THAILAND

Rate: 12%      Rank: 55

(US Rate: USA – 12% Rank: 54)

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

Thailand, officially the Kingdom of Thailand and formerly known as Siam, is a country at the centre of the Southeast Asian Indochinese peninsula composed of 76 provinces. At 513,120 km (198,120 sq mi) and over 68 million people, Thailand is the world’s 50th-largest country by total area and the 21st-most-populous country. The capital and largest city is Bangkok, a special administrative area. Thailand is bordered to the north by Myanmar and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the west by the Andaman Sea and the southern extremity of Myanmar. Its maritime boundaries include Vietnam in the Gulf of Thailand to the southeast, and Indonesia and India on the Andaman Sea to the southwest. It is a unitary state. Although nominally the country is a constitutional monarchy and parliamentary democracy, the most recent coup, in 2014, established a de facto military dictatorship under a junta.

Health and medical care is overseen by the Ministry of Public Health (MOPH), along with several other non-ministerial government agencies, with total national expenditures on health amounting to 4.3 percent of GDP in 2009. Non-communicable diseases form the major burden of morbidity and mortality, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues.

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

COMMUNITY

The Prevention of Preterm Birth

The Prevention of Preterm Birth

Samitivej Hospitals – Sep 27, 2017

Preterm birth is a major concern in Thailand because the rate of preterm births is about 12% of all births. Preterm babies are at increased risk of death, disability or complications. During prenatal care, the cervical length is measured by transvaginal ultrasound between 18-24 weeks of pregnancy. When the cervical length is less than 2.5 cm, women face the probability of preterm delivery. We can prevent this by giving natural progesterone to at-risk pregnant women. A follow-up examination is then made to determine any cervical length shortening and other possible complications. In the case of a short cervical length, management techniques include using a silicone pessary (made from body friendly silicone) which is placed around the cervix transvaginally, or tightening the cervix with a stitch (cervical cerclage). With the 3P Concept initiated by the Preterm Prevention Clinic, the risk of preterm birth is reduced by 50% (compared to the WHO’s target).

The Lancet editor Richard Horton honored with Roux Prize

Dr. Richard Horton, the “activist editor” of the international medical journal The Lancet, was honored June 10 for his accomplishments as one of the world’s most “committed, articulate, and influential advocates for population health.” He received the Roux Prize, given annually to individuals on the front lines of global health innovation in data science.

 

Interview: Ryan McAdams, US

In our Interview series, we are grateful to present this interview with  @Ryan McAdams , US, a neonatologist who is also a painter. We were curious to speak with Ryan about his art work, and the intersection of neonatology, child health and arts. By Stefan Johansson – October 3, 2018:

Could you please introduce yourself and where you currently work?

I am Ryan McAdams, the Neonatology Division Chief and Neonatal-Perinatal Medicine Fellowship Program Director at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. I’m married and have two wonderful children.

How did your professional career lead you to this spot?

After my fellowship training in San Antonio, Texas, I worked on a naval base in Okinawa, Japan, as an officer and neonatologist in the United States Air Force. I was the Air Transport director responsible for orchestrating and often going on flights to transport critically ill neonates throughout the Western Pacific who required care in the NICU. I met some amazing people in the military and learned a lot about other cultures. While in Japan, I became passionate about global neonatal health and did volunteer medical work in Mongolia, Cambodia, Zambia, and Malawi. After leaving the Air Force, my wife and I moved to Seattle, Washington, where I accepted a job at the University of Washington and Seattle Children’s Hospital. I continued to do global health work with colleagues in Seattle, mainly working in Uganda, with a focus on using education to empower local providers to deliver quality neonatal care. This global health work helped reinforce my strong belief that every baby everywhere is valuable and deserves the best opportunities to thrive.

While in Seattle, I worked with a talented team of neonatologists, and was fortunate to have numerous opportunities to conduct translational and clinical research focused on understanding perinatal lung and brain injury. After eight enlightening years in Seattle, I was recruited to be the Neonatology Division Chief at the University of Wisconsin, Madison. Since I was born and raised in Wisconsin, I was thankful to be close to my family again.

You are also a painter – please tell us what led you into painting?

As a child, my aunt gave me an oil paint set, which encouraged me to start painting. I have always had a keen interest in the myriad of colors and subtle details that abound in nature, so exploring the world through art has been a gratifying experience. In medical school, I decided painting would be a healthy creative outlet to stay well-rounded in the midst of intense studying. Short on money, I drove my grandmother to a local craft store and used her senior citizen discount to buy a plethora of art supplies. I built an easel and began to paint. At the time, I was a big fan of Salvador Dali, so his surrealistic style influenced my initial approach to painting. Throughout medical school, I often stayed up all night long painting, a method not always ideal for the rigorous demands of medical school. With my first big canvas painting, I entered an art contest in JAMA magazine and my painting “A Grasshopper Which Sprang From Indecision While a 3-Day-Old Peeled Banana Waited to Be Painted (JAMA. 1998; 280:1189) was a Grand Prize winner. This germinal success misinformed my understanding of how complicated, competitive, and cultivated the art world was, a realization that I learned while in my pediatric residency in northern California. I developed a quick sense of humility after peddling my painting portfolio around the art galleries in San Francisco where the exorbitant price tags of authentic Chagall and Miró prints led me to a somewhat disheartening assimilation of my place outside the circle of established artists. This epiphany led to introspection and a self-declaration that my painting needed to serve a purpose to bless others in a way unhindered by any motivation for supplemental income.

While living in Japan, inspired by the woodblock masterpieces of Hokusai, I painted a contemporary series of acrylic paintings featuring a hybrid of themes from famous Japanese prints. I also began working on a collection of paintings illustrating the teachings and ministry of Christ described in the Gospel of Luke, a book written by Luke, who was a physician. As I became more involved in global health, the focus of my art centered on the plight of the impoverished and marginalized children of our world.

Do you have art school training or are you an auto-didact?

While I am certain formal training would have been advantageous, I am a self-taught painter.

Can you expand on your themes in your paintings?

