COMMUNITY-

FINLAND

Finland has one of the lowest preterm birth rates in the world and we do not know why. Many theories are shared, and in time research may allow us to understand the dynamics in this Baltic Paradise that promote maternal and  newborn health.

Wikitravel: Finland (Finnish: Suomi, Swedish: Finland) is in Northern Europe and has borders with Russia to the east, Norway to the north, and Sweden to the west.  Finland is a thoroughly modern welfare state with well-planned and comfortable small towns and cities, but still offers vast areas of unspoiled nature. Finland has approximately 188,000 lakes (about 10% of the country) and a similar number of islands. In the northernmost part of the country the Northern Lights can be seen in the winter and midnight sun in the summer. Finns also claim the mythical mountain of Korvatunturi as the home of Santa Claus, and a burgeoning tourist industry in Lapland caters to Santa fans. Despite living in one of the most technologically developed countries in the world, Finns love to head to their summer cottages in the warmer months to enjoy all manner of relaxing pastimes including sauna, swimming, fishing and barbecuing. Today, Finland has a distinctive language and culture that sets it apart from the rest of Nordic Europe.

Full Source: http://wikitravel.org/en/Finland

 The Preterm birth rate in Finland is very low at 5.5% compared to the Global Average of 11.1%_

Full Article: http://www.marchofdimes.org/mission/global-preterm.aspx

Health Care Partners-

Much love and gratitude to our preterm birth nurses…

NICU Deaths – Supporting NICU Nurses-

Supporting the neonatal nurse in the role of final comforter – Abstract:

The death of an infant in the neonatal intensive care unit (NICU) without the presence of family members can be a stressful event for the care nurse, who may feel obligated to provide love and comfort to the infant, in addition to medical care. The nurse may experience role conflict while attempting to meet all of the infant’s perceived needs. This article explores the unique needs and circumstances of the NICU nurse in the role of final comforter for a dying infant when a family member is not present. The provision of such emotionally demanding work requires the nurse to receive education, mentoring, and support from colleagues and administration. NICU nurses who receive education on grief management and palliative care, mentorship from experienced nurses, and post-mortem grief support are better able to manage their own experiences with grief after the death of an infant in their care. To access the full article,  follow this link!

Full Article: http://www.journalofneonatalnursing.com/article/S1355-1841(16)30115-6/abstractInternational

 Neonatal Nursing Excellence Award 2016    

‘Recognizing champions in high burden, low-resource settings’

Globally, there are 2.7 million newborn deaths each year. Three quarters of these deaths are in South Asia and Sub Saharan Africa. The Sustainable Development Goals towards 2030 include a target for ending preventable newborn. Achieving this target will require universal and quality health care for sick and small newborns and could save over 500,000 lives each year. The Every Newborn Action Plan calls for strengthening the health care workforce particularly midwives and nurses with skills of care for small and sick newborns.  

Nurses provide the majority of care to sick newborns in health facilities, yet very few nurses and midwives have the opportunity to specialize in newborn care especially in the highest burden settings. Staffing neonatal units with skilled and dedicated nurses is extremely difficult due to an acute shortage of neonatal nurses. Within low-resource countries, there is a desperate need for champions to promote:

• the role neonatal nursing plays in preventing newborn deaths
• the need to define national qualifications for neonatal nursing advanced practice

. This award recognizes the commitment of nurses working on the frontlines of newborn care in resource-challenged countries, where the majority of newborn deaths occur.

Full Article: http://www.healthynewbornnetwork.org/international-neonatal-nursing-excellence-award-2016/

International Neonatal Nursing Excellence Award 2016 – Adeyemo Abass Kola 

Abstract: Suboptimal bonding impairs hormonal, epigenetic and neuronal development in preterm infants, but these impairments can be reversed. Kommers D^1,2, Oei G^3,4, Chen W², Feijs L², Bambang Oetomo S^1,2.

This review aimed to raise awareness of the consequences of suboptimal bonding caused by prematurity. In addition to hypoxia-ischaemia, infection and malnutrition, suboptimal bonding is one of the many unnatural stimuli that preterm infants are exposed to, compromising their physiological development. However, the physiological consequences of suboptimal bonding are less frequently addressed in the literature than those of other threatening unnatural stimuli. CONCLUSION: This review found that suboptimal bonding significantly impaired hormonal, epigenetic and neuronal development, but these impairments could be reversed by bonding interventions. This suggests that neonatal intensive care units should focus more on interventions that optimise bonding.

Full Source: Acta Paediatr. 2016 Jul;105(7):738-51. doi: 10.1111/apa.13254. Epub 2015 Dec 8.

