Enlighten  Presence  mHealth

Uruguay, officially the Oriental Republic of Uruguay, is a country in South America. It shares borders with Argentina to its west and southwest and Brazil to its north and northeast, while bordering the Río de la Plata to the south and the Atlantic Ocean to the southeast. It is part of the Southern Cone region of South America. Uruguay covers an area of approximately 176,215 square kilometers (68,037 sq mi). It has a population of almost 3.5 million people, of whom nearly 2 million live in the metropolitan area of its capital and largest city, Montevideo.

Uruguay is highly ranked in international measurements of democracy, government transparency, economic freedom, social progress, income equality, per capita income, innovation, and infrastructure.  It is classified as a high-income economy and has fully legalized cannabis—the first country in the world to do so—as well as same-sex  marriage, abortion and euthanasia. Uruguay is also a founding member of the United Nations, the OAS, and Mercosur.

The current Uruguayan healthcare system is the State Health Services Administration (ASSE) created in 1987. The National Healthcare Fund (FONASA) is the financial entity responsible for collecting, managing and distributing the money that the state has destined for health in the country. It was created in 2007 to entitle all employees and pensioners to health care outside of the public health system. Latest government figures state that there are 2.5 million people registered with Fonasa – out of a total population of just over 3 million. This would mean that 500,000 Uruguayans are left choosing between the public system or having to pay the full amount for private health care.

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

COMMUNITY

Much has been written about medical errors that reach patients.  Almost without exception, these accounts focus on tragic outcomes, cases in which patients suffer harm or die as a result of mistakes in diagnosis, treatment, or communication. Entire fields of research, safety initiatives, reporting systems, and regulatory frameworks have been developed in response. By framing medical error as a systems problem rather than an individual failing, health care has sought to encourage transparency, promote reporting, and ultimately reduce preventable harm. This approach is necessary, ethical, and long overdue.

Nevertheless, another category of medical error receives little attention in the literature or in public discourse. It is an uncomfortable and largely unspoken phenomenon: errors that reach patients and, paradoxically, improve their clinical course.

These events are rarely documented, formally reported, or analyzed. They tend to live in the realm of anecdote, shared quietly in hallways or over coffee, often accompanied by discomfort or nervous humor. A test ordered on the wrong patient reveals a life-threatening condition that would otherwise have gone undetected. An unintended medication change exposes a diagnosis sooner than expected. A deviation from standard practice uncovers a better therapeutic pathway. There is no research into these “random” improvements. These occurrences are typically dismissed as luck, coincidence, or, for some, providence.

Occasionally, they are more than that. Medical history itself is replete with discoveries born of accident. Penicillin was not discovered through a carefully designed protocol but through contamination. Countless diagnostic insights have emerged from unexpected findings. While these events do not excuse error, they complicate the narrative that all deviations from protocol are uniformly harmful.

This raises an unsettling question: Is all medical error inherently detrimental to patient care?

From the standpoint of risk management and patient safety, the answer must be yes. No health care institution would, or should, endorse error as a tool for discovery. Indeed, no clinician has ever been sued for failing to make a mistake, although many have been sued for making one. The legal, ethical, and professional imperatives are clear. Errors must be minimized, reported, and prevented.

However, the practice of medicine is not merely the execution of flawless protocols. It is a human endeavor, characterized by uncertainty, variation, and judgment, which some would call the “practice” of medicine. If medical care were delivered without any deviation, without experimentation, adaptation, or learning from the unexpected, would we consider that the “perfection” of medicine, or its stagnation?

Consider the randomized clinical trial, the “gold” standard of medical evidence. By design, half of the participants receive a therapy that ultimately proves inferior. When the superior arm emerges, we do not label the inferior treatment a medical error, nor do we report it to risk management. Instead, we publish the findings, celebrate the advance, and change practice accordingly. Progress is achieved precisely because uncertainty was permitted within ethical boundaries.

Honestly, though, the best path may not be through completing the trial but through interim analysis or using alternative research strategies such as “play the winner.” In seeking strategies that optimize good science rather than patient outcomes, we may find ourselves stuck promulgating only treatment modalities that have been completed and accepted for publication. Moreover, negative studies are usually not accepted for publication. In this context, error and expertise begin to blur. What is considered a mistake today may, in retrospect, be recognized as the first step toward tomorrow’s innovation. This does not absolve clinicians or systems of responsibility, nor does it diminish the real harm caused by preventable errors. (1, 2) Instead, it challenges us to acknowledge that medicine advances not only through precision but also through humility, recognizing that our current standards are provisional and that learning often emerges from imperfection.

The task, then, is not to romanticize error, but to understand it more honestly. Error, like medical expertise, may ultimately lie in the eye of the beholder. What is labeled a mistake in one era may later be understood as the necessary precursor to discovery, refinement, or progress. This reality does not weaken the moral obligation to protect patients from harm, nor does it excuse preventable failures in care. Instead, it underscores the complexity of practicing medicine in a world of uncertainty, evolving evidence, and imperfect knowledge.

The challenge for modern medicine is to uphold the highest standards of safety and accountability while preserving the intellectual flexibility that allows clinicians and scientists to question assumptions, recognize unexpected patterns, and learn from outcomes that diverge from expectations. Only by balancing vigilance with curiosity can the field continue to evolve in ways that serve both current patients and future generations.

Source: https://www.neonatologytoday.net/newsletters/nt-dec25.pdf

Abstract

Objective

To assess the effectiveness of an mHealth neonatal intensive care unit (NICU) parent support smartphone application to improve psychosocial well-being, specifically reduced stress and anxiety, increased parenting competence, and improved social support among a diverse group of parents with infants born preterm in 3 Chicago-area NICUs.

Study design

A time-lapsed, quasiexperimental design in which control participants were enrolled and then intervention participants enrolled. Data collection occurred at 3 timepoints: NICU admission (AD), discharge (DC), and 30 days post-DC (DC+30). Validated outcome measures included parenting sense of competence, stress, anxiety, and social support.

Results

Intention-to-treat analyses included 400 participants (156 intervention; 244 control). After covariate adjustment, a significant increase in parenting sense of competence (AD–DC, DC+30), decrease in stress (AD–DC+30), decrease in anxiety (AD–DC, DC+30), and increase in social support (AD–DC) were noted but did not differ by study arm. However, secondary analysis of parents with infants born at <32 weeks of gestational age (156 participants) showed decrease in stress (AD–DC+30) that was greater in intervention vs control group (P = .03). Among intervention participants who were Black, a significant increase in social support (AD–DC) total score (P = .01), and 2 subscales of emotional/informational support (P = .02) and positive social interaction (P = .02) were found.

Conclusions

This novel mHealth intervention shows evidence of reduced stress and anxiety while increasing social support among some subsets of parents at high risk of negative psychosocial experiences in the NICU, potentially enhancing outcomes for infants born preterm by ensuring that parents are less stressed and better supported.

Source:https://pubmed.ncbi.nlm.nih.gov/39880156/

Background: The need for paternal support is rarely addressed in neonatal intensive care units (NICUs). Neonatal nurses often primarily focus on the needs of the mother and infant and may not be trained in support of fathers.

Purpose: To investigate nurses’ self-efficacy (SE) in guiding and supporting fathers after implementing a father-friendly NICU.

Methods: Nurses from the intervention NICU and 13 control NICUs were included in a before-and-after intervention study. Questionnaires measuring nurses’ SE regarding support of fathers and mothers were obtained when starting the development process, before and 18 months after the implementation. The primary outcome was the difference between nurses’ SE scores for father and mother questions in the intervention group compared with the control group.

Results: In total, 294, 330, and 288 nurses responded to the first, second, and third questionnaires, respectively. From the first to third questionnaires, the intervention group showed a significantly higher increase in SE scores for father questions compared with the control group (0.53 vs 0.20, P = .005) and a nonsignificantly higher increase for mother questions (0.30 vs 0.09, P = .13). In the third questionnaire, the intervention group showed a higher SE score for father questions compared with the control group (9.02 vs 8.45, P = .002) and the first questionnaire (9.02 vs 8.49, P = .02).

Implications for practice and research: By implementing a father-friendly NICU, nurses’ SE for providing support to fathers increased significantly. Training in a father-friendly approach increases nurses’ ability to support both parents. Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the National Association of Neonatal Nurses.

Source: https://pubmed.ncbi.nlm.nih.gov/37463518/

Every situation is different, every mother and every family are different, and what ‘works’ for some parents may not work for others. Don’t pre-judge or assume. No one can be prescriptive about what to say or do, but here were some phrases and behaviors we heard about that were typically either helpful or not helpful.

Phrases that were un-helpful

  • At least you still have one
  • You can try again (for another pregnancy)
  • It wasn’t meant to be
  • Maybe you weren’t ready; maybe [twin’s name] wasn’t ready
  • Why don’t you stop thinking about or forget about [twin’s name] and just focus on the other twin?
  • You’ll get over it
  • You’ll soon get over it
  • I know what you going through (unless of course, you have been in a very similar situation)
  • You need to talk about it (this is very different to saying ‘would you like to talk about it’ or ‘do you want to tell me when it would help to talk’)

Behaviors that weren’t helpful

  • Not talking about the twin because you are worried about upsetting the parents
  • Not calling the twin by their name (if they had one) or forgetting their name
  • Not recognizing the twin identity (trying to behave as if it was a singleton pregnancy)
  • Staying away, not ringing or messaging, because you felt uncomfortable (any discomfort you feel is insignificant compared to the parents’ grief)
  • Trying to focus on, or just talk about, the surviving baby or babies
  • Where a triplet dies, suggesting that the two surviving babies are ‘only twins’ (although some parents told us they wanted to think of the surviving babies as twins, typically where the triplet loss was quite early in pregnancy). If you are not sure, ask the parents.
  • Not saying anything because you don’t know what to say (sometimes saying ‘I am really sorry, I don’t know what to say’ is enough)
  • Discarding any mementos from the baby who died – photos, cot cards, name tags, blankets & clothes (however dirty, do NOT wash them without asking parents), items bought for the baby before they were born e.g. clothes

Phrases that were often helpful

  • I’m really sorry, do you want to talk about it?
  • I’m sorry
  • Do you want to tell me when it would help you to talk about her or him? (even better to use the baby’s name)
  • Is there anything I can do to help?

Behaviors that were often helpful

  • Talking about the twin by name
  • Asking if you can say hello and goodbye to the baby who died
  • Helping make memories, collect mementos
  • Taking and keeping photos (with parents permission)
  • Offering to help with ‘household’ chores – parents of babies on NICU struggle to do routine tasks – walk the dog, go shopping etc. However, be careful not to ‘smother’ families or remove their family identity/role
  • Offering to help with other siblings
  • Offering to tell other family members or friends what has happened. However, always ask parents first what they would like.

The grief and sadness that parents feel will stay with them for months and years, often their whole life. Offering to talk months or years later about their grief, or talking about the baby who died by name is appreciated by most parents. If they are a close friend, or family, and you do not know what they would like, ask them!

Source: https://www.neonatalbutterflyproject.org/resources/

HEALTHCARE PARTNERS

My name is Marília Rêgo, and I’m an occupational therapist working in the neonatal intensive care unit (NICU) of a public hospital in Recife, Brazil. Every day, I have the privilege—and the responsibility—of accompanying premature babies and their families through some of the most fragile and formative moments of their lives.

Among all the babies I’ve cared for, there is one who left a lasting mark on me. She was born with a rare syndrome, incredibly delicate, and spent two months in the NICU. During that time, our bond was built not through dramatic interventions, but through the quiet power of presence. I would often go to her bedside just to change her diaper slowly, calmly—so that she could have a positive experience of touch and human connection, even in the middle of so many wires and monitors.

There were days when there was no specific therapeutic plan for her. And still, I showed up. Because sometimes the most powerful thing we can offer is our presence, our gentleness, our intention.

And then, one day, she passed away.

Even though she had received every professional care possible—medical support, therapies, loving attention—that loss hurt deeply. But it also revealed something profound to me: that our work in neonatal care is not only about helping babies recover or thrive. It’s also about loving them fully, even when there are no guarantees. It’s about being a bridge, even when the road is short.

Her story changed me. It reminded me that care isn’t measured only in days of life, but in the love and intention that fill those days. That sometimes, a baby’s mission is brief—but never meaningless. And that if there is love, there is purpose.

I’m sharing this not to romanticize pain, but to honor the truth that sometimes, it teaches us the most. If you are a parent, a caregiver, or a healthcare professional reading this—what you do matters. Even when it feels small. Even when it ends sooner than you hoped.

Your presence matters. And that, in itself, is a form of healing.–Marília Rêgo

Source: https://nidcap.org/

THE BASICS

Key points

  • Brief interactions in the NICU can have an impact on caregivers’ self-efficacy and bonding with their newborn.
  • It’s important to train healthcare professionals to actively listen, use nonverbal gestures, and empathize.
  • Comforting and compassionate patient-provider interactions may be the most healing interventions for family.

For parents and family caregivers, navigating a child’s medical condition can be the most stressful of life experiences. When a child begins their life in the Neonatal Intensive Care Unit (NICU), caregivers are often catapulted into feelings of uncertainty, fear, and powerlessness. No one anticipates that having a new baby will involve being in a hospital indefinitely relying on physicians and nurses for lifesaving care. Sensitive and compassionate parent-provider interactions are critical for parents to develop feelings of safety, trust, and hope during this overwhelming period.

Even brief interactions at the NICU bedside may make or break a caregiver’s sense of self-efficacy and confidence in caring for their babies (Labrie et al., 2021). A 2021 meta-analysis by Labrie and colleagues revealed that these frequent moments with providers have far-reaching impacts on parents’ coping ability, their understanding of their baby’s condition, their participation and satisfaction with care, and their ability to attach to and bond with their newborn. Most importantly, these effects were often related to routine bedside interactions – not solely to structured conversations at family conferences.

Personal experiences

The authors are both psychologists who have worked in medically complex settings with patients across the lifespan. The perspectives and tips are based on working with patients experiencing unexpected medical adversity as well as personal experience.

Joanna: Six years ago, my son spent the first month of his life in the NICU following an unexpected birth trauma, leading to a sudden loss of blood and oxygen. Waiting for medical updates felt unbearable. It was as though the MRI machine and medical team held the key to our family’s future. Emotions fluctuated like a rollercoaster from shock and numbness, to anxiety, anger, grief, and – eventually – hope.

Occasionally, in an effort to manage our expectations, health care team members reminded my husband and me of how “medically fragile” our son was at birth. These “warnings” tended to overshadow positive news and made me question my gut sense that our baby would get well. I preferred updates on even the smallest steps our son made: hearing that he moved his tongue slightly when given a drop of breastmilk felt uplifting.

Simple, previously taken-for-granted events were deeply felt on a visceral level. When the elevator was out of order and the physician walked me up the stairs from the NICU to my own hospital floor, his support and kindness deepened the level of trust in the entire treatment team. My obstetrician standing patiently and quietly beside me at our son’s NICU crib provided immense comfort. Oftentimes, silence, presence, and accompaniment are the most healing interventions.

No matter how much time has passed, these patient-provider verbal and nonverbal communications remain imprinted in the memories of NICU parents and caregivers.

Bedside manner

“Bedside manner” has long been held as an important virtue of effective medical care. Ancient Greek writing urged providers to be “sober, not a winebibber” and to act “not with head thrown back (arrogantly).”

Teachings have evolved over time and have been incorporated into medical school education. Despite this development, issues of time, financial pressures, and the complexity and urgency of medical needs due to advances in technology may interfere with effective patient-provider communication.

Current healthcare education highlights the importance of listening to the entire message or question from the patient or family caregiver without interruption, showing genuine interest through nonverbal gestures including tone of voice, using understandable, non-jargon language, providing comfort, and putting oneself in the patient’s shoes to cultivate empathy (Deepak, 2024).

Examples of unhelpful vs. helpful communication

Unhelpful

  • Opening with, “I have some bad news,” which can lead to catastrophic thinking
  • Using jargon such as “We need to do a needle stick,” which can evoke an upsetting image
  • Describing the situation as “very severe,” even if true

Helpful

If appropriate, starting with, “Your baby is okay, but I wanted to share that…”

Using accurate language such as “We need to draw some blood.”

Using specifics like, “The blood transfusion is helping your baby with the blood loss,” provides a degree of hope, even in dire times

Tips for fostering effective communication in the NICU

These tips apply to communication with mothers, fathers, other caregivers, and integral supports. Including all caregivers in communications can help ensure the whole family feels seen and acknowledged as important to the baby’s care.

Medical professionals can optimize communication and bedside manner by:

  • Validating that what caregivers are experiencing is scary and difficult.
  • Using comforting nonverbal communication: sitting down, giving full attention and listening deeply to the family’s concerns and questions, and using a calming, reassuring touch when appropriate.
  • Letting family members know that providers are available and how to reach them.
  • Acknowledging that uncertainty exists while also expressing specific efforts to make things better.

Family and friends can further enhance a sense of support by:

  • Listening without offering advice. It is natural to want to lighten the mood or “fix” a problem. However, active listening and acknowledging how things are may be what the caregiver needs.
  • Checking in after the baby leaves the hospital. Support may be strong at the beginning but tends to taper. However, parents may struggle with the adjustment to life after the NICU.

Psychology providers working with caregivers in the NICU can help by:

  • Collaborating to make a list of questions or script in advance of medical appointments to ensure that concerns are addressed.

In navigating these challenging encounters with the medical team, caregivers can utilize the following communication strategies:

  • Taking initiative in asking specific questions to convey self-efficacy and active hope.
  • Making time to interact with their partner or other supports outside the hospital setting. Separation from the NICU and having conversations about other topics is a healthy way to cope.
  •  

Lessons learned

Just as parents/caregivers need to be highly attuned to subtle cues to develop secure attachments to their babies, the suggested communication tips highlight the importance of nonverbal communication. Voice tone, posture, eye contact, deep listening, and presence foster feelings of security and agency in the receiver.

As a psychologist who ended up on the receiving end of care, my own patients’ stories now resonate more deeply. Beyond what I could possibly learn in graduate school, the personal experience has informed the clinical wisdom of sitting calmly, presently, holding space for patients to discover their unformulated feelings, and being human to whatever emerges. I choose my words carefully – for they may never be forgotten.

Source: https://www.psychologytoday.com/us/blog/psychological-trauma-coping-and-resilience/202409/creating-effective-parent-provider

Abstract:

The environment in the neonatal intensive care unit (NICU) is often unpredictable and loud, leading to overstimulation and stress. A variety of negative auditory input, including alarms, respiratory support machines, speech, and other environmental sounds, occurs daily. When sound policies are implemented, they may help mitigate infants’ negative auditory experiences. The purpose of this paper is to provide an overview of the auditory development of the fetus and NICU infant and the role that music might play in ameliorating the adverse effects of life outside of the protective womb. Of particular importance is the family’s role in using music to provide developmental care that supports auditory development while still meeting the infant’s medical needs, such as physiological parameters, weight gain, and reduced hospitalization length. Utilizing the mother’s singing has positive ramifications as an ideal source of auditory input, given the continuity and predictability of music’s acoustic properties, along with careful consideration of the infant’s auditory development across gestational age and the medical and developmental needs at that moment. In addition, when mothers sing to their infants in the NICU, it can have a significant impact on maternal mental health. Music therapy researchers have examined the use of the maternal voice for preterm and term infants; music therapists taught mothers to sing and use their voices to support their infants, resulting in increased singing at home and improved mother-infant bonding. This paper will discuss recommendations for auditory stimulation, based on years of music therapy research in the neonatal intensive care unit, to promote healthy neurologic development.

Introduction to Music Therapy:

Before discussing fetal and infant auditory development and the role of music and sound for preterm infants in the neonatal intensive care unit (NICU), we would like to provide an overview of music therapy. While it might be considered a new field, the profession has existed as an organized entity in the United States since the 1950s. Music therapy is a healthcare profession in which evidence-based music interventions are used to address non-musical goals within a therapeutic relationship. Entry into the profession requires a Bachelor’s degree or completion of an Equivalency Program in music therapy. Eligibility to sit for the board exam depends on completing academic coursework and 1200 clinical training hours. Credentialed professionals use the term music therapist-board certified, “MT-BC,” which is provided through the Certification Board for Music Therapists (www.cbmt. org); music therapists must recertify every 5 years, and some states have licensure. The current professional organization is the American Music Therapy Association (www.musictherapy. org), which oversees student training .

Music therapists are trained to use music to address sensory, physical, cognitive, communication, social, emotional, and spiritual needs. We address these needs through evidence based interventions, often involving live, client-preferred music across multiple settings. Music therapists commonly work within the following settings:

• Medical hospitals/outpatient clinics

 • Neurorehabilitation facilities

• Hospice/palliative care

 • Psychiatric hospitals/community mental health centers

*Early intervention and day care treatment centers

• Public school systems

• Correctional facilities

• Private practice

This paper is based on the approach of the Institute for Infant & Child Medical Music Therapy. created by Dr. Jayne Standley at Florida State University in 2003. Standley established this approach by drawing on medical and developmental models, endorsing and teaching music therapy based on empirical evidence. There are other models of music therapy in the NICU, such as psychodynamic approaches, but we prefer to use this model since it closely aligns with the medical profession and developmental care of the preterm infant.

Auditory Development of the Fetus/Infant and Impact on Neurological Development

 The NICU environment can increase preterm infants’ risk of long-term hearing impairment; however, it is essential first to understand how auditory development occurs in the womb. This is a highly intricate process that begins early within fetal development. At 23–25 gestational weeks, all major structures of the ear, including the cochlea, are in place, allowing the fetus to hear and process sounds in utero, with a consistent response to sound by 29 weeks of gestation. Beginning at 25 weeks, thousands of fine hair cells known as sensory receptors in the cochlea begin to respond to specific frequencies of sound.  These hair cells are arranged tonotopically throughout the cochlea. As the fetus develops, it becomes finely tuned to various sound frequencies transmitted through amniotic fluid and skull bone vibrations. Starting at 28 weeks and throughout the third trimester of pregnancy, the auditory system is maturing as myelination of the auditory nerve enables auditory responses and processing between the cochlea and the brainstem . As the walls of the uterus thin towards the end of pregnancy, sounds of higher frequency (>500 Hz) gradually pass through the womb (13), preparing the fetus for language development after birth. During fetal development, the womb acts as a low-pass filter, promoting the healthy development of the cochlea by limiting exposure to higher-frequency sounds . Fetuses can safely process low-frequency sounds (250–500 Hz) between 25–27 weeks and high-frequency sounds (1000–3000 Hz) by 29–31 weeks . However, most sounds in the NICU environment exceed 3000 Hz or exceed the recommended maximum sound level of 45 decibels (dB) set by the American Academy of Pediatrics, making it difficult for proper cochlear development to occur and creating an acoustic gap between the NICU and the womb. Exposure to high-frequency sounds in the NICU can not only cause stress but also lead to apnea, hypoxemia, and inadequate oxygen saturation levels that can affect growth, neurodevelopment, and hearing impairment . To better support auditory and overall sensory development, there is currently a need to identify developmental care interventions, based on gestational age and medical status, that are embedded in a family-centered care model and support optimal neural network development. The clinical use of music in the NICU can reflect the predictable, rhythmic, and organized environment of the womb, supporting positive auditory development while yielding consistent, positive outcomes such as stabilization of physiologic parameters, increased weight gain, and shortened length of stay as well as a decrease in maternal stress, making it an optimal developmental intervention throughout an infant’s stay until discharge.

Clinical Use of Music by Gestational Age:

25–28 Weeks: The cochlea and auditory cortex begin to process sound at 25 weeks and are critical to the development of the auditory system; however, they are easily affected by sounds and care practices in the NICU environment . Starting at 26 weeks, the process of tonotopic tuning begins, in which hair cells in the cochlea are finetuned to specific frequencies of sound, which are then processed into electrical signals sent to the brainstem and auditory cortex . As stated earlier, infants between 25–27 weeks can efficiently process sounds between 250–500 Hz ; however, frequencies above 1000 Hz can adversely affect autonomic functions. A stimulus considered critical, especially for infants in the NICU, is the maternal voice, which typically resonates between 200– 300 Hz, making it optimal for auditory processing and early language development.

According to the literature, the maternal voice is the strongest acoustical signal for the developing fetus and has yielded positive effects not only on auditory system development but also on autonomic functioning and behavioral responses. Similar results have been reported for preterm infants born between 25 and 32 weeks of gestation: the maternal voice significantly decreased heart rate, suggesting possible improvements in autonomic stability and neurobehavioral development  In addition, mothers of preterm infants often use “baby talk” when speaking to their infants, which has a regulatory effect on their behavior and lays the foundation for early language development.

The presence of meaningful sounds, such as the mother’s voice, is pertinent to the appropriate development of the auditory system, and music has been considered an impactful stimulus for infant development in the NICU when provided in a meaningful way. Lullabies have long been considered the most effective type of music for mitigating overstimulation in preterm infants, due to their simple, repetitive, and predictable structure. When using music for infants 25–28 gestation weeks, it is recommended to use live lullaby singing that includes a single female voice without additional instruments, slow tempo, little to no dynamic changes with limited pitch range, and repetitive play of each lullaby with a high degree of continuity among the lullaby music that is used. The recommended duration of music at this age is no more than 30 minutes based on infant response. Since the mother’s voice is preferred, live lullaby singing by the mother or caregiver is best to promote family-centered care. Maternal singing during kangaroo care is highly recommended and has a significant impact on both the infant and the mother, reducing infant distress and maternal anxiety. If recorded music is to be used, it is recommended to present it binaurally, following the same parameters as previously mentioned, while closely observing the infant to adjust the music/turning it off based on infant responses. If possible, a recording of the maternal voice is recommended. Classical music, nature sounds, musical toys, and white noise machines are not recommended, as they could be overstimulating due to their unpredictable or unorganized structure and do not provide the meaningful auditory input needed to support auditory development at this gestational age.

29–32 Weeks:

During this time period, tonotopic tuning of hair cells in the cochlea continues, and it is recommended that sounds/music remain between 250–500 Hz until 33 weeks, when the auditory system can safely process sounds at higher frequencies of 1000–3000 Hz . Lullaby music remains preferred for auditory development, and the aforementioned protocol should be used when providing either live lullaby singing or recorded lullaby music. The maternal voice is highly recommended at this time as it supports the auditory skills needed to process basic human speech sounds.

Preterm infants are considered to be at a high risk for developing language delays and impairments due to the lack of exposure to the maternal voice while in the NICU. Lullabies share characteristics with “baby talk” provided by the mother, such as simple prosodic contours, higher pitches, and short lyrical phrases that convey emotions necessary for promoting early language development and communication in preterm infants. Infants at this age can also discriminate between different phonemes, indicating the beginnings of language and speech development. Regarding music processing, it has been found that preterm infants at this age can detect differences in simple and complex beats/meters in auditory recordings, indicating early neural auditory discrimination .

33–36 Weeks: From 33 to 37 weeks, the fetus changes to process complex sounds, with differences apparent in the older fetus: a gradual increase in heart rate that did not change with sound levels. The authors stated that the older fetus might attend to the music. In contrast, the younger fetus might respond to the acoustic properties of the sound, such as pitch, loudness/intensity, and timbre. At this time, infants process higher frequencies of 1000– 3000 Hz.

Based on this information, it is crucial to continue to provide positive auditory input to infants in the NICU, including singing, reading, and speaking. If the infant is medically stable and responds positively to simple songs over several days, it is appropriate to progress to more complex songs. Thus, shifting from songs that have a simple melody, such as “Mary Had a Little Lamb,” which consists of 4 notes within a narrow range of a perfect fifth and contains two chords if an accompaniment is provided, to more complex songs, such as “Twinkle, Twinkle Little Star. Twinkle, Twinkle Little Star” consists of 6 notes within a range of a major sixth interval and has three chords if an accompaniment is provided. After an infant shows positive responses to music, such as cooing, smiling, turning towards the sound source, and maintaining heart rate and oxygen saturation within baseline levels before music listening, it may be appropriate to gradually introduce more complex and new songs into the routine.

Eventually, more complex songs might be beneficial, including songs with three chords and eventually four chords, longer song duration, and a chorus and verse. The overall goal is to provide auditory input to the infant systematically to prepare them for the home environment, including the car ride home from the NICU, during which the radio might be playing. It is important to start with simple, repetitive songs first to determine how the infant is handling sensory input, since what is appropriate one day might not be another due to new experiences (a first bath) or medical procedures (an eye exam). Also, infants who were born extremely low birthweight (ELBW) and/or have experienced significant amounts of respiratory assistance across time as well as those with major complex medical needs might not be ready for complex presentation of music at 36 weeks postmenstrual age (PMA), while an infant born at 32 weeks might be ready for more complex songs at 35 weeks PMA. The presentation of music must be carefully considered by the families and medical team. The IRainbow

 provides guidelines for the use of music and auditory input based on the infant’s medical stability and physiological maturity.

By 35 weeks, the fetus’s learning includes memory formation  Thus, caretakers will want to continue to utilize songs and rhythmic books that have already been presented to the infant at an earlier age, but it is important to integrate new information through new songs. Infants habituate to repeated presentations of the same information, and auditory stimuli become less relevant; hence, musical mobiles and sound devices that loop the same song are still not advised for the NICU or even the home environment. Parents need to be involved in their infant’s care, including providing auditory input.  Having lists of songs appropriate to musical complexity and medical and developmental needs (abilities) might be one way to involve parents in providing their infant with appropriate auditory experiences. Providing song lyrics will also help parents to remember and recall songs.

Parents need to be involved in their infant’s care, including providing auditory input . Having lists of songs appropriate to musical complexity and medical and developmental needs (abilities) might be one way to involve parents in providing their infant with appropriate auditory experiences. Providing song lyrics will also help parents to remember and recall songs.

When parents cannot visit the NICU, it would be beneficial to record the mother’s voice reading and singing to her infant to be played at the bedside. If recorded music is used, only music that has a single accompanying instrument, such as a guitar or piano, should be used. Researchers have found positive effects of singing combined with guitar accompaniment on both male and female infants’ physiological outcomes and length of hospitalization . Regarding the duration of musical and auditory stimulation, a longer duration would yield greater benefits, but there is potential harm when providing auditory input without research supporting the protocol. Eight hours of music per day, 4 hours during the day shift and 4 hours during the night shift, resulted in infants being hospitalized longer than the control group; hence, recorded music or other auditory stimulation should not be played continuously. Protected sleep, especially REM sleep, is pertinent and necessary for learning . Meaningful auditory input is necessary for infant development; thus, providing live singing or recorded music might be best during clustered care when infants are awake or in quiet sleep. For example, when infants are awakened for diaper changes and vitals prior to feeding, the time frame before feeding might help the infant achieve an alert, awake state. Similarly, singing soothing lullabies after feeding might help infants fall asleep. Of particular importance is providing auditory stimulation in a quiet environment, as preterm and term infants cannot discern meaningful auditory input if the noise exceeds 60 decibels.

36 Weeks and Older:

Auditory processing skills continue to develop and refine from 36 weeks PMA through term. By term, the fetus adjusts to specific elements of music, such as sound intensity (loudness) and frequency (high versus low notes), among others. In an fMRI study, infants were aware of previously heard musical elements, such as tempo, which led to positive connections in the auditory cortex . Consequently, families should continue using past songs and books, and introduce new stimuli if the infant shows positive responses to auditory stimulation to decrease habituation. Mothers should use their voice  and be encouraged to sing. Medical staff should continue to control the amount and quality of auditory stimulation in the NICU environment to reduce adverse developmental outcomes.

As infants evince positive responses to music and are medically stable and thriving, they might be ready for movement to music that involves midline orientation and hand-to-hand play (such as a modified “Patty Cake” or “Itsy Bitsy Spider”) (53). Since newborns discriminate between speech and other sounds, indicating a sensitivity to the frequencies and timbres of speech (49, 53), infants should be encouraged to engage in cooing and babbling. Songs such as “Little Green Frog” and “If All the Raindrops” involve distinct lip and tongue movements that might help prompt infants to respond with vocalizations or facial movements.

Summary:

Using music to support auditory development can be highly effective, particularly given the infant’s gestational age and medical stability. The above recommendations are based on evidence-based research and should be followed to reduce the risk of harm. Music can also be used in the NICU to encourage parent involvement in their infant’s care and development. Many neurosensory programs, such as SENSE and iRainbow©, advise parents to sing and/or talk to their infants to enhance auditory development. The above recommendations provide clear guidance on how best to use music within these programs and may increase parent involvement, as music is an easy way to bond with and care for an infant in the NICU. Clinical and developmental care staff should adhere to the above guidelines to best support auditory development while promoting family-centered care for preterm infants and their families.

Source:https://www.neonatologytoday.net/newsletters/nt-dec25.pdf

PREEMIE FAMILY PARTNERS

Spilling the Tea is an educational series for new preemie moms and dads brought to you by TEACUP Preemie Program®. These brief but in-depth videos will explore aspects of prematurity including emotional and mental effects, the NICU environment, breastfeeding & pumping, reclaiming attachment & bonding, and others. Preemie parents share their experiences through intimate video journals, and experts in infant development and prematurity offer guidance and information. In this second episode of Spilling the Tea, two preemie moms share about the effects of the premature birth on their own mental health. Licensed Mental Health Counselor Jenny Estrada offers insights and information about PPD, Anxiety, and PTSD to help preemie moms know when and how to find help.

INNOVATIONS

This review explores methodological considerations in estimating racial disparities in mortality among very preterm infants (VPIs). Significant methodological variations are evident across studies, potentially affecting the estimated mortality rates of VPIs across

racial groups and influencing the perceived direction and magnitude of racial disparities. Key methodological approaches include the birth-based approach versus the fetuses-at-risk approach, with each offering distinct insights depending on the specific research questions posed. Cohort selection and the decision for crude versus adjusted comparison are also critical elements that

shape the outcomes and interpretations of these studies. This review underscores the importance of careful methodological planning and highlights that no single approach is definitively superior; rather, each has its strengths and limitations depending on the research objectives. The findings suggest that adjusting the methodological approach to align with specific research questions

and contexts is essential for accurately assessing and addressing racial disparities in neonatal mortality

IMPACT:

● Elucidates the impact of methodological choices on perceived racial disparities in neonatal mortality.

● Offers a comprehensive comparison of birth-based vs. fetuses-at-risk approaches in the context of racial disparity research.

● Provides guidance on the cohort selection and adjustment criteria critical for interpreting studies on racial disparities in very preterm infant mortality.

Source: https://www.nature.com/articles/s41390-024-03485-w

ABSTRACT

Aim

Extremely preterm infants (born before 28 weeks of gestation) face substantial risks of mortality and severe morbidity. This study aimed to identify early clinical predictors of survival and major complications in this vulnerable population in order to guide individualized neonatal care strategies.

Materials and Methods

A retrospective cohort analysis was conducted on 102 infants born between 22+0 and 27+6 weeks of gestation and admitted to a tertiary neonatal intensive care unit from 2017 to 2020. Demographic, perinatal, and clinical variables were extracted from their medical records. Survival and morbidity outcomes were compared across gestational subgroups. Statistical analyses included chi-square, t-tests, and receiver operating characteristic (ROC) curve analysis.

Results

The overall survival rate was significantly influenced by gestational age, birth weight, and the type of respiratory support received. Infants born at 22-25 weeks exhibited lower survival rates and higher incidences of respiratory distress syndrome, invasive ventilation, and patent ductus arteriosus (PDA). Mortality was independently associated with lower birth weight (p<0.0001), invasive ventilation (p=0.0014), and the presence of hemodynamically significant PDA (p=0.0243). In contrast, longer durations of non-invasive ventilation correlated with improved survival (p<0.0001). ROC analysis demonstrated high predictive performance for birth weight [area under the curve (AUC)=0.82] and non-invasive ventilation duration (AUC=0.96).

Conclusion

Early postnatal respiratory parameters, birth weight, and cardiovascular status are critical determinants of survival in extremely preterm infants. Optimizing non-invasive ventilation strategies and timely PDA management may enhance outcomes. Notably, the rate of antenatal corticosteroid administration was markedly low in our cohort, which may have contributed to adverse respiratory and survival outcomes, underscoring the need for improved perinatal care strategies in extremely preterm births.

Source: https://jpedres.org/articles/survival-predictors-and-morbidity-risk-factors-in-extremely-preterm-infants-a-clinical-cohort-study/doi/jpr.galenos.2025.33427

Babies born prematurely can have a number of complications at birth, simply because they are brought into the world before their organs are fully developed. One complication is called patent ductus arteriosus (PDA).

PDA occurs when a small fetal blood vessel in the heart remains open after birth. Much like trying to drink through a straw with a hole in it, the condition can cause unnecessary stress on the heart and lungs, as they have to work harder to push blood throughout the body.

However, treatment for the condition remains controversial among neonatologists, cardiologists, and pediatricians alike. Results from a clinical trial published in the Journal of the American Medical Association, or JAMA, brings physicians one step closer to an answer.

Led by neonatologist Matthew Laughon, MD, MPH, the study found that using medication to treat patent ductus arteriosus was associated with higher mortality compared with an expectant, or “watchful waiting,” approach.

“There is wide variation in treatment of PDA in preterm infants,” said Laughon, who is a professor of perinatal-neonatal medicine at the UNC School of Medicine and lead author on the paper. “Some clinicians always treat, and some clinicians never treat. We need to know which one is better for babies”

A total of 482 extremely pre-term infants (born between 22 weeks and 28 weeks of gestation) with PDAs were enrolled in the clinical trial. All of the infants were born within affiliated hospitals of the NICHD Neonatal Research Network, a collaborative network of neonatal intensive care units across the United States.

Participants were randomized into two treatment groups: those to receive pharmacologic treatments (either acetaminophen, indomethacin, or ibuprofen) and those to receive expectant management, or a “wait and see” approach.

Researchers wanted to know which intervention would decrease the risk of death or bronchopulmonary dysplasia (BPD), a serious lung condition caused by life-saving efforts to ventilate and oxygenate into the lungs, by the time the infants reach 36 weeks adjusted age.

Through statistical analysis, researchers found that infants given expectant management had treatment had nearly double the chance of survival before 36 weeks.

“This trial showed no benefit of active treatment of the PDA in extremely preterm infants,” wrote Laughon. “In fact, it identified a higher chance of survival for expectant management, consistent with

emerging data on the effects of early (i.e., prior to one or two weeks after birth) pharmacologic PDA treatment.”

The medications themselves, which are all commonly used to treat the PDA, can also alter the immune system, reduce blood flow to the intestine, or cause gastrointestinal mucosal injury. These effects may lead to serious conditions like sepsis or the death of intestinal tissue, called necrotizing enterocolitis.

Results from this trial will help inform new treatment strategies for preterm infants with patent ductus arteriosus, saving more lives and putting families on a path towards growth and healing.

This work was supported by The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Source: https://news.unchealthcare.org/2025/12/unc-study-confirms-early-use-of-medications-may-lead-to-life-threatening-conditions-in-preterm-infants-with-heart-defect/

The three Betos of Zumba—creator Alberto Perez and partners Alberto Aghion and Alberto Perlman—are not often fully recognized for the powerful global impact their vision has inspired. Zumba has become one of the most effective, joyful, and widely embraced exercise programs in the world, blending cardiovascular training, strength-building, and flexibility through energetic, Latin- and globally inspired music and dance. Workouts feel less like exercise and more like a celebration, leaving participants feeling uplifted, embraced, confident, and connected. Today, more than 15 million people take part in Zumba classes each week across roughly 200,000 locations in about 180 countries, a testament to its extraordinary reach and influence on global physical activity, community health,  and engagement. This sense of unity comes alive each year at the international Zumba Convention, where instructors from around the world gather and the shared humanity of the global community is visible—our oneness acknowledged, individuality celebrated, and human creativity welcomed with open arms. Every Zumba class has the power to create a space of acceptance, belonging, and shared joy. A great Zumba class reminds us to celebrate the uniqueness and precious presence of ourselves and others. Zumba is, at its core, a love dance—and there is no power greater than love.

GHOSTS, HORIZONS, EMERITUS

Belize is a country on the north-eastern coast of Central America. It is bordered by Mexico to the north, the Caribbean Sea to the east, and Guatemala to the west and south. It also shares a maritime boundary with Honduras to the southeast. Despite being in central America, Belize identifies with the Caribbean region, and is a member of the Caribbean Community (CARICOM) and the Commonwealth Caribbean, the historical British West Indies.

The Maya civilization spread into the area of Belize between 1500 BCE and 300 CE and flourished until about 1200. European contact began in 1502–04 when Christopher Columbus sailed along the Gulf of Honduras. European exploration was begun by English settlers in 1638. Spain and Britain both laid claim to the land until Britain defeated the Spanish in the Battle of St. George’s Caye (1798). It became a British colony in 1840, and a Crown colony in 1862. Belize achieved its independence from the United Kingdom on 21 September 1981.[  It is the only mainland Central American country which is a Commonwealth realm, with King Charles III as its monarch and head of state, represented by a governor-general.

Belize’s abundance of terrestrial and marine plants and animals and its diversity of ecosystems, including extensive coral reefs, give it a key place in the globally significant Mesoamerican Biological Corridor. It is considered a Central American and Caribbean nation with strong ties to both the American and Caribbean regions.

It has an area of 22,970 square kilometres (8,867 sq mi) and a population of 397,483 (2022). Its mainland is about 290 km (180 mi) long and 110 km (68 mi) wide. It is the least populated and least densely populated country in Central America. Its population growth rate of 1.87% per year (2018 estimate) is the second-highest in the region and one of the highest in the Western Hemisphere. Its capital is Belmopan, and its largest city is the namesake city of Belize City. The country has a diverse society composed of various cultures and languages. It is the only Central American country where English is the official language. Belizean Creole and Spanish are widely spoken, followed by the Mayan languages and Garifuna. Over half the population is multilingual due to the diverse linguistic backgrounds of the population. It is known for its September Celebrations and punta music.

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

Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.

In contrast to the public health sector, the private health sector provides care to a smaller portion of the population. However, similar to the public sector, private health services are offered at a relatively low cost with a shared emphasis on quality of care and quality improvement.

The Human Rights Measurement Initiative[3] finds that Belize is fulfilling 83.0% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Belize achieves 99.1% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 86.6% of what is expected based on the nation’s level of income. Belize falls into the “very bad” category when evaluating the right to reproductive health because the nation is fulfilling only 63.2% of what the nation is expected to achieve based on the resources (income) it has available.

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

COMMUNITY

Longest continuously running study on preterm birth that has followed research participants for more than 35 years published in JAMAURI College of Nursing Professor Amy D’Agata’s study shows that the effects of preterm birth can linger throughout an individual’s lifetime, necessitating the inclusion of birth history in adult health records.

KINGSTON, R.I. — August 4, 2025 — The stress preterm infants experience at birth can carry on throughout a lifetime and cause negative health impacts later in life, necessitating the routine inclusion of birth history in medical records and the development of clinical guidelines for adults born preterm, the longest continuously running study of individuals born preterm in the United States has shown.

University of Rhode Island College of Nursing Professor Amy D’Agata is continuing the work that began in the 1980s with a group of babies born preterm at Women & Infants Hospital. Involving 215 people born 35 years ago—including a control group of full-term babies, and preterm babies born at 22 to 36 weeks—the study tracks the successes and difficulties preterm babies continue to face into adulthood, and compares them to the group of participants born full term. The project has so far garnered more than $10 million in research grant funding.

D’Agata, who took over as principal researcher after the retirement of Professor Emeritus Mary Sullivan, has published the most recent results in the Journal of the American Medical Association. The published paper focuses physiological and psychological health outcomes that D’Agata and her team of researchers have identified as the study participants approach 40 years old. Those born preterm have shown a higher risk of high blood pressure, high cholesterol, increased abdominal fat, and low bone density. Psychologically, the group tends to internalize problems, often resulting in increased levels of depression and anxiety.

“Preterm birth is not just a neonatal issue. It, in fact, is a lifelong condition,” D’Agata said the study shows. “For individuals who have medical complications early in life, we are now seeing an increased risk of different chronic health issues later in life. We are now realizing that there is a very strong link between what happens to you early in life and later health outcomes.”

The study offers important takeaways for health-care clinicians, who are not always aware a patient was born preterm because birth history is not commonly included in adult medical records. D’Agata’s study is showing the need to include the information, and to develop adult screening guidelines for individuals who have a history of preterm birth. The work is also helping people who have been impacted by preterm birth understand that their birth history should be included in their medical records and should be considered in the context of their overall health.

“In this country, millions of people born preterm have grown into adulthood and are now seeing clinicians across primary care and various specialties, yet providers rarely ask about birth history,” D’Agata said. “We are urging that birth history be included as a standard question on every adult intake form. Health cannot be fully optimized if we overlook such a critical assessment piece.

Understanding an individual’s birth history, alongside growing research identifying increased health risks for those born preterm and the development of targeted clinical guidelines, will advance health equity for survivors of early birth. We believe a paradigm shift is needed in health care that recognizes preterm birth as a chronic condition requiring lifelong monitoring and support.”

While the study’s most recent results were just published in JAMA Network Open in July, D’Agata is already looking toward the next set of findings. Continuing to work with fellow URI professor Justin Parent, D’Agata is examining epigenetic age acceleration among individuals born preterm. Understanding any differences in epigenetic aging that may exist between preterm and full-term born adults may be another approach to understanding long-term health.

Source:https://www.uri.edu/news/2025/08/preterm-birth-can-cause-health-problems-later-in-life-should-be-considered-in-adult-health-records-uri-study-shows/

In the heart of the Cuban capital, the Dr. Cosme Ordoñez Carceller Teaching Polyclinic stands as a testament to the nation’s unique approach to healthcare: universal, free of charge, accessible, regionalized, community-centered, and deeply rooted in preventive medicine. Unlike the profit-driven models that dominate much of the world, Cuba’s system prioritizes equitable access, public health education, and early intervention.

At the core of this approach is a commitment to health promotion through education, disease prevention through habit management, and the integration of medical care and rehabilitation. By emphasizing proactive healthcare rather than reactive treatment, the system ensures that communities receive continuous, comprehensive support to maintain overall well-being.

During a recent visit to the Dr. Cosme Ordoñez Carceller Teaching Polyclinic in Havana, the staff detailed how the system was developed and how it ensures that no Cuban, regardless of income, is left without medical care.

The structure of Cuba’s healthcare system

Cuba’s National Health System operates as a hierarchical, state-run model designed to ensure seamless coordination of care. At the top, the National Assembly oversees the Ministry of Public Health, which sets national policies and directs specialized health institutes that tackle broader public health concerns.

Below the Ministry, provincial governments, answering directly to the Assembly, oversee provincial health departments, which manage larger hospitals and specialized medical facilities. These provincial bodies, in turn, delegate responsibilities to municipal governments, which run the municipal health departments and smaller hospitals that serve local populations. At the community level, municipal health departments manage Cuba’s extensive polyclinic network, the cornerstone of the country’s healthcare system. These polyclinics not only provide specialized care, diagnostics, and emergency services, but they also coordinate closely with family doctor-and-nurse teams, who serve as the first point of contact for Cuban citizens.

These frontline providers play a crucial role beyond immediate treatment, emphasizing preventive care, home visits, and alternative therapies such as nutrition counseling, acupuncture, and plant-based medicine. Despite supply shortages exacerbated by US sanctions, this integrated, top-down approach ensures that resources are distributed efficiently, maintaining consistent healthcare access nationwide.

Founded in 1974, the Dr. Ordoñez Carceller Polyclinic serves approximately 13,000 residents, offering care in medical specialties such as cardiology, orthopedics, fertility consultations, and genetic testing. The clinic is named after Dr. Cosme Ordoñez Carceller (1927–2019), an epidemiologist and pioneer of Community Medicine, who championed the polyclinic model that emerged in the 1960s and 1970s. He played a key role in training young physicians in comprehensive general medicine and launched innovative programs like the Grandparents’ Circles, a senior care initiative so effective that it was replicated nationwide.

Cuba’s system prioritizes equitable access, public health education, and early intervention. The country’s healthcare approach is rooted in promoting health through education, preventing disease by managing habits, and ensuring comprehensive medical care and rehabilitation. Unlike the fragmented, for-profit US healthcare model, Cuba’s integrated, community-based approach ensures better health outcomes and higher patient satisfaction. At polyclinics like Ordoñez Carceller, primary care is not just about treating illness but about education, prevention, and holistic well-being. This commitment to accessible, people-centered medicine reflects Cuba’s broader philosophy: that healthcare is not a privilege, but a fundamental human right.

Cuba’s healthcare achievements: A global leader in public health

Despite enduring over six decades of economic embargo, Cuba has achieved remarkable public health milestones. The following list highlights key accomplishments of both the Ordoñez Carceller Polyclinic and the Cuban healthcare system as a whole:

  • AIDS: Cuba identified HIV in 1983 and quickly set up a system to track and treat it. By 2014, it eliminated mother-to-child transmission of HIV and syphilis, a milestone the US has yet to reach.
  • COVID: Cuba developed two COVID vaccines, kept infections low, and even sent vaccines abroad.
  • Diabetes: The nation has developed an effective medication that treats diabetic ulcers (skin wounds that result from poor blood sugar control)
  • Alzheimer’s research: Cuba developed a drug that may help reverse Alzheimer’s effects
  • Maternal-fetal medicine: 99% of Cuban children are vaccinated, and the country has a lower infant mortality rate than the US
  • Nutrition: While obesity is not an issue in Cuba, malnutrition is an increasing concern due to shortages caused by the US embargo
  • Home health Doctors make house calls to care for the elderly and new mothers.

Profit vs. public health: How medical education and healthcare delivery differ in Cuba and the US

The paths to becoming a doctor in Cuba and the United States could not be more different. In the US, medical students take on crippling debt, often exceeding USD 200,000, before ever treating a patient. The pressure to repay loans steers many toward high-paying specialties, leaving primary care and rural communities underserved. The system is structured around financial incentives rather than public need, reinforcing the idea that medicine is a business first, a service second.

Cuba takes the opposite approach. Medical education is fully state-funded, allowing students to focus on patient care instead of profit. Training begins immediately after secondary school, with students placed in community clinics early in their careers. By the time they specialize, they have already served in primary care settings, ensuring that the system produces physicians committed to public health, not private wealth.

A focus on prevention, not just treatment

Cuba’s prevention-first model stands in stark contrast to the reactive nature of US healthcare. While American medicine often prioritizes treatment over lifestyle interventions, Cuban doctors routinely incorporate nutrition, exercise, and disease prevention strategies into care plans. The country’s polyclinic system ensures patients receive consistent, community-based healthcare rather than navigating a fragmented, for-profit system that often leaves them behind.

The US blockade: An unjust barrier to health

The US embargo continues to hinder Cuba’s healthcare system by restricting access to essential medicines, medical equipment, and scientific research. Pharmaceutical and shipping companies, fearing US penalties, avoid business with Cuba—leading to severe shortages of everything from aspirin to cancer treatments.

Even medical journals and online resources are blocked due to US restrictions, forcing Cuban researchers to work under constraints that most Western physicians never encounter.

Yet, rather than succumbing to these barriers, Cuba has turned to self-sufficiency, investing in biotechnology, vaccine development, and herbal medicine research to compensate for limited imports. If freed from economic sanctions, Cuba’s contributions to global healthcare innovation could expand exponentially.

For decades, Cuba has exported medical expertise worldwide, sending doctors to disaster-stricken and underserved regions. These global medical brigades have provided care to millions, particularly in Latin America, Africa, and the Caribbean. Yet, rather than supporting these humanitarian efforts, Washington has sought to dismantle them. In February 2025, the US expanded sanctions on Cuba’s international medical program, further restricting its ability to send doctors abroad. The move reflects a deeper failure to understand Cuba’s model of solidarity-driven healthcare, a stark contrast to the US system, where medicine is often dictated by profit rather than public service.

It is within this profit-driven framework that Cuba’s medical missions are misunderstood, labeled as “forced labor” by those who cannot imagine doctors choosing service over salary. The very idea of healthcare as a human right, rather than a commodity, challenges the US worldview, leading to efforts to discredit and sanction those who practice it differently.

What could be if the embargo were lifted

Cuba’s healthcare system is a model of resilience and innovation, but its full potential remains hindered by decades of US sanctions. If given access to global resources and technology, Cuban researchers could expand medical advancements in infectious diseases, chronic illness treatment, and disaster response. For now, Cuban doctors continue their work—undaunted by external pressures, committed to the principle that healthcare is a right, not a privilege.

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch.  Renée L. Quarterman, MD, FACS, is a surgical breast specialist. She is the director of Delaware Breast Care, a part of US Oncology.

Source: https://peoplesdispatch.org/2025/03/18/healthcare-in-cuba-how-a-tiny-island-defies-us-sanctions-to-lead-in-healthcare/

HEALTHCARE PARTNERS

Quality improvement (QI) initiatives have become essential to advancing patient outcomes in the neonatal intensive care unit (NICU), where high acuity and complex care are the norms. NICU nurses are uniquely positioned to find inefficiencies, propose practical solutions, and drive meaningful change. However, despite the growing emphasis on QI in nursing practice, well-intentioned projects fall short due to avoidable missteps in the planning and execution phases.

The following guide can be utilized by NICU nurses to navigate through common pitfalls in QI research and offers evidence-based strategies to overcome them. By focusing on foundational principles and real-world examples, this guide supports nurses in conducting impactful, sustainable QI work that enhances neonatal outcomes and team collaboration.

Common Pitfalls in QI Research

Lack of Clear Problem Definition

A common pitfall in QI efforts is the failure to define the problem thoroughly. Without a precise understanding of the issue, teams may invest critical time and resources into solutions that do not address the root cause.

For instance, a unit may notice an uptick in central line-associated bloodstream infections (CLABSIs) and immediately implement new sterile techniques without investigating the underlying variables. Was the increase related to staffing changes, procedural drift, or equipment issues? Without a clear problem definition, interventions risk being misaligned or ineffective.

Strategy: Use structured problem-identification tools—such as root cause analysis (like the Five Whys) or fishbone diagrams—to uncover deeper system issues. Frame the problem in a way that is specific, data-informed, and agreed upon by stakeholders. A clearly defined problem becomes the foundation for targeted and measurable interventions.

Neglecting Stakeholder Involvement

Successful QI initiatives require input and collaboration across disciplines. A common misstep occurs when projects are developed in isolation, often without input from those who will implement or be affected by the change. This can lead to resistance, logistical challenges, or unintended consequences.

For example, consider a QI team aiming to improve feeding initiation times by adjusting nursing workflows. If respiratory therapists or neonatal physicians are not consulted, the new protocol might inadvertently clash with intubation or stabilization practices, resulting in delays rather than improvements.

Strategy: Identify all stakeholders early in the project, including nurses, physicians, respiratory therapists, pharmacists, and families, when appropriate. Conduct stakeholder analyses and engage representatives in project design and testing phases. Inclusive collaboration fosters ownership, smoother implementation, and more sustainable outcomes (Institute for Healthcare Improvement, n.d.).

Poorly Defined Metrics

Without clearly defined, relevant, and measurable outcomes, a QI initiative’s impact is difficult to assess. Broad or vague goals such as “improve thermoregulation” fail to provide direction or an evaluation method.

Strategy: Use SMART goals—Specific, Measurable, Achievable, Relevant, and Time-bound—to guide metric development. For instance, instead of aiming to “reduce hypothermia,” a SMART goal might be: “Increase the percentage of newborns with normothermic admission temperatures (36.5°C–37.5°C) from 65% to 90% over six months.” Tools and resources are available to learn how to develop clear metrics, help track progress, guide adjustments, and communicate results to the team and leadership (Agency for Healthcare Research and Quality, 2020).

Inadequate Data Collection Planning

Even well-designed projects can falter without a strong plan for data collection. Inconsistent, incomplete, or biased data limit the ability to draw valid conclusions and make informed decisions.

Strategy: Design a standardized data collection process before the intervention begins. Identify what data are needed, who will collect data, how often, and how data will be stored and analyzed. Use validated tools where possible and use the electronic health record (EHR) system to reduce manual workload and increase reliability. Pilot test the data collection process to identify issues before scaling up.

Failure to Pilot Interventions

Another frequent misstep is implementing large-scale changes without first evaluating them in a controlled way. Skipping the pilot phase can lead to disruptions in care, staff confusion, or overlooked safety concerns.

Strategy: Use Plan-Do-Study-Act (PDSA) cycles to test changes on a small scale. For instance, a new bedside handoff tool can be trialed with one team for over a week before expanding unit wide. Piloting helps refine interventions, identify barriers early, and build staff confidence.

Lack of Sustainability Planning

Often, improvement is easier to achieve than sustain. QI initiatives can experience initial success but not maintain gains over time due to a lack of follow-up, ownership, or integration into routine practice.

Strategy: Plan for sustainability from the outset. Embed new practices into policies, electronic systems, and training programs. Assign champions to monitor compliance, provide feedback, and adapt as needed. Ongoing measurement and leadership support are critical to prevent regression.

Not Sharing or Publishing Results

When results are not shared beyond the unit, valuable insights and lessons are lost. This limits the potential for broader impact and professional growth.

Strategy: Disseminate findings through presentations, newsletters, or professional journals. Even small projects can inspire similar efforts elsewhere and contribute to the collective advancement of neonatal care. Sharing also strengthens the culture of learning and improvement.