As a neonatologist who has been privileged to do global health medicine and work in large medical centers NICUs, I have witnessed a substantial amount of suffering and death. I have also witnessed the incredible resilience of children and the awe-inspiring dedication and love of their families. These experiences shape why and what I now paint. Themes of social injustice, survival, pain, and grief are the basis for my art since these ageless motifs are still globally preeminent today.

What messages to you want to convey to those viewing your paintings with neonatal themes?

My paintings are an amalgamation of emotions constructed with colors, lines, and textures into a tangible declaration aimed at validating the importance of children who have struggled or died, regardless of the brevity of their life. My hope is that my art will validate the existence of these amazing children and provide insight for the viewer, who can contemplate the stories I have tried to capture in acrylics.

Do you direct the painting to the general public or a more niched “neonatal audience”?

I paint for the general public, recognizing that the medical community may be more accessible to share my work with, but hopeful that any viewer will pause to consider my art.

Are those painting also part of your own processing of experiences?

When I paint a subject or theme related to an intense event, such as the death of a child that I was privileged to care for, this experience provides me a way to work through my emotions and cope with grief. Engaging in this process often requires me to relive difficult experiences in a vivid and immersed manner, which can be quite overwhelming, at times resulting in tears, frustration, scrutiny, and speculation. When I paint a baby or child who died, I approach each painting with deep reverence, often engrossed in deep reflection and prayer about the child’s family, wondering what things would have been like had the child survived. In some ways, the final painting becomes a testimony that substantiates an otherwise untold story, a story that I hope will help others.

After the unexpected death of my father, at a time when my neonatology work schedule was especially onerous and severe sciatica from my herniated disc was a constant torment, I used painting as I means to deal with my pain and grief. My painting, “Self-Portrait” conveys a period of darkness I experienced and now reminds me that my resilience prevailed despite my trying circumstances. I feel that all people have seasons of struggle and sorrow, so finding constructive coping mechanisms is key to overcome anticipated or unexpected adversity. Right before moving to Wisconsin, my mother, a comical and quick-witted woman who was avid reader and art lover, was diagnosed with lung cancer. A year later, after multiple bouts of chemotherapy, she died days after her birthday. Both my parents encouraged my creativity, so although I can no longer show my latest paintings to them, they still inspire me in a way that I feel I am able to share my work with them.

Where have you presented your art?

I have presented my work at small venues including a café, hair salon, church, and at a medical conference. No museums yet, but hopefully someday.

And, those of us wanting to see more of your work – when to we go where?

I have had 8 paintings published in medical journals (see links below), but I do not have a website to view my work, since I have not had sufficient time to develop and maintain a quality site.

For newly graduated colleagues around the world – what would be your advice for their future professional and personal development, with regards to mixing of NICU work and creative work?

I encourage anyone to explore the value of painting from a wellness perspective. Painting is an amazing way to engage your mind and body in an emotional outlet that provides mechanisms to relax, laugh, grieve, reflect, share, process, and cope with the variety of experiences we face in life. I feel everyone has creativity they can express and that a blank canvas should not be a daunting endeavor, but an amicable invitation to express yourself.

And finally, what about your own future plans?

While living in Japan, I conceptualized a way to help support orphans using art. I would love to develop a nonprofit organization where people can purchase online prints of original paintings and then choose a non-governmental organization of their preference to dedicate 100% of the profits to benefit children in need. My grander vision is to establish an international museum dedicated to orphans that would include donated art from global artists and would feature art from orphans around the world. This museum, which would serve as a voice for our most vulnerable children and represent a place where their importance is highlighted, could generate financial resources to support constructive programs, such as academic scholarships, that will help future generations thrive. I am grateful to be a neonatologist, a husband, a father, and an artist, so I look forward to further applying my talents to advocate for children.

Source: https://99nicu.org/99nicu-news/interview-ryan-mcadams-us-r95/

Hurray!!!! It’s that time of year  Our Neonatal Womb Warrior/Preterm Birth Community benefits  from the Global attention that shines upon us on this significant date.  Prevention is key, and exploration, research  and creating a healthy and connected community will empower us to support the joy and well-being we all desire.

WORLD PREMATURITY DAY    NOVEMBER 17, 2019

World Prematurity Day is observed on 17 November each year to raise awareness of preterm birth and the concerns of preterm babies and their families worldwide. Approximately 15 million babies are born preterm each year, accounting for about one in 10 of all babies born worldwide. Urgent action is always requested to address preterm birth given that the first country-level estimates show that globally 15 million babies are born too soon and rates are increasing in most countries with reliable time trend data. Preterm birth is critical for progress on Millennium Development Goal 4 (MDG) for child survival by 2015 and beyond, and gives added value to maternal health (MDG 5) investments also linking to non-communicable diseases. For preterm babies who survive, the additional burden of prematurity-related disability may affect families and health systems.

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

World Prematurity

 

Global and Country-Level Preterm Birth Estimates

The Global Burden of Preterm Birth affects families in every country. While more than 80 percent of preterm births occur in Asia and sub-Saharan Africa, the problem is universal. In fact, the United States and Brazil are among the top 10 countries with the highest number of preterm births. Preventing deaths among babies born too soon is a major challenge for many countries. But the most urgent action to prevent, diagnose and manage preterm birth is needed in the 10 countries that account for nearly two-thirds of all deaths from preterm birth complications .

Source: https://www.healthynewbornnetwork.org/resource/world-prematurity-day-2018-global-and-country-level-preterm-birth-estimates/

World Prematurity Day 2019 Message Map

Born too Soon: Providing the right care, at the right time, in the right place

The Healthy Newborn Network (HNN) is an online community dedicated to addressing critical knowledge gaps in newborn health.

Ensure High Quality Care for Every Baby Everywhere

WHY

• Small and sick newborns, most of whom are born preterm, have the highest risk of death and contribute to the majority of the world’s disabled children
• The most vulnerable newborns are those in marginalized groups, rural areas, urban slum environments and humanitarian settings. Girls are more vulnerable in South Asia
• Delivering inpatient care for small and sick newborns is often a challenge in low- and mid-income countries– and even more so in humanitarian settings
• High quality, affordable care (Universal Health Care) before, during and after childbirth for all women and babies can prevent many maternal and newborn deaths.

