SWEDEN
Estimated number of preterm births per 100 live births Rate: 5.9% RANK: 174
(US Rate: USA – 12% Rank: 54)
Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3
Sweden, officially the Kingdom of Sweden is a Scandinavian Nordic country in Northern Europe. It borders Norway to the west and north and Finland to the east, and is connected to Denmark in the southwest by a bridge-tunnel across the Öresund, a strait at the Swedish-Danish border. At 450,295 square kilometres (173,860 sq mi), Sweden is the largest country in Northern Europe, the third-largest country in the European Union and the fifth largest country in Europe by area. Sweden has a total population of 10.2 million of which 2.5 million has a foreign background. It has a low population density of 22 inhabitants per square kilometre (57/sq mi). The highest concentration is in the southern half of the country.
Sweden ranks in the top five countries with respect to low infant mortality. It also ranks high in life expectancy and in safe drinking water. A person seeking care first contacts a clinic for a doctor’s appointment, and may then be referred to a specialist by the clinic physician, who may in turn recommend either in-patient or out-patient treatment, or an elective care option. The health care is governed by the 21 landsting of Sweden and is mainly funded by taxes, with nominal fees for patients.
Source: https://en.wikipedia.org/wiki/Sweden
PREEMIE STRONG
New studies confirm improved survival of extremely preterm babies
MARCH 26, 2019 by Ivan Couronne
Until the 1980s, doctors estimated the earliest gestational age a baby could be considered viable outside the womb was 28 weeks, Survival rates of extremely preterm infants have improved by leaps and bounds since the 1980s, with US and Swedish studies published this week providing new data on the trend.
Doctors previously estimated the earliest gestational age a baby could be considered viable outside the womb was 28 weeks, when they weigh around 2.2 pounds (one kilogram)—about 12 weeks short of the 40-week length of a normal pregnancy. Babies are considered premature under the 37-week mark.
But over the last nearly 40 years, that 28-week limit has steadily dropped, and now some babies delivered at 24, 23 or even 22 weeks (measured from their mothers’ last menstruation) are able to survive, even as they weigh 1.1 pounds or less.
A Japanese baby who weighed only 9.44 ounces (268 grams) when he was born at 24 weeks made headlines in February: he was headed home in good health after five months in the hospital.
“I’ve been in this business for 40 years, and I’ve seen the threshold of viability move back about one week every 10 years or so in my practice,” Edward Bell, a neonatologist at the University of Iowa Children’s Hospital, told AFP.
Sweden holds the world record for earliest neonatal viability: 77 percent of babies born between 22 and 26 weeks in 2014 to 2016 survived one year, up from a 70 percent about 10 years before, according to a study published Tuesday in the Journal of the American Medical Association (JAMA).
In those 10 years, Sweden standardized its procedures for neonatal advanced life support: immediate intubation at birth, administration of drugs and a quick transfer to a neonatal intensive care unit (NICU).
Nearly 90 percent of deliveries in Sweden now occur in one of six hospitals in the country that have top-level NICUs.
“Before, for a baby born at 22 or 23 weeks, an individual doctor could say that it is not worthwhile to do anything,” said Mikael Norman, coauthor of the Swedish study and a neonatologist at Karolinska University Hospital in Stockholm.
For infants younger than 22 weeks, the survival rate has improved from 3.6 percent to 20 percent over the last decade, and for those born at 26 weeks, eight in 10 survive.
US lags behind
Since the 1990s, there have been three major medical advances in the effort to improve premature infant survival.
Artificial surfactants help keep babies’ poorly developed lungs inflated when they exhale, while maternal steroid injections right before birth can speed up fetal lung development (growing as much in one day as what might usually take a week) and improved mechanical ventilation techniques also help premature babies.
These techniques are widely available in developed countries, but significant disparities remain—from country to country and even between various hospitals.
In Britain, France and the United States, about half of extremely preterm infants (less than 26 or 27 weeks) survive, according to studies conducted in the last few years.
And the US system is not equivalent to its Swedish counterpart. American health care is rife with inequalities that can play out in the level of antenatal care pregnant women in different demographics receive.
A study in JAMA shows that geographic racial segregation in the US manifests itself in health care, as premature black infants have a greater likelihood of being born in lower-quality hospitals.
But the survival rate is still improving, even in the very rare instance of babies who are born weighing under 14 ounces, the subject of a third JAMA study—focused on US data—published Monday.