Better QI Creates Lasting Change

Quality improvement is a powerful tool NICU nurses use to enhance care and outcomes. By avoiding common pitfalls—such as unclear problem definitions, poor metric planning, and lack of sustainability—nurses can lead effective and lasting change. Through structured planning, collaborative engagement, and thoughtful execution, every QI effort becomes an opportunity for growth and better care for our most vulnerable patients. (Institute for Healthcare Improvement, n.d.).

Source: https://nann.org/publication/feature-34/

Ghosting is one of those terms that seem out of place in medicine, borrowed from social media and dating culture. However, the phenomenon itself is alive and well in our clinical ecosystems. In fact, medicine may be one of the most fertile environments for it. How else can someone remain deeply involved, wholly committed, ever-present in the work, yet increasingly pushed to the side, rendered peripheral to decisions they once shaped?

In the professional world, ghosting is less dramatic and more insidious. It is not someone vanishing; it is colleagues stepping around them. It is conversations that slip behind closed doors. It is the rise of intermediaries and buffers. It is the subtle but unmistakable shift from direct speech to third-person references. It is the choice to go around rather than through.

It is ostracizing, but with a veneer of civility. It is quiet exclusion disguised as efficiency.

 And yes, it does not feel very good. For many, the experience intensifies with seniority. The more seasoned someone becomes, the more they know, the more institutional memory they carry, the more perspective they bring; the easier it becomes for others to rationalize keeping them out of the loop. People frame it as respect, as courtesy, as a desire not to “burden” them. Nevertheless, the line between courtesy and dismissal is thin and often crossed.

Technology, ironically, amplifies the problem. Zoom, Teams, and the creeping normalization of AI presence create new pathways for invisibility. What once required the discomfort of face-to-face avoidance now happens silently. Disengagement becomes frictionless. They can be physically present on a screen and still be utterly alone in the room. When they realize they are the only one who showed up in person, while everyone else has delegated their attendance to an AI proxy, they feel the ghostliness in full.

Ghosting rarely begins with an attack. It begins with a narrative.

“They’re too busy for this.”

 “They have so much on their plate already.”

“They’re so senior; we shouldn’t bother them with this.”

“They don’t need feedback—they’re above the evaluators.”

What begins as deference quietly morphs into distance. And distance, unchecked, hardens into exclusion. Soon, the storyline shifts:

“They’re not involved.”

“They didn’t attend the last meeting.”

 “They never weigh in anymore.”

What remains unsaid and often unnoticed is that no one invited them, no one asked for their opinion, and no one created space for them to be part of the process.

Decisions move forward. Processes evolve. Incentives and priorities shift. Meanwhile, the ghosted clinician continues to do their work, unaware that the landscape is changing around them in ways that diminish their role, complicate their tasks, or diminish their influence. When they finally recognize that something fundamental has shifted, it is often too late to re-enter the conversation.

What does this feel like? It feels exactly like being a ghost.

The film The Sixth Sense offers a powerful metaphor. (Spoiler Alert) Bruce Willis’s character, after suffering a fatal gunshot wound, continues living as though nothing has changed. He goes to work, he engages in therapy, and he attempts to connect with his wife. However, something is off. People drift away. His wife is distant. Rooms feel colder. It is only through his sessions with a child who can “see dead people” that he finally confronts the truth: he is no longer part of the living world, no longer part of the relationships he believes himself to be nurturing.

 Professionally, the comparison is not perfect, but it is evocative. In medicine, the “ghosts” have not died. They walk our halls. They mentor trainees. They contribute to scholarship. They carry decades of clinical experience. They built the foundations upon which our teams now stand.

Nevertheless, they are treated as if they no longer inhabit the same professional world as everyone else.

Ghosting in medicine is not just a social slight; it is a cultural wound. It erodes respect. It weakens teams. It destroys continuity. It discards institutional memory. It creates unnecessary rifts between generations of clinicians. It deprives trainees of mentorship. It can turn accomplished physicians into isolated figures who continue to serve, but without the acknowledgment or inclusion that sustains service.

 Most dangerously, ghosting perpetuates the illusion that this is normal. That it is natural. That it is simply the denouement of a career.

But it does not have to be.

In an era where burnout is widespread, where talent is scarce, and where the wisdom of experience is more valuable than ever, ghosting is a luxury medicine cannot afford. Inclusion is not just good manners: it is good practice. It strengthens teams, enhances decision-making, and honors the very people who paved the way.

So the next time you see a colleague who seems peripheral, someone once central, now slowly fading from the edges of the conversation—pause before stepping around them. Invite them in. Ask their opinion. Keep them part of the fabric of the work. The difference between belonging and ghosthood may hinge on the smallest acts of acknowledgment, the simplest acts of inclusion. Because the ghost you see before you today is not a relic to be ignored; they are a reflection, a warning, of what any one of us might become.

Source: https://neonatologytoday.net/newsletters/nt-nov25.pdf

PREEMIE FAMILY PARTNERS

Key Points

At well-baby visits, your baby’s provider checks your baby’s health and development and gives your baby vaccinations to protect them from diseases.

If your baby has a medical condition, they may need ongoing care from different healthcare providers.

If you think your baby is sick, call their provider. If you think it’s an emergency, call 911.

If your baby needs medicine or medical equipment at home, learn how to give or use it correctly before your baby leaves the NICU.

When does your baby need to see their healthcare provider?

Your baby will get several checkups (well-baby visits) with their provider during their first year. At each visit, talk to their provider to make sure your baby’s developing in a healthy way. Are they rolling over, sitting up, crawling, and walking when they should? These skills are called developmental milestones. You may need to remind the provider that your baby spent time in the neonatal intensive care unit (NICU), because this may affect when they reach the milestones.

Take your baby’s medical file to your first visit with your baby’s provider. This file includes their discharge summary and other information from the hospital. The provider needs to know what happened during and after your baby’s birth. Hospital staff may send the summary directly to the provider.

If your baby has a medical condition, such as a birth defect, they may need ongoing care from different  healthcare providers. Find a way to keep track of your baby’s medical appointments. This may be on a calendar in your kitchen or on your phone with an alert to remind you. Decide if it’s easier to schedule a few appointments on the same day or spread them out over different days.

Ask your providers to keep your baby’s main provider up to date about all visits and treatments. This helps make sure that all members of your baby’s healthcare team have the same information.

Keep your own record of any checkups, tests, and treatments your baby has had. When your doctor makes a change to your baby’s care or medication, make sure this is also shared with your baby’s in-home nursing care agency and equipment company if you use these services.

What should you do if your baby gets sick?

All babies get sick from time to time. But babies who were in the NICU are more likely than other babies to get infections. Watch for signs that your baby may be sick so you can get medical help right away. You should call your baby’s healthcare provider if your baby:  

  • Looks blue around the nose, lips, or on the skin, or is paler than usual
  • Refuses to eat or doesn’t eat enough
  • Throws up (which is more serious than spitting up or reflux)
  • Has less than five wet diapers in a 24-hour period, or has diarrhea for more than a day
  • Has a large or hard belly that they have not had before
  • Has a temperature higher than 100.4 F or lower than 97 F (using a rectal thermometer)
  • Has apnea or trouble breathing. Apnea is when the baby stops breathing for 15 seconds or more.

You know your baby best. If you think something is wrong, call their provider, call 911, or take your baby to the emergency room.

How do vaccinations help protect your baby?

All babies, including those who spend time in the NICU, need vaccinations to help protect them from serious diseases. Some babies start getting these shots while they’re in the NICU. Check with your baby’s provider about when they need their vaccinations. Keep a record of your baby’s vaccinations in your medical file for them.

If you have other children, they need their vaccinations, too. This helps keep them from passing infections to the baby. During flu season, everyone in the family, including parents, should get a flu shot. Any adult who may have contact with your baby also needs a Tdap vaccination. This vaccination helps protect against tetanus, diphtheria, and pertussis (whooping cough). If you didn’t receive your Tdap vaccine during pregnancy, you can get it after you’ve given birth. To create a safe space for your baby, it is important for everyone who will be in contact with your baby to receive their vaccinations.

How can you protect your baby from respiratory syncytial virus (RSV)?

RSV is a common virus. It affects almost all children before they reach age 2. Most of the time, it causes a slight cold. But for preterm babies (born before 37 weeks of pregnancy), this virus can be more serious. Babies born preterm or who have heart or lung problems may benefit from a medicine to keep them from getting RSV. Ask your baby’s healthcare provider if your baby got this medicine in the NICU or if they should get it now that they’re at home.

What do you need to know about giving your baby medicine?

Some babies go home from the NICU still taking medicines. Learn how to give your baby their medicine before they leave the hospital. Write down all the directions. If you have questions or are worried about giving your baby medicine, tell the nurse or other NICU staff. They can show you exactly what to do so you feel comfortable and confident about giving your baby medicine.

When giving your baby medicine, make sure you know:

  • Where you can get the prescription filled (at a grocery store, drug store, or pharmacy). A prescription is an order for medicine given by a healthcare provider.
  • How much medicine to give, how often to give it, and when to stop giving it
  • If you can give it before, during, or after feedings
  • If the medicine needs to be refrigerated, prepared, or mixed
  • What to do if you miss a dose
  • If your baby needs more than one medicine, if you can give them together at the same time
  •  

You also need to know:

  • What position your baby should be in to take the medicine
  • What to do if your baby spits up or vomits the medicine
  • If there are side effects from the medicine and what to do if your baby has them

To track your baby’s different medicines and when to give them, use a chart. Ask the nurse to help you make the chart.

How can you manage your baby’s medical equipment at home?

If your baby has medical equipment at home, this can feel like a lot to manage. Staying organized and planning ahead can help. Keep a list of your baby’s equipment and medical supplies, including order numbers, size, and quantity. The equipment company can give you a checklist. Be sure to re-order supplies with enough time, as shipments can sometimes be delayed. Always be prepared when you leave the house, make sure you have your baby’s supplies even when you’re just going to the park.

If the equipment uses electricity:

  • Share information about your baby’s medical condition with your local fire department and emergency or first responders so they know what to expect in case they’re called to your home for an emergency. Invite them to come to your home to meet you and your baby.
  • Contact your utility companies to let them know your baby’s healthcare needs. They may have a priority list for repairing power outages or plowing snow.
  • Make a plan for if the power goes out. Have back-up batteries and know how long they will last.

Last reviewed April 2025: https://www.marchofdimes.org/find-support/topics/neonatal-intensive-care-unit-nicu/continuing-medical-care-after-nicu

Anxiety is another word for feeling worried or scared. It’s normal for children and teens to feel anxious sometimes, like before a big test at school or talking in front of a group of people. But if your child’s anxiety gets in the way of normal activities, such as sleeping alone at night, playing outside or going to school, they may need extra support.

The good news is that there are things you can do to help prevent your child from feeling anxious and help them handle worries when they happen. Talk with your pediatrician to discuss strategies and tips that can help.

What are some common signs of anxiety in children?

If your child is feeling anxious, they may not be able to tell you. Your child may feel bad or sick without knowing why, or you may notice they seem restless or tired.

  • Feeling as if their heart is racing
  • Sweating or blushing
  • Shaking or feeling sick to their stomach
  • Feeling very cold or hot
  • Trouble paying attention or sitting still
  • Touching the crotch area (for young boys)

How can I help my child manage anxiety at home?

These tips are helpful for all children, but they can be especially helpful for children with anxiety. Parenting is a busy job, so use your judgment about which tips make the most sense for your family.

Connect with your child

  • Set aside one-on-one time every day without TV or other media. Even just 10 minutes each day can make a big difference. Try gardening or taking care of houseplants, drawing or going for a bike ride.
  • Praise your child and make them feel good about themselves. For example, “You did a great job on that homework assignment!” or “Thank you for helping me with the laundry. I’m so lucky to have your help.”
  • Find out what’s worrying your child, because stress can make them feel anxious. Things such as being bullied at school, divorce, or a death in the family can make a child feel anxious. Your child may need extra help to handle issues such as these.

Help your child learn to manage fears

When your child is calm, start a conversation about things they can do to manage fears and worries when they happen. For example, let them know that they can

  • Practice deep breathing and muscle relaxation.
  • Use positive self-talk (for example, “I can try this” instead of “I can’t do this”).
  • Think of a safe place, such as their bedroom or favorite place outdoors.
  • Gradually facing fears. Consider gradually exposing your child to feared objects or activities.
  • Praise and reward brave behavior: the goal is to cope, not avoid.

Build healthy habits to support mood

Healthy lifestyle habits can help reduce stress and support a positive mood.

  • Get active! Encourage your child to be active for at least an hour every day. This activity can include playing outside, joining a sports team or an activity at the YMCA, biking or walking to school, or dancing at home to favorite music.
  • Eat healthy. Eat healthy meals every day, including fruits and vegetables, whole grains, and protein foods. Remember to eat breakfast!
  • Get plenty of sleep. School-aged children need 9 to 12 hours of sleep every night, and teens need 8 to 10 hours.
  • Build a family media plan to set healthy guidelines around entertainment screen time. Avoid scary or violent TV shows, video games, and movies.
  • Set up family routines. Follow a regular schedule for playtime, mealtime, and bedtime. Knowing what to expect can help your child feel safe and secure.
  •  

How can I help my child manage school anxiety?

Children may find it hard to focus on or even go to school when they’re feeling worried. If your child is having trouble in school, try these ways to help.

  • Gently but firmly tell your child why it’s important to go to school.
  • Talk with your child’s teachers and the guidance counselor about what to do if your child asks to go home from school early.
  • If you think your child may be upset by family stress or pressure to do well in school, let them know they are doing a good job and you’re proud of them.
  • Help your child set realistic goals for school. If they set goals that are too hard to meet, they may feel worse about themselves.
  • Remind your child that they can take steps to control their worries. For example, they can think about what to do ahead of time to handle a stressful situation.
  • Reward your child’s brave behaviors at school. Spending time doing fun activities with a parent is a very powerful reward.

Remember, you know your child best.

Whether it’s at school or the doctor’s office, you are your child’s biggest advocate. Don’t hesitate to speak up on behalf of your child.

When do I need to go back to the doctor?

If your child’s anxiety doesn’t go away or gets worse, get back in touch with the doctor. You and the doctor can make a plan to try new approaches or strategies with your child.

It’s especially important to talk with your child’s doctor if:

  • Your child starts to experience other behavior problems, such as shyness.
  • Something scary happens in your child’s life that may make their anxiety worse, such as an injury or death in the family.
  • You suspect your child’s anxiety is affecting another medical condition (for example, if your child’s asthma gets worse with anxiety).

The doctor can also help you decide whether visiting a specialist may help. For example, a type of therapy called cognitive behavioral therapy can be helpful for children with anxiety.

Make time to care for yourself, too.

Parenting can be stressful. If you’re feeling overwhelmed, don’t be afraid to ask for support from family, close friends, social services, or your faith community. Children pick up on the stress and worries of adults, so getting support for yourself can help your child too.

Last Updated – 09/24/2024 –https://www.healthychildren.org/English/family-life/family-dynamics/Pages/help-your-child-manage-fears-and-anxieties.aspx

The neonatal intensive care unit (NICU) is a special unit in the hospital for babies born preterm, very early, or who have some other serious medical condition. Most babies born very early will need special care after birth. This is done by or under the supervision of a neonatologist, a doctor with special training in the care and problems of newborns.

This article discusses the consultants and support staff who may be involved in the care of your infant depending on your infant’s specific medical needs.

Information

AUDIOLOGIST

An audiologist is trained to test a baby’s hearing and provide follow-up care to those with hearing problems. Most newborns have their hearing screened before leaving the hospital. Your health care providers will determine which hearing test is best. Hearing tests may also be done after leaving the hospital.

CARDIOLOGIST

A cardiologist is a doctor that has special training in the diagnosis and treatment of heart and blood vessel disease. Pediatric cardiologists are trained to deal with newborn heart problems. The cardiologist may examine the baby, order tests, and read test results. Tests to diagnose heart conditions may include:

If the structure of the heart is not normal due to a birth defect, a cardiologist might work with a cardiovascular surgeon to perform surgery on the heart.

CARDIOVASCULAR SURGEON

A cardiovascular (heart) surgeon is a doctor who has special training in doing surgery to correct or treat defects of the heart. Pediatric cardiovascular surgeons are trained to deal with newborn heart problems.

Sometimes, surgery can correct a heart problem. Other times, complete correction is not possible and surgery is done just to make the heart work as well as possible. The surgeon will work closely with the cardiologist to care for the baby before and after surgery.

DERMATOLOGIST

A dermatologist is a doctor who has special training in diseases and conditions of the skin, hair, and nails. Such a doctor might be asked to look at a rash or skin lesion on a baby in the hospital. In some cases, the dermatologist might take a sample of the skin, called a biopsy. The dermatologist might also work with the pathologist to read the biopsy results.

DEVELOPMENTAL PEDIATRICIAN

A developmental pediatrician is a doctor who has been specially trained to diagnose and care for infants who have trouble doing what other children of their age can do. This type of doctor often evaluates babies who have already gone home from the NICU and will order or perform developmental tests. The doctor can also help you find resources near your home that provide therapies to help infants and children in meeting development milestones. Developmental pediatricians work closely with nurse practitioners, occupational therapists, physical therapists, and sometimes neurologists.

DIETITIAN

A dietitian has special training in nutritional support (feeding). This type of provider may also specialize in pediatric (children’s) nutritional care. Dietitians help determine if your baby is getting enough nutrients, and may recommend some choices of nutrition that can be given through the blood or a feeding tube.

ENDOCRINOLOGIST

A pediatric endocrinologist is a doctor with special training in the diagnosis and treatment of infants with hormone problems. Endocrinologists might be asked to see babies who have problems with the level of salt or sugar in the body, or who have problems with the development of certain glands and sexual organs.

GASTROENTEROLOGIST

A pediatric gastroenterologist is a doctor with special training in the diagnosis and treatment of infants with problems of the digestive system (stomach and intestines) and liver. This type of doctor might be asked to see a baby who has digestive or liver problems. Tests, such as x-rays, liver function tests, or abdominal ultrasounds, might be done.

GENETICIST

A geneticist is a doctor with special training in the diagnosis and treatment of infants with congenital (inherited) conditions, including chromosomal issues or syndromes. Tests, such as chromosome analysis, metabolic studies, and ultrasounds, may be done.

HEMATOLOGIST-ONCOLOGIST

A pediatric hematologist-oncologist is a doctor with special training in the diagnosis and treatment of children with blood disorders and types of cancer. This type of doctor might be asked to see a baby for bleeding problems due to low platelets or other clotting factors. Tests, such as a complete blood count (CBC) or clotting studies, might be ordered.

INFECTIOUS DISEASE SPECIALIST

An infectious disease specialist is a doctor with special training in the diagnosis and treatment of infections. They might be asked to see a baby that develops unusual or serious infections. Infections in babies can include blood infections or infections of the brain and spinal cord.

MATERNAL-FETAL MEDICINE SPECIALIST

A maternal-fetal medicine doctor (perinatologist) is an obstetrician with special training in the care of high-risk pregnant women. High-risk means there is an increased chance for problems. This type of doctor can care for women who have premature labor, multiple gestations (twins or more), high blood pressure, or diabetes.

NEONATAL NURSE PRACTITIONER (NNP)

Neonatal nurse practitioners (NNP) are advanced practice nurses with extra experience in the care of newborn infants in addition to completing master’s or doctoral level educational programs. The NNP works along with a neonatologist to diagnose and treat health problems in babies in the NICU. The NNP also performs procedures to help diagnose and manage certain conditions.

NEPHROLOGIST

A pediatric nephrologist is a doctor with special training in diagnosing and treating children who have problems with the kidneys and urinary system. This type of doctor might be asked to see a baby who has problems in the development of the kidneys or to help care for a baby whose kidneys do not work properly. If a baby needs kidney surgery, the nephrologist will work with a surgeon or urologist

.NEUROLOGIST

A pediatric neurologist is a doctor with special training in the diagnosis and treatment of children with disorders of the brain, nerves, and muscles. This type of doctor might be asked to see a baby who has seizures or bleeding in the brain. If the infant needs surgery for a problem in the brain or spinal cord, the neurologist might work with a neurosurgeon.

NEUROSURGEON

A pediatric neurosurgeon is a doctor trained as a surgeon who operates on children’s brains and spinal cords. This type of doctor might be asked to see a baby who has problems, such as spina bifida, skull fracture, or hydrocephalus.

OBSTETRICIAN

An obstetrician is a doctor with special training in taking care of pregnant women. This type of doctor might also assist women who are trying to get pregnant and follow women with medical conditions, such as diabetes or decreased fetal growth.

OPHTHALMOLOGIST

A pediatric ophthalmologist is a doctor with special training in diagnosing and treating eye problems in children. This type of doctor might be asked to see a baby who has birth defects of the eye.

An ophthalmologist will look at the inside of the baby’s eye to diagnose retinopathy of prematurity. In some cases, this type of doctor might perform laser or other corrective surgery on the eyes.

ORTHOPEDIC SURGEON

A pediatric orthopedic surgeon is a doctor with special training in the diagnosis and treatment of children who have conditions involving their bones. This type of doctor might be asked to see a baby who has birth defects of the arms or legs, hip dislocation (dysplasia), or fractures of the bones. To see the bones, orthopedic surgeons might order ultrasounds or x-rays. If needed, they can perform surgery or place casts.

OSTOMY NURSE

An ostomy nurse is a nurse with special training in the care of skin wounds and openings in the belly area through which the end of the intestine or the collecting system of the kidney stick out. Such an opening is called an ostomy. Ostomies are the result of surgery needed to treat many intestinal problems, such as necrotizing enterocolitis. In some cases, ostomy nurses are consulted to help care for complicated wounds.

OTOLARYNGOLOGIST/EAR NOSE THROAT (ENT) SPECIALIST

A pediatric otolaryngologist is also called a pediatric ear, nose, and throat (ENT) specialist. This is a doctor with special training in the diagnosis and treatment of children with problems with the ear, nose, throat, and airways. This type of doctor might be asked to see a baby who has problems with breathing or a blockage of the nose.

OCCUPATIONAL/PHYSICAL/SPEECH THERAPISTS (OT/PT/ST)

Occupational and physical therapists (OT/PT) are professionals with advanced training in working with infants with developmental needs. This work includes neurobehavioral assessments (postural tone, reflexes, movement patterns, and responses to handling). In addition, the OT/PT professionals will help determine a baby’s nipple-feeding readiness and oral-motor skills. Speech therapists will also help with feeding skills in some centers. These types of providers might also be asked to provide family education and support.

PATHOLOGIST

A pathologist is a doctor with special training in lab testing and examination of body tissues. They supervise the lab where many medical tests are performed. They also examine tissues under the microscope that are obtained during a surgery or an autopsy.

PEDIATRICIAN

A pediatrician is a doctor with special training in the care of infants and children. This type of doctor might be asked to see a baby in the NICU, but is usually the primary care provider for a healthy newborn. A pediatrician also provides primary care for most babies after they leave the NICU.

PHLEBOTOMIST

A phlebotomist is a specially trained professional who takes your blood. This type of provider may take the blood from a vein or a baby’s heel.

PULMONOLOGIST

A pediatric pulmonologist is a doctor with special training in diagnosing and treating children with respiratory (breathing) conditions. Even though the neonatologist cares for many infants with respiratory problems, the pulmonologist might be asked to see or to help care for babies who have unusual conditions of the lung.

RADIOLOGIST

A radiologist is a doctor with special training in obtaining and reading x-rays and other imaging tests, such as barium enemas and ultrasounds. Pediatric radiologists have extra training in imaging for children.

RESPIRATORY THERAPIST (RT)

Respiratory therapists (RTs) are trained to deliver multiple treatments to the heart and lungs. RTs are actively involved with babies having breathing problems, such as respiratory distress syndrome or bronchopulmonary dysplasia. An RT might become an extracorporeal membrane oxygenation (ECMO) specialist with further training.

SOCIAL WORKERS

Social workers are professionals with special education and training to determine the psychosocial, emotional, and financial needs of families. They help families find and coordinate resources in the hospital and community that will help to meet their needs. Social workers also help with discharge planning.

UROLOGIST

A pediatric urologist is a doctor with special training in diagnosing and treating conditions involving the urinary system in children. This type of doctor might be asked to see a baby with conditions such as hydronephrosis or hypospadias. With some conditions, they will work closely with a nephrologist.

X-RAY TECHNICIAN

An x-ray technician is trained in taking x-rays. X-rays can be of the chest, stomach, or pelvis. Sometimes, solutions are used to make body parts easier to see, as with barium enemas. X-rays of bones are also commonly performed on babies for a variety of reasons.

Source: https://medlineplus.gov/ency/article/007249.htm

INNOVATIONS

OBJECTIVE

Pediatric surgical conditions are a significant source of morbidity and mortality in low- and middle-income countries (LMICs), where children with surgically treatable conditions lack access to care owing to an insufficient number of pediatric surgeons, poor and limited training, and financial barriers. There is a growing shift from charitable missions to capacity-strengthening projects, which strengthen the skills and resources of communities. The objective of this study was to synthesize the literature to identify capacity-strengthening projects, their methods and outcomes, and their limitations and barriers.

METHODS

MEDLINE, EMBASE, Cochrane, and Web of Science were searched until May 5, 2023. Eligibility criteria were as follows: (1) inclusion of pediatric surgery patients; (2) designation as capacity-strengthening interventions; (3) outcomes of improved access defined through Lancet Commission on Global Surgery Indicators; and (4) designation as an LMIC defined by the World Bank. Two independent reviewers conducted screening and extraction.

RESULTS

A total of 80 studies met inclusion criteria. Interventions were implemented in 69 LMICs and used 19 different methods of capacity strengthening. Common capacity-strengthening methods included the following: international surgical visits, training programs, partnerships, mobile clinics and camps, infrastructure enhancements, and telemedicine. Common methods used included the following: training of local providers, continuous contact between both countries after the visit was completed, improved access for rural families, and economic support for low-income families. A total of 1 357 077 pediatric surgeries were performed through these interventions. Limitations included the fact that only peer-reviewed studies were included. Included studies were mainly case series or small observational studies with qualitative data.

CONCLUSIONS

This review identifies methods to implement capacity-strengthening interventions in LMICs, including their successes and barriers. Future research should report ethical concerns and quantitative outcomes to determine effectiveness.

Source: https://publications.aap.org/pediatrics/article-abstract/156/6/e2025072119/205410/Improving-Access-to-Pediatric-Surgery-in-LMICs?redirectedFrom=fulltext

Introduction

Neonates and infants are commonly referred to as “therapeutic orphans” due to the overall scarcity of therapeutic interventions that have been developed and tailored to their needs and specific characteristics. This is well known by care providers and researchers active in this field, but is perhaps less on the radar of authorities, funding bodies or the broader public. There is significant health inequity when comparing newborns to other age populations in terms of specific drug and device development and therapeutics. In addition there are health inequities in the provision of neonatal care globally which require special attention in terms of improvement.

Bronchopulmonary dysplasia, neonatal seizures, poor growth, necrotizing enterocolitis (NEC) and short bowel, hypoxic-ischemic encephalopathy, retinopathy of prematurity (ROP), neonatal infections and sepsis hereby serve as a non-exhaustive list of “orphan conditions” in need of more equity, through adequately and urgently funded research and improvement.

The good news is that there have been increased efforts, in recent years, by researchers and regulatory bodies to focus on the provision of drugs, devices, and treatment modalities tailored for neonatal use, while further advocacy remains an obvious need . This brings perspective and explains the initiative taken to organize a focused research topic on what is on the horizon as well as recent advances.

Overview of the topics covered

We targeted emerging or new aspects related to monitoring, diagnostics and therapeutics in neonatal care for the current research topic. Fortunately, this research topic was perceived as very relevant by the research community, as 135 authors expressed their interest as contributors, resulting in 20 accepted papers. This serves as a signal of the importance to continue to work on this topic.

Post-hoc, and in a somewhat arbitrary way (because of overlap in these subcategories) these papers were subdivided by the editors into different subcategories, with focus on (1, 5 papers) perinatal biomarkers in blood and urine and how these relate to or predict outcomes, (2, 6 papers) adaptations of existing and newly emerging equipment in neonatal units, (3, 3 papers) needed advances in pharmacotherapy, (4, 3 papers) machine learning or deep learning applications in neonatal care, and finally, (5, 3 papers) underreported aspects of contemporary NICU care, with a focus on the holistic nature of care for the infant and the family.

Perinatal biomarkers in blood and urine and how these relate to or predict outcomes

Two papers focused on biomarkers related to gestational diabetes, with reflections and data on maternal and neonatal outcomes. Postnatal maternal levels of glycated albumin and hemoglobin A1c in mothers of large-for-gestational-age (LGA) informed us of the relevance of accurate diagnosis during pregnancy. This is because postpartum women without diagnosis during pregnancy had higher glycated albumin values, associated with LGA and associated complications (Železnik et al.). Interestingly and related to this paper, Yin et al. reported on a untargeted metabolomics study in women with gestational diabetes, with the recommendation of a maternal serum metabolite panel to forecast neonatal adverse outcomes (hypoglycemia and macrosomia) (Yin et al.).

Other papers focused on the use of vitamin D, acid-base and biomarkers associated with fetal growth restriction with impaired neurodevelopmental outcome. In a cohort of 217 preterm neonates, a multivariate regression analysis identified antenatal steroids as protective, and lower birth weight, duration of ventilation, sepsis and the serum 25-(OH)D vitamin as risk factors to develop ROP (Yin et al.). Musco et al. reported on a systematic review on blood biomarkers indicating risks of adverse neurodevelopmental outcome in fetal growth restricted infants (Musco et al.). While the authors retrieved some data on neuron specific enolase and S100B, the overall conclusions reflect a call for further research. Finally, an association between lactate levels in umbilical cord blood and cerebral oxygenation in preterm neonates was studied as a secondary outcome analysis (Dusleag et al.). In non-asphyxiated preterm neonates with respiratory support, lactate levels were negatively associated with cerebral and arterial oxygenation. In term neonates without respiratory support, no associations were observed.

Adaptations of existing and newly emerging equipment in our units

In a review on emerging innovations in neonatal monitoring, Krbec et al. concluded that there is an urgent, still unmet need to develop wireless, non- or minimal-contact, non-adhesive technology, capable to integrate multiple signals in a single platform, tailored to neonates (Krbec et al.). Related to this call of action, Svoboda et al. reported on their pilot experience with contactless assessment of heart rate, applying imaging photoplethysmography (Svoboda et al.). Rectal and axillary temperature monitoring on admission were compared in a cohort of preterm (n = 80, <32 weeks gestational age) by Halabi et al., reporting that rectal measurement was likely more reliable in the event of hypothermia (Halabi et al.). Ultrasound-guided measurement of anterior cerebral artery resistive index in the first week of life in 739 preterm neonates (<35 weeks) was not associated with subsequent co-morbidities on admission or during neonatal stay (asphyxia, sepsis, NEC) (Singh Gill et al.). A case series of neurally adjusted ventilatory assist to rescue pulmonary interstitial emphysema in 5 extremely low birth weight infants illustrated the potential value of this ventilatory equipment and strategy and need for further study (Chen et al.). Finally, van Rens et al. compared a conventional to a modified Seldinger technique (a dedicated micro-insertion kit) for peripherally inserted central catheter (PICC) placement, illustrating the relevance of developing “low risk, high benefit” type of medical devices, adapted to the specific needs of neonates (van Rens et al.).

Advances needed in pharmacotherapy

The currently available medicines and dosing regimens in neonatal care are limited and there is an urgent need for improvement in this domain. This was illustrated by articles on sepsis, septic shock and steroids. Inequity in provision of neonatal care across the globe ought to be a major focus of improvement. Gezahegn et al. described the outcome in neonates admitted with sepsis in Harar (Ethiopia). Low white blood cell count, desaturation, preterm birth, absence of prenatal maternal care, and chorioamnionitis were important risk factors for sepsis-related mortality (Gezahegn et al.). Addressing these prognostic factors hold the promise to act as levelers to improve outcomes. A pilot study compared noradrenaline and adrenaline as first line vasopressor for fluid-refractory sepsis shock (Garegrat et al.). Both interventions were comparable to resolve the septic shock, while the overall mortality (13/42, 30%) remained significant, highlighting the need for better diagnostic and therapeutic options. Finally, in a systematic review, outcome of postnatal systemic corticosteroids (hydrocortisone to dexamethasone) were compared as reported in randomized controlled trials (Boscarino et al.). The authors concluded that dexamethasone appeared to be somewhat more effective than hydrocortisone in improving respiratory outcomes, but with inconclusive but relevant concerns on the uncertainties on long-term neurodevelopmental outcome, again highlighting the need for better therapies for prevention and management of chronic lung disease of prematurity.

Machine learning or deep learning applications in neonatal care

Artificial intelligence is a rapidly advancing area with fast evolving clinical applications in healthcare, including in the NICU (6). It is no surprise that the current research topic also contains papers illustrating its relevance to improve our practices and outcomes. Two papers hereby focused on NEC, and a 3rd paper on prediction of significant patent ductus arteriosus (PDA). In a mini-review, Cuna et al. reports on the various pathophysiological processes underlying NEC endotypes, and how artificial intelligence holds the promise to influence further understanding and management (Cuna et al.). An approach to enhance surgical decision making in NEC is illustrated by Wu et al. Based on x-rays from 263 neonates diagnosed with NEC (94 surgical cases), a binary diagnostic tool was trained and validated, with Resnet18 as approach applied (Wu et al.). For PDA, an ultrasound-based assessment of ductus arteriosus intimal thickness in the first 24 h after birth was applied in 105 preterm neonates. A prediction model for closure on day 7 included birth weight, mechanical ventilation, left ventricular end-diastolic diameter, and PDA intimal thickness (Hu et al.). Such models can be considered to better target future study, integrated in a precision medicine approach. Use of AI and big data have the potential to significantly improve our understanding of neonatal conditions and also support neonatal researchers in asking better research questions.

Underreported aspects of contemporary NICU care, holistic care

As part of this research topic, we also accepted papers reporting on the use of music on pain management, on multisensory stimulation to improve maternal milk volume production, and parents’ experiences related to congenital cardiac surgery. All these 3 papers reflect the need for holistic care and to further integrate the perspectives of (former) patients and parents into neonatal practice.

In a systematic review, Ou et al. demonstrated that music is an effective intervention to relief procedural pain (e.g., Premature Infant Pain Profile score) in preterm neonates, as it reduced some markers of stress, and improved blood oxygen saturation (Ou et al.). Multisensory stimulation (audiovisual, or audiovisual + olfactory) compared to a control setting improved maternal milk volume production, with evidence of positive effects of both interventions, even more pronounced if both interventions are combined (Cuya et al.). Finally, a quantitative analysis of parent’s experiences with neonates admitted to NICU with a congenital heart disease reinformed us on the importance of actively focusing on parental experiences of care (Catapano et al.).

From advances in neonatal care to implementation In our opinion, this research topic nicely illustrates the diversity in ongoing clinical research activities, that all hold the promise to improve our clinical management practices, with the overarching aim to improve neonatal outcomes. There is an urgent need to focus on the current health inequities in the provision of care to neonates (3). The trend towards a “neuro” dedicated NICU care is an illustration on how relevant progress may occur. This progress is based on improved neuromonitoring techniques (7), improved management and precision medicine in the field of anti-epileptic drugs (8), and integrating families as partners in neonatal neuro-critical care and similar improvement programs (9). The good news is that we are already experiencing a shift in the right direction. The neonatal community and all other relevant stakeholders need to work better together to improve the pace and scale of this improvement.

Source:https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2025.1552262/full

Despite the widespread use of pain rating scales in neonatal care worldwide, a new Cochrane review shows that current tools for assessing pain in newborns are based on very low quality evidence. According to the review, none of the pain rating scales in use today are methodologically reliable enough to measure pain.

The Cochrane analysis, which included 79 studies involving over 7,000 infants across 26 countries, evaluated 27 different clinical rating scales. The findings reveal significant limitations in the reliability and clinical usefulness of all currently available tools, raising concerns about whether healthcare professionals can accurately measure pain in this extremely vulnerable population.

“We were truly hoping that one pain scale would be stronger than another, but instead we found that all of them are poorly developed. This is an issue that also affects Swedish clinical practice and research. For example, a recent publication out of KI found that 25 percent of Swedish infants were assessed without using a rating scale at all, which was already shocking, and now we can confirm that the remaining 75 percent of the infants were assessed with rating scales that are now known to not be methodologically sound enough to measure pain. So, this unfortunately means that medical professionals cannot be sure whether they are measuring pain at all.” says Emma Persad, Phd student at the Department of Women’s and Children’s Health, Karolinska Institutet.

Yet, from this uncertainty comes a call to action. The researchers hope these findings will spark a global collaborative effort, led by Swedish experts, to develop a new, robust, and evidence-based pain assessment scale for newborns. Such a tool could greatly improve neonatal care worldwide and further establish Sweden as a leader in the field of neonatology.

According to the article “this involves developing better rating scales or physiological techniques to measure pain”.

““This is precisely what we are hoping to do. Through convening the global community we hope these findings and the outcome become a global collaborative effort, driven by Swedish researchers, to finally develop a pain rating scale that is robust and evidence-informed (and will hopefully be properly adapted and translated for use worldwide). We hope that Sweden’s role in neonatology can further be solidified through this work,” says Emma Persad.

Source: https://news.ki.se/swedish-led-initiative-aims-to-revolutionise-pain-assessment-in-newborns

Dr. Michael Copass, M.D.—a Harborview Emergency Medicine physician instrumental in the early development and later leadership of the Medic One paramedic training program, helping expand it beyond cardiac care—worked alongside Dr. Leonard Cobb and Seattle Fire Chief Gordon Vickery to shape what would become one of the world’s most respected emergency medical systems. When the original grant funding for the Medic One program ended unexpectedly, the community rallied in extraordinary ways: bake sales, marathons, neighborhood drives, even children donating their birthday money. Their efforts raised nearly $200,000, inspiring the creation of the Medic One Foundation in 1974 to ensure this lifesaving work would never fade. Since that time, more than $35 million has been invested in Medica One’s training, equipment, and research, contributing to lifesaving outcomes on a daily basis.

Years later, that legacy still lives and breathes inside the halls of Harborview Medical Center. As a student assistant with the University of Washington School of Medicine and the UW surgical residency program, I had the privilege of witnessing something quite extraordinary. Each week, an Emeritus physician would return to the hospital—not for recognition or ceremony, but simply to sit down for lunch and vibrant conversation.

Those gatherings were never formal lectures. They were living, breathing exchanges of wisdom — stories from the early days of emergency medicine, thoughtful clinical reflections, and gentle reminders that compassion matters just as much as technical skill. Students, interns, residents, fellows, and senior attendings all pulled up chairs. Hierarchies faded. Curiosity filled the room. Medicine, in its truest form, felt like a shared calling.

It was in those moments that I truly understood the impact Emeritus physicians have on the medical community. They often carry history, perspective, humility — and they give it away freely. Their mentorship strengthens not just clinical practice, but the heart of healthcare itself. The legacy of Medic One isn’t only found in ambulances and survival rates — it is also found in conversations around cafeteria tables, where knowledge is passed from one generation to the next.

And as we continue to advocate for fragile newborns and medically complex children, that lesson stays with me: when compassion, community, courage, and teaching come together, the ripple effect is immeasurable — and hope continues forward.

–Kathryn Campos & Kathy Papac

Voices, Targeting Healthcare, Breaking Bread

Lebanon, officially the Republic of Lebanon, is a country in the Levant region of West Asia. Situated at the crossroads of the Mediterranean Basin and the Arabian Peninsula, it is bordered by Syria to the north and east, Israel to the south, and the Mediterranean Sea to the west; Cyprus lies a short distance from the coastline. Lebanon has a population of more than five million and an area of 10,452 square kilometres (4,036 sq mi). Beirut is the country’s capital and largest city.

Lebanon is a parliamentary democracy that includes confessionalism. The National Pact, erected in 1943, laid out a governing arrangement intended to harmonize the interests of the country’s major religious groups. The President has to be a Maronite Christian, the Prime Minister a Sunni Muslim, the Speaker of the Parliament a Shi’a Muslim, the Deputy Prime Minister and the Deputy Speaker of Parliament Eastern Orthodox. This system is intended to deter sectarian conflict and to represent fairly the demographic distribution of the 18 recognized religious groups in government.

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

COMMUNITY

Background

Most of the Infant and Family Centered Developmental Care (IFCDC) Standards focus on evidence-based approaches to care of the baby and family while in intensive care. An ever expanding literature provides rationale for promoting the best care environments for the baby’s developing brain, as well as for parents’ physical and emotional adjustment as they transition to parenthood. As babies may spend days, weeks, and sometimes months during a critical time for brain and behavioral organization, an emphasis has been placed on neuroprotective caregiving strategies and environmental protection to enhance medical, developmental, and psychosocial outcomes.

Both neurodevelopmental and physiological research focus primarily on the age range of babies from birth to discharge, typically ending at 40 weeks post-conceptional age, or when the baby goes home. As babies may be discharged at earlier ages than in previous years—when medically stable, but before many neurodevelopmental tasks have been firmly established (e.g., coordinated eating, sleeping, and regulation)– it is important to extend the focus to the weeks and months after discharge when the baby is still in a developmental fast track.

Babies deemed medically stable enough to transition home need appropriate supports for discharge and preparation for life after hospitalization. A growing literature documents best practices for that preparation, assuring a smooth and uncomplicated transition to community services.

Post-discharge visits to the baby’s pediatrician typically focus on medical stability, as is appropriate. However, most follow-up clinic visits, which include developmental assessment and monitoring, may not occur until the baby is 3-6 months of age. Early intervention services in the United States provide developmental assessment and intervention, if appropriate, for those babies who are “categorically eligible” through Part C of the Individuals with Disabilities Education Act (IDEA). https://www.ed.gov/laws-andpolicy/individuals-disabilities/idea.

Each state determines the qualifications for eligibility, often including diagnoses of established conditions that demonstrate evidence of significant developmental delay (e.g., Down syndrome, chromosomal abnormalities, deafblind conditions, etc.). Often, low birthweight is either not included or restricted to birthweight under 1200 grams, which excludes those babies who have been identified as likely to have lingering developmental deficits (e.g., late preterm babies 34-36 weeks post-conceptual age). Part C assessment and follow-up are mandated to occur within a 45-day timeframe. However, many babies are not identified while they are in the hospital and may not be deemed eligible until obvious developmental concerns surface.

Rationale for assuring continuity of developmental and psychosocial supports from hospital to home.

Support for early brain organization during the neonatal period and throughout the first years of a baby’s life is critical for later development. The literature is replete with evidence regarding neurophysiological and behavioral development, as well as an emphasis on the need for appropriate relationship environments to promote optimal outcomes. Emerging evidence of specific brain development during the first few months of a baby’s life (often referred to as “the fourth trimester”) lends emphasis to the importance of not only understanding the enormity of brain development during this period, but also the potential opportunities for creating appropriate environments and caregiving.

The impact of early birth, medical complexities, and associated hospitalizations on brain development and organization indicates that short and long-term neurophysiologic, behavioral, and mental health outcomes are affected. These and many other outcome studies emphasize the need for early, appropriate environmental and developmental protections, as well as individualized care. Given the recent findings regarding the significant brain development and organization during the first three to six months (in addition to development during the last trimester), it becomes apparent that a significant focus should be on effective interventions both before and after discharge.

Brain and behavior development in parents

Brain changes also occur as parents are transitioning to becoming primary caregivers of their new baby. Emerging evidence of neuroendocrine, neurophysiologic, and behavioral changes during pregnancy, delivery, and postpartum indicates that the experience of becoming parents—for both mothers and fathers — has significant implications for later physical and mental health. Fewer studies indicative of brain changes in parents of early born and medically fragile babies are available; however, there are clear associations with parental mental and physical health challenges.

 Punctuated events and recalibration

As babies transition from being fetuses to newborns, there is a significant impact on their brain and behavioral organization. The environment is significantly different, necessitating adaptation from uterine to a maternal caregiving environment. This dramatic change has been referred to as a “punctuated event,” which signifies a significant change in both physiology and behavior, resulting in a period of adaptation and recalibration of behavior.

As previously proposed, a similar punctuated event occurs when the baby transitions from the familiar hospital caregiving environment to the novel home/community environment. (39, 40) It is no wonder that the babies who transition home experience changes in physiology and behavior as a result. Often, medical issues arise, sleep states are disorganized, feeding challenges occur, and previously effective calming strategies seem to be ineffective.  If the parent and baby have not had a chance to experience intimate and consistent caregiving in the hospital, which provides the continuity of a trusting relationship, there can be challenges in the process of recalibration.

Parents also experience significant life-changing events to which they must adapt and recalibrate. Pregnancy to delivery and delivery to parenting represent significant punctuated events that may cause other physiologic and/or mental health concerns to emerge. Most parents of term and medically stable babies have had opportunities to adapt to this change cognitively and psychologically. For parents who have a challenging pregnancy, a difficult delivery, and/or a baby at risk for medical challenges, these punctuated events can raise physiological and psychological challenges to which recalibration is complicated.

As with the transition home for babies, the transition home for parents can be disorganizing and difficult. Parents may not only be dealing with their own physical and/or mental health issues as a result of pregnancy, delivery, and hospitalization of their baby, but with the full-time care and adjustment to care in their own home environment. (48-50) Often, the demands of baby care and selfcare are discrepant, resulting in poor sleeping and eating, lack of exercise and social interactions, and other mental health concerns becoming issues that need to be addressed. Unfortunately, these issues may not be addressed quickly and may persist for the first 3-6 months of the family’s life together at home.

Relationship environments are essential for optimal development.

 One of the most significant influences on babies’ outcomes is the relationship environment with their primary caregiver. Given the significant neurophysiological and behavioral changes that occur in both newborns and their parents during the first few months after delivery, the development of robust and mutually supportive interactions is fraught with a variety of challenges and successes. These are particularly challenging for parents who come to parenting with significant mental health issues, economic and/or cognitive challenges, few social supports, and/or limited educational backgrounds.  Effective interventions have been developed to enhance the parent/baby relationships applied in community settings.

Although effective interventions in communities to promote relationships between parents and their babies have been developed, the application of these programs for parents of medically fragile or early born babies and related research is limited.  Having a hospitalized baby presents challenges to early relationship development. A multitude of medical, psychosocial, environmental, cultural, and systems events can challenge early relationship development. Early separation of baby and parent, postpartum medical issues in the postpartum period, family and job responsibilities, grief reactions and fear, poor communication with professionals, as well as restrictive policies and procedures, are but a few of the interfering variables that can affect robust relationship development. 

The Infant and Family Centered Developmental Care (IFCDC) Standards address continuity from the hospital to the community.

The IFCDC standards emphasize the importance of collaboration with parents to ensure they are well-prepared to support their baby’s development both in the hospital and after discharge. Each NICU system should engage in collaborative efforts among team members, including parents and caregivers.

The focus should promote and ensure parents’ preparation for transition to community resources, which can be accomplished by providing competent and relevant physical, developmental, and psychosocial services throughout the hospital stay and into the community.

The IFCDC standards also emphasize the need for collaboration with follow-up and community providers who will support their families in the weeks and months after hospitalization.

Conclusion:

Continuity during the transition from intensive care to the family’s home and community presents neurophysiological, psychosocial, and behavioral challenges for both babies and their parents. These occur during a particularly vulnerable time, as the last trimester and the first 3-6 months represent a sensitive period of brain, behavior, and relationship development. Interventions in the hospital should focus not only on neurodevelopmental support and environmental protection but should also emphasize parental involvement in preparation for supporting their baby’s development after discharge. As delineated in the IFCDC standards, it is essential for the intensive care community to not only engage parents as team members and prepare them during hospitalization for post-discharge care, but also to ensure continuity of well-prepared community support and medical follow-up. Currently, the kind of intervention that addresses the specific needs of babies and their parents — early and often, during the first 3-6 months —is not consistently practiced in the United States. There is a need for appropriately trained providers who can sensitively and knowledgably address health, development, relationship, and mental health, development, relationship, and mental health issues for vulnerable families during this vulnerable period.                    

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Source: https://www.marchofdimes.org/ways-to-give/donate?utm_campaign=2021advocacy&utm_content=footer&utm_medium=email&utm_source=advocacy

Since 7 October 2023, 47% of attacks on health care – 65 out of 137 – have proven fatal to at least one health worker or patient in Lebanon, as of 21 November 2024.

This is a higher percentage than in any active conflict today across the globe – with nearly half of all attacks on health causing the death of a health worker.

In comparison, the global average is 13.3%, based on the SSA’s figures from 13 countries or territories that reported attacks in the same period, 7 October 2023–18 November 2024 – among them Ukraine, Sudan and the occupied Palestinian territory (oPt). In the case of oPt, 9.6% of the total number of incidents has resulted in the death of at least one medical professional or patient.

According to the SSA, 226 health workers and patients were killed in Lebanon and 199 injured between 7 October 2023 and 18 November 2024.

In the same period, the SSA registered a combined total of 1401 attacks on health in oPt, Lebanon and Israel – 1196 in oPt, 137 in Lebanon and 68 in Israel.

Civilian health care has special protection

“These figures reveal yet again an extremely worrying pattern. It’s unequivocal – depriving civilians of access to lifesaving care and targeting health providers is a breach of international humanitarian law. The law prohibits the use of health facilities for military purposes – and even if that is the case, stringent conditions to taking action against them apply, including a duty to warn and to wait after warning,” said WHO Representative in Lebanon Dr Abdinasir Abubakar.

International humanitarian law states that health workers and facilities should always be protected in armed conflicts and never attacked. Health facilities must not be used for military purposes, and there should be accountability for the misuse of health facilities.

“There need to be consequences for not abiding by international law, and the principles of precaution, distinction and proportionality should always be adhered to. It’s been said before, indiscriminate attacks on health care are a violation of human rights and international law that cannot become the new normal, not in Gaza, not in Lebanon, nowhere,” said WHO Regional Director for the Eastern Mediterranean Dr Hanan Balkhy.

The majority of incidents in Lebanon impact health workers

The majority (68%) of incidents in Lebanon registered by the SSA impacted health personnel, a pattern seen repeatedly in the last few years, including in Gaza in the past year. In Lebanon, roughly 63% affected health transport and 26% affected health facilities.

Attacks on health care hit twice. First, when health workers lose their lives or when a health centre is obliterated, and again in the following weeks and months when the injured can’t be treated, those who are dependent on regular care don’t receive it and when children can’t be immunized. 

“Casualty numbers among health workers of this scope would debilitate any country, not just Lebanon. But what the numbers alone cannot convey is the long-term impact, the treatments for health conditions missed, women and girls prevented from accessing maternal, sexual and reproductive health services, undiagnosed treatable diseases and, ultimately, the lives lost because of the absence of health care. That is the impact that’s hard to quantify,” said Dr Abubakar.

1 in 10 hospitals in Lebanon directly impacted

The greater the blow to the health workforce, the weaker the longer-term ability of a country to recover from a crisis and deliver health care in a post-conflict setting.

Lebanon is a lower middle-income country with a fairly advanced health system that’s been hit hard by multiple crises in recent years. After hostilities in Lebanon escalated in September 2024, the growing number of attacks on health have caused further strain on an already over-burdened system.

Today, the country’s health system is under extreme duress, with 15 out of 153 hospitals having ceased to operate, or only partially functioning. Nabatieh, as an example, one of Lebanon’s 8 governorates, has lost 40% of its hospital bed capacity.

“Attacks on health care of this scale cripple a health system when those whose lives depend on it need it the most. Beyond the loss of life, the death of health workers is a loss of years of investment and a crucial resource to a fragile country going forward,” Dr Balkhy concluded.

So far this year, between 1 January 2024 and 18 November 2024, a total of 1246 attacks on health care were registered globally, in 13 countries or territories, killing 730 health workers and patients and injuring 1255.

Note to editors

The Surveillance System for Attacks on Health Care (SSA), established in 2017 by the World Health Organization, is an independent global monitoring mechanism whose goal is to collect reliable data on attacks on health care and to then identify patterns of violence that inform risk reduction and resilience measures so that health care is protected. The SSA also provides an evidence base for advocacy against attacks on health care.

Source: https://www.who.int/news/item/22-11-2024-lebanon–a-conflict-particularly-destructive-to-health-care

HEALTHCARE PARTNERS

Skin-to-skin care helps newborn babies in many ways – brain development, regulating heart rate and body temperature, and bonding with their caregivers.

When a baby needs to be in the NICU, skin-to-skin care is especially important, but there can be challenges.

The team at Regional One Health’s Sheldon B. Korones Newborn Center is helping address that through an innovative use of existing equipment that helps facilitate skin-to-skin care.

After a baby is born, skin-to-skin contact is a powerful tool to bond with your baby, improve their brain development, and help them regulate their heart rate and body temperature. But when a baby needs to be in the NICU, skin-to-skin care can be more challenging.

“After a routine delivery, moms are encouraged to have skin-to-skin care right away,” said Ajay Talati, MD, medical director at Regional One Health’s Sheldon B. Korones Newborn Center. “If the baby has to go straight to the NICU for treatment, that can’t happen.”

Challenges can remain once a baby is in the NICU, said Kelley Smith, NICU Nursing Manager. If a baby is on an oscillator, a mechanical ventilation device used to help premature or ill infants breathe, they are connected to tubing that has to stay at the same level as their incubator.

“With an oscillator, the tubing is very stiff – it can’t be bent,” Smith explained. “That makes it hard to move the baby into the parents’ arms for skin-to-skin care.”

The NICU team started looking for a solution and found it in an innovative new use for a piece of equipment that is commonly found in other parts of the hospital.

Cardiac chairs are typically used to help cardiac and stroke patients rest in an optimal position. Because the chairs can go up and down, recline, and even lay flat, Smith and Assistant Nursing Manager Heather Burgess saw an opening to use them in the NICU for skin-to-skin care.

“With this chair, we can have the mom or dad sit in the chair and raise the chair to the level of the oscillator’s tubing,” Smith said. “It makes it easier to get the baby out of the incubator.”

Skin-to-skin care helps babies in a number of ways. “After a routine delivery, moms are encouraged to have skin-to-skin care right away,” said Ajay Talati, MD, medical director at Regional One Health’s Sheldon B. Korones Newborn Center. 

A generous Regional One Health Foundation supporter stepped up to donate a cardiac chair to the NICU, and the nursing team is now educating patients about its use and making it available to all families that can benefit. Along with families whose baby is on an oscillator, moms who have had a C-section are finding the chair useful.

“Many moms can’t sit upright for 12 to 24 hours after a C-section, and it can be uncomfortable trying to get in and out of a chair,” Dr. Talati said. “We use it whenever a mom or baby needs it. It’s great for when a baby is too sick to be lowered or when a mom has pain after a C-section.”

Burgess said finding a solution was important to the NICU team because skin-to-skin care has many proven medical benefits for babies and moms.

For the baby, skin-to-skin care helps regulate body temperature, breathing and heart rate and improves brain development, Burgess said. For moms, skin-to-skin can help improve breastmilk production, regulate postpartum hormone balance, and reduce anxiety and stress.

There’s also the matter of bonding, which applies not only to new moms, but to all caregivers.

“We encourage parents to do skin-to-skin care in the first week of their baby’s life, especially for very small, very sick babies,” Smith said. “When you have a baby in the NICU, you’re anxious and afraid, so sometimes parents wait until they go home. That can be a missed opportunity for bonding. The sooner we start skin-to-skin, the better off the family unit will be.”

Dr. Talati, Smith and Burgess have seen the value of skin-to-skin care on multiple occasions.

Moms, dads and other caregivers can all take part in skin-to-skin care. “We encourage parents to do skin-to-skin care in the first week of their baby’s life, especially for very small, very sick babies,” NICU Nursing Manager Kelley Smith said. 

The first mom to use the chair had impressive results. “Her baby came off the oscillator the next day!” Smith said. “It’s amazing to see. We’ll have babies on an oscillator with an oxygen saturation in the low 90s…then they do skin-to-skin and it shoots up to 100!”

Burgess said another mom provided skin-to-skin care in the NICU every day, and it contributed to her baby getting healthy enough to go home much sooner than originally expected.

Dr. Talati said there is plenty of evidence behind those individual experiences. Factors like better milk production and better feeding, the ability to regulate body temperature and heart rate, and increased oxygen saturation can all help a baby get stronger.

“It’s a lot of little things that can add up to the baby making faster progress toward going home,” he said. “We hope it can speed that up and we can help more babies go home sooner.”

Source: https://www.regionalonehealth.org/blog/2025/01/22/nicu-finds-innovative-way-to-facilitate-skin-to-skin-care-helping-families-improve-their-babys-health-and-get-home-sooner/

Have you ever wondered how the Neonatal Resuscitation Program (NRP) guidelines are created—and more importantly, who decides what changes and why? In this episode, we take you behind the scenes of the science and collaboration that shape NRP. From the rigorous evidence review conducted by the International Liaison Committee on Resuscitation (ILCOR) to how these findings are translated into bedside practice, you will learn exactly how research becomes reality. 

Together, Dr. Gary Weiner and Amanda Williams break down the multi-layered process of evidence evaluation, guideline development, and educational translation, while highlighting the critical role nurses play in shaping the NRP used daily. Whether you are new to NRP or a seasoned instructor, this episode will inspire you to see the program through a whole new lens and recognize the power of your voice in shaping neonatal care. 