HOW

• Strengthen and transform health systems at every level
• Use the evidence by providing quality, equitable access to high-impact evidence-based interventions throughout the life-course. Midwife-led continuity of care reduces preterm birth by 24%.
• Focus on strengthening the health workforce, especially midwives and nurses with special skills in newborn care
• Invest in care for women and newborns in humanitarian and fragile settings (The Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings)
• Engage stakeholders from across humanitarian and development sectors to ensure newborns survive and thrive even in the most difficult circumstances
• Design, test and scale-up new and innovative service-delivery approaches and cost-effective health-care technologies
• Engage communities around adherence of quality service and access to care, especially amongst the most vulnerable populations

Provide Nurturing Care for the Best Start in Life

WHY

• Nurturing care is the set of conditions that provide for children’s health, nutrition, security and safety, responsive caregiving and opportunities for early learning
• Nurturing care promotes physical, emotional and cognitive development
• Nurturing care promotes skin-to-skin contact between baby and family and ensures baby receives mother’s milk
• Health providers partnering with parents and families is necessary to provide nurturing care, and improves outcomes for babies
• Zero separation maintains infant-parent unity and protects the family bond

HOW

• Ensure every small and sick newborn receives nurturing care, including early, essential newborn care
• Implement simple, cost-effective ways to promote developmentally supportive care, e.g. gentle touch, skin-to-skin care, kangaroo care, age-appropriate stimulation and interaction, protection from noise and bright light, or nesting
• Ensure health facilities have the guidelines, equipment, supplies, and infrastructure they need to care for preterm babies, including space for families to partner in that care with zero separation, i.e. at all hours and respectful care
• Initiate early breastfeeding / breastmilk feeding
• Empower fathers to participate in nurturing care and be included in the family unit in facilities
• Ensure communication between health providers and families on preterm babies’ special needs, and provide physical and emotional support to the family
• Champion policies and regulations that support nurturing care and family engagement in the health system, particularly inpatient care of newborns

Empower Women and Adolescent Girls to Deciding for their Health

WHY

• Women and adolescent girls have the right to decide whether, when and with whom they want to have children but are often not able to make these decisions themselves.
• Early (adolescent/young age), frequent and closely spaced pregnancies increase the risk of preterm birth
• Women have a right to respectful care before, during and after pregnancy
• Preconception care is critical to prevention of many adverse birth outcomes
• In many countries, girls suffer from lack of access to good nutrition and quality healthcare due to gender inequality
• In many countries, child marriage is an issue for increasing burden of mortalities and morbidities among young girls and their newborns

HOW

• Ensure all women and adolescent girls have information and access to care, including family planning and knowledge around risk factors
• Empower women and adolescent girls everywhere to make healthy choices
• Implement high quality, equitable healthcare to women and girls, including midwife-led continuity of care, and nutrition throughout their life-course, irrespective of their pregnancy intentions.
• Address gender inequalities that impact the ability of women and girls to achieve good health outcomes and realize their human rights and full potential
• Engage with men and boys to encourage more equitable decision-making and policy support at all levels

Source: https://www.healthynewbornnetwork.org/resource/world-prematurity-day-2019-message-map/

HEALTH CARE PARTNERS

Effects of Massage Therapy and Kinesitherapy to Develop Hospitalized Preterm Infant’s Anthropometry: A Quasi-Experimental Study

Author links open overlay panel – María JoséÁlvarezPhD, MSc, PT^aDoloresRodríguez-GonzálezRN^bMaríaRosónMD^bSantiagoLapeñaPhD, MD^bJuanGómez-SalgadoPhD, MSc, RN^cdDanielFernández-GarcíaPhD, MSc, RN^e

Highlights-This study examined the effects of massage and kinesitherapy on the anthropometry of preterm infants.The massage therapy and kinesitherapy protocol improved weight, size and head circumference in preterm infants.Massage therapy is an easy and cost-effective intervention to improve preterm infants’ anthropometric development.

Abstract: 

Purpose-The aim of this study was to analyze the efficacy of massage therapy and kinesitherapy on the anthropometric development of hospitalized preterm infants applied by parents.

Design and methods-A prospective quasi-experimental study was designed. Hospitalized preterm infants received a daily 15-minute session of massage therapy and kinesitherapy. The control group received regular medical and nursing care.

Results-The massage therapy and kinesitherapy protocol significantly improved the anthropometric parameters studied: weight (895.7 ± 547.9 vs 541.8 ± 536.2; p < 0.001) size (5.5 ± 4.3 vs. 3.0 ± 3.1; p < 0.001) and head circumference (4.2 ± 3.2 vs 2.4 ± 2.6; p < 0.001).

Conclusions-The implementation of a massage therapy and kinesitherapy protocol is beneficial for the anthropometric development of hospitalized preterm infants.

Practice implications-An easy to administer and cost-effective intervention such as massage therapy and kinesitherapy can improve the anthropometric development of preterm infants and reduce growth-related morbidity in the short, medium, and long term.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0882596319300478

What is Neonatal Nursing?

National Association of Neonatal Nurses – Loading…

Published on Sep 9, 2019

Learn about and celebrate the meaningful experiences and amazing impact of neonatal nurses inside the walls of the NICU and beyond.

 

Supporting Our Health Care Family    

The Association of American Medical Colleges has predicted a nationwide shortage of between 40,800 and 104,900 physicians in the USA by the year 2030. The biggest barrier to providing an adequate physician workforce in the USA may be the limits the system itself places on the number of residency spots available to resident physicians, and this is a system issue that could be fixed. A person must ponder why it has not been adjusted (follow the money, of course).  Another consideration may include an evolution-resistant, haze-centered culture limping through the 21st Century. In order to make becoming and working as a physician in the USA a humane and healthy career option, changes are required. Our health care community as a whole is worthy of the same employment law protections and benefits that apply to the Public at large. Cheers to those of you working globally to promote safety, health and wellness within the  provider community.

