POLAND
Poland, officially the Republic of Poland, is a country located in Central Europe. It is divided into 16 administrative subdivisions, covering an area of 312,696 square kilometres (120,733 sq mi), and has a largely temperate seasonal climate. With a population of approximately 38.5 million people, Poland is the sixth most populous member state of the European Union. Poland’s capital and largest metropolis is Warsaw.
Poland’s healthcare system is based on an all-inclusive insurance system. State subsidised healthcare is available to all Polish citizens who are covered by this general health insurance program. However, it is not compulsory to be treated in a state-run hospital as a number of private medical complexes exist nationwide.
All medical service providers and hospitals in Poland are subordinate to the Polish Ministry of Health, which provides oversight and scrutiny of general medical practice as well as being responsible for the day-to-day administration of the healthcare system. In addition to these roles, the ministry is tasked with the maintenance of standards of hygiene and patient-care.
SOURCE: https://en.wikipedia.org/wiki/Poland
Born Too Soon – Preterm Birth Rates
Rate: 6.7% Rank: 157
(USA Rate: 12.0% Rank: 54
SOURCE: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3
COMMUNITY
Preemies often face dental complications related to their premature birth and related treatment. Enamel defects and palette formation (in older preemie survivors) are issues we address in our blog this month. We wonder how we as a Family may be able to reduce preterm birth globally (including countries like the USA where maternal morbidity and preterm birth rates are high) through the effective use of group preterm birth care.
Newborn & Infant Nursing Reviews
Dental Outcomes of Preterm Infants
Diane L. Eastman, MA, RN, CPNP Enamel Defects NAINR. 2003;3(3)
Enamel defects are a well-studied complication of prematurity. Enamel is a hard tissue that once formed, unlike bone, does not remodel. For that reason, insults during enamel development are permanent on the tooth surface. Dental enamel formation begins during the second trimester of pregnancy and is complete by about 18 years of age. The major portion of the newborn’s stores of calcium and phosphorus are accumulated in the third trimester of pregnancy. Therefore, an ELBW infant will not have accumulated these stores. Enamel hypoplasia is defined as “deficient quantity of enamel resulting from developmental aberrations, and may occur in the form of pits, grooves, or larger areas of missing enamel.” Enamel opacity is defined as a qualitative change in the translucency of the enamel.
The common medical complications of premature infants including surfactant-deficiency respiratory distress syndrome, asphyxia and hypoxia, hypocalcemia, renal immaturity, feeding difficulties, and infection are just some of the problems that may affect enamel formation. The biochemical cause of enamel hypoplasia is not fully understood, but growing evidence indicates it is strongly linked to calcium homeostasis. There are several studies that suggest a direct relationship between enamel hypoplasia in primary teeth and neonatal hypocalcemia. There are numerous pre- and postnatal problems that cause hypocalcemia in the newborn. The more premature and the lower the birth weight, the more problems with calcium homeostasis. Maternal diabetes mellitus, placental insufficiency, often related to preeclampsia, and maternal deficiency of dietary calcium and vitamin D are all in utero factors. Traumatic delivery, asphyxia, cerebral injury, and prematurity itself with deranged calcium metabolism are perinatal factors that contribute to hypocalcemia. Additional contributors to hypocalcemia include hypoxia, sepsis, and hyperbilirubinemia.
The prevalence of enamel defects ranges from 43% to 96% of VLBW infants. Seow et al reported a direct relationship between birth weight and gestational age with the greatest prevalence of enamel defects occurring in the lowest birth weight group. The clinical significance of enamel defects is not only esthetic, although these teeth can appear cream colored, yellow, or brown. Enamel hypoplasia is linked to plaque accumulation, dental caries, and in more severe cases, with space loss and malocclusion. In a longitudinal study by Lai et al[5] there was a significant association with enamel defects and dental caries in the VLBW group that was noted on exams of the children at 44 and 52 months of age. The most dental caries were observed in those children who had both enamel hypoplasia and opacity.
Enamel defects have also been identified in the permanent dentition of children born prematurely. Pimlott et al[4] found enamel hypocalcification in at least one maxillary permanent incisor in 58% of the 106 VLBW infants examined; however, the other permanent teeth were not examined. Seow matched 55 VLBW and 55 normal birth weight (NBW) controls at a mean age of 7.7 years for defects in enamel of permanent incisors and molars. The VLBW group had a higher percentage of enamel defects in the permanent molars (21% v 11%) and permanent lateral incisors (12% v 0%) compared with controls. Most of the defects were enamel opacities. Aine et al matched 32 preterm to 64 control children. The prevalence of enamel defects in preterm compared with control children was higher in both primary (78% v20%) and permanent (83% v 36%) dentitions. Because the permanent teeth are believed to begin mineralization a few months after the preterm birth, it is hypothesized that persistent metabolic disturbances affect the mineralization and calcium homeostasis of the first few permanent teeth.