Of infants born between 22 and 26 weeks and weighing less than 14 ounces in 21 US hospitals between 2008 and 2016, 13 percent survived—one of them weighed only 11.6 ounces.
At such a low gestational age, the risk of complications is much higher, as three fourths of children born that early show developmental delays at age two.
All told, “it tells you that survival is possible,” said Bell, a coauthor of one of the US studies.
“One can’t say clearly that these babies should be always resuscitated,” Bell said, “but parents deserve to have this information and probably should have a say in whether they’re resuscitated.”
Source: https://medicalxpress.com/news/2019-03-sweden-world-extremely-preterm-babies.html
COMMUNITY
Inaugural WHO Partners Forum launches new push for collaboration on global health
9 April 2019 – News release – Stockholm
To meet the world’s most pressing health challenges, WHO, governments and global health leaders today called for improved partnerships and resourcing to support WHO’s mission to deliver care, services and protection for billions of people by 2023. The inaugural two-day WHO Partners Forum opens Tuesday (9 April) in Stockholm and will be co-hosted with the Government of Sweden.
The meeting will result in a shared understanding of how to strengthen partnerships and improve effective financing of WHO, with an emphasis on predictability and flexibility.
Global leaders in health and development, representing the public sector, health partnerships and non-State actors, will come together to launch a new era of collaboration and innovation around WHO’s resource needs. Under the Organization’s Thirteenth General Programme of Work (GPW13), WHO needs US$14.1 billion between now and 2023.
“WHO is committed to leaving no one behind as we strive for the highest attainable standard of health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is building stronger and more strategic partnerships with governments, international organizations, philanthropies and the private sector to deliver on the health-related targets in the Sustainable Development Goals (SDGs).”
At the heart of the GPW13 are the “triple billion” goals of ensuring that by 2023, 1 billion more people are benefitting from universal health coverage, 1 billion more people are better protected from health emergencies, and 1 billion more people are enjoying better health and well-being.
Peter Eriksson, Sweden’s Minister for International Development Cooperation, says: “The first WHO Partners Forum is a historic moment for honest discussions on tackling modern global health threats. If the world is to meet current and future health challenges, we need to ensure WHO is equipped and supported to be able to lead the global response.”
Sweden’s Minister for Health and Social Affairs, Lena Hallengren, says great advances have been made in global public health in recent decades, but new threats are putting communities, countries and economies at risk.
“Countries and health partners alike must collaborate even closer to respond to health challenges,” says Ms. Hallengren. “Fighting antimicrobial resistance, combating disease outbreaks and providing essential health services for all are keys not only to improving people’s wellbeing, but also to promoting growth and development. Only by coming up with a sustainable model to respond to pressing health threats in all countries will we be able to deliver on the ambition of the SDGs.”
Other participants in the Inaugural WHO Partners Forum include leadership of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill & Melinda Gates Foundation, International Federation of Red Cross and Red Crescent Societies and Gavi, the Vaccine Alliance.
We 
CUBA 
Kat and I want to express our humble gratitude, appreciation, respect for the medical community in Cuba, especially ELAM, the largest medical school in the world. Thank you ELAM for educating a robust global community of health care providers around the world, including US students, at a time when we are experiencing a global health care shortage crisis. The Cuban model for training primary care physicians is a premier model, influencing healthcare education and care on all corners of the planet. The Neonatal Womb Warriers community is significantly impacted by the Cuban approach to maternal and infant care, an approach that reduces preterm birth as reflected in Cuba’s preterm birth rate 6.4% (per 100 births), Rank: 169 (USA Rate: 12.0%, Rank: 54, Global average 11.1%).
Source: https://www.marchofdimes.org/mission/global-preterm.aspx#tabs-3
***See our 07/04/16 blog-World Warriors-Cuba-https://neonatalwombwarriors.blog/2016/07/04/world-warriors-cuba/
MEDICC supports students and graduates of Havana’s Latin American School of Medicine (ELAM), the world’s largest medical school, educating socially committed physicians from low-income families in the USA and developing countries.
MEDICC Deplores Latest US Move Against Cuba
Posted at 10:54hin MEDICC in the Media, Press Releases by medicc2016
April 19, 2019—This week the US administration announced more sanctions against Cuba, in a cruel move that puts at risk the health of people in both our countries. Building upon two MOUs in health signed under Presidents Barack Obama and Raúl Castro, scientists and health professionals had begun stepping up cooperation to address diabetes, cancer and other diseases, and prepare to jointly confront threats from new epidemics. Much hope for these initiatives was already dashed by stepped-up hostility from Washington under the current president, who has used drastic limitations in US visas to leave the MOUs in the “dead letter” box.
However, this week US national security adviser John Bolton went further. He announced the US would allow suits in US courts against foreign investors in Cuba if their investments involve Cuban-American properties nationalized by the Cuban government; cap the dollar amounts of family remittances to Cubans on the island; and further limit already-restricted travel by Americans to Cuba.
“This is a bitter day for all of us,” noted MEDICC Executive Director Dr. C. William Keck. “Not only do the new measures hurt ordinary Cubans, they also drive a wedge in the budding and all-important cooperation between our countries begun by professionals and researchers committed to our health.”
“Much can be learned from Cuba’s universal health care, as recently noted a Lancet editorial,” Keck said. “Cuba’s infant mortality, lower and with fewer disparities than our own, is one example. And Cuban biotech innovations could become a lifeline for US patients suffering an array of conditions, from diabetic foot ulcers to lung cancer.”
But, despite clear signals that the majority of Cubans and Americans—including Cuban-Americans—favor rapprochement, this administration is bent on undoing it and demonizing Cuba and the Cuban people in the process. This must beg the question: whose interests does this policy shift serve? Certainly not those of our health, in either country.
Source-http://medicc.org/ns/medicc-deplores-latest-us-move-against-cuba/
Domestic violence and preterm birth is an issue that deserves attention. Prevention of preterm birth is our number one goal because prevention is cost effective, humane, critically necessary and achievable. Identifying the diverse causes of preterm birth creates opportunity to develop policies, resources, treatments, interventions and guidelines focused on prevention. Reducing domestic violence is an issue we CAN impact.
Understanding Abuse and Preterm Birth: What Can Be Done?
April 02, 2019
More than 1 in 4 women experience domestic abuse. When a woman becomes pregnant, the frequency and severity of this abuse may be at risk of increasing (1). Domestic abuse has also been shown to increase a woman’s risk of delivering before 37 weeks, potentially putting her child in danger of lifelong complications. On the other side, early delivery is associated with an increased risk of maltreatment for infants born prematurely. Despite this pervasive link between domestic abuse and prematurity, it is rarely acknowledged in prevention education. For our March Collaboratory, we invited researchers, neonatologists and social workers to help us confront this challenging topic and lead a discussion on how we can all come together in the name of prevention.
The event, hosted at UCSF’s Mission Hall and moderated by Laura Jelliffe-Pawlowski, began with PTBi-CA epidemiologist Rebecca Bear, who provided a brief introduction to her work analyzing California hospital records. Bear explained that through her research she saw a correlation between a woman’s history of abuse and whether or not a person had a preterm birth. The results of her research indicated that the rates of preterm birth among women who had experienced abuse were nearly double than those who had not experienced abuse. However, this rate was not found once adjusting for variables such as age. Bear explained that the study was able to shed light on how health issues such as high blood pressure may be the indicator of stress that can be traced back to the violence and the preterm birth.
Human Service Agency Social Worker, Alexis Cobbins, shared her experience working directly with families who suffer from domestic violence and preterm birth. She explained that when child protective services removed a mother’s baby at birth because of the threat of violence from her abusive partner, “the babies’ attachment and bonding were disrupted. It was almost like she was suffering twice. Once from his abuse and then from child protective services – from their lens of keeping the child safe”. Though Alexis noted through her agency’s advocacy efforts they were able to reunite baby and mother, there needs to be a better understanding of how meet the mother’s needs of safety rather than focusing solely on the child.
Hector Santamaria, a social worker at the Human Service Agency, and Artanesha Jackson, a Clinical Social Worker at UCSF Benioff Children’s Hospital Oakland, also spoke about their experiences working firsthand with survivors of domestic violence how it related to their preterm births. Hector explained that what is needed is more than a specific intervention but rather, “a change in culture. I think it starts with those difficult conversations within our own families and our own communities.”
Liz Rogers, a Neonatologist and California PTBi researcher, spoke about how babies with complex medical needs are at greater risk of experiencing abuse or neglect and that babies who are born early are at risk of having complex medical needs. Through her research, she was able to drill down to see which complications of preterm birth increased risk for non-accidental traumas, such as fractures, which indicates abuse or neglect. Rogers noted, “really across the board [of medical complications] there remained a significantly higher risk of non-accidental traumas.”
Source:https://pretermbirthca.ucsf.edu/news/understanding-abuse-and-preterm-birth-what-can-be-done
HEALTHCARE PARTNERS
Randomized Trial of Platelet-Transfusion Thresholds in Neonates
Anna Curley, M.D., Simon J. Stanworth, F.R.C.P., D.Phil., Karen Willoughby, B.Sc., Susanna F. Fustolo-Gunnink, M.D., Vidheya Venkatesh, M.D., Cara Hudson, M.Sc., Alison Deary, M.Sc., Renate Hodge, M.Sc., Valerie Hopkins, B.Sc., Beatriz Lopez Santamaria, M.Sc., Ana Mora, Ph.D., Charlotte Llewelyn, Ph.D., et al., for the PlaNeT2 MATISSE Collaborators*
January 17, 2019 N Engl J Med 2019; 380:242-251 DOI: 10.1056/NEJMoa1807320
BACKGROUND
Platelet transfusions are commonly used to prevent bleeding in preterm infants with thrombocytopenia. Data are lacking to provide guidance regarding thresholds for prophylactic platelet transfusions in preterm neonates with severe thrombocytopenia.
METHODS
In this multicenter trial, we randomly assigned infants born at less than 34 weeks of gestation in whom severe thrombocytopenia developed to receive a platelet transfusion at platelet-count thresholds of 50,000 per cubic millimeter (high-threshold group) or 25,000 per cubic millimeter (low-threshold group). Bleeding was documented prospectively with the use of a validated bleeding-assessment tool. The primary outcome was death or new major bleeding within 28 days after randomization.
RESULTS
A total of 660 infants (median birth weight, 740 g; and median gestational age, 26.6 weeks) underwent randomization. In the high-threshold group, 90% of the infants (296 of 328 infants) received at least one platelet transfusion, as compared with 53% (177 of 331 infants) in the low-threshold group. A new major bleeding episode or death occurred in 26% of the infants (85 of 324) in the high-threshold group and in 19% (61 of 329) in the low-threshold group (odds ratio, 1.57; 95% confidence interval [CI], 1.06 to 2.32; P=0.02). There was no significant difference between the groups with respect to rates of serious adverse events (25% in the high-threshold group and 22% in the low-threshold group; odds ratio, 1.14; 95% CI, 0.78 to 1.67).
CONCLUSIONS
Among preterm infants with severe thrombocytopenia, those randomly assigned to receive platelet transfusions at a platelet-count threshold of 50,000 per cubic millimeter had a significantly higher rate of death or major bleeding within 28 days after randomization than those who received platelet transfusions at a platelet-count threshold of 25,000 per cubic millimeter. (Funded by the National Health Service Blood and Transplant Research and Development Committee and others; Current Controlled Trials number, ISRCTN87736839.)
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1807320?query=recirc_curatedRelated_article
*** Follow-up: April 18, 2019 – N Engl J Med 2019; 380:1584-1585 DOI: 10.1056/NEJMc1902638
Source: https://www.nejm.org/doi/full/10.1056/NEJMc1902638?query=featured_secondary
Collecting quality data is key: registries of babies treated for Retinopathy of Prematurity (ROP) can improve health, care, and science
POSTED ON 28 FEBRUARY 2019
Retinopathy of Prematurity (ROP) is a disease of the eye affecting preterm born babies. It is characterised by changes in the developing blood vessels of the retina (the light-sensitive layer in the back of the eye that sends visual signals to the brain). All preterm babies born before around 31 weeks of pregnancy or having a birth weight of less than 1,250g to 1,500g need to have eye examinations by a specialised eye doctor, called ophthalmologist, to check how the vessels in the eye develop.
This ensures that the development of ROP is detected early and can be treated if needed. Since there is a lag period after birth until ROP develops, the first screening usually takes place after four to six weeks following birth. It continues until the ophthalmologist can note that the vessels have fully grown in the outer parts of the eye and any ROP has resolved. Increasingly, photographs of the retina are being taken either by NICU personnel or by staff from the ophthalmology department for the ophthalmologist to evaluate the status of the eye and to document how the vessels develop.