Discover why NRP is more than a textbook—it is a living, breathing, global collaboration grounded in science and strengthened by the people who use it. 

For the past 10 years, I have worked as a pediatrician and neonatal hospitalist in multiple Level 2 NICUs across Georgia and other states. Over time, I have come to a realization that I cannot ignore: there is a significant public health imperative—and a gap in equitable access—when it comes to developmental and family support services in Level 2 NICUs.

Level 3 and 4 NICUs often have consistent access to lactation consultation, feeding therapy, physical and occupational therapy, and even music therapy. In Level 2 settings, those services are less consistently available—sometimes absent altogether. This discrepancy has a lasting impact on infants and families.

The common perception is that if a baby is born at or after 32 weeks and weighs ≥ 1500 grams—the typical admission criteria for Level 2—that they have “made it.” But research tells a different story. Moderately and late-preterm infants, even those who meet Level 2 thresholds, remain at high risk for readmission, feeding difficulties, developmental delays, and long-term neurodevelopmental challenges (1-4). Prematurity in any form is not a short-term hurdle—it is a lifelong risk factor that requires intentional support from the start.

So, why are we not introducing key developmental concepts, early intervention techniques, and consistent family education into Level 2 NICUs? Why are we not equipping nurses and families with the same foundational knowledge and access to services that higher-level NICUs utilize?

The NICU is not only a place for acute medical stabilization—it is a unique window of opportunity to shape lifelong outcomes. Families in Level 2 units should see themselves as vital participants in their baby’s success and be empowered with the tools to support feeding, bonding, sensory development, and early learning before discharge. Nurses should have access to training that enables them to integrate trauma-informed, developmental care principles into their daily practice, even when an entire therapy team is not available on the unit.

I believe it is time to establish a Task Force on Level 2NICU Care, bringing together neonatologists, neonatal hospitalists, nurses, therapists, public health professionals, and parents, to examine the current state of developmental and family support services in these units, identify barriers, and develop scalable strategies for improvement.

Potential strategies include: • Standardized education for nursing staff on early-intervention techniques, family engagement, and trauma-informed developmental care.

 • Telehealth access to lactation consultants, feeding/ occupational/physical therapists, and other specialists when on-site resources are limited.

• Parent-education toolkits that cover feeding, developmental milestones, safe sleep, and the importance of follow-up and early-intervention services.

• Structured discharge planning that includes referrals to early-intervention programs and developmental follow-up clinics for all eligible infants.

The public-health impact of closing these gaps is profound. If we can equip Level 2 NICUs with consistent developmental care education and tools, we can reduce readmissions, improve neurodevelopmental outcomes, and strengthen families’ ability to support their child’s growth and resilience.

The babies in Level 2 NICUs deserve the same intentional approach to developmental care as those in higher-level units. They may have “made it” past the highest-risk thresholds, but they have not yet crossed the finish line. We can—and must—do better.

Now is the time to act. Clinicians, hospital leaders, and policymakers must collaborate to prioritize Level 2 NICUs in state and national maternal-child health agendas. By identifying service gaps, piloting telehealth and staff-training models, and measuring family-centered outcomes, we can transform Level 2 NICUs from sites of short-term stabilization into launchpads for lifelong development, resilience, and equity.

Source: https://neonatologytoday.net/newsletters/nt-oct25.pdf

INNOVATIONS

Introduction: The huge prevalence of neurodevelopmental disorders underscores the necessity for novel, comprehensive prevention strategies for neuroprotective intervention, particularly in preterm infants. The COVID-19 pandemic has accelerated the transformation of healthcare services, emphasizing the use of digital resources. Given the rapid brain development in infants in the first 1,000 days of life and the demonstrated impact of adaptive neuroplasticity, the implementation of early and ecological interventions are essential for supporting optimal neurodevelopment in this vulnerable population. Aim of this project is to develop a digital tool for parent-led parent-based intervention and assess its feasibility and accessibility.

Materials and methods: We collected evidence on early intervention strategies for preterm infants through a non-systematic review of current literature to develop the platform and created an ad-hoc questionnaire to evaluate the tool’s feasibility and acceptability in our neurological follow-up.

Results: “NE@R” is a digital platform designed to support neurodevelopment through parents-delivered play. The platform offers evidence-based information, videos, and practical activities to enhance motor, cognitive, social, and language development at each developmental phase. We introduce the resource in our clinical setting and collect 100 preterm infants’ families feedback. The majority of parents reported finding the resource beneficial, with many expressing increased confidence in supporting their child’s development.

Discussion: Preterm babies families’ support represents a precious field of intervention both for parents and infants at risk. “NE@R” has proven to be an effective, low-cost tool within our follow-up program, aligning with the principles of family-centered care.

Patricia Odero is an innovation facilitator extraordinaire based in Nairobi, Kenya, working for The Duke Global Health Institute. Patricia is trained in Medicine, Business and Social innovation and uses her skills and experience to help entrepreneurs in West Africa and beyond with funding and growth. She talks about the importance of networks, particularly in health entrepreneurship – long-term relationships and support programmes for organisations of different sizes and stages. Patricia has great advice for entrepreneurs and really interesting stories from the field. You can follow Patricia on Twitter @TrishOdero, BMJ Innovations @bmjinnovations and podcast host Helen Surana @hjsurana.

BMJ innovations is grateful to the World Innovation Summit for Health WISH for making this podcast series possible.

Takeaways

  • Children born preterm were significantly less likely to complete high school or university compared with full-term peers, according to a large Quebec-based study.
  • Non-graduation rates were highest among those born extremely preterm (40.2%) and lowest among full-term births (27.1%).
  • Low maternal education, male sex, unmarried parents, and low neighborhood socioeconomic status were major predictors of poorer academic performance.
  •  The odds of completing high school are reduced among children born preterm vs full-term, according to a recent study published in JAMA Network Open.

Approximately 10% of infants are born preterm, which may cause early exposure to noxious factors and influence brain development, challenging neurodevelopment and mental well-being. Additionally, socioeconomic factors often prevent children from accessing support systems that can mitigate disabilities.

“Few researchers have conducted studies on long-term educational outcomes across the full spectrum of preterm birth using large population-based cohorts that account for other health-related determinants and socioeconomic factors,” wrote investigators.

Assessing preterm birth and education

The birth cohort case-control study was conducted to assess the impacts of preterm birth and sociodemographic factors on educational outcomes. Live preterm births in Quebec, Canada, between January 1, 1976, and December 31, 1995, were included in the analysis.

Each preterm individual was matched with 2 full-term patients, defined as 37- to 42-weeks gestation. Exclusion criteria included multiple pregnancies, triplet births, and death between 1976 and 2019 without Quebec Ministry of Education records.

Extremely preterm birth was defined as under 28 weeks, very preterm as 28 to under 32 weeks, and moderate-to-late preterm as 32 to 37 weeks. Forty-three years of follow-up data was obtained from administrative databases.

High school performance was measured using the final high school average recorded in the Quebec Ministry of Education database, using marks obtained in grades 10 and 11. Covariates included year of birth, birth order, sex, stillbirth history, primary language, matrimonial status at birth, maternal education, and neighborhood socioeconomic status.

Participant characteristics and academic performance

There were 297,820 participants included in the final analysis, 0.6% of whom were born extremely preterm, 4.4% very preterm, 27.9% moderate-to-late preterm, and 67% full-term. Under 11 years of maternal school were reported in 20.6%, 24%, 23%, and 20.3%, respectively.

Preterm birth groups also more often reported primary languages other than French or English, and more recent birth years were reported in those born extremely preterm. Overall, the rate of preterm births in Quebec rose from 4.6% between 1976 and 1980 to 6.1% between 1991 and 1995.

Significant differences were not reported in high school performance based on preterm birth, with final mean scores of 69.4, 70.2, 70.7, and 71 for extremely preterm, very preterm, moderately preterm, and term births, respectively. However, rates of not graduating from high school were 40.2%, 34.4%, 31.1%, and 27.1%, respectively.

This data indicated significantly reduced odds of high school graduation from preterm birth. These patients were also more likely not to graduate from university. Rates included:

  • 83.3% for extremely preterm
  • 80.2% for very preterm
  • 78.2% for moderately preterm
  • 75.8% for full-term

Socioeconomic and demographic influences

In regression analyses, a B coefficient range of 0.15 to 1.45 was reported for the link between preterm status and final high school average. Low maternal education, male sex, low neighborhood socioeconomic status, not being first-born, and mother not married had the most significant B coefficients for low average marks of 4.43, 2.84, 2.30, 2.30, and 1.98, respectively.

These results indicated reduced odds of graduating from high school or university among children born preterm vs their full-term counterparts. Investigators concluded long-term follow-up is needed in both health care and education among individuals born preterm.

This data highlights the importance of preterm birth prediction. Identifying individuals at an increased risk of preterm birth may be more accurate through the use of neighborhood-level indices, according to Daniel L. Kuhr, MD, third-year fellow in maternal fetal medicine at the Icahn School of Medicine at Mount Sinai.

According to Kuhr, an increase in prediction was only noticeable when including individual patient characteristics. This highlights a need to evaluate other social determinants of health that may influence preterm birth risk.

“The best thing that you can do is take a really good history when you meet a patient at the beginning of pregnancy, and really make sure you can get accurate gestational ages of delivery when possible, because we do know that history of a prior spontaneous preterm birth is also a risk factor,” said Kuhr.

Source: https://www.contemporarypediatrics.com/view/preterm-birth-linked-to-reduced-odds-of-high-school-graduation

PREEMIE FAMILY PARTNERS

One of the first things that comes to mind when I think about the holidays is…food. Whether I’m crowded around a dinner table with family and friends or pulling my favorite cranberry and pear pie out of the oven to take to a holiday gathering, there’s something special about breaking bread with the ones you love.

Food, it seems, has a language of its own. In communities across the globe, food has a unique way of bringing people together. And this holiday season, we wanted to help you connect with your friends, family and with the World Relief community by sharing a few recipes from around the world in our new ebook — Breaking Bread Across Borders: Global Recipes from Refugee Kitchens.

https://worldrelief.org/blog-breaking-bread-recipes-around-the-world/DOWNLOAD THE RECIPES!

This ebook is filled with stories and recipes from immigrants who are part of  World Relief Western Washington’s Commercial and Teaching Kitchen — an innovative program that connects members of the community with their immigrant neighbors through workshops and events led by immigrant chefs while providing low-cost commercial kitchen space for immigrant caterers to rent and run their businesses. 

For women like Katya, who owned a bakery when she lived in Ukraine, the commercial and teaching kitchen is a way to bring people joy while pursuing her passion here in the U.S.
“​​I love to bring joy to people with my baking,” Katya said. “You become a piece of people’s special events [when you bake for them]. You become a piece of the joy.”

Source: https://worldrelief.org/blog-breaking-bread-recipes-around-the-world/

ABSTRACT

Background: 

The formation of the family is interrupted following a Neonatal Intensive Care Unit (NICU) admission, and fathers report experiencing delayed infant bonding due to unit barriers and separation. Fathers state comfort with early infant bonding through language, fearing physical contact with the sick newborn. During hospitalization, active engagement supports ongoing infant/parent vocalization and infant stabilization.

Purpose: 

This prospective descriptive pilot study explored the infant’s physiological response to the father’s voice during a live reading activity.

Methods: 

After Institutional Review Board approval and consent, 27 infant/father dyads were observed pre/post and during a live reading activity. All infants were in private rooms and positioned supine in open cribs, adjusted to 36 weeks or greater postmenstrual age, in a 34-bed Level III NICU in the Midwest. Outcome measures included cerebral oxygenation, oxygen saturation, heart rate (HR), and respiratory rate. Infants were monitored for 30 minutes prior to father reading, 10 minutes during and 30 minutes post reading.

Results: 

A clinically significant increase in cerebral oxygenation was noted, based on near-infrared spectroscopy readings in response to the father’s voice. Most infants had HR stabilization during the father’s active reading time frame.

Implications for Practice and Research: 

NICU nurses and staff can encourage a father’s engagement through speaking or reading to their infant. Nursing staff can promote verbal engagement between father–infant dyads by role modeling this behavior at the bedside. NICUs can provide books for families to further encourage exposure to father’s voices. Further study of premature infants at earlier chronological and adjusted ages is needed.

Source:https://journals.lww.com/advancesinneonatalcare/abstract/9900/the_response_of_the_infant_to_the_father_s_voice.231.aspx

About the Study

Anxiety disorders are defined and classified in diagnostic systems like the Diagnostic and Statistical Manual of Mental Disorders (DSM, currently version IV-TR, American Psychiatric Association) and the International Classification of Diseases (ICDS) (ICD, currently version 10, World Health Organization). Many anxiety disorders have clinical aspects across multiple systems, such as high levels of anxiety, physiological anxiety symptoms, and behavioural problems such as severe avoidance of fearful situations, and related discomfort or impairment. However, there are distinctions, and it’s worth noting that narrowly classified anxiety disorders like panic disorder, agoraphobia, and subtypes of certain phobias have a lot of phenotypic variety or heterogeneity.

From time to time, all children have worries and fears. However, anxiety in children can sometimes cross the line to a disorder that prevents them from normal everyday concerns doing the things they need to do. It may even prevent them from properly understanding life.

How do we determine whether the child’s worries and fears are more than just passing thoughts?

Here are a few questions to ponder:

• Do they express fear or anxiety on a regular basis, for weeks at a time?

• Is it difficult for them to sleep at night? Do they seem abnormally drowsy or exhausted during the day?

• Is it difficult for them to concentrate?

• Do they seem angry or easily irritated?

Anxiety disorders can manifest itself in a variety of ways in children. Some of the most common are:

Generalized Anxiety Disorder (GAD)

GAD children are overly concerned about a variety of things, including school, their own safety and health, the health of family members and friends, money, and the security of their families. The list could go on indefinitely. A child suffering from GAD may constantly imagine the worst-case circumstance. These anxieties may induce physical symptoms in children with GAD, such as headaches and stomach-aches. Because they are so burdened by their fears, your child may isolate themselves, avoiding school and friends.

Panic disorder

A panic attack is a sudden, acute experience of worry that occurs for no particular reason. The child’s heart may race, and he or she may be out of breath. The child may have tremors, dizziness, or numbness. (If the child is hyperventilating, encourage them to breathe gently and deeply.) Breathing through a brown paper bag can be beneficial.) Panic disorder is diagnosed when the child has experienced two or more of these episodes and is preoccupied with fears of them happening again.

Separation Anxiety Disorder (SAD)

Separation anxiety affects all children to some extent. It’s a normal developmental stage for babies and toddlers. Even older children, especially in new situations, may become clingy with their parents or caretakers. Separation anxiety disorder may affect older children who become especially upset when leaving a parent or another close relative, who have difficulty calming down after saying goodbye, or who become highly homesick and disturbed when away from home at school, camp.

Social phobia

In typical, everyday social circumstances, a child with social phobia experiences extreme anxiety and self-consciousness. This isn’t just a case of timidity. When talking with classmates, answering a question in class, or doing other common activities that require interacting with people, the socially anxious child is afraid of embarrassing themselves. This fear may prevent your child from attending school and participating in extracurricular activities. In severe instances, young children may even be unable to speak.

These are the type of anxiety disorders and their assessments on the children, to be considered by the parents, and treat their children accordingly.

Source: https://www.omicsonline.org/open-access/the-assessment-of-anxiety-in-children-and-the-types-of-anxiety-disorders-118047.html

✨ December Kindness for Neonatal Womb Warriors ✨

As December arrives—a month shaped by reflection, generosity, and deeper emotions—the Neonatal Womb Warriors community is reminded that kindness is one of the most powerful tools we have for calming fear and nurturing resilience. Many of us began life in fragile circumstances, where uncertainty, hope, and anxiety coexisted side-by-side. Because of that beginning, we understand how small comforts can soothe big worries. The neonatal world teaches us that healing happens moment by moment, and that gentleness, patience, and compassion are essential for helping families and children navigate anxious seasons.

For families with babies in the NICU, the holidays can intensify feelings of overwhelm, isolation, or emotional strain. Parents may carry silent anxiety about outcomes, siblings may sense stress without understanding it, and clinicians may feel the weight of supporting so many families at once. A simple act—sharing a grounding story of your own journey, sending a message of reassurance, offering a listening ear, or just showing presence without expectation—can ease the mental load for someone facing long days beside an incubator. These gestures remind families that they are not alone in managing the fear that often accompanies the NICU experience.

This month, we invite every Womb Warrior to choose a way—large or small—to give back emotionally or practically. Create a comfort bag for parents spending the holidays in the NICU. Donate time to a local children’s charity, NICU support network, or preemie nonprofit. Offer to read aloud or do a calming activity with siblings who may be feeling anxious. Volunteer at a community event that supports vulnerable families, or simply check in on someone who has been quiet. These actions not only lift others but also model for children that kindness is a powerful antidote to anxiety.

The strength of our community lies in its shared empathy—preemie survivors who have lived through uncertainty, NICU families who have learned courage through adversity, and clinicians who bring dedication and steadiness to every fragile moment. When we turn these lived experiences into acts of compassion, we help others feel grounded, less overwhelmed, and more hopeful. Kindness becomes the bridge between anxiety and reassurance, especially during a season that invites us to slow down and connect.

As we move through December, we encourage each of you to commit to one intentional act of kindness each week. Whether it’s offering comfort to a NICU family, expressing gratitude to a clinician, volunteering in your community, or choosing patience with yourself or your child during moments of stress—every act matters. Together, we carry forward the heart of Neonatal Womb Warriors: grounded in hope, strengthened by compassion, and united in helping families and children navigate anxiety with courage and care.

The whatifs/ A book to help kids overcome anxiety/bedtime story

Fun Story Time Kids Mar 30, 2022

What if my dog run away? what if I forget my homework? what if the sun stops shining? What if my crayon breaks? Will Cora be able to change her worry-filled thoughts into hopeful ones? Find out in this timely picture book about overcoming anxiety.

FELLOWS, FUTURES, FAMILIES

Senegal, officially the Republic of Senegal, is the westernmost country in West Africa, situated along the Atlantic Ocean coast. It borders Mauritania to the north, Mali to the east, Guinea to the southeast and Guinea-Bissau to the southwest. Senegal nearly surrounds The Gambia, a country occupying a narrow strip of land along the banks of the Gambia River, which separates Senegal’s southern region of Casamance from the rest of the country. It also shares a maritime border with Cape Verde. The capital and largest city of Senegal is Dakar.

Healthcare in Senegal is a center topic of discourse in understanding the well-being and vitality of the Senegalese people. As of 2008, there was a need to improve Senegal’s infrastructure to promote a healthy, decent living environment for the Senegalese.

Additionally, the country needs more doctors and health personnel, particularly general practitioners, gynecologists, obstetricians,  pediatricians,  pulmonologist, and cardiologists. In fact, Senegal has seven doctors per 100,000 citizens, while 32% of rural citizens have no access to medical care at all. Moreover, there is a strong need to have more of these personnel in rural areas: in 2008, Senegal had only twenty full-fledged hospitals, seven of which are in Dakar.

From approximately 1905 to the present, there have been significant shifts in Senegal’s healthcare system, the system’s structures, specific diseases that are problematic in Senegal, as well as issues affecting women and children and access to healthcare in the country. As of 2019, there were 1,347 medical facilities, including 20 major hospitals.

COMMUNITY

 Problem Statement: Neonatal Intensive Care Unit (NICU) trainees experience high intensity situations under suboptimal physiologic and psychologic conditions that can lead to burnout and/or secondary traumatic stress. The mental health of NICU fellows can have significant impact on their well-being and the quality of patient care they provide. The overall goal of this project is to improve Neonatal Fellow mental health and well-being in a level 3 NICU by using Trauma Informed care (TIC) principles to identify needs that may warrant connection to further resources.

Abstract:

Methods:

 Key stake holders were identified: the ACGME director, the fellowship program director, the associate program director, the chief fellow, the psychologist, the fellow cohort, division chief, lead NNP, and the program coordinator. We aimed to develop a wellness curriculum and standardize the frequency of sessions, duration of sessions, attendance of sessions, confidentiality, location and topics. Key drivers rooted in the 6 principles of TIC became the foundation of the topics explored during the Wellness Sessions. These six principles / primary are 1. Safety, 2. Trustworthiness and Transparency, 3. Peer Support, 4. Collaboration and Mutuality, 5, Empowerment, voice, and choice, 6. Cultural sensitivities. These promoted the following standardized topics: Crucial conversations with mentors, Performance anxiety, Debrief challenging cases, debrief death, Navigating personal relationships (motherhood, significant other, daughter/son), Work life balance, Individualizing wellness, Cognitive behavioral strategy for stress management. A force field diagram was the QI tool used to mediate conversations to gain approval for this Wellness curriculum pilot. Driving forces in support of this pilot were having a dedicated NICU psychologist, ACGME recommendation for embedded Wellness training, fellow interest, previous match history, program evaluation demonstrating a gap for wellness training and existing private fellow office space. Restraining forces included scheduling time away from board preparation didactics, patient care and research duties, 360 degree buy in, post-call protected time, literacy of NICU psychologist role, and human bias to new process. Our outcome measure is compliance with monthly meetings characterized by completed monthly sessions from November 2023 to April 2024. The process measure is compliance with attendance for fellows that desired to attend the wellness session and not encounter barriers.

Results:

In the initial 6 months implementation period from November 2023 to April 2024 there was 30% compliance with monthly meetings. PDSA cycles revealed the challenges to completing a session. These included the available protected didactic times were filled with other lectures and case conferences, preparation for In-training-exams (ITE’s), research timelines, graduating fellow interviews, schedule gaps for anticipated and unanticipated medical leaves, and fellow graduation exit procedures. Compliance for attendance of the fellows conflicted with patient care duties and lack of commitment to protected time away from the NICU. Qualitative feedback from fellows was in support of establishing the permanence of this wellness curriculum and they specifically appreciated the topics and the time to pause and reflect on their experiences. Fellows’ feedback included: “mental health sessions are equally as important as the pathophysiology lectures,” the curriculum prioritizes “resetting the mindset more positively” and “improve work-related satisfaction.” This feedback, the start of the new chief fellow term, and persistent advocacy to establish this wellness curriculum enabled this pilot to continue for an additional 6 months. The frequency of sessions has increased in collaboration with program director approving bimonthly sessions.

Conclusions:

Implementation of a fellow wellness program was met with initial resistance, but over time has proven beneficial in fellow satisfaction and performance leading to increased support from key stakeholders, increased frequency of scheduled sessions and reduction in barriers to allow for fellow attendance. Future direction is to incorporate fellow wellness curriculum into monthly didactic schedule and standardize a curriculum to be replicated.

***** Please See Neonatology Today  September 2025 Edition to view numerous interesting and informative Abstracts selected by Gravens By Design from the recent 38th Annual Gravens Conference on the Environment of Care for HighRisk Infants and Their Families

Source: https://neonatologytoday.net/newsletters/nt-sep25.pdf

The latest statistics from the MSAS reveal a critical shortfall: there is currently only one midwife available for every 1,197 women of reproductive age.

This shortage has left numerous health centers, especially in rural areas, operating without qualified personnel capable of providing prenatal care or safely assisting with deliveries.

In some of the country’s most isolated communities, pregnant women are still forced to travel dozens of kilometers in search of professional medical assistance.

This persistent gap in healthcare access continues to put adolescent girls, expectant mothers, and newborns at risk, especially when it comes to managing high-risk pregnancies.

In response, the government has initiated a targeted recruitment drive under the broader SWEDD+ program—an initiative for Women’s Empowerment and the Demographic Dividend in West Africa.

The project aims to recruit a total of 500 midwives across 11 of Senegal’s most vulnerable regions, where the shortage is most pronounced.

The newly announced recruitment of 220 midwives marks the first wave of this effort, which is supported by key international partners including the World Bank and the United Nations Population Fund (UNFPA).

Beyond simply filling vacant roles, the goal is to ensure that skilled healthcare professionals are present and retained in the country’s most neglected areas—regions often bypassed by young professionals due to poor infrastructure and difficult living conditions.

Authorities hope this measure will significantly reduce maternal mortality, limit preventable childbirth complications, and improve access to essential services for women and adolescents.

However, health experts warn that recruitment alone will not be enough. For the initiative to succeed in the long term, newly deployed midwives will require proper housing, transportation, equipment, and incentives to remain in rural posts.

Despite these challenges, the decision signals a shift in policy direction. While the number of recruits may not fully meet the country’s needs, the move represents a concrete and long-overdue commitment to rebuilding Senegal’s maternal healthcare system from the ground up.

Source: https://dailymailafrica.com/senegal-recruitment-of-220-midwives-to-tackle-maternal-health-crisis/

The World Health Assembly has officially designated November 17 as World Prematurity Day! The recent WHO endorsement is a major step forward – calling on governments around the world to prioritize preterm birth in their national health agendas. 

“As one of the founding organizations of World Prematurity Day in 2008, we at GFCNI are deeply proud to see it officially recognized by the World Health Organization,“ says Silke Mader. “This milestone is a tribute to our tireless efforts together with parent and patient organizations, healthcare professionals, and advocates around the world. A heartfelt thank you to Doris, whose dedication made this endorsement possible. Together, we have turned a vision into a worldwide movement for preterm babies and their families.”

“This is truly a huge milestone for the global movement for premature babies,” adds Doris Mollel, founder of the Doris Mollel Foundation in Tanzania, whose tirelessly advocacy, supported by the Tanzanian government, has been pivotal in bringing global attention to the needs of preterm infants. “This is just the beginning. Together, we are building a future where every child has a fighting chance, and every life matters.”

Source: https://www.gfcni.org/campaigns/world-prematurity-day

The latest statistics from the MSAS reveal a critical shortfall: there is currently only one midwife available for every 1,197 women of reproductive age.

This shortage has left numerous health centers, especially in rural areas, operating without qualified personnel capable of providing prenatal care or safely assisting with deliveries.

In some of the country’s most isolated communities, pregnant women are still forced to travel dozens of kilometers in search of professional medical assistance.

This persistent gap in healthcare access continues to put adolescent girls, expectant mothers, and newborns at risk, especially when it comes to managing high-risk pregnancies.

In response, the government has initiated a targeted recruitment drive under the broader SWEDD+ program—an initiative for Women’s Empowerment and the Demographic Dividend in West Africa.

The project aims to recruit a total of 500 midwives across 11 of Senegal’s most vulnerable regions, where the shortage is most pronounced.

The newly announced recruitment of 220 midwives marks the first wave of this effort, which is supported by key international partners including the World Bank and the United Nations Population Fund (UNFPA).

Beyond simply filling vacant roles, the goal is to ensure that skilled healthcare professionals are present and retained in the country’s most neglected areas—regions often bypassed by young professionals due to poor infrastructure and difficult living conditions.

Authorities hope this measure will significantly reduce maternal mortality, limit preventable childbirth complications, and improve access to essential services for women and adolescents.

However, health experts warn that recruitment alone will not be enough. For the initiative to succeed in the long term, newly deployed midwives will require proper housing, transportation, equipment, and incentives to remain in rural posts.

Despite these challenges, the decision signals a shift in policy direction. While the number of recruits may not fully meet the country’s needs, the move represents a concrete and long-overdue commitment to rebuilding Senegal’s maternal healthcare system from the ground up.

Source: https://dailymailafrica.com/senegal-recruitment-of-220-midwives-to-tackle-maternal-health-crisis/

PREEMIE FAMILY PARTNERS

Was your baby born more than 3 weeks early? Premature development differs from full-term, but there’s no need to worry! Let’s explore effective ways to understand and support your baby’s growth and milestones. Premature babies are often born with more extended (straight) positions, while full-term babies get a curled up (flexed) feeling from being in the womb longer. Babies need both flexion and extension to help their motor skill development. Try these activities to aid your preemie’s physical growth and work on their flexion. Always consult your healthcare provider for personalized advice. • Swaddling: Helps bring your baby’s arms to the middle, providing comfort and aiding in muscle development. • Side Lying: Reduces gravity’s impact, making it easier for your baby to move their arms and legs. • Bringing Arms and Legs to Midline: Encourages flexion by helping your baby bring their limbs to the center of their body. • Tummy Time: Strengthens neck, back, shoulder, and core muscles crucial for overall development.

 👪 ABOUT PATHWAYS.ORG Pathways.org is a non-profit organization that provides free, trusted resources so that every parent is fully empowered to support their child’s development. Our milestones are supported by American Academy of Pediatric findings. Our resources are developed with and approved by expert pediatric physical and occupational therapists and speech-language pathologists.

Source: file:///C:/Users/Kathy%20P/Downloads/Global_Preterm_Birth_Organizations_Map_2025.html

Join Our Global Community

If your country or region isn’t yet listed, we’d love your help expanding this network.  Share your local preemie-family organization, NICU support group, or foundation by contacting us at NeonatalWombWarriors@gmail.com Together, we can make sure every family and their communities — no matter where they are — are able to gain needed support. We are stronger together.

Having a baby in the hospital NICU is a very stressful time for all members of a family, including big brothers and sisters. Siblings often feel confused, anxious, or even left out during a NICU stay. Children look to adults for reassurance, so it’s important to guide them through the experience with honesty, love, and consistency.

This guide offers simple, practical tips for NICU sibling support that help kids feel included, valued, and secure during this challenging time.

Helping Children Cope with a NICU Stay

BE CONSISTENT

Maintaining normal routines like bedtime, meals, and school helps young children feel safe. Consistency is especially important during a time when so much else is changing.

SET ASIDE SPECIAL TIME

Even small moments of connection, like reading a bedtime story, a short walk, or a chat in the car, can go a long way. Your time and attention matter more than perfection.

ASK FAMILY AND FRIENDS FOR HELP

Don’t be afraid to lean on your support system. People want to help, but they don’t always know how. Let them know what you need. Ask friends or family to help with school drop-offs or meals. Giving others a chance to help allows you to show up more fully for your children.

SURROUND THEM WITH FAMILIAR PEOPLE

If you have family members and friends providing child care, have them come to your home as much as possible. With so many changes, having a known and trusted adult around will help younger children cope, especially if they have a difficult time being separated from mom and dad. Familiarity offers comfort when parents are spending long hours at the hospital.

ADAPT THEIR DAILY ROUTINES

Routines are an important part of helping children cope with the NICU. You may have to temporarily change up your child’s routines to align with having a baby in the NICU. If your usual family dinners are now spent at the hospital, try shifting that special time to breakfast or bedtime instead. Flexibility can help kids still feel connected.

LEAVE NOTES OF LOVE

Leave your children love notes and messages when you have to be away. You may even sign some messages from the baby: “I am so lucky to have you as my big sister!” This can help them feel connected to the baby, especially if they can’t visit them.

CELEBRATE THEI ROLE AS BIG BROTHER OR SISTER

Remind siblings how important they are. Make a list of all the things your older children can do that the new baby can’t do and share it with them. Talk about their role in the family and how they will be helping to teach the new baby about these things.

ENCOURAGE YOUR CHILDREN TO TALK ABOUT THEIR FEELINGS

Even if they don’t ask, make time to talk. Let them know that it is okay if they are feeling sad, angry, lonely or frustrated. Let them know that they can tell you if they feel like they need you to spend some time with them. Create space for your children to talk about how they’re feeling by asking simple questions like: “What was the best part of your day?” or “Is anything making you feel sad or worried today?” Let them know it’s okay to feel all their feelings, and that you’re always there to listen.

LET THEM ASK QUESTIONS

Children often have big imaginations and need help making sense of what it means that the baby is in the NICU. Giving them age-appropriate, honest answers can ease their fears. For example: “The baby is in a special place where doctors are helping them get stronger.”

What are they worried about? What do they think might happen? Let their questions guide your conversations.

Model Coping and Resilience

Kids learn by watching you. Show them that it’s okay to be sad or overwhelmed, and that those feelings don’t last forever. Let them see you ask for help, take breaks, and care for yourself.

You Are Not Alone

The NICU experience can be tough on siblings, but it can also bring families closer. The most important thing we can do for our children is to give them support, encouragement, information and most of all reassurance that they are still important members of the family. With thoughtful support and simple routines, you can help your children feel secure, seen, and loved during this time.

Source: https://handtohold.org/im-special-too-how-to-support-siblings-when-your-baby-is-in-the-nicu/

HEALTHCARE PARTNERS

Abstract

Purpose

The purpose of this research is to evaluate how AI integration in nursing education influences educational and practice performance outcomes, and to understand the roles of technological acceptance and institutional support in this process. Issue: AI’s role in nursing education and practice is not fully understood, particularly in terms of its effects on performance and the barriers to its effective implementation.

Method

A sample of 500 participants was surveyed, and data was analyzed using Smart-PLS 4.0 to assess the direct, indirect, and moderating effects between variables like AI integration, performance outcomes, and institutional factors. Results showed significant positive relationships between AI application in practice and nursing performance, with technological acceptance acting as a strong moderator.

Findings

AI integration in nursing education positively affects nursing performance (p < 0.001). Technological acceptance significantly enhances both educational and clinical outcomes, with interaction effects between technological acceptance and AI integration improving performance (p < 0.001).

Research policy implications

Policy should focus on supporting AI adoption in nursing curricula, with investments in faculty training, technological infrastructure, and fostering technological acceptance to maximize AI’s benefits in healthcare settings.

Conclusion

AI integration is crucial for advancing nursing education and practice, with technological acceptance and institutional support playing key roles in successful AI adoption. The findings underline the importance of targeted policy initiatives to foster these elements.

Introduction

Artificial Intelligence (AI) is rapidly transforming healthcare and nursing, providing new opportunities for education and practice. The integration of AI in nursing education is reshaping the way nursing curricula are developed, while the application of AI in clinical settings is enhancing the efficiency and accuracy of patient care. Despite these advancements, the impact of AI on global nursing education and practice remains inadequately explored, with few studies addressing both its benefits and challenges. This research aims to provide a comprehensive understanding of how AI integration in nursing education influences nursing performance, both in academic and clinical settings, and how AI applications in practice improve patient outcomes and care efficiency (Iqbal et al., 2025)

The adoption of AI in nursing education and practice is growing at an unprecedented rate, offering tools that range from curriculum enhancement through AI-driven learning tools to decision support systems (DSS) in clinical settings. AI is revolutionizing nursing by providing advanced technology for clinical training, decision-making, and patient monitoring (Chowdhury et al., 2021; Rana et al., 2024). However, the integration of AI in nursing education is often challenged by factors such as curriculum development, technology access, and the need for comprehensive training. Similarly, in clinical practice, the application of AI for clinical decisions and patient monitoring is reshaping nursing roles, yet concerns remain about how these technologies affect nursing practice performance (Denecke et al., 2020; Iqbal et al., 2023, 2024). Despite these changes, few studies have explored how these technological advances impact both nursing education and clinical performance in a holistic manner.

Although AI is increasingly being implemented in nursing education and practice, there is a lack of comprehensive research examining the direct effects of AI integration on nursing education performance (NEP) and nursing practice performance (NPP). Moreover, the factors that moderate or mediate the influence of AI such as technological acceptance, institutional support, and infrastructure have not been fully investigated. Understanding how these variables interact can provide valuable insights into the effectiveness and challenges of AI implementation in nursing.

These main three main research questions are:

1. How does AI integration in nursing education (curriculum design, technology access, and clinical training) influence nursing education performance, including academic performance, skill development, and clinical competency?

2. In what ways do AI applications in nursing practice (clinical training, decision support, and patient monitoring) affect nursing practice performance, particularly patient outcomes, satisfaction, and clinical accuracy?

3. How do factors such as technological acceptance and institutional support mediate and moderate the effects of AI integration and application in nursing education and practice?

These main three main research objectives are:

1.To examine the impact of AI integration in nursing education on nursing education performance (NEP).

2. To assess how AI applications in nursing practice affect nursing practice performance (NPP).

3. To analyze the role of technological acceptance and institutional support in moderating and mediating the relationship between AI integration and performance outcomes in nursing education and practice.

This study will provide crucial insights into how AI integration in nursing education and practice affects various performance outcomes, offering actionable recommendations for educators, healthcare policymakers, and technology developers. By exploring the moderating and mediating effects of technological acceptance and institutional support, the research will help identify strategies to overcome barriers to effective AI adoption in nursing. The findings will also contribute to the development of a conceptual framework for evaluating AI’s role in nursing education and practice, promoting more effective and sustainable implementation of AI in these fields.

This study will be conducted using Smart-PLS 4.0 to analyze the relationships between AI integration in nursing education and practice and its impact on nursing performance outcomes. The research will include an examination of the independent variables (AI integration in education and practice) and their effects on the dependent variables (nursing education and practice performance). Additionally, the moderating effects of technological acceptance and the mediating role of institutional support will be explored. This will lead to a set of practical recommendations for the integration of AI into nursing curricula and clinical environments.

Section snippets/Literature review

Artificial Intelligence (AI) has emerged as a transformative force in both nursing education and clinical practice. The integration of AI into nursing education, through innovations in curriculum design, clinical training, and simulation, is reshaping how nurses are trained and prepared for modern healthcare challenges. Similarly, AI applications in nursing practice, such as decision support systems (DSS) and AI-enhanced patient monitoring, are changing the way nurses deliver care, improving

Research methodology

This study will employ a quantitative research methodology to examine the impact of Artificial Intelligence (AI) integration on global nursing education and practice. The research will use Smart-PLS 4.0, a software tool for structural equation modeling (SEM), to analyze the relationships between the variables outlined in the study framework. SEM is chosen due to its capability to handle complex models involving multiple independent, dependent, mediating, and moderating variables (Hair et al.,)

Result analysis and discussion

The path coefficients in Table 1 reveal strong, significant relationships between AI integration and nursing performance outcomes. The T-values consistently exceed the threshold of 1.96, confirming the statistical significance of the direct paths. In Table 2, total indirect effects show meaningful mediating influences, with T-values above 1.96 for most variables, indicating significant indirect relationships. Confidence intervals in Table 3 further validate these findings, with narrow ranges

Conclusion

This study has demonstrated the significant impact of AI integration in both nursing education and practice. The results show that AI Application in Nursing Practice (AIANP) and AI Integration in Nursing Education (AIINE) have substantial positive effects on Nursing Education Performance (NEP) and Nursing Practice Performance (NPP). Key findings include the strong relationship between AIANP and Institutional Support (IS), as well as the enhancement of Technological Acceptance (TA) through AI.

Source: https://www.sciencedirect.com/science/article/abs/pii/S1355184125001000

The unpredictable hours of residency make romantic relationships tough—but not impossible. Here’s how to date and maintain a love life during residency.

The long and unpredictable hours of residency make starting and maintaining a romantic relationship tough. But it’s not impossible.

Here’s how to date and make the most of your love life during residency.

First, let’s address the elephant in the room. If you’re going into residency single and haven’t spent much time dating or figuring out what you need from a partner, taking on this challenge during residency will be difficult. Building a deep, romantic relationship requires time, which is something you have very little of in residency.

Even the act of finding a relationship requires a significant time investment. You’ll need to put yourself out there socially, such as going to events or joining community groups, work on your own personal development, and zero in on what you’re actually looking for from a partner.

If this sounds like you as a resident, do not despair. It is possible to find and build a relationship during residency, but you need to understand both what your priorities are and how many hours you have to find and keep that special someone. If finding a relationship in this stage of your life is important to you, you’ll need to intentionally carve out and block time for it, much like when you are studying for boards.

Don’t allow your years of residency to fly by without being intentional about every aspect of your life—this includes your professional development, personal wellness, hobbies and interests, and love life.

If starting a family and settling down is a top priority for you at this stage, you need to act like it. This will mean you have less time for other things, such as research you wanted to pursue, personal hobbies, or binging Netflix shows alone.

Alternatively, you may decide a serious relationship is less important to you at this time, which is perfectly okay too. Don’t fall into the trap of doing what those around you are doing just because it seems like the logical next step. Jumping into a serious relationship or beginning to start a family because you think you should, and not because you want to, is a recipe for disaster.

With that in mind, if dating is a priority for you, it’s time to get serious about identifying your needs.

Identify Your Needs

One of the biggest questions to ask yourself is whether or not you want to be with someone in medicine, as there are pros and cons to both choices.

A partner in a medical field, such as another resident or someone pursuing another healthcare career, will share an understanding of the time-consuming nature and challenges of residency. They are more likely to be comfortable with your limited and unpredictable hours because they experience the same thing. You’ll also have plenty to talk about in the realm of medicine, but this can be both positive and negative.

Your shared interests may keep the conversation going, but you run the risk of talking about medicine all the time. A partner outside of healthcare can offer new topics of conversation, and you can learn new things from each other. Additionally, a non-resident partner can more easily work around your rigid schedule.

If both of you are pursuing a career in healthcare, you may have similarly unpredictable schedules. If you each only have one small sliver of free time, it’s likely they won’t align, making it difficult to carve out time together.

However, your career path is only one small element of determining your own needs.

Are you looking for someone who wants to have children? Are you eager to start that process right away, or do you want to wait a few years? Do you want someone who shares your passion for fitness and wellness? Is preferring Star Trek over Star Wars a deal breaker for you?

By the time you’re in residency, you likely have a better understanding of yourself and what you hope your future will look like. Determine what you’re looking for in a partner to save yourself time during the dating process, as you don’t have any time to waste. However, ensure you’re not too rigid in your quest for love. The more you idealize your perfect partner, the harder your search will be.

After all, no one is perfect, and every relationship involves compromise.

Finding a Partner

After spending time identifying your preferences, it’s time to go out and find that special someone, which is easier said than done, especially for residents.

Unlike treatment algorithms, there are no x + y + z instructions to find a partner. It takes time, patience, and a whole lot of trial and error. Put yourself out there and continue meeting new people. Choose events, groups, and activities that align with your interests so you find someone who shares your values.

For example, if fitness is a top priority for you, join a gym or athletic community group you’re interested in, such as a running club, kickboxing class, or yoga in the park. If religion is an important aspect of your life, make time to go to church or temple events, and get more involved in religious community initiatives. If you’re passionate about books and storytelling, join local library events and begin participating in a book club.

Dating apps can also help you streamline the dating process. If used effectively, they can aid residents who have very little free time. Be sure to choose dating apps that align with your needs. If you’re looking for a serious relationship with someone who wants to start a family, don’t waste your time on an app known for its hookup culture.

If you’re looking for someone who is also in medicine, there are dating apps specifically for healthcare workers, such as ForeverX and DowntoDate.

Use dating apps to your advantage, but understand their limitations. If your residency is in a small town, you will have fewer options. The pros and cons of dating apps and how to optimize online dating are discussed in video on my Kevin Jubbal, M.D. channel.

Maintaining a Healthy Relationship

Starting a relationship is just one part of the equation. As a resident, you’ll have to put in more effort than usual to help maintain it. Here’s how to keep a healthy relationship strong.

1 | Be Clear About What to Expect

The first and most important tip is to be upfront with your partner about what to expect over the next few years. This will be easier if you’re dating a fellow resident or someone in the medical field, but either way, it’s vital that both of you have clear expectations.

Your free time will be very limited. Your schedule may be so hectic at times that all you can do after a long day is go home and sleep. Your free time will also be unpredictable, as you may be on call, which can and likely will result in cancelled plans, sometimes at the last minute. Preparing your partner for these situations from the outset will prevent conflict.

When approaching commitments, use percentages. With what percent confidence can you commit to an event? Is there a 90 percent chance you can make it, a 70 percent chance, or 30? Knowing this upfront will result in fewer misunderstandings and hurt feelings.

If hurt feelings do occur, be sure to allow your partner to vent. Constantly canceling plans will be frustrating for them at the very least, and if they aren’t working in healthcare, your schedule and priorities during this time will be difficult to understand.

Being in medicine in some ways is as close to being in the military as you can get, with an arguably even more unpredictable day to day schedule at times.

Be clear right from the start that you will be under a tremendous amount of stress. This is in no way carte blanche for you to be rude or self-obsessed; however, they should know there will be times when you come home after having been chewed out by an attending or after having lost a patient. You may not always be able to put on a happy face and forget about your day the moment you walk through the door.

2 | Develop Open and Honest Communication

Next, communication is the foundation of any strong relationship, and it’s what will save you during residency. Explain when your shifts are, when you’re on call, and share your exact schedule, but strive to go beyond that. You need to share what’s going on in your inner life as well, including your feelings, concerns, and current energy levels.

Be honest. Don’t put on a brave face. They need to know how to support you through your dark days, which means you need to give them the full and honest picture of the job from the start.

If a patient dies, it’s important to share how it affected you. Don’t act as though your partner can’t help you or pretend you don’t need help when they can see that you do. If you deny your feelings, you’re more likely to crack under the immense pressure you’re under. Plus, you’re taking away your partner’s agency. Of course, they can’t help you with everything, but when they can, let them. If you have the right partner, they’ll be happy to offer you support.

However, remember that communication is a two-way street. Your partner isn’t there just so you can talk at them about how rewarding or challenging it is to be a doctor. They need to know they can vent to you when they are stressed, no matter their career path. Being a teacher, accountant, waiter, or business owner comes with its own stresses. They must be able to talk about their day too.

While the relationship does largely rely on your schedule, it’s not all about you.

3 | Don’t Allow Medicine to Rule Your Life

Next, while it’s important to be honest about your work and how it makes you feel, it shouldn’t be the only thing you talk about, and it shouldn’t rule your lives.

It is essential to take time to decompress before you see your partner and to put a time limit on hospital or clinic talk.

Dr. Joshua Goldman has found success using his drive home to transition his mindset. He has two children, so he uses his commute to move from serious plastic surgeon to playful dad. Dr. Goldman shares how he balances his family and work life in an episode of Day in the Life.

Even though it may not feel like it at times, you are more than just a doctor. Developing a healthy life outside of medicine will aid both your relationship and your career. You’ll be able to go into work fresh and ready to start again, rather than carrying it with you 24/7.

Work with your partner on finding a balance in your conversations. This is especially important if both of you are in residency. It’s great that it’s a passion you both share, but you are more than just residents. What are your hobbies and values outside of medicine? If you have to, make a rule that when on dates or when sharing a meal, you don’t talk about medicine. This will allow you to get to know each other on a deeper level and grow your connection beyond your shared careers.

4 | Intentionally Block Time for Your Relationship

The fourth tip is to intentionally make time for your relationship and your partner. Even with your busy schedule, make specific plans, put them in your calendar, and do your best to commit to them. You may only have a few extra hours each week to dedicate to your partner, but know that any time spent together is better than nothing.

Neglecting time as a couple will erode any relationship. If you’re not careful, those few hours of free time will get eaten up by something else, and before you know it, four weeks will have passed by without the two of you spending any quality time together.

You need to block time for your relationship and ensure being together occurs in some form or another. When your schedule is tight, get creative about blending other commitments. How can you turn tasks like grocery shopping, cooking, or even cleaning the house into a date?

Completing these seemingly boring tasks together will make them more enjoyable while giving you more opportunities to see each other. That said, don’t allow your only time together to be over laundry and dishes, as this is a surefire way to lose that romantic spark.

On days when you only have a few moments to spare, taking the time for a small gesture like bringing home food or flowers or just texting them a kind message can brighten your partner’s day.

Don’t only focus on what you want out of a relationship. What does your partner prefer? You might care about gifts and small gestures while what’s most important to your partner is hearing words of affirmation.

This is commonly referred to as your love language. The five love languages are physical touch, acts of service, quality time, words of affirmation, and gifts.

If you don’t know your preferred love languages, there are plenty of online quizzes you can take. While by no means scientific, they can provide insight into your own needs and preferences as well as your partner’s. If your love languages align, awesome! If they do not, don’t be discouraged. Taking the time to learn more about each other’s preferences will help you both get what you need from the relationship.

This again falls back on effective communication. Neither of you are mind readers. Make every effort to ensure both of your needs are met.

Romantic relationships during residency can be tough—but they’re rewarding too. Residency is tremendously challenging, and having someone you can lean on during this time is extremely valuable.

Source: https://medschoolinsiders.com/medical-student/dating-and-relationships-in-residency/

Abstract

Background: 

Neonatal nurses have a major role in helping parents engage with their infant. A high level of parent participation, called Parent-Partnered Care, integrates parents as full partners in the delivery of hospital care to their infants. One parent-partnered intervention that improves infant, parent, and parent-infant outcomes is H-HOPE (Hospital to Home: Optimizing the Preterm Infant Environment). H-HOPE has 2 components: Massage+ and Parents+.

Purpose: 

The purpose of this article is to present an evidence-based guide showing how to deliver Parents+ and the implications for nursing practice.

Methods: 

The nursing approach to Parents+ includes participatory guidance and social support, which fosters a partnership with parents. The guidelines for using participatory guidance include a detailed description of each teaching/learning session along with implications for nursing practice.

Results: 

Parents’ experienced many benefits from participating in the Parents+ sessions. They reported feeling more confident in the care of their infant and more satisfied with learning and delivering Massage+. Additionally, parents also reported less fears handling their infants, increased feelings of bonding/attachment, and a sensitivity/responsiveness to their infant’s behavioral cues.

Implications for practice: 

Parents+ presents an opportunity for nurses to help parents engage with their infants and increase their confidence and competence. Parents’ desire a neonatal intensive care unit culture that embraces a comprehensive collaborative approach with healthcare professionals that is individualized to their infant’s health and well-being.

Neonatal nurses have a major role in helping parents engage with their infant and provide direct care. The inclusion of parents as full partners in the care of their infant in the neonatal intensive care unit (NICU) has greatly expanded to include routine caregiving, developmentally supportive care, and engagement with the neonatal team regarding infant healthcare decisions. A high level of parent participation in the care of their infants, called Parent-Partnered Care, is defined as “approaches that center or integrate parents as full partners in the delivery of hospital care to their ill or small newborns.”

One parent-partnered intervention that improves infant, parent, and parent-infant relationship outcomes is H-HOPE (Hospital to Home: Optimizing the Preterm Infant Environment). H-HOPE is a parent-focused intervention that fits within the Parent-Partnered Model of Care where members of the healthcare team partner with parents in care delivery . H-HOPE includes both an infant-focused intervention, Massage+ (formerly termed the ATVV, Auditory, Tactile, Visual, and Vestibular Intervention), and a parent-focused intervention, Parents+. A large body of research documents that Massage+ significantly increases infant alertness, clarity of the infant’s cues, oral feeding and growth, and fosters the development of infant social communication and the parent-infant relationship in hospital. Additionally, Massage+ has been associated with reduced acute care visits and improved parent-infant interaction at 6-weeks corrected age. Massage+ is designed to be provided by parents while Parents+ provides guidance and support from nurses so parents can confidently provide Massage+ with sensitivity to their infant’s cues.

H-HOPE: one model of parent-partnered care.

As an early behavioral intervention for preterm infants and their parents, H-HOPE is designed to be integrated within a culture that supports parents as partners in care. H-HOPE incorporates 3 key elements of Parent-Partnered Care: presence, participation, and engagement. The physical presence of parents is necessary to provide them the opportunity to participate in caregiving activities like Massage+. Parents may participate in care activities with the support of nurses or independently depending upon their confidence and experience. Parents+ requires collaboration between the nurse and parent to teach parents how to understand their infant’s behavior and deliver Massage+. Engagement occurs when a parent is emotionally involved in their infant’s health and healthcare through their actions. Engagement is not fixed, rather it exists along a continuum. Over time, the delivery of H-HOPE by parents increases parents’ confidence in their caregiving and engagement with the healthcare team.

A comprehensive toolkit, including instructions and videos showing the step-by-step process of Massage+ is available to support nurses and parents in the delivery of Massage+ on Pathways.org (https://pathways.org/massage-tool-kit-H-hope) at no cost. Pathways.org also has detailed information and developmental resources for nurses to use during the Parents+ sessions. After completion of Parents+, the website is available for parents.12 These materials and videos are especially helpful for parents to review content at any time. However, detailed guidelines for the nurse to deliver Parents+ is not currently available in the literature. Therefore, the purpose of this article is to present an evidence-based guide showing how to deliver Parents+ and the implications for nursing practice.

PARENTS+ CONCEPTUAL BASIS

Parents+ consists of teaching/learning sessions that help parents understand infant behaviors and cues, shows them the steps of Massage+, and provides experiences that build parent confidence in providing Massage+ guided by their infant’s cues. The conceptual basis supporting Parents+ includes participatory guidance,principles of adult learning and experiential learning.

  • Participatory guidance occurs when a skilled clinician guides the process of learning how to perform a complex task, with the mutual goal of moving the learner from novice to expert. This approach changes the relationship from “instructor-student” to a collaboration. When using this approach, nurses foster bidirectional communication with parents.
  • Adult learning involves respecting and integrating what the parent brings to the sessions, such as their own experience in caring for an infant. It is their “history” related to the context of their lives, including their preterm infant, family, socioeconomics, cultural factors, and other responsibilities.
  • Experiential learning provides opportunities that foster integration of the new experience into the learner’s everyday skills. This learning approach provides hands on practice (Massage+) and supports parents as they gain confidence and competence while interacting with their infants. Experiential learning is also a component of Bandura’s well-known social learning theory widely used as an effective model for behavior change programs.

The learning strategies derived from these concepts promote parent participation and engagement (Parent-Partnered Care), build trust between nurses and parents, and increase parents’ confidence and competence with infant care. The integration of these strategies fosters growing parent competency. One advantage of Parents+ is its strong conceptual approach that assists nurses in conducting parent education that is both planned and effective, allowing nurses to provide consist of support across shifts and nursing assignments. This common understanding of how to conduct parent education is much needed; as noted in a recent scoping review that described the inability of health professionals to articulate the systematic teaching strategies they used.

DESCRIPTION OF THE PARENTS+ SESSIONS

Parents+ consists of 3 to 4 sessions: 2 in-hospital and 1 to 2 post-discharge. The focus of each session is the parents’ engagement with their infant, as they learn to understand their infant’s behavioral cues and how to build the parent-infant relationship. Parents learn about cues both through the nurse teaching about behavioral cues as well as the nurse asking about what cues the parents have seen in their infant and pointing out cues the infant may exhibit during the Parents+ session (Table 1). Through this repeated process, parents learn to read, interpret and respond to engagement and disengagement cues. For example, when their infant is overstimulated and exhibits a potent disengagement cue, the parent learns how to modify his/her behavior to reduce overstimulation (see Session 1 for definitions of engagement and disengagement behaviors below).

TABLE 1. – Parents+ Content: Example Session Questions and Talking Points

Open session with parent concernsLet’s start by discussing how you’re doing. How are things going for you? Do you have any questions about your baby?
Infant behavioral statesHave you noticed how your infant wakes up? What state is your infant in right now?
Engagement & disengagement cuesThese pictures show some ways infants show they are ready to interact with you or want to continue. Which ones have you noticed that your infant does?
Orally directed behaviorsHere are some things infants do to show they are getting ready to eat. What does your infant do when s/he is ready to eat?
Hunger & satiation cuesHere are some things infants do to show they are getting ready to eat or that they are full. What behaviors does your infant have when they are getting ready to eat and when they are full?
Massage+Massage+ is an activity that stimulates all your infants’ senses and is enjoyable for both of you Massage+ helps infants become alert and ready to feed, so they eat and sleep better. Do you notice any benefits for your infant when doing Massage+? Infants may like some parts and not others. Do the parts your infant likes. Remember to pause if they need a break. How does your infant respond to Massage+?
Back to sleepDo you know the best position to put your infant in for sleeping?
Signs & symptoms of illnessBefore you go home, we’d like to review what you might see in your baby that would need immediate attention.
How to calm a fussy babyDoes your infant ever get fussy? What do you do? Let’s talk about different things that you can do to calm the infant when s/he is fussy.
Feeding is more than eatingFeeding is an important time to relate to your infant Whether breast or bottle feeding, your infant needs to be close to you and have your full attention while feeding. This is a time for you and your infant to relax and enjoy each other
Tummy timeTummy time is important for your infant’s development and achievement of milestones Let’s review ways you can get tummy time in each day
Developmental milestonesInfants do not develop the same way, but knowing what developmental milestones to be on the lookout for can help you monitor their progress. Let’s review some 0-3 month milestones. Have you seen any of these in your infant yet?
Close session with parent check-inDo you have any further questions or concerns about what we’ve discussed, or anything else?

Infant behaviors and Massage+ are introduced at the first session and reviewed and practiced in subsequent sessions. While teaching Massage+, the nurse talks about infant behaviors and caregiving, adding new content to each Parents+ session. Content of Parents+ can be divided into multiple smaller sessions to accommodate both parent and nurse time constraints. When this occurs, documentation of parent education in the electronic health record (ideally into the existing parent education documentation) serves as a communication tool between nurses to ensure completion of a Parents+ session, picking up where necessary. If an infant is discharged earlier than expected, missing content can be delivered during the post-discharge visits.

Each Parents+ session follows the same plan:

  • Address (re-address) parent concerns
  • Review any previous content
  • Introduce new content
  • Complete each session by returning to the parent’s continuing concerns and any questions about their infant.

The focus on parent needs at the beginning and end of each session is in response to the high stress, anxiety and fear many parents report during their time in the NICU. Nearly all parents’ have emotional needs related to caring for their vulnerable infants and are often hesitant about even touching their infant. The psychological distress of having a preterm infant, exacerbated by the stress of the NICU environment, along with the context of parent’s lives outside the hospital, affect their ability to fully participate in caregiving of their infant and engage with the healthcare team regarding their infant and family’s needs. For parents to fully engage during this stressful time, their needs must be addressed in conjunction with the infant’s needs. However, parents are rarely given an opportunity to discuss their own feelings and needs. Parents+ helps mitigate parents’ distress by acknowledging their needs and concerns and asking what they want to learn about their baby to support their learning and engagement.21 While some concerns are too complex to be resolved or may require referrals, simply acknowledging parent concerns helps parents feel heard and builds trust. Detailed guides for each session are available on Pathways.org.