Enamel defects can be both generalized or localized. Generalized defects are symmetrically distributed and likely caused by systemic illnesses associated with prematurity. As mineral stores in the preterm infant are depleted, calcium and phosphorus entering the developing tooth is insufficient for enamel formation. This theory is supported by a study of preterm children who had neonatal rickets secondary to severe osteopenia. In the study, every child with rickets also had severe enamel hypoplasia. A later study by the same investigators[14] demonstrated that all preterm children with enamel hypoplasia also had decreased cortical mineralization of the humerus. This study demonstrated a direct relationship between enamel hypoplasia and diminished bone mineral stores.
Trauma may also cause some enamel defects. Controlled studies by Seow et al demonstrated that children who had been orally intubated and required mechanical ventilation had more enamel defects on the left maxillary teeth (63% v 40%) compared with nonintubated children. A Swedish study of full-term infants who were intubated in the neonatal period demonstrated similar results of more defects on the left side. The process of laryngoscopy would account for this primarily left side defect. Inadvertent force is often placed on the left side as the laryngoscope is pushed more to that side to allow room to insert the orotracheal tube along a groove in the right side. Although the tube itself has been considered to be the cause of the trauma, the tube would likely cause more even distribution of force to both right and left sides.
Source: https://www.medscape.com/viewarticle/461574_3
Group prenatal care reduces preterm birth and low birth weight
Posted October 12, 2018
Researchers at Yale School of Public Health have found that group prenatal care for expecting mothers reduces the risks for preterm birth and low birth weight. The findings are published in the Journal of Women’s Health.
This study, conducted in collaboration with Vanderbilt University Medical Center, examined over 9,000 women and found that women who received either Centering Pregnancy or Expect With Me group prenatal care compared to traditional one-on-one care.
Researchers found that group prenatal care patients had a 37 percent lower risk of having a preterm birth and a 38 percent lower risk of having a low birth weight baby than women receiving traditional one-on-one care. Better attendance at the group visits also resulted in more pronounced benefits. Women with five or more group prenatal care visits had a 68 percent lower risk of having a preterm birth and a 66 percent lower risk of having a low birth weight baby than their peers receiving traditional care.
These findings come from the largest study comparing group prenatal care to traditional one-on-one care, to date.
“The health benefits of group prenatal care are enormous,” said Jessica Lewis, deputy director of pregnancy research at Yale School of Public Health and a co-author of the study. “Preterm birth and low birth weight are the second leading causes of infant mortality in the US, and cost more than $38 billion dollars per year.”
Group prenatal care typically brings together 8 to 12 women for 2-hour long sessions on the same schedule as traditional prenatal care. Each patient gets a brief one-on-one check-up and then most of the time is spent in a facilitated discussion on the topics of pregnancy and childbirth. Women receive 20 hours of care over the course of a pregnancy, compared to 2 hours in traditional care.
Groups are led by prenatal care providers, who offer education and support, while working to increase patient engagement. Expect With Me includes a social media platform, where women can continue to access resources, track their health metrics and connect with other moms and providers between visits.
Previous studies of group prenatal care have primarily focused on young, low-income, minority women. The study provides evidence that group prenatal care sharply reduces adverse birth outcomes for a diversity of women, said lead author Shayna Cunningham, Ph.D., research scientist at Yale School of Public Health. “We need to expand access to group prenatal care for all women to improve outcomes and eliminate health disparities.” “Future analyses will aim to understand the mechanisms by which group prenatal care results in better outcomes,” Cunningham said.
HEALTH CARE PARTNERS
Antibiotic use in preemies and premature brain development are important issues that are currently the focus of significant scientific research. In the article about antenatal counseling John Lantos MD drew us in with this proposal “Three factors suggest that it may be time to revisit the norms that govern conversations between doctors and parents who are facing the anticipate birth of a baby who is extremely premature”.
What are the risks of antibiotics in premature babies?
By Preeti Paul – June 16, 2018
A recent article in Science evaluated the risks of overusing antibiotics in premature babies and provided insight into their safe and effective use.
Premature babies, also known as preemies, enter the world many weeks before full-term babies. Preemies need special care and are kept in neonatal intensive care units (NICUs) in hospitals. Infection is a threat to a premature baby’s life and doctors usually prescribe antibiotics to prevent or treat infections. In fact, antibiotics are the most common medicines used in the NICUs. It is customary to use antibiotics for preemies, sometimes even when there is no evidence of an infection.