From the point of view of our monthly topic “Data collection and documentation” in February, we are especially interested in the question, how single hospitals can evaluate their patients with retinopathy of prematurity, as they usually have only very few cases within a year. To provide all stakeholders with reliable information and outcomes, systematic collections of reliable data of quality registries focused on ROP for clinical research are of utmost importance as they help that different hospitals can evaluate their cases together and can compare the patients within a country, but even between countries.
We thus would like to present you two national ROP registries, the Retina.net ROP registry from Germany and the SWEDROP registry from Sweden and talked to the medical experts in charge, Professor Andreas Stahl (Retina.net ROP registry), Head of Ophthalmology at the Greifswald University Medical Center, Germany, and Professor Ann Hellström, Professor in Pediatric Ophthalmology, Sahlgrenska Academy, from The Queen Silvia Children´s Hospital, Göteborg, Sweden, and Professor Gerd Holmström (register holder), Department of Ophthalmology at the University Hospital Uppsala, Sweden.
The German Retina.net ROP registry is a collaborative network of academic institutions in Germany. It was created as a joint effort to acquire sufficient data of treated infants in a multicentre approach to analyse typical clinical features of infants, epidemiology, and treatment patterns of severe ROP.
SWEDROP is a national quality registry to evaluate screening and treatment for ROP in Sweden and to investigate possible modifications of the present screening guidelines. Almost all infants in Sweden born before a gestational age (GA) of 31 weeks are screened for ROP until the retina is fully vascularised, approximately at 40 weeks postmenstrual age (PMA). SWEDROP is organised through a steering committee where representatives from the University Hospitals (n=7) collaborate and are responsible to capture data from their regions.
Large Shortages in Primary, Specialty Physicians Seen by 2032
Kerry Dooley Young – April 25, 2019
There could be a shortage of 46,900 to 121,900 physicians by 2032, in both primary and specialty care, with burnout potentially affecting retirement timing and a trend toward shorter working hours contributing to the wide range of estimates, a new report shows.
The Association of American Medical Colleges (AAMC) on Tuesday released its latest outlook on the supply and demand for physicians, which was conducted by IHS Markit, a data analysis and market intelligence firm based in New York and London.
AAMC said in 2015 that it made a commitment to commission annual updates of national physician workforce projections. The 2019 report shows a dearth of primary care physicians by 2032, with a shortage of 21,100 to 55,200 seen in this field.
Among specialty care, the shortage is expected to be in the range of 24,800 to 65,800, including between 1900 and 12,100 medical specialists; between 14,300 and 23,400 surgical specialists, and between 20,600 and 39,100 other specialists such as pathologists, neurologists, radiologists, and psychiatrists, the report shows.
“The United States would need an additional 95,900 doctors immediately if healthcare use patterns were equalized across race, insurance coverage, and geographic location,” the AAMC states in a news release.
Physicians’ decisions on when to retire will play a key role in determining the extent of the future shortage, AAMC said. Physicians between ages 55 and 64 make up 27% of the active workforce, with those older than age 65 accounting for another for 15% of it.
“Thus, over 40% of the physician workforce is at risk for retiring over the next decade,” the AAMC report shows.
And, the toll of burnout on physicians could lead some to accelerate retirement plans, the report authors said, citing Medscape data. The 2018 Medscape National Physician Burnout and Depression Report found 42% of physician respondents reported burnout as a result of causes such as long work hours and excess bureaucratic tasks.
AAMC said it is fielding a physician survey this year to collect data about physician retirement patterns and physician work patterns. This information is intended to address questions of whether high levels of physician burnout may accelerate retirement plans or lead to reduced work hours.
Other issues that AAMC highlighted for further research include the effects of an expected increased supply of physician assistants (PAs) and advanced practice registered nurses (APRNs). It is also still unclear how an expected rise in the number of retail health clinics may affect demand for physicians, the report authors said.
The report noted the potential impact of “a trend toward physicians of all ages working fewer hours.” It added that the decline in hours worked appears “particularly large when comparing recent hours-worked patterns of younger physicians relative to physicians of a similar age a decade ago.”