 

 Perspective

Parenting during Graduate Medical Training — Practical Policy Solutions to Promote Change.

Debra F. Weinstein, M.D., Christina Mangurian, M.D., and Reshma Jagsi, M.D., D.Phil.

Physicians have long grappled with the challenge of integrating professional and non–work-related responsibilities, but this tension demands renewed scrutiny amid growing concerns about physician burnout. Work–life integration is notoriously elusive for graduate medical trainees; residency and fellowship training have historically been all-encompassing. Parenting during clinical training involves particularly difficult challenges. As a substantial number of residents and fellows become parents, their struggles highlight the need for systemic solutions.

Some of the problems faced by trainees with children are predictable, such as sleep deprivation compounded with a newborn at home, lack of accessible and affordable childcare that aligns with trainees’ work hours, and geographic distance from extended family who could otherwise provide support. Other challenges are less obvious but pervasive, including worry that taking parental leave will prolong training or limit career options, guilt about “dumping” work on colleagues, and concern about being regarded as less committed to medicine than colleagues without children. For childbearing mothers, such stresses are compounded by the physical demands of pregnancy and nursing.

Graduate medical education (GME) program directors strive to support trainee-parents amid multiple constraints. Provision of parental leave is constrained by hospitals’ reliance on residents to deliver care and the need to comply with work-hour regulations — both of which limit scheduling flexibility. Programs must also ensure that trainees receive comprehensive education and fulfill board-certification requirements, which may include achieving specific case-log quotas. Assessing residents’ readiness for practice can also be more difficult when family leave reduces opportunities for observation. Finally, efforts to support family leaves can spur equity concerns among trainees.

Program directors are often left to navigate these obstacles without resources or established policies. A recent study revealed that about half of leading teaching hospitals lack an institution-wide parental-leave policy for residents.¹ Absent such policies, program directors must navigate the expectations of trainees, faculty members, and department chairs, as well as societal norms, to create their own program wide policy or, worse, resort to negotiating parental leave on an individual basis. Case-by-case negotiations are especially precarious, given the lack of sufficient staffing to insulate other trainees from the effects of their colleagues’ leaves.

Certifying boards add further complexity by setting seemingly arbitrary thresholds for the amount of time trainees must make up after a leave, which vary by specialty. Two of us highlighted this problem more than a decade ago,³ and it remains a substantial obstacle. Delaying graduation to accommodate makeup time creates havoc for trainees seeking jobs and, particularly, for those continuing on to fellowships that operate on the standard academic cycle. Such requirements also pose important logistic problems — especially for small programs that lack sufficient case volume or faculty to accommodate trainees beyond their planned graduation date.

A substantial number of trainees become parents during residency or fellowship programs, amid increasing expectations that both parents take a leave. We believe that structural changes are needed. Steps to support trainee-parents could be taken at the national, institutional, and program levels (see table below).

First,we call on GME oversight organizations to develop a unified, 21st-century approach to parental leave. The Accreditation Council for Graduate Medical Education (ACGME) recently mandated greater transparency regarding parental-leave policies, requiring that relevant information be provided to applicants and included in trainee contracts. Trainees must also be given “timely notice of the effect of leave(s)” on their ability to complete their program and become eligible for board certification.

Such requirements represent important progress, but we believe that standards should be strengthened to ensure that institutions provide paid leave to all parents (distinct from postpartum medical leave, when needed). Twelve weeks of paid leave, as supported by the American Academy of Pediatrics,⁵ would benefit both parents and children, but 6 weeks could be established as a more feasible initial step.

We also advocate that specialty boards abandon requirements that trainees make up approved absences. In an era of competency-based education, on-time graduation should be allowed after parental or other approved leave as long as trainees are deemed competent for independent practice. Special tracks involving truncated clinical training (such as the American Board of Internal Medicine clinician-investigator pathway) already rely on assessment methods to affirm readiness for practice. Eliminating quotas for procedures or other training activities in favor of competency-based assessments would also be appropriate.

In addition, we recommend that the ACGME, the American Board of Medical Specialties (ABMS), and GME-sponsoring organizations cooperatively track and report aggregated data related to parenting during GME. The number and frequency of births and adoptions; the association between parenting and trainees’ educational experiences and duration, clinical assessments, and academic accomplishments; and the influence of specific policies and resources on trainee well-being and on costs and logistics for teaching hospitals can be used to inform best practices and resource planning. The ACGME and ABMS could also collaborate on facilitating institutional development of part-time GME tracks for trainees seeking a less-intensive professional commitment while building a family.

Second, we urge teaching institutions to promulgate family-friendly policies for trainees and to facilitate access to parenting resources. Until national GME policies include specific parental-leave provisions, written policies should be implemented at the institutional level, rather than by individual programs, to prevent programs with more intensive patient-coverage demands or fewer resources from providing substandard benefits. Codifying 12 weeks of parental leave as institutional policy is important because the Family and Medical Leave Act, which guarantees this benefit, has a 12-month employment-eligibility threshold, thus effectively excluding new trainees. In addition, specifying the duration of paid leave in institutional policies places responsibility for funding these leaves on institutions, rather than on individual programs, and ensures parity throughout specialties.

Providing sufficient staffing to cover resident absences — without placing additional burden on other residents — is another institutional responsibility that can be accomplished by creating deliberate redundancy in resident staffing or funding short-term coverage by other clinicians or moonlighting trainees.

Institutions could also support trainee-parents by providing access to affordable, nearby childcare and backup care and, ideally, space where children can visit briefly with an on-call parent. Allowing regular breaks for nursing mothers and providing convenient lactation facilities (equipped with refrigerators, as well as computers to facilitate multitasking) are essential to enable breast-feeding. Teaching institutions could help cultivate cross-specialty collaboratives for trainee-parents to facilitate information sharing, mutual support, and practical solutions such as shared childcare. Making these additional investments will be extremely difficult for many teaching hospitals facing serious financial constraints, but we believe that such initiatives should be prioritized and used as opportunities for innovation.