In recent years, some doctors and researchers are becoming more conscious of using antibiotics for newborns. Many studies suggest that using antibiotics in preemies is associated with health problems such as asthma, obesity, and autoimmune disorders later in life.
A recent article in the Science magazine brings our attention to the seriousness of the risks associated with the use of antibiotics in preemies. The article discusses the work done by neonatologist Josef Neu and microbiologist Gautam Dantas, who have been working to understand the dangers of antibiotic overuse. Neu and Dantas advocate for the intelligent use of antibiotics, especially in premature babies.
The dangers of antibiotics –
Premature babies are at risk of infections such as sepsis and strep B. Undoubtedly, antibiotics help keep them alive. However, a blanketed prescription of antibiotics for all preemies is not the correct approach.
Many studies show that antibiotics wipe out a baby’s developing gut microbiome. The gut bacteria influence the health of an individual in many ways. An unhealthy balance of the gut microbiome is related to certain diseases, nutritional status, and immune function.
The researchers found that preemies who were given antibiotics had ten-fold fewer species of bacteria in the gut, compared to babies born at full-term. A less diverse microbiome means a higher likelihood that bad bacteria will over colonize in the gut. In addition, antibiotics kill the good bacteria in the gut resulting in an imbalance in the microbiome makeup.
Antibiotic use leads to resistant bacteria –
Researchers conducted DNA sequencing studies on all the bacteria present in the stool of preemies. The results showed that most of the bacteria found in the babies’ gut were very close to the ones found in hospitals. These bacteria were resistant to all the commonly used antibiotics because when antibiotics are used for someone who does not need them, there is a risk of developing bacteria that grow resistant to these antibiotics. Therefore, the gut of the preemies on antibiotics becomes the breeding ground of antibiotic-resistant microorganisms.
Scientists also found that over time, the use of antibiotics can increase a baby’s risk of getting fungal infections, late-onset sepsis, and necrotizing enterocolitis, a deadly intestinal disorder.
Can antibiotics for babies be avoided? –
Preventing the vulnerable preemies from life-threatening infections is the main responsibility of the doctors. However, the effect of antibiotics on the gut microbiome of babies is a cause for concern. The scientists have put forward some suggestions to change the trend of antibiotic overuse.
Neonatologist Karen Puopolo recently developed an algorithm based on gestational age, infant’s clinical exam, and maternal risk factors to screen for serious infections in a newborn. This tool has helped reduce the percentage of full-term babies given antibiotics.
In preemies, however, the method of delivery, whether vaginal or C-section, may help to distinguish a high risk or a low risk of infection in the baby because C-section does not expose the baby to bacteria in the birth canal. Another way to reduce antibiotic overuse is developing better tests for infection diagnosis that, unlike blood culture, are quick and sensitive to indicate an infection.
Preemies in the years to come –
A healthy gut microbiome plays a vital role in diverse functions such as synthesizing vitamins and strengthening immune systems. Microbiologist Dantas traced the gut microbiome of preemies long after they left the hospital. He found that babies who left with poor gut microbial ecosystem are able to develop diverse gut microbiome in the years to come, but he suggests that these babies are not able to catch up to have the same healthy microbiome as that of full-term babies.
This difference might explain why early use of antibiotics is associated with certain health conditions such as obesity, asthma, and autoimmune disorders. Moreover, the antibiotic-resistant bacteria stay in the gut of the preemies long after they leave the NICU, putting themselves and others around them at risk.
Future research should focus on developing safer antibiotics for preemies –
Antibiotics can help save babies’ lives but antibiotics also give them a lifetime of poor health. The gut microbiome is an important part of a healthy body and plays a critical role in many important functions. The make-up of the gut microbiome is affected by many genetic and environmental factors, such as the use of antibiotics.
Awareness and understanding of the impact of antibiotics, especially on premature babies, may change the trend of customary use of antibiotics. Additionally, developing antibiotics that are safe and effective for the little patients should be considered as the next steps for future research.
Written by Preeti Paul, MS Biochemistry Reference: Broadfoot, Marla. Too many antibiotics can give preemies a lifetime of ill health, Science Apr 5, 2018.
SOURCE: www.sciencemag.org/news/2018/04/too-many-antibiotics-can-give-preemies-lifetime-ill-health
Antenatal – definition:Antenatal care is a form of health service provided to a woman throughout pregnancy to ensure a safe gestation and childbirth, and prevent complications to the mother and the baby.
What is the Purpose of Antenatal Counseling?
