the preemies regularly during their first three years to assess their progress, especially regarding motor, language and cognitive skills. If there are gaps, her staff will connect them to the appropriate supportive services. “Getting adequate and targeted therapies can be life-changing for babies,” she says.

In her 13 years of practice, Dr. O’Reilly had never seen a baby born as early as Cian survive. Each of the triplets are doing better than she expected, and that success is what makes her work so worthwhile. She says: “It really is amazing, because you can learn about the numbers of premature infants that survive, but really experiencing it with the parents and seeing the joys in their faces, and the kids too, it’s just magnificent.”


Breastmilk for preterm babies | pumping | exclusive human milk diet and donor human milk bank

CanadianPreemies  Aug 3, 2020

Fabiana Bacchini, CPBF’s Executive Director, talks with Natalie Millar about the importance of breastmilk for preterm babies, pumping, exclusive human milk diet and donor human milk bank. . Natalie has been a clinical dietitian for 15 years with 10 years dedicated to the Regina General Hospital NICU. She is a certified lactation consultant; co-chair of the Donor Human Milk committee of Saskatchewan and Coordinator of the Regina General Hospital’s Milk Drop for NorthernStar Mothers Milk Bank Milk. According to her two young kids, Natalie’s job is to steal milk from ladies and feed it to all the teeny babies.

Strategies to Improve Mother’s Own Milk Expression in Black and Hispanic Mothers of Premature Infants

Cartagena, Diana PhD, RN, CPNP; McGrath, Jacqueline M. PhD, RN, FNAP, FAAN; Reyna, Barbara PhD, RN, NNP-BC; Parker, Leslie A. PhD, RN, NNP-BC, FAAN; McInnis, Joleen MS, LIS, MFA Strategies to Improve Mother’s Own Milk Expression in Black and Hispanic Mothers of Premature Infants, Advances in Neonatal Care: February 2022 – Volume 22 – Issue 1 – p 59-68 doi: 10.1097/ANC.0000000000000866



Mother’s own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants.


A review of the literature was conducted to answer the clinical question: “What evidence-based strategies encourage and improve mother’s own milk expression in Black and Hispanic mothers of premature infants?”

Methods/Search Strategy: 

Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7).


Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area.

Implications for Practice: 

Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice.

Implications for Research: 

Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers.