SWITZERLAND

Rate: 7.4%     Rank: 146 –Estimated number of preterm births per 100 live births

(USA – 12%)

SOURCE: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3

Switzerland, officially the Swiss Confederation, is a country situated in western, central and southern Europe It consists of 26 cantons, and the city of Bern is the seat of the federal authorities. The sovereign state is a federal republic bordered by Italy to the south, France to the west, Germany to the north, and Austria and Liechtenstein to the east. Switzerland is a landlocked country geographically divided between the Alps, the Swiss Plateau and the Jura, spanning a total area of 41,285 km (15,940 sq mi) (land area 39,997 km (15,443 sq mi)). While the Alps occupy the greater part of the territory, the Swiss population of approximately 8.5 million people is concentrated mostly on the plateau, where the largest cities are to be found: among them are the two global cities and economic centres Zürich and Geneva.

Health:

Swiss residents are universally required to buy health insurance from private insurance companies, which in turn are required to accept every applicant. While the cost of the system is among the highest, it compares well with other European countries in terms of health outcomes; patients have been reported as being, in general, highly satisfied with it. In 2012, life expectancy at birth was 80.4 years for men and 84.7 years for women, the highest in the world. However, spending on health is particularly high at 11.4% of GDP (2010), on par with Germany and France (11.6%) and other European countries, but notably less than spending in the USA (17.6%). From 1990, a steady increase can be observed, reflecting the high costs of the services provided. With an ageing population and new healthcare technologies, health spending will likely continue to rise.

SOURCE: https://en.wikipedia.org/wiki/Switzerland

 

COMMUNITY

Humanitarian Neonatology

Many Swiss neonatologists are involved in humanitarian projects in low and middle income countries. The Swiss Society of Neonatology strongly supports such efforts and therefore has decided set up this platform.

Frequently, these projects remain hidden, unless the topic comes up in a random conversation, revealing common interests and similar problems that are all facing when working in different parts of the world – when in fact, one could benefit from the experience of the other, from their contacts, their achievements and their mistakes.

The goal of this platform is to provide information, to offer opportunities to get involved, to share experiences and find synergies. Neonatologists can present their humanitarian projects and invite other medical professionals to join them in their efforts.

Finally, the Swiss Society of Neonatology has decided to set up an Annual Award Program for Humanitarian Neonatology.  Interested medical professionals can apply for a grant of CHF 5‘000.00.

SOURCE: https://www.neonet.ch/en/humanitarian-neonatology/

 

NEO FOR NAMIBIA – Helping Babies Survive is a non-profit organization based in Switzerland that focuses on the implementation of simple medical interventions that are known to improve survival rates of newborn infants.

What we do – Simple interventions will save lives

The founders of NEO FOR NAMIBIA – Helping Babies Survive, Prof. Thomas M. Berger, a Swiss pediatrician, neonatologist and pediatric intensivist and his wife Sabine Berger, a pediatric registered nurse, have visited several sub-Saharan African countries (Ivory Coast, the Gambia, Namibia) in the past years to assess neonatal and pediatric care at various hospitals in these countries.

During these visits, they observed recurrent themes: poor infrastructure related to both high acquisition costs and lack of proper maintenance, unreliable supply chains for spare parts and consumables, and shortage of qualified health care professionals.

They are convinced that simple interventions will have a huge impact; any delay will lead to additional, potentially preventable deaths. The time to act is now!

The activities of NEO FOR NAMIBIA – Helping Babies Survive are officially approved by the Ministry of Health and Social Services and supported personally by the Honorable Minister of Health, Dr. Bernard Haufiku. “I highly appreciate the efforts of NEO FOR NAMIBIA – Helping Babies Survive. I am convinced that the proposed interventions will play an important role in reducing neonatal deaths in the Kavango region of Namibia. Potentially, other regions of this country could benefit from this experience. I can guarantee that the Ministry of Health and Social Services of Namibia will support Prof. Berger and his team”.

NEO FOR NAMIBIA focuses on the following aspects of the care of newborn infants:

• Provide essential equipment to improve neonatal care (including warming beds, consumables appropriate for the use in newborn infants, monitors, devices for respiratory support)
• Regular teaching of both physician and nursing staff in basic neonatal care, such as thermoregulation, Kangaroo care, neonatal resuscitation, appropriate use of antibiotics, fluid and nutrition management, respiratory care
• Develop standard operating procedures (SOPs) together with the local health care professionals
• Support of local champions (physicians and nurses who will train and supervise their peers)

SOURCE: https://www.neo-for-namibia.org/what-we-do

HAPPY ANNIVERSARY NEONATAL WOMB WARRIOR BLOG! THREE HEARTWARMING YEARS OF EDUCATION AND COMMUNITY. Thanks All!

 

HEALTH CARE PARTNERS

We value medical and psycho-social research related to preterm birth survivors as they age. 