John D. Lantos, MD-PlumX Metrics Children’s Mercy Kansas City, Missouri
In this volume of The Journal, Kharrat et al report the results of a systematic review designed to explore parental expectations and preferences regarding communication and decision-making for infants born extremely premature. I’d like to highlight 2 important points from their paper. The first focuses on the main findings of their review. In 19 published articles that met their inclusion criteria, they found, unsurprisingly, that parents want information about anticipated chances of survival and about long-term prognosis. More surprisingly, unlike many doctors, parents did not usually think of these conversations as ones about whether or not to provide neonatal intensive care unit care and life support. Instead, parents wanted this information to help them prepare to participate in the care of their babies. They were dissatisfied when information was exclusively negatively framed. They did not want to be reminded repeatedly of the potential for neurodevelopmental disability. Emphasizing such information made parents distrust physicians.
Parents want healthcare professionals to be sensitive, compassionate, and attentive to their goals.
These findings should come as no surprise to any health professional who has worked with parents facing the birth of a baby who is extremely premature. Parents in this situation want what patients and family members want in any similar situation—compassion, sensitivity, honesty, and hope. We know from studies of communication in other situations that physicians who are more optimistic and patient-centered care are perceived as trustworthy and compassionate.
Often, however, antenatal counseling (ANC) does not give parents what they say they want. Instead, for doctors, the goal of ANC is to offer the parents the opportunity to make an informed choice about foregoing intensive care. To achieve that goal, doctors try hard to honestly communicate pessimistic information. Thus, doctors’ goals for ANC may be fundamentally at odds with parents’ goals.
The roots of this mismatch can be understood by examining the history of our current approach to ANC. Kharrat et al refer, indirectly, to that history by limiting their analysis to articles published after 1990 because, as they say, “Our publication date cut off was guided by the 1990 seminal publication on family centered neonatal care by Harrison.” They thus rightly highlight the outsized role that Harrison’s critiques of neonatology played in reshaping the norms of communication about outcomes and complications for babies born premature.
Harrison wrote a guidebook for parents of preemies. In writing that book, she had many conversations and correspondences with parents of preemies. She came to the conclusion that doctors often withheld information from parents about infants’ poor prognosis. She wrote, “In medical situations involving very high mortality and morbidity, great suffering, and/or significant medical controversy, fully informed parents should have the right to make decisions regarding aggressive treatment for their infants.” For parents to be fully informed, they “must have available to them the same facts and interpretation of those facts as the professionals.” She believed that, if given this information, many parents would choose to forego intensive care and, instead, allow their babies to die. She further believed that this would spare many families the burdens and suffering that she associated with raising a disabled child.
There is a certain irony in the fact that Ms. Harrison’s own experiences with neonatal intensive care unit care did not seem consistent with her critiques. That history is worth highlighting because, in many ways, her actual experiences may be more typical than the types of experiences she feared and tried to prevent. As a result, her recommended approach to ANC may not reflect what most parents actually want.
In 1975, Ms. Harrison was 28 weeks pregnant with her first baby when she developed fever and back pain. She was diagnosed with listeriosis. Her son Edward weighed 1275 g at birth. His prognosis was not good. His father recounted that the neonatologist was completely honest and told him, “Don’t even hope. He has seven major conditions, any one of which would be of serious concern.” Mr. and Ms. Harrison tearfully made the decision to turn off the respirator. But Edward did not die. He grew up to be, according to his father, “A major joy to Helen and me…a delightful human being who plays music for himself all day, sings, dances, and reads Dr. Seuss books out loud with heavy intonations.” Edward also had significant disabilities. Over his childhood, he had 20 surgeries.
The groundbreaking paper that Harrison wrote did not seem to reflect her own experiences or those of her family. The Harrison family was given bad news about their baby straightforwardly. They engaged in a process of shared decision-making. As it turned out, the prognosis that they were given was not unduly optimistic. It was unduly pessimistic. When life support was removed, their baby survived. Nevertheless, Harrison’s critiques of neonatologists for withholding information struck a nerve. Her suggested remedies have been widely adopted as the preferred approach to ANC.
But perhaps they are not the best approach. Three factors suggest that it may be time to revisit the norms that govern conversations between doctors and parents who are facing the anticipate birth of a baby who is extremely premature. First, and most importantly, the study by Kharrat et al suggests that current approaches do not reflect the preferences of most parents. Many parents find that negatively framed information undermines trust and interferes with compassionate care. Instead, they prefer optimistic or hopeful messages, ones that acknowledge and even anticipate the possibility of good outcomes as well as bad ones. Such messages can be given without being dishonest. They only require that doctors discuss the range of possibilities and outcomes for babies who are premature.
A second important factor that might lead us to re-evaluate the purpose of ANC is that it is often undertaken in contexts in which parents do not really have choices. The studies reviewed by Kharrat et al focus on counseling for parents whose babies were expected to be born between 22 and 26 weeks of gestation. Today, in most centers in the US, there is no choice for babies born at 24-26 weeks. The American Academy of Pediatrics strongly recommends treatment for babies born at 25 weeks and greater.7 Recently published data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network show that neonatologists follow these recommendations. At 24 weeks and greater, virtually every baby receives active treatment. Parental preferences, then, guide treatment decisions only at only at 22 and 23 weeks. Treatment for more mature babies is guided by the principle of the child’s best interest. Nevertheless, it is likely that parents of all babies whose birth is expected to be between 22 and 26 weeks routinely receive ANC. If there are no choices to be made, it is unclear what the purpose of such counseling should be.
Even when there are choices to be made, there are problems with antenatal discussions that focus on giving quantitative information about the probabilities of different outcomes. One problem is that the prognosis changes with each passing day, and it is difficult to predict when any woman will deliver. Most women who receive ANC because they are at risk of giving birth prematurely do not, in fact, go on to give birth between 22 and 26 weeks of gestation. In 1 study, about 75% of the pregnant women who were counseled antenatally did not deliver their baby in this gestational age window. Even for those who did, the information given when they were at 22 or 23 weeks would no longer be accurate or relevant if they delivered at 25 weeks.
Finally, we also know now that doctors do not all give parents the same information. Stokes et al studied ANC and found that, for a specific baby, 12 different neonatologists gave 13 unique numeric estimates of the probability of survival. The estimates ranged from 3% to 50%. There is even more variation in prognostic estimates by doctors of different specialties.
The goal of ANC, as proposed by Harrison and as implemented by many doctors, is for doctors and parents to decide together whether to provide intensive care treatment or, instead, to provide palliative care only with the goal of keeping the baby comfortable during the dying process. Two implicit assumptions in this approach are that a decision must be made before birth and that that decision will be irreversible. But neither of these assumptions is true. Perhaps a better approach would be to counsel with a goal of conveying the uncertainties inherent in the situation and to prepare parents for the idea that they may face a series of decisions after their baby is born and doctors have a chance to assess the baby. As shown in the studies reviewed by Kharrat et al, this approach seems to be what most parents want.
In implementing this approach, doctors should strive to understand what parents want. To do that, they would need to do less talking and more listening. Given a chance, parents will tell us a lot about their hopes, fears, values, and preferences. They will ask questions that will reveal what they want to learn and need to know. By such careful, active listening, doctors will be in a better position to individualize their discussions and respond to each family’s needs. That would be a truly family-centered approach to ANC.
SOURCE: https://www.jpeds.com/article/S0022-3476(17)31755-9/fulltext
Premature brains develop differently in boys and girls
September 19, 2018 Summary: Brains of baby boys born prematurely are affected differently and more severely than premature infant girls’ brains.
Brains of baby boys born prematurely are affected differently and more severely than premature infant girls’ brains. This is according to a study published in the Springer Nature-branded journal Pediatric Research. Lead authors Amanda Benavides and Peg Nopoulos of the University of Iowa in the US used magnetic resonance imaging (MRI) scans as part of an ongoing study on premature babies to examine how the brains of baby boys and girls changed and developed.
The researchers took high-quality MRI scans of the brains of 33 infants whose ages were corrected to that of one year. The sample included babies who were carried to full term (at least 38 weeks) and preterm (less than 37 weeks). The scans were analyzed in conjunction with information gathered from questionnaires completed by the infants’ mothers and other data collected when they were born.
“The window between birth and one year of age is the most important time in terms of brain development. Therefore studying the brain during this period is important to better understand how the premature brain develops,” explains Benavides.
Brain measurements taken from the MRIs showed that even at this very young age, there are major sex differences in the structure of the brain, and these are independent of the effects of prematurity. Brain tissue is divided into cerebral gray matter which includes regions of the brain that influence muscle control, the senses, memory, speech and emotion, and cerebral white matter which helps to link different parts of grey matter to each other. While boys’ brains were overall larger in terms of volume, girls had proportionately larger volumes of gray matter and boys had proportionately larger volumes of white matter. These same sex differences are seen in children and adults, and therefore document how early in life these differences are seen.
In regard to the effects of prematurity, the researchers found that the earlier a baby was born, the smaller the overall cerebral volume. However, the effect of prematurity on the specific tissues was different depending on a baby’s gestation age in conjunction with its sex. The earlier a baby boy was born, the lower the researchers found his cortex volume (gray matter) to be. The earlier a baby girl was born, the lower was the volume of white matter in her brain. Overall, although the effects of prematurity were seen in both boys and girls, these effects were more severe for boys.