Source-https://www.medscape.com/viewarticle/912259
PREEMIE FAMILY PARTNERS
YOUTUBE
28 weeker micro preemie-Willie’s first diaper change with Mommy
Naturally boost oxytocin levels for Neonatal Bonding | Living Healthy Chicago
LivingHealthyChicago Published on Mar 11, 2019
Oxytocin is naturally occurring hormone that plays a role in social bonding. Today Jackie learns about scent clothes that are helping babies who spend time in the NICU bond with their parents! Find out why scent cloth hearts are making a big difference for the very youngest of patients. Living Healthy Chicago is a health and wellness program that airs Saturday mornings at 9am on WGN. We aim to educate and inspire our viewers to live healthier lives.
One year update after the opening of the NICU in the Teck Acute Care Centre
October 29, 2018
One year ago today, 110 patients were moved into the new Teck Acute Care Centre (Teck ACC) in just five hours. Use this image as both the current Page Image and for News listings.
It was a truly awe-inspiring feat and an auspicious beginning for the newest health-care facility on the BC Children’s Hospital and BC Women’s Hospital + Health Centre campus on Oak Street in Vancouver.
The Singhs were one of a few families who transitioned from the old Neonatal ICU (NICU) to the new one with the opening of the Teck ACC. Baby Harmeher Singh weighed just 450 grams when he was born prematurely. Harmeher and his family experienced an immediate, positive change in both care and environment between the two vastly different spaces.
“Harmeher means God’s blessing, and he truly is God’s blessing to us,” said Harmeher’s mother, Bubblepreet Randhawa. “We’re so thankful that the NICU team saved him and to have been in this bigger private room, where my husband spent the night here and Harmeher’s big brother was able to come visit to spend more time with his baby brother and share mommy-time.”
We’re happy to announce Harmeher is a thriving 13-month old (true age); his corrected age is nine and a half months. He is very intelligent and loves to play with his brother, Gurmeher. “Again, we are so grateful he is healthy and for the care he received. Thank you!”
“The BC Women’s NICU is North America’s first purpose-built unit of its kind, where mothers receive their postpartum care in the same room, from the same NICU nurse, as their newborns who need neonatal intensive care so that these mothers and babies need not be separated after birth,” said Cheryl Davies, chief operating officer, BC Women’s Hospital + Health Centre. “New and expectant mothers and their newborns now have state-of-the-art facilities in the new Teck ACC—an environment that supports our medical care providers and staff to provide the best patient care possible.”
The Teck ACC houses a range of patient care services, including the labour and delivery unit for complex pregnancies, expanded dedicated obstetrical surgical suites, blood transfusion services, centralized medical equipment depot and sterile processing services, the Emergency Department, and more than 200 private patient rooms supporting patient- and family-centred care.
Benefits for patients and their families in the new building are more natural light and access to therapeutic outdoor spaces, and amenities like kitchenettes, laundry, family lounges and play areas.
The Teck ACC is part of the BC Children’s and BC Women’s Redevelopment Project to improve care at BC Children’s and BC Women’s hospitals.
The Teck Acute Care Centre at BC Children’s Hospital – Video Tour with Michael Bublé
BC Children’s Hospital Foundation Published on Oct 26, 2017
Take a tour of the Teck Acute Care Centre at BC Children’s Hospital, hosted by Michael Bublé. Patients’ and their families’ entire journey—of body, mind and spirit—has been planned and designed in extraordinary detail.
New series on cohorts of the Research on European Children and Adults born Preterm (RECAP preterm) project
POSTED ON 17 APRIL 2019
Our new series presents the cohorts of the EU-funded project „Research on European Children and Adults born Preterm“ (RECAP preterm), which aims at contributing to a better understanding on the long-term effects of preterm birth and thus to an improvement of the follow-up of these children. A research cohort is a group of people who share a defining characteristic, e.g. in the case of RECAP preterm, the cohorts consist of children (and later adults) born very preterm or with very low birth weight (VPT/ VLBW cohorts). This group is then accompanied over time to research the different consequences of preterm birth that can occur. RECAP preterm brings together Europe’s strongest pregnancy, child to adult cohorts and a highly experienced group of organisations and individual researchers.
We start with the ESTONIA I & II cohorts and are delighted to present you a guest article by the expert in charge, Dr Heili Varendi from the University of Tartu.
A guest article by Dr Heili Varendi, associate professor and neonatologist at University of Tartu
The main idea for the cohorts collected in Estonia was to fill a gap – by 2006 there was no national population-based data available about the outcome of very preterm births (VPT) after 7 postnatal days in Estonia. The aim was to collect nationwide data and create a system to assess quality of perinatal and neonatal care.