Abstract: A meta‐analysis of neurodevelopmental outcomes at 4–10 years in children born at 22–25 weeks gestation    Sharon Ding – Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada

Aim

To update our meta‐analysis on neurodevelopmental disability rates in children born at 22–25 weeks gestation. The main outcome measure was rates of neurodevelopmental disability in survivors at age 4–10 years.

Methods

We used a peer‐reviewed electronic and grey search to identify articles. Two authors independently reviewed cohorts published after May 2012 with: born ≥1995 in a developed nation; assessed at 4–10 years; prospective; >65% follow‐up; definitions for neurodevelopmental disability as per the EPICure cohort; results reported by gestation. We contacted authors for clarification. Random effects meta‐analysis was used to estimate pooled proportions of neurodevelopmental disability. Within each study, the absolute change in proportions with each week was estimated and then pooled.

Results

We reviewed 3980 records; 21 articles were assessed and six were included. With the previous 9 cohorts, the meta‐analysis now contains 15. Rates of moderate‐to‐severe neurodevelopmental disability were as follows: 42% (95% CI 23,64%; I² 0%) at 22; 41% (95% CI 31,52%; I² 20%) at 23; 32% (95% CI 25,39%; I² 45%) at 24; 23% (95% CI 18,29%; I² 60%) at 25 weeks. The analysis shows a significant decrease in risk of moderate‐to‐severe neurodevelopmental disability between each week (8.1% (95% CI −11.8, −4.5%); I² 0%; p < 0.001).

Conclusion

Physicians can use this high‐quality data to support parents during decision‐making.

SOURCE: https://onlinelibrary.wiley.com/doi/10.1111/apa.14693

 

Platelet Transfusions in Neonates — Less Is More

• Martha C. Sola-Visner, M.D. January 17, 2019

• Thrombocytopenia is common in preterm neonates. At some point during their stay in the neonatal intensive care unit, this condition affects up to 73% of infants with a birth weight of less than 1000 g.¹ The smallest and most premature infants also have the highest incidence of bleeding; in approximately 30% of neonates born with a weight of less than 1500 g, an intracranial hemorrhage develops, usually in the first week of life.² Because of the high rates of both thrombocytopenia and bleeding in this population, it has been widely accepted that preterm infants should receive platelet transfusions at higher platelet-count thresholds than those used in older children and adults. However, the specific platelet count below which a platelet transfusion is beneficial has been unknown.
• Before the trial by Curley and collaborators reported in this issue of the Journal,³ the only randomized trial comparing platelet-transfusion thresholds in preterm neonates had been published 25 years earlier. That trial involved 152 premature neonates who had a birth weight of less than 1500 g and a platelet count of less than 150,000 per cubic millimeter. The neonates were randomly assigned to receive platelet transfusions during the first week of life at a platelet-count threshold of 150,000 per cubic millimeter or to receive no platelet transfusions unless the platelet count was less than 50,000 per cubic millimeter or the neonate had bleeding. The trial showed no significant differences between the two groups in the incidence of the primary composite outcome of new intracranial hemorrhages or worsening of existing intracranial hemorrhages. These results led neonatologists to embrace 50,000 per cubic millimeter as the most frequently used threshold for platelet transfusions in preterm neonates, although limitations in this single randomized trial left room for uncertainty and several unanswered questions, including which transfusion thresholds to use beyond the first week of life and whether platelet counts lower than 50,000 per cubic millimeter were safe in preterm neonates. In the absence of additional trials, surveys and observational studies over the past decade revealed a striking worldwide variability in thresholds for platelet transfusions in neonates.⁵
• The trial by Curley et al. was well designed to address critical questions in this field. In this multicenter trial, 660 neonates who had a median gestational age of 26.6 weeks and a median birth weight of 740 g and in whom thrombocytopenia had developed were randomly assigned to receive platelet transfusions at platelet-count thresholds of 50,000 per cubic millimeter (high-threshold group) or 25,000 per cubic millimeter (low-threshold group). The primary outcome was a composite of death or new major bleeding within 28 days after randomization, and bleeding was quantified with the use of a validated neonatal bleeding-assessment tool. A total of 90% of the infants in the high-threshold group and 53% of those in the low-threshold group received at least one platelet transfusion.
• Surprisingly, infants in the high-threshold group had a significantly higher rate of death or major bleeding within 28 days after randomization than those in the low-threshold group (26% vs. 19%; odds ratio, 1.57; 95% confidence interval, 1.06 to 2.32). In a subgroup analysis, findings were similar in neonates who were born at less than 28 weeks of gestation (the highest-risk group) (Table S4 in the Supplementary Appendix of the article by Curley et al., available with the full text of the article at NEJM.org).⁶ With regard to secondary outcomes, the incidence of bronchopulmonary dysplasia (defined as dependency on oxygen at 36 weeks of postmenstrual age) was higher among infants in the high-threshold group than among those in the low-threshold group, and rates of major bleeding through trial day 28 were 14% and 11%, respectively.
• The observation that major bleeding was not more common in the low-threshold group than in the high-threshold group was consistent with previous observational studies showing a poor correlation between the degree of thrombocytopenia and bleeding risk, and it suggests that factors other than the low platelet count account for the high incidence of bleeding among neonates with thrombocytopenia. A total of 37% of infants in the trial underwent randomization on or before day 5 of life, and 59% underwent randomization by day 10, the highest-risk period for bleeding.⁷ However, 39% of the infants in the trial received one or more platelet transfusions before randomization; this raises important questions about whether the infants received these transfusions during this high-risk period and, if so, for what reasons and at what platelet-count thresholds.
• The rates of death and bronchopulmonary dysplasia observed to be higher in the high-threshold group than in the low-threshold group also raise obvious questions regarding the mechanisms mediating these adverse effects. Are they related to the presence of adult platelets (which are more reactive than infant platelets) tilting the neonatal primary hemostatic balance toward a prothrombotic state that promotes microthrombosis?⁸ A previous study that showed increased risks of arterial thrombosis and in-hospital death associated with platelet transfusions among adults with platelet-consumptive disorders provides some support for this hypothesis.⁹ Or are these adverse events mediated by the increasingly recognized effects of platelets on inflammation,¹⁰ a particular concern in neonates with infection, as in approximately 60% of the infants in the trial by Curley et al.?
• Although the mechanisms underlying the findings are unknown, the trial by Curley et al. is a major advance in neonatal hematology. More than two decades after the first randomized trial comparing platelet-transfusion thresholds in preterm infants, this long-awaited trial provides neonatologists with high-level evidence that should translate into a shift toward restrictive thresholds for prophylactic platelet transfusions in neonates who have not had recent major bleeding (since this trial excluded infants with major bleeding within the previous 72 hours which was either already known or detected on cranial ultrasonography performed within 6 hours before randomization). In clinical practice, recent cranial ultrasonographic findings are not always available when decisions are made regarding platelet transfusions. This raises concerns, particularly for infants during the first week of life. Nevertheless, it is now clear that platelet transfusions may have deleterious effects in preterm neonates, and the evidence from this trial strongly suggests that less is more when it comes to the management of neonatal thrombocytopenia.