According to the research team, it is well known that male fetuses are more vulnerable to developmental aberration, and that this could lead to other unfavorable outcomes. Findings from the current study now add to this by showing how the brains of baby boys born too early are affected differently to that of baby girls.
“Given this background, it seems likely and even expected that the effects of prematurity on brain development would be more severe in males. The insults to the premature brain incurred within the first few weeks and months of life set the stage for an altered developmental trajectory that plays out throughout the remainder of development and maturation,” says Nopoulos.
SOURCE: https://www.sciencedaily.com/releases/2018/09/180919100958.htm
PREEMIE FAMILY PARTNERS
Breast feeding and brain development, nurses sharing…
10 Notes from NICU Nurses to
Parents of Premature Babies
“Never underestimate the strength and resiliency of babies.”
Every year 15 million babies around the world are born preterm, before 37 weeks of gestation. Premature birth is the leading cause of infant death in the U.S. and even if a woman does ‘everything right’ during pregnancy, there’s still a risk. However, technological advancements and growing expertise about prematurity are increasing preterm babies’ chances of survival. Over the last 10 years, the smallest baby saved has improved from 550 to 350 grams, and the youngest baby saved has improved from 26 to 22 weeks.
Every year 15 million babies around the world are born preterm, before 37 weeks of gestation. Premature birth is the leading cause of infant death in the U.S. and even if a woman does ‘everything right’ during pregnancy, there’s still a risk. However, technological advancements and growing expertise about prematurity are increasing preterm babies’ chances of survival. Over the last 10 years, the smallest baby saved has improved from 550 to 350 grams, and the youngest baby saved has improved from 26 to 22 weeks.
The Pulse asked Neonatal Intensive Care Unit (NICU) Nurses for notes that they would share with parents who are currently in the NICU. Here are their words of wisdom and encouragement.
1. “Don’t ever be afraid to ask questions. There is no such thing as a stupid question. You know your baby the best.”-Cheryl Cavallaro, NICU Nurse
2. “It’s important to include the extended family members for the health of your baby and extended family. Try Facetime or Skyping with family members from the unit. Post updates and photos on social media or through the clinical blog, CaringBridge. – Joyce Abrames, NICU Nurse
3.“Don’t try to compare your experience (or your baby’s) to anyone else’s. Take each new milestone or victory and celebrate it with all you have. Those little victories will get you through. Spend all the time you can with your baby – bond, learn and love. Finally, be kind to yourself, and practice self-care whenever you can. You can do this.”-Morgana Jokiel, NICU Nurse
4. “There are good days and bad days. It will feel like a roller coaster, and you’ll have to be patient. Ask a lot of questions. If you don’t understand something, ask.” -Mary Jane Stover, NICU Nurse
5. “Once you have a premature baby, you enter a world you never knew existed. The surprising result is that you will meet a group of people you will never forget for the rest of your life. We will always be there to get you through. You are not alone.” -Rebecca LaClair, NICU Nurse
6. “Remember that your love for your baby (or babies!) is the most important things you can bring 100% of the time, and don’t forget its incredible power. Your infant can feel that, even in the smallest touch.”-Alissa Ray, Clinical Nurse
7. “You will never be alone on this journey. Your family is surrounded by caring and dedicated professionals who will listen to your concerns, cry with you during difficult times, hold your hand, and make you understand that whatever it takes, we are in this journey together to make sure that your precious one will get the best care ever.” -Liberty Abelido, Nurse Manager
8. “Parents need to take time to care for themselves so that they are better able to provide care for their baby. Talk to your baby. Touch them. They relax and are better able to cope with the environment because they will hear a familiar voice and that provides a sense of security.”-Tarisai Zivira, NICU Nurse
9. “Every day may be so different from the next. Keep your eye on the goal–your baby’s safety, health, and happiness. Babies are so much smarter, stronger and braver than we can imagine. They let us know when they are ready to go home with you. ” -Clara Song, Faculty Neonatologist
10. “Never underestimate the strength and resiliency of babies. Preterm, ill, congenital anomalies or whatever condition brings them into the NICU, they are still sweet babies that ENDURE and give something to their parents and families, no matter how small…HOPE! Take that hope and bring good energy to your baby every time you visit.” -Donna Dichirico, Nurse
SOURCE: http://newsroom.gehealthcare.com/10-notes-from-nicu-nurses-to-parents-premature-babies/
Breast milk helps in brain development in premature babies
Published on Sep 22, 2018: New Delhi, Sep 23 (ANI): Breast milk sure has a lot of health benefits for babies. According to a new research, babies born before their due date show better brain development when fed breast milk rather than formula milk. Premature birth has been linked to an increased possibility of problems with learning and thinking skills in later life, which are thought to be linked to alterations in brain development. Experts say that helping mothers to provide breast milk in the weeks after giving birth could improve long-term outcomes for children born pre-term. Studies have shown that pre-term birth is associated with changes in the part of the brain’s structure that helps brain cells to communicate with one another, known as white matter. Researchers at the University of Edinburgh studied MRI brain scans from 47 babies from a study group known as the Their world Edinburgh Birth Cohort. The babies had been born before 33 weeks gestation and scans took place when they reached a term-equivalent age, an average of 40 weeks from conception. The team also collected information about how the infants had been fed while in intensive care – either formula milk or breast milk from either the mother or a donor. Babies who exclusively received breast milk for at least three-quarters of the days they spent in the hospital showed improved brain connectivity compared with others. The effects were greatest in babies who were fed breast milk for a greater proportion of their time spent in intensive care. The study appeared in the Journal of NeuroImage.