Session 1

The first Parents+ session can be initiated when the parents are physically and emotionally ready, even if the infant is not old enough to receive Massage+ (Massage+ begins when the infant reaches 31-32 weeks postmenstrual age and is physiologically stable). Infants born between 33 and 35 weeks may also begin Massage+ once they are physiologically stable. This first session includes substantial content about preterm infant behaviors and cues that are highly relevant for all parent caregiving and engagement with the infant. Sharing information about preterm infant behavior and cues prior to the infant’s readiness for Massage+ allows parents’ time to become comfortable learning to read, interpret, and respond to their infant’s cues.

During Session 1, 4 content areas related to preterm infant behaviors are discussed. Nurses use active listening to understand parents’ concerns and tailor content to support learning. The session begins with a description of infant behavioral states and engagement and disengagement cues to help parents understand the many behaviors that infants use to express themselves. These cues also include orally directed behaviors (pre-feeding behaviors) and those that indicate hunger and satiation. When working with parents, using the term pre-feeding behaviors is easier for parents to understand. Later in this session, parents learn the steps of Massage+ and practice Massage+ on their infant with guidance. Cues are further reinforced when parents learn to read, interpret, and respond to the infant’s behavior while giving Massage+ to their infant.

  • Infant Behavioral States: Behavioral states include quiet sleep, active sleep, drowsiness, active alert, quiet alert, and crying. Identifying the infant’s behavioral state indicates readiness or lack of readiness to engage. During the active alert state, the infant’s eyes are open and the infant looks around; arms and legs may be moving, indicating readiness to feed. This state is most optimal for oral feeding, regardless of whether feeding is provided by bottle or breast feeding. During the quiet alert state, the infant’s eyes are open, the infant is calm and ready for social interaction with the parent.
  • Engagement and Disengagement Cues: These cues are important indicators of the infant’s readiness to interact or needing a break. Both engagement and disengagement cues can be potent (eg, easy to understand such as looking at the parent, or cry) or subtle (eg, difficult cue for the parent to read and interpret such as hands open or grimace). Preterm infants often show more subtle engagement cues such as brow raising, facial brightening, feeding posture, and hands open with fingers slightly flexed. As they mature, the frequency of potent cues increases. Potent disengagement cues include a cry face and halt hand, turning head away, and spitting up. Subtle disengagement cues include fast breathing, gaze aversion, and yawning.
  • Orally Directed Behaviors (Pre-Feeding): Orally directed behaviors indicate the infant’s readiness to feed. These include mouthing, rooting, tonguing, hand-to-mouth, hand swipes at mouth, empty sucking, sucking on hand, and sucking on tongue.7,30
  • Hunger and Satiation Cues: Hunger cues include arms and fingers bent, facial grimace or crying, mouthing and sucking movements. Satiation cues include arms relaxed or by the infant’s side, relaxed fingers, infant has a neutral face (no expression), or infant is asleep.26,27,31 These cues provide additional indicators of the infant’s hunger or feeling full. This is important for parents who often want to feed their preterm infant the entire oral feeding even though they are exhibiting satiation cues.

Session 2

Session 2 begins 1 to 2 weeks before discharge. Planning for Session 2 well before discharge allows additional time to address parents’ questions and concerns and to support the parent-infant relationship before heading home. This session also offers additional opportunities to integrate new information with previous learning.

Session 2 content includes signs and symptoms of illness and back to sleep. This information is often already incorporated into discharge education. However, the participatory guidance approach of H-HOPE (Parents+) acts as a reinforcement of the importance of active listening to address parents’ questions with bi-directional communication and incorporating the context of the parents’ needs and concerns as they transition to home. As discussed above, this may include referrals or additional resources to support parent self-care.

Sessions 3 and 4

One or two virtual sessions occur within 2 weeks after parents are discharged home with their infant. Parent feedback from our previous research indicated that this is also a stressful time for parents and they appreciated the additional support and educational content. The purpose of these post-discharge sessions is to offer support to parents, answer questions related to Massage+ and infant behavioral cues that were taught during the first session, as well as infant care. New topics include calming a fussy baby, feeding is more than eating, tummy time, and developmental milestones. Parents are also encouraged to use the Pathways.org App for continuing information about developmental milestones that can be easily downloaded onto their phones.

Depending on the parents’ schedules at home, these 2 sessions can be combined into 1 session. However, the rationale for providing 2 post-discharge virtual sessions was developed as a result of previous research with parents’ who found these visits valuable for their transition to home.

DISCUSSION

The purpose of this article was to present an evidence-based guide showing how to deliver Parents+ and the implications for nursing practice. While parents appreciated Massage+ in previous research studies, they reported high anxiety while handling their infants and not clearly understanding their infant’s behavior. Parent feedback led to the development of Parents+ which offers parent support and guidance to improve outcomes for infants, parents, and the parent-infant relationship. Massage+ is designed to be provided by parents while Parents+ provides guidance and support from nurses so parents can confidently provide Massage+ with sensitivity to their infant’s cues.

Parents+ is a model for collaboration between parents and nurses enabling the delivery of Parent-Partnered Care, and has benefits for parents, infants and nurses, as discussed below. The first Parents+ session was intentionally designed to guide parents in learning and practicing the steps of Massage+ on their infant. When Massage+ is provided by parents, they can see their infant’s positive behavioral responses and growing developmental capacities. The process of providing Massage+, a multimodal dyadic intervention, helps parents’ experience handling their infant and responding appropriately to infant cues; skills that readily transfer to virtually all other caregiving.

Thus, the experience of providing Massage+ begins to build the parent-infant relationship. In both qualitative and quantitative assessments, parents reported feeling more confident in the care of their infant and more satisfied with learning and delivering Massage+. In other intervention and engagement studies, parents reported improved mental health, increased confidence and competence while caring for their infant. Parents also reported less fears handling their infants, feelings of bonding/attachment, and parental sensitive-responsiveness to their infant’s behavioral cues.1Significantly, this response has been proposed as the foundation for the development of the parent-infant relationship.

Benefits for Parents+.

Overall, the benefits of H-HOPE (Massage+ and Parents+) for infants have been well documented in the literature. Infants of different post-menstrual ages (31-36 weeks) responded with improved alertness, increased orally directed behaviors, faster progression from gavage to oral feeding, improved growth, and fewer illness visits after hospital discharge.2,4,6-8 In addition, other investigators reported an improvement in neurodevelopmental outcomes following interventions focused on the parent-infant relationship. Interventions that also include the transition into the home as with Parents+ Sessions 3 and 4 are ideal because this offers additional support for parents and infants post-discharge.

Importantly, Parents+ also benefits staff, providing a practical guide that both novice and expert nurses can use to more effectively help parents engage with their infants. Conducting Parents+ using a participatory guidance approach further develops interactive and teaching skills for nurses. Essentially, the participatory guidance approach can be used for any instruction with parents. These skills foster a culture for parent participation, using bidirectional communication and demonstrating how parents can collaborate with the nurse as a partner. Showing respect and understanding of the parent perspective is particularly salient, as nurses play an important role in making parents feel comfortable and welcome in the NICU environment, as well as increasing their confidence in providing care for their preterm infants.

IMPLICATIONS FOR CLINICAL PRACTICE

Increasingly, the nurse’s opportunity to provide parent support and guidance is challenged by a continually, complex clinical environment, staffing shortages and family stressors. Parents+ presents an opportunity for nurses to help parents engage with their infants and increase their confidence and competence. Physical therapists, occupational therapists, and speech language pathologists trained to administer H-HOPE are well equipped to provide the intervention and can partner with nurses’ to provide these services. However, in most NICUs, the primary responsibility will likely reside with nurses, as they are the only clinicians in the NICU who are at the bedside 24/7. Moreover, evidence-based parent focused developmental approaches to preterm infant care have been shown to affect neurodevelopmental outcomes for infants, driving the need to become a standard of care in the NICU.45 The Vermont Oxford Network issued a statement, “All care is brain care,” to emphasize the importance of developmentally based care for the preterm infant.As NICUs move forward with advancing this type of care, a unit culture that incorporates a developmental and behavioral approach to caregiving by nurses is critical and necessary to achieve optimal outcomes. To support a unit culture of developmental care, staff education and training, from orientation through skill review sessions, is imperative.

The parent perspective can be found in the literature, via feedback from parent advisory groups, and local and national parent support networks (eg, https://nicuparentnetwork.org; https://www.marchofdimes.org/our-work/nicu-family-support; https://handtohold.org; https://www.projectnicu.com). Parents desire a NICU culture that embraces a comprehensive collaborative approach with healthcare professionals that is individualized to their infant’s health and well-being. The goal for all parents is to achieve optimal outcomes for their infant.44 However, this may require more than changing the NICU culture. There are many factors besides NICU culture and socioeconomics that are barriers and challenges for parents. These include insufficient knowledge about how to care for the infant and understanding realistic expectations for growth and development, as well as access to resources to support the parent’s and infant’s needs.

A successful practice change that incorporates the parent perspective also depends upon experienced leadership; operational and clinical leaders who set consistent expectations for implementing and sustaining evidence-based standards of care. In addition, assessment of staffing needs is critical to incorporate a practice change into nursing workflow. Parents need nurses who have the time to help them learn a behavioral intervention like H-HOPE and provide essential developmental care. NICUs where parent education and engagement are highly valued, and a cornerstone of nursing practice, will likely be more willing to accept H-HOPE. It is imperative for NICUs today to focus on meeting the needs of parents’ and infants, address the challenges, and implement evidence-based practices. In addition to assessing staffing needs, each institution must consider other logistical factors, such as reimbursement for services and who conducts the post-discharge sessions. While nursing time inpatient is not reimbursable, outpatient often is, which may cover the 2 post-discharge Parents+ visits. These post-discharge visits could be completed by a discharge nurse or developmental specialist, depending on the resources of each institution.

CONCLUSION

Parents+ is an innovative behavioral intervention with benefits for parents, infants and staff. Parents+ incorporates a model of Parent-Partnered Care, which helps mitigate parent’s distress by addressing parents’ needs and concerns to support their learning and engagement with their infant. The Parents+ sessions are designed to provide education and support during the NICU stay and post-discharge. Understanding the evidence that supports developmental and behavioral care is key to recognizing the rationale for incorporating Parents+ into the standard of care by staff. Incorporating a culture of developmental and behavioral care for parents and their infants is imperative to address their needs, improve outcomes, and advance nursing practice in the NICU.

 Summary of Recommendations for Practice and Research

What we know:Parents+ is a behavioral intervention that incorporates Massage+ to help parents learn their infant’s cues and contributes to optimal neurodevelopmental outcomes. Parents+ is an evidence-based approach to behavioral care in the NICU. Nurses are essential for providing Parents+.
What needs to be studied:Further research is recommended to identify effective strategies incorporating H-HOPE into neonatal nurses’ workflow. Research is critical to describe how NICUs embrace developmental care as the standard of care. Data are needed to document parent and infant outcomes from the delivery of Parent-Partnered Care.
What can we do today that would guide caregivers in the practice setting considering the use of this evidence for guiding practice?Provide leadership support for a developmental and behavioral approach to NICU care. Educate nurses on the principles of Parent-Partnered Care. Engage parents to understand the behavioral cues of their infant as a component of their caregiving.

Source: https://journals.lww.com/advancesinneonatalcare/fulltext/2025/10000/parents___an_early_behavioral_intervention_as_a.4.aspx?context=featuredarticles&collectionid=3

INNOVATIONS

Background

Club cell secretory protein (CC16) is a pneumoprotein that has anti-inflammatory and antimicrobial properties and whose levels are reduced in preterm infants.

Objective

We sought to investigate the role of circulating CC16 in the association of preterm birth (<37 weeks) with lung function and asthma from childhood into young adult life in longitudinal and mediation analyses.

Methods

Using the BAMSE (Swedish abbreviation for Barn/Children, Allergy, Milieu, Stockholm, Epidemiology) birth cohort (2,557 participants and 10,631 longitudinal observations), we assessed plasma CC16 (ages 8 and 24 years), spirometry (ages 8, 16, 24, and 26 years), and asthma (ages 8, 12, 16, 24, and 26 years). Longitudinal associations between preterm birth, CC16, percent predicted values of FEV1/forced vital capacity (ppFEV1/FVC), and asthma were examined in longitudinal multivariable mixed models. CC16 (ages 8-24 years) was tested as a mediator for the relationship of preterm birth to pre- and postbronchodilator ppFEV1/FVC and asthma in adulthood (ages 24-26 years).

Results

Preterm birth was associated with reduced plasma CC16 (−1.15 ng/mL; 95% CI, −1.22 to −1.08; P < .0001), lower ppFEV1/FVC (−1.9%; 95% CI, −3.1 to −0.8; P = .001), and higher risk for asthma (1.83; 95% CI, 1.28 to 2.62; P = .001) across ages 8 to 26 years. CC16 deficits were related to decreased ppFEV1/FVC (P < .0001) and increased risk for asthma (P = .007) in adulthood. Multivariable mediation analyses suggested that CC16 mediated 16% and 9% of the effects of preterm birth on ppFEV1/FVC and asthma in adult life, respectively.

Conclusions

Low CC16 is a potential mediator of the effects of prematurity on lung function deficits and asthma in young adulthood. Future studies should address whether CC16 can be used as a predictive biomarker and, possibly, a therapeutic target in individuals born preterm.

Section snippets

Participants

BAMSE is an observational population-based birth cohort study that enrolled 4089 children born in Stockholm between 1994 and 1996.35 The study design and enrollment process are detailed in this article’s Online Repository at www.jacionline.org. Perinatal data were obtained from the Swedish medical birth register.36 Plasma CC16 levels were measured at ages 8 and 24 years. Spirometry was conducted at ages 8, 16, 24, and 26 years. Asthma questionnaires were answered by parents at ages 8, 12, and

Results

Overall, 2,557 BAMSE participants were included in this study, contributing to a total of 10,603 longitudinal observations for asthma (526 for preterm participants) and 6,109 for lung function (324 for preterm participants). Compared with the 1,532 excluded participants because of missing CC16 and/or phenotypic data, those included were more likely to be females and have older, nonsmoking mothers and higher-educated parents with a history of asthma (Table I). There were no significant

Discussion

In this study—using a large, long-term, population-based birth cohort—we demonstrated that low circulating CC16 levels may mediate part of the effects of preterm birth on lung function and asthma in young adult life, supporting a protective role of CC16 in obstructive lung diseases of individuals born prematurely. These findings highlight the potential of CC16 for risk stratification and, possibly, novel therapeutic strategies for preterm individuals at risk for obstructive lung disease.

The role of CC16 in the associations of preterm birth with lung function and asthma in adult life – ScienceDirect

Empowering Voices: Honoring the Educators Who Shape Our Journeys

As we begin Neonatal and Preemie Awareness Month, we celebrate not just our survival stories, but the growth and purpose that follow. For those of us who began life in the fragile space of an incubator, this month is a reminder of how far we’ve come—and of the people who continue to help us become who we are meant to be. This November, our theme is “Educators as Warriors of Empowerment”—because teachers, mentors, and guides are often the ones who help transform early struggle into lifelong strength.

Many of us know that being a preemie can mean growing up with a different pace, a different rhythm, or a different way of learning. It’s our teachers who see that difference and choose to nurture it rather than correct it. They are the ones who remind us that resilience isn’t about perfection, it’s about discovery. Whether it’s the preschool teacher who cheered every word we learned to speak, or the university professor who saw our curiosity, these educators become part of our extended story of becoming.

This month, we celebrate their quiet strength—the patience to listen, the creativity to adapt, and the belief that every child’s journey matters. They empower us to see ourselves not as “born early,” but as born with perspective—the ability to find meaning in milestones others take for granted. Through education, we learn to define our own possibilities, rewrite old narratives, and embrace the uniqueness that began long before we could even open our eyes.

To every educator who has walked beside a preemie—thank you for being part of our collective story of empowerment. And to every survivor reading this: remember, your journey didn’t stop at survival. It continues through the lessons you share, the knowledge you seek, and the lives you touch. This month, let’s honor the teachers who reminded us that we are not defined by our start in life, but by how brightly we choose to grow.

REDISGNS, GHG, EMOTIONAL INTELLIGENCE

The Czech Republic, also known as Czechia and historically known as Bohemia, is a landlocked country in Central Europe. The country is bordered by Austria to the south, Germany to the west, Poland to the northeast, and Slovakia to the southeast.]The Czech Republic has a hilly landscape that covers an area of 78,871 square kilometers (30,452 sq mi) with a mostly temperate continental and oceanic climate. The capital and largest city is Prague; other major cities and urban areas include Brno, Ostrava, Plzeň and Liberec.

The Czech Republic has a universal health care system, based on a compulsory insurance model, with fee-for-service care funded by mandatory employment-related insurance plans since 1992. According to the 2018 Euro Health Consumer Index, a comparison of healthcare in Europe, the Czech healthcare is ranked 14th, just behind Portugal and two positions ahead of the United Kingdom.

COMMUNITY

Stories of preterm birth are stories of joy and heartbreak, faith and love. Moving and uplifting. They have the power to inspire. This montage is an all-time favourite of ours and reflects the true heart and face of our work to prevent preterm birth. The Australian Preterm Birth Prevention Alliance is eternally grateful to these wonderful women, these mothers of premature babies, for sharing their very powerful stories.

Abstract: The World Health Organization has named climate change as the greatest threat to public health. In the United States, the healthcare sector accounts for 8.5% of greenhouse gas (GHG) emissions. Neonatal Intensive Care Units (NICUs) and the patients and families who rely on their medical interventions and overall guidance are uniquely impacted by climate change. So, what should NICU professionals know, and what should NICU professionals do? NICU clinicians and designers should recognize that healthcare contributes to climate change, which in turn worsens health issues, especially for vulnerable groups affected by social determinants of health. NICU professionals are well-positioned to understand and influence health equity, having participated in related efforts. Insights gained from addressing health equity can inform strategies for approaching climate change. Individuals should advocate within their organization for climate-forward policies and can counsel patients on climate-forward behavior, implementing education programs where possible. NICUs can transition to reusable surgical gowns and linens safely. Additionally, NICU professionals should advocate for decarbonized building systems whenever new construction or renovations are proposed. Hospitals should advocate for integrating sustainability into their operations and culture. Decarbonization plans should be developed and implemented to reduce climate impacts. Healthcare systems should strive to decarbonize their operations and also consider influencing their supply chain. The NICU has a unique opportunity to make a difference.

Introduction: Our most difficult and stressful challenges all end up at the hospital, and especially in the Neonatal Intensive Care Unit. NICU professionals, such as neonatologists, nurses, therapists, administrators, environmental services staff, and facilities staff, intimately know the details of their most challenging cases. The impact on families is profound. . Families do not want others to experience what they have experienced.

Nevertheless, climate change exacerbates health challenges and may ultimately lead to increased NICU admissions, This represents a vicious cycle: providing NICU care produces carbon emissions that lead to environmental harm, which in turn increases NICU admissions. The implications are clear. The NICU must deliver excellent care while reducing its environmental footprint. NICUs, in particular, have a moral imperative and an opportunity to minimize carbon and other environmental impacts. To achieve this goal, what should neonatologists know, and how can they help?

This paper provides an informational overview, citing literature on the climate crisis, the role of healthcare, and the role of the NICU in contributing to the crisis. It briefly considers health equity as a model for both how societal challenges impact the NICU and how NICUs have responded to address these challenges. Then it identifies some practical ways NICUs can reduce their impact on climate change while buttressing the resilience of the patients and families they serve.

What You Should Know

Humans Impact Climate Change

The scientific foundation of climate change is unequivocal. The Intergovernmental Panel on Climate Change (IPCC), in its Sixth Assessment Report confirmed that human activity—primarily the combustion of fossil fuels and deforestation—is responsible for the observed rise in global average temperatures since the pre-industrial era. The Earth’s surface has already warmed by 1.1°C, with current trajectories placing the planet on track to exceed 1.5°C of warming within the next two decades unless emissions are drastically curtailed.

This warming is driving a cascade of systemic changes, including the increasing frequency and severity of heatwaves, wildfires, droughts, storms, and floods; rising sea levels and coastal erosion; ocean acidification; and biodiversity loss. The climate system’s destabilization is not only an environmental phenomenon— it has become a structural determinant of human health.

The IPCC warns that without immediate and drastic reductions in GHG emissions, the world is likely to exceed 2°C of warming by mid-century, a threshold associated with widespread agricultural collapse, mass displacement, and infrastructure failure (6). For healthcare systems, this future portends interrupted services, overwhelmed emergency rooms, supply shortages, and soaring demand for mental health and infectious disease care. Thus, climate action is foundational to public health preparedness and systems resilience.

Climate Change Impacts Health

 From the standpoint of healthcare, climate change poses a comprehensive threat to public health, affecting every organ system, population, and location. The World Health Organization (WHO) has called it “the single biggest health threat facing humanity”. Key health impacts include heat-related illnesses and deaths, vector-borne diseases, including malaria, dengue, Lyme disease, and West Nile virus , respiratory conditions: from exposure to fine particulate matte , increasing asthma exacerbations, COPD flare-ups, and cardiovascular morbidity. Climate change poses significant risks to agriculture in a world where 2 billion people lack essential micronutrients . Climate-related trauma, such as displacement, economic instability, and environmental grief, can increase anxiety, depression, PTSD, and substance use disorders, as well as food and water insecurity. These mental health impacts fall most heavily on low-income groups, communities of color, Indigenous peoples, children, and the elderly, who already face structural barriers to healthcare.

Climate Change Particularly Impacts Neonatal and Perinatal Health

Children are among the most vulnerable populations to the health effects of climate change. They are not only physically more susceptible to environmental hazards since they breathe more air and consume more food and water per kilogram of body weight than adults, but also developmentally dependent on the stability of ecological, social, and healthcare systems. Furthermore, exposures during critical developmental windows, particularly in utero and during the neonatal period, can have lifelong implications for respiratory health, neurodevelopment, immune function, and cardiovascular risk . A systematic review found that maternal exposure to extreme heat is associated with a statistically significant increased risk of adverse pregnancy outcomes.

Particulate matter (especially PM2.5) from traffic, fossil fuels, and increasingly wildfires, which are more common due to a changing climate, is associated with increased risk of low birth weight and preterm birth.

Climate Change puts demands on NICU Operations

The climate crisis also poses increasing operational and ethical challenges to neonatal intensive care units (NICUs). Facilities themselves are vulnerable to climate disruptions, including flooding, wildfires, supply chain interruptions, and power outages. Clinicians must now consider climate resilience as a core function of the NICU. This includes investments in redundant power systems, emergency planning for neonatal transport, and sustainable design to ensure uninterrupted care delivery.

The carbon footprint of neonatal care, caused by single-use plastics, energy-heavy incubators, and anesthetic gases, prompts questions about how NICUs can cut emissions while ensuring safety.

Structural/Social Determinants of Health impact NICU Admissions and NICU outcomes Structural and social determinants of health (SDOH) significantly influence neonatal outcomes, especially in NICUs, where medical vulnerability intersects with systemic inequities. Social determinants of health include access to and quality of education, healthcare, neighborhood and built environment, social and community context, and economic stability (15). Recent studies offer strong empirical evidence linking race, socioeconomic status, geography, and language to disparities in NICU experiences and clinical outcomes (16–19). Addressing these determinants is crucial not only for equity but for clinical excellence in neonatal care.

Climate Change Intensifies the Inequitable Impact of Social Determinants of Health

Climate change exacerbates the social determinants of health that already affect children. Infants born into poverty, homelessness, or marginalized communities face a triple threat: they are more exposed to environmental risks, less likely to access high-quality healthcare, and more affected by systemic racism. For example, historically redlined neighborhoods in US cities are more likely to be heat islands, characterized by fewer green spaces and higher rates of air pollution, which correlates with higher rates of chronic disease.

Indigenous children face disproportionate health risks from water insecurity, wildfire displacement, and food system collapse. Worldwide, children in the Global South will bear the most significant disease burden despite contributing the least to the climate crisis.

 For neonatologists, these inequities are not abstract. They show up in disparities in preterm birth rates, NICU admissions, and developmental outcomes, trends that will worsen without targeted intervention.

 Healthcare is a major contributor to Greenhouse Gas Emissions (GHG)

While healthcare systems are at the frontlines of climate impact, they are also major contributors to the crisis. Globally, healthcare is responsible for 4.4% of net GHG emissions . In the United States, the sector emits roughly 8.5% of national emissions, making it one of the largest institutional sources of pollution.

Emissions arise from energy use, high-impact anesthetic gases such as desflurane and nitrous oxide, pharmaceutical and medical supply chains, patient transportation, waste incineration, and water consumption.

Thus, the Act of Delivering Healthcare Can Cause Harm

Critically, these emissions pose a contradiction to the sector’s mission: the act of delivering care can simultaneously cause harm through environmental degradation. As such, climate mitigation must be reframed as a core component of healthcare quality, safety, and ethics.

Organizations can make a difference despite changing national-level policies.

In this context, a diverse array of actors, including healthcare organizations, nonprofits, local, provincial/state, and national governments, as well as international organizations, have mobilized in response. While the role of nations is important, climate action happens at the provincial/state, local, organizational, and even individual levels. At the time of this writing, several changes to United States federal policy were made. The Office of Climate Change and Health Equity was disbanded by executive order, eliminating one of the few federal bodies explicitly focused on climate equity in healthcare. Additionally, NIH climate and health research funding was paused or eliminated. Even during times of changing federal policy, other actors, including health care organizations, can continue to make progress.

Healthcare Systems Have Made or Maintained Commitments to Decarbonize

In 2025, the Health Sector CARES Pledge (Climate Action, Resilience, and Equity Solutions) was introduced to replace a repealed US Health and Human Services Health Sector Pledge. The CARES pledge invites hospitals and health systems to publicly commit to a 50% reduction in Scope 1 and 2 emissions by 2030, complete Scope 3 emissions inventories within one year, and embed climate resilience and equity into their operations.

Within months of its release, more than 60 systems, including CommonSpirit Health, Providence, and NYC Health + Hospitals, had signed on.

Additionally, the National Academy of Medicine (NAM) has continued to push for sector-wide decarbonization.

It is possible to Decarbonize Building Emissions.

Building utility decarbonization is possible, and several hospitals are making significant progress in their plans to decarbonize. Decarbonizing building and utility emissions involves three fundamental steps: 1. Reduce the consumption of electricity as much as possible; 2. Switch your systems (for example, heating, sterilizers, kitchen equipment, etc.) to run on electricity instead of fossil systems (natural gas, steam, etc.); and 3. Procure electricity from renewable sources. When you have electrified emissions and procured your electricity from renewable sources, you have effectively decarbonized. Reducing energy as a first step enables you to decrease the amount of energy that needs to be electrified, thereby lowering costs.

On the electricity production side, onsite- or offsite-owned zerocarbon energy (such as solar) reduces purchases of emissions from dirty sources. Organizations can enter contracts to procure renewable energy. Within renewable energy purchasing, there is CommonSpirit Health, Providence, and NYC Health + Hospitals, had signed on. Additionally, the National Academy of Medicine (NAM) has continued to push for sector-wide decarbonization.

 It is possible to Decarbonize Building Emissions.

Building utility decarbonization is possible, and several hospitals are making significant progress in their plans to decarbonize. Decarbonizing building and utility emissions involves three fundamental steps: 1. Reduce the consumption of electricity as much as possible; 2. Switch your systems (for example, heating, sterilizers, kitchen equipment, etc.) to run on electricity instead of fossil systems (natural gas, steam, etc.); and 3. Procure electricity from renewable sources. When you have electrified emissions and procured your electricity from renewable sources, you have effectively decarbonized. Reducing energy as a first step enables you to decrease the amount of energy that needs to be electrified, thereby lowering costs. On the electricity production side, onsite- or offsite-owned zerocarbon energy (such as solar) reduces purchases of emissions from dirty sources. Organizations can enter contracts to procure renewable energy. Within renewable energy purchasing, there is a concept called additionality. Additionality refers to renewable energy contracts where the purchase results in an increase in the total amount of renewable energy. For example, a contract to purchase renewable electricity from an existing hydroelectric power plant is not additional, since the energy would be placed on the grid regardless of whether you made the purchase or not. An investment in a new wind farm would be additional, since the new wind farm would not exist without purchase. By purchasing additional renewable energy, you are actually reducing greenhouse gas emissions. Decarbonizing existing facilities can be challenging, but there are resources available to support the process. The Guidebook for Decarbonizing Healthcare (www.decarbhealthcare.com) provides helpful information. For new buildings, the ASHRAE/ASHE Decarbonizing Hospital Buildings Guidebook (24) provides a detailed guide focused on the design, construction, and operation of new hospital buildings and major renovations. This guidebook includes a treatment of embodied carbon—the carbon associated with a building’s construction (as opposed to operation), which is helpful. The healthcare industry is focused on decarbonization, and there are practical guides available to help achieve this goal.

What Can “You” Do?

 Be Motivated by NICU-led Health Equity Work

You should also be aware of the progress made in thinking on NICU, health equity, and population health, as NICU professionals have played a unique role in this space.

The Neonatal Intensive Care Unit (NICU) plays a pivotal yet often underrecognized role in shaping population health trajectories. Traditionally viewed as acute care settings, NICUs are now being reimagined as launchpads for long-term developmental, social, and community health outcomes. Bold new ideas in design further this trend (25). A growing body of literature supports the integration of NICU care with broader public health models to address disparities and promote lifelong well-being. Several studies stand out.

Population-based NICU care models have been developed to redesign follow-up programs for children at risk of falling through safety nets.  For example, Litt et al. propose a Life Course Health Development (LCHD) framework that emphasizes the importance of early experiences in shaping long-term outcomes. Their model encourages NICUs to coordinate care that extends beyond survival, integrating follow-up services, community engagement, and policy reform. The theoretical strength of this model lies in its comprehensive approach to public health through individualized care for neonates .

Equity audits, culturally competent care, and social supports are being developed to mitigate the compounded effects of racial and socioeconomic inequities on neurodevelopmental outcomes post NICU. Neonatologists are proposing new models of neonatal follow-up that emphasize family and child function. For example, leveraging existing staff, a NICU raised the level of social risk screening coupled with referral to resources in the NICU, with effective results.

Moreover, the familiar Vermont Oxford Network Potentially Better Practices for Follow Through are a key acknowledgement of the idea that “As neonatal care providers, we play critical roles in the lives of small and sick newborns and their families and therefore are uniquely positioned to address social determinants of health. Our responsibility to infants and families extends beyond the walls of the hospital or clinic. We must follow through. Follow-through is different from the more typical neonatal practice of ‘follow-up.’ It is a comprehensive approach that begins before birth and continues into childhood. Health professionals, families, and communities must partner to meet the social as well as medical needs of infants and families to achieve health equity”. 

These efforts are highly relevant for two reasons. First, climate change will exacerbate health equity challenges. The forward thinking NICU will therefore need to be even more diligent about addressing social determinants of health and disparities, even to maintain its current level of outcomes. NICU professionals should be aware of this and the ways that colleagues have effectively done this work. Second, NICUs have uniquely developed systems to address complex problems that involve both upstream and downstream factors, for which it may initially seem that the NICU has little to no control. This type of thinking and action provides important lessons and motivation as NICUs strategize to impact decarbonization.

At the Individual Level: Empowering Climate-Conscious Healthcare Workers

Individual healthcare workers and patients are often the first points of contact in the climate-health interface. Although their personal choices might seem modest in scale, the cumulative effect across a large workforce and patient population can be profound. For instance, clinicians can make deliberate choices to avoid low-value care, such as ordering unnecessary diagnostic tests or procedures, which then not only reduces patient harm but also curbs resource waste and emissions. Similarly, choosing digital over printed materials, avoiding overuse of disposables, and advocating for reusable equipment where safe are all everyday actions that help reduce waste streams.

Clinicians also influence clinical practice. By counseling patients on climate-resilient behaviors, such as adopting plant-based diets, quitting smoking, and using active transportation like walking or biking, they can advance both individual health and climate goals. Hospitals like Kaiser Permanente have adopted this ethos, offering incentives for green commuting, including subsidized transit passes, bike facilities, and carpooling programs.

Education is essential. Frontline providers who are informed about the health effects of climate change are better equipped to communicate with patients and colleagues, thereby reinforcing a culture of climate literacy and sustainable practices—these actions, while individual, are essential building blocks for larger systemic change.

Neonatologists are uniquely positioned to advance climate-responsive care. Their roles span clinical advocacy, research, systems improvement, and public health engagement. NICU professionals should collaborate with hospital leadership to reduce waste, switch to lower-impact equipment, and improve energy efficiency. Other actionable steps include implementing clinical screening for climate-related risk factors: housing instability, exposure to air pollution, maternal heat stress, and advocacy for policies that reduce air pollution, expand maternal protections during heatwaves, and strengthen infrastructure for birth centers and NICUs.

 Additionally, NICU professionals can lend their voices to interdisciplinary coalitions that recognize child health as a core pillar of climate justice. Their authority, rooted in science and ethics, can shape public discourse and health policy.

At the NICU Level: Greening High-Intensity Care Without Compromising Safety

The NICU represents one of the most resource-intensive settings within a hospital. Infants in NICUs often require continuous monitoring, temperature control, oxygen therapy, and sterile environments, all of which demand energy and generate waste. Nevertheless, even here, there are viable strategies for reducing environmental impact without compromising safety.

NICUs can rethink single-use items. Many NICUs have historically relied heavily on disposable gowns, linens, and medical tools to ensure sterility. However, studies suggest that switching to reusable surgical gowns offers both environmental and financial benefits.

NICU professionals should insist that major renovation or new construction projects are designed to use zero operational carbon. The NICU should enthusiastically support any hospital decarbonization efforts. This includes supporting energy reduction projects. NICUs rely on constant power to support incubators, ventilators, and monitors. Retrofitting these spaces with LED lighting, motion sensor controls, and energy-efficient HVAC systems can lead to substantial energy savings.

Additionally, better waste segregation can reduce the overclassification of waste as “regulated medical waste,” which is often incinerated and carries a carbon footprint several times greater than general waste.

 Finally, NICUs may consider approaches to manage the use of oxygen and anesthetic gases, especially during surgeries involving neonates. Choosing lower-impact anesthetic agents and using them judiciously not only reduces GHG emissions but also protects staff from exposure.

At the Hospital Level: Embedding Sustainability in Operations and Culture

At the hospital level, climate mitigation must become a central tenet of operational planning. Hospitals are significant consumers of energy, water, and materials, and they generate substantial waste, including high GHG emissions from anesthetic gases and sterilization processes.

A critical area for action is the operating room, which can account for 30% or more of hospital waste. Hospitals like Hackensack University Medical Center have implemented successful initiatives to eliminate the use of desflurane, a potent anesthetic with a global warming potential more than 2,500 times that of carbon dioxide. By switching to sevoflurane or total intravenous anesthesia, they significantly reduced emissions without compromising patient care.

Food services represent another high-impact area. Hospitals serve millions of meals each year, and most of these meals traditionally rely on carbon-intensive meat and dairy products. Transitioning toward plant-forward menus, sourcing food locally, and implementing food waste diversion programs, such as composting and donating excess food, can significantly reduce a hospital’s environmental impact. Several institutions working with Health Care Without Harm have reported cost savings and improved patient satisfaction with healthier, sustainable meals).

Additionally, investing in green building standards, such as LEED certification, for new construction or retrofitting existing infrastructure with high-performance HVAC systems, water recycling systems, and smart building automation can generate long-term savings and enhance resilience. Hospitals like the Cleveland Clinic have reduced their emissions by 20–30% between 2010 and 2020 with a plan to continue improving energy and waste performance.

These changes often require a cultural shift. Hospitals must empower a “green team” of clinicians, facilities managers, and executives to drive change, track metrics, and communicate progress regularly to staff and the community.

At the Health System Level: Leading Climate Action Through Policy and Partnerships

 At the top of the pyramid, health systems have the unique capacity to shape supply chains, influence public policy, and lead national or global climate action. They can develop system-wide sustainability roadmaps that set science-based targets for emissions reductions and embed climate goals into governance structures. Large health systems, such as Kaiser Permanente in the US, have achieved carbon neutrality through investments in renewable energy, the elimination of coal-based power contracts, sustainable procurement practices, and aggressive energy efficiency efforts. Their model proves that decarbonization is achievable at scale with proper leadership and investment.

On a broader level, health systems can influence their entire supply chain by prioritizing vendors that meet environmental, social, and governance (ESG) criteria. Given that the majority of healthcare’s emissions are Scope 3 (indirect) emissions from supply chains, procurement reform is one of the most powerful levers available (36).

Finally, resilient infrastructure planning is essential. Hospitals now require climate-resilient infrastructure, microgrids, and emergency plans to ensure they remain operational during floods, wildfires, and extreme heat events.

Organizations that act decisively can not only reduce their environmental footprint but also improve population health, lower costs, and build long-term resilience. Every part of the healthcare system is essential in the move toward climate-smart care.

Conclusion:

Climate change is a threat to public health, impacting children and neonates all around the world, making them more likely to end up in the NICU and more likely to have adverse long-term outcomes. Likewise, climate change will augment health inequities. Like all areas of hospitals, NICUs contribute significantly to greenhouse gas emissions. There is an imperative for NICUs to have a positive impact on the climate. Fortunately, this is possible. By leveraging their unique voice and in-depth understanding of complex problems, NICU professionals can advocate for policies and projects that significantly reduce the carbon footprint of operating the NICU, thereby continuing to save babies and families.

Click to access nt-jul25.pdf

HEALTHCARE PARTNERS

To learn more, check out our article here: https://trueconf.com/blog/reviews-com.

Check out the video to see the best option for your medical practice.

PREEMIE FAMILY PARTNERS

Having a baby in the NICU changes you. Even after your preemie is home, the emotional rollercoaster doesn’t always stop. The stress, anxiety, fear, and trauma of premature birth and intensive care can linger—and that’s completely normal.

In fact, parents of premature babies are more likely to experience postpartum depression, anxiety, and even post-traumatic stress. That’s why supporting your mental health isn’t optional—it’s essential. This article will help you recognize what you’re feeling, know when to seek support, and give yourself permission to heal and thrive alongside your baby.

Common Emotional Experiences for Preemie Parents

You may feel a complex mix of emotions—many of them contradictory:

  • Joy at progress and milestones
  • Fear of setbacks or illness
  • Guilt for not being able to prevent early birth
  • Grief over the loss of a “normal” birth or newborn experience
  • Helplessness during the NICU stay
  • Overwhelmed during the transition home

These are real, valid, and common. There’s no “right” way to feel.

Attending routine well-child exams at Kids Central Pediatrics helps ensure your baby is growing and developing properly, and allows their doctor to detect diseases or illnesses before serious complications arise.

Common Causes of Premature Birth

Understanding why prematurity happens is helpful, though sometimes a specific cause is never found. Common reasons include:

  • Multiple pregnancies (twins, triplets, etc.)
  • Maternal infections or chronic conditions (like high blood pressure or diabetes)
  • Problems with the placenta or uterus
  • Premature rupture of membranes (water breaking early)
  • Smoking, substance abuse, or poor prenatal care
  • History of previous premature births

Often, a combination of factors is involved. Regardless of the cause, your focus now shifts to supporting your baby’s health and development from day one.

Signs You May Be Struggling

It’s okay to feel stressed—but if it starts interfering with your ability to function or connect, it’s time to talk to someone. Look out for:

  • Trouble sleeping even when baby is sleeping
  • Constant worry or racing thoughts
  • Feeling numb or detached from your baby
  • Crying frequently or feeling hopeless
  • Panic attacks or shortness of breath
  • Avoiding social interactions or appointments
  • Feeling like you’re failing, even when others say you’re doing great

Partners can experience these feelings too, even if they show up differently (withdrawal, irritability, overworking).

Postpartum Depression, Anxiety, and PTSD

Postpartum depression (PPD) and postpartum anxiety (PPA) are not limited to moms of full-term babies. Preemie parents are often at even higher risk due to:

  • Medical emergencies during labor and birth
  • Separation from baby in the NICU
  • Prolonged uncertainty and fear

Some parents also develop post-traumatic stress disorder (PTSD) after a difficult NICU journey.

You are not weak or broken if you’re experiencing any of this. These are medical conditions that deserve treatment, just like any other.

When and How to Get Help

If your emotions are interfering with your daily life or sense of well-being, reach out early:

  • Talk to your pediatrician—they often screen parents for mental health, not just babies
  • Call your OB-GYN or primary care provider
  • Connect with a therapist—ideally one who understands perinatal or NICU-related trauma
  • Ask your hospital social worker or NICU follow-up clinic for resources

Getting help isn’t selfish—it’s one of the best things you can do for your baby and your family.

Coping Strategies That Help

While professional support is key, there are daily habits that can make a big difference too:

Talk about it

  • Share your story with people you trust
  • Join an online or local NICU parent support group

Practice self-care (even in small doses)

  • Take a hot shower, short walk, or 10-minute break
  • Eat nourishing meals and drink water
  • Ask for help with meals, errands, or childcare

Sleep whenever you can

  • Trade night shifts with a partner or loved one
  • Let chores go when possible

Lower your expectations

  • This is not the time for perfection
  • Focus on bonding and surviving one day at a time

Celebrate progress

  • Write down your baby’s wins—and your own
  • Acknowledge how far you’ve come

Supporting Each Other as Partners

Preemie journeys can be hard on relationships. Open communication, shared responsibilities, and giving each other space to grieve or cope differently are essential.

  • Ask each other, “How are you really doing?”
  • Divide tasks fairly, including night feedings, appointments, and household needs
  • Make time for connection—even if it’s just a short walk or a meal together

What If You’re Feeling Better Now?

That’s wonderful—and also normal. Not every parent develops a mental health condition, and many experience healing as their baby grows stronger. Still, check in with yourself often, especially during big transitions (like going back to work, starting daycare, or hitting developmental milestones).

Your journey as a preemie parent is ongoing, and emotions can resurface at any time.

You are not alone, and you are not failing. The strength it takes to care for a premature baby is immense—but you don’t have to carry it alone. Prioritizing your mental health is not a luxury—it’s a foundation for healing, resilience, and parenting from a place of wholeness.

You deserve support, just like your baby does. Reach out. Speak up. You are worth it.

https://kidscentralpediatrics.com/supporting-your-mental-health-as-a-preemie-parent/

Families of preterm and sick newborns face unique challenges that require strong support, advocacy, and collaboration. Around the world, dedicated parent and patient organizations provide vital guidance, raise awareness, and drive improvements in neonatal and maternal care. Their voices ensure that the needs of babies and families are heard at every level – from local communities to international policy.

Collaboration Opportunities for Parent and Patient Organizations

If you have already established a charitable parent or patient organization, advocacy group, or self-help initiative, we welcome your interest in collaborating with us. Ideally, your group has a clear vision for supporting families of preterm babies in your region and a defined path toward achieving these goals.

Accepted parent and patient organizations benefit from:

  • Regular exchange and digital meetings with our global network, including updates on GFCNI’s activities 
  • Workshops and training opportunities designed to strengthen your impact 
  • Access to a worldwide community of organizations eager to share knowledge and experience 
  • Free information and campaign materials, potentially available in your local language 
  • Opportunities to participate as supporters in global awareness campaigns 
  • Occasional involvement in research projects as parent or patient representatives

Our Global Network of Parent and Patient Organizations

Across the world, parent and patient organizations are leading change for preterm and sick newborns and their families. By joining our global network, we create a stronger voice for advocacy, share valuable knowledge and resources, and work together to ensure that every baby and family has access to the care and support they need.

Below, you can explore the wide range of parent and patient organizations that are already part of our international community. If your organization is interested in joining our network, we warmly invite you to contact us at network(at)gfcni.org.

When Nash Keen was born, he weighed just 10 ounces, less than a can of soda. His journey is one of medical innovation, relentless teamwork, and the unique capabilities of University of Iowa Health Care’s Stead Family Children’s Hospital, one of the few places in the world equipped to treat babies born so early.

Nash’s birth came just after crossing the hospital’s 21-week threshold for active intervention — timing that high-risk obstetrician Malinda Schaefer, MD, PhD, called “a new frontier in maternal-fetal medicine.” A multidisciplinary team of 21 neonatologists, nine NICU fellows, and dedicated nurse practitioners, nurses, respiratory therapists, dietitians, pharmacists, physical and occupational therapists, and more sprang into action. They inserted a breathing tube — an extraordinary feat for a baby so small — and began targeted organ support using hemodynamic monitoring, a technique pioneered at University of Iowa that allows clinicians to modify treatment based on real-time assessments of heart function and blood flow.

“When he was first born, his blood pressure was really low,” said neonatologist Amy Stanford, MD. “With hemodynamics, we could see that his heart was functioning well, so we adjusted our approach.” This precision medicine approach cuts the chance of death or major brain bleeding in very premature babies in half.

Over the next six months in the NICU, Nash underwent surgery, received dozens of medications, and was monitored around the clock. “They were on top of it every step of the way,” said his father, Randall Keen.

“They made sure we were well-informed and kept us involved in all the decision-making.”

Today, Nash is learning, playing, and growing like any other two-year-old. His Guinness World Record-breaking outcome reflects the strength of academic medicine: a blend of cutting-edge science, collaborative care, and compassion that gives even the smallest, most vulnerable patients a chance at life.

“Every patient teaches us something,” said Stanford. “And we use those lessons to improve care for the next.”

https://www.aamc.org/news/5-stories-survival-made-possible-academic-medicine

INNOVATIONS

https://www.sciencedirect.com/science/article/pii/S0033350624004402

Scientists linked a maternal gut microbe that degrades key pregnancy hormones to early labor, potentially serving as a predictive risk biomarker.

During pregnancy, expectant mothers often take steps to prepare for the arrival of their baby, such as taking vitamins and supplements and avoiding smoking or alcohol. While a typical pregnancy lasts about 40 weeks, preterm birth—defined as birth before 37 weeks of gestation—can occur and is the leading cause of neonatal and under-five mortality worldwide.

Although much research has focused on the vaginal microbiome and its potential connection to preterm birth, the role of the gut microbiome remains less understood. This gap in knowledge motivated a group of researchers in China to explore the maternal gut microbiome more closely and assess its potential link to preterm birth.

In a recent study, published in Cell Host & Microbe, the team identified maternal gut microbes associated with a higher risk of preterm birth during early pregnancy, especially those that can degrade estradiol, an important pregnancy hormone.2 The researchers hope to further explore this association of estradiol-degrading bacteria as potential predictive biomarkers for preterm birth.

First, the researchers gathered stool and blood samples from two groups of pregnant women—one in early pregnancy and the other in mid-pregnancy. Using metagenome and 16S rRNA sequencing, the team identified similar gut microbiota profiles across the women. From this, they found five prevalent genera: Blautia, Faecalibacterium, Bacteroides, Anaerostipes, and Streptococcus. At the same time, they tracked each woman’s preterm delivery status.

The researchers then turned to statistical models to dive deeper into the relationship between the gut microbiota and factors like gestational duration and preterm birth. Their analysis uncovered 11 specific genera linked to these outcomes, but one species stood out: Clostridium innocuum. This bacterium had the strongest connection to preterm birth.

Intrigued by C. innocuum, the team investigated its role in sex hormone metabolism and found that it makes an enzyme that degrades estradiol, a hormone important in pregnancy. To explore this further, they tested the bacterium’s estradiol degrading ability in female mice across different gestational periods (from early pregnancy to having a near-term fetus) and found that doses of C. innocuum significantly reduced estradiol levels by converting it into estrone. Additional analysis revealed key enzymes in the bacterium that played a critical role in this process.

Because of these findings, the researchers hypothesize that a high prevalence of C. innocuum may dysregulate estradiol levels and increase the risk of preterm birth. However, the team also acknowledged that scientists would need to evaluate more cohorts to validate these findings in broader populations.

“This study suggests that for pregnant women or women preparing to become pregnant, it may be important to monitor their gut microbiome to prevent potential adverse pregnancy outcomes,” said study coauthor An Pan, an epidemiologist at Huazhong University of Science and Technology in a press release.

https://www.the-scientist.com/improving-serological-pipetting-for-cell-culture-72953

20250120-2836186-ozrr5m.pdf

Bow Wow, OJT, WHO Listed

Liberia, officially the Republic of Liberia, is a country on the West African coast. It is bordered by Sierra Leone to its northwest, Guinea to its north, Ivory Coast to its east, and the Atlantic Ocean to its south and southwest. It has a population of around 5.5 million and covers an area of 43,000 square miles (111,369 km2). The official language is English. Over 20 indigenous languages are spoken, reflecting the country’s ethnic and cultural diversity. The capital and largest city is Monrovia.

Liberia has 5,000 full-time or part-time health workers and 51 Liberian doctors to cater to a population of 3.8 million, according to the 2006 health survey. That’s the equivalent of one doctor serving about 76,000 civilians. Most of the hospitals, clinics and equipment were destroyed as a result of the 14-year civil war from 1989 to 2003. Strengthening the health sector faces financial problems. The government used only 16.8% of the total health expenditure in the country.

Liberia is heavily dependent on the international community for health infrastructure and assistance. International aid organizations assist the government in rebuilding medical facilities and providing basic health care to its citizens. The World Health Organization (WHO) donated equipment and helped provide and assist in vaccinating people to prevent the spread of many infectious diseases.

The Global Alliance for Vaccines and Immunization (GAVI) is investing $160 million to improve Liberia’s health care system and improve the quality of immunization services. The international medical humanitarian organization Médecins Sans Frontières (MSF) helped Liberia after the civil war (2003) by running free hospitals, treating more than 20,000 women and children each year.

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

COMMUNITY

Monrovia Liberia: Liberia has received a major boost to its healthcare sector as 26 leading medical professionals from the United States, Canada, Europe, and beyond have arrived for the Liberia Medical Mission (LMM) 2025. The mission, a special initiative led by President Joseph Nyuma Boakai’s administration, represents a transformative step toward improving healthcare delivery across the country.

As part of the mission, over $500,000 worth of life-saving medicines will be distributed across five counties, aligning with President Boakai’s vision for a healthier and stronger Liberia.

The mission’s launch was celebrated with a special reception at the Tea House, Executive Mansion in Monrovia, where President Boakai expressed deep gratitude for the medical team’s commitment to making a difference.

“This mission exemplifies the power of compassion and service,” President Boakai said. “You’ve left the comfort of your homes to bring healing and hope to our people. Liberia is truly grateful for your selfless contributions. My administration is committed to supporting and expanding this mission so that more lives can be saved.”

He reiterated the government’s dedication to modernizing Liberia’s healthcare system, ensuring that medical professionals and facilities are equipped to improve service delivery nationwide.

Expanding Medical Care Across Liberia’s Counties

The Liberia Medical Mission 2025 aims to provide essential healthcare services to thousands of Liberians in need. Over $500,000 worth of medicines will be distributed to hospitals and clinics in Gbarpolu, Cape Mount, Bomi, Grand Bassa, and Montserrado counties. The mission will provide the following critical healthcare services:

• Cataract Surgeries at Emirates Hospital: Restoring vision to patients from Gbarpolu, Bomi, Cape  Mount, and Montserrado counties.

• Mental Health Awareness & Training: Focused on trauma-informed care, with training for healthcare workers, educators, and security agencies.

• CPR & Emergency Training: Aimed at enhancing life-saving emergency response skills for 7 security personnel.

• Biomedical Equipment Repairs: At John F. Kennedy Memorial Hospital and other key medical centers to improve service efficiency.

• Specialized Urology Surgeries: Performed by leading urologists at JFK Memorial Hospital.

This initiative is being led by Minister Mamaka Bility, the Minister of State Without Portfolio for Presidential Affairs, and is directly overseen by the President’s Delivery Unit (PDU). Minister Bility spoke on February 21, 2025, at the event, highlighting the government’s unwavering commitment to reshaping Liberia’s healthcare sector.

“This mission reflects President Boakai’s vision for a reformed healthcare system,” Minister Bility stated. “We are honored to host the Liberia Medical Mission again this year, as their critical services will touch and improve countless lives.”

Liberians Abroad Give Back to Their Country

Many of the medical experts participating in this mission are Liberians who have spent years abroad, gaining experience in their fields, and are now returning home to contribute to the development of their country’s healthcare system.

As the mission progresses, President Boakai has called on all Liberians to work together with the medical team to maximize its life-saving impact.

“This is a national effort, and every Liberian has a role to play in ensuring the mission’s success,” President Boakai said. “My administration remains dedicated to advancing healthcare policies and mobilizing resources to build a more resilient healthcare system for Liberia.”

The Liberia Medical Mission 2025 offers free medical checkups, surgeries, and other essential services at no cost to the government or private institutions, making it a crucial component in the country’s healthcare transformation.

A Step Toward a Healthier Liberia

The Liberia Medical Mission 2025 stands as a testament to the collective efforts of both international and Liberian medical professionals who are dedicated to improving healthcare in the country. With the government’s ongoing support, this initiative is set to deliver lasting benefits for thousands of Liberians in need of medical care.

Source:https://knewsonline.com/liberia-boosts-healthcare-with-arrival-of-26-medical-professionals-for-2025-mission

The World Health Organization (WHO) has officially designated Health Canada, the Ministry of Health, Labour and Welfare/Pharmaceuticals and Medical Devices Agency (MHLW/PMDA) of Japan, and the Medicines and Healthcare products Regulatory Agency (MHRA) of the United Kingdom as WHO-Listed Authorities (WLAs), a status granted to national authorities that meet the highest international regulatory standards for medical products.

With these latest designations, WHO expands the growing list of WLAs, now involving 39 agencies across the world, supporting faster and broader access to quality-assured medical products, particularly in low- and middle-income countries (LMICs).

In addition, the Republic of Korea’s Ministry of Food and Drug Safety (MFDS) – one of the first regulatory authorities to complete the WLA assessment for both medicines and vaccines in October 2023 – has had its listing scope successfully expanded, now covering all regulatory functions.

“This recognition reflects the deep commitment of these authorities to regulatory excellence,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Their designation as WHO-Listed Authorities is not only a testament to their robust regulatory systems but also a critical contribution to global public health. Strong and trusted regulators help ensure that people everywhere have access to safe, effective, and high-quality medical products.”

Around 70% of countries worldwide still face significant challenges due to weak or inadequate regulatory systems for evaluating and authorizing medical products. The WLA framework promotes regulatory convergence, harmonization and international collaboration, allowing WHO Prequalification Programme and regulatory authorities, especially those in LMICs, to rely on the trusted work and decisions of designated agencies. This collaboration supports efficient use of limited resources, enabling better and faster access to quality-assured life-saving medical products to millions more people.

“The principle of reliance is central to WHO’s approach to regulatory systems strengthening and a cornerstone for effective, efficient and smart regulatory oversight of medical products,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Health Systems, Access and Data. “WHO-Listed Authorities are key enablers in promoting trust, transparency, and faster access to quality-assured medical products, especially in low- and middle-income countries.”

In a world where health threats, including substandard and falsified medical products, know no borders, WLAs also serve as critical pillars of preparedness and equity, making life-saving products available more broadly, rapidly and efficiently.

The designations follow a rigorous performance evaluation process carried out by WHO using its globally recognized benchmarking and assessment tools. These evaluations were reviewed by the Technical Advisory Group on WLAs (TAG-WLA), which convened in June 2025.

Canada, Japan and the UK’s regulatory authorities were previously recognized as Stringent Regulatory Authorities (SRAs). Their designation under the WLA framework marks an important step in moving beyond the old SRA system, while ensuring continuity and stability in global procurement processes of quality-assured medical products.

Launched in 2022 to replace the previous SRA model, the WLA initiative provides a transparent and evidence-based pathway for global recognition of regulatory authorities to facilitate regulatory convergence and reliance. It builds on decades of WHO leadership to help countries work together more closely on regulating medical products, speeding up access to safe, effective and quality-assured medical products for people around the world. 

Source: https://www.who.int/news/item/07-08-2025-who-designates-new-who-listed-authorities–strengthening-global-access-to-quality-assured-medical-products

Here is our list of the best team building ideas for healthcare professionals.

Team building ideas for healthcare professionals are exercises, activities, and games that build morale and keep healthcare employees positive and engaged. Examples include daily positive affirmations, Secret Number, and Mystery Diagnosis. The purpose of these activities is to build healthcare teams that are motivated to best serve patients.

These exercises are examples of team building activities for technical teams, small group team building activities, team building exercises, and team building events.

This list includes:

  • team building activities for caregivers
  • communication activities for healthcare workers
  • team building exercises for nurses
  • team building ideas for doctors
  • healthcare team building games

Let’s get started!

List of team building ideas for healthcare professionals

It is not uncommon for healthcare professionals to feel stress and fatigue when under constant pressure. As a result, healthcare leaders must engage in fun and meaningful team building exercises and activities with their teams. Here is our list of the top ideas to improve bonds between teams of healthcare workers.

1. Thanks and Gratitude Circle

If you want to boost communication activities for healthcare workers in your facility, then start by fostering a culture of recognition and gratitude on your team. Building and maintaining a positive work culture can lay the foundation for a strong and successful team of healthcare professionals.