Please say Hello (or Meow) to our new family member Gannon, our rescue (PTSD) Tabby!-

Preemie Family Partners-

Nationwide Children’s in Columbus, Ohio offers an innovative family-centered care in the hospital and at home. Honor Roll List of U.S. News & World Report’s Best Children’s Hospitals 2016-2017

Extremely Premature Infant Care: The article notes that the  survival rate for babies born at 23 weeks was 10 percent only a short time ago.  Today, the survival rate at Nationwide Children’s for babies born at 23 weeks is 63 percent. The site states “At the heart of the Small Baby Program is a standardized protocol for care, developed by the neonatology team at Nationwide Children’s and tested at the bedside, providing a uniform, interdisciplinary approach to the family-centered care of extremely premature babies. The guidelines outline care regarding development, nutrition, cardiovascular functioning, infection and other potential health concerns throughout these infants’ hospitalization. As a result, premature babies at Nationwide Children’s are doing more than surviving. They’re catching up to their peers and thriving with outstanding developmental outcomes”.

Full Article:http://www.nationwidechildrens.org/caring-for-your-baby

Understanding Preterm Infant Behavior in the NICU

Maureen Mulligan LaRossa, R.N. Nurse Mulligan LaRossa states “All living things are in constant communication with their environment. The trick is learning how to understand their method of communication”. Per the article, Heidi Als, Ph.D. has been a pioneer in helping us understand how to “read” preterm infant’s cues, especially while they are still in the NICU. Dr. Als has made her life’s work observing preterm infants, and thanks to her we have a greater understanding of what these fragile infants are trying to tell us. Many nurseries have incorporated Dr. Als’ ideas into their nursery practice, and much has been written on this topic. This is meant to be a brief summary of the main points of her theory and a few examples of how it is applied to care in the NICU.  The Synactive Theory of Infant Development provides a framework for understanding the behavior of premature infants. The infant’s behaviors are grouped according to five “subsystems of functioning.” The five subsystems are as follows:

1. MOTOR – We look at the infant’s motor tone, movement, activity and posture.
2. AUTONOMIC – This is the basic physiologic functioning of our body necessary for survival. The easily observable indicators of this subsystem are skin color, tremors/startles, heat rate and respiratory rate.
3. STATES – This is a way of categorizing our level of central nervous system arousal – sleepy/drowsy, awake/alert and fussing/crying.
4. ATTENTION/INTERACTION – This is the availability of the infant for interacting, alertness and the robustness of the interaction.
5. SELF-REGULATORY – This is the presence and success of the infant’s efforts to achieve and maintain a balance of the other four subsystems.

Each subsystem can be described independently, yet functions in relation to the other subsystems. The autonomic system has to be functioning (the baby breathing and has a heat rate) to be able to assess an infant’s ability to look at something. The process of subsystem interaction (how the five subsystems work together or influence each other) is what is meant by the term “synaction.” This synaction is combined with the infant’s continuous interaction with the environment to formulate the “Synactive Theory of Infant Development.” The basic concept underlying this approach is that the infant will defend him/herself against stimulation if it is inappropriately timed or is inappropriate in complexity or intensity. If an inappropriate stimuli persists the infant will no longer be able to maintain a stable balance of subsystems (e.g., decrease or increase in heart or respirations may be observed or skin color may change, or muscle tone decrease). If properly timed and appropriate in complexity and intensity, stimulation will cause the infant to search and move toward the stimuli, while maintaining him/herself in a stable balance (e.g., appropriate color, even heart and respiratory rate and/or good muscle tone). In healthy full term infants these systems generally work smoothly supporting and promoting each other. In the preterm infant these systems are not fully developed and ready to function. Therefore, the preterm infant’s behaviors are generally characterized by disorganization and signs of stress. The preterm infant is more dependent, than the full-term infant, on its environment to help support and maintain balanced equilibrium. Technology, which focuses care solely on the autonomic system (respiratory, cardiac, digestive and temperature control functions), comes at the expense of the motor, state, organizational and self-regulatory systems, which are intimately dependent on an adaptive environment.

***Providers and parents: Please view the full article! Nurse LaRossa provides empowering insight into recognizing signs and developing interventional strategies that may allow us to promote the health and well-being of the preterm infant!

Enter Here: https://www.pediatrics.emory.edu/divisions/neonatology/dpc/nicubeh.html

 

Innovations-

Kat and Nurse after heart surgery            Mom and Kat at 2 months in NICU

The Power of Touch!

Home / Science News Brains of premature babies respond differently to touch-

The experience of touch is the beginnings of the development of human communication-

By Brooks Hays   |   March 16, 2017 at 2:06 PM: The brains of premature babies respond differently to touch than those born at full term. The difference could affect the way their brains continue to grow and develop.