(c) Dr Heili Varendi, University of Tartu
Paediatricians from three 3rd level maternity units and two regional children hospitals in Estonia initiated a national pilot register for all sick newborns in 2007 – 2008. We also prepared national guidelines for follow-up of high-risk (incl. very preterm) infants until 2 years, that was published in 2008 and had been implemented in 2009. To prepare for these activities, our team collected good examples from Finland and Sweden.
Along with the pilot register, a prospective population-based study of very preterm infants born in 2007-2008 (n= 360) was carried out with follow-up at 2-years corrected age for all VPT (n=155) and at 5 years for a subgroup (n=49) born <1000g and <29 weeks gestational age (Estonia II). For the historical control group, retrospective national perinatal-neonatal data were collected for all very preterm births (n=264) in 2002-2003, and at 5 years assessed the health and development of the subgroup (n=61), born <1000g and <29 weeks GA (Estonia I). We have also collected data about health costs and use of health care resources for all these groups (Estonia I and II, n=624) from birth until 5 years.
Challenges in data collection were: lack of resources (e.g. Tallinn Town Government supported creation of the first database but all paediatricians collected perinatal data on voluntary basis; we applied for a research grant but only received 50% of the requested rate).
It was challenging to select tests for assessment of development; most of the available tests were not translated nor validated in Estonian and Russian.
During last 10 years we have worked to achieve a systematic data collection for high risk newborns from birth to preschool age, and finally, in 2019 we’ll get the opportunity to have a chart for very preterm infants until discharge or 44 postmenstrual weeks included in the Estonian Medical Birth Registry.
Results: With these two cohorts we could see changes in perinatal and neonatal care and outcome of very preterm infants in Estonia. We had the opportunity to compare Estonian results internationally and provide feedback to obstetricians and specialists in neonatal care. We saw positive trend in increase of survival without concomitant rise in severe neonatal morbidity and long-term disability. But we faced different unexpected problems in child development at preschool age. Based on these results we could recommend prolongation of follow-up activities and interventions to extremely preterm children beyond 2 years, until school age.
With our cohorts we hope to help the families with very preterm deliveries by demonstrating what the potential prognosis of their VPT children is to survive and develop until preschool age.
Source:https://www.efcni.org/news/series-on-cohorts-recap-preterm/
INNOVATIONS
Brilliant Duo’s Affordable Innovations Are Saving Lives of ICU Patients & Preemies!
In a country where 37 per cent of patients on mechanical ventilators get pneumonia and where 50 per cent of babies are born away from well-equipped hospitals, these medical marvels are proven life-savers.
by Tanvi Patel March 1, 2019, 3:56 pm
Nitesh Jangir grew up in Shivnagar village, Rajasthan.
Nachiket Daval, a son of a now-retired naval officer, lived in many parts of India due to the nature of his father’s profession.
Despite their different backgrounds, the two friends-cum-business partners have similar experiences with regards to the prevalent healthcare system in India at both village and district levels.
Nachiket and Nitesh saw upfront how the lack of medical facilities—existing and advanced—spelled doom for the people awaiting their turn at the Primary and Secondary Healthcare Centres.
While Nitesh went on to study engineering, Nachiket pursued design. But, always present back of their minds were the patients sitting at the hospitals waiting for treatments they could neither access and frankly, nor afford.
One of Lung India’s studies found that 37.5 per cent patients on mechanical ventilators in Indian ICUs catch pneumonic infections. In a large number of cases, such infections can be life-threatening.
Another shocking find stated that out of all children born, 53 per cent die under the age of 5 years during the neonatal stage. These studies propelled Nitesh and Nachiket to search for solutions.
And COEO Labs was the result.
Nitesha and Nachiket’s company makes medical devices with the aim to meet the medical needs in critical care. Together, they designed two devices; Saans—a low-skill, low-cost, neonatal Continuous Positive Airway Pressure (CPAP) device and VAPCare– an intelligent secretion management device to prevent ventilator-associated pneumonia (VAP).
Saans
On a night shift at the hospital we saw an auto come into the emergency department. Three people came out of the auto carrying a new-born. The doctor’s started the medical procedure immediately but they couldn’t save the baby,” Nachiket tells TBI.
The friends later found out that the baby had been a premature who suffered complications due to severe lack of oxygen. Lack of appropriate medical support at the hospital where the baby had been delivered, and the time it took to transfer the baby to another hospital proved fatal for the infant.