There are different ways you can show gratitude toward your team and make a fun game out of it. Communication is key in any workplace, so we recommend conducting your gratitude activity by getting your entire team together at the end of each day.

You should begin by having all team members sit together in a circle. Then, you can go around the circle and have each employee express gratitude for one teammate. A great way to think about this exercise is to have each participant start with the words, “Today, I want to thank blank.” For example, you could say: “Today, I want to thank Amanda for going above and beyond in treating her patients and helping other members of the team who were struggling with their patients.”

This communication exercise is a meaningful way for all teammates to build camaraderie by sharing words of thanks and gratitude toward other team members. Communication exercises for recognition and appreciation are also a great way to end each day.

2. Daily Positive Affirmations

One of the most beneficial team building activities for caregivers is to practice positive affirmations at work.

Positive affirmations are phrases that can help you build yourself up and overcome negative thoughts.

Here are a few examples:

  • I am making a difference.
  • I will show kindness and empathy to every patient.
  • I will care for myself as I care for my patients.
  • I help others in their most vulnerable moments.
  • I am energized and ready for the day.
  • I will make today a great day.
  • I am strong.
  • I am proud of myself and the work I do.

Affirmations like these are ideal for all employees to stay motivated and positive. Caregivers must remain positive as they work with patients dealing with difficult and sometimes life-threatening diseases and disorders.

Positive affirmations can be a great help in allowing employees to free their minds and stay positive, even during a tough day at work. Plus, the whole team can collectively build their positivity and confidence by having employees recite positive affirmations together.

3. Coffee Chats and Tea Time

As a doctor, it can be challenging to make time to socialize with your team regularly. As a result, one of the best team building ideas for doctors is to set aside time each week to socialize with their team over a cup of coffee or tea.

Gathering in the break room with your team can provide the perfect opportunity to get to know each other and take a much-needed break in the middle of a busy day. To make your coffee chat and tea time a success, you should remember to stock up your break room with various coffees and teas.

In addition, you should make a goal for yourself to chat with a new coworker new each week. It can be tempting to talk to your well-known coworkers and friends, but by chatting with a new colleague each week, you will meet different teammates while building new relationships in your workplace.

4. Line Leader

When it comes to communication activities for healthcare workers, the exercise that may help your team most is a nonverbal communication game.

Nonverbal games are an effective way to build communication skills. Instead of relying solely on spoken words, healthcare professionals can learn to look at nonverbal cues and body language to decipher patients’ and colleagues’ needs and wants.

Line leader is a nonverbal communication game in which the group must form a line in a specific order without talking to each other. Instead, teammates must ​​rely on silent cues and body language to get in the correct order while working together. The moderator is the only player allowed to speak in this game.

For example, the game’s moderator can ask the team to get in a line starting from January birthdays through December birthdays. In this case, the first player in the line should be the team member with the first January birthday, while the last player in line should be the member with the last December birthday.

Since players may not speak to each other, they must determine the correct order by using body language and signs. The game Line Leader is an ideal activity that can help healthcare professionals better understand the nonverbal communication cues they may receive from patients or colleagues.

5. Secret Number

A nonverbal communication game your team can play together is Secret Number. To play this game, you should break your group into two teams of three to ten players. These teams will ultimately compete against each other, and it is best if your teams are large.

You should begin the game by designating one player as the moderator. The game’s moderator should communicate instructions or guidelines to other players. The moderator should then give each team a piece of paper and a pencil.

Before the game officially begins, each team should devise a secret code to use throughout the activity. This secret code will come in handy when players get stumped, as they will not be allowed to speak with each other or write anything down.

You can use the following steps to ensure a smooth game:

  1. The moderator gives each team leader a “secret number.”
  2. Each leader should communicate this number to each member of their team one by one. However, the leader should not speak or spell out the number with their hands.
  3. As each team member reads the leader’s nonverbal clues, the player should write down their guess of the secret number.
  4. Once the team leader has communicated with each participant, they should signal to the moderator that their team is finished.
  5. The winner of the game is the team that finishes the fastest and can guess the correct number.

To keep the game exciting, you should switch team leaders for each turn so different players can have the opportunity to lead. Secret Number is a great way to get teams accustomed to nonverbal cues as they engage in friendly competition.

6. Care Packages

Among the different types of healthcare professionals in the workforce, nurses typically feel higher levels of stress and burnout. As a result, one of the most ideal team building exercises for nurses to combat burnout is to have the team leader send out care packages.

By sending care packages to your team, you are sending the message that you care about employee wellbeing.

Here are a few items you can include in your care packages for self-care:

  • Herbal teas
  • Bath bomb
  • Face masks
  • Candles
  • Meditation subscription
  • Positive affirmation cards
  • Snacks

Assembling care packages is a great exercise to decrease burnout, boost morale, and increase employee satisfaction. A well-rested team of nurses is most likely to provide the utmost level of care to patients.

7. Question of the Day

One of the most classic healthcare team building games is icebreakers. This team building activity works well for new teams that are just meeting each other or teams that want to get to know each other better.

A great icebreaker to begin each shift with is Question of the Day. As part of this icebreaker exercise, designate one person on your team to come up with the day’s question. From there, the employee tasked with creating the question should kick off the icebreaker exercise by stating the question and their own answer. Question of the Day is a great icebreaker to help coworkers learn more about each other.

A few suggestions for Question of the Day prompts include:

  • What is one important skill that all nurses should have?
  • If you had an extra hour in your day, what would you do during that time?
  • If you were not a nurse, what kind of job do you think you would have?

Icebreakers can help teams build unity by learning more about each other. Plus, when a team feels more united, they are more likely to excel in their roles and keep hospital operations running smoothly.

8. Workshops

Workshops provide an excellent opportunity to learn new things while spending time with coworkers. We recommend organizing monthly workshops that employees can attend throughout the work day or on their breaks.

Although the workshop may take place during the workday, it is important to know that these sessions do not have to be directly related to job training or building on-the-job skills. Instead, these workshops should focus on building camaraderie while promoting employees’ well-being.

Here are a few suggestions for the types of workshops that you can get your team excited about:

  • Yoga and meditation
  • Healthy habits
  • Journaling
  • Resume writing
  • Networking

Each workshop will provide employees with the opportunity to decompress while learning new skills that can help them in their daily job.

9. Board Games

If you are looking for healthcare team building games to engage your group, start with board games. Board games are a fun and competitive way to get your team to interact.

Some suggestions:

  • Monopoly
  • Sorry!
  • Trouble
  • The Game of Life
  • Taboo
  • Operation

It can be a good idea to keep a handful of board games in your facility’s break room. Having easy access to a few board games allows your team to choose different options to play with teammates during their lunch break or at other team building events.

10. Escape Room

If you are looking for a team building activity that promotes problem-solving and resolution skills, then consider completing an escape room challenge. Escape rooms are activities in which teams are locked in a room full of puzzles and tasks that they must complete to escape.

To successfully complete an escape room, team members must communicate effectively to solve the many puzzles and challenges. You can find a variety of themes to meet the needs and interests of your whole team.

Fun escape room themes include:

  • Mystery
  • Science or high-tech
  • Fantasy
  • Horror or suspense
  • Holiday

Although teammates may have differing perspectives and ideas, all players need to work together to escape the room within the given time frame. Escape rooms contain different puzzles and clues that teams must work together to solve, making this activity an optimal choice for a team of healthcare professionals looking to boost teamwork and trust.

11. Team Outing

Engaging with your team outside the workplace can provide a much-needed change of scenery while providing an opportunity to get to know each other and socialize more. Fun activities and team outings can help boost employee happiness and morale.

A few examples:

  • Happy Hour
  • Boat ride
  • Fancy dinner
  • Karaoke night
  • Paint and sip class
  • Science museum
  • Art museum

When it comes to team building ideas for doctors, you cannot go wrong with visiting a science museum. In fact, a group of doctors may be especially excited to enjoy a trip to the local science museum and spend an afternoon learning and exploring.

12. Mystery Diagnosis

Role-playing is one of the best team building exercises for nurses that can help improve their patient care skills. To conduct a role-playing exercise with your team, you will need to choose one team member who will act as the doctor.

Here are a few steps to keep in mind when participating in this role-playing game with your team:

  • You can start by having the team “doctor” leave the room. Once this player leaves, the rest of the team should come up with an illness or injury. The players should discuss symptoms and scenarios they can later share with the team’s doctor.
  • When the doctor comes back into the room, they will diagnose the patient based on the information the remaining players share.
  • To make the game challenging, you should give the doctor a timeframe of about 90 seconds to fully diagnose the patient.
  • If the team doctor can provide the correct diagnosis in the given timeframe, then the doctor can be declared the winner. The other players win the game if the doctor fails to provide the correct diagnosis.

You can encourage your staff to act out rare and obscure diseases or illnesses to make the game even more fun. For example, some players may pretend to fall asleep while doing everyday activities. The doctor of the game would then need to understand why patients are exhibiting such strange behavior, and ultimately provide a diagnosis.

Role-playing can be helpful for nurses to build upon their analysis, critical thinking, and problem-solving skills. This role-playing exercise is also a great way for a team of nurses to improve their relationships with each other as a team.

13. Bake-Off

Having a team bake-off is a fun way for your team to show off their baking skills while building collaboration skills.

To host a team bake-off, you should split your group into teams of three. Next, have each team choose a pastry or dessert to bake together. You can provide a two-hour time limit for each team to bake their dessert.

Once the teams have finished baking, you should have a team of judges taste each creation to determine a winner. A team bake-off is a great team building exercise as you can get teammates in the kitchen with each other working together on a tasty dessert.

Conclusion

Team building exercises are a great way to get your team of healthcare professionals more comfortable with each other. These activities also have the power to motivate teams to work more efficiently and in sync with one another, especially when serving patients.

Overall, team building is essential for healthcare professionals and it is a great skill for all teams to master. By engaging in team building exercises, you are taking the right steps toward improving relationships between team members with each other, which can lead to happier employees and satisfied patients.

FAQ: Team building ideas for healthcare professionals

Here are answers to questions about team building ideas for healthcare professionals.

What are team building ideas for healthcare professionals?

Team building ideas for professionals are activities that build camaraderie among healthcare teams while keeping employees motivated and happy. Healthcare professionals need to build their team’s morale and collaboration skills with each other both in and out of the workplace. As a result, team building exercises and activities come in handy when you are looking to form a stronger and more united team.

What are some good team building ideas for healthcare professionals?

There are many team building ideas to engage healthcare teams. Here are a few examples of team building exercises and activities for healthcare professionals:

  • Icebreaker
  • Coffee break
  • Team outing
  • Escape rooms

Team building activities can motivate employees to work effectively as a team, which can also help employees when they are caring for patients or working hard to solve a problem.

How do you encourage teamwork on healthcare teams?

It is important to encourage your team to work efficiently and collaboratively. A creative way to encourage teams to work together is by organizing team building activities for caregivers and other healthcare professionals.

Team building activities are sure to get your entire team working together as they have fun.

Source: https://teambuilding.com/blog/healthcare-team-building

PREEMIE FAMILY PARTNERS

If a baby is born before 37 weeks, they’re considered a preemie, and their senses might develop a bit differently from those of full-term babies. This doesn’t mean you need to worry! Knowing this can help you better understand and support your little one! During pregnancy, babies develop their senses in a specific order: touch, movement and balance, smell, taste, hearing, and vision. But once they’re born, these senses begin to work in reverse order. This means your preemie’s vision and hearing are quickly adjusting to the lights, sounds, and new environment around them. Preemies have their milestones adjusted for their corrected age, but their visual development might align more closely with their actual age. To help your baby’s vision, use toys with black, red, and white colors—these are easiest for them to see in the early months.

There are many different members of the health care team that you may meet in the NICU. Besides a bedside nurse, every baby has a NICU medical team managing the overall care of your baby. Each team is supervised by an attending neonatologist. Below is some basic information on the other members of your health care team.

Attending Neonatologists: Doctors who specialize in the care of newborns (neonates).

Chaplains: Give emotional and spiritual support to families and patients of all faiths and
cultures.

Clinical Leaders and Charge Nurses: Senior staff members who are able to take care of any problems or concerns.

Fellows: Doctors that are training to be neonatologists.

Lactation Team: Trained to help you reach your breastfeeding goals and answer any pumping/breastfeeding questions.

Licensed Practical Nurses (LPN): A nurse who works under the supervision of an RN to provide direct patient care. LPNs give much of the same care as RNs, except they do not give IV medicines.

Neonatal Nurse Practitioners (NNP): A nurse who has finished advanced graduate education and training. A NNP can help the Attending Neonatologists and Pediatric Surgeons treat babies and perform certain procedures.

Nurse Case Managers: Registered Nurses who provide care coordination for you and your baby while you are at the hospital. They will also help with the discharge process.

Nutritionists /Dieticians: Make sure babies are getting the right amount of calories and nutrients for the best growth and development. They will also give nutrition education for special diet needs.

Occupational Therapists (O.T.) and Physical Therapists (P.T.): Focus on babies’ movements and motor development. An O.T. may also help with feeding and oral stimulation.

Parent Advisors: Other parents who have had babies in the NICU. They give emotional support to families. Also, they lead the weekly Parent Pizza Night.

Patient Care Assistants (PCA): Also known as Patient Support Assistant (PSA), they work under the supervision of an RN. They can take vital signs, perform heel sticks, give baths, and feed babies.

Pharmacists: Help the doctor prescribe drugs for your baby. They also watch how well the drugs work for your baby and make sure the drug levels are right in the blood.

Registered Nurses (RN): Nurses who specialize in the nursing care of your baby. They assess your baby’s condition and progress and carry out the doctor’s orders. The RN will tell the doctor or NNP if there are any changes in your baby’s condition.

Residents: Doctors who are training to become pediatricians (a doctor who cares for children).

Respiratory Therapists: Manage and adjust the ventilators and other breathing equipment. They perform treatments that help with breathing and lung function.

Social Workers: Give emotional support, crisis intervention, information on community resources, and help with communication between families and the medical team.

Unit Clerks: Often the first people you meet when you enter the NICU. They answer the phone when you call to check on your baby and take care of many of the NICU’s administrative needs.

Volunteers: NICU volunteers have attended special training, and they help with many different tasks in the unit. They can hold and rock babies (if you wish) when parents are not able to.

Source: https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/resources-for-parents-and-kids/nicu-resources/general-information/meet-your-childs-care-team

HEALTHCARE PARTNERS

Tiny fingers grasp at invisible demons as the sterile beeps of hospital monitors become the haunting soundtrack to a newborn’s first memories. This haunting image raises a profound question: Can babies experience Post-Traumatic Stress Disorder (PTSD) from birth? As our understanding of infant mental health grows, researchers and healthcare professionals are increasingly exploring the possibility that even the youngest among us may be vulnerable to the lasting effects of trauma.

PTSD, a mental health condition triggered by experiencing or witnessing a terrifying event, has long been recognized in adults. The American Psychiatric Association reports that approximately 3.5% of U.S. adults are affected by PTSD in any given year. However, the concept of PTSD in infants is a relatively new area of study, challenging our preconceptions about early childhood experiences and their long-term impacts.

As we delve deeper into the realm of infant mental health, it becomes crucial to consider the potential for trauma during the earliest stages of life. The birth process itself, along with the immediate postnatal period, can be a source of significant stress for newborns. This realization has led to a growing awareness of the importance of nurturing infant mental health from the very beginning.

The Possibility of PTSD in Babies: Exploring the Evidence

Current research on infant PTSD is still in its infancy, but emerging studies suggest that babies may indeed be capable of experiencing trauma-related stress responses. While the traditional diagnostic criteria for PTSD were developed with adults in mind, researchers are now adapting these frameworks to better understand and identify trauma in non-verbal infants.

One of the primary challenges in diagnosing PTSD in babies lies in their inability to verbalize their experiences and emotions. Unlike adults who can describe their symptoms and traumatic events, infants communicate their distress through behavioral and physiological cues. This necessitates a different approach to identifying and assessing trauma in the youngest patients.

Despite these challenges, healthcare professionals have identified several signs and symptoms that may indicate trauma in babies. These can include heightened startle responses, difficulty sleeping, excessive crying or irritability, and problems with feeding. Some infants may also exhibit a withdrawal from social interactions or show signs of hypervigilance, constantly scanning their environment for potential threats.

It’s important to note that while these symptoms may be indicative of trauma, they can also be associated with other developmental or medical issues. This underscores the need for comprehensive assessments and a nuanced understanding of infant behavior and development when evaluating potential trauma responses.

Potential Causes of Birth-Related Trauma in Infants

Several factors during the birth process and immediate postnatal period can potentially contribute to trauma in newborns. Complicated or traumatic deliveries, such as those involving emergency cesarean sections, forceps, or vacuum extraction, may be particularly stressful for infants. These interventions, while often necessary for the safety of mother and child, can introduce an element of physical and emotional distress that may have lasting effects.

Premature birth is another significant risk factor for infant trauma. Babies born before 37 weeks of gestation often require extended stays in the Neonatal Intensive Care Unit (NICU), exposing them to a range of stressful experiences. The NICU Stays and Babies: Long-Term Effects, Impact, and Potential for PTSD can be profound, influencing both physical and psychological development.

Separation from parents immediately after birth can also be a source of distress for newborns. The importance of early bonding and skin-to-skin contact is well-documented, and disruptions to this process may contribute to feelings of insecurity and anxiety in infants. This separation is often unavoidable in cases of medical emergencies or when babies require specialized care, but its potential impact on infant mental health should not be overlooked.

Medical interventions and procedures, while often life-saving, can be another source of trauma for newborns. Frequent blood draws, intubation, and other invasive procedures can be painful and frightening for infants, potentially contributing to a heightened stress response and increased risk of trauma-related symptoms.

PTSD in NICU Babies: A Closer Look

Babies who spend time in the Neonatal Intensive Care Unit (NICU) face unique challenges that may increase their vulnerability to trauma-related stress. The NICU environment, while designed to provide life-saving care, can be overwhelming for fragile newborns. Constant noise from medical equipment, bright lights, and frequent handling can disrupt an infant’s developing sensory systems and sleep patterns.

Research on the long-term effects of NICU stays on infant development has revealed a range of potential impacts. These can include delays in cognitive and motor development, difficulties with emotional regulation, and increased risk of behavioral problems later in childhood. While not all NICU graduates will experience these challenges, the potential for lasting effects underscores the importance of trauma-informed care in these critical early days.

Studies examining PTSD symptoms in NICU graduates have yielded intriguing results. A study published in the Journal of Perinatology found that infants who spent time in the NICU showed higher rates of PTSD-like symptoms compared to full-term infants who did not require intensive care. These symptoms included heightened startle responses, difficulty with emotional regulation, and problems with attachment.

It’s important to note that while these findings suggest a potential link between NICU experiences and trauma-related symptoms, more research is needed to fully understand the relationship. The complex interplay of medical, environmental, and developmental factors in the NICU makes it challenging to isolate the specific causes of these symptoms.

Recognizing and Addressing Trauma in Infants

Identifying trauma in non-verbal infants requires a keen eye and a deep understanding of infant behavior and development. Behavioral and physiological indicators of infant distress can include changes in sleep patterns, feeding difficulties, excessive crying or irritability, and withdrawal from social interactions. Some infants may also exhibit physical symptoms such as increased heart rate, rapid breathing, or sweating in response to perceived threats.

The importance of early intervention cannot be overstated when it comes to addressing potential trauma in infants. Research has shown that early experiences play a crucial role in shaping brain development and laying the foundation for future mental health. By identifying and addressing trauma-related symptoms early, healthcare providers and caregivers can help mitigate the long-term impacts and promote healthy development.

Trauma-informed care for newborns and NICU babies is an emerging approach that recognizes the potential for early life experiences to impact long-term well-being. This approach emphasizes creating a nurturing environment that minimizes stress and promotes healing. Key elements of trauma-informed care include minimizing painful procedures when possible, promoting skin-to-skin contact with parents, and creating a calm, low-stimulation environment.

Supporting Infant Mental Health and Preventing PTSD

Promoting infant mental health and preventing trauma-related stress begins with recognizing the importance of early bonding and attachment. Skin-to-skin contact, also known as kangaroo care, has been shown to have numerous benefits for both full-term and premature infants. This practice helps regulate an infant’s body temperature, heart rate, and breathing, while also promoting feelings of security and reducing stress.

Minimizing separation between infants and parents is another crucial aspect of supporting infant mental health. When possible, rooming-in arrangements that allow parents to stay with their newborns can help promote bonding and reduce stress for both babies and parents. In cases where separation is necessary due to medical needs, efforts should be made to facilitate frequent visits and involvement in care routines.

Creating a calm and nurturing environment for newborns is essential, particularly in hospital settings. This can involve reducing noise levels, dimming lights during rest periods, and minimizing unnecessary handling or procedures. In the NICU, practices such as clustered care (grouping necessary interventions to allow for longer periods of undisturbed rest) can help reduce stress on fragile infants.

Providing support for parents of traumatized infants is also crucial. Postpartum PTSD: Recognizing and Overcoming Birth Trauma is a reality for many parents, particularly those who have experienced complicated deliveries or have babies in the NICU. Offering counseling, support groups, and education about infant mental health can help parents better understand and respond to their baby’s needs while also addressing their own emotional well-being.

As our understanding of infant mental health continues to evolve, it becomes increasingly clear that the experiences of our earliest days can have profound and lasting impacts. While the concept of PTSD in babies may still be controversial in some circles, the growing body of research suggests that infants are indeed capable of experiencing trauma-related stress responses.

Ongoing research in the field of infant PTSD is crucial to further our understanding of how early life experiences shape long-term mental health outcomes. As we continue to explore this complex topic, it’s essential to approach newborn and NICU care with a trauma-informed perspective, recognizing the potential for both positive and negative impacts on infant development.

By acknowledging the importance of infant mental health and implementing practices that support early bonding, minimize stress, and promote healing, we can work towards ensuring that every child has the best possible start in life. As we move forward, it’s crucial that healthcare providers, researchers, and policymakers continue to prioritize the mental health needs of our youngest and most vulnerable patients, recognizing that the foundations of lifelong well-being are laid in these earliest moments of life.

Source: https://neurolaunch.com/can-babies-have-ptsd-from-birth/

Abstract

Introduction

Premature infants require specialized care, and nurses need to have specific skills and knowledge to provide this care effectively.

Objective

To evaluate the impact of an on-the-job training program on the improvement of nurses’ knowledge and practice related to creation of a healing environment and clustering nursing procedures.

Methods

From January to April 2022, a study utilizing a one-group pre- and post-test design was conducted at NICUs in governmental hospitals. The study participants involved 80 nurses working in these NICUs. Researchers used predesigned questionnaire and checklist practice to collect the data pre and post the intervention.

Results

37.5% of the participants were aged between 25 and less than 30 years, with a mean age of 28.99 ± 7.43 years. Additionally, 73.7% of the nurses were female, with a mean experience of 9.45 ± 3.87 years. Prior to the intervention, the study found that a majority of the nurses (62.4%) demonstrated poor knowledge. However, after the intervention, a significant improvement was observed, with 60.0% of the nurses demonstrated good knowledge. Likewise, prior to the intervention, the study revealed that the majority of the nurses (83.8%) exhibited incompetent practice. However, post-intervention, a substantial improvement was observed, with 81.3% of the nurses demonstrated competent practice.

Conclusion

On-the-job training had significant improvements in nurses’ knowledge and practices regarding applying healing environments and clustering nursing care. On-the-job training is suggested as an adaptable, effective and low-cost technique to train nurses. To maintain the improvement achieved, ongoing instruction, feedback, assessment/reassessment, and monitoring are encouraged.

Source:https://journals.sagepub.com/doi/10.1177/23779608241255863?icid=int.sj-abstract.similar-articles.3

Abstract: Effective leadership in today’s dynamic environments rests not simply on experience, but on intentional coaching and apprenticeship. This article explores how coaching emerging leaders through structured apprenticeship models foster transferable skills, organizational continuity, and leadership identity. Drawing on scholarly research in leadership education, youth development, and coaching theory, it outlines actionable strategies for embedding coaching-as-apprenticeship within professional settings. Case studies and frameworks highlight how critical reflection, mentor guided practice, and identity formation synergize to elevate both individual and organizational performance.

Closing teaser: If you are ready to transform your leadership legacy by raising apprentices, not just subordinates, read on to discover how to build, guide, and sustain the next generation of leaders

Introduction: The Leadership Gap and the Coaching Imperative Organizations often struggle with leadership continuity, not because of a shortage of talent, but due to the lack of developmental pathways for emerging leaders. Traditional training is often episodic, outcome-focused, and disconnected from real-world work. In contrast, apprenticeship-style coaching integrates on-the-job practice, guided reflection, and mentor scaffolding, offering a more durable model for leadership development. This approach recognizes that leadership is not merely a set of competencies, but a mindset and identity forged over time. The urgency to shift from transactional leadership development to transformational apprenticeship-based coaching is underscored by the increasing volatility of organizational environments, where agile and empathetic leadership is critical. Coaching emerging leaders through apprenticeship enables them to learn by doing, internalize the organization’s values, and develop the confidence necessary to lead effectively in complex situations.

Coaching Young Leaders: Foundations and Key Benefits:

Research increasingly supports the idea that coaching has a disproportionate impact when targeted at younger or less experienced leaders. Not only do these individuals exhibit higher growth trajectories in leadership identity and self-efficacy, but they also tend to show increased engagement and retention. Coaching becomes a vehicle for establishing positive habits, fostering psychological safety, and creating alignment with core organizational values at the earliest stages of one’s leadership journey. Coaching supports the holistic development of young leaders, improving both their technical capabilities and their emotional intelligence. Moreover, when coaching is introduced early, it becomes embedded in their leadership DNA, making them more likely to coach others in the future. This creates a ripple effect of development, where coaching becomes not just a practice but a cultural norm. Organizations that invest in coaching young talent are investing in a long-term, sustainable leadership pipeline.

Apprenticeship as a Leadership Model:

Unlike ad hoc mentorship, apprenticeships are structured to emulate expert-apprentice learning paradigms found in fields such as medicine or skilled trades. These involve a deliberate, phased progression: observation, participation, leadership with supervision, and finally autonomous execution. Apprenticeships in leadership also emphasize the social construction of leadership identity. Through cycles of feedback and reflective inquiry, the emerging leader gradually integrates personal values with professional expectations. This model positions leadership as an evolving identity, not a static role. Apprenticeship also enables learning from lived experience rather than abstract instruction, reinforcing the importance of real-world exposure, feedback loops, and relationship based development. It fosters humility in the coach and curiosity in the apprentice, setting the stage for deep trust and mutual growth. Apprenticeships elevate leadership development from sporadic training to an intentional journey of transformation.

Shared and Super-Leadership: Enabling Young Leaders:

Shared leadership refers to distributing leadership responsibilities across roles rather than concentrating them in a single position. When younger leaders are empowered to co-lead projects, they not only gain experience but also receive validation as future in-fluences. This approach builds confidence, fosters innovation, and enhances team collaboration. Super-leadership, defined by the ability to help others lead themselves, offers another powerful coaching mindset. Rather than creating dependents, leaders cultivate autonomy, encouraging apprentices to develop their own leadership identities and decision-making capabilities. Super leaders invest in unlocking the potential within others by fostering critical thinking, self-direction, and ownership. These frameworks challenge traditional hierarchical models, favoring instead a collaborative environment where every team member is seen as capable of contributing leadership value. By doing so, organizations not only enhance their leadership capabilities but also foster cultures of empowerment and resilience.

Designing a Coaching-Apprenticeship Program:

Building a coaching-apprenticeship program begins with intentional matching; coaches should be trained not only in their disciplines but also in delivering feedback and reflective questioning. Programs should incorporate a phased structure with clear goals per stage, shadowing opportunities, and assigned leadership responsibilities. Embedding reflection points, journaling, peer discussions, or coach debriefs, creates a feedback-rich environment that accelerates development and reinforces critical thinking. Designing such a program also entails aligning the apprenticeship with the organization’s strategy. What leadership behaviors and mindsets are most critical for your future? These should be embedded in coaching conversations, project assignments, and developmental goals. Regular check-ins, performance reviews, and cross-functional exposure can enhance the apprentice’s understanding of broader business operations. Moreover, integrating the program into HR and L&D systems ensures sustainability, scalability, and accountability.

Case Examples & Research Evidence:

 Data from academic institutions and corporations demonstrate measurable improvements in leadership capability, confidence, and identity when coaching and apprenticeship programs are implemented in tandem. One study found that undergraduates who received leadership coaching outperformed their peers in self-evaluation, initiative-taking, and communication. Similarly, organizations that pair junior executives with seasoned leaders on real-world projects report greater succession readiness and improved cultural continuity. For instance, a healthcare system implemented a year-long leadership apprenticeship for high-potential clinical managers, resulting in a 25% increase in internal promotions and significantly reduced turnover. These examples underscore the power of experiential learning and the trust it fosters between generations. The most impactful programs are those that strike a balance between structure and flexibility, allowing apprentices to stretch while remaining supported. The case for apprenticeship is not just anecdotal; it is data-driven and results-proven.

Overcoming Challenges in Coaching Apprentices:

Leaders struggle to find time for coaching or mistakenly default to giving directives. An effective apprenticeship requires a shift in mindset: from command to inquiry, from short-term results to long-term development. Another challenge is the temptation to clone oneself—coaches must resist imposing their exact styles. Instead, they should encourage apprentices to explore and refine their voices, emphasizing authenticity and self-discovery over replication. Leaders must also learn to relinquish control, allowing apprentices to make mistakes, learn, and recover. For the apprentice, imposter syndrome and fear of failure can hinder growth, coaches must be adept at building psychological safety and modeling vulnerability. Lastly, organizational structures must support this effort; when performance metrics favor only short-term outcomes, coaching can be deprioritized. Addressing these challenges requires intention, effective communication, and a commitment across all leadership levels.

Measuring Success and Institutionalizing the Practice:

To sustain apprenticeship models, organizations must define clear metrics of success and integrate coaching into their leadership pipelines. Effective metrics include observable behavior changes, feedback from peers and supervisors, and progression into formal leadership roles. Making coaching part of job expectations, and distributing time in calendars and budgets, signals organizational commitment and reinforces its strategic value. Institutionalizing the practice also requires training and support for coaches. Not everyone is naturally equipped to coach; it must be seen as a skill to be developed. Recognition and reward systems can further encourage participation and excellence. Over time, the goal is to normalize coaching-as-apprenticeship as a cultural standard, not a temporary initiative. When embedded deeply, it becomes self-perpetuating: today’s apprentices become tomorrow’s coaches.

Action Plan – Six-Month Coaching Apprenticeship Template: Month Activity

1. Identify apprentice and coach pair; set mutual goals. Clarify expectations and agree on communication rhythm.

2. Shadowing senior leader in meetings, decision-making, and interpersonal scenarios. Focus on observation and questioning.

¾. Apprentice leads small initiatives or portions of projects under supervision. Provide real-time feedback and adjust tasks as needed.

5. Deep reflection session: discussing key learnings, identify growth areas, and recalibrate developmental objectives.

6. Final project debrief: summarize progress, co-create a personal leadership vision statement, and develop a transition roadmap.

This plan is not a rigid template but a guide for phased development. Each month’s focus allows for a gradual transition from observation to ownership. Coaches facilitate experiences while ensuring support and reflection. By the end of six months, apprentices should not only demonstrate enhanced skills but also articulate a personal leadership philosophy shaped by feedback and experience.

Conclusion:

Coaching young leaders through an apprenticeship approach creates multiplier effects, developing not only leadership skills but also leadership identity, confidence, and organizational continuity. This shifting paradigm, from managing tasks to growing people, challenges leaders to measure legacy by who they raise, not just what they achieve. Investing in apprenticeship coaching today helps ensure stronger, more adaptive organizations tomorrow. By embracing apprenticeship as a strategic imperative, leaders cultivate a lasting impact, one that extends far beyond their tenure and

shapes the trajectory of future generations.

More importantly, the coaching-as-apprenticeship model restores a human-centric ethos to leadership development. It recognizes the power of relationships, trust, and long-term investment in others. It transforms organizations into learning communities, where leaders are not only accountable for business outcomes but also for building capacity in others. The impact ripples outward, from individual apprentices to teams, departments, and entire institutions.

Every seasoned leader has the opportunity —and the responsibility —to create space for others to grow. Leadership, at its best, is not a destination but a legacy to be passed down. Moreover, that legacy is measured not only in profit margins and productivity metrics, but in the readiness, values, and courage of those who follow. Coaching future leaders as apprentices ensures that the mission and values we lead with today endure and evolve through those we mentor tomorrow.

Challenge question: As a leader, are you merely managing today’s results, or are you actively shaping tomorrow’s leaders through intentional apprenticeship?

Source:https://neonatologytoday.net/newsletters/nt-jul25.pdf

INNOVATIONS

Health care challenges have long stood in the way of Liberia’s national development. With limited access to quality medical services, many Liberians have found themselves traveling abroad or relying on prayer and hope in the face of serious illness.

But a new chapter is unfolding, one driven by local leadership, global standards, and a bold commitment to change.

Located along the Congo Town back road, WPMC delivers safe, customer-centered, world-class services, all provided by Liberian professionals. Its offerings range from advanced laboratory diagnostics to outpatient care and medical screenings for international visa applicants.

Metering system installation services.

WPMC’s practices are in line with national and international standards and are supported by technologies sourced from the U.S., Europe, and Asia. From the outset, the center has been designed to restore trust in Liberia’s medical system.

The official launch ceremony brought together distinguished guests, including former President Ellen Johnson Sirleaf, health sector leaders, staff, and the general public. The event not only marked a major milestone in health care delivery but also celebrated the vision and leadership that made it possible.

At the heart of WPMC is Dr. Nicole Cooper, the facility’s Medical Director. A passionate health leader, who shared the journey that led to the creation of the center.

“I’ve seen too many people praying outside hospital rooms, hoping that everything aligns just to save a life,” she said. “Too many are forced to leave the country for basic health care because they don’t trust that it can be done here.”

That reality, Dr. Cooper explained, planted a seed back in 2009, the early inspiration behind what would eventually become Wellness Partners. In 2021, she returned to Liberia with the goal of building a system that met international standards but remained accessible and reliable for all Liberians.

She began with Wellness Partners Clinic, a small pilot that tested health care delivery models, affordability, and customer care strategies. From those humble beginnings, the initiative expanded into the full-fledged Wellness Partners Medical Center.

“We’re different,” she said. “We invest in our people, prioritize quality and safety, and put transparency at the center of what we do.”

“Our vision is bold yet simple: to become the safest, most reliable, and most convenient network of medical care in Africa,” she told attendees. “This is what’s possible when we believe in ourselves and build from the inside out.”

Representing the WPMC Board of Directors, Mrs. Monique Cooper Liverpool echoed that sentiment, calling the center “a homegrown solution led by Liberian talent with world-class expertise.”

Also speaking at the event was Mrs. Sophie Parwon, CEO of Benson Hospital, who highlighted the growing contribution of the private sector in Liberia’s health care ecosystem.

“While the government remains the main provider of health services, the private sector is increasingly stepping up, contributing to service delivery, financing, innovation, and capacity building,” she said.

Mrs. Parwon praised Dr. Cooper as a “public health icon” and called on government and development partners to strengthen support for private health initiatives that align with national priorities.

As WPMC opens its doors, it does more than offer medical services. It offers hope, hope for a health care system where Liberians no longer need to look abroad for basic care, where dignity and quality go hand in hand, and where innovation is driven from within.

Source:https://thenewdawnliberia.com/a-homegrown-medical-facility-emerges/

Abstract

Objective To assess the feasibility and clinical utility of daytime polysomnography (PSG) in infants ❤ months of age.

Methods A prospective observational study of a convenience cohort analysing PSGs that were conducted for clinical purposes in infants less ❤ months of age, between 1 May 2021 and 31 May 2024. A comparison was made between results for daytime PSG in the neonatal intensive care unit (NICU) and overnight PSG in the sleep laboratory. The type of PSG performed (daytime vs overnight) was based on the workflow of the sleep laboratory. Primary outcomes were successfully completed PSGs (feasibility) and per cent sleep efficiency (clinical utility). Secondary outcomes compared other sleep parameters between groups. Patient and public feedback directly informed the development of the research question and outcome measures.

Results Of 60 PSGs, 28 were daytime and 32 were overnight. Daytime studies had a younger age (median 18 vs 55 days, p<0.001) and shorter median recording time (8.2 vs 10.4 hours, p<0.001). All daytime PSGs were successful, indicating feasibility. After adjusting for age at PSG and total recording time, per cent sleep efficiency was equivalent in the two groups (95% CI −12.4 to 5.7; p 0.456), indicating their clinical utility. For secondary outcomes, daytime PSGs had a higher % rapid eye movement (REM) sleep by 9.9% points (95% CI 1.1 to 18.8; p 0.028) compared with overnight PSG. Parameters that were not different included: frequency of spontaneous arousals, REM latency, sleep latency, Apnoea-Hypopnoea Index and Obstructive Apnoea-Hypopnoea Index. A decline in requests for overnight PSGs and a corresponding increase in daytime PSGs over the course of the study were observed.

Conclusion Daytime PSGs performed in NICU were feasible and provided clinically useful results in infants ❤ months of age. Availability of daytime PSGs performed at the infant’s bedside expands resource capacity and has the potential for cost savings.

Source: https://bmjpaedsopen.bmj.com/content/9/1/e003641

With support from the World Health Organization (WHO), the National Public Health Institute of Liberia (NPHIL) and the Ministry of Health concluded a residential hands-on in-country training on genomic sequencing and bioinformatics at the National Public Health Reference Laboratory (NPHRL) from 29 September to 19 October 2024 in Margibi County. Facilitated by a team of experts from the Noguchi Memorial Institute for Medical Research in Ghana, a total of 10 national laboratory technicians received a 2-week intensive training followed by a 1-week practice session. 

Genomic surveillance plays a critical role in tracking emerging pathogen variants. It has become a fundamental global public health tool for detecting, monitoring, and responding to infectious disease outbreaks, as demonstrated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. During the in-country training, national laboratory scientists analyzed additional mpox-positive samples and detected another mpox strain, clade IIb.

“Before the training, we were reliant on international laboratories to identify the circulating pathogen strains. Now, we have the capability to conduct sequencing and bioinformatics analysis in-country, enabling us to rapidly identify emerging pathogens and their geographic origins,” Francis Omega Somah, laboratory technologist at the National Reference Laboratory in Liberia.

This training is a significant milestone in the integration of pathogen genomics and bioinformatics into public health surveillance, outbreak detection, and investigation, which will enhance disease control and prevention efforts in Liberia. “This is a game-changer for the country as we will now have the national capacity to sequence and characterize pathogens of epidemic prone diseases in our country. We thank WHO for this strategic investment and their continuous technical and financial support towards strengthening Liberia’s capacity to detect and manage epidemics,” said Dr Dougbeh Nyan, Director General of NPHIL. 

In 2022, WHO published a global genomic surveillance strategy to support countries in expanding their capacities. Unfortunately, 50% of Member States, including Liberia, lacked domestic sequencing capacity. To address this gap, WHO, under the AFRO HERA project, is supporting six African nations: Liberia, Burundi, the Central African Republic, Comoros, Eritrea, and Togo to establish and strengthen genomic sequencing and bioinformatics capacity, thereby expanding detection and genomic surveillance of epidemic-prone priority pathogens across the African Region. WHO has significantly invested on the continent in infectious disease and genomics surveillance. 

“The most important aspect of capacity building is training the right experts. When a country has skilled professionals with the right platform, expertise, and infrastructure, they can respond swiftly and effectively to public health emergencies,” said Dr. Coulibaly Sheik, WHO AFRO Lead Diagnostic and Laboratory Services Unit.

Dr. Peter Clement, WHO Country Representative, thanked the team of facilitators and WHO AFRO for supporting Liberia through the EU-funded project which will strengthen the country’s laboratory systems. “By empowering local experts with the skills to conduct genomic sequencing and bioinformatics analysis, we are ensuring that Liberia is better prepared to rapidly identify emerging threats and implement timely interventions,” said Dr. Peter Clement, WHO Liberia Representative.

Source: https://www.afro.who.int/countries/liberia/news/strengthening-liberias-capacity-detect-and-manage-epidemics-through-genomic-sequencing-and

The Healing Power of Comfort Pets in Children’s Hospitals

In the high-stakes environment of a children’s hospital, every source of comfort matters. Beyond the dedicated medical staff and cutting-edge technology, one often overlooked hero is the comfort or service pet. These animals, specially trained to provide emotional support, offer more than companionship—they bring a sense of calm, joy, and connection during some of the most challenging times in a young patient’s life.

For pediatric patients, comfort pets can help reduce anxiety, ease feelings of isolation, and even promote healing. A gentle nuzzle or playful paw can break through the walls of fear that sometimes build during hospital stays. Studies have shown that interaction with therapy animals can lower stress hormones, improve mood, and provide a sense of routine and normalcy for children who are often navigating complex medical treatments. In the neonatal context, while the infants themselves may not directly interact with pets, families of NICU babies experience the calming presence of therapy animals, helping them manage stress, fear, and the emotional weight of having a critically ill newborn.

Families may benefit greatly from the presence of comfort pets. Parents and siblings frequently carry their own anxieties as they support a hospitalized child. In the NICU, where the emotional toll is heightened by uncertainty and intensive care routines, therapy animals offer brief but meaningful moments of relief, allowing families to smile, laugh, and connect. These moments can strengthen the parent-child bond, provide emotional grounding, and even support parents’ ability to be present and engaged in their baby’s care.

Healthcare workers often report the positive impact of comfort pets. Long shifts, high emotional demands, and the intensity of neonatal and pediatric critical care can take a toll on staff well-being. Therapy animals provide a moment of grounding and a reminder of the simple joys in life, helping to reduce burnout and improve morale.

In NICUs and pediatric wards alike, the presence of a comfort pet is a win-win: patients receive care enriched by joy, families feel supported, and staff experience a boost in their own emotional resilience.

Our very own Bennie Boo (hypoallergenic, gentle, and loving) may be a perfect candidate for comfort care training in his future. This is a pathway we may consider next year when he turns two.

Anthony gets a lesson from Liberia’s first ever surfer, Alfred Lomax. He doesn’t catch a wave, but locals manage to catch more than enough fish for a fresh seafood feast, served with a beer, of course!

EMERGENCE, DADS, CLABSI

Cyprus, officially the Republic of Cyprus, is an island country in the eastern Mediterranean Sea. Situated in West Asia, its cultural identity and geopolitical orientation are overwhelmingly Southeast European. Cyprus is the third largest and third most populous island in the Mediterranean, after Sicily and Sardinia. It is located southeast of Greece, south of Turkey, west of Syria and Lebanon, northwest of Israel and Palestine, and north of Egypt. Its capital and largest city is Nicosia. Cyprus hosts the British military bases Akrotiri and Dhekelia, whilst the northeast portion of the island is de facto governed by the self-declared Turkish Republic of Northern Cyprus, which is separated from the Republic of Cyprus by the United Nations Buffer Zone.

A universal national health system, known as GESY, was implemented in Cyprus in June 2019. The system was created as part of a requirement in the bail-out agreement with the International Monetary Fund, the European Commission and the European Central Bank (the Troika). The new system aims to provide affordable and effective medical care to all people residing permanently in Cyprus.

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

COMMUNITY

The neonatal intensive care unit (NICU) is often seen through the eyes of mothers and clinicians, but another voice remains underrepresented: fathers. In June 2025, AngelEye Health hosted a national webinar bringing together NICU dads and clinicians to discuss fatherhood in the NICU. What emerged was honest, emotional, and long overdue. These fathers revealed that while the NICU centers around the fragile infant, it is also a crucible for shaping new fathers through fear, resilience, and love.

Meet the Facilitator:

Dr. Craig Garfield is a professor of pediatrics and a NICU hospitalist with over 25 years of experience caring for premature infants in an 85-bed Level III NICU. Dr. Garfield’s research focuses on understanding the role fathers play in the lives of families and elevating the voices of fathers in the healthcare system.

 Meet the Dads:

Teo Muñoz became a first-time father while still in his early twenties. His son was admitted to the NICU following an emergency transfer during a complicated delivery at only 24 weeks and 2 days of gestation. Teo juggled hospital visits, work transitions, and supporting his fiancée during a NICU stay that lasted 128 days.

Jared Muscat and his wife experienced a premature birth of their son at only 24 weeks of gestation that led to a NICU stay of 97 days. With a background in healthcare advocacy and personal experience managing his epilepsy, Jared brought a thoughtful perspective on communication, peer support, and emotional resilience.

Adam Wood entered the NICU after a high-risk pregnancy and a traumatic delivery following IVF. His son required intensive support immediately after birth at 25 weeks of gestation. Overwhelmed and unprepared, Adam gradually found purpose in presence and routine throughout the 135-day journey.

Their stories reflected a broad range of emotions and circumstances, yet common themes emerged—ones that can inform how neonatal teams engage fathers moving forward.

Lesson 1: Dads Need to Be Seen—and Heard:  As Teo reflected, “I was running upstairs to see my wife, downstairs to see the baby, back home to get things we forgot—we were still just kids ourselves.” NICU dads often carry invisible burdens as they work hard to try to keep things going for their partners. Many fathers report that they shoulder an increasing number of burdens to alleviate the burdens that fall on mothers. Their role is typically seen as secondary or supportive, yet they are equally affected. Many expressed feeling overlooked by both care teams and support systems, highlighting a need to engage fathers as partners in care intentionally—not just visitors or helpers, but as essential members of family-centered care who, like many mothers, are grieving the loss of a “normal” pregnancy.

 Lesson 2: The Mental Health Toll Is Different—but Just as Deep: Dr. Garfield noted, “Our studies show that while maternal stress often decreases over time, paternal stress levels remain steady— because their needs are frequently unaddressed.” (1, 2) Several dads described post-traumatic stress symptoms and emotional suppression during their baby’s stay, only processing their experience months or even years later. As Teo shared, “I did not start talking about it until a week ago, when my son turned one.”

Lesson 3: Identity and Purpose Emerge from Chaos: Adam described his transformation: “I hadn’t finished the nursery. I hadn’t even finished reading the book (The Expectant Father). (3) But once I figured out how to help—whether it was delivering milk or simply being present, I started to feel like a dad.” Many echoed this shift: from feeling helpless to finding meaning through routine, presence, and celebrating small milestones.

Lesson 4: Fathers Want—and Need—Connection: Fathers found strength through connections with care teams and with one another. Jared shared how he found a dad whose twins shared the same pod as him and his wife, and they committed to meeting up each Thursday night after they both finished their skin to-skin time. “We built a routine and stuck to it. After visiting our sons each night, we’d go out together just to talk—even if it wasn’t about the NICU.” Whether through structured peer groups or informal moments of release and connection, relational touchpoints proved vital to their emotional survival.

Lesson 5: Communication Matters—Even When It Is Hard: Fathers stressed the importance of being included in updates and decision-making. Medical jargon, even when simplified, could still feel overwhelming. Jared noted, “They kept using grams and kilograms—I started doing my own math to stay involved.” Humor and engagement became bridges for understanding and partnership.

Practical Insights from NICU Dads In follow-up reflections, both Adam Wood and Teo Muñoz offered practical guidance for clinicians working with fathers in the NICU. Their combined perspectives provide actionable strategies that underscore the importance of presence, effective communication, and emotional attunement.

For Physicians:

● Acknowledge the father’s emotional entry point. Teo emphasized that many dads are the first to see or touch their newborn in the NICU—an emotionally complex moment that while can be filled with joy in finally seeing their baby, for many dads it is accompanied by feelings of guilt that their partner may not be with them and sadness that the pregnancy ended prematurely. Recognize the complexity of that moment.

● Be realistic—but human. Honest, grounded communication helps parents stay mentally prepared.

● Include fathers in real-time updates. A brief call can make a meaningful difference.

● Affirm their efforts. Let dads know their presence matters and is beneficial for their baby.

● Many dads are grateful to be prescribed roles and responsibilities, such as helping moms by cleaning and preparing the pump supplies or delivering the expressed colostrum when ready.

● Ask how they process information. Tailor the level of detail to each father’s preferences.

For Nurses:

● Encourage hands-on participation. Reassure fathers that their gentle touch and care are meaningful.

● Help build confidence. Demonstrate caregiving techniques to ease fear.

● Create personal mementos. Milestone cards or NICU photos tailored for dads can strengthen bonding.

● Use humor and connection. Lightness can break tension and invite deeper engagement.

● Consider QI projects and initiatives that support bedside staff in working with fathers.

Final Reflection: As Adam Wood shared, “This baby is our world and we are entrusting you with helping not only our baby—but us—make it out. Show us that you care. Build trust. Let us advocate for our baby with your support.”

Implications for Clinical Practice

Fathers are not secondary parents—they are essential pillars of the NICU family. As clinicians, we must:

 – Normalize emotional check-ins for dads, not just moms – Provide anticipatory guidance tailored to  

    fathers

 – Offer dedicated peer support pathways

–  Acknowledge and affirm their identity as caregivers

When we reframe NICU care to include the whole family unit, outcomes improve not just for infants but for every caregiver who walks through the NICU doors. These changes do not require significant resources—just intentionality. The impact on family connection, parental confidence, and outcomes can be profound.

 Conclusion: “Celebrate the ounces gained,” Adam said. “Celebrate every milestone. Because if you don’t, it’s easy to get lost in everything else.” These fathers have shown us what presence means. Their voices challenge us to rethink how we engage, educate, and empower every member of the NICU family. Fathers are not extra. Fathers are not optional. Fathers are critical—and they deserve to be seen that way. As NICUs strive to become more inclusive and equitable, elevating the father’s voice is not only overdue—it is essential. To hear these fathers’ stories in their own words, you can view the recorded here:https://us02web.zoom.us/webinar/register/WN_HYS5KcDDTFK9GV_7Z7HkYw.

Cyprus’ President, Nicos Anastasiades, has bestowed the Grand Cross of the Order of Makarios lll on Paphos-born Dr Kypros Nicolaides, a world-renowned pioneer in fetal medicine, in recognition of his invaluable contribution to science and society more generally.

At a ceremony at the presidential palace, Anastasiades paid tribute to the London-based doctor whose discoveries have revolutionised the field and earned him the title the ‘Miracle Maker.’

Anastasiades noted that Cyprus’ highest honour is normally awarded to heads of government, and only in exceptional cases to distinguished personalities.

“As President of the Republic of Cyprus, taking into consideration the invaluable contribution of Professor Kypros Nicolaides in promoting health, and particularly the field of fetal medicine, I decided that the only worthy honour to this world known scientist was to award the Grand Cross of the Order of Makarios lll,” the President said.

As a doctor, Nicolaides has dedicated his life to fetal health, developing pioneering research and clinical programmes for prenatal diagnosis and treatments and inextricably linking his name to numerous breakthroughs in diagnostics, including of Down Syndrome.

Through his work in medical schools and scientific publications he has helped advance prenatal medicine and opened up the horizons to the revolutionary sector of fetal surgery, the President said.

Nicolaides has helped promote accessibility to these breakthroughs with the establishment of the non-profit Fetal Medicine Foundation in 1995 which has invested millions in research and training, and offered scholarships to doctors worldwide, among other.

Cyprus has also benefitted from the doctor’s expertise and generosity, the President said. The Fetal Medicine Centre has worked closely with the Makarios Hospital’s gynecological department to deal with high-risk pregnancies, while Nicolaides donated cutting edge ultrasound equipment to the hospital. In recognition of the professor’s contribution, a maternity ward at the hospital was named after him.

Indicative of the world recognition Nicolaides enjoys was his recent election to the US national academy of medicine – one of only 10 clinical doctors who are not US citizens, Anastasiades said.

Pioneer of fetal medicine, Dr Kypros Nicolaides, has been awarded Cyprus’ highest honour.

Accepting the award, Nicolaides said he saw it as a tribute to the love and support to the doctors worldwide who have dedicated their lives to the service of women and their newborns.

“To those who will not compromise with the tragic reality that every minute a woman somewhere in the world dies as a result of a complication in her pregnancy or at childbirth and that the large majority of these can be avoided. To the doctors who dedicated their lives to reducing peri-natal mortality, forecasting and preventing premature births, congenital anomalies, placental insufficiency, and other,” he said.

Source: Cyprus Mail.https://greekherald.com.au/news/greece/pioneer-fetal-medicine-dr-kypros-nicolaides-awarded-cyprus-highest-honour/

For over 50 years there has been a commitment to multilateralism and funding for science and health. Recent shifts around the world jeopardise the ability of all countries to address existing and new health crises, and specifically threaten hard-won progress in reproductive, maternal, newborn, and child health, including for preterm babies who are particularly vulnerable.

Preterm birth remains a silent emergency of a global scale. Every 2 seconds, a baby is born too soon.  Every 40 seconds, one of those babies dies. An estimated 13.4 million babies were born preterm (before 37 weeks of pregnancy) in 2020 – equivalent to nearly one in ten babies being born preterm worldwide.

Preterm birth is the leading cause of child deaths, accounting for more than 1 in 5 of all deaths of children occurring before their 5th birthday. From 2010 to 2020, an estimated 152 million babies were born preterm. Yet, rates of preterm birth have remained stagnant, with some regions even witnessing an increase. For preterm survivors, challenges extend far beyond the neonatal period, as they face a higher risk of lifelong health complications, including developmental delays, disabilities, and chronic conditions . Limited advancements in the prevention of preterm births and gaps in the implementation of the care of preterm newborns have contributed to the global slowdown in progress for reducing newborn and child mortality since the adoption of the Sustainable Development Goals (SDGs) in 2015. Hence, progress remains insufficient to achieve the necessary reductions in newborn and child mortality to meet the SDG targets by 2030. In response, the 77th World Health Assembly Resolution on accelerating progress for maternal, newborn, and child health included a strong call for intensified global action to address the root causes and effects of preterm birth.

To fast-track evidence-based implementation on the prevention of preterm birth and care for preterm babies, this supplement expands content from the 2023 report “Born too soon: decade of action on preterm birth” . We are also building on the first Born Too Soon report in 2012 , which presented the first ever national and global preterm birth estimates, and the linked BMC Reproductive Health supplement (2013), which translated the chapters into academic articles. We have emulated this approach with a supplement in the same journal. The papers in this supplement expand on the chapters in the 2023 edition of Born Too Soon. Each paper presents evidence synthesis based on literature reviews, country case studies about good practices on policy and implementation and lived experiences and community perspectives.

This 2025 supplement anchors preterm birth as a key issue within the continuum of maternal and newborn care, including the prevention of stillbirth. The supplement highlights the importance of women’s sexual and reproductive health and rights (SRHR). It places additional emphasis on adolescent girls, who have an increased risk of preterm birth but often have far less access to the services and care that they need to support their health and well-being. Importantly, a life-course perspective is foundational and recognises the intergenerational impacts of preterm birth. Hence, we place additional emphasis on the follow-up care and support that is needed for survivors of preterm birth and their families.

The 2023 Born Too Soon report was part of a campaign to elevate awareness around the burden, solutions and priorities for preterm birth. This movement for action was spearheaded by the Partnership for Maternal, Newborn and Child Health (PMNCH), the world’s largest alliance for women’s, children’s and adolescents’ health and wellbeing, and harnessed three shifts: power of data, people’s stories and partnerships.

Priorities to catalyse change/Power of data and new evidence

The 2010 estimates on preterm birth showed that preterm birth affected every country, including high-income ones, with the USA in the top ten for numbers of babies born too soon. Evidence-based action could save over a million children who die needlessly each year. Equity gaps are enormous, with only 1 in 10 extremely preterm babies (< 28 weeks) surviving in low-income countries, compared to more than 9 in 10 in high-income countries . These inequities in survival are driven by a lack of access to quality care and determine the likelihood of preterm birth, death, and disability. Disparities, however, do persist in high-income countries, where marginalised groups face significant challenges in accessing timely and effective care. Poverty often limits access to essential services such as prenatal care, proper nutrition, and safe living conditions, which are critical for preventing preterm births and managing complications. Systemic racism further exacerbates these issues, with minority groups frequently encountering bias, lower-quality care, and obstacles in navigating healthcare systems, resulting in poorer outcomes for both mothers and babies .

Yet, investment in preterm birth prevention and care can unlock more human capital than at any other time across the life course, impacting futures for millions of families and resulting in significant human and economic returns.

Power of people at the centre

These data and large numbers reflect affected individuals and communities – women, babies and their families and healthcare workers – which PMNCH put at the heart of the campaign. An essential dimension of the Born Too Soon movement was a collection of narratives from affected families and other lived experiences, including healthcare workers [13]. Parent and patient groups along with healthcare professional associations have led the charge for preterm birth; in this supplement, we argue for a broad and multi-constituency mobilisation around this agenda, to improve investments in preterm birth across sectors.

Power of partnerships

The 2023 Born Too Soon report , and this supplement were fuelled by engagement of 70 organisations, including 140 individuals from 46 countries. The campaign reached 215 media products across six continents, for a total estimated media reach of 3.47 billion people. With a diverse authorship explicitly including leaders from low- and middle-income countries (LMICs) and young experts, the papers in this supplement position the prevention and care for preterm babies as a cornerstone of integrated and high-quality maternal and newborn care, including stillbirth prevention. The 2023 Born Too Soon report was co-published by PMNCH, WHO, UNICEF and UNFPA, and guided by a high-level Advisory Group. In addition, this supplement has been published as part of the 2025–2026 joint WHO and PMNCH advocacy campaign, linked to the 2025 World Health Day theme: “Healthy Beginnings, Hopeful Futures”, calling for unified action and urgent prioritisation of maternal and newborn health.