SOURCE: https://www.nejm.org/doi/full/10.1056/NEJMe1813419?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Healthy Nurse Healthy Nation Grand Challenge-Leading the Nation’s Journey to Better Health

WHAT IS THE HEALTHY NURSE, HEALTHY NATION™ GRAND CHALLENGE?

If all 4 million registered nurses increased their personal wellness and then their families, co-workers and patients followed suit, what a healthier nation we would live in! That is the goal of the Healthy Nurse, Healthy Nation™ Grand Challenge, an initiative to connect and engage nurses, employers, and organizations around improving health in five areas: physical activity, nutrition, rest, quality of life, and safety.

Nurses are less healthy than the average American. Research shows that nurses are more likely to be overweight, have higher levels of stress, and get less sleep. As the largest and most trusted health care profession, nurses are critical to the health of the nation. Healthy nurses are great role models for their patients, colleagues, families, and neighbors.

1. Register to join “Healthy Nurse, Healthy Nation™ Connect”
2. Take the health assessment survey and get a heat map of your health risks.
3. Pick your focus area(s), make a health commitment, and participate in health challenges.

                          Activity   Rest   Nutrition  Quality of life    Safety

4. Connect with others for support, advice, and share successes.
5. Repeat the survey annually to see how far you’ve come!

SOURCE: http://www.healthynursehealthynation.org/

To Join Now: https://ebiz.nursingworld.org/SSO/Login.aspx?vi=26&vt=4a7230dbafb794d393f9c03658de055848682fa82b9e936fcdb5ae6b66b5ccf193189ee871628bb452bc5e9551037675cccf78fc331cf64bfc4498535899098347a29bcb088ec5011a42910eed3007cf&r=SWL&L=SWL

 

Working Out And Staying Fit In Medical School and Residency!

Antonio J. Webb, M.D.       Published on Oct 29, 2017

In this video, Dr. Webb discusses working out and staying fit while in residency.

 

Antonio J. Webb, M.D.       Published on Oct 29, 2017

In this video, Dr. Webb discusses working out and staying fit while in residency.

 

PREEMIE FAMILY PARTNERS

Matt Ryan’s Cause: Care and Support for Preterm Babies and Their Families

By MATT RYAN

November 28, 2018

This Sunday, when the Falcons play the Ravens, you’ll see Matt Ryan wearing a new pair of blue cleats. The March of Dimes, a non-profit that works to support the health of mothers and babies, will be printed on his right shoe; Northside Hospital Miracle Babies, a program to support families of preemies born at the Atlanta hospital, will be printed on the left. Ryan’s cleats will be auctioned off to raise money for both organizations through the NFL’s My Cause, My Cleats platform, but the Falcons quarterback and dad to nine-month-old twin boys also has a very personal reason behind his choice.