In a country where about half of the children born are, at the most, 5-10 km away from a care centre, the number of babies who die due to lack of medical facilities is staggering.
Sometimes deliveries may not always be in a hospital with respiratory support systems for premature babies. In some cases, well-equipped ambulances may do the needful but what of those who cannot afford to wait for an ambulance or where the ambulance too, is does not have the necessary equipment?
“Currently, all neonatal CPAP machines (including bubble CPAPs) require electrical power or compressed gases to function—neither of which is easily available in primary care centres, or during transport in low-resource settings,” says the COEO team.
Saans is the world’s first neonatal CPAP device that can be powered in multiple ways – through direct source electricity (including a vehicle’s electrical supply), a rechargeable battery, compressed gas, or even manual air pumping.
When there is a power cut, as is very frequent in many parts of India and Saans can be operated manually with the help of a standard Bag Valve Mask bag (BVM) (a manual resuscitator) fixed to it. The system, patented by COEO, converts a variable flow of the BVM bag to a continuous and controlled airflow.
Saans, which took over three years testing and finalisation, has already started showing results. Nitesh shares a story which has a permanent place in the team’s heart.
“We deployed a Saans device to a low-resource hospital in Kolar, Karnataka. This hospital has a high volume of premature births but lacks infrastructure to support the existing CPAP machines. A few days after we gave them the device, we got a message from the doctor saying that there was a premature baby admitted to the hospital,” says Nitesh.
The doctor said that they had tried everything they could to save the baby. When nothing else worked, they tried Saans and the baby’s condition improved within two hours. At night, during a power cut, the device continued to work thanks to its manual settings.
“The doctor messaged saying that the baby survived because of Saans and he congratulated the whole team for developing the device.”
Source: https://www.thebetterindia.com/173836/india-medical-innovation-cheap-ventilators-premature/
WARRIORS:
Some people say there’s nothing new under the sun. I still think that there’s room to create, you know. And intuition doesn’t necessarily come from under this sun. It comes from within- Pharrell Williams
KAT’S CORNER 
Intuition guided my mom, brother Seth and I to adopt our PTSD cat Gannon. We had been dealing with a rat problem in our garage which my mom, my sister Ciara and I had passionately attempted to get rid of, but the rats out-smarted us every step of the way. None of us consider ourselves “cat people”(we love big dogs!) but my brother Seth is and had been looking for a cat after his had passed. Thinking a cat may solve the rat issue and that Seth may enjoy a new member of the family one day my mom casually looked at cat adoption information. Scanning cat pictures and bios she was completely taken by Gannon’s handsome and intelligent face, his history of rehabilitation at a local prison and his PTSD status. Gannon, a mane coon – mackerel tabby had been living in the pet store for over a year. Mom located the adoptable cat and we drove to see him late that evening. For my mom and me it was deep love at first sight. Excitedly we informed Seth about Gannon and started a plan for adoption. When we contacted management about adoption, they informed us they wanted Gannon to go to a man. Seth came up from California to finalize the adoption process. A week later we welcomed Gannon into our family and the rest is history. It has taken hard work to create an environment where Gannon (Ganzie) feels safe. His PTSD habits are very similar to our own. He shows us every day he appreciates us, and he demands to lick and clean our hands and give us love bites in exchange for our petting, massages and care. He heals us as we support his healing. Intuition at it’s best……
Nikola Tesla’s Secret of Intuition- Bright Insight
Published on Mar 11, 2017
Nikola Tesla utilized an incredibly powerful combination of Intuition and creativity to develop his inventions. Tesla spoke of the energies of the Universe, Frequency and how Intuition made his inventions possible. Tesla utilized Intuition to create his inventions, and established more than 700 patents around the world. Yet, mainstream science seems bent on suppressing this incredible knowledge.
Surf city winterjam 2012 / Varberg
Jonah Lake-Loading…Published on Dec 10, 2012
This is a short mix of a surf gathering/competition held in Varberg Sweden the 9th of December. It’s probably one of, if not, the coldest surfevent ever held in the world. In the morning the temp was below -14´C and some part of the ocean close to shore was ice. During the comp it got warmer up to -4,5´C. Surfers from Sweden, Peru, Costa Rica and Panama entered the competition.
Helsingborg Sweden
The Neonatal Womb Warriors 