Papers in this supplement

This supplement, Born Too Soon: Progress, Priorities, and Pivots for Preterm Birth, expands on the content of the Born Too Soon 2023 report, adopting a life-course approach that follows women and their newborns over time within a continuum of care. The supplement consists of seven analysis papers and four commentaries.

We present updated data and evidence from the 2012 report , now examined through a broader lens, including new data on preterm birth rates, trends, risk factors, and advances in measurement globally; maternal health and care relevant to preterm prevention, with an emphasis on sexual and reproductive health and rights; care for small and sick newborns; and implementation learning for systems change, extending beyond preterm care alone. Within each paper, content was organised by three domains:

  1. 1. progress, particularly in the last decade, related to preterm birth;
  2. 2. programmatic priorities based on up-to-date and policy-relevant evidence; and
  3. 3. pivots needed to accelerate change in the decade ahead
  4.  

Five papers in this supplement align to the 2012 set including:

  • Paper 1: Learning from the past to accelerate action in the next decade.
  • Paper 2: Global epidemiology of preterm birth and drivers for change .
  • Paper 3: Progress and priorities for respectful and rights-based preterm birth care.
  • Paper 4: Women’s health and maternal care services, seizing missed opportunities to prevent and manage preterm birth..
  • Paper 5: Care for small and sick newborns, evidence for investment and implementation.
  • Paper 6: Integration of intersectoral interventions for impact on preterm birth.
  • Paper 7: Accelerating change to 2030 and beyond.
  • Two new papers cover novel topics of increasing importance with new evidence that were not included in the 2012 Born Too Soon report:

Overall, these supplement papers emphasise a healthy beginning for vulnerable babies, and the life course approach underlining the follow-up care and support needed for survivors of preterm birth and their families over the course of their lives. The first paper reviews progress during the last decade since the last report, primarily from a policy perspective, and considers the challenges that have hindered advancements and looks ahead, positioning preterm birth as a pivotal issue for driving more rapid and integrated progress for women and children.

The second paper presents updated national estimates of preterm birth rates for 195 countries, with trends for the last decade emphasising the flatlining of progress for preterm birth rates in every region, with new insights on risk factors. There are positive improvements in measurement and opportunities to more accurately count and account for preterm births and use these data to drive action.

The third paper focuses on rights and respect for women and their babies, calling for a rights-based approach to respectful care for the mother-baby dyad, especially small and preterm babies who are the most vulnerable. This paper also promotes an enabling environment for healthcare workers with supportive policies and accountability mechanisms .

The fourth paper focuses on women’s health and maternity services, highlighting the evidence and the importance of seizing missed opportunities in preventing and managing preterm birth within existing care packages. A broader emphasis on sexual and reproductive health and rights is also championed.

The fifth paper highlights the opportunity for impact and high return on investment with small and sick newborn care, and sets out interventions and innovations for faster implementation with health systems shifts to ensure newborns survive and also thrive and families are at the centre of care. Crucial gaps for infrastructure, devices, data and especially workforce are highlighted.

The sixth paper focuses on intersectoral interventions to improve preterm birth and highlights the need for an intersectoral approach that addresses the multifaceted challenges of prevention and care for preterm birth, focusing on equity and rights, education, economy, environment (including nutrition and climate) and emergencies (“the five Es”)

The seventh and final paper outlines a forward-looking call to action, highlighting investment, implementation in partnership with women and families, integration, and innovation to drive progress.

Three additional commentaries are also included in the supplement: the first is a high-level political commentary by prominent signatories, including three heads of agencies and the PMNCH Board chair, the second focuses on community voices; and the third highlights data and findings on preterm births from recent work led by Countdown to 2030 and partners, placing preterm birth within the context of the maternal-newborn-stillbirth transition framework and the Every Woman Every Newborn Everywhere coverage targets.

Progress is possible

The Born Too Soon movement, the report and these papers, take stock of the journey of the past decade – the good and the bad, the challenges and the opportunities to accelerate preterm birth prevention and improved neonatal care into the next decade. Born Too Soon shines a spotlight on countries’ achievements and innovations that can inspire and inform faster progress. The agenda for preterm birth is central to the SDGs, recognising that progress on maternal and newborn health and stillbirths depends on collaboration across sectors. Highlighting where progress is happening, this supplement looks to the future to reduce the burden of preterm birth by investing more in high-quality, respectful care for women and babies so that they can survive and thrive, in every country, in the decade to come.

Born Too Soon: Priorities to improve the prevention and care of preterm birth | Reproductive Health | Full Text

PREEMIE FAMILY PARTNERS

June is National Safety Month, and it’s the perfect time to share a few key tips to help keep babies safe while they sleep. At First Candle, we know how overwhelming all the advice can be, so we’re keeping it simple: safe sleep saves lives.

Each year, thousands of babies die from Sudden Unexpected Infant Death (SUID), which includes SIDS and Accidental Suffocation. The truth is, most of these deaths involve more than one unsafe sleep practice—and nearly 60% happen when a baby is sharing a sleep surface with someone else.

Here’s what you really need to know:

  • Back is Best: Always place baby on their back to sleep, on a firm, flat surface with a tight-fitting sheet. If the surface is too soft (like a couch or adult mattress), it can increase the risk of suffocation.
  • Clear the Crib: Keep baby’s sleep space totally empty—no pillows, bumpers, stuffed animals, or blankets. (Yes, even a soft little blanket can be deadly.) Use a wearable blanket instead if you’re worried about warmth.
  • Watch the Products: Swings, rockers, loungers, and other inclined gear might be great for awake time, but they’re not safe for sleep. If baby nods off, move them to a crib, bassinet, or play yard right away.
  • If You’re Tired, Put Baby Down: We know how comforting it is to cuddle your little one, but if you’re feeling sleepy—even just for a second—lay baby down in a safe space. Babies can suffocate in a parent’s arms if the parent falls asleep. Don’t take the risk.

We’re here to help make safe sleep simple. These small changes can make a huge difference—and give you peace of mind while your baby rests.

Let’s spread the word this National Safety Month and protect every little life we can.

Source: https://firstcandle.org/2025/06/02/keeping-baby-safe-during-sleep-what-every-parent-needs-to-know/

This educational video introduces the importance of preventing Central Line-Associated Bloodstream Infections (CLABSIs) as part of a broader effort to reduce hospital-acquired conditions and support children’s recovery. The video explains that a central line is a special tube placed in a large vein near the heart to aid in treatments, and while helpful, it carries a risk of infection if not properly managed. To help prevent CLABSIs, parents and caregivers are encouraged to: — Talk daily to the healthcare team about the need for the central line. — Wash hands thoroughly before touching the line or the area around it. — Help with daily cleaning using Chlorohexidine Gluconate (CHG) wipes if the child is over 2 months old. — Check that the dressing is clean, dry, and secure. — Change bed sheets daily to reduce infection risk. The video emphasizes that parents play a critical role in infection prevention and encourages them to continue watching the series.

Key Points

Having a baby in the NICU can be stressful for families. Expect to have many different feelings about your baby’s health and care.

You, your partner, and your family may cope with the stress of the NICU differently. It’s OK to have different feelings.

It’s important to take care of yourself so that you can care for your baby.

You may feel sad and worried during your baby’s NICU stay. If you think you have a more serious condition, like depression or anxiety, talk with your healthcare provider or NICU team right away.

What emotions could you have when your baby is in the neonatal intensive care unit (NICU)?

Many parents feel very alone during their baby’s NICU stay. The stress of having a baby in the NICU can go on for weeks and months. It can be tiring to learn so much about your baby’s medical condition and make care and treatment decisions. No parent is fully prepared for life in the NICU. But parents can find ways to get comfortable there.

You may have many different feelings, including guilt, helplessness, sadness, anger, fear, shock, and a sense of loss when your baby’s in the NICU. There is no “normal” way to feel. You and your partner may cope differently. Know that your feelings are shared by many families who have had a baby born early, with birth defects, or other medical conditions. Over time, you will be able to better face and cope with your feelings.

There are a lot of ways to get support. Letting other people know how you’re feeling may help you on your journey through the NICU. Your partner, friends, family, and hospital staff can play a big role in how you cope.

How can you take care of yourself when your baby is in the NICU?

It’s hard for parents to leave their baby in the NICU. It may be even harder to think about taking care of yourself, because you’re so focused on your baby’s needs. But doing so means that you can stay well and have more energy to spend time with your baby.

One way to take care of yourself is to have a daily routine. This means eating meals, drinking plenty of water, taking showers, and getting regular sleep while your baby’s in the NICU. If you’re having trouble doing these things, talk to your healthcare provider, the NICU social worker, or your baby’s nurse. As part of your routine, decide when you want to be with your baby in the NICU. Share these times with your baby’s nurse so they know when to expect you.

Another way to take care of yourself is to connect with NICU families. If your baby is in a single room, look for families at NICU classes or in the family lounge. If your baby is in a room with many babies, take time to get to know the other families. They may understand your experience better than other people in your life.

It’s also helpful to find healthy ways to take breaks from the NICU. This can include going outside, getting lunch with a friend, or taking a nap at home. It’s OK to make time for yourself and your family at the hospital and at home.

What can you do if you need to go back to work when your baby’s in the NICU?

If you need to go back to work while your baby is still in the NICU, it may be helpful to talk with NICU staff. Let them know your work schedule and when you plan to be with your baby. You also may want to discuss your work schedule with your employer. Ask if you can get time off from work while your baby is in the NICU. Or see if you can work different hours so you can be with your baby when it’s best for them. Know that you’re doing the best that you can and try not to be too hard on yourself.

What if you feel sad and worried when your baby’s in the NICU?

Having a baby in the NICU can be an emotional time for parents. You may feel sad and worried. Lots of NICU parents feel this way during their child’s NICU stay or even once they’ve come home. Sometimes you or your partner may have more serious conditions, like depression and anxiety. These conditions can be brought on by the NICU stay but also your body’s reaction to your baby being born. Having depression or anxiety can make it hard for you to take care of your baby.

Baby blues are feelings of sadness a mom may have in the first few days after having a baby. Baby blues are also called postpartum blues. Postpartum means after giving birth. Baby blues can happen 2 to 3 days after you have your baby and can last up to 2 weeks. They usually go away on their own, and you don’t need any treatment. If you have sad feelings that last longer than 2 weeks, tell your healthcare provider. They may want to check you for a condition called postpartum depression.

Postpartum depression (PPD) is a kind of depression that some people get after a baby is born. PPD is strong feelings of sadness, anxiety, and tiredness that last for a long time. These feelings can make it hard for a parent to take care of their baby. This depression can happen during pregnancy or in the first year after a baby is born. PPD is more common in people who have or have had a baby in the NICU. It often starts within 1 to 3 weeks of having a baby. It’s a medical condition that needs treatment to get better.

If you think you may have PPD, call your healthcare provider or talk with your NICU team right away. There are things you and your provider can do to help you feel better. If you’re worried about hurting yourself or your baby, call 911.

Last reviewed: April 2025 –https://www.marchofdimes.org/find-support/topics/neonatal-intensive-care-unit-nicu/coping-stress-nicu

HEALTHCARE PARTNERS

Highlights:

– NICU-specific CLABSI bundle reduced infection rates by over 80%.

– Central line days and total healthcare costs decreased significantly.

– Preterm-specific modifications improved bundle safety and feasibility.

– Multidisciplinary approach enhanced bundle adherence and sustainability.

Abstract:

Background

Central Line-Associated Bloodstream Infections (CLABSIs) in Neonatal Intensive Care Units (NICUs) significantly impact patient outcomes and healthcare costs. This study evaluates the effect of NICU-specific bundle designed to prevent CLABSIs.

Method

This retrospective single-center study was conducted at Hacettepe University Faculty of Medicine from March 2020 to August 2021. It was designed to compare 2 periods: pre-intervention and post-intervention period.

Result

The implementation of the bundles led to a significant reduction in infection rates, with CLABSIs decreasing from 29 to 4 per 1000 central line days in NICU-1 and from 14.2 to 2.6 per 1000 central line days in NICU-2. This decline was accompanied by an 80% reduction in the average healthcare cost per patient.

Conclusion

The implementation of a NICU-specific CLABSI prevention bundle significantly reduced infection rates and lowered healthcare costs by approximately 80% per patient. These findings highlight the effectiveness of structured, multidisciplinary infection control strategies in improving neonatal outcomes and resource utilization.

Source: https://www.ajicjournal.org/article/S0196-6553(25)00427-4/abstract

Building Trust and Transparency in Trauma-Informed Developmental Care: A Foundation for Healing

In trauma-informed developmental care (TIDC), trust and transparency are foundational principles that nurture the connection between caregivers, families, and infants. These values are essential in creating an environment where healing can truly thrive. Within the NICU, every action, communication, and decision shapes the experience of both families and clinicians, making trust and transparency vital elements for fostering a safe and supportive space.

Why Trust and Transparency Matter in TIDC

For families in the NICU, trust is more than just a comfort; it is a lifeline. The NICU can be an overwhelming place, where uncertainty often looms and the ability to make sense of complex medical information is a challenge. When caregivers lead with openness and integrity, they provide families with a sense of stability and assurance, letting them know that they are not alone in this journey.

Transparency is equally important—it bridges the gap between clinical decisions and family understanding. Through honest and clear communication, transparency ensures that families are not left in the dark. They become active participants in their baby’s care, making informed decisions that honor both their role and their connection to their child. This empowers families and builds a collaborative, respectful partnership between clinicians and parents.

Building Trust Through Consistent Communication

In TIDC, building trust requires more than a single moment of reassurance. It is an ongoing commitment to consistent, open communication. Caregivers can foster trust by:

  • Being present and available: Spending time with families, answering questions, and genuinely listening to their concerns builds a foundation of trust that extends through every interaction.
  • Providing information proactively: Rather than waiting for questions, sharing updates and explaining procedures in a way that’s accessible and respectful shows families that you value their involvement.
  • Honoring family perspectives: Listening to families’ insights about their baby and their own needs fosters a partnership that acknowledges their expertise and deep connection to their child.

Each of these actions reinforces that caregivers are allies on this journey, deeply invested in the well-being of the family and their baby.

Practicing Transparency with Compassion

Transparency in TIDC goes beyond simply sharing information—it involves delivering it in a way that is compassionate and supportive. Here are some key aspects of practicing transparency in a trauma-informed way:

  • Clarity in communication: Avoiding jargon and speaking in clear, accessible language ensures families can understand and feel comfortable asking questions.
  • Honesty about challenges and limitations: Being forthright about the uncertainties or potential complications in care allows families to feel genuinely informed and respected, rather than shielded from difficult truths.
  • Inviting collaboration: Transparency means involving families in care discussions and decisions as much as possible, allowing them to be active participants rather than passive recipients of care.

By integrating compassion into transparent communication, caregivers build trust while respecting the vulnerability and emotional experience of families in the NICU.

The Ripple Effect of Trust and Transparency in the NICU

When trust and transparency are at the heart of trauma-informed care, the effects are far-reaching. Families feel valued and empowered, creating a foundation of resilience that will benefit them and their child beyond the NICU. Babies, too, benefit from this foundation, as families who feel confident and supported are better equipped to provide the emotional nurturing and bonding that are essential for healthy development.

Moreover, trust and transparency extend to the clinicians themselves. When caregivers practice these principles, they create an environment of respect and honesty that fosters teamwork and mutual support. This culture of openness reduces stress, enhances job satisfaction, and helps create a more compassionate and connected caregiving community.

Trust and Transparency: Essential Pillars of Trauma-Informed Care

In trauma-informed developmental care, trust and transparency are not just principles; they are acts of love and respect that resonate deeply within the caregiving environment. By leading with these values, we create a NICU space where families and clinicians feel valued, connected, and empowered to provide the best possible care.

At Caring Essentials, we believe that trust and transparency are essential pillars of trauma-informed care, supporting every interaction, every decision, and every relationship within the NICU. By honoring these principles, we are building a future where families and clinicians alike can find strength, healing, and hope—together. With unwavering commitment to fostering trust, Mary Coughlin.

Source: https://caringessentials.net/post/building-trust-and-transparency-in-trauma-informed-developmental-care-a-foundation-for-healing

INNOVATIONS

Clinical innovations in neonatology have historically faced roadblocks. Among other reasons, designing and executing studies that test safety and efficacy in a vulnerable patient population is a challenging pursuit. Neonatologists at Cleveland Clinic Children’s aim to overcome barriers within the field by engaging colleagues in a dialogue about innovations on the horizon in neonatal care.

Innovation was the theme of the recent Symposium on Health Innovation and Neonatal Excellence (SHINE). The meeting, hosted in Orlando, included a variety of speakers and sessions and one element that introduced a new twist—a competition.

Following an international call for submissions of noncommercialized innovations, the symposium directors received 36 proposals from centers around the world. Submissions underwent a peer-review process by a scientific committee—a panel of distinguished neonatologists—and were evaluated based on originality and potential impact within the field.

Read on for a recap of the top seven projects underway, listed below in no particular order.

A new screening paradigm for retinopathy of prematurity

The current approach to screening for retinopathy of prematurity (ROP), the leading cause of childhood blindness, is both technically challenging for providers and physiologically stressful for neonates, and most will never require ophthalmic intervention. Researchers have developed two new camera technologies that combine ultra-widefield imaging and AI: one is a low-cost 2D camera, and the other is a 3D optical coherence tomography device. These technologies examine patients’ retinas without the need for dilation, bright white light, scleral depression — or an ophthalmologist. The screening is completed in less than 10 seconds and provides immediate results. These innovations are poised to reimagine ROP screening by providing an objective evaluation, enhancing the patient experience and offering lower-cost technology for families and providers. Presenting author: J. Peter Campbell, MD, Oregon Health & Science University

Converting bCPAP sounds into clinical insights

The bubble continuous positive airway pressure (bCPAP), a mainstay in neonatal care, has considerable limitations, including a circuit system prone to obstruction and leaks. Nurses and respiratory therapists must conduct frequent manual checks to resolve the issue. Currently, providers rely on bCPAP sounds to affirm the device is working properly. The project proposes to leverage acoustic sounds by converting them into electronic signals to help quantify pressure, oscillations and leaks. This could provide real-time insights into CPAP therapy, informing and optimizing the management of neonates. Presenting author: Wissam Shalish, MD, PhD, Montreal Children’s Hospital, McGill University

Deep learning that combines video with vital signs

This innovation uses a deep learning algorithm trained on video and physiological data to detect and quantify events in the NICU. The project addresses a need within neonatal care for accurate and continuous monitoring of infant stressors, which are currently captured manually with the Neonatal Infant Stressor Scale. The trained model can accurately estimate short-term physiological responses and identify activities that induce significant stress responses. Researchers are hopeful that the technology can facilitate earlier detection of adverse events and support appropriate interventions to improve outcomes. Presenting author: Ryan M. McAdams, MD, University of Wisconsin-Madison

Reimagining the CPAP nasal interface

Continuous positive airway pressure (CPAP) is a noninvasive and effective alternative to nasal cannula therapy for infants and neonates experiencing respiratory distress. However, the nasal interface consists of multiple pieces that can make assembly burdensome and dislodgment of the interface a common occurrence. This project aims to reimagine the device by developing a single-piece nasal CPAP interface that integrates multiple components into a secure, ergonomic and scalable product. The device could lead to improved use and adoption, offering a low-cost, high-impact option for a broader patient population. Presenting author: Mohamed Mohamed, MD, Cleveland Clinic Children’s

Earlier detection of opioid withdrawal symptoms

Conventional approaches to assessing opioid withdrawal in infants rely on subjective clinical observation of symptoms. A new algorithm-based technology, the physiologic opioid withdrawal score (POWS) system, offers an objective, real-time monitoring option. It’s trained on retrospective data of infants with neonatal opioid withdrawal syndrome (NOWS) and, taken together with physiologic data, the proposed tool—a portable, hospital-grade device— aims to continuously monitor vital signs to improve treatment timing and reduce variability. Presenting author: Zachary Vesoulis, MD, Washington University

Optimizing NIRS sensor placement to detect necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is one of the leading causes of death in preterm infants. Early detection and intervention of malperfusion can mitigate fulminant NEC. Near-infrared spectroscopy (NIRS) is the gold standard for measuring intestinal perfusion; however, it is imprecise, as it also includes cerebral NIRS for abdominal applications. Researchers have developed a novel computational model to enhance existing technology by utilizing an algorithm that predicts the NIRS fluence rate signal in the neonate’s abdomen. This approach could significantly improve early detection and offer a cost-effective, scalable solution for reducing neonatal mortality. Presenting author: Vishnu S. Emani, BS, Harvard University

Feeding tube capable of vital sign monitoring

Trinity Tube is a multifunctional, sterile, single-use nasogastric feeding tube. It integrates enteral feeding with vital sign monitoring, including ECG, temperature and continuous airway pressure assessment. Designed specifically for neonatal care, it eliminates the need for skin-mounted sensors, thereby reducing the risk of skin injury and infection. It also contains a pressor sensor that supports continuous non-invasive assessment of airway pressure and allows teams to transition infants to “pressure targeted high flow therapy,” a novel approach that combines high-flow nasal cannula with the effectiveness of CPAP. The device aims to simplify care, improve the patient experience and reduce the nursing burden in NICUs.

Source: 7 Emerging Innovations in Neonatology

Despite a 44% reduction in neonatal mortality since 2020, 65 countries still risk missing the Sustainable Development Goal to reach a neonatal mortality rate of 12 per 1000 livebirths or less by 2030, and approximately 2·3 million preterm and sick newborns die each year. Health care for neonates is extremely challenging. With recommendations to drive innovation, the Lancet Child & Adolescent Health Commission on the future of neonatology presents an ambition for equitable, innovative, research-driven neonatal medicine that will both close treatment gaps and seize more opportunities within the neonatal period to reduce mortality and shift the health trajectory of every newborn towards lifelong wellbeing.

Uncertainty lingers across many fundamental aspects of neonatal medicine, and the Commission analyses the delays and disruptions in research and development that hinder innovation. Just a few neonatal conditions—acute respiratory failure, bronchopulmonary dysplasia, hypoxic-ischaemic encephalopathy, congenital malformations, necrotising enterocolitis, and severe infections—account for 76% of neonatal deaths. Yet none of these conditions are understood well enough, pathophysiologically, to develop preventive measures and effective therapies. Much practice in neonatal critical care, including management of septic shock and multisystem organ failure, are informed by adult critical care. Similarly, common treatments—including essential medicines such as sedatives and analgesics for pain management—have, by necessity, been adopted from other areas of medicine to address unmet needs for neonates. The Commission argues for stronger financial and regulatory support to ensure such treatments are specifically designed for and tested in neonates, enabling tailored treatments and a high quality of evidence.

The Commission identifies medicines and medical devices that could strengthen clinical practice. It also outlines how the neonatal research ecosystem is shaped by stakeholders of neonatal health: institutional review boards, ethics committees, and regulatory agencies; industry; physicians and allied health-care professionals; former patients, family representatives, and advocacy groups; and governments, universities, and academic medical centres. Each are offered recommendations to address challenges with knowledge gaps, funding, and regulatory and commercial obstacles to development.

For the 68% of the world’s children who are born in resource-constrained settings, overcoming issues with cost, infrastructure, and human resources are immediate priorities to improve neonatal care. The Commission speaks to these logistical hurdles but challenges the assumption that blanket expansion of existing interventions is safe and productive. Antenatal steroid prophylaxis and therapeutic hypothermia are key examples of interventions that showed initial promise in clinical trials but proved far from universally safe across all settings. To realise the vision of equitable neonatal health, the Commission emphasises the importance of evidence-based neonatal medicine through research and development that is both accelerated and sustainable to benefit all neonates.

Accompanying Comments highlight three of the Commission’s main themes: the role of caregivers in improving neonatal research; special considerations for research and development in low-resource settings; and the value of collaboration and training. Arti Maria beckons leaders in neonatal wards to disrupt entrenched hierarchies and welcomes families as equal partners in neonatal research. Msandeni Chiume and colleagues call for collective ambition in implementation research across low-resource regions and point to Africa’s successes in securing national investments in sustainable neonatal health. Finally, Chris Gale and colleagues share insight on cultivating a strong research ethic, emphasising training for the entire neonatal care team—especially neonatal nurses—to contribute to research. Thought leadership across these diverse settings shows the immense opportunity for innovative partnerships in neonatology.

Neonatology has profound potential to influence population health across the lifespan. All stakeholders of neonatal health must contribute towards innovation, collaboration, and resources to realise this potential. Neonatologists are especially encouraged by the Commission to use their expertise in high-level decision making across academia, industry, government, and the charitable sector. As advocates for neonates’ health-care needs, they can ensure neonatal research and development reaches the top of population health agendas worldwide.

Source: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(25)00189-0/fulltext

Womb Warriors: The Power of Small Kindnesses

To my fellow preemie survivors—August is often a month marked by both warmth and reflection. It’s a time when summer winds down, school gears up, and the world seems to shift gears quietly. This month, in honour of World Humanitarian Day, I want to remind us of something beautiful: we don’t need to be loud to be powerful. We don’t need to be big to make a difference. Sometimes, the smallest acts of kindness speak the loudest—especially for those of us who started out small but mighty.

I’ve always found a special kind of joy in watching children support each other in everyday ways. Whether it’s a classmate quietly cheering on a friend at soccer practice, or a child helping another with their backpack after school, these moments—simple and unassuming—have such weight. They remind me that the spirit of kindness is often most alive in the tiniest gestures. As someone who once fit in the palm of a hand, I’ve learned that small things can carry immeasurable strength.

This August, I encourage all of us—parents, survivors, and supporters—to take part in acts of kindness, however small they may seem. Share your crayons. Smile at a stranger. Send a note to a NICU nurse who once held your life in their hands. Compliment a friend on their effort, not just their achievement. These actions, rooted in compassion, build a softer yet stronger world—one we know from experience is worth manifesting.

Born a preemie, our vulnerability and strengths are exposed, and our relationship with communities is born.  Born to soon, we are blessed with a deeper capacity for empathy, forged in our earliest days. Let’s carry that forward. Let’s choose kindness this month—not because the world is perfect, but because we understand how powerful it is when someone simply cares.

Because even now, long after the wires and monitors are gone, we are still warriors. And warriors don’t just survive—we lift others up along the way.

With strength, gratitude, and hope, Kat

PRAISE, FAME & SECRETS

Guyana, officially the Co-operative Republic of Guyana, is a country on the northern coast of South America, part of the historic British West Indies. Georgetown is the capital of Guyana and is also the country’s largest city. Guyana is bordered by the Atlantic Ocean to the north, Brazil to the south and southwest, Venezuela to the west, and Suriname to the east. With a land area of 214,969 km2 (83,000 sq mi), Guyana is the third-smallest sovereign state by area in mainland South America after Uruguay and Suriname, and is the second-least populous sovereign state in South America after Suriname; it is also one of the least densely populated countries on Earth. The official language of the country is English, although a large part of the population is bilingual in English and the indigenous languages. It has a wide variety of natural habitats and very high biodiversity. The country also hosts a part of the Amazon rainforest, the largest and most biodiverse tropical rainforest in the world.

The region known as “the Guianas” consists of the large shield landmass north of the Amazon River and east of the Orinoco River known as the “land of many waters”. Nine indigenous tribes reside in Guyana: the Wai Wai, Macushi, Patamona, Lokono, Kalina, Wapishana, Pemon, Akawaio and Warao. Historically dominated by the Lokono and Kalina tribes, Guyana was colonised by the Dutch before coming under British control in the late 18th century. It was governed as British Guiana with a mostly plantation-style economy until the 1950s. It gained independence in 1966 and officially became a republic within the Commonwealth of Nations in 1970. The legacy of British colonialism is reflected in the country’s political administration, lingua franca and diverse population, which includes Indian, African, Indigenous, Chinese, Portuguese, other European, and various multiracial groups.

Guyana is the only mainland South American nation in which English is the official language. However, the majority of the population speak Guyanese Creole, an English-based creole language, as a first language. In 2017, 41% of the population of Guyana lived below the poverty line. Guyana’s economy has been undergoing a transformation since the discovery of crude oil in 2015 and commercial drilling in 2019, with its economy growing by 49% in 2020, making it, by some accounts, currently the world’s fastest-growing economy. As it is said to have 11 billion barrels in oil reserves, the country is set to become one of the largest per capita oil producers in the world by 2025. The discovery of over 11 billion barrels of oil reserves off the coast of Guyana since 2017 is the largest addition to global oil reserves since the 1970s. Guyana is now ranked as having the fourth-highest GDP per capita in the Americas after the United States, Canada, and The Bahamas. According to the World Bank in 2023, very significant poverty still exists and the country faces significant risks in structurally managing its growth.

Health:

Compared with other neighbouring countries, Guyana ranks poorly in regard to basic health indicators. Basic health services in the interior are primitive to non-existent, and some procedures are not available at all. Although Guyana’s health profile falls short in comparison with many of its Caribbean neighbours, there has been remarkable progress since 1988, and the Ministry of Health is working to upgrade conditions, procedures, and facilities.

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

COMMUNITY

LESS than three months after its launch, President, Dr Irfaan Ali’s Newborn Cash Grant initiative is already transforming lives across Guyana, bringing hope, relief and a stronger sense of security to thousands of families.


Launched on March 8, 2025, at the Arthur Chung Conference Centre, the initiative provides $100,000 for every child born to a Guyanese mother on or after January 1, 2025.

President Ali, who has led a people-first development agenda since taking office, described the grant as a long-term investment in the future of our nation and a commitment to nurturing the next generation of leaders.


Mothers who have already benefitted from the programme shared their gratitude and explained how the grant has positively impacted their lives.

Region Four resident Aranza Krishna said she is “whole-heartedly thankful to the government and the Ministry of Health for this appreciated initiative.”


“This grant has benefitted me a lot, because it helped me to buy formula, which is very expensive; pampers which is [sic] very expensive, and it also help [sic] me to save because instead of taking out that money from my pocket, the government made that possible for me to be able to save,” she shared.

Another beneficiary, Hasyah Dodson, also from Region Four, expressed similar sentiments. “It helped me to get certain things, to put in an early savings for the baby,” she stated.


Dodson further stressed the importance of continued support, particularly for young mothers who may lack a strong support system.


“I think that the government should continue giving; in relation to young mothers that do not have the support,” she posited.

With more than 17,000 births projected for 2025, the government has reaffirmed its commitment to ensuring each newborn receives this financial start in life.

The initiative, which was first announced during the presentation of the 2025 National Budget, is part of a broader effort to enhance family welfare and social development. In total, approximately $1.3 billion will be allocated annually to facilitate the grant.

Source:https://guyanachronicle.com/2025/06/03/a-brighter-future-begins-at-birth/

At the 78th World Health Assembly (WHA), countries endorsed World Prematurity Day as an official global health campaign – part of a decision that highlights the urgent need for investment to prevent preterm births and expand access to lifesaving care for babies born early or small. 

Preterm births – defined as births that occur before 37 completed weeks of pregnancy – are the leading cause of death amongst children aged under 5 years. Complications such as difficulties breathing, infections and hypothermia are common, while survivors can face significant and long-term disability and ill health.  

The WHA decision document urges countries to expand access to proven, high-impact interventions, like special newborn care units, support for affected families and kangaroo mother care (KMC), which combines exclusive breastfeeding and skin-to-skin contact. For prevention, the document highlights the need to strengthen antenatal services and more broadly, improve women’ underlying health. 

“Recognizing this is a crucial issue increasingly shaping child health and survival, WHO welcomes the decision to incorporate World Prematurity Day into its official calendar,” said Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing. “It will be an important opportunity to educate, raise awareness and advocate for action to tackle this leading cause of child mortality, while highlighting the need for additional practical, financial and policy support for affected families.” 

In 2022, WHO released new clinical guidelines for care of preterm and low birthweight infants, with new guidance to help countries expand kangaroo mother care expected later this year. Alongside partners, the Organization also supports countries to deliver comprehensive newborn care packages, including special services for small and sick babies. 

World Prematurity Day has been observed for over a decade, driven by advocacy from families, civil society, and health professionals. Its formal recognition by WHO is expected to further galvanize global attention and action to this critical issue for maternal and child health. 

The decision was agreed following discussions on the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). It aligns with the 2023 WHA Resolution to accelerate progress in maternal, newborn, and child survival, as well as the 2025 World Health Day theme: “Healthy beginnings, hopeful futures.” 

World Prematurity Day will be officially marked by WHO, Member States, and partners on November 17, starting in 2025. 

Source:https://www.who.int/news/item/28-05-2025-member-states-endorse-world-prematurity-day-as-official-global-health-campaign

HEALTHCARE PARTNERS

https://nanncast.podbean.com/e/from-idea-to-impact-leading-research-evidence-based-practice-ebp-and-quality-improvement-qi-projects-in-the-nicu/?token=65e182662d891c31925b537e906dbb0e

Source:https://neonatologytoday.net/newsletters/nt-may25.pdf

PREEMIE FAMILY PARTNERS

Source:https://hiehelpcenter.org/2024/04/04/advocating-nicu-baby-7-tips-former-obstetrical-nurse/

INNOVATIONS

https://www.sciencedirect.com/science/article/pii/S2772628224000451

Recent decades have seen transformative advancements in neonatal care, significantly improving survival rates for preterm and critically ill neonates. From the introduction of neonatal intensive care units (NICUs) to advances in ventilation techniques and surfactant therapy, the field has evolved to meet the growing needs of vulnerable newborns . Despite these achievements, neonatal care remains a rapidly advancing specialty driven by ongoing research and technological innovation. The twenty-first century has introduced groundbreaking tools and approaches, such as stem cell therapy , artificial womb technology, and telehealth applications, which have the potential to redefine the standard of care.

Despite the above-mentioned advancements, neonatal morbidity and mortality rates remain alarmingly high, particularly in low- and middle-income countries (LMIC). Neonatal mortality remains a significant global burden, with an estimated 2.3 million neonatal deaths occurring annually worldwide. Preterm birth, a leading cause of neonatal mortality and long-term complications, affects about 15 million infants each year. Conditions such as prematurity, low birth weight, and birth asphyxia continue to pose significant challenges, contributing to long-term neurodevelopmental and physical disabilities . Neonatal hypoxic–ischemic encephalopathy (HIE) occurs in 1 to 8 per 1000 live births in high-income settings and has an even higher incidence in low-resource areas, where access to therapeutic hypothermia is limited. Similarly, bronchopulmonary dysplasia (BPD) affects nearly 40% of infants born before 28 weeks of gestation who require prolonged oxygen therapy, whereas necrotizing enterocolitis (NEC) has an incidence of 2%–5% among very low birth weight infants and is a major contributor to neonatal morbidity and mortality. In addition, the burden of neonatal care extends beyond clinical concerns, encompassing ethical dilemmas, resource allocation, and disparities in healthcare access. The economic burden associated with preterm birth and its complications is immense, with direct medical costs and long-term care requirements placing significant strain on healthcare systems globally. These persistent issues demand innovative solutions to bridge the gap between current practices and unmet needs in neonatal care.

Technological breakthroughs have emerged as powerful tools in tackling these challenges. Stem cell therapy holds promise for treating conditions, such as hypoxic–ischemic encephalopathy and bronchopulmonary dysplasia], whereas artificial womb technology offers a potential solution for extreme prematurity, enabling the continuation of fetal development outside the maternal womb. Telehealth applications have revolutionized neonatal care delivery, especially during the COVID-19 pandemic, by increasing accessibility, facilitating parental education, and enabling remote monitoring. These innovations not only aim to improve immediate clinical outcomes but also focus on enhancing long-term quality of life for neonates and their families.

This paper aims to provide a comprehensive examination of three major innovations in neonatal care: stem cell therapy, artificial womb technology, and telehealth applications. By exploring their clinical applications, potential benefits, and associated challenges, this study seeks to highlight the transformative potential of these advancements [13]. Furthermore, it emphasizes the need for continued research and interdisciplinary collaboration to optimize these technologies and address existing gaps in care delivery [14]. Ultimately, the study underscores the importance of integrating these innovations into routine neonatal practice to improve outcomes and ensure equitable healthcare for all neonates.

Stem cell therapy in neonatology

Stem cell therapy has emerged as a promising approach in neonatal care, offering potential treatments for conditions that previously lacked effective solutions. Among these are HIE, BPD, and NEC.

Current applications and clinical trials are listed as follows. Mesenchymal stem cells (MSCs) derived from bone are widely studied but require invasive harvesting procedures. Umbilical cord blood MSCs offer collection, low immunogenicity, and anti-inflammatory properties, making them ideal for HIE. Placental/Wharton’s jelly–derived MSCs are ethically and provide abundant cell yields. Induced pluripotent stem cells (iPSCs) constitute patient-specific therapies but face challenges, such as genetic instability and high production costs. Adipose-derived stem cells are easily accessible via liposuction but exhibit variability in quality depending on donor age and health . Among these, MSCs have demonstrated potential in preclinical and early clinical trials for conditions, such as HIE, BPD, and NEC

.

HIE is a leading cause of neonatal morbidity and mortality, often resulting in long-term neurodevelopmental impairments . Traditional interventions, such as therapeutic hypothermia, have shown efficacy in reducing mortality, but many infants still experience residual disabilities. HIE contributes significantly to neonatal deaths worldwide, with an estimated incidence of 1 to 8 per 1000 live births in developed countries and a much greater incidence in resource-limited settings. Stem cell therapy, particularly the use of MSCs, has demonstrated potential in preclinical and early clinical trials. These cells, derived from bone marrow, umbilical cord blood, or placental tissue, have neuroprotective effects, promoting tissue repair and reducing inflammation in animal models

.

BPD is a chronic lung disease predominantly affecting preterm infants requiring prolonged mechanical ventilation. It remains a major cause of long-term respiratory complications in preterm infants, affecting up to 40% of extremely preterm neonates who require supplemental oxygen. The role of MSCs in modulating inflammation and enhancing lung repair has been investigated. Several preclinical studies have reported improved alveolarization and reduced fibrosis following stem cell administration. Early phase clinical trials, such as the CARE–BPD trial, have evaluated the safety and feasibility of MSC transplantation, with promising initial results. In addition, the PNEUMOSTEM clinical trial in South Korea investigated the use of allogeneic umbilical cord-derived MSCs for BPD, and reported a reduction in the incidence of severe BPD among extremely preterm infants.

NEC, a severe inflammatory condition of the gastrointestinal tract, remains a significant cause of neonatal mortality. Preclinical studies suggest that stem cells can restore intestinal barrier integrity, reduce inflammatory responses, and enhance tissue regeneration. Clinical trials investigating the efficacy of stem cell-based interventions for NEC are ongoing, with early results showing reduced disease severity and improved survival rates. However, challenges remain in optimizing stem cell delivery for NEC, including timing, dosage, and the most effective cell source for therapy.

Potential benefits and challenges

Stem cell therapy holds significant promise for neonatal care by promoting tissue repair, modulating inflammation, and providing neuroprotection. Stem cells possess the ability to differentiate into various cell types, contributing to the regeneration of damaged tissues. For instance, in bronchopulmonary dysplasia (BPD), stem cells have been shown to restore lung architecture through the promotion of alveolar and vascular growth. Their immunomodulatory properties enable them to suppress proinflammatory pathways and release anti-inflammatory cytokines, thereby mitigating inflammatory damage in conditions, such as necrotizing enterocolitis (NEC) and BPD. In cases of hypoxic–ischemic encephalopathy (HIE), stem cells exert neuroprotective effects by secreting trophic factors that enhance neuronal survival, stimulate axonal growth, and support synaptic repair, as demonstrated in both preclinical and early clinical trials.

Despite these promising therapeutic effects, several challenges remain in translating stem cell therapy into widespread clinical practice. Obtaining adequate cell sources, ensuring Good Manufacturing Practice (GMP) compliance, and maintaining quality during cell processing represent major logistical and financial barriers. Ethical considerations regarding cell sourcing and infrastructure limitations, particularly in LMICs, further complicate equitable access. Long-term data on safety, efficacy, and potential adverse effects, such as immune reactions or ectopic tissue formation, remain limited and require ongoing surveillance. In addition, the absence of harmonized regulatory frameworks for stem cell isolation, characterization, and clinical application impedes broader implementation.

In conclusion, while stem cell therapy represents a transformative advancement with the potential to address critical neonatal conditions, such as HIE, BPD, and NEC, sustained research efforts and international collaboration are necessary to optimize its clinical translation and ensure global accessibility.

Artificial womb technology

The concept of ex utero gestation has long been a topic of scientific exploration, aiming to replicate the intrauterine environment to support fetal development outside the maternal womb. Significant progress has been made in recent years, culminating in prototypes such as the Biobag, a system designed to simulate amniotic fluid and uteroplacental exchange crucial for fetal survival . Notably, researchers have successfully sustained fetal lambs equivalent to 22–24-week-old human infants for several weeks in such systems, demonstrating feasible extrauterine support through a pumpless oxygenation circuit and fluid-filled environment. These proof-of-concept studies underscore the potential of artificial wombs to bridge the current viability gap for extreme prematurity, although the technology has not yet been tested in humans and remains in the experimental stage. Multiple teams worldwide are now refining these systems—from the Children’s Hospital of Philadelphia to groups in Europe, Japan, and Australia—in preparation for first-in-human trials targeting 22–24-week preterm infants once safety and efficacy criteria are met. Such efforts reflect a growing consensus that we are closer to clinical application than ever, even as critical engineering and biological challenges continue to be addressed.

Key advancements and potential impacts 

Advanced extracorporeal membrane oxygenation (ECMO) technologies ensure efficient gas exchange without damaging immature lungs. Innovative vascular interface techniques (e.g., ultrashort cannulas attached to the umbilical cord) harness the fetus’s own heart to drive circulation, providing stable blood flow through the external oxygenator without introducing damaging pressure pulses. This refinement improves hemodynamic stability during ex utero support and is critical in the prolonged support achieved in animal models. Simulating amniotic fluid provides mechanical protection and promotes lung and gastrointestinal development. Innovative methods to replicate placental nutrient transfer support optimal growth. These advancements represent a paradigm shift in neonatal care, moving closer to clinical application for human neonates.

Extreme prematurity remains a leading cause of neonatal mortality, with survival rates plummeting for infants born before 24 weeks of gestation. Artificial womb technology offers a means to extend gestational age artificially, enabling these infants to complete critical developmental milestones outside the womb. The potential to improve survival rates for these vulnerable infants is unprecedented, potentially reducing neonatal mortality in high-risk populations. Early preclinical successes lend support to this optimism—for instance, fetal lambs supported ex utero showed normal growth and organ maturation over a four-week period—suggesting that, in the future, infants born at the edge of viability might be sustained until they are mature enough to thrive outside an artificial environment.

Preterm infants are highly susceptible to a range of complications due to underdeveloped organ systems. Artificial wombs could mitigate these issues by replicating the natural intrauterine environment. For example, a controlled environment reduces exposure to external mechanical stressors, minimizing the risk of intraventricular hemorrhage (IVH). Similarly, avoiding mechanical ventilation during early lung development can significantly reduce the incidence of BPD and other chronic respiratory conditions. Furthermore, sustained exposure to a controlled, nurturing environment supports optimal brain development, potentially reducing long-term cognitive and motor impairments. From a broader perspective, artificial womb technology could alleviate the emotional and financial burden on families by improving survival rates and reducing NICU stays while also lowering societal healthcare costs associated with prematurity-related complications.

In addition to bridging viability, artificial wombs may enable new treatment avenues for fetuses with congenital conditions. By temporarily transferring a fetus into an artificial environment, doctors can perform critical surgical interventions or therapies earlier in pregnancy than currently possible and then continue gestation in the device. This approach, which is still speculative, offers hope for improving outcomes in cases where treating a fetus in utero is challenging. These potential benefits highlight that artificial womb technology is not only about saving premature infants but could also transform fetal medicine by providing a stable platform for intervention while maintaining fetal development (Fig. 1).

Challenges and barriers

Artificial womb technology presents complex ethical, technical, and logistical challenges that must be carefully addressed before clinical application. Ethically, redefining the threshold of viability—potentially lowering it significantly from the current standard of around 24 weeks—raises profound questions about the beginning of life, parental autonomy, and reproductive rights. These debates intersect with broader legal and moral frameworks surrounding abortion and fetal rights, highlighting the need for clear guidelines that balance maternal autonomy with fetal interests. Ensuring that parents make fully informed decisions and addressing concerns about long-term quality of life for survivors are critical ethical priorities.

Financial and technical barriers further complicate the development and implementation of artificial wombs. These systems remain experimental, requiring substantial investment, sophisticated equipment, and specialized expertise [48]. Early clinical prototypes, supported by multimillion-dollar grants and private funding, demonstrate both the promise and the high costs associated with this technology. The integration of artificial wombs into neonatal intensive care units would demand dedicated sterile environments, continuous power supply, and around-the-clock skilled monitoring to prevent complications, such as infections or mechanical failures. Regulatory challenges also persist, as internationally harmonized standards for safety and ethical use have yet to be fully established.

Equitable access remains a major concern, as the initial deployment of artificial womb technology will likely be confined to well-resourced centers, risking disparities for patients in resource-limited settings. Overcoming these barriers will require coordinated efforts across clinical, ethical, logistical, and regulatory domains to ensure that this transformative technology benefits the broadest possible patient populations.

Telehealth applications in neonatology

Telehealth has emerged as a transformative tool in modern neonatal medicine, facilitating remote consultation, monitoring, and parental education. The COVID-19 pandemic accelerated the adoption of telehealth services, demonstrating their potential in reducing hospital visits, enhancing parental engagement, and improving neonatal outcomes. Advances in digital health technologies, including real-time video consultations, remote patient monitoring, and artificial intelligence (AI)-powered analytics, are shaping a new era of neonatal care.

Telehealth platforms provide parents of preterm or medically complex infants with virtual consultations, enabling them to access real-time guidance from neonatologists, lactation consultants, and specialists. Virtual coaching programs have been particularly effective in supporting breastfeeding initiation and adherence, as well as empowering parents to manage their infants’ medical needs post discharge.

Wearable sensors and home monitoring systems allow healthcare providers to track vital signs, such as oxygen saturation, heart rate, and respiratory patterns remotely. These innovations reduce the need for prolonged NICU stays by enabling early discharge with continued monitoring. AI-driven alert systems further increase safety by detecting early warning signs of deterioration.

In geographically remote or underserved areas, telehealth bridges gaps in access to neonatal subspecialists. Studies have shown that telehealth consultations significantly reduce the time to specialist intervention, improving clinical outcomes for neonates requiring urgent evaluation.

Potential benefits of telehealth 

Providing continuous virtual access to neonatal specialists enhances parental confidence in caring for their infant at home, reducing anxiety and improving long-term adherence to care plans. By decreasing the need for in-person visits, hospital readmissions, and travel expenses, telehealth contributes to significant cost savings for both healthcare systems and families. Recent economic analyses indicate that telehealth interventions reduce overall neonatal care expenditures by up to 30% in well-integrated models. Studies suggest that remote monitoring and early intervention through telehealth can decrease complications associated with prematurity, including infections and rehospitalization rates.

Challenges and barriers

The integration of telehealth into neonatal care offers significant benefits, including improved accessibility, enhanced parental engagement, and better clinical outcomes. However, several barriers must be addressed to achieve equitable and sustainable implementation. Limited access to reliable internet infrastructure and disparities in digital literacy hinder telehealth adoption, particularly in low-income and rural communities. Variability in telehealth reimbursement policies across healthcare systems further complicates widespread use, while some regions have expanded coverage post-pandemic, others continue to impose restrictions that limit provider compensation for virtual neonatal consultations. Ensuring that telehealth platforms comply with Health Insurance Portability and Accountability Act (HIPAA) standards to safeguard sensitive neonatal health information is also critical.

Overcoming these challenges requires continued investment in digital health infrastructure, harmonization of reimbursement policies, and advancements in secure, AI-enhanced telehealth technologies. By addressing these barriers, telehealth holds the potential to revolutionize neonatal care delivery and promote global health equity.

Ethical and global health perspectives and future directions

Innovations such as stem cell therapy, artificial womb technology, and telehealth are poised to transform neonatal care. However, their successful integration requires addressing profound ethical, regulatory, and equity-related challenges.

One major concern is access and equity. Advanced neonatal technologies are predominantly concentrated in high-income countries (HICs), while LMICs struggle to provide even basic neonatal care.

Technologies such as artificial wombs and stem cell therapies are expensive and complex, potentially exacerbating disparities unless international efforts focus on affordability and scalability. Telehealth, while promising to bridge care gaps, risks widening inequities if digital infrastructure and training are not adequately developed.

Ethical and regulatory challenges further complicate adoption. Innovations such as artificial wombs raise questions about viability definitions, parental autonomy, and reproductive rights. Stem cell therapies pose dilemmas around sourcing, manufacturing standards, and long-term safety. Telehealth applications must carefully balance data privacy concerns with the convenience of remote monitoring. Clear international guidelines and harmonized regulatory frameworks are urgently needed to ensure that emerging technologies are adopted safely and equitably.

Global collaboration will be pivotal to overcoming these barriers. Cross-border partnerships, supported by organizations such as the World Health Organization, can promote knowledge sharing, funding mechanisms, and capacity building. Engaging LMIC stakeholders will be essential to ensure that innovation benefits are distributed equitably and context-specific solutions are prioritized.

Future research must focus on optimizing and expanding the clinical applications of these innovations. Stem cell therapy has shown significant potential for treating conditions such as HIE and BPD by promoting tissue repair and neuroprotection. Priorities include improving delivery methods, scaling up production, and ensuring ethical application. Similarly, artificial womb technology represents a groundbreaking advancement in supporting extremely preterm infants. Prototype systems like the Biobag mimic the intrauterine environment and have demonstrated success in preclinical models. However, ensuring clinical safety, establishing ethical frameworks, and developing robust regulatory standards are essential steps before widespread implementation. Telehealth, which has proven effective in enhancing neonatal monitoring and early intervention, must continue to evolve with investments in infrastructure, provider training, and regulatory support. Overcoming barriers such as connectivity gaps, digital literacy disparities, and cost constraints will be critical to global telehealth equity.

Emerging technologies such as gene therapy and AI-driven care offer additional opportunities for improving neonatal outcomes. Gene-based interventions could correct congenital disorders early in life, while AI tools could optimize diagnosis, monitoring, and individualized care plans. Nevertheless, these advances must be implemented thoughtfully, with attention to the specific needs of vulnerable neonatal populations, especially in resource-limited settings. Successful integration of these technologies into neonatal practice will require updating clinical protocols, training healthcare providers, and ensuring that neonatal units are equipped with necessary resources. Strong regulatory and policy frameworks should be established to support safe and efficient adoption, including mechanisms for funding, access expansion, and outcome monitoring.

By addressing these multifaceted challenges, the neonatal care community can achieve transformative advancements that improve survival rates, enhance quality of life, and reduce global health disparities. In the long term, these innovations hold the potential to reshape neonatal and childhood outcomes, alleviating burdens on families and healthcare systems worldwide.

In conclusion, this manuscript highlights the transformative potential of innovations in neonatal care, emphasizing their role in addressing persistent challenges, such as high neonatal mortality, long-term morbidity, and healthcare disparities. Key findings demonstrate that stem cell therapy offers promising solutions for conditions such as HIE and BPD by promoting tissue repair and reducing inflammation. Similarly, artificial womb technology provides hope for improving outcomes for extremely preterm infants by replicating the intrauterine environment and enabling continued fetal development . Telehealth applications complement these advancements by expanding access to neonatal care, particularly in underserved regions while empowering families and reducing the burden on healthcare systems.

The importance of innovation in neonatal care cannot be overstated. These advancements have the potential to redefine the standard of care, improve survival rates, and enhance the quality of life for neonates and their families. However, their successful integration into clinical practice requires addressing ethical concerns, regulatory challenges, and inequities in access. A concerted effort to bridge these gaps will be critical in ensuring that these technologies benefit all populations, regardless of socioeconomic or geographic constraints. To achieve this vision, researchers, policymakers, and clinicians must collaborate closely. Researchers should prioritize translational studies that validate the efficacy and safety of these technologies, whereas policymakers should develop robust frameworks that address cost barriers and promote equitable access. Clinicians, as frontline implementers, play a pivotal role in integrating these innovations into routine practice while advocating for patient-centered approaches.

By fostering interdisciplinary collaboration and investing in global partnerships, the neonatal care community can overcome existing barriers and pave the way for a brighter future. The ultimate goal is to ensure that every neonate, irrespective of their circumstances, receives the highest standard of care. This collective commitment to innovation, equity, and compassion has the power to reshape neonatal medicine and improve outcomes for generations to come.

Source: https://link.springer.com/article/10.1007/s12519-025-00927-1

Source: https://pubmed.ncbi.nlm.nih.gov/40433702/

SIBEN, Key Trends, Insights

Sierra Leone, officially the Republic of Sierra Leone, is a country on the southwest coast of West Africa. It is bordered to the southeast by Liberia and by Guinea to the north. Sierra Leone’s land area is 73,252 km2 (28,283 sq mi). It has a tropical climate and environments ranging from savannas to rainforests. As of the 2023 census, Sierra Leone has a population of 8,460,512.  Freetown is its capital and largest city.

Sierra Leone is a presidential republic, with a unicameral parliament and a directly elected president. It is a secular state. Its constitution provides for the separation of state and religion and freedom of conscience. Muslims constitute three-quarters of the population, and there is a significant Christian minority. Notably, religious tolerance is very high.

Available healthcare and health status in Sierra Leone is rated very poorly. Globally, infant and maternal mortality rates remain among the highest. The major causes of illness within the country are preventable with modern technology and medical advances. Most deaths within the country are attributed to nutritional deficiencies, lack of access to clean water, pneumonia, diarrheal diseases, anemia, malaria, tuberculosis and HIV/AIDS.

Healthcare in Sierra Leone is generally charged for and is provided by a mixture of government, private and non-governmental organizations (NGOs). There are over 100 NGOs operating in the health care sector in Sierra Leone. The Ministry of Health and Sanitation is responsible for organizing health care and after the end of the civil war the ministry changed to a decentralized structure of health provision to try to increase its coverage.

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

COMMUNITY

Margaret Yainkain Mansaray Becomes First Sierra Leonean to compete in the Africa Prize for Engineering Innovation

Posted on December 1, 2022 by Design in Design Innovation

Sierra Leonean Innovator and CEO of Women in Energy-SL Margaret Yainkain Mansaray became the first Sierra Leonean to be listed among Innovators competing for the Africa Prize for Engineering Innovation 2023. An award organized annually by the Royal Academy of Engineering UK (The United Kingdom’s national academy of engineering). 

Mansaray, who is the only female rising to compete against 14 other innovators from ten countries across Africa was recognized for her invention of a Smart Green Stove. The smart green stove is a fast and efficient non-electric cooking device she designed to reduce greenhouse gas emissions and health risks that greatly affect women and girls in Africa. 

The stove burns briquettes made from recycled local materials such as coconut and jelly shells which are usually discarded. The insulator absorbs most of the heat and makes the stove nearly smokeless, reducing the harmful soot which would otherwise be released into the environment. 

“My team and I are working tirelessly to uplift women and girls by addressing time and energy poverty. I’ve always been the only woman in a room full of men, and so one of my aims is to educate women and girls, specifically on the role engineering can play in improving their lives.”, Mansaray said.

The Africa Prize for Engineering Innovation was launched in 2014 by the Royal Academy of Engineering. An award for ambitious African innovators creating local and scalable solutions to pan-African and international challenges. The innovations shortlisted in 2023 tackle challenges approaching the UN’s Sustainable Development Goals, including clean water and sanitation, sustainable cities and communities, clean energy, good health and well-being, and quality education. 

According to the Royal Academy of Engineering, Innovators shortlisted for the Africa Prize will benefit from a special package of support including business incubation, mentoring, fundraising and communications. The package will also include access to the Academy’s global network of high-profile and highly experienced engineers and business experts in the UK and Africa. Four finalists will be chosen to direct their innovations and business plans to Africa Prize judges at an event in Accra, Ghana, on July 6th, 2023. The winner will have a take-home of £25,000, and three runners-up will win £10,000 each. An additional One-to-Watch award of £5,000 will be given to the most promising entrepreneur from the remaining shortlist.

Mansaray took to her Facebook handle and expressed her joy as she took pride in being that this is the first time Sierra Leone has been shortlisted for the Royal Academy Africa prize. She emphasized that her achievement is a win for the country and especially for vulnerable girls and women. 

“I am happy to share that for the first time Sierra Leone has been shortlisted in the Royal academy Africa prize and I am the only female among 10 African countries.”, Mansaray wrote.

Source: https://dlit.co/margaret-yainkain-mansaray-becomes-first-sierra-leonean-to-compete-in-the-africa-prize-for-engineering-innovation/

Papi J – Waterloo Waterloo

🎧 | 2025 SIERRA LEONE MUSIC 🇸🇱 | Music Sparks

Latest Sierra Leone

The song “Waterloo” is amazing! We discovered it through a promotion by Jakey Jake and instantly fell in love. This talented artist, known as Papi J, deserves to be signed to a record label. In this song, Papi J describes his hometown, Waterloo—a place known for its cassava bread, fried fish, and hardworking community.