It was a Tuesday morning last January, and we were getting ready to the play the Eagles in last year’s divisional round of the playoffs. I was at work, in a normal quarterbacks’ meeting that we have. I had my phone with me, only because I knew my wife, Sarah, had a doctor’s appointment that day.

We’d found out she was pregnant during training camp, and we were both so excited. It was something that we had been trying for, for a long time. And then when we found out she was having twins, that was a special day, too. We were happy and excited and nervous—all of the things that go along with that.

Twin pregnancies are always high-risk, so Sarah was going in for regular doctor’s appointments bi-weekly, if not more, throughout her entire pregnancy. She went in on this Tuesday morning for what was supposed to be a routine check-up. And then she called me and said she was getting admitted to the hospital.

Sarah had a complication with her pregnancy at 24 weeks and five days.

It was around 8:15 a.m. when I got the call, and I left the Falcons facility and stayed at the hospital with her the rest of the day through the next morning. We were just trying to get as much information as we could. It was still so early in her pregnancy. When they talk to you about the percentages of survival with children being born at that gestational age, that’s a scary and terrifying time.

That week before the Eagles game was touch and go. We were unsure as to what was going on, what was going to happen. The game was a huge opportunity for us as a team, and I was excited about that, but obviously I was most concerned with the well-being of my family. You don’t want to leave; you want to be able to be there and support her in any way that you can. We had reassurance from the doctors that things were stable before I left for Philadelphia, and we were lucky that Sarah was able to have family come down to be with her while I was gone.

After we lost to the Eagles, the next five weeks were basically spent at Northside Hospital, in Room D8. Sarah’s mom, Susie, came and stayed with us, and we alternated staying overnight with Sarah. We watched TV, read books, played cards. She and her mom were really into Gin Rummy, and we oddly played a lot of Uno, which was just kind of a brainless way to pass the time. It’s not easy having to be on bed rest, not able to leave a room for six weeks, but not once was Sarah restless or angry or anything like that. She’s incredibly selfless.

The one thing we both learned through this process is that each day that the babies were able to stay inside was huge. So each day that passed, each week that passed, the amount of development for our boys was monumental. We’re so fortunate she was able to keep them in there as long as she did, to give our boys a really good chance. Sarah has an unbelievable strength to her that I knew was there, but when you go through something like that, it opens your eyes to it even more.

Feb. 21 started out like every other day in the hospital. I left to get in a workout, and I got a call in the early afternoon that Sarah was uncomfortable. I went back, and the doctors and nurses got her a little bit more comfortable. We ordered some take-out salads for dinner around 6 p.m. By 7 p.m., she was in labor. I think anybody who has been in the room when children are born knows it’s an unbelievable experience. With our boys being premature, we also had a little bit of a crew in the room. The hospital had a team of five or six nurses and doctors each, waiting to take them up to the neonatal intensive care unit (NICU).

Our boys were born at 30 weeks and six days. Marshall was first, weighing 2 lbs., 15 oz. Seven minutes later, Johnny arrived. He was 2 lbs., 14 oz. They were small, but they were strong. Sarah’s maiden name was Marshall, and John is a family name for both of us. Johnny’s middle name is Matthew, and Marshall’s middle name is Thomas, the same as mine, so it was cool to be able to give each of them each a little bit of my name. Sarah was able to hold both babies, but within about 10 minutes of being born, they were taken upstairs to a different part of the hospital. I went up there, and a different group of doctors were running all kinds of tests.

We were really fortunate to receive the care that we did. While Sarah was in the hospital, she had access to medicines to help prevent premature labor. Our boys were able to get two rounds of steroid injections for their lungs so their breathing was really good when they were born, which was critical in their success. They were able to be taken off breathing assistance within the first week that they were born, which was huge. They were off the high-flow support for their lungs within 10 days or so, though Johnny had to go back on a couple different times. This is one reason why we are supportive of the March of Dimes, because they do so much research into medicines like these that can help moms and babies.

You never really know how things are going to shake out when babies are born prematurely. They give you a window of time that they might need to stay in the NICU if there are no complications, and it’s usually around when they would be born full-term. Part of the reason that Sarah chose Northside Hospital was because of the NICU specifically. It’s widely known as one of the best NICUs in the country. With a high-risk pregnancy with twins, that was something that was really important to us.

It was a stressful time. During the boys’ stay in the NICU, early on there was more restriction on the amount of time they could be outside of the incubator. Once every eight hours for an hour was roughly the amount of time that you could have them out and with you. We got into a pretty good routine of going back three times a day at different shifts so we were able to spend time with them. One of the things they said is best for their development is skin-to-skin contact, so you’d take both of the boys out of the incubator and you would hold them up against your chest. We would read to them a lot, just fill them in about what was going on, talk to them. In the early stages, that was really all we could do.

As they matured in the NICU and they were in open-air cribs, and you could be there whenever you wanted. Sarah was nursing the boys while they were there, and we would bathe them. Our days were spent at their cribside. The boys each had a hotline number, so you could call in overnight and check on how they’re doing. If you woke up during the night. you would call. And you’d call first thing in the morning. You also have that Northside NICU number saved in your cell phone, and they would call you with updates. Any time you would see that number come through, your heart would start racing.

Marshall came home first. He spent five weeks in the hospital and left at 5 lbs, 5 oz. You’re so proud and happy for him to be coming home, but it’s also tough when he’s leaving his brother, and you’re leaving his brother, who still has to be at the hospital. That was a hectic week, trying to take care of Marshall at home and still make sure Sarah was at the hospital as much as she could to help with Johnny. A week later Johnny came home, just a little bit heavier than Marshall. That was a really special day, to have everybody at home together for the first time.

We’re so thankful that our life brought us to Atlanta, and that Sarah’s pregnancy took us to Northside, and for the unbelievable care we got there. Sandy Jun was the main doctor who took care of both of our boys during their extended stay in the NICU, and Gretchen Koontz from Atlanta Maternal-Fetal was Sarah’s doctor during her hospital stay. And then the countless nurses and people who helped us during both the day and night shifts. They are dealing with you in a situation that’s stressful and difficult, and they’re so patient and so good to the children there.

Those were long days, but the time went by quickly. Our boys are nine months old now, and they’re doing awesome. I remember being able to fit them in my hand. They’re getting big now. They’ve been fighters from Day One.

I want other families going through this to know they’re not alone. But we’re also sharing our story to create awareness for finding ways to help babies who are born prematurely and providing our doctors with every opportunity to give these kids the best chance. It’s the first time we’ve supported either of these charities and hospital, but this is just the beginning for us. This is just one small piece of what we plan to do to try and help Northside and the March of Dimes.

I think back to that day in January when Sarah was first admitted to the hospital. That was the scariest time, because we had no idea how things were going to go. All you want to hear is what can be done to help your sons. We want to help other families get the same help we did.

SOURCE: https://www.si.com/nfl/2018/11/28/matt-ryan-my-cause-my-cleats-premature-babies-march-dimes-northside-hospital

Kathy: Organ donation was not available to me when my son Cruz (Kat’s twin brother) died and I do not know if any of his organs (24 weeks. gestation) would have been viable for donation. I would have pursued donation if that had been an option. Dust in the Wind (Reference song by Kansas – 1998), or life in the wind.  I would choose life!

Of Tragedies and Miracles — Neonatal Organ Donation  NEJM

Beatrice E. Lechner, M.D. – November 29, 2018

Baby K. was born at full term after an uncomplicated pregnancy, with sweet baby thighs, adorable little hands and feet, and a soft crown of wispy hair. But at 5 days of age, rather than snuggling with his mother and breast-feeding, he was lying on a cooling blanket in a neonatal intensive care unit (NICU), attached to a ventilator, monitors, and IV fluids. When his hypothermia therapy for encephalopathy ended that day, he underwent an EEG and an MRI. I’m sure his parents suspected what these tests would reveal, but it broke my heart to have to put their worst fears into words.

Over the years, I’ve had many difficult conversations with parents about devastating test results and the possibility of shifting an infant from curative care to comfort care. Some parents react with denial, some with anger. Others take the initiative in choosing redirection of care, and some quietly acquiesce to my guidance. As the team and I sat down to talk with Baby K.’s parents, I thought I’d seen the full spectrum of possible parental reactions.

But without waiting for my explanations or opinions, Baby K.’s father said something I’d never heard a newborn’s parent say: “We would like to donate his organs.”

Tears erupted from the few eyes in the room that had managed to remain dry.

Then we leapt into action — or tried to. This was my first experience with neonatal organ donation, and I had no idea how rarely that process took place. I was keenly aware that I didn’t know what steps I needed to take, and that nobody else seemed to know either.

The first stumbling blocks we encountered were our own assumption that infants with significant organ injury could not be organ donors and our doubt about whether it was possible to diagnose brain death in a neonate — and if not, whether organs could be donated anyway. We learned that day that some level of injury to organs may be acceptable: neonatal organs are hard to come by, so transplant surgeons make case-by-case decisions based on the condition of both the organs and the recipient. A baby who would otherwise die soon may benefit from a less-than-healthy organ, whereas a baby who is stable may be better off waiting.

As the day stretched into night, I learned that what I’d been taught about neonatal brain death during training was incorrect. I’d believed that brain death can’t be diagnosed in neonates for physiological reasons, but in fact there were simply no well-disseminated guidelines for this age group. The 1981 Guidelines for the Determination of Death covered patients 5 years of age or older, and the 1987 American Academy of Pediatrics (AAP) guidelines expanded the criteria to cover patients as young as 7 days old.

We spent that long night trying to reconcile the fact that the organ bank could not legally accept an organ from a patient who had not been declared dead with the fact that I could not conscionably declare a 5-day-old brain dead because it wasn’t standard practice. We felt that we couldn’t give up until we’d found a solution for Baby K.’s family. They were willing to give so much even as they were losing so much that I could not refuse their gift on the basis of technicalities. As we sat in the team room discussing options with the organ bank coordinator and our hospital risk manager, I remembered Thomas Edison’s famous words: “I have not failed. I’ve just found 10,000 ways that won’t work.”

Then serendipity stepped in. The neonatology fellow on call that night had been a chief resident at a neighboring children’s hospital. Wondering what the pediatric intensive care unit (PICU) at that hospital did in these situations, he contacted the on-call PICU attending. That intensivist happened to be on a committee charged with developing a new pediatric brain-death policy for the PICU, and she had just received a draft of it. She had not yet read it, but she was willing to share it with us. Although it was designed for an older population, the draft policy pointed us toward the AAP guidelines for the determination of brain death in children, an update to the 1987 recommendations that included guidelines on the determination of brain death from birth onward for infants born at 37 weeks’ gestation or later.1 Even the people we’d spoken to at the New England Organ Bank (NEOB) had not been aware of these 2011 guidelines.

Despite the guidelines, pediatricians’ ability to define and apply the concept of brain death leaves substantial room for improvement, so it’s not surprising that cases of neonatal organ donation are rare. Between 1988 and 2013, there was a yearly average of 100 U.S. organ donors under 1 year of age. In the New England region, the average was 1.5 per year, according to the NEOB, and Women and Infants Hospital, home of the only level IV NICU in Rhode Island, had had no organ donations at all between 2000 and 2013. Furthermore, over the previous 28 years, only two neonatal organ donations had occurred in the entire New England region. All of this strongly suggests that before Baby K.’s parents proposed donating his organs, there had never been a neonatal organ donation in the state of Rhode Island.

As my colleagues and I worked to help Baby K.’s parents achieve their goal, I wondered whether neonatal organs are not being donated because NICU physicians are unaware of the donation criteria and so are missing many possible donors or whether there are actually few newborns who meet the criteria. Recent retrospective studies of theoretically suitable cases indicate that though it’s unlikely that a large number of potential donors are being missed, there is room for improvement in physicians’ awareness.3,4

Baby K.’s father asked me why he had to be the one to raise the question of organ donation. I think the complex answer is that we often believe that the family will find the idea too difficult to bear, we may be too uncomfortable ourselves to take the necessary steps, and we may assume that a given newborn wouldn’t qualify as a donor.

Ultimately, the strength that Baby K.’s parents showed launched a cascade of unanticipated good. First and foremost, they saved another baby’s life, thereby “saving another family from the anguish [they] were living through,” as they put it. But they did more than that.

They allowed the NICU team to feel not just the sadness and failure that we experience when a baby dies under our care, but also the comfort of knowing that we were part of something miraculous. Although we could not save our patient’s life, we played at least a small role in saving another baby’s life — and so saw a faint light that we had not seen before. Baby K. and his family reminded us not only that miracles in medicine may sometimes arise out of the deepest tragedies, but also that patients and their families may offer their care providers such profound gifts as humility, strength, and inspiration.

And Baby K. and his parents challenged us to expand our clinical horizons beyond our comfort zone by educating ourselves. They thereby opened the door to future lifesaving donations: we now have a policy for neonatal organ donation and have been teaching our staff and trainees about the process.

During our final family meeting, Baby K.’s parents asked me to raise awareness about neonatal organ donation so that in the future more parents of dying newborns are offered the choice and more babies’ lives can be saved. If we actively screen for qualified donors, perhaps we can avoid missing so many opportunities to turn heartbreaking tragedy into bittersweet success.

SOURCE: https://www.nejm.org/doi/full/10.1056/NEJMp1809147

INNOVATIONS

Regenerative Therapies for sick term and preterm born infants

Posted on 08 June 2018

An interview with Professor Mario Rüdiger, Professor for Neonatology and Pediatric Intensive Care Medicine, Head of Department at the Neonatal Research Group at the University Hospital Dresden, Germany

What was the idea behind the planned project?

In the past decades, improvements in feto-neonatal care have significantly reduced mortality. Long-term morbidity however, still represents a major problem. Most prominent disease entities with a feto-neonatal origin are chronic lung disease of preterm infants, sepsis and brain injury. Though affecting hundred thousands of patients every year, these diseases are of little interest to the industry.