SOURCE: https://youtu.be/SKjbpwDXI_U
Our Neonatal Womb family needs innovation and a scientific effort to identify and treat hearing deficits in preterm birth survivors. We are excited to learn that EFCNI is unique and progressive within the Neonatal Womb community in efforts to research and provide support to preterm birth survivors into their adulthood.
INNOVATION
Published: September 14, 2017
Hearing impairment in premature newborns—Analysis based on the national hearing screening database in Poland
Katarzyna Wroblewska-Seniuk , Grazyna Greczka, Piotr Dabrowski, Joanna Szyfter-Harris, Jan Mazela
Abstract – Objectives
The incidence of sensorineural hearing loss is between 1 and 3 per 1000 in healthy neonates and 2–4 per 100 in high-risk infants. The national universal neonatal hearing screening carried out in Poland since 2002 enables selection of infants with suspicion and/or risk factors of hearing loss. In this study, we assessed the incidence and risk factors of hearing impairment in infants ≤33 weeks’ gestational age (wga).
Methods
We analyzed the database of the Polish Universal Newborns Hearing Screening Program from 2010 to 2013. The study group involved 11438 infants born before 33 wga, the control group—1487730 infants. Screening was performed by means of transient evoked otoacoustic emissions. The risk factors of hearing loss were recorded. Infants who failed the screening test and/or had risk factors were referred for further audiological evaluation.
Results
Hearing deficit was diagnosed in 11% of infants ≤25 wga, 5% at 26–27 wga, 3.46% at 28 wga and 2–3% at 29–32 wga. In the control group the incidence of hearing deficit was 0.2% (2.87% with risk factors). The most important risk factors were craniofacial malformations, very low birth weight, low Apgar score and mechanical ventilation. Hearing screening was positive in 22.42% newborns ≤28 wga and 10% at 29–32 wga and in the control group.
Conclusions
Hearing impairment is a severe consequence of prematurity. Its prevalence is inversely related to the maturity of the baby. Premature infants have many concomitant risk factors which influence the occurrence of hearing deficit.
SOURCE: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184359
The European Foundation for the Care of Newborn Infants (EFCNI) is the first pan-European organisation and network to represent the interests of preterm and newborn infants and their families.
We bring together parents, healthcare experts from different disciplines, and scientists with the common goal of improving long-term health of preterm and newborn children. Our vision is to ensure the best start in life for every baby. With our activities we want to reduce preterm birth rates, ensure the best possible treatment, care, and support and to improve the long-term health of preterm infants and newborns with illnesses.
Research on European Children and Adults born Preterm (RECAP preterm)
Background: from data collection to data sharing
The overall aim of the EU-funded research project RECAP preterm is to improve health, development, and quality of life of children and adults born very preterm (VP) or with a very low birth weight (VLBW):
- VP: less than 32 weeks of gestation
- VLBW: less than 1500 g
- Core steps – RECAP preterm will…
- The innovative element of RECAP preterm is to provide the bridge from data collection to data sharing: the members aim to establish a digital platform for harmonizing and exploiting data of European cohort studies with babies, children, and adults born preterm as well as Nordic registry data. This broadened data basis shall ensure improved understanding, diagnosis and evidence-based, personalized prevention of mental and somatic disorders that are associated with preterm birth. Long term effects of different treatments, especially the use of (off-label) medication applied for these patients are meant to be analyzed by combining adult cohorts with available data from preterm babies. By developing mHealth applications, the cohort participants shall be encouraged to sustainably collect follow-up data (mHealth/mobile health = the use of information and communication technology for collecting health data, delivery of healthcare information, monitoring of patient vital signs, and telemedicine).