Finally, it is important for GME programs to provide trainees with explicit information and thoughtful guidance about integrating parenting and training responsibilities. Clarifying the implications of parental leave in more detail than the ACGME requires — including which rotations or clinical experiences must be made up and which can be omitted, what schedule adjustments are feasible to accommodate pregnant or postpartum residents, and whether “work-from-home” elective rotations are possible — will help trainees make important life decisions and help applicants choose training programs.

Individual GME programs can also develop creative pilots. Examples might include policies that allow trainees to take paid leave on an intermittent or part-time basis. Opportunities for shared residency positions might also be explored.

Family-friendly national standards, transparent local policies, and structural resources are all critical to better supporting trainee-parents. Financial investments should yield ample rewards by promoting trainee recruitment and, more important, by reducing stress and burnout among a vulnerable group of physicians — benefiting not only them, but also their children, their teams, and their patients.

Source: https://www.nejm.org/doi/full/10.1056/NEJMp1904721

PREEMIE FAMILY PARTNERS

A stay in neonatal care – An animated guide

 The NICU Foundation   Published on Apr 30, 2019

Funded by The NICU Foundation and created in partnership with The South West Neonatal Network, this animation was made to support new parents who find themselves in the unfamiliar environment of a NICU. The animation focuses on the role of parents in the NICU and what they can expect.

For individuals and couples traveling the preterm birth journey, the road ahead can be overwhelming, the pathways and outcomes unknown, while emerging complexities, stress, economic and physical demands require our attention.  You will likely receive ample advice, direction, resource referrals and hopefully helping hands.  Sometimes just considering a simple concept can guide us. Maybe tenderness can light the way forward, kindle a little fire in a heart that feels frozen in time….. 

Tenderness Important for Relationship Satisfaction

By Rick Nauert PhD – Associate News Editor – Last updated: 8 Aug 2018

A new study from the Kinsey Institute at Indiana University reveals that cuddling and caressing are important for long-term relationship satisfaction.

Surprisingly, tenderness was more important to men than to women.

The international study reviewed relationship and sexual satisfaction throughout committed relationships.

Also contrary to expectations of the researchers, men were more likely to report being happy in their relationship, while women were more likely to report being satisfied with their sexual relationship.

The couples, more than 1,000 from the United States, Brazil, Germany, Japan and Spain, were together an average 25 years.

The study is the first to examine sexual and relationship parameters of middle-aged or older couples in committed, long-term relationships.

According to the experts, research efforts to understand the place of sexuality in human lives rarely involves intact couples in ongoing relationships.

“You hear repeated research and commentary about divorce; but it’s important to note that though divorce rates are high in the U.S., couples tend to stay married — more than 50 percent of U.S. couples remain in their first marriage, and that number goes up to 90 percent in Spain,” said Julia Heiman, Ph.D., lead author of the article.

“We know from other research that being in a long-term relationship has some value to health. Perhaps we can learn more about what makes relationships both sustainable and happy.”

Participants in the study were 40- to 70-year-old men and their female partners, either married or living together for a minimum of one year. The study included around 200 couples from each country. The men and women answered gender-specific questionnaires and were assured that their responses would not be shared with their partner.

“This study on heterosexual couples provides a basis for future research on sex and gender, such as how same-sex couples may or may not show similarities and differences in relationship and sexual satisfaction,” Heiman said.

For men, relationship happiness was more likely if the man reported being in good health and if it was important to him that his partner experienced orgasm.

Surprisingly, frequent kissing or cuddling also predicted happiness in the relationship for men, but not for women. Both men and women reported more happiness the longer they had been together, and if they themselves scored higher on several sexual functioning questionnaires.

Across all five nationalities, for both men and women, the Japanese were significantly happier with their relationships than Americans, and Brazilians and Spanish reported less relationship happiness than Americans.

Men and women both were likely to report sexual satisfaction if they also reported frequent kissing and cuddling, sexual caressing by the partner, higher sexual functioning, and if they had sex more frequently.

On the other hand, for men, having had more sex partners in their lifetime was a predictor of less sexual satisfaction.

Men did report more relationship happiness in later years, whereas for women, their sexual satisfaction increased over time. Women who had been with their partner for less than 15 years were less likely to report sexual satisfaction, but after 15 years, the percentage went up significantly.

“Possibly, women become more satisfied over time because their expectations change, or life changes with the children grown,” Heiman said. “On the other hand, those who weren’t so happy sexually might not be married so long.”

Compared with the U.S. men, Japanese men reported significantly (2.61 times) more sexual satisfaction in their relationships. For women, Japanese and Brazilian women were more likely to report being satisfied sexually than Americans.

“We recognize that relationship satisfaction and sexual satisfaction may not be the same thing for all couples, and in all cultures,” Heiman said.

“Our next step is to understand how one person’s health, physical affection and sexual experiences relate to the relationship happiness or sexual satisfaction of his or her partner. So, we hope for more couple-centered than individual-centered understanding on relationship functioning and satisfaction.”

The study is published in the journal Archives of Sexual Behavior.

Source: https://psychcentral.com/news/2011/07/06/tenderness-important-for-relationship-satisfaction/27497.html

All the NICU Babies (Beyoncé Parody)

AdvocateHealthCare                Published on Dec 6, 2018

PUT YOUR HANDS UP! Check out “All the NICU Babies,” a Beyoncé parody inspired by “All the Single Ladies!” Make sure to wait until the end for a very special THEN & NOW dedication to some of our NICU graduates.

Victoria Vitale, a music therapist at Advocate Children’s Hospital, and Tess Bottorff, a neonatal nurse at Advocate Children’s Hospital, partnered to write the lyrics to this adorable song. Victoria also recorded the song, and shot/edited the music video that featured some of our tiniest patients.