Scientific evidence suggests a beneficial effect of regenerative therapies in these disease entities, with the most promising intervention being based on mesenchymal stromal cells (MSC)[1]. Whereas MSC have become standard therapy in some adult diseases, translation into neonatal routine care was hampered by the lack of firstly, a cell product of clinical grade that can be used in newborns and secondly, well-performed clinical studies testing these cells.

That’s where our project offers solutions to overcome these problems.

What are mesenchymal stem cells?

MSC are considered somatic stem cells which possess the potential to adapt to the microenvironment of injured organs and to regulate the healing process by secreting various factors. Therefore, they have also been termed “medicinal signalling cells” which ameliorate severe complications of diseases. MSC will not stay within the host tissue but will disappear after about two weeks. Therefore the risk of potential long-term complications is very low and the cells are considered to be safe.

What will you be doing in the project?

Our group has developed a way to manufacture MSC from the umbilical cord tissue of healthy term born infants in a high quality and has thereby opened a unique chance of successfully transferring MSC-based therapies into neonatal routine.

Based on that technique, we, the MASC-collaboration will establish the prerequisites for getting the MSC licensed for chronic lung disease of preterm infants. Therefore, we will conduct four clinical trials in Europe, Canada and the USA. The results from these trials will then be analysed together in a meta-analysis based on single patient data.

Furthermore, we will investigate prospectively further applications of MSC in newborns, focusing on brain-injury, sepsis and on the patient/parent perspective.

What is the aim of the “MASC-n-EU” project?

The European MASC-collaboration dedicates its effort with the “MASC-n-EU” project (“MSC to Ameliorate Severe Complications in Newborns in Europe”) to introduce umbilical cord-MSC-based therapy into neonatal care, with a special focus not only on treating but also preventing diseases originating in the feto-neonatal period. By providing a medicinal product specifically developed for the use in newborns we are addressing a great need and will improve the health of children in Europe.

Which professional areas will be involved?

The European MASC-collaboration dedicates the combined expertise and enthusiasm of leading scientists, clinicians, patient organisations, regulatory authorities and industry to make MSC-based regenerative therapies an integral part of clinical routine in newborns. Thereby, the European collaboration is embedded in a strong international network of experts, ensuring the success and sustainability of the project.

Thank you Prof. Rüdiger, for giving us insights into this innovative project.

[1] multipotent stromal cells that can differentiate into a variety of cell types.

SOURCE: https://www.efcni.org/news/regenerative-therapies-for-sick-term-and-preterm-born-infants/

 

WARRIORS:

16 Apps and Websites to Help Young Adults Stay

Healthy and Fit

Millennials and young adults are taking care of themselves. Using apps and websites to enhance their healthy lifestyles is an obvious choice for this tech-loving generation.

We reviewed the 16 recommended APPS and all will appeal to many of us for varying reasons. We found the APPS listed below especially interesting!

7 minute workout

The 7-minute workout uses the exerciser’s body weight to create exercises that build strength and muscle, rather than having to go to a gym or use equipment. While the app is free, some of the programs need to be purchased, most for a nominal fee.

https://itunes.apple.com/us/app/7-minute-workout-free-daily/id650762525?mt=8

Couch to 5K (C25K)

C25K takes couch potatoes and exercise slackers and slowly moves them from sitting to running a 5K (3 miles). The time period for this evolution is 2 months, and there’s a strong, supportive community available online for those in the program.* Tailored for first time runners

http://www.c25kfree.com/

Map My Fitness

If your young adult runner is a traveler, Map My Fitness is a handy tool to help him or her find the best and most convenient running routes in cities around the world, and it syncs to other fitness apps to keep track of miles run and calories burned.

https://www.mapmyfitness.com/us/

Rise

Rise is a weight loss program that is Tailored to the individual, backed by scientific research, focuses on healthy living and uses daily accountability to keep clients on track. Also unique to Rise is their photo-based communication between user and coach/trainer. With an emphasis on helping busy people stay on track, Rise is popular with millennials who are on the go and working long hours.

https://www.rise.us/

SOURCE: https://www.verywellfit.com/apps-and-websites-to-help-young-adults-stay-healthy-4122512

KAT’S CORNER

My Beloved Warriors: This month’s blog marks our three year anniversary of exploring, looking at, listening to, communicating with and immersing ourselves in our very large, diverse, and wonderful preterm birth community. The communities we have explored instruct and humble us to our core. You and I are survivors; our community has provided us with critical support and we will all work to understand, assess and treat our future health and wellness needs. Many of us have been reliant on the support of others to sustain our lives in very unique ways. For some of us taking on the responsibilities of caring for our own health and wellness needs may be quite daunting. When I look at the world at large I see humanity in need of collaboration. I am a recipient of so many gifts and I ask myself what will I contribute?  The beauty of looking at the whole world through the eyes of a preterm birth survivor is that I am transformed on a regular basis through exposure to our amazing preterm birth community in  every part of the world. Recently, I have become increasingly aware of how large our community is, and how our health and well-being is affected by the global community at large. Developing countries have taught us every bit as much as the so-called developed nations.  Maternal and infant health and mortality are not dependent on a nation’s net worth, but rather on that nation’s values, wisdom, humanity and vision.