- create a sustainable data platform of national and European cohorts of VP/VLBW children and adults to optimise the use of population data for research and innovation in healthcare and policy (view more)
- develop hypothesis-driven research on health status and medical care of VP/VLBW children and adults that builds on the unique opportunities provided by the larger sample sizes of combined cohorts and the added value of their geographic and temporal diversity
- integrate exchange with various stakeholders to disseminate results and to translate them into evidence-based care and policy (e.g. obstetricians, neonatologists, paediatricians, psychologists, psychiatrists, other healthcare providers, educators, scientists, economists, policy planners, health insurance companies, and patient and parent groups).
- emphasise patient and public involvement in order to reflect real-world needs
Next steps for 2018-
- Finalise first version of stakeholder map
- Start planning of winter school 2020
- Verbalise the upcoming research findings in order to make them easier to understand for non-expert target groups like the general public or parents and patients
- Conceptualise a meeting bringing together RECAP preterm researchers and representatives of national parent organisations to exchange on the project.
The RECAP preterm consortium-
RECAP preterm brings together European child to adult cohorts and a group of highly experienced organisations. The expertise of the partners covers a wide and complementary range of fields, including life course epidemiology, methodology, neonatology, paediatrics, early-life stressors, non-communicable disease research, epigenomics, economics, psychology, and mental health as well as e-learning technologies, eHealth/mHealth applications, communication, dissemination and project management.
SOURCE: https://recap-preterm.eu/
SOURCE: https://www.efcni.org/activities/projects/recap/
YOUTUBE: Image video of the European Standards of Care for Newborn Health Project by EFCNI –Published on May 22, 2017
European Standards of Care for Newborn Health is an interdisciplinary European collaboration to develop standards of care for key topics in newborn health. The project brings together more than 220 healthcare professionals of different professions, parent representatives and selected industry specialists, from more than 35 countries. The focus of the project is the treatment and care of preterm and ill newborn babies in hospital and as they grow up. The project was initiated by the European Foundation for the Care of Newborn Infants. View more about the project at http://www.newborn-health-standards.org
WARRIORS:
KAT’S CORNER
Growing up as a young child I experienced bullying likely as a result of my (much) smaller than average stature and jack-o-lantern smile. Due to my intubation as a preemie my oral cavity and jaw developed differently, creating a deeply indented palate and a very cute but wildly crooked smile.
Between 1st and 2nd grade I was consistently taunted by kids on the playground for my pearly whites. One particular boy physically assaulted me daily and organized a group of boys to chase me. When I came from school with gravel and bark embedded in my skin my Mom told me to fight back. Permission given, I took matters into my own hands (literally). Eventually though, due to lack of school support (bullying was allowed back in the day), I choose to transfer to an alternative elementary school.
I began wearing braces at age 8, complete with a stellar set of head-gear to reset my jaw and to support the big smile I have today. Like most kids with braces the comments of having a metal mouth quickly became a background noise norm. It wasn’t until I was 16 years old that I got my braces off, although I wore a retainer until last year. In reflection, I realize I was very fortunate that my mom was able to provide me with dental care and braces. Having my teeth straightened has impacted my daily life in a very positive way. I can enjoy eating without the anxiety of being awkward in my eating habits due to the large unorderly spaces between my teeth and silent fear of rude commenters. Braces helped my confidence in smiling at/with others and in conversing comfortably in social situations.
Learning about how life as a preterm birth survivor may impact dental and oral health outcomes of patients is fascinating to me. Dental health is a critical component of experiencing health in life. My hope is that with current dental health research families of preterm birth babies and preterm birth survivors themselves may become aware of the ways their dental development may be impacted. I also hope that attention to dental outcomes in preterm birth patients may aid in bridging the gaps that may exist between the dental and medical fields so that collaborative measures may be taken to aid in the research, understanding, innovation, and collaboration of pediatric related medical and dental care of preemies. Furthermore, as our current healthcare system does not offer adequate dental coverage as a critical component of healthcare I hope that current research findings may aid our healthcare community in pushing for better oral care coverage and acknowledging that dental care is a critical part of overall health, not just for preemies but for people in general.
Kitesurfing Jastarnia, Poland 2017
–Marcin Bachrynowski Published on Sep 13, 2017-Summer holiday in Jastarnia with a lots of kiresurfing. Letnie wakacje w Jastarnii z pływaniem na kitesurfingu
The Neonatal Womb Warriors 