“In creating ‘All the NICU Babies,’ I hoped to highlight some of the ways in which music therapy benefits patients, families, and staff in the Neonatal Intensive Care Unit,” says Victoria. “Normalizing the ICU environment and returning the caregiver role back to parents at bedside helps decrease perceived stress and improve parent-infant bonding. I wanted to help parents make something meaningful of their hospitalization and feel a sense of mastery and purpose during a time when so much is out of their control. I watched parents smile, laugh, hold, kiss, and dance with their babies. This project has not only helped build a sense of community with our parents, but has significantly boosted morale amongst staff. Music therapy enhances the patient, parent, and staff experience–and this is just one way in which I work as a music therapist in the NICU!”

 

Prevalence of Survival Without Major Comorbidities Among Adults Born Prematurely

October 22/29, 2019    Casey Crump, MD, PhD^1,2; Marilyn A. Winkleby, PhD³; Jan Sundquist, MD, PhD^1,2,4; et al Kristina Sundquist, MD, PhD^1,2,4

Key Points

Question  What is the prevalence of survival without major comorbidities in adulthood among persons born prematurely?

Findings  In this population-based cohort study of more than 2.5 million persons born in Sweden from 1973 to 1997, 54.6% of those born preterm (gestational age <37 weeks) and 22.3% of those born extremely preterm (22-27 weeks) were alive with no major comorbidities at ages 18 to 43 years, compared with 63.0% of those born full-term. The prevalences were statistically significantly lower in those born at earlier gestational ages vs full-term.

Meaning  Among Swedish persons born prematurely, a large percentage survived into adulthood and had no major comorbidities.

Abstract

Importance  Preterm birth has been associated with cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood. However, the prevalence of survival without any major comorbidities is unknown.

Objective  To determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term.

Design, Setting, and Participants  National cohort study of all 2 566 699 persons born in Sweden from January 1, 1973, through December 31, 1997, who had gestational age data and who were followed up for survival and comorbidities through December 31, 2015 (ages 18-43 years).

Exposures  Gestational age at birth.

Main Outcomes and Measures  Survival without major comorbidities among persons born extremely preterm (22-27 weeks), very preterm (28-33 weeks), late preterm (34-36 weeks), or early term (37-38 weeks), compared with full-term (39-41 weeks). Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which includes conditions that commonly manifest in adolescence or young adulthood, including neuropsychiatric disorders; and the Charlson Comorbidity Index (CCI), which includes major chronic disorders predictive of mortality in adulthood. Poisson regression was used to determine prevalence ratios and differences, adjusted for potential confounders.

Results  In this study population, 48.6% were female, 5.8% were born preterm, and the median age at end of follow-up was 29.8 years (interquartile range, 12.6 years). Of all persons born preterm, 54.6% were alive with no AYA HOPE comorbidities at the end of follow-up. Further stratified, this prevalence was 22.3% for those born extremely preterm, 48.5% for very preterm, 58.0% for late preterm, 61.2% for early term, and 63.0% for full-term. These prevalences were significantly lower for earlier gestational ages vs full-term (eg, adjusted prevalence ratios: extremely preterm, 0.35 [95% CI, 0.33 to 0.36; P < .001]; all preterm, 0.86 [95% CI, 0.85 to 0.86; P < .001]; adjusted prevalence differences: extremely preterm, −0.41 [95% CI, −0.42 to −0.40; P < .001]; all preterm, −0.09 [95% CI, −0.09 to −0.09; P < .001]). Using the CCI, the corresponding prevalences were 73.1% (all preterm), 32.5% (extremely preterm), 66.4% (very preterm), 77.1% (late preterm), 80.4% (early term), and 81.8% (full-term) (adjusted prevalence ratios: extremely preterm, 0.39 [95% CI, 0.38 to 0.41; P < .001]; all preterm, 0.89 [95% CI, 0.89 to 0.89; P < .001]; adjusted prevalence differences: extremely preterm, −0.50 [95% CI, −0.51 to −0.49; P < .001]; all preterm, −0.09 [95% CI, −0.09 to −0.09; P < .001]).

Conclusions and Relevance  Among persons born preterm in Sweden between 1973 and 1997, the majority survived to early to mid-adulthood without major comorbidities. However, outcomes were worse for those born extremely preterm.

Source: https://jamanetwork.com/journals/jama/article-abstract/2753371?widget=personalizedcontent&previousarticle=188026

 

INNOVATIONS

New technology helps save premature twins

WKYC Channel 3 -Published on May 30, 2019-

Another medical first in Northeast Ohio as Rainbow Babies and Children’s Hospital used a new device to plug blood vessels in the hearts of premature twins.

 

Peer Reviewed        NEONATOLOGY TODAY
Peer Reviewed Research, News and Information in Neonatal and Perinatal Medicine

Transforming Pediatric Care with Telehealth Technology                       Kirby Farrell, Lindsey Koshansky, RN, MSN

Remote patient monitoring has transformed healthcare, with evolving technology allowing physicians and patients to con­nect in ways never before possible. But as telehealth has evolved, most platforms have focused on serving aging popu­lations. Pediatrics is a population that has been overlooked by telehealth developers and where an opportunity exists to fun­damentally change the way young patients are treated. This is why the Locus Health platform was created.

Locus Health bridges the gap between hospital and home with an RPM platform that connects parents with their child’s care team after they have been discharged following NICU stays. Locus’ HIPAA-compliant modular construction allows for con­figuration of both the app and dashboards, providing effective remote monitoring for any population — from chronic to com­plex. Locus provides a fully managed, SaaS solution that uti­lizes an iOS-based application to improve the home monitoring of medically complex pediatric patient populations. The plat­form was designed specifically to create operational efficien­cies by seamlessly integrating with the providers’ EMR. Most importantly, it allows doctors to spend more time caring for their patients.

Locus has been proven to reduce the length of hospital stays (1), lower readmission rates, reduce in-person clinic visits, and lower the overall cost of care. These results have led to implementation of the Locus platform at more than 25 leading Children’s Hospitals in the U.S. and Canada. This rapid growth has been possible because the platform was developed by experienced healthcare professionals, notably a team of for­mer NICU nurses, who understand the complexities of daily healthcare and the pressing need to integrate telehealth into care regimens. Building a platform that integrates into existing workflows for doctors, nurses, CIO’s and hospital administra­tors was vital.