Babies experience the world through touch. While premature babies are separated from mom and often subjected to surgeries and other medical procedures, full-term babies continue to experience a series of sensations inside the safety of their mother’s womb. Scientists believe the discrepancy explains why neural reactions triggered by touch are different for premature babies when they finally get home from the hospital. The disparity problems can be improved by ensuring preterm babies receive as much gentle skin-to-skin contact as possible while in the hospital. “Making sure that preterm babies receive positive, supportive touch such as skin-to-skin care by parents is essential to help their brains respond to gentle touch in ways similar to those of babies who experienced an entire pregnancy inside their mother’s womb,” Nathalie Maitre, a researcher and pediatric expert at the Nationwide Children’s Hospital and Vanderbilt University Medical Center, said in a news release. “When parents cannot do this, hospitals may want to consider occupational and physical therapists to provide a carefully planned touch experience, sometimes missing from a hospital setting.” Maitre and her colleagues measured the brain response to touch of 125 preterm and full-term babies right before they were discharged from the hospital. A soft head cap of 128 electrodes measured the neural response when each baby experienced a soft puff of air on the skin. Air puffs were less likely to elicit a brain response in preterm babies than full-term babies, and preterm babies who had experienced more pain and significant medical procedures were the least likely to register a brain response. Increased gentle skin-to-skin contact with parents and hospital staff helped diminish the effects on brain response for preterm babies, the researchers said.

Researchers published their findings in the journal Current Biology. The article continues:http://www.upi.com/Science_News/2017/03/16/Brains-of-premature-babies-respond-differently-to-touch/8861489684220/

The March For Science April 22, 2017

Leif Nelin, MD, on small baby guidelines-

 

WARRIORS-

Research from Finland reports that young adult preemies are less likely to consider themselves sexy. Embracing our full beauty and healthy sexuality is something we can create for ourselves! This article is interesting and offers us an invitation to explore our individual self-perceptions.

Full Article: http://www.reuters.com/article/us-adult-preemies-love-life-idUSKBN0KZ0AC20150126 -By Lisa Rapaport

(Reuters Health) – Twenty-somethings who were born prematurely are less likely to move in with a lover or have sex than their peers born at full term, Finnish researchers find. These young adults are also less likely to consider themselves sexy. And, more of them have never moved out of their childhood home. “Previous studies have found that individuals born preterm might be more cautious and less risk-taking than those born at full term, which might also be reflected in our findings of lower likelihood of romantic relations,” said lead study author Dr. Tuija Mannisto, a researcher and fellow in clinical chemistry with the National Institute for Health and Welfare and the Northern Finland Laboratory Centre Nordlab in Oulu, Finland, in email to Reuters Health. Pregnancy normally lasts about 40 weeks, and babies born after 37 weeks are considered full term. In the weeks immediately after birth, preemies often have difficulty breathing and digesting food. Some premature infants also encounter longer term challenges such as impaired vision, hearing, and cognitive skills as well as social and behavioral problems. To examine the romantic prospects of preemies later in life, the researchers reviewed questionnaires completed by people born in Finland between 1985 and 1989. The average age of the study participants was about 23 years. Overall, 149 participants had been born early preterm (less than 34 weeks gestation), 248 were born late preterm (between 34 and 37 weeks), and 356 were born at full term. Compared to individuals who were full-term, those born late preterm were 20 percent less likely to have ever lived with a romantic partner and 24 percent less likely to have ever had sex. The findings were similar for people born early term, though after taking other variables into account, the difference wasn’t statistically significant. The researchers also saw that fewer of those born early had ever moved out of their parents’ house, but that difference too was no longer statistically significant after adjusting for other factors. Asked to rate their sexual attractiveness on a scale of zero to 10, preemies on average gave themselves a lower score. With 10 being the sexiest, full-term participants rated themselves a 6.9 on average, compared with 6.5 for late preterm individuals and 6.2 for early preterm. The findings show that social outcomes related to preterm birth aren’t limited to those with the most severe prematurity, and, in fact, extend to many people born even just a week a two early, the researchers note in their report in the journal Pediatrics. While the results may have some relevance outside of Finland, babies born there have many advantages not as widely available elsewhere. For example, Finland has few children living in poverty and offers generous parental leave and allowances for childcare, all factors that can contribute to better outcomes for preterm infants. At the end of the day, one of the best predictors of outcomes is maternal income and education and socioeconomic status,” said Dr. Kristi Watterberg, a neonatologist at the University of New Mexico who wasn’t involved in the study. A preemie born to a mother living in poverty in the U.S. who works multiple jobs and has no access to affordable child care is probably going to fare worse than a baby born with more advantages in Finland, she told Reuters Health. Still, there are several things parents can do to improve prospects for their preemie, said Watterberg, who also chairs the American Academy of Pediatrics Committee on Fetus and Newborn. In the weeks immediately after birth, preemies can benefit from skin to skin contact, breastfeeding, and being touched in a gentle, soothing way that doesn’t overstimulate them, she said. Cooing, and mimicking their sounds and actions also helps these babies engage with the world around them and build social skills. Watterberg also cautioned that the Finnish study findings may not necessarily mean that preemies grow up to be unhappy adults. “What we have seen with kids is that babies who are born preterm tend to be more risk averse and shy and more fearful,” Watterberg said. “But on the other hand, we have seen that these kids tend to grow up and develop a good life, a life the kids and their parents are happy with.”

FULL SOURCE: bit.ly/1kCYrQ1 Pediatrics, online January 26, 2015.

Arctic Swell – Surfing the Ends of the Earth-