Long, yet concise and comprehensive, this article is abundant in its research, collaboration, big-picture perspective, and applicability. Well worth the read!

Recommendations of the Iberoamerican Society of Neonatology (SIBEN®) for “Transdisciplinary and Humanized care for the Newborn and the Family”: XIV SIBEN CLINICAL CONSENSUS (English Version)

Jorge Pleitez Navarrete, MD, Carmen Dávila-Aliaga, MD, Lordes Lemus-Varela, MD, María Teresa Montes Bueno MT, Cristian Muñoz, MD, Augusto Sola, MD, Sergio Golombek, MD, and participants of the XIV SIBEN Clinical Consensus of the Iberoamerican Society of Neonatology (SIBEN)

Abstract: A cultural change in Iberoamerican neonatal hospitalization units is imperative to guarantee respect for the rights of newborns and their families during hospitalization, with equity at different levels of care, without differences based on geographic areas or socioeconomic level. It is essential to train and improve the competencies of the health team, from managers to healthcare professionals, to provide transdisciplinary and humanized care (CTH) for newborns and their families. There is sufficient evidence that CTH positively impacts the outcomes of newborns and their families when their families are involved in the care of their hospitalized babies.

This paper summarizes the results of the XIV SIBEN® Clinical Consensus on “Transdisciplinary and humanized care for newborns and their families,” in which 50 SIBEN® members, neonatologists, and nursing graduates from 14 Iberoamerican countries actively participated during 2023, before, during and after the face-to-face meeting held in Mar de Plata, Argentina in November 2023. This article answers questions based on the best available evidence and describes recommendations of clinical significance for truly providing transdisciplinary and humanized care (CTH).

Introduction:

In the 19th century, infant deaths were considered part of the natural order 1. In 1802, the first pediatric hospital, L’Hôpital des Enfants Malades, was founded in Paris, which promoted breastfeeding and the emotional needs of children.

Neonatology emerged in the 20th century owing to technological advances that increased neonatal survival but with reduced parental involvement. Research, such as the “Citizens’ Committee for Children of New York City” and the “Platt Report” in the United Kingdom, influenced the acceptance of parental presence in hospitals, demonstrating that their presence did not increase infection rates. Spitz coined the term “hospitalism” to describe the adverse effects of prolonged hospital confinement . In the 1980s, the family-centered model of neonatal care was introduced, demonstrating its effectiveness in caring for premature infants.

In 1984, the European Parliament approved the Charter of Patients’ Rights. In 1986, it adopted the European Charter for Hospitalized Children, which recognized 23 rights, including the right to be accompanied by their parents or primary caregivers for as long as possible. This charter was adopted by international organizations such as the WHO and UNICEF. Western countries began to ease visitation restrictions on parents as early as 1990.

Not all neonatology units in Ibero-America had adequate conditions to implement CTH by 2016. A study by the Ibero-American Society of Neonatology (SIBEN®)  revealed that 63% of the units offered space for mothers to stay with their infants (27% overnight), and in 60% of cases, there were time restrictions for parental visits. This demonstrates the need for a cultural change in Ibero-American NICUs to guarantee respect for the rights of neonates and their families during hospitalization.

Concept and principles of transdisciplinary humanized care (CTH) for newborns and families

In recent years, different denominations have incorporated families into the care of hospitalized newborns. We consider that this care is provided by many disciplines to the newborn (NB) and its family in an integrated, simultaneous, non-hierarchical, organized manner, according to the needs of the newborn and, above all, in a humanized way; therefore, SIBEN calls this model of care “Transdisciplinary Humanized Care (CTH) for the newborn and its family.”

With a comprehensive approach, the CTH for the NB and its family emphasizes family participation, respect for their needs, and transparent communication . These interventions reduce neonatal stress, favor their development, reinforce the family’s caregiver role, and improve family bonding and quality of care.

The fundamental principles of CTH are respect, honoring families’ diversity, flexibility, exchange of information, no medical terminology, participation and decision-making, collaboration between the patient, family, and health care providers, and family empowerment to discover their strengths.

Levels of Intervention of CTH for the Newborn and Family :

 • First level: Support parents through psychoeducational, communication, and environmental interventions to help them cope with hospitalization and prepare them for the newborn’s follow-up.

 • Second level: Interventions provided by the parents focused on improving the development and recovery of the newborn, with psychological and physical benefits for parents who received education from the clinical team.

• Third level: Collaborative care models, where parents are fully involved in newborn care.

Elements of CTH (12)

According to the currently available scientific evidence, we agree with the following elements:

• Recognition of the family as an important and indispensable part of the care of hospitalized neonates

 • Constant participation of the family in decision-making, as well as the procedures carried out

• Facilitate family/professional collaboration at all levels of care.

• Communication and exchange of information by health personnel at all times with the family.

• Recognition of family diversity, including ethnicity, socioeconomic, educational, racial, geographic, 

   etc., thus avoiding value judgments.

 • Incorporate models that contribute to parents’ learning regarding the care of their children through courses and educational programs.

 • Unrestricted access at all times and the family can always be involved in the care of their child

• Creation of family support networks.

 • Recognize the family’s strengths, feelings, emotions, concerns, and ability to help and contribute,thus validating them as an important, fundamental, and indispensable part of the NB’s care.

• Facilitate the parents’ stay as much as possible by providing a comfortable space for them to be close to their child for as long as possible.

In 2011, the book Neonatal Care, Discovering the Life of a Sick Newborn by Sola, A  introduces and emphasizes the concept that: “parents are not visitors” and that there should not be limited hours for a mother to be with her baby who is in the neonatal intensive care unit (NICU).

Changes, benefits, and tools for performing CTH:

* promote the newborn’s neurological and physical development

*  humanize care

*  reduce stress

*  improve health

*  improve adherence to treatment

* facilitate breastfeeding

 * optimize discharge care and transition to home care

* increase the quality of care

* increase parental satisfaction

The following are some essential strategies to achieve this objective:

1. Information and awareness-raising: Promote the benefits of BFHC through programs aimed at medical teams, families, and public policymakers.

 2. Staff training: Implementation of workshops, courses, and internships to train staff in CTH.

 3. Involve parents from the beginning: Encourage their presence and participation in medical procedures and daily care to strengthen bonding.

4. Empower parents: Provide them with tools and training so that they can actively participate in making decisions about their babies’ health.

5. Adapt physical spaces: Design areas that allow parents to stay close to their children.

 6. Ongoing emotional support: Offer psychological support programs to help families manage stress and emotional difficulties.

 7. Planning and evaluation: Ensure gradual implementation with constant adjustments and collaboration of professionals, parents, and the community to achieve more humane and effective care.

 Some tools to promote parental involvement in neonatal care include:

 a) Welcome Kit: This kit contains educational information on neonatal care, educational resources,and guidance for parental involvement.

b) Skin-to-skin contact: improves thermal stability, facilitates breastfeeding, and reduces stress in parents and infants (7,18)

c) Care diary: Parents record the baby’s daily activities, such as feeding, diaper changes, and procedures, which allows them to feel more engaged in their care and evaluate their progress as caregivers.

d) Medical rounds participation program: Parents can discuss the baby’s condition and treatment, ask questions, and express concerns.

 e) Training classes and workshops: Educational resources on neonatal care and child development are provided.

 f) Mobile applications and online platforms: Allow parents to access up-to-date information on their baby’s condition, schedule visits, and communicate with medical staff.

g) Support groups and counseling: Facilitate mutual support among parents, share experiences, and get involved in their child’s care.

Difficulties or obstacles in the CTH process:

Including the family in the care of the hospitalized neonate is a humanized and recommended practice, although it is not always implemented in all neonatal units. Some professionals consider that the presence of parents is not necessary, arguing that they may generate anxiety, not be prepared for invasive procedures, or that the physical space is insufficient. In addition, lack of knowledge about family-centered care and institutional regulatory barriers negatively affect the care of the infant and family.

Skin to skin contact: Skin-to-skin contact (SSC) has ancestral origins in different cultures and times, and it is a common practice between mothers and their healthy or sick babies. In protocolized form, it began in the 1970s in Bogota, Colombia; the maternal body heat allowed it to stabilize physiologically and provide comfort and security to neonates. Since 1990, the success of this practice has spread, and it has been adopted in several countries as a neonatal care option.

SSC is beneficial for both term and preterm newborns, and it is applied immediately after delivery, during the first hour of postnatal life, during hospitalization, and even at home. It is associated with decreased maternal postpartum depressive symptoms, improved perspective on motherhood, and intrinsic and extrinsic gratification, especially being able to care for her baby. Lower maternal salivary cortisol levels have been reported at one week and one month postpartum.

 In addition, recent studies have shown a significant prolongation of breastfeeding at six months (5.08 months vs. 2.05 months). Other findings highlight additional benefits, such as increased weight gain of the NB, reduction of hospitalization time, strengthening of the mother-child bond, and contribution to the overall development of the NB.

CTH and the advantages of breastfeeding

CTH includes the concept of 24-hour “open-door units” where fathers are encouraged to be present during breastfeeding and participate in feeding, either directly from the breast or by expressed milk. This approach promotes bonding, analgesia, neurodevelopment, milk production, and breastfeeding.

CTH and family satisfaction:

Parents of hospitalized NBs may experience acute or posttraumatic stress, affecting their physical, psychological, and social health, as well as their relationship with their children. Parents’ confidence increases when they know how to act and the impact of their actions on their infant’s health.

When CTHs are established, the family is recognized as a permanent reference in the child’s life, even during hospitalization. Family members become involved in the care, take an early part in it, and participate in decision-making regarding their child, promoting the parent-child bond .

The most important dimensions of neonatal care for parents are safety, care, communication,information, education, environment, monitoring, pain management, and participation .

SIBEN® recommends:

1. Change the paradigm and improve the communication skills of healthcare personnel to meet the family’s needs regarding the illness, treatment, and recovery of the neonate.

2. Encourage empathy, accessibility, and confidentiality in communication with families, increasing their participation in decisions about care and treatment. In addition, family functioning is considered to be crucial support during the newborn’s hospitalization.

3. Apply CTH from the admission of the newborn, integrating the family as active and competent caregivers of their child.

Family satisfaction helps in dealing with grief.

The NICU neonatal health team focuses on preserving the newborn’s life through therapeutic interventions . When parents face the loss of an infant, the grief they experience requires compassionate accompaniment by multidisciplinary teams that pay attention to psychological, emotional, and spiritual aspects of the family and offer empathy and respect for the parents to mitigate their pain .

 Infrastructure to Implement CTH for the Newborn and Family

The World Health Organization (WHO) recommendation of 24-hour parental presence in the NICU has motivated the construction of neonatal units with private rooms, encouraging these indications. The implementation and use of private rooms in the NICU as a recommendation dates back to approximately 1990.

Impact and Advantages of private rooms for the newborn.

 • Reduction of infections. Decreases the spread of nosocomial infections and makes the isolation of patients colonized by potentially pathogenic microorganisms possible.

• Increased weight gain. Preterm infants who remained in private rooms with their parents in the short term had a higher rate of weight gain during hospitalization.

 • Less pain, with fewer procedures and lower pain scores in infants in private rooms compared to infants in shared rooms.

 • Better neurobehavioral outcomes. Infants in private rooms had significantly less physiological stress, hypertonicity, and lethargy.

• Lower noise levels. In the shared NICU model, 20 decibels were found to be 20 decibels higher.

• Fewer days of hospitalization. More infants were discharged early.

• Increased breastfeeding. 90% achieved breastfeeding in private rooms compared to only 66% is shared.

 • Fewer episodes of apnea. In the group stratified on the PEMR (Physician’s Estimate of Mortality Risk) scale, there was a 57% decrease in total apnea events in preterm infants.

• Reduction in direct cost.

• Reduction in illumination. Neonates admitted in open and private NICU rooms at Sanford Children’s Hospital in Sioux Falls, USA, were compared, and a reduction in illumination was shown: 48.4 lux and only 6.4 lux in private rooms (p < 0.05), with longer sleep time in neonates.

• Post-discharge: fewer consultations and hospitalizations. Comparing two groups of preterm infants it was found that they had lower rates  of rehospitalization and requests for medical care at discharge.

• Higher cognitive scores. At an 18-month follow-up, Bayley III cognitive language and motor scores were compared in private and shared rooms in preterm infants under 30 weeks of gestational age. Infants with high maternal involvement in both NICUs had improved cognitive scores.

Disadvantages and risks of private rooms

The optimal types and frequencies of stimulation for very preterm brain development are unknown. Still, the isolation of these infants in relatively dark and quiet private rooms may be going in the wrong direction.  However, auditory stimulation, such as parental voices, is considered positive in the NICU environment, being associated with better motor and language outcomes. Therefore, the need for greater parental permanence and involvement in the single-family room is emphasized, as otherwise, this aspect may be considered a disadvantage.

NICU nurses are at greater risk of fatigue, anxiety, and depression than nurses in general wards. Burnout in neonatal nurses continues to be a problem.

 Is family presence during neonatal resuscitation or other invasive procedures advisable? ANSWER: YES. Parents or family members should be welcome to be present during an inpatient procedure and should not be asked to leave the room if they wish to be there.

 SIBEN® Position. There is no scientific evidence to justify separating parents from critically ill NBs or those requiring advanced cardiopulmonary resuscitation. On the contrary, numerous studies report the beneficial effects on the parents, family, and even their approach concerning the care received. They always respect the parents’ decision to participate and are accompanied by health personnel who explain the situation and what they are seeing.

It is advisable, after the presence of the parents during the resuscitation, to carry out a joint analysis with their presence, to provide feedback to explain the procedures performed, to clarify their doubts, and also to consider their observations and concerns to improve the quality of the procedures performed in our units.

A philosophical concept to be taken into account is the following, which establishes a position in this regard: “Thus, from Anthropology, it can be noted that throughout the history of mankind, women have sought assistance at the time of childbirth, while the rest of mammals do it alone. It is considered that this is due to the complexity implied by the bipedestation, the pelvic cavity, and the human cephalic perimeter.”

 Recommendations to implement transdisciplinary care in Neonatal Units:

• The importance of names: the name of the NB and his/ her parents. Knowing and referring to the mother, father, and newborn by name is essential. Never call or refer to the newborn as: “the baby in incubator number such and such”.

The art of communication. The importance of listening and making yourself understood.

Use simple and straightforward language to ensure that what has been expressed has been understood, especially when listening to the family’s concerns and encouraging them to ask questions and express emotions. Respect the family’s cultural and religious beliefs and customs.

 We are part of the same team—”Parents Are Not Visitors”  The importance of encouraging, facilitating, and accompanying the participation of the mother and family. Encourage skin-to-skin contact.

We should also consider the participation of the newborn’s brothers or sisters, grandfathers and grandmothers, or other designated persons, with the authorization of their mothers and/or fathers.

Interpreting beyond words. The importance of feelings and mental health support. Health care professionals should identify situations where the mother expresses fatigue, anguish, hopelessness, sadness, frustration, depression, crying, etc.

 They are not alone. The importance of the peer support network and parent associations (such as FAMISIBEN)

In 2021, SIBEN®, with the FAMISIBEN working group, drafted recommendations for parents of neonates in the NICU. These recommendations are available in digital format on its website, https://sites.google.com/siben.net/famisiben/, free of charge for family members, caregivers, health professionals, and the general public.

Common questions for implementing CTH in the NICU:

  1. Should the pacifier be banned? Answer: NO. Why? Non-nutritive sucking (NNS) is an integral part of infant developmental physiology. Based on the available evidence, the “SIBEN Mini Clinical Consensus / 2021” authors recommend initiating stimulation with a pacifier (NNS) at 28-29 weeks gestational age. Centers that “prohibit or forbid” the use of pacifiers, teats, or whatever it is referred to should review this restriction and know that this is not baby-friendly but quite the opposite.
  • Should the mother be made to feel welcome for 1440 minutes each day? Answer: YES “Parents are not visitors.”  CTH for the family promotes stress reduction for the parents and a more positive relationship between the parents and the newborn.
  •  Can the mother stay 24 hours a day in the hospital where the NICU is located? Answer: YES. We should encourage the mother or father to stay close to the baby even in the NICU; mothers and fathers in single family nurseries care more for their baby, including skin-to-skin contact compared to mothers in the open NICU, improving infant growth and neurodevelopmental outcomes.
  • d. Is there a minimum or maximum length of stay for at least one parent in the NICU? Answer: NO. There is evidence that the separation of hospitalized patients alters the dynamics of parental care and affects all family group members.
  • e. Will the family member (mother, father, or whoever the mother indicates) be able to participate in NICU care? Answer: YES. Family involvement is a key element in all infants’ physical, cognitive and psychosocial development, including those in the NICU.
  • f. What are the benefits of performing a blood sampling, vaccine placement, peripheral vein cannulation, or other pain-generating procedure with the infant nestled, held, and sucking? The SIBEN® Clinical Consensus on the diagnostic and therapeutic approach to pain and stress in the newborn  recommends non-nutritive sucking when performing procedures that cause mild to moderate pain. Breastfeeding is considered the first choice treatment because of its safety, ease of administration, and availability, in addition to its multiple benefits, which have been extensively studied both nutritionally and immunologically.
  •  What is the role of the “schools for parents” in the CTH for the newborn and the family? The schools are a training space for parents whose roles are as follows:

 1. To allow conscious and active participation of parents in neonatal care.

 2. Teach parents about the child’s physiological states, biorhythms, and adaptation mechanisms.

 3. To offer knowledge for post-discharge care of the newborn.

 4. To instruct on the benefits of breastfeeding and newborn feeding.

 5. To teach and promote skin-to-skin contact.

 6. Teach parents about hygiene, care, and medication administration.

 7. To teach warning signs, infection prevention, and infant cardiopulmonary resuscitation.

 8. Provide tools to work on psychomotor development stimulation, forms of stimulation, and

     expected emotions of the newborn in different circumstances to ensure adequate growth and  

     development of children.

     h. What key actions are indispensable and essential for CTH to exist?

1. First and foremost, a paradigm shift is necessary, associated with a theoretical/practical

     educational plan for all personnel, providing them with specific tools and skills to promote

     change.

2. Achieving the multidisciplinary participation of all neonatology staff without dissonant or

     opposing voices (“everyone cooperates”).

 3. It must be recognized that discussing this type of neonatal care is not enough since

     implementing CTH in action requires facing and overcoming many challenges in different areas.

4. Modify the environment: It is essential to have areas, offices, and spaces for private conversations

     with parents and family.

 5. Partnering with health care administrators and financiers in the task

  i. In the NICU of an institution certified as “mother and child friendly,” is CTH practiced for   the care of the newborn and its family? In many NICUs, even in many hospitals certified as “mother friendly”, mothers are still separated from their babies, and there is little or no space for mothers, and a chair or bed is not always provided next to the newborn’s incubator.

 Key points from SIBEN® about CTHs in the NICU:

• The brain’s structural plasticity is in response to maternal auditory stimulation.

• The quality of experience significantly influences the brain and the function and structure of the  

   developing central nervous system

• The presence of the family in neonatal care has beneficial effects, including improved bonding of  

   the NB with the family and improved quality of care.

 • It should be emphasized that “parents are not visitors.”

• Smooth transition from the hospital environment to the home: no rush and no pressure. Ideally,

   this occurs during pre-hospitalization, especially in prolonged hospitalizations of more than three

  weeks.

• Setting concrete, everyday actions and deeds (not just words or documents) into practice, such as  

   those discussed in this manuscript, is very useful in achieving the best results.

• Periodically carry out critical and continuous self-evaluation of the neonatal team.

Source: https://neonatologytoday.net/newsletters/nt-apr25.pdf

International cooperation and solidarity are essential in tackling global challenges, including efforts to ensure the effective realization of the right to health for all nations.

As proclaimed by the United Nations, promoting international cooperation and solidarity is a duty of States.

In this context, we express our profound appreciation, gratitude, and recognition to Cuban health professionals who have provided—and continue to provide—their services in multiple nations.

Since 2019, and with even greater intensity now, a dishonest campaign has been unleashed to discredit Cuba’s international medical cooperation, exert pressure on recipient governments, and deprive populations of essential healthcare services. 

No one with a basic sense of honesty can doubt that this is an attack on multilateralism, a manipulation for political purposes, and a continuation of aggression and hostility against Cuba.

Access to healthcare is a human right, and millions of people cannot be deprived of this inalienable right for political reasons.

Attempts to delegitimize Cuban medical cooperation overlook the fact that the shortage of health professionals is a pressing issue worldwide, whose solution demands greater international cooperation and solidarity, not unfounded attacks.

Cuba has devoted considerable efforts and resources to health care and today has one of the highest ratios of doctors per capita in the world, enabling it to make a significant contribution to global health.

Cuban international medical cooperation has made it possible to provide high-quality health care to millions of people around the world.

Over the past 60 years, more than 605,000 Cuban health collaborators have completed missions in 165 nations.

Their feats are notable in the fight against Ebola in Africa, blindness in Latin America and the Caribbean, cholera in Haiti, and the COVID-19 pandemic. Numerous brigades from the Cuban International Contingent of Doctors Specialized in Disasters and Major Epidemics ‘Henry Reeve’ have carried out humanitarian work in many nations.

Cuban professionals and technicians participating in these programs do so exclusively upon the express request of the concerned countries, offering their expertise and services freely and voluntarily.

Many of them work in remote rural areas to save lives, even at the risk of losing their own. They provide care to all patients without distinction, refraining from getting involved in internal political affairs and strictly respecting the laws and customs of the countries where they work.

Additionally, Cuba has provided free medical training to 43,000 healthcare professionals from 120 nations. In numerous countries, medical faculties have been established with Cuban professors.

It is imperative to defend and recognize the valuable contributions of thousands of Cuban health professionals who, through immense personal sacrifice, continue to offer their cooperation.

Neither discrediting campaigns nor the devastating effects of the intensified economic, commercial, and financial blockade have succeeded in preventing Cuba from continuing to save lives and share its limited resources with other nations in need.

Cuban medical cooperation will remain a symbol of hope, dedication, humanity, and solidarity.

(Cubaminrex-Permanent Mission of Cuba in Geneva)

Source:https://cubaminrex.cu/en/statement-ministers-health-non-aligned-countries-support-cubas-international-medical-cooperation

***The Non-Aligned Movement is a forum of 120 countries that are not formally aligned with or against any major power bloc, and dedicated to representing the interests and aspirations of developing countries. It was established in 1961.

Source: https://dominicanewsonline.com/news/homepage/news/statement-ministers-of-health-of-the-non-aligned-countries-in-support-of-cubas-international-medical-cooperation/

HEALTHCARE PARTNERS

ProgenyHealth Releases 2025 Key Trends and Insights Report on Maternal & Infant Health

ProgenyHealth      Jan 15, 2025

Report identifies 7 of the most pressing industry trends that will shape the months and years ahead

ProgenyHealth, LLC, a recognized national leader in Maternity and NICU Care Management, today announced the release of its 2025 key trends and insights report, “Steep Challenges & Uneven Progress.” This year’s highly anticipated annual report identifies critical areas within maternal and infant health to watch in the year ahead, for health plans, hospitals, and healthcare providers.

The state of maternal and infant health in America remains precarious. By now, the sobering data has become all too familiar – The United States’ mortality rate is the highest of all high-income nations. Tragically, as many as 80% of maternal deaths, many of which occur in the first 42 days after giving birth, are preventable.

“While many challenges exist, there is continued hope on the horizon, as an increasing volume of healthcare-focused experts strategize to turn this situation around—and as new trends emerge to offer fresh opportunities and solutions,” said Linda Genen, Chief Medical Officer, ProgenyHealth. “These shifts promise to upend the present state of maternal and infant health, setting the nation on a new and better path forward.”

Key findings and predictions of the 2025 trends report include:

  • Maternal Decision-Making Will Take Center Stage. The concept of self-determination in the birthing process is being taken more seriously by medical institutions that are piloting programs to create dedicated care teams to listen to, work with and support those going through the birthing process. Research continues to show that providing women with a more empowered birthing experience pays dividends down the road.

  • Neonatology Will Continue to Advance the Viability of Micro Preemies. Until recently, very few infants born before 26 weeks were likely to survive. Today, many infants born as early as 22 weeks are not only surviving but thriving due to medical advancements. These extraordinary advancements have entirely improved the outlook for those born too young and too early.

  • Payers Will Increase Focus on Postpartum Support for Women. Between 2017 and 2019, nearly 30% of pregnancy-related deaths happened in the six weeks to 12 months after women gave birth, CDC data shows. Notably, many of these deaths were tied directly to mental health issues, which tend to go both undetected and untreated in the postpartum period. It is estimated that 50% of all postpartum depression cases go undiagnosed.

  • Amid Rising Costs, Employers Will Demand Alternatives to Standard Insurance Products. Since total birth costs are one of the top cost categories for health coverage, employers will likely begin to focus on proactive managed care partnerships to provide additional support during this complex period.

  • Increased Birth Anomalies Will Require More Complex Care. Congenital anomalies are among the chief causes of infant mortality, and as births increase across the nation—particularly in states with reproductive health restrictions in place—these anomalies are expected to climb. Children born with such anomalies may require surgical intervention, ongoing physical or occupational therapy, long-term educational support, or an array of assistive devices—needs that may evolve and last for life.

  • Whole Genome Sequencing Will Become a Game-Changer for Newborn Care. Rapid Whole Genome Sequencing (rWGS) testing for newborns may soon address this widespread genetic disorder blind spots. This genetic test can be used to identify and diagnose numerous conditions, including developmental delays, seizure disorders, conditions that affect hearing, vision, and immune deficiencies. rWGS is faster and more accurate than other genetic testing and considers a person’s full DNA sequence. While rWGS remains unavailable to many families, that situation is likely to change in the years ahead.

  • The Rate of Home Births Will Keep Rising – as Will Insurers’ Potential Role in Covering Them. Given the growing number of home births, some states are now exploring ways in which supporting this birth choice—and making it safer and more routinized, with intervention available in case of emergency—may help to combat certain aspects of the maternal health crisis

Source: https://www.prnewswire.com/news-releases/progenyhealth-releases-2025-key-trends-and-insights-report-on-maternal–infant-health-302349557.html

Newborn Health Resources: Trainings and Tools for Improving Newborn Health in Humanitarian Settings

In 2018, the Global Health Cluster lead by the World Health Organization (WHO) conducted a capacity survey of Global Health Cluster partners to capture information on partners’ self-assessment of their technical, operational, and coordination capacities. The results showed that most international and national partners reported a lack of capacity and expertise to provide maternal and newborn health (MNH) services. Less than half reported an ability to provide Basic Emergency Obstetric and Neonatal Care (BEmONC) and Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) at primary and secondary level respectively, and only 42% of the international partners and 50% of the national partners reported providing Essential Newborn Care (ENC).

To accelerate newborn health services in humanitarian settings, recent global interagency efforts have led to the development of the 2018 Inter-Agency Working Group on Reproductive Health in Crises (IAWG)-endorsed Newborn Health in Humanitarian Settings: Field Guide (NBFG); the Newborn Care Supply Kits for Humanitarian Settings; and a Roadmap to Accelerate Progress for Newborn Heath in Humanitarian Settings: 2020–2024.

In addition, these resource cards were developed to facilitate capacity building of humanitarian stakeholders. To build these cards, a consultant conducted a mapping of key maternal and newborn health trainings across the development and humanitarian sectors using a methodology that included a desk review of existing trainings, stakeholder interviews, and a short online survey delivered to Health Cluster Coordinators. The findings of the mapping exercise were presented and discussed at an experts meeting organized by Laerdal Global Health, Maternity Foundation, and Save the Children in Stavanger, Norway in 2019.

Overall, the mapping identified a great variety of existing training programs, mainly for clinical health care providers, on all aspects of newborn care and at all levels of care provision. Existing trainings for program managers were somewhat scarce, and access to available tools and guidelines could be improved.

Thus, we have packaged these resource tools as a quick pocket reference to aid  program managers and implementers in humanitarian and fragile settings with  identifying and accessing the most relevant trainings, tools, implementation guidance, and clinical guidance

Resource File: https://healthynewbornnetwork.org/hnn-content/uploads/HNN-Resource-Cards_Web.pdfhttps://healthynewbornnetwork.org/resource/2020/newborn-health-resources-trainings-and-tools-for-improving-newborn-health-in-humanitarian-settings/

Rethinking Platelet and Plasma Transfusion Strategies for Neonates: Evidence, Guidelines, and Unanswered Questions

Rozeta Sokou, Eleni A. Gounari, Alexandra Lianou, Andreas G. Tsantes, Daniele Piovani,,Stefanos Bonovas , Nicoletta Iacovidou, Argirios E. Tsantes

Abstract

The transfusion of platelets and fresh frozen plasma (FFP) to critically ill neonates in neonatal intensive care units (NICUs) is a common intervention, yet it is still widely performed without adhering to international guidelines. The guidance itself on the therapeutic management of neonatal coagulation disorders is generally limited due to the absence of strong indications for treatment and is mainly aimed at the prevention of major hemorrhagic events such as intraventricular hemorrhage (IVH) in premature neonates. Historically, the underrepresentation of neonates in clinical studies related to transfusion medicine had led to significant gaps in our knowledge regarding the best transfusion practices in this vulnerable group and to a wide variability in policies among different neonatal units, often based on local experience or guidance designed for older children or adults, and possibly increasing the risk of inappropriate or ineffective interventions. Platelet transfusion and, particularly, FFP administration have been linked to potentially fatal complications in neonates and thus any decision needs to be carefully balanced and requires a thorough consideration of multiple factors in the neonatal population. Despite recent advances toward more restrictive practices, platelet and FFP transfusions are still subject to wide variability in practices.

This review examines the existing literature on platelet and FFP transfusions and on the management of massive hemorrhage in neonates, provides a summary of evidence-based guidelines on these topics, and highlights current developments and areas for ongoing and future research with the aim of improving clinical practices.

Source:https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2601-9364

PREEMIE FAMILY PARTNERS

Connecting with your premature infant in the Neonatal Intensive Care Unit (NICU) may seem overwhelming and complicated. It can be a unique and challenging experience since it involves the emotional well-being of the parents and the development of the baby.

However, with the proper knowledge, resources, and support, bonding with your preemie may be a lovely and joyful experience. With the appropriate guidance and techniques, these may foster a closer relationship with your infant in its new surroundings.

Every baby and every situation is unique. Be patient with yourself and your baby as you navigate the NICU. Understand preemies’ distinct needs and the most significant ways to help them. This article will delve into everything you need to know about bonding with your premature baby in the NICU.

Understanding Preterm Development: How It Helps With Bonding

Preterm and full-term newborns have a developmental trajectory, even if preterm babies grow at a different rate. Premature infants, or preemies, as they’re fondly called, have a distinct development.

A clear understanding of preterm development is critical to the bonding process between parents and their preemies—a great way to get closer to your baby. You can still establish a connection with your preemie while in the NICU by being aware of their developmental milestones.

Parents must understand their unique requirements and developmental stages to effectively care for and support them. Some of these characteristics include:

Small Body, Thin and Delicate Skin

Overall, premature babies have significantly low birth weight; hence, their physical size is relatively small. Additionally, they have thin and delicate skin. These unique features require special care in handling and bathing them.

Sensitivity to Touch

Premature babies learn about the world mainly through touch. More importantly, a sense of touch is the key for parents to bond with them. However, they’re more sensitive to touch than full-term babies, so providing a gentle and comforting touch is critical.

Vulnerability to Overstimulation

Light and noise are two stimuli that easily overwhelm premature babies. It’s best to create a calm and quiet environment that makes them feel more secure and facilitates bonding.

Delayed Bone and Muscle Development

As advised by medical experts, involve your premature infant in gentle exercises and motions to help support their development and create opportunities for bonding.

Premature babies may have delayed physical development, including muscle and bone development. Late preterm babies, born between 34 and 36 weeks, may have fully developed organs but still have changes happening in their brains.

Premature babies born earlier than 28 weeks and babies born with an extremely low birth weight of less than 1 kg have the highest chance of developing problems.

Potential for Neurodevelopmental Challenges

Premature babies may experience long-term effects on their cognitive and neurological development, including learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and difficulties with executive functioning.

Parents must be aware of these developmental challenges; hence, bonding and interaction with their baby should consider these disabilities. 

Needs Specialized Care

Premature babies in the NICU require specialized medical care, which makes it challenging for parents to bond with them. However, being involved in their care, such as participating in diaper changes or helping with feeding, can still contribute to their bonding success.

Potential for Longer Hospital Stays

Premature babies need to stay in the hospital for an extended period, which can be emotionally challenging for parents. Finding ways to stay connected and involved with their care can help maintain the bond during this time.

Understanding these unique characteristics helps parents bond with their premature babies. By being aware of their baby’s needs and sensitivities, parents can provide a comforting and supportive environment that promotes bonding and development.

Bonding with Your Premature Baby in the NICU

Managing the difficulties and uncertainties of having a preemie could be complex. You need to focus on developing a strong bond, even while in the NICU. By prioritizing this bond, you provide your baby with love and encouragement despite hardship.

Maintaining a deep bond with your baby through care and engagement is essential for their development and general well-being throughout their stay in the NICU. Premature infants who receive loving care are more likely to experience favorable developmental outcomes.

Remember that every baby and family’s situation is unique, so it’s important to tailor your approach based on the specific needs and guidelines provided by the NICU staff

There are many ways to develop a bond with your baby. Here are some tips to consider:

1.   Spend quality time.

Find time to visit your baby regularly at the NICU and make the most of the time you have together. Even if your baby is sleeping or connected to monitors, your presence creates a sense of familiarity and constant support.

Your presence alone provides a long-term positive impact on your baby’s development and gives you confidence as a parent too. Spending time with your baby is such an important part of bonding in the NICU.

2.   Learn your baby’s cues.

With your regular visits to your preemie, you take time to learn your baby’s cues. Get involved in their care, especially on how to make your baby comfortable at all times. You may ask the NICU staff for guidance on how to interact with your baby.

3.   Kangaroo care.

Also known as skin-to-skin contact, kangaroo care is highly encouraged and affords numerous benefits to premature babies. This involves holding the baby against your bare chest with only a diaper on for an extended period.

Hold your baby against your chest so they can hear your heart beating. For a premature baby, such moments are crucial for physical and emotional bonding.

This skin-to-skin contact helps regulate the baby’s temperature, heart rate, and oxygen levels, promotes breastfeeding and breathing, and reduces stress for both the parent and baby. It also promotes weight gain and digestion. All these benefits foster bonding with your preemie.

4.   Gentle touch.

Premature babies are sensitive to touch due to their underdeveloped nervous system. Use a light and gentle touch to stroke your baby’s skin, hands, and feet. This tactile stimulation helps promote relaxation and bonding—a soothing effect that helps establish a connection with the parent.

These comforting touches provide reassurance and make the baby feel loved and secure. Your care team will guide you to feel comfortable while touching your baby. They will guide you in specific ways that your baby will be looking for and can tolerate.

Some NICU infants can be held right away, while others may need an alternative approach. Once their condition is stable, massage can also help them relax. They will feel calm, cared for, and supported. You could hold your baby’s hand or stroke their head, for example.

5.   Talk, sing, and read.

Premature babies benefit from hearing their parent’s voices. Even though they may seem too small to understand or respond to, talking, singing, and reading softly to them create a sense of familiarity and connection. It helps them recognize and connect with your voice, promoting bonding.

Engage in gentle conversation and sing lullabies. Your voice will become familiar to them, providing a sense of security. Your baby recognizes your voice from when they were inside the womb, so hearing it can be comforting and soothing—a source of bonding during the NICU stay.

6.   Help with care tasks.

Discuss with the NICU staff if you could participate in your baby’s care routine as much as possible. Changing diapers, feeding if permitted, and bathing your baby enhance your bonding experience and help you feel more connected with your little one.

Other simple tasks could just be providing comfort through swaddling and positioning. These activities help establish a sense of parental responsibility that promotes bonding.

7.   Create a sense of normalcy.

Despite a highly medicalized environment, try to create a sense of normalcy by personalizing the baby’s space. You can bring familiar items, such as a blanket or a small toy, to make the surroundings feel more like home.

8.   Leave your scent.

Check with NICU staff to learn what cloth items are appropriate to place in your baby’s space. Sleep with that item or wear it all day tucked under your clothing, then place it in your baby’s space. In this way, you’re establishing a connection with your baby through your scent.

Sweet premature baby in an incubator with oxygen and unrecognizable mom caressing baby trying to calm him down

9.   Take care of yourself.

Prioritize self-care during this challenging time, taking care of your physical and emotional well-being during this stressful period. Have a balanced diet, get enough rest, and engage in activities that give you joy and relaxation.

When you’re calm and well-rested, it positively impacts your interactions and connection with your baby.

10.  Seek emotional support.

The NICU experience can be emotionally overwhelming and exhausting, especially for moms. It’s essential to seek support from your partner. Also, from healthcare professionals, therapists, family, friends, and support groups specific to parents of premature babies.

Sharing experiences and emotions can help cope with the challenges and strengthen the bond during this critical period. They can provide comfort, understanding, and guidance, which are essential for maintaining a healthy emotional state during this challenging time.

11.  Seek support from NICU staff.

Ask the medical staff for guidance and support on ways to bond with your premature baby. They have experience working with families in similar situations and can offer valuable advice and resources.

12.  Ask questions.

Don’t hesitate to ask questions or seek clarification from the medical team regarding your baby’s condition, progress, and care plan. Being well-informed helps alleviate anxiety and empowers you to initiate more meaningful interactions with your baby.

13.  Celebrate milestones.

Premature babies often reach developmental milestones later than full-term babies. Celebrate each small achievement, such as gaining weight, moving to an open crib, or starting to breastfeed.

These milestones testify to your baby’s progress and strengthen the bond between you and your little one. Maintaining a positive outlook can help strengthen your bond and offer hope during the NICU journey.

Make Bonding Moments with Your Preemie at the NICU

Nothing is as unique as a parent’s and baby’s bond, despite the challenges. Even in the NICU, you can create lasting memories and form a connection that will grow as your baby grows. Understand your baby’s growth and foster a happy atmosphere with your preemie.

Bonding happens over time, and it’s built on everyday moments like smiling at your baby, touching them, using loving words, and responding to their needs. With the strategies outlined in this article, determine which technique works best for you and your baby.

While every baby is different, you may try various approaches. Enjoy every bonding moment. Your preterm baby may be physically small, but they’re strong and have a lifetime of love and opportunity ahead of them.

Source:https://www.omegapediatrics.com/bonding-your-premature-baby-in-the-nicu/

Our twin pregnancy

In late 2021, I was pregnant with twins, 2 little siblings for my son Rico. The pregnancy was very exciting, and we couldn’t wait to meet them. We wanted to do a gender reveal, but sadly we didn’t get the opportunity.

At 21 weeks, I had a scan which found that my cervix was open. I had to have an emergency cerclage on New Year’s Eve 2021, and was in hospital for 2 weeks.

A week after being sent home, my waters broke. I was 24 weeks pregnant at this point and very scared. I rushed back to hospital where they told me I would remain until the twins were born.  

Giving birth  

10 days later, after multiple scans, I went into labour. My beautiful twins were born at 25 + 6 weeks at 2:03am (Luna) and 2:36am (Luca).

Both babies were transferred to NICU to begin their fight.  

At 4 days old, suddenly and unexpectedly, our baby boy Luca died. We had to wait 6 months for his postmortem results to find out why, which is when we were told he’d died of NEC. Our survivor Luna spent 87 days in NICU before coming home.

How I coped

The early days of grief I just shut myself away from people. I was at the hospital everyday with Luna and I just engrossed myself in caring for her. I had bereavement therapy which didn’t really help me, but what did help immensely was PTSD therapy.

I’ve also used the Facebook community to reach out to other people who have been through similar situations. I’ve made friends through those communities and we regularly message and support each other when things get tough.

Honouring Luca

We miss Luca every day. Having a surviving twin is such a complex mix of emotions – we feel happy and sad at the same time. We honour Luca daily and include him in our family.

We have a garden for him at home and in my parent’s garden. I also wear jewellery to remind me of him, and have lots of little ornaments around the house in his memory. On the twin’s birthday, we had a cake for both of them (pink and blue).

Every year, I try to do something for charity in his name. Last year I raised over a £1000 in a swimming challenge and this year I took part in Tommy’s Walk for Hope and managed to raise £400.

Advice for others

My advice to anyone who loses a twin baby would be:

Embrace the feelings of happiness and sadness. Losing a baby is something that no one should have to go through, but you’re a twin parent and your survivor will always be a twin.

Reach out to support through charities, and take counselling if you can. You will probably be suffering from some form of PTSD and working through that really helped me. 

Source: https://www.tommys.org/baby-loss-support/baby-loss-stories/baby-loss-stories/having-surviving-twin-such-complex-mix

Led by trained PSI facilitators, our online NICU group is intended for parents of babies who are currently or formerly in the NICU. This peer support group is for those with babies up to two years old who experienced a NICU stay for any reason. Connecting with others who have experienced the uniquely stressful environment of a NICU will provide parents with understanding, as well as helpful tools and resources. Whether your baby is currently in the NICU or you have finally returned home, our NICU Postpartum Parents support group is here for you.

Register Here

Note: This group is not for people processing the details and trauma of pregnancy and/or infant loss. Please join one of our Loss and Grief Support Groups for this important support.

PSI Support Groups

All of our groups are FREE and virtual. When registering for Sharewell for the first time, skip the unlimited offer on the payment page.

What to Expect

Our groups are 90 minutes (1.5 hours) in length. The first ~30 minutes is spent providing information, education, and establishing group guidelines. The next ~60 minutes is “talk time,” in which group members share and talk with each other. Group members must be present for the group guidelines before joining in the discussion or “talk time.”

Student and clinical observations are not allowed in our group spaces due to confidentiality and creating a safe space.

  • Cameras are required during introductions for the safety of all group members. Please make sure your technology allows you to turn on your camera at least briefly for this portion of the session.
  • The session will take place via Zoom (from the ShareWell website), so make sure your device is compatible with the Zoom app. This may require updating or downloading the Zoom app.
  •  

Student and clinical observations are not allowed in our group spaces due to confidentiality and creating a safe space.

Registration Information

PSI Support Groups are hosted on ShareWell and are split into different “wells.” Click on the registration link above to go to the Well, which includes support groups in each category.

When signing up for groups and making an account:

  • Skip the unlimited offer on the payment page (all of our groups are free!)
  • Access PSI support groups in each dedicated community
  • Reach out to groups@postpartum.net if you have any questions

In this new platform, we will no longer have a waitlist function. **We will allow up to 16 group members to enter the group, so please arrive on time to get a spot. Once we reach 16 members OR we have started talk time, the group space will be closed.

Source:https://postpartum.net/group/nicu-postpartum-parents/

Sick or premature babies: tips for family and friends

Key points

  • Parents of sick or premature babies have a lot of stress in the early months of their babies’ lives.
  • Practical help and emotional support from friends and family can help parents cope.
  • It’s good to ask parents exactly how you can help.

Supporting parents of sick or premature babies

Parents of sick or premature babies go through a lot of emotional ups and downs in the early weeks and months of their babies’ lives.

When they get practical help and emotional support from family and friends, parents often cope a lot better with the experience. And when they’re managing well, they’re better able to look after their babies.

Here’s how you can help

  1. Celebrate as you usually would when a baby is born

Offer congratulations, send a card or flowers, and ring the new parents. By celebrating the birth of their baby in this way, you’re helping them celebrate as well. Give a gift if this is what you’d usually do. Small gifts for the parents can help them feel nurtured too.

If you’re thinking of giving clothes for the baby, make sure they’re very easy to put on and take off – loose necklines and armholes are good. If the baby is premature, size 00000 clothes can also be useful, because many parents won’t have bought these smaller sizes. Baby clothes for later are wonderful too, because they help the parents think about the future, when their child is at home.

Another gift could be a voucher for hospital parking. Or you could give a voucher for a restaurant close to the hospital, so that parents can have a meal and some time together but not be far from their baby.

You might be able to contribute to or help the parents organise cultural or religious traditions or ceremonies to celebrate their baby’s birth.

2. Offer practical help

Parents will be visiting the hospital as often and for as long as they can for days, weeks or months to come. This means that everyday chores are hard to fit in or don’t get done, which can be stressful.

Here are helpful things you could offer to do:

  • Mow the lawn or walk the dog.
  • Prepare meals or do the weekly grocery shopping.
  • Take older siblings to preschool or school or look after the other children in the evening.
  • Give parents a lift to the hospital – parking and transport can be very expensive.
  • Set up a messaging group or social media page, so that parents can send updates to just one source.

3. Support parents in whatever way they need

It’s OK to ask parents what they need. Some parents want to shut themselves off and cope with the situation alone or with a few close friends and family. Respect their wishes, but also let them know that you’re thinking of them. You could try to offer help when they seem ready.

Some parents need a lot of people around for support. These parents might love having company at the hospital. You could offer to drive, have lunch or just sit with them. Some parents want to talk about things other than the baby. Parents’ needs can change as their baby grows and changes.

4. Stay in touch with parents

A text message, an email, a quick phone call or voice message, or even an old-fashioned card in the mail – these are simple ways to let parents know you’re thinking of them. They help parents feel supported and remembered.

Try to understand how stressed the parents are and avoid judging them if they forget a birthday, can’t get to a family gathering, or take less interest in what’s happening in your life. It’s not that they don’t care – it’s just that right now, all their energy and focus is on their baby.

5. Say positive things about the baby

You can show your support by saying positive things like ‘Your baby is growing fast already’, or ‘They’re strong just like you’.

Avoid talking about setbacks that might happen or challenges that the baby could face, unless the parents bring it up with you. Also avoid giving advice about the baby.

6. Don’t expect to cuddle the baby

Sick or premature babies are very sensitive to touch, noise, infection and other things in their environment, so cuddling or touching is often limited or not allowed. Parents can also be very protective of their babies.

You might not even be able to see the baby, because there are usually limits on the number of visitors allowed at one time. Often it’s only 2 visitors. Sometimes only family is allowed – often this is only the baby’s parents. Each hospital has its own set of rules. Instead, you could ask to see photos of the baby (if the parent feels up to sharing them) or have a coffee with the parents at the hospital café.

Don’t be surprised if you still can’t have a good cuddle when the baby goes home. Many babies are still easily overwhelmed and might need to be protected from too much handling and too many new people.

If you’re sick, it’s important to avoid visiting a family with a baby in the neonatal intensive care unit (NICU) or the special care nursery. Sick or premature babies can get illnesses and infections very easily.

7. Listen to parents

Parents are likely to have mixed and strong feelings about their sick or premature baby and their experiences of the birth or hospital. These might not surface for weeks, months or even years.

Be open, let them talk and avoid giving advice unless it’s asked for. Avoid comparing them with other parents who’ve had a hard time. If you listen more than talk and follow the lead of the baby’s parents, you’re more likely to be helpful.

8. Keep offering help after the baby comes home

Parents might be tied to the house for some weeks once the baby comes home. Having someone organise shopping or preschool and school runs can really help.

Source: https://raisingchildren.net.au/newborns/premature-babies-sick-babies/neonatal-intensive-care/premature-babies-tips

Premature babies, or “preemies,” are born before 37 weeks gestation.

Hailey Petersburg was born at 24 weeks and five days.

Considered a “micro-preemie” and weighing just one pound and seven ounces, Hailey had a 40% chance of survival and a long road ahead of her in the Neonatal Intensive Care Unit (NICU). She spent 133 days in the NICU, where she underwent multiple surgeries and was treated for anaemia of prematurity. “Every day was a rollercoaster,” said Hailey’s mother and Leidos Data Scientist Allison Petersburg. “She was in a critical stage where her condition changed so rapidly every day.”

Before Hailey even reached what would have been full-term at 40 weeks, she received almost two dozen transfusions, which were crucial to her treatment plan.

Hailey’s tiny body was working as hard as it could, often enduring bradycardic events where her heart was beating too slow. Her medical team provided blood and platelet transfusions to help carry oxygen throughout her body; their impact was immediate, improving Hailey’s health and significantly increasing her vital signs.

In the United States, someone is in need of blood or platelets every two seconds. For many months, Hailey was one of those people. She received blood or platelet transfusions almost daily in the first weeks of her life, decreasing over time as she grew stronger each day. “Throughout the NICU experience of being in day-to-day survival mode, the gift of blood was a vital stability for Hailey,” said Allison.

Blood and platelets can’t be manufactured and must be donated. They also have an expiration date, so there is always a need for more blood donors. Since the beginning of the COVID-19 pandemic, the American Red Cross has seen a decline in blood donations, resulting in a national blood crisis. Between blood, platelets, and plasma, “nearly 16 million blood components are transfused each year in the United States.”

“Whenever Hailey had a transfusion, she would immediately begin breathing better, her heart rate was stable. As she received blood, the bradycardic and oxygen desaturation events decreased and all her vital signs improved,” said Allison. “They were lifesaving.”

After almost four and a half months in the hospital, Hailey Petersburg was ready to go home. Fast forward five years, and now Hailey is a recent preschool graduate, who, according to her mother, “is doing absolutely amazing.”

She’s an active soccer player, swimmer, and dancer, as well as an avid Disney princess fan, currently infatuated with Jasmine from Aladdin. Allison thinks Hailey intuitively knows how hard she had to fight soon after she was born, citing her joie de vivre, “she’s just the happiest little girl.”

Hailey is an example of why it’s so imperative to donate blood if you’re able. With nearly 30,000 units of blood needed each day, the Red Cross is continually in need of donors and one pint of blood can save up to three lives.

Even during a global pandemic, Leidos remained committed to diminishing the national blood crisis, collecting more than 311 units over the past two years. Since 2016, we’ve hosted 23 blood drives at our Global Headquarters in Reston, VA, thanks to 674 donors. Other offices, including our Columbia, MD, and San Diego, CA, locations regularly host blood drives, as well as one of our subsidiaries, QTC. The Columbia Leidos office has collected 125 units of blood since 2017.

Not only is donating blood so important, but the process is very quick, only taking about 20 minutes for the physical donation. For perspective, if just 1% more of all Americans donated, blood shortages “would disappear for the foreseeable future.”

“It was clear that the donated blood Hailey received in her transfusions saved her life,” said Allison. “I don’t know if my daughter would be with us today if not for blood donors.”

Schedule an appointment to donate blood today – and save a life.

Source: https://www.leidos.com/insights/whole-new-world-thanks-blood-transfusions

INNOVATIONS

Editorial

The still predominant siloed, vertical structure of academia, health care systems, funding institutions/mechanisms, and public health organizations around the world pose an important challenge to tackle complex societal and health challenges for people, animals, and ecosystems. Understanding and acknowledging the delicate interdependence between ecosystem, human, and animal health is needed to design and implement comprehensive and holistic health strategies, beyond just human health. Infectious diseases with a zoonotic component have caused widespread human suffering in recent decades, with increased interactions between human and animal populations making people ever more vulnerable to new infections, given the rapidly and constantly changing global ecosystem. Additionally, socio-cultural, political, and economic factors impact the ability of systems to better prevent, detect, and respond to public health challenges at the human, animal, and environmental interface. This complex landscape applies to non-communicable diseases as well, requiring multisectoral approaches well beyond the traditional, narrow biomedical model. Hence, a wholesale shift is needed in how we approach public health. Instead of equating public health only with human health, we need to recognize what it truly is: the inter-related health of the world’s people, animals, and the environments we all share.

The complete interdependence between human, animal, and ecosystem health has been long recognized within Indigenous communities; however, the emergence and rapid expansion of the fields and practice of both One Health (OH) and Planetary Health (PLH) are recent developments in the right direction [1]. While the OH approach has been advocated for mostly in the context of addressing global threats related to zoonotic diseases and antimicrobial resistance, this approach is also relevant for several major public health challenges including pollution management, the environmental/agricultural component of food safety, food security, and nutrition. For example, the OH approach may lead to ecologically sustainable dietary patterns impacting the prevention and management of chronic conditions, such as cardiovascular disease.

The OH/PLH approaches have experienced considerable growth and expansion in academia, and within governmental and non-governmental organizations (NGOs)—with greater traction occurring in the past decade . While OH and PLH are highly complementary approaches based on transdisciplinary, multisectoral, and system-based approaches to health, challenges remain when translating ideas into policy and practice. “Overall, One Health and Planetary Health provide an opportunity to build a stronger research community to collectively address pressing public and global health issues in a truly integrated way”.

In March 2023, the Quadripartite organizations: the Food and Agriculture Organization of the United Nations (FAO), United Nations Environment Programme (UNEP), World Health Organization (WHO), and World Organisation for Animal Health (WOAH), issued an unprecedented call for enhanced global action to use the OH approach to “achieve together what no one sector can achieve alone”, emphasizing the need to translate the OH approach into policy action. Additionally, the Quadripartite institutions, in December 2023, published the One Health Joint Plan of Action with recommendations to implement OH approaches at national levels. Similar movements are occurring within the PLH space. For example, a National Planetary Health Action Plan (NPHAP) is being developed in Malaysia “to mainstream planetary health in all national policies and plans through a holistic and whole-of-nation approach”. Having endorsements from national and international organizations are important; however, there are still elements lacking when considering the implementation of OH/PLH to ensure human, animal, and ecosystem health.

What is next? Local community leadership and involvement is needed to build upon progress to date at the global level. To tackle complex public health challenges, a “bottom-up” approach is needed that complements global and national efforts. An emphasis on local, practical, and feasible solutions are also needed to address complex problems, while engaging local stakeholders and affected communities. A key aspect, however, of implementing OH and PLH approaches into public health strategies is to account for the socio-cultural, religious, and economic factors among local and rural communities. This is especially important when working with those most marginalized, such as Indigenous and rural communities, who are often already closely and directly attached to having strong connections with the ecosystem they inhabit.

Scientific, biomedical, and health knowledge is necessary, but not sufficient alone. Successful public health interventions that work at the human-animal-ecosystem interface require the broad and committed collaboration of members from all levels of society. A coordinated, multisectoral approach that involves animal health and public health authorities, health practitioners, physicians, veterinarians, environmental workers, politicians, researchers, experts in social, cultural, and communication issues, as well as economists, farming and agricultural groups, and local communities is necessary. Importantly, bold and courageous political leadership is essential to co-lead while securing public support for health policy decisions and implementation [5]. It is key to develop a OH/PLH “business case” (e.g. cost-benefit analysis), with governments enabling, facilitating, and supporting implementation processes both financially and within appropriate legal frameworks. This will ensure the recognition for not only the importance of economic benefits derived from reducing a specific health issue, but also for assessing the broader public health and societal benefits and impacts.

While OH and PLH offer a rational systems approach for safeguarding health in an interconnected world, to secure its benefits, public health must do what humans, animals, and plants have always done—evolve!

Source: https://academic.oup.com/eurpub/article/35/1/3/7815848

Comparison of maternal and neonatal outcomes of midwifery-led care with routine midwifery care: a retrospective cohort study

Shirin Shahbazi Sighaldeh, Elaheh Eskandari, Shahla Khosravi, Elham Ebrahimi, Shima Haghani & Fatemeh Shateranni

BMC Nursing volume 24, Article number: 158 (2025)

ABSTRACT

Introduction

Globally, the management of low-risk pregnancies by midwives often leads to a more natural childbirth process, which enhances physical and psychological outcomes for mothers and their babies. Midwives implement various models of maternal care in practice. This study investigates and compares maternal and neonatal outcomes associated with midwifery-led care versus routine midwifery care in private hospitals in Iran.

Methods

This retrospective cohort study was conducted in Iran in 2022. The study population consisted of two groups including 387 women in the Routine Care Group (RCG) and 397 women in the Private Care Group (PCG). Participants were selected through continuous sampling in accordance with the inclusion criteria. The two groups were compared in terms of some maternal and neonatal outcomes. The research data collection tool was a researcher-made checklist with variables adjusted according to the ‘Iman’ system of the Iran Ministry of Health. Based on this tool, the data were extracted from the mentioned system and analyzed with SPSS software.

Findings

The results indicated no significant difference between the two groups in terms of the type of delivery (p = 0.999), the use of forceps or vacuum (P = 0.5) and transferring the mother to the operating room (OR) or the intensive care unit (ICU) immediately after delivery (P = 0.744). However, there was a statistically significant difference between the two groups in terms of labor pain control (P < 0.001), induction of labor (P < 0.001), and the use of episiotomy (P < 0.001). Regarding neonatal outcomes, there was no statistically significant difference between the two groups in relation to the average infant weight (P = 0.46), Apgar score (P = 0.75), need for resuscitation (P = 0.999), skin-to-skin contact (P = 0.626), initiation of breastfeeding (P = 0.241) and admission to the neonatal intensive care units (NICU) (P = 0.66).

Conclusion

Given the positive impact of private care on key maternal outcomes, it is recommended that health policymakers create the conditions necessary for establishing a continuous midwifery care model in both governmental and private hospitals. Besides, more quantitative, qualitative, and especially mixed methods research should be conducted to explore the challenges and facilitators of this model across various settings.

Source: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-025-02789-4

Early prediction of preterm birth in cell-free RNA could reshape prevention strategies

by European Society of Human Genetics  edited by Sadie Harley, reviewed by Robert Egan

May 24, 2025

Children born before 37 weeks of gestation have a considerably increased risk of dying before they reach the age of five. Predicting the risk of preterm birth (PTB) and hence implementing preventive strategies is complicated by the heterogeneity of the condition, the many unknown mechanisms involved, and the lack of reliable predictive tools.