Locus Health was developed in conjunction (2) with doctors and nurses at the University of Virginia Health System (UVA) in Charlottesville, VA. where Locus is also headquartered. In ear­ly 2018, Dr. Brooke Vergales, a Neonatologist at UVA, met with the clinical innovation team at Locus Health. Her goal was to tailor the Locus platform for premature infants admitted to the UVA Children’s Hospital’s NICU unit who could be discharged home sooner than the average NICU stay of about 24 days. Lo­cus had been supporting a wide range of pediatric patient pop­ulations at UVA with its remote care management solution, and had already achieved strong improvement in clinical outcomes, including improved mortality and oral feeding rates among pe­diatric patients discharged home with congenital heart disease (CHD).

Dr. Vergales had several key objectives: to improve the quality and timeliness of transition home while ensuring that these pre­mature infants thrived more quickly; to keep the care team con­nected in the same way they would if the infant had remained in the hospital; and to help the NICU improve its ability to admit more complex cases and maintain its high census. Dr. Vergales and the Locus team immediately focused on key metrics for evaluating the success of the program, developing targets for:

• Enrollment, targeting 10-12% of NICU admissions in the first year of the program, typically infants viewed as “feed­ers and growers” that did not require more complex NICU care in the hospital.
• Length of Stay (LOS), targeting more than a 5-day de­crease in average length of stay.
• Transition to Oral Feeding, using nasogastric (NG) tube placement in the home (3), aiming to transition to full oral feeding more quickly than in the hospital-setting, while maintaining targeted weight gain metrics.
• Quality and clinical satisfaction with a new “Virtual Round­ing” approach, as measured by daily family adherence to program tasks and the quality of data/trends collected.

Parents of the infants enrolled in the program were provided a personalized iPad with the Locus platform and mobile app installed. They were shown how to enter key metrics (e.g. daily weights, daily feeding intake, output, SpO2). In addition, the UVA team provided educational content directly through the Lo­cus iPad app that otherwise would have been sent home in an infrequently used binder of printed papers. Parents were able to utilize secure photo and video capabilities through the Locus app to support critical interaction with the care teams, including support for lactation consults.

Neonatology teams at UVA used the Locus platform to both round virtually on a daily basis and review alert notifications through the mobile app for clinicians, helping them manage by exception, and identify trends outside of acceptable parame­ters well in advance of an emergent event.

Since UVA and Locus launched the program in late spring of 2018, UVA has enrolled more than 50 infants in the program and seen a significant reduction in LOS. The reduction in LOS associated with this approach to home discharge of premature infants from the NICU is dramatic. Industry estimates indicate an average cost to payers of more than $3,000 per day in the NICU, indicating an average payer savings of nearly $25,000 per infant discharged to the Locus platform. At UVA’s initial tar­get enrollment rate of 10-12% of NICU discharges, this equates to about $1.5 to 2M in payer savings annually.

However, the economic benefits of this approach do not only accrue to payers. At UVA, and many other Level III/IV NICUs where capacity constraints exist throughout the year, the ben­efits to the UVA Children’s Hospital associated with discharging these “feeders and growers” more quickly include an increase in average reimbursement per day in the range of $1,500 to $2,000, the result of making a NICU bed available to an infant with more complex care needs. Analysis of UVA reimbursement indicated an incremental revenue opportunity of up to $1M an­nually as a result of this shift toward more complex admissions in the NICU. And while the program has been discharging more families sooner, the UVA NICU has maintained its census con­sistently above 90%.

Most importantly, the quality of care in this approach to NICU discharge management has only improved at UVA Children’s Hospital: infants that would otherwise be monitored for the same potential issues in the hospital clearly are thriving more at home from a feeding and oral skills perspective, they bond with their parents more quickly in a nurturing home environ­ment, and the care teams at UVA have been able to manage and monitor at the same quality standard while making more of the NICU available to infants that truly need in-hospital care.

The feedback from both the care teams (4) and the parents of these infants has been overwhelmingly positive. Flossie Hor­ace, the guardian and grandmother of Elliyon Horace, told CBS News in a report (5) that aired nationally in May 2019, that the Locus Health platform has made her grandson’s home recovery more manageable and reduced the number of times she has had to make the 4-hour round trip journey from her home in Roanoke to UVA in Charlottesville.

“I love the iPad. It helps out a lot. It gave me more assurance that I know what I’m doing,” said Horace.

References:

1. “Doctors create iPad program to get NICU babies home sooner” by Julie Mazziotta, PEOPLE Magazine, March 13, 2019.
2. https://people.com/health/doctors-ipad-program-nicu-ba­bies-get-home-faster/
3. “UVA’s pediatric remote monitoring program Building Hope

Source:file:///C:/Users/sacre/AppData/Local/Microsoft/Windows/INetCache/IE/4X4DWPN4/nt-oct19.pdf

Science News from research organizations

Point-of-care diagnostic for detecting preterm birth on horizon

Date: October 22, 2019 Source: American Society for Microbiology

Summary:

A new study provides a first step toward the development of an inexpensive point-of-care diagnostic test to assess the presence of known risk factors for preterm birth in resource-poor areas. The study found that measuring levels of TIMP-1 and D-lactic acid in vaginal secretions may be a noninvasive, cost-effective way to assess the risk for preterm birth due to a short cervix and microbiome composition.

A new study provides a first step toward the development of an inexpensive point-of-care diagnostic test to assess the presence of known risk factors for preterm birth in resource-poor areas. The study found that measuring levels of TIMP-1 and D-lactic acid in vaginal secretions may be a non-invasive, cost-effective way to assess the risk for preterm birth due to a short cervix and microbiome composition. The research is published in mBio, an open-access journal of the American Society for Microbiology.