I am sharing the article below because although in the USA preterm birth survivors themselves currently represent an estimated 9-12% of the infant/youth and young adult population we need to consider not only our prematurity-specific healthcare needs but the general healthcare issues confronting youth and young adults in our local nation as we are a part of that family as well.

So let’s put our phones away when we drive, call an Uber if tired or intoxicated, educate ourselves regarding guns and gun control, recognize and take appropriate action if we suspect a friend who seems to be depressed may cause harm to themselves or others. My Mom says, “Dead kids aren’t fun kids”. She would know… Let’s live with joy, connect with love and collaborate with curiosity and intelligence.

The Problem for Children in America

• Edward W. Campion, M.D.

Children in America are dying or being killed at rates that are shameful. The sad fact is that a child or adolescent in the United States is 57% more likely to die by the age of 19 years than those in other wealthy nations. In 2016, there were more than 20,000 deaths of Americans 1 to 19 years of age. Physical injury accounted for 61% of this tragic total. As the Special Report by Cunningham et al.² in this issue of the Journal documents, America’s children and adolescents are at far higher risk for death than are youth in other developed countries such as England, Sweden, and Australia.

The death of a child is a crime against nature. These tragedies leave enduring pain and may be the most stressful thing that can happen to parents and siblings. The devastated families take no comfort from the fact that childhood deaths are now far less common than they were in centuries past. In recent decades, there has been progress, but the United States is clearly not effectively protecting its children.

The problem is not deficiencies in medical care; it is the high rate of lethal traumatic injury. Firearm injury, the second leading cause of death, is only a minor contributor to childhood mortality in other developed countries. Cunningham et al. report that in 2016, children and adolescents in the United States were more than 36 times as likely to be killed by gunshots as their counterparts in other high-income countries. The grim statistics include suicides, which occur mainly in adolescents and which accounted for 35% of firearm-related deaths and 13% of all deaths among children and adolescents in 2016.

The largest single cause of child and adolescent deaths is motor vehicle crashes, which account for 20% of such deaths. In 2016, the U.S. rate of death from motor vehicle crashes (5.21 per 100,000 children and adolescents) was more than triple that in other developed countries, a finding consistent with other international comparisons. There has been substantial improvement in this rate over the past 20 years in this country, mainly thanks to safety engineering in car construction and road design. However, between 2013 and 2016, mortality from car crashes increased, most likely owing to the distracting and dangerous use of cellphones by both drivers and pedestrians. This is an area in which tougher laws and enforcement can save lives, but perhaps new technological solutions will be necessary to help keep eyes on the road rather than on small screens.

The biggest barrier to preventing the many deaths from injury is the sense of helpless inevitability conveyed by the word “accident.” Car crashes and lethal gunshots are not random results of fate. Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma. Strong leadership by the medical and public health communities is needed. Education, awareness, and very feasible interventions can help protect children and adolescents from the six top causes of death from trauma, namely those related to motor vehicles, firearms, suffocation, drowning, drug overdose or poisoning, and fire or burns. Our country has led the way in so much medical research, but the facts summarized by Cunningham et al. reveal a need to invest far more in research on the prevention of the injuries that threaten the lives of children and adolescents.

Progress will not be easy. The approach to this underrecognized public health problem has to be social as well as technological, and the risks are highest in areas of poverty and social isolation. Essential medical care should be guaranteed for every child in the country. That care needs to include access to the social supports and mental health services that promote health and safety and save lives. Such a commitment would be an investment in the next generation that can promote family stability and healthy development while reducing the underlying causes of trauma and violence. Laws and programs are also urgently needed to improve gun safety, and these initiatives need the support of those on all sides of the contentious political debates about guns. Here, the medical community is in the best position to take the lead. The guiding principle should be to save the lives of children.

We are living in a divisive era in which there are few areas of consensus and agreement. Perhaps one of the few core beliefs that all can agree on is that deaths in childhood and adolescence are tragedies that we must find ways to prevent. Shouldn’t a child in the United States have the same chance to grow up as a child in Germany or Spain or Canada? We ought to be able to agree that in a country with America’s wealth and resources, children should have the opportunity to live, play, and grow to become adults.

SOURCE: https://www.nejm.org/doi/full/10.1056/NEJMe1814600

World’s Most Extreme Nighttime Stunts in Switzerland!

devinsupertramp   Published on Nov 17, 2017- Lume Cube, creator of The World’s Most Versatile Light, brought some of the world’s greatest athletes to Interlaken, Switzerland to step out of their comfort zones and into the night!