Now, however, researchers have been able to show that blood cell-free RNA (cfRNA) signatures can predict PTB over four months before delivery date. The research was presented at the annual conference of the European Society of Human Genetics.

Dr. Wen-Jing Wang, an associate researcher at BGI Research in Shenzhen, China, together with team leader Professor Chemming Xu from the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China, and colleagues analyzed blood plasma samples from 851 pregnancies (299 PTB cases and 552 controls) at about 16 weeks gestation to identify cfRNA markers associated with spontaneous PTB, and found significant alterations in cfRNA between PTB and birth at term.

The study included both preterm births with intact membranes and premature rupture of membranes (when the waters break before labor starts), with fewer than 3% having a prior preterm birth.

“Being able to detect these predictive signals over four months suggests early biological priming for PTB, far earlier than current clinical recognition,” she says. “This extended window could revolutionize prevention strategies.”

Annually, about 13.4 million newborns worldwide are delivered prematurely, accounting for approximately one in 10 of all live births. Nearly one million of these preterm infants die each year, and PTB remains the primary cause of mortality in children under five.

Because children born preterm have immature organs that are not yet prepared for life outside the womb, it means that they will have a far higher risk of complications than those born at term. This can lead to a range of health issues such as respiratory problems, jaundice, feeding difficulties, and infections.

Long-term health problems for these children include cerebral palsy, epilepsy, and blindness, and impose substantial emotional and financial burdens on families.

“Practically, our method uses the same blood draw timing as routine Non-Invasive Prenatal Testing (NIPT), enabling dual testing. Current cfRNA sequencing costs are similar to NIPT pricing, but future optimization using targeted qRT-PCR panels could reduce expenses significantly. This creates a potential route to both monitoring patients at high risk and for wider population-level screening,” says Dr. Wang.

Before this diagnostic technique can be used more widely, the researchers say that standardized protocols for sample handling need to be developed, given RNA’s instability compared with DNA.

Prediction algorithms need to be developed in diverse population studies, and the causes of different PTB subtypes explored to be able to guide targeted interventions. The team is pursuing these goals and seeking to collaborate with other institutions in order to accelerate the use of their findings in clinical practice.

Chair of the conference, Professor Alexandre Reymond, said, “Advances in sequencing and analysis technologies are now offering many new diagnostic possibilities. This is a fascinating example of the use of sequencing readouts to evaluate risk, rather than assessing genetic background to assess predisposition.”

Source: https://medicalxpress.com/news/2025-05-early-preterm-birth-cell-free.html

Saving Tiny Lives: The Critical Need for Blood and Platelet Donations for Preemie Babies Undergoing Surgery

Premature infants, especially those born before 32 weeks of gestation, often face life-threatening challenges that require surgical intervention. These delicate babies are at heightened risk for bleeding complications due to their underdeveloped organs and fragile blood vessels. In fact, studies indicate that platelet transfusions are administered to 5.8%–53.0% of neonates with a gestational age at birth below 32 weeks, underscoring the critical need for these life-saving donations.

When it comes to blood versus platelets, it’s essential to understand the differences. Blood transfusions typically involve the whole blood or red blood cells, which help provide oxygen to the body’s tissues. For preemie babies, blood transfusions are often required to address anemia, a condition where the body doesn’t have enough red blood cells to carry sufficient oxygen. Platelet transfusions, on the other hand, are crucial for babies who are at risk of bleeding or have low platelet counts, which are essential for blood clotting. While blood transfusions address oxygen needs, platelet transfusions play a vital role in preventing severe hemorrhaging in these tiny patients.

The impact of blood and platelet transfusions on preemie babies cannot be overstated. For instance, a study involving neonatal surgeries revealed that 14% of neonates received perioperative red blood cell transfusions. Among those transfused, 30-day mortality rates were significantly higher, and they also experienced increased rates of complications such as wound dehiscence, mechanical ventilation beyond 48 hours, cardiac arrest, and septic shock. Platelet transfusions, however, are often the key to minimizing bleeding risks during surgeries and promoting recovery in fragile babies.

Recognizing the importance of these donations, I recently contributed by donating platelets to support children undergoing cardiac surgery. This experience highlighted the profound difference that blood and platelet donations make in the lives of critically ill children. Each donation has the potential to save lives and improve outcomes for these vulnerable patients. If you’re considering how you can make a tangible impact, donating blood or platelets is a powerful way to help. Your donation could be the one that gives a tiny baby the chance to grow, thrive, and lead a healthy life. To learn more about how you can donate and make a difference, visit your national blood donation agency’s website. Your generosity can be the lifeline these babies desperately need.

Surf’s up in Sierra Leone

Sierra Leone’s beaches and waves make them attractive for surfers. But the country has just one surf club. It tries to get boys and girls off the streets and into the water, despite equipment and personnel being in short supply. Sierra Leone is still infamous for its civil war and poverty. But it’s also incredibly beautiful. Enjoy the breathtaking views from Bureh Beach — a perfect spot for surfing.

NW Warriors – Call to Action!

The Dominican Republic is a North American country located on the island of Hispaniola in the Greater Antilles of the Caribbean Sea in the North Atlantic Ocean. It shares a maritime border with Puerto Rico to the east and a land border with Haiti to the west, occupying the eastern five-eighths of Hispaniola which, along with Saint Martin, is one of only two islands in the Caribbean shared by two sovereign states. In the Antilles, the country is the second-largest nation by area after Cuba at 48,671 square kilometers (18,792 sq mi) and second-largest by population after Haiti with approximately 11.4 million people in 2024, of whom 3.6 million reside in the metropolitan area of Santo Domingo, the capital city.

There are three tiers of healthcare in the country:

  • Subsidized regime, which is financed by the government for unemployed, poor, disabled and indigent people.
  • Contributive regime, which is financed by workers and employers
  • Contributive subsidized regime, which is financed by independent workers, technical workers, and self-employed people, but subsidized by the state[16]

Even those for whom care is supposedly provided may have to pay for medical supplies. However, considerable progress in health and overall development was experienced in the country. For instance, there is a substantial increase in health coverage in the nation that is the health insurance coverage from 23% in 2011 to 65% in 2015 (Centers for Disease Control and Prevention n.p). Significantly, updating the list of beneficiaries was the major challenge since the list based on disease prioritization and financial sustainability. Therefore, the first fitness elements, such as migration, poverty education, and gender-based, should be considered in the strategy of hindrance suites.

Government expenditure on healthcare is about $180 per person per year, slightly more than half the average for the Latin American and Caribbean region.

Essentially, there are steps considered by healthcare in the Republic. Firstly, the sponsored organization that caters to the poor, unemployed, and disabled people. Also, the active personnel contained a contributive establishment. Though the low-classes are dependents, the majority of the population is independent on matters of health, according to the Dominican Republic (World Health Organization n.p). Therefore, government expenditure per person is slightly higher in the Dominican Republic compared to other states.

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

COMMUNITY

European Standards of Care for Newborn Health/CALL TO ACTION

Europe needs new ideas and solutions to address the disparities in the care of preterm and ill babies. The European Standards of Care for Newborn Health project presents such a solution by providing European reference standards for this health care area.

With its transdisciplinary focus and international composition of the working groups, the project sets new benchmarks for the care of preterm and newborn babies and can serve as a role model for countries in Europe and worldwide. About 220 experts from more than 30 countries accepted to dedicate their free time to work on this ambitious project over several years. At the time of the launch of the standards, 108 healthcare societies and associations as well as 50 parent organisations have accepted EFCNI’s invitation to officially support the newly developed standards.

Through its multi-stakeholder approach, the perspective of parents, healthcare professionals, and relevant third parties were equally considered, aiming at identifying current best practice. Industry partners were involved in the project by supporting it financially. Their representatives could join the Chair Committee meetings in an observing role and they were welcome to share their knowledge and expertise without exerting influence. Initiated by patient (parent) representatives for patients, it is a true patient-centred project and, for the first time, patients were involved in absolutely every step in the development of the standards. All project participants work together in an open and respectful partnership to pave the way for change and set newborn health on the international and national agendas.

On a political level, addressing European Standards of Care for Newborn Health will stimulate a new debate that can help questioning existing structures, identify gaps and deficiencies, and advance national healthcare systems. To read the standards and to learn more about their development, please visit our project website European Standards of Care for Newborn Health.

On the project website, you also find further information like a project report, an information brochure or social media graphics.

The European Standards of Care for Newborn Health now available in Italian – Gli Standard Assistenziali Europei per la Salute del Neonato sono disponibili in italiano

The Italian Society of Neonatology (SIN) and Vivere ONLUS, the Italian National Coordination of Parents’ Associations, took the initiative to translate the standards into Italian, with Italy becoming the first European country to make this important document available in their national language. The first two sets of standards can be downloaded from our project page.

Call to Action for Newborn Health in Europe

The UN Convention on the Rights of the Child has been ratified by 196 countries and proclaims that “the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth”.  Article 6 affirms every child has the right to life, survival, and development. Furthermore, children have a right to be cared for by their parents and should not be separated from them, as far as possible (Articles 7 and 9). However, upholding the Rights of the Child in reality remains a major challenge.

The European Standards of Care for Newborn Health help support these rights from the beginning of life by serving as a reference for the development and implementation of binding standards and guidelines on a national and international level. European and national policy makers, hospital administrators, insurers, professional and patient associations, and industry should work together to bring the standards into practice and to ensure quality, equity, and dignity for the smallest.

Download the Call to Action Brochures: The Call to Action is available in about 20 languages and can be downloaded here.

March of Dimes Named 2025 Labor Partner Charity of Choice for United Food and Commercial Workers International Union

News provided by March of Dimes Inc.   Mar 18, 2025

ARLINGTON, Va., March 18, 2025 /PRNewswire/ — March of Dimes, the leading organization committed to improving the health of moms and babies, has been named the United Food and Commercial Workers International Union’s (UFCW) Labor Partner Charity of Choice for 2025. As UFCW’s designated national charity partner, March of Dimes and UFCW will work together to support and advocate for healthy pregnancies, strong families, and improved maternal and infant health outcomes in the US.

“For more than 85 years, March of Dimes has stood alongside labor unions to champion the health and well-being of working families,” said Cindy Rahman, President and CEO of March of Dimes. “Our partnership with UFCW builds on this proud legacy, strengthening our ability to advocate for policies, provide essential resources, and drive meaningful change to improve maternal and infant health outcomes. We will work together to ensure that every family—no matter where they live or work—has access to the care and support they need for a strong, healthy start.”

The US remains the most dangerous high-income nation for childbirth, earning a D+ for a third consecutive year in March of Dimes’ latest Report Card, which measures the state of maternal and infant health in the US. Through this partnership, UFCW and its more than 1.2 million members will have opportunities to engage in fundraising efforts, volunteer initiatives, and awareness campaigns aimed at addressing this growing crisis.

“The UFCW Charity Foundation is committed to supporting organizations that make a real difference in the lives of working families,” said UFCW International President Marc Perrone. “March of Dimes has led the fight to improve maternal and infant health for decades, and we are proud to stand with them in this important work. By joining forces, we have the opportunity to help even more families access the care and resources they need for healthy pregnancies and strong futures.”

Partnering with labor unions to protect the health of working families is a cornerstone of March of Dimes’ mission. We’re honored to have strong and long-standing national and local partners like UFCW through our Labor of Love movement, which raises critical funds to pioneer research, advocate for change, and pave the way for greater equity to give all families the best possible start.

Before being named UFCW’s Charity of Choice, UFCW members have actively supported March of Dimes, raising over $3 million through golf outings, sporting clay events, auctions, and March for Babies teams. They have also uplifted the voices of their own members, like Daniel Scott of UFCW Local 1996, whose twins spent time in the neonatal intensive care unit (NICU) after a challenging pregnancy. For families like the Scotts, March of Dimes’ work is more than a cause—it’s a lifeline, ensuring that babies born too soon or facing complications receive the critical care they need.

For more information on how to get involved, visit https://www.marchofdimes.org/get-involved/partner/labor-union

About March of Dimes
March of Dimes leads the fight for the health of all moms and babies. We support research, education, and advocacy, and provide programs and services so that every family can get the best possible start. Since 1938, we’ve built a successful legacy to support every pregnant person and every family. Visit marchofdimes.org or nacersano.org for more information. Follow us on social at @marchofdimes.  SOURCE March of Dimes Inc.

Source: https://www.prnewswire.com/news-releases/march-of-dimes-named-2025-labor-partner-charity-of-choice-for-united-food-and-commercial-workers-international-union-302404305.html

Falling through the cracks: what happens to survivors of preterm birth?

Andrew Bush    Anne Greenough    Alvar Agustí 

To the Editor:

Premature birth has consequences across the course of life, including reduced life-expectancy, and the most prematurely born have the worst outcomes [1, 2]. Survivors of prematurity have increased respiratory morbidity and mortality, airflow obstruction, asthma-like symptoms and COPD, and cardiovascular disease [1–4]. A history of prematurity is often not sought in adult clinics [5]. We hypothesised that the long-term consequences of prematurity are insufficiently appreciated, likely with detriment to patient care.

We used an online survey developed by a panel of neonatologists, paediatricians, allergologists and pulmonologists. The survey included 21 items addressing four main topics: 1) awareness level among respiratory care providers regarding the long-term respiratory risks of premature birth; 2) communication of neonatal information between different medical specialties; 3) healthcare journey of preterm babies to paediatricians and other respiratory care providers; 4) the knowledge gaps and potential solutions. The survey was customised to each specialty: seven items were for neonatologists only; three for paediatricians; one each for allergologists and respiratory consultants; five for paediatricians, allergologists, and respiratory consultants; and four for all specialties.

We invited 14 651 neonatologists, paediatricians, allergologists and respiratory consultants from Australia, France, Germany, Italy, Spain, the UK, and the USA to participate, excluding physicians with less than 2 years’ experience; 1002 (7%) responded. A web link was emailed from listings extracted from Chiesi Farmaceutici S.p.A and from proprietary databases of external healthcare providers. All had previously consented to email contact. Two email reminders were sent and incomplete surveys were rejected.

Sample size was opportunistic in the absence of data enabling a power calculation. The survey results were analysed using Microsoft Excel and Microsoft Power BI. All items involved categorical answers, and absolute and relative frequencies were calculated. All frequencies were treated descriptively. No geographical comparisons were performed due to sample size limitations. The questionnaire is available on request from the corresponding author.

Results are summarised in figure 1. Of the 1002 respondents, 91% had been in practice for more than 5 years, and 62% were practising in an outpatient facility. In terms of specialities, 282 (28%) were neonatologists, 183 (18%) paediatricians, 290 (30%) allergologists, and 247 (24%) were respiratory consultants. Figure 1a shows that neonatologists regarded the presence of respiratory symptoms as being most important in the decision to refer. By contrast, for paediatricians, birth weight was the most important factor, irrespective of respiratory symptoms (figure 1b). All specialists highlighted that the most important gap was lack of clear recommendations for follow-up (figure 1c) and the need for continuing medical education programmes (figure 1d). Most (96%) respondents considered prematurity and bronchopulmonary dysplasia (BPD) risk factors for lung diseases in adulthood. Nevertheless, 74% of respondents perceived only moderate to very low awareness among colleagues. Adult pulmonologists perceived the lowest level (85%) of awareness among the specialties surveyed.

FIGURE 1

Reasons for neonatologists (a) and paediatricians (b) to refer preterm-born patients to a respiratory specialist. The gaps and potential solutions to improve the long-term respiratory care of preterm-born individuals are shown in (c) and (d). The bars show the percentage of participants who selected each option. NICU: neonatal intensive care unit; BPD: bronchopulmonary dysplasia.

Most (77%) paediatricians “always” took a perinatal history, compared with allergologists (34%) and pulmonologists (21%). Irrespective of specialty, the proportion who always took this history increased with increasing years of clinical experience. Most (95%) neonatologists shared information on gestational age, birth weight, need for supplemental oxygen and respiratory support, BPD diagnosis and other lung sequelae of prematurity (>80%), and this was consistently reviewed by paediatricians (83%). This information was mainly through medical records (57%) and by oral communication (52%). Allergologists and respiratory consultants used feedback from other physicians (58% and 37%, respectively) and electronic medical records (43% and 26%, respectively) to gather neonatal information. They reviewed less neonatal information, although BPD diagnosis and lung sequelae were reviewed by 72% and 65% of allergologists and respiratory consultants, respectively.

Most neonatologists (99%) shared information with parents and caregivers, and more than 70% of paediatricians and allergologists received information from the caregivers. Only 59% of adult pulmonologists acknowledged receiving information from parents and caregivers.

Most neonatologists (70%) followed up preterm babies for two years, but 27% for only 1–2 years. Most (>75%) of all those surveyed, believed that premature babies should be followed up lifelong.

Most (>80%) allergologists modified clinical management, at least partially, if they were aware that the patient was born preterm. Only 60% of adult pulmonologists adapted management pathways in preterm survivors.

Most (>60%) respondents considered that preterm-born individuals and their parents and caregivers should be empowered to ensure they receive the best respiratory care. Other suggested initiatives were measuring lung function during follow-up from 5 years of age, streamlining access to the perinatal medical history and the development of a portable record with neonatal information. Going forward, the use of a lifelong electronic patient record, accessible to all who are involved in patient care, would likely greatly facilitate communication between specialist groups.

In summary, there is inadequate awareness of the importance of preterm birth for management across the life course; communication between specialist teams is inadequate; and there is lack of clear guidance as to how to follow-up preterm born survivors.

The European Respiratory Society [6], and the American Thoracic Society [7] have published guidelines with conditional recommendations on low strength evidence. However, the former only covered the follow-up of BPD survivors [6], and the latter were limited to the follow-up of preterm-born children and adolescents with respiratory symptoms [7]. These guidelines are limited, not least because we now know that the risk of compromised lung health later in adulthood exists even for early term born infants [4, 8, 9]. However very few paediatricians actually referred extremely preterm or low birth weight babies to a respiratory specialist. An international consensus on how to structure respiratory follow-up remains an unmet need [1, 10].

Most allergologists (80%) and adult pulmonologists (60%) modified diagnostic pathways and treatment approaches, at least partly, when they were aware the patient was born premature. Lack of appreciation of the implications of prematurity across the life course may lead to wrong treatment being prescribed. For example, school-age wheeze and variable airflow obstruction is common in preterm survivors [11]. Some may respond to treatment with inhaled corticosteroids (ICS) [12] but in others there is no evidence of type 2 inflammation so they should not be treated with ICS [13]. They may have dysanaptic airway growth [14], which is known to be associated with poor outcomes in term-born children [15]. More work is needed to determine disease pathology in preterm survivors and to stimulate new research. Trials to stimulate lung development at birth and control airway inflammation in extremely premature babies are underway with stem cell-based therapies, insulin-like growth factor 1 and intratracheal surfactant/budesonide.

Proposed mitigation strategies to improve the current situation include better continuing medical education. Another is empowering patients and caregivers by supplying accurate information which they can ensure is available to subsequent caregivers, including during transition to adult services.

The main strength of the survey is that it includes >1000 physicians from different specialties and countries. There are some limitations. The overall response rate was relatively low, although similar to the British Thoracic Society survey [5], and there is a risk of selection bias. General practitioners were not invited, and this was a mistake given their role in follow-up care.

In conclusion, we need to increase awareness of the long-term implications of prematurity to ensure optimal follow-up for these babies, and design studies to obtain an evidence base for the development of improved guidelines.

Source:https://publications.ersnet.org/content/erjor/11/1/00643-2024

Juan Luis Guerra 4.40 – El Farolito (Live) (Video Oficial)

Juan Luis Guerra

3 years ago #JuanLuisGuerra #ElFarolito #EntreMaryPalmeras

Juan Luis Guerra 4.40 – El Farolito (Live)

Imperforate Hymen: Continuing Education Activity

Houda M. Abdelrahman; Suzanne M. Jenkins; Michael P. Feloney.

Last Update: November 12, 2023.

When the hymen, a thin membrane of stratified squamous epithelium circumscribing the vaginal introitus, does not spontaneously rupture during neonatal development, it is referred to as an imperforate hymen. An imperforate hymen is a rare cause of primary amenorrhea and can present with obstructive symptoms of the female genital and urinary tracts during the perinatal, pediatric, or adolescent years. Timely diagnosis and prompt treatment are critical. Specific pediatric and gynecologic knowledge and skills are necessary to provide comprehensive, patient-centered care. In addition to the anatomical and physiological aspects of imperforate hymen, its clinical presentation, and potential complications, the psychological impact on affected individuals must be understood. Best practices will ultimately improve patients’ quality of life and reproductive health outcomes. This activity reviews the evaluation and treatment of imperforate hymen and highlights the role of the interprofessional team in improving care for patients with this condition.

Continue for training and assessment!

Source: https://www.ncbi.nlm.nih.gov/books/NBK560576/

PREEMIE FAMILY PARTNERS

Preemie Dads Share About Their NICU Journeys

Jun 17, 2023

Spilling the Tea is an educational series for new preemie moms and dads brought to you by TEACUP Preemie Program®. These brief but in-depth videos will explore aspects of prematurity including emotional and mental effects, the NICU environment, breastfeeding & pumping, reclaiming attachment & bonding, and others. Preemie parents share their experiences through intimate video journals, and experts in infant development and prematurity offer guidance and information. Episode 3: Dads in the NICU, takes you through the emotional rollercoaster experienced by Beau, Chris, and Steve, three preemie dads who have been there. Get ready to be moved and inspired by their stories of resilience, love, and the extraordinary bond they formed with their little miracles.

Mitigating the iatrogenic psychological effects of medical care in the Neonatal Intensive Care Unit (NICU) and beyond is a moral and ethical imperative for quality healthcare delivery. Research has long established the lifelong effects of early childhood adversity, toxic stress, and the critical role of pediatric clinicians in addressing these challenges, and most recently, the American Academy of Pediatrics (AAP) published a clinical report and policy recommendations for the adoption of a trauma-informed paradigm across all child health services.  Provenzi and Montirosso  confirm that preterm birth is an early adverse experience characterized by exposure to toxic stress and reduced access to the buffering effects of maternal care. Understanding the concepts of infant medical stress and its association with alterations in brain growth and development highlights the biological relevance of a trauma-informed developmental approach to care in the NICU and beyond.

Early life adversity, often mediated through relationships with caregivers, is associated with attachment disturbances, posttraumatic stress disorder (PTSD), and developmental trauma disorder (DTD) in survivors . Experiences of maternal separation and cumulative toxic stress within the NICU have profound implications for infants, families, and the healthcare team . Adversity during infancy is associated with significantly poorer health outcomes, risky health behaviors, and socioeconomic challenges . Parents, too, experience significant emotional and psychological distress, which can persist for decades, further reinforcing the need for trauma-informed approaches to care).

During sensitive and critical periods of development, the experiences associated with critical illness and hospitalization take on new meaning as they direct and disrupt biological processes in the wake of toxic stress. These biological processes, mediated by epigenetic mechanisms, have lifelong implications for an individual’s physiologic and psychological health and wellbeing . Maternal separation is the most significant trauma experienced by all newborn mammals, and preterm and critically ill newborns are no exception . Separation of mother and infant at just two days of age for 1 hour has been linked to a 176% increase in autonomic reactivity and an 86% reduction in quiet sleep . The experience of maternal separation in the NICU becomes the foundation for cumulative toxic stress exposures, ranging from inappropriate sensory stimuli to hazardous hospital routines that do not honor the personhood of the infant. These early stressors compound, leading to long-term health and developmental challenges.

 Separation also has profound implications on the parent, leading to depression, anxiety, feelings of helplessness, loss of control, and posttraumatic stress, which may last for decades. These feelings can impact parenting behaviors and the capacity to partner with clinicians in caring for their infant. Understanding the interplay of physical and emotional health, economic and social resources, medical systems, and structural inequities is critical for co-creating compassionate, collaborative, and supportive relationships with infants, families, and clinicians in the NICU.

 Trauma-Informed Care:

A trauma-informed approach realizes the pervasiveness of trauma in everyday life, recognizes its signs and symptoms in patients, families, colleagues, and self, and responds to trauma by integrating knowledge and evidence-based best practices that mitigate and prevent trauma into policies, procedures, and language; and resists re-traumatization by ensuring consistency and compassion in service delivery. The core principles of trauma-informed care—safety, trust and transparency, healthy relationships and interactions, empowerment, voice and choice, equity, anti-bias efforts, and cultural/gender affirmation—guide all interactions in the NICU.

Parenting is central to a trauma-informed approach, as caregivers play a fundamental role in mitigating the stress and trauma of early hospitalization. The research underscores the powerful buffering effect of parental presence, engagement, and nurturing care in reducing toxic stress responses and promoting infant resilience . When parents feel supported and empowered in their caregiving role, they experience lower stress levels, increased confidence, and enhanced bonding with their infant. This benefits the family’s emotional well-being during the NICU stay and has lasting implications for child development and attachment security.

The short-term outcomes of a trauma-informed parenting approach include improved neurodevelopmental stability, reduced incidences of apnea and bradycardia, and better weight gain trajectories for preterm infants. Additionally, trauma-informed care has been linked to greater autonomic stability, reduced stress hormone levels, and improved sleep patterns, all contributing to enhanced physiological regulation and early developmental progress . These immediate benefits lay the groundwork for stronger immune function and better feeding outcomes, helping infants build the resilience needed for longterm health and well-being . Parents who are actively involved in their infant’s care through practices such as skin-to-skin contact and responsive caregiving exhibit lower levels of anxiety and depression, leading to a healthier emotional environment for both the child and the family unit .

Long-term, trauma-informed parenting interventions significantly impact developmental trajectories, reducing the risk of cognitive delays, emotional dysregulation, and behavioral challenges in childhood . Secure attachment formed during these early interventions fosters resilience, social-emotional well-being, and stronger parent-child relationships well into adolescence and adulthood. Studies have also linked early trauma-informed care to improved educational outcomes and a reduced risk of mental health disorders later in life .

Providing parents with the knowledge, tools, and emotional support necessary to engage confidently in trauma-informed caregiving is critical in shaping the health and well-being of NICU graduates . By prioritizing the parent-infant dyad and leveraging evidence-based interventions, trauma-informed care offers a transformative model that extends far beyond the NICU walls, laying the foundation for lifelong resilience and well-being. When parents are given the resources to understand their infant’s cues, respond sensitively, and participate actively in care, they develop a sense of mastery and confidence that translates into more substantial, more secure attachments. This engagement benefits the infant’s immediate well-being and fosters a more compassionate, informed approach to parenting that can positively influence future generations.

 Clinical Application of Trauma Informed Care:

Parent-driven interventions in the NICU center include parents as active participants in their baby’s care, fostering attachment and reducing trauma. One such intervention is The Zaky HUG®, a therapeutic device designed to extend the parent’s presence by mimicking their hands’ touch, warmth, and scent (Fig. 1). Created by a Ph.D. engineer and former NICU and kangaroo mother, this tool emerged from a deeply personal experience of neonatal hospitalization and has since been developed to support sleep, neuroprotection, attachment, developmental care, pain management, and parental involvement. This device helps create a comfortable, warm, and predictable environment, allowing infants to rest and sleep more peacefully. It is designed to provide the benefits of multiple tools, including positioning, nesting, soothing, and attachment.

Initially motivated by the need to provide connection, continuous comfort, and reduce the association of touch with pain and her own infant’s stress, the creator of this hand-mimetic device applied principles of ergonomics and safety engineering to design a device that fosters secure attachment, supports positioning, predictable experience for the infant, family, and clinicians.

Protected sleep is critical for neurodevelopment and overall well-being. Sleep is a primary driver of brain maturation, memory consolidation, and emotional regulation in preterm and critically ill infants. Interruptions to sleep can disrupt these critical processes, leading to increased stress responses, metabolic instability, and impaired neurodevelopmental outcomes. Ensuring a supportive sleep environment requires balancing between providing necessary medical interventions and minimizing disruptions to natural sleep cycles. Frequent repositioning, environmental disruptions, and inconsistent containment can negatively impact an infant’s sleep-wake cycles. Research by Russell et al. has shown that because these nurturing devices are versatile and work for positioning, nesting, attachment, soothing, and sleep support, they reduce the need for frequent repositioning, offering a stable, soothing environment that promotes restful sleep both during kangaroo care and while in the incubator or crib. These devices help infants transition between sleep states more smoothly, reducing startle reflexes and excessive wakefulness by providing gentle, consistent containment and proprioceptive support.

Additionally, they assist in creating a cocoon-like space that mimics the security of the womb, further enhancing sleep continuity and quality. Further, consensus guidelines advocate for supporting parents in providing frequent, safe, and prolonged skin-to-skin care, reinforcing the role of these interventions in achieving sleep protection . Research has also highlighted that skin-toskin contact improves sleep patterns, stabilizes respiratory rates, and reduces cortisol levels, mitigating the physiological impacts of stress. When infants experience uninterrupted, restorative sleep, they exhibit improved feeding behaviors, enhanced weight gain, and greater autonomic stability, all crucial for their long-term development.

The Pain and Stress Prevention and Management measure prioritizes proactive pain mitigation strategies. By minimizing stress and discomfort, infants can better participate in essential activities of daily living, such as feeding and movement, which further support their growth and development. The integration of non-pharmacologic interventions such as kangaroo care, proprioceptive input, and containment through trauma-informed devices significantly enhances an infant’s ability to self-regulate and cope with stress . Parents play a vital role in this process, providing direct comfort before, during, and after procedures. Studies show that utilizing familiar, comforting sensory stimuli, such as parental scent-infused devices, can effectively minimize procedural stress and discomfort, reinforcing the protective role of parental presence in the NICU.

Activities of Daily Living, including posture, nourishment, and hygiene, are essential to infant development. Establishing predictable and supportive care routines in these areas helps to create a sense of security and stability for infants, reducing stress and promoting optimal development. Ensuring infants receive proper postural support can facilitate musculoskeletal alignment, improve digestion, and reduce discomfort caused by medical interventions. Additionally, consistent caregiving routines help infants develop circadian rhythms, supporting sleep-wake cycles and overall well-being. Kangaroo care safety devices support proper postural alignment, promoting successful breastfeeding and early oral feeding behaviors. One pair of hand mimetic devices further enhances postural stability, allowing for individualized positioning without restricting movement, facilitating optimal comfort and developmental support. These devices can also provide gentle containment, mimicking the boundaries of the womb, which is particularly beneficial for preterm infants adapting to extrauterine life. Furthermore, integrating nurturing devices in caregiving practices encourages parental involvement in routine care activities, reinforcing their role and confidence in caring for their baby even in a high-tech NICU environment.

Finally, Compassionate Collaborative Relationships focus on emotional well-being, self-efficacy, and communication. Clinicians play a vital role in supporting these trauma-informed measures, ensuring that both parents and staff are equipped with the knowledge and tools to facilitate optimal trauma-informed developmental care. These trauma-informed interventions support neurodevelopment and empower parents, reinforcing their role as primary caregivers. By enabling continuous sensory presence and minimizing separation, these devices help establish a sense of predictability, safety, and emotional security for infants and their families. The research underscores the long-term benefits of these interventions, showing reductions in parental stress and anxiety while fostering stronger attachment and advocacy skills.

By integrating trauma-informed devices and caregiving practices, neonatal teams can transform the NICU experience, bridging the gap between medical excellence and human connection. As neonatal care continues to evolve, integrating trauma-informed interventions into everyday practice is not just beneficial—it is imperative for fostering lifelong resilience in the most vulnerable patients. Prioritizing the five core measures for trauma-informed developmental care ensures that every infant and family receives care that is not only evidence-based but also deeply compassionate and developmentally appropriate.

Summary: Recognizing the trauma experienced by babies and families in the NICU is the first step toward transforming and humanizing neonatal care. This recognition must be followed by meaningful action—integrating trauma-informed practices, supporting parental involvement, and embracing innovative, evidence-based products and solutions that prioritize the holistic well-being of infants and their families. Trauma-informed interventions, particularly those that integrate parental involvement and ergonomic design, provide a compassionate, evidence-based approach to mitigating the effects of early life adversity. By centering the voices of parents and clinicians while utilizing trauma-informed tools designed to enhance neurodevelopment and emotional security, we can reshape the NICU experience and the transition to home after discharge into one that fosters healing rather than deepens distress. By leveraging these nurturing strategies, clinicians can enhance infant and family well-being, improve healthcare outcomes and satisfaction, reduce the cost of care, and foster a culture of healing and resilience in the NICU.

This shift requires dedication from institutions, practitioners, and advocates who believe in the profound impact of early experiences. Investing in trauma-informed developmental care is not just a clinical imperative—it is a moral and ethical responsibility that holds the power to transform lives. The NICU should not only be a place of survival but also one of healing, connection, and love. Every baby, every family, and every clinician deserves an environment that nurtures the body and the soul, where science and compassion intersect to create the best possible start for our most vulnerable patients. Through thoughtful, evidence-based approaches, we can transform neonatal care into a support, compassion, and empowerment model for every infant and family. Now is the time to act—to advocate, to innovate, and to implement trauma-informed care that acknowledges the human experience behind every NICU admission. The smallest among us deserve the best care, and it is our collective responsibility to ensure that their earliest moments are filled with safety, love, and hope.

Source: https://neonatologytoday.net/newsletters/nt-mar25.pdf

Preemie’s reaction to dad’s song is a miracle | Humankind #Shorts

@HumankindVideos

Short and Long-Term Impact of Prematurity on the Siblings

CanadianPreemies  Jun 25, 2021

The birth of a premature infant has a profound effect on the family and may require a large portion of parental time, attention, finances, and psychological support. During all this time, the sibling may feel confused and left out of the loop and may resent the amount of time the parents are away with the new infant in the NICU. If the preemie is found to have a disability, these issues are compounded as the parents may be grieving and require further time away to attend several appointments. In this session, Dr. Saigal will discuss strategies to support siblings of premature babies. Dr. Saroj Saigal is a neonatologist and a Professor Emerita at McMaster University, Canada. She is internationally recognized for her long-term studies to adulthood which focuses on the quality of life and consequences of having been born extremely prematurely. She has also participated as a collaborator in several multi-center randomized perinatal clinical trials. Dr. Saigal co-founded Adult Born Preterm International Collaboration (APIC) and invited collaborators from around the world who were doing studies on premature infants in adulthood to participate in data sharing. She is the recipient of many awards from the Canadian Pediatric Society and the American Academy of Pediatrics. She was awarded the 2018 Virginia Apgar Award of the American Pediatric Society for distinguished contributions to perinatal medicine. She was also recognized by her alma mater with the McMaster Faculty of Health Sciences Community of Distinction Award, 2018.


HEALTHCARE PARTNERS

What if a single event could sway health, exercise capacity, learning style, social interactions, and even personal identities–yet individuals had no memory of the event? Adults born preterm are an under-recognized and vulnerable population. Multiple studies of individuals born prematurely, including our 35-year longitudinal study, have found important health concerns that adult healthcare providers should consider in their assessments. Concerns include increased rates of cardiovascular disease, metabolic syndrome, depression, anxiety and attention problems, lower educational attainment and frequency of romantic relationships. A Nordic study of over six million individuals found a linear relationship between gestational age and protection against early adult mortality, with preterm individuals showing 1⋅4 times increased likelihood of early mortality as full-term peers.

At the same time, surviving premature birth has become increasingly common. For the last several decades, nearly one in nine U.S. babies is born early, and now more than 95% survive. Global prevalence and survival data indicate more than 15 million preterm birth survivors annually reach adulthood. This suggests a new population of individuals with emerging healthcare needs for adult health providers.

Birth history should be part of every patients’ medical record.5 Due to the varied risks and prevalence of premature birth, all healthcare practitioners should be aware of the potential for long-term effects. With one in ten 30-year-old patients born preterm, clinical specialists who treat long-term complications of prematurity (i.e., neurology, psychiatry, cardiology) may have more preterm-born patients. Recognizing preterm birth as a cumulative, lifelong risk factor is the first step.

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

Health risks from prematurity are also risks to equality and justice. Women who bear social risk factors are more likely to give birth early. This includes Black women, those living in socio-economically depressed areas, and women with two or more Adverse Childhood Experiences. The many arms of racism and caste-based inequalities can complicate and worsen the health of people already at risk from preterm birth.

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

For many born preterm, prematurity is not just a health concern, it’s a matter of who they are. Their perception of health over time, or health related quality of life (HRQL), is a critical outcome. To date, this evidence varies with age, degree of prematurity and reporter; clinicians and parents tend to rate HRQL more negatively than survivors. Preterm-born individuals may not have event memories but, early birth repercussions can reverberate through family narratives and unique life experiences. Some identify as typically developed individuals who happen to have been born early, others as functional and well-adapted “preemies”, and others see prematurity as having colored their lives in negative ways. As prematurity researchers, we aim to uncover and bring awareness to the health outcomes and risks from early birth. A critical need exists for more evidence about adult health following preterm birth and yet, how do we protect individuals with statistically increased risk without unnecessarily pathologizing them?

In clinical practice and research settings, we can take the opportunity to listen to people who were too young as patients to speak for themselves but have riveting and complex stories about preterm birth’s effects. We are aware of just one other published qualitative study about the experiences of adults born preterm. Because most adult healthcare providers have yet to acknowledge and factor this experience into patient care, individuals born preterm are finding alternative avenues to be seen. Adults born preterm report seeking online community and support, connecting globally with people over shared early life experiences, while simultaneously making their needs and identities known.

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

Source:https://pmc.ncbi.nlm.nih.gov/articles/PMC9186090/

Fellows Column: The Quiet Strength of The Toybox Inn 11

Kevin Kafaja, MS III

As a third-year medical student, I had rotated through cardiac, neuro, and general ICUs. Each one buzzed with alarms and urgency, charged with adrenaline. But the NICU was different. It didn’t scream. It whispered.

My mother is a pediatrician, and I spent much of my childhood in the corners of her clinic—listening in on patient visits and soaking in the soft rhythm of care. I thought I understood Peds. But the NICU was something else entirely. It was intimate. Intentional. There were hours of serenity—gentle beeping monitors, quiet footsteps—but the stillness could break in an instant. A desaturation alarm. A sudden change. A Code White echoed overhead, and then the team would move—fast, focused, all hands in motion.

That’s where I met her—in the corner of the NICU, they lovingly called Toybox Inn 11, home to some of the tiniest, most vulnerable patients. Her crib was tucked neatly within that space, surrounded by soft blankets, daily goal charts, and quiet victories.

She was born on January 9th at just 31 weeks and 1 day, weighing 940 grams. Her mother’s pregnancy had been complicated— monochorionic diamniotic twins, Twin Anemia-Polycythemia Sequence (TAPS), and maternal hyperthyroidism managed with antithyroid medication. She was delivered via C-section under emergent conditions, including ruptured membranes and maternal fever. She required a partial exchange transfusion and respiratory support on 100% FiO₂ shortly after birth.

When I met her on March 5th—Day of Life 55—she had already fought through respiratory distress syndrome, anemia of prematurity, hyperbilirubinemia, and bradycardic spells. She was breathing room air, feeding fully by mouth, and steadily gaining strength. She was growing stronger, one quiet breath at a time.

In my mind, I called her The Little Engine. I loved toy cars growing up—tiny vehicles that raced like giants. She reminded me of that: small but full of force. Her strength wasn’t loud. It was steady. Unshakable.

At first, I was cautious. How do you care for someone so small? But the NICU team showed me—how to cradle her safely, how to monitor her saturation, how to read her tone and anticipate spells. She’d had a few brief episodes—one during a feed, another while asleep—but none in the final 72 hours before discharge.

The Toybox wasn’t just a clinical space. It was a nursery in progress. A pink blanket draped above her crib. A chart titled “My Day” tracked goals and daily wins. Books sat at her bedside— Goodnight Moon and When I Grow Up I Want to Be…, the latter filled with colorful flaps. I’d read it while keeping watch, wondering who she might become and what her future might hold.

Around her were all the quiet markers of care: diapers, wipes, a milk warmer, and an infant stethoscope. Her corner of Toybox Inn 11 was filled with love and progress, written in the smallest details.

Every Wednesday, during interdisciplinary rounds, we reviewed her journey: apnea monitoring, growth tracking, iron and Epoetin for anemia, and feed progression—35 mL of fortified formula every 3 hours. Her hemoglobin held at 9.9, and her reticulocyte count was strong at 5.4. She crossed the 2000-gram milestone. Each marker is a step closer to going home.

Her mother was a constant presence—gentle and calm. Watching her feed and hold her daughter reminded me that medicine begins not with machines but with presence.

She stayed in the NICU for 2 months and 8 days, and on March 18th, she went home—discharged at 40 weeks and 6 days corrected age, weighing 2170 grams. Her final measurements were length 43 cm, head circumference 34 cm, and abdominal girth 27 cm. She left wrapped in pink, lying in her open crib, breathing independently on room air.

Her discharge plan included a high-calorie formula, follow-up with her pediatrician for weight and EPO management, appointments at the High-Risk Infant Clinic, and a referral to the Regional Center within 1–2 months. I was there the day she left. I watched her resting peacefully in her open crib, bundled and ready to go. Her parents arrived later after I had already stepped away. But when I heard she had gone home—to reunite with her twin brother—it felt like a quiet victory. One we all shared.

In The Toybox, I learned that strength doesn’t always shout. Sometimes, it weighs just over two kilograms, sleeps under a pink blanket, and softly breathes while growing stronger every day.

She was my patient. But more than that, she was my teacher. And in that quiet corner of the NICU, I learned that even the smallest hearts can leave the most lasting marks.

Source:https://neonatologytoday.net/newsletters/nt-mar25.pdf

Highlights

– Adults born preterm report experiences of social exclusion such as being bullied

– They report high sensitivity, reduced stress resilience and tire more easily

– Many report that family, peer and mental health support has helped them most

– Prematurity should be recognized as lifelong condition by health professionals

– Many express gratitude for their life and lead a good life

Abstract

Background

Adults born preterm face greater social, cognitive, mental and physical challenges in adulthood than their full term born peers according to longitudinal studies. In contrast, little is known about the lived experiences of adults born preterm.

Objective

The study investigates the lived experiences of adults born preterm across the life course and their views on health care support.

Methods

A qualitative study of 21 participants completing semi structured interviews analyzed through content analysis.

Results

Over half of adults born preterm report trauma and feeling of otherness since early childhood, high sensitivity to the environment, higher introversion/shyness and social or performance related anxiety. Over half reported that their parents were traumatized by the preterm birth and tried to compensate by overprotective parenting that, however, stifled them becoming independent. Over half experienced bullying victimization and many have continuing mental health problems. Overload by demands in school or work is a consistent theme that makes it hard to have the energy to socialize. Many received physical therapy in childhood and most had psychotherapy in adulthood. Many feel that health professionals trivialize the long-term effects of prematurity and most find support from their parents or peer network.

Conclusions

Prematurity has significantly shaped the life of adults born preterm. Greater awareness and recognition of the unique needs of this group are essential to provide adequate support. Existing services fail to address these needs highlighting an urgent demand for enhanced social and psychological services for educational and workplace settings.

Full Study

Source: https://www.sciencedirect.com/science/article/pii/S0378378225000581

INNOVATIONS

Top 10 Neonatology Startups with Cutting-Edge Medical Devices

Magdalena Sroka, Content Writer   30.08.2024

Neonatology startups aim to take care of newborns, especially premature babies. These highly vulnerable beings require exceptional care, as even the smallest changes can significantly impact their health and development. Sometimes, even the experience and knowledge of doctors aren’t enough to save the little one. Therefore, in a world where technology plays an increasingly vital role, neonatology startups become invaluable support for medical care. By combining advanced technology with specialized knowledge, it is possible to provide newborns, particularly those born prematurely, with the best care and a chance for a healthy start in life.

Necessity is the mother of invention. When designing medical devices for newborns, it is crucial to remember that they will serve the most fragile patients. This often requires an unconventional and comprehensive approach to problem-solving. In this article, we present 10 neonatology startups, whose innovative ideas have the potential to transform this field of medicine.

Neonatology Startups Which Can Shape The Future

  1. AMNION LIFE
    Amnion Life is working on an advanced incubator called AmnioBed, designed to replicate the conditions inside the womb. The goal is to support the development of premature infants by regulating temperature, protecting the skin, and managing fluids. The device is intended to provide warmth, humidity, and protection to newborns in a way that prevents hypothermia and water loss.
  • PRAPELA
    Founded in 2018, Prapela is a startup developing a device that uses vibrations to improve breathing patterns and sleep in newborns. This is aimed at helping stabilize breathing and oxygenation, particularly in infants suffering from apnea, intermittent hypoxemia, and neonatal opioid withdrawal syndrome (NOWS).
  • PEDIAFEED
    PediaFeed’s mission is to improve the feeling process for newborns who struggle with it. The company is developing a special type of tube for neonatology and pediatric patients, which minimizes the risk of tube displacement. It is also designed to be easy to insert and remove both in hospitals and at home, while causing minimal discomfort to the baby. Without proper nutrition it is hard to provide a healthy development.
  • PREGANBIT PRO
    This startup has developed a telemedical device for monitoring fetal well-being through cardiotocography (CTG). The portable device enables remote diagnostics and allows regular monitoring of the health of both mother and baby, including fetal heart rate and uterine contractions. Thanks to this technology, women can perform tests at home between medical visits, with results being transmitted and analyzed by doctors. Pregnabit Pro aims to enhance early detection of potential risks, increase pregnancy safety, and provide peace of mind to expectant mothers.
  • ZOUNDREAM
    Zoundream utilizes artificial intelligence and sound recognition to develop technology that can identify and interpret different types of newborn’s cries. The technology not only focuses on distinguishing the baby’s needs (hunger, tiredness) but is also capable of alerting parents to potential pathologies or developmental disorders. Zoundream’s goal is to provide a tool that enables faster responses to an infant’s needs while offering better support for parents.
  • VENTORA
    Ventora aims to create a device that allows precise real-time monitoring of airway pressure in newborns. The company is working on a solution that improves the process of mechanical ventilation while minimizing the risk of complications associated with traditional ventilation. Additionally, Ventora’s device is designed to assist in selecting the best therapy for the youngest patients.
  • OTONEXUS
    OtoNexus is a startup developing a diagnostic device (in the form of an otoscope) to detect middle ear infections and distinguish their origins in children and infants. The technology behind it is based on ultrasound, which enables quick and precise diagnosis, helping doctors make informed treatment decisions. Moreover, this approach could reduce the number of misdiagnosed and unnecessary antibiotic treatments.
  • BAMBI MEDICAL
    Bambi Medical has developed a wireless system for monitoring the vital signs of newborns, such as breathing, pulse, and temperature. Their solution replaces traditional invasive methods that rely on wires and cables. This provides greater comfort and freedom of movement for preterm infants, and is also gentler on the skin. The device sends data to the NICU monitor and alarm system, collected via a silicone strap placed on the baby’s chest, and alerts when apnea occurs.
  • PREEMIE SENSOR
    Preemie Sensor is working on an advanced device to analyze breast milk for nutrient content, specifically measuring fat, protein, and caloric value. The sensor is paired with software, allowing for the monitoring and optimization of nutrient intake by babies. Ensuring proper nutrition reduces the likelihood of complications associated with prematurity.
  1. OWLET BABY CARE
    Owlet Baby Care is a startup specializing in the creation of smart devices for supervising the vital signs of infants, such as heart rate and blood oxygen levels. The data is collected via socks worn on the baby’s foot and then displayed in a mobile app. This technology provides continuous monitoring, giving parents peace of mind and a chance to feel less stressed and anxious.

Summary

The solutions developed by these neonatology startups not only make it easier to monitor and manage the health of the youngest patients, but also enhance the safety and comfort of both children and their parents. Although not all devices are available on the market yet. Some are awaiting certification, yet they offer hope for saving more premature babies. Thanks to these innovations, the future of neonatal care is becoming increasingly promising, bringing relief and peace of mind to families around the world. Good job startupers! 🫶

If you’re interested in supporting or helping shape the future of neonatal care, don’t hesitate and get in touch with us!

Source:https://consonance.tech/blog/top-10-neonatology-startups-medical-devices/

New evidence from a world-leading Victorian study following premature babies into adulthood shows that babies born before 28 weeks’ gestation are doing surprisingly well as young adults in their twenties.

In a paper published in PEDIATRICS, new data released from the Victorian Infant Collaborative Study (VICS) 1991-92 cohort reveals insights from the 25-year point of the long-term study.

The study, co-led by the Royal Women’s Hospital and Murdoch Children’s Research Institute (MCRI), shows that extremely prematurely born adults are just as likely to have completed secondary school, be in paid work, and be in a romantic relationship, compared to their peers born at full term.

Dr Lauren Pigdon, Research Officer at MCRI, analysed the new data from the unique Australian geographic cohort who were recruited at birth and followed for 25 years.

“A strength of this study is that it represents the earliest survivors of the post-surfactant era to navigate the transition into adulthood and fills a gap in knowledge,” Dr Pigdon said.

The introduction of exogenous surfactant in the early 1990s was a game changer in treating respiratory distress syndrome in newborn intensive care. Since then, there has been a dramatic rise in survival of infants born extremely preterm (younger than 28 weeks’ gestation) or with extremely low birthweight (less than 1000g).

With increased survival rates of even the tiniest babies, concerns arose that these tiny babies might have increased chances of health and developmental problems as children and adults. And that this may in turn have an impact on their transition into adult life. But is this true?

“Our data paints a positive and encouraging picture,” Dr Pigdon said. “There were minimal group differences in self-reported general interpersonal relationships, satisfaction with different aspects of life, and current smoking behaviour.”

However, Professor Jeanie Cheong, Consultant Neonatologist at the Women’s and Co-Group Leader of the Victorian Infant Brain Studies group at MCRI, said there were some differences between the groups.

“More adults born extremely preterm had their main income source from government financial assistance and more had not yet moved out of the parental home compared with their peers born full term,” Professor Cheong said.

“Data from the past 25 years has allowed us to look at how, over time, care has improved for Victoria’s youngest and most vulnerable patients,” Professor Cheong said.

“While survival rates have gone up, we now also know that these babies have the chance to become fully functional members of our society.

“Findings from our study are relevant when counselling families after their baby is born, to put into perspective what the long-term outcomes may mean for their child.”

Meet Duane:

Duane has certainly grown up since he was born extremely premature at 26 weeks’ gestation in March 1992. He weighed only 886 grams at birth.

“I was so tiny that my father’s wedding ring could fit all the way up my arm to my shoulder,” Duane remembers.

After a happy and normal childhood, Duane completed high school and became a competitive slalom skier, trying out for the Australian National Team. While he is an experienced downhill racer avoiding major obstacles, Duane faced a few health issues and injuries in his early 20s.

Duane is now a professional skiing and snowboard instructor. He follows the snow seasons and enjoys living and working abroad. He spent a long time in Austria, where he completed a sports diploma in Innsbruck, and now speaks German fluently.

Currently, Duane is keen for his torn ACL in the knee to heal. Then he plans to hit the slopes again and has offers to work in the USA, Japan and Europe.

Source:https://www.thewomens.org.au/news/prem-babies-become-capable-adults-when-grown-up-new-study-confirms

134 Imperforate hymen: considerations for an early diagnosis

British Association of General Paediatrics

Bushra Rafique1, Hamid Idriss2, Rajesh Bagtharia3, Premilla Kollipara3, Geeta Subramanian3

Abstract

Objectives: Imperforate hymen (IH) is one of the most common obstructive congenital anomalies of the female genital tract. In this condition the hymen occludes the vaginal opening obstructing effluent discharge. Early diagnosis is possible, as new-born vaginal secretions stimulated by maternal oestrogen cause hymenal bulge, which is an abnormal finding.

The aim of this abstract is to highlight potentially missed opportunities for a neonatal diagnosis of IH. Delayed presentations are associated with significant morbidity such as chronic and severe abdominal pain, acute urinary retention, obstructive uropathy and endometriosis.

A full physical examination of the new-born within 72 hours after delivery is the required standard of the New-born and Infant Physical Examination Screening Programme (NIPE) and National Institute of clinical Excellence (NICE) quality standard 37, statement 7. This includes anogenital examination looking at patency of orifices at birth and at 6 weeks check.

Methods: We conducted a survey, using Survey Monkey portal with the objective to review current clinical practice in postnatal examination. The link was distributed via WhatsApp and email to paediatric trainees, general practice trainees and clinical fellows at our trust and London wide.

Responses were collected over 12 weeks. Following questions were asked looking for a yes or no response.

– Do you perform a genital examination in NIPE?

– Are you aware that NIPE recommends complete examination of the genitals to check for normal

  appearance and patency?

– Do you examine for hymenal opening in female babies by separating labia?

– Are you aware of the findings in imperforate hymen?

– Are you aware of the consequences of delayed diagnosis of imperforate hymen?

– Have you ever picked up an imperforate hymen in neonatal examination?

Results: Out of 220 doctors, 132 responded to the survey questions which resulted in a 60% response rate.87.8% performed a genital examination as a part of NIPE.78.7% were aware that normal patency and appearance of the genitals must be checked. Only 25.7% were examining hymenal opening by separating the labia majora and 35.6% were aware of the findings of IH. 7 out of 132 doctors had made a diagnosis in the neonatal examination. 60% were aware of consequences of a delayed diagnosis.

Conclusion: Our survey highlights insufficiencies in female new-born genital examination. There is a need for increased awareness amongst clinicians about this condition, as there exists a window of opportunity to make an early diagnosis and minimise suffering and morbidity.

Source: https://adc.bmj.com/content/108/Suppl_2/A103.2

UNESCO Global Youth Community

Preemie Power: Global Voices, Lasting Impact

🌍 WARRIORS: A Global Conversation for Preemie Survivors

Premature birth doesn’t end at discharge—it echoes throughout life. As survivors, we are not defined by our early start—we are defined by our strength, our resilience, and the legacy we choose to build. From the NICU to adulthood, our stories carry both scars and strength. And now, more than ever, the world needs our voices.

The NW Warriors community reflects a growing global collective—of preemie survivors, families, clinicians, researchers, and advocates—who recognize that prematurity is not a condition left behind in infancy. It is a thread woven into identity, healthcare, and social equity across the lifespan. Whether you were born early, raised a NICU warrior, or cared for one—you are part of a movement greater than any diagnosis.

💥 Why the Warrior Movement Matters

Prematurity is not just a medical event—it’s a lifelong journey. Survivors grow into athletes, educators, scientists, artists, and caregivers. Some carry physical or emotional complications. Others carry memories of separation, struggle, or stigma. All carry a story of endurance.

This is a historic moment. For the first time, the world is witnessing a full generation of NICU survivors reaching adulthood in global numbers. Their experiences bring urgency to overlooked conversations—on trauma-informed care, long-term health, and identity. Their insights are reshaping how neonatal care is defined, not just in the early days, but across the life course.

We are not just patients.
We are architects of change.
We are storytellers.
We are warriors.

🌐 A Growing Global Dialogue

Across countries and cultures, NICU survivors and neonatal communities are coming together. We are asking new questions:

  • What does it mean to be born too soon—and grow into your power?
  • How can we center survivor experiences in clinical and policy conversations?
  • What role does memory, trauma, or advocacy play in healing?
  • How do we recognize preterm birth not just as a medical statistic, but as a lived reality that shapes lives and futures?

There is no single answer. But there is space for all of us here. Some find their power through writing, art, research, or mentorship. Others speak through quiet acts of presence and parenting. Some fight for structural change. Others simply want to be heard, held, and understood.

What unites us is this:
We were born into adversity—and we rise with intention.

🛡️ Rewriting the Narrative

As adults born preterm, or as families and clinicians who lived that journey, we are no longer hidden in hospital charts or lost in long-term data. We are here—visible, vocal, and unafraid to lead.

This movement doesn’t require permission. It begins in honest conversations, in shared memory, in reclaiming our stories from silence. It grows as we listen to each other, uplift survivor narratives, and demand that care systems honor the full trajectory of human life.

We are not asking for pity. We are offering power.
We are not defined by fragility. We are evidence of strength.
We are not waiting. We are rising.

✊ Join the Conversation

Wherever you are—in policy, in practice, in healing, in hope—this conversation is yours. The warrior journey is not just about what we survived. It’s about what we build next.

#NWWarriors #PreemieStrong #GlobalNICU #BornToLead #EchoesOfPrematurity

With love, Kathryn

Building Community: Mohamed Anowar´s Youth Environment

The World Around

MEET THE YOUNG CLIMATE PRIZE COHORT! After Mohammed Anowar fled Myanmar with his family to a refugee camp in Bangladesh, he saw hundred of trees being cut down and decided to start a climate hub. The Community Climate Action Initiative aims to tackle pressing climate challenges such as heatwaves, landslides, and flooding through a multifaceted approach. The project includes a Tree Planting Campaign designed to combat deforestation and mitigate heat impacts by increasing local green cover. Complementing this, Climate Awareness Sessions are held to educate community members in the Kutupalong refugee camp about climate change and effective resilience strategies. Additionally, Youth Leadership Training is provided to equip young leaders with the skills needed to advocate for climate action and promote sustainable practices. The initiative is expected to yield a range of positive outcomes, including an improved local environment, heightened climate awareness, and a cadre of empowered youth spearheading climate resilience efforts in the community.

I Am We, A Book of Community

Renee Walters