“We have found that there are components in the vagina, proteins and bacteria, that can be used to identify women who are at elevated risk for preterm birth,” said Larry Forney, PhD, a member of the Institute of Bioinformatics and Evolutionary Studies and Distinguished University Professor in the Department of Biological Sciences, University of Idaho, Moscow, Idaho. “There is a need to have a cost-effective diagnostic that can be used to identify women who are at risk for a preterm birth, so more intensive monitoring and, if needed, the most appropriate therapies can be initiated. The goal is to have a point-of-care diagnostic that people can use in a clinic that doesn’t require any advanced technology, expensive instrumentation, or extremely specialized skills.” Dr. Forney, along with Steven Witkin, PhD, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA and Antonio Moron, MD, PhD, Department of Obstetrics, Federal University of Sao Paulo, Sao Paulo, Brazil, served as principal investigators of the new study.

Complications of preterm birth account for roughly a third of the world’s 3.1 million neonatal deaths each year. For years, clinicians have known that a short cervical length and depletion of Lactobacillus species in the vaginal microbiome are significant risk factors for preterm birth. In prosperous countries, most pregnant women undergo a transvaginal ultrasound at 18 to 24 weeks gestation, to determine cervical length, and women with a short cervix are treated with progesterone, a cerclage, or a cervical pessary, to reduce the likelihood of premature delivery. Similarly, women who show signs of bacterial vaginosis, by microscopy of Gram-stained smears or various diagnostics based on gene amplification, are given antibiotics to restore dominance of lactobacilli and reduce the risk of preterm birth.

In many less prosperous areas of the world, however, the resources to perform a transvaginal ultrasound or characterize the composition of vaginal bacterial communities are unavailable. Often, women in resource-poor countries who are at-risk for preterm birth fall through the cracks. “Women with shortened cervixes can have ascending infections from the vagina into the uterus that can elicit inflammation and trigger contractions and preterm births,” explained Dr. Forney. “If you can identify people at risk, there are standard therapies that can be given, but if you don’t know who is at risk, then you can’t very well have a basis of choosing who should receive the additional therapy.”

In the new study, funded by the Bill and Melinda Gates Foundation, researchers from Idaho, Brazil, and New York City set out to identify low-cost, point-of-care measures that might be used to predict bacteria that dominate the vaginal microbiome and indicate the presence of a shortened cervix. The researchers collected and analyzed vaginal fluid samples from 340 mid-trimester pregnant women to determine correlates of a short cervix. Roughly 10% of women in the study had a short cervix. They found that tissue inhibitor of matrix metalloproteinases (TIMP-1), D-lactic acid, p62, age and race all directly affected cervical length. TIMP-1, p62 and belonging to the black race had strong negative effects on cervical length (standardized regression coefficients of -0.162, -0.094, and -0.181, respectively).

“Measuring levels of TIMP-1 and D-Lactic acid in vaginal secretions might be a straightforward way to assess a woman’s risk for preterm birth,” said Dr. Forney. “Our next step is to do a larger study that includes women in their first trimester so that if the findings are similar, monitoring and possible treatment can begin earlier in gestation.”

The researchers said the work wouldn’t have been possible without the expertise of several disciplines coming together as a team. “This is a prime example of the kind of research that can be done when you bring people in from different disciplines,” said Dr. Forney. “This team of investigators included obstetricians, gynecologists, immunologists, microbial ecologists, and statisticians.”

Story Source:Materials provided by American Society for Microbiology.

Source: https://www.sciencedaily.com/releases/2019/10/191022080736.htm

 

WARRIORS:

For Survivors of Preverbal Trauma

Posted on August 4, 2018-  If you have experienced and overwhelming experience as a small child or infant and you may have PTSD. We want to take you beyond coping techniques and get to the root of the problem.

The Instinctual Trauma Response™ (ITR) Method.

The Instinctual Trauma Response™ (ITR) method is an evidence-supported method that focuses on treating the roots of trauma symptoms, ending the triggers that cause them. It is a simple but profound method used to complete a traumatic event and integrate consciousness, body, brain, memory narrative, and parts.

The ITR™ method was developed by Dr. Louis Tinnin, psychiatrist, and his wife, Dr. Linda Gantt, an art therapist, after over 30 years of working in hospitals and out-patient clinics. Together they have helped thousands who found relief after trying many other methods. The ITR method works by directly and intentionally “re-coding” traumatic memories so that they finally are placed in the past. It includes the Graphic Narrative™ process and the Externalized Dialogue™ procedure.

The Graphic Narrative™ Process

The Graphic Narrative process consists of a series of drawings depicting the components of the Instinctual Trauma Response.  They can cover a single event or a series of similar events. The client is coached through these drawings and they can be very simple including just the important aspects of each component including the non-verbal aspects such as feelings, thoughts or body sensations.

The Externalized Dialogue™ Procedure

The Externalized Dialogue procedure is a skill for life. It can be done in a variety of ways including writing, audio recording or video recording.  It allows the true-self to collaborate and negotiate with the parts that were hurt or stuck in the traumas. This procedure can be done before or after the Graphic Narrative process.

 

KAT’S Corner

“The healthiest form of projection is art.”   Fritz Perls

Check out the website below which offers numerous ideas for exploring our soul searching efforts as we heal from any pre-verbal trauma we may have experienced as preterm birth survivors.  I elected to try a quick exercise (work, school, research are all calling me) in order to engage in this process. My “art” was created at 9 PM at the local Whole Foods over a period of about ten minutes while I devoured my delicious gluten free grilled chicken sandwich.  What I experienced drawing my tree was a childlike joy as pencil and paper collided, a bit of intensity as the drawing took form, and a smile of satisfaction once I set the pencils down! Long term effects? Unknown. A precious moment in time -affirmative!   

My drawing

Draw yourself as a tree. Your roots will be loaded with descriptions of things that give you strength and your good qualities, while your leaves can be the things that you’re trying to change.

Source: https://www.expressiveartworkshops.com/expressive-art-resources/100-art-therapy-exercises/

 

Kata Beach Surfing Contest 2017 Wrap (29-30 July)-

Published on Aug 1, 2017

All the action from the 2017 Kata Beach Surfing Contest held off Kata Beach in Phuket, Thailand from 29th to 30th July, 2017.