BABY BEHAVIORS. HAPP-E, OUR STORIES!

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NETHERLANDS

Preterm Birth Rates – Netherlands

Rank: 127 –Rate: 8% Estimated # of preterm births per 100 live births (USA – 12%)

https://www.marchofdimes.org/mission/global-preterm.aspx

The Netherlands (Dutch: Nederland, informally Holland, is a country in Northwestern Europe with some overseas territories in the Caribbean. In Europe, it consists of 12 provinces that border Germany to the east, Belgium to the south, and the North Sea to the northwest, with maritime borders in the North Sea with those countries and the United Kingdom. Together with the Caribbean NetherlandsBonaire, Sint Eustatius and Saba—it forms a constituent country of the Kingdom of the Netherlands.

Healthcare in the Netherlands can be divided in several ways: firstly in three different echelons; secondly in somatic versus mental healthcare; and thirdly in “cure” versus “care”. Home doctors form the largest part of the first echelon. Being referred by a first echelon professional is frequently required for access to treatment by the second and third echelons, or at least to qualify for insurance coverage for that treatment. The Dutch health care system is quite effective in comparison to other western countries but is not the most cost-effective.

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

Spring Solstice is March 19th this year! Wishing you all Health, Happiness, and Great Adventures Spring 2020!

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COMMUNITY

A simple solution for healthier premature babies?

       CBS    CBC News: The National    Published on Feb 12, 2018

Is there a simple solution to improve the health of premature babies? A new Canadian-led study suggests there is. The study’s results showed that by simply getting a premature baby’s parents involved in the care process sooner, the baby gained 15 per cent more weight. There was also another effect — the parents also showed less stress.

 

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Nine News Melbourne MCG Masquerade Ball 2020 event preview: Unmasking Preterm Birth

Published on Jan 20, 2020

Melbourne’s health, sporting, business and philanthropic community is set to usher in autumn in grand style as it unites for a highly anticipated event at the MCG to benefit mothers and babies at risk of preterm birth. WIRF provides world leading research into the prevention of pre-term birth. An issue that causes more death and disability in children than any other. With your support we can help our WIRF continue their life-saving research.

 

Psychosocial developmental trajectory of a cohort of young adults born very preterm and/or with a very low birth weight in the Netherlands

Published: 07 March 2019

Abstract:

The achievement of age-specific developmental milestones in youth is of great importance to the adjustment in adult life. Young adults who were born preterm, might go through a different developmental trajectory and transition into adulthood than their peers. This study aimed to compare the psychosocial developmental trajectory of young adults who were born preterm with peers from the general population. Young adults from the POPS (Project On Preterm and Small for gestational age infants) cohort study, born in 1983 in the Netherlands, completed online the Course of Life Questionnaire (CoLQ – achievement of psychosocial developmental milestones) at 28 years of age. Analysis of variance by group, age and gender was performed to test differences on the CoLQ scale scores between the POPS-group and 211 peers (25–30 years) from the general population (Ref-group). Differences on item level, representing the achievement of individual milestones, were analyzed with logistic regression analyses by group, age and gender.

Results

The POPS-group (n = 300, 32,3% biased response) scored significantly lower than the Ref-group on the scales Psychosexual Development (effect size − 0.26, p < 0.01), Antisocial Behavior (ES − 0.44, p < 0.001) and Substance Use & Gambling (ES − 0.35, p < .001). A further exploration on item-level revealed, among others, that the POPS-group had their first boyfriend/girlfriend at later age, were more often single, misbehaved less at school and smoked, drank and gambled less than the Ref-group. On the scales Autonomy Development and Social Development no differences were found between the POPS-group and the Ref-group.

Conclusions

A relatively less vulnerable respondent group of young adults born preterm showed some psychosocial developmental trajectory delays and might benefit from support at teenage age. Because of the non-response bias, we hypothesize that the total group of young adults born preterm will show more severe psychosocial developmental problems.

Journal of Patient-Reported Outcomes volume 3, Article number: 17 (2019)

Source: https://jpro.springeropen.com/articles/10.1186/s41687-019-0106-5

 

intergrowth

Introducing the INTERGROWTH-21st clinical tools in IBADAN, Nigeria

Following the successful visit to Oxford last year of Dr Yetunde John-Akinola (Faculty of Public Health, College of Medicine, University of Ibadan), who spent 6 weeks with the INTERGROWTH-21st team on an AfOx Visiting Fellowship, Professor Stephen Kennedy visited the University and University College Hospital, Ibadan, Nigeria, in January 2020. His visit was hosted by Dr John-Akinola and Dr Idowu Ayede (Department of Paediatrics, College of Medicine, University of Ibadan).

Professor Kennedy led a 2-day ‘training-the-trainers’ workshop attended by obstetricians, neonatologists, nurses and midwives, who completed the two INTERGROWTH-21st and three INTERPRATICE-21st online modules (participants pictured below with their certificates after successfully completing the course). These trainers will now go on to spread the use of the clinical tools further.

The University and University College Hospital have, in principle, committed to implement the INTERGROWTH-21st tools into routine obstetric and neonatal practice, with a focus on: 1) estimating gestational age accurately with ultrasound; 2) assessing size at birth, and 3) monitoring preterm postnatal growth, all with the INTERGROWTH-21st Standards, as well as 4) promoting exclusive breastfeeding because the national rate is currently only 17%. Their commitment is evidenced by allocating space in their newly built research institute to the project and funding two research nurses to support the project there.

The unmet need in Nigeria is massive: 27 newborns die every hour in the country.

https://intergrowth21.tghn.org/introducing-intergrowth-21st-clinical-tools-ibadan-nigeria/

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INNOVATIONS

New study HAPP-e is looking for participants from all over the world

Posted on 04 February 2020

happe

Copyright INESC TEC and ISPUP

Studying the health of adults born preterm is the aim of the EU-funded study HAPP-e, which has been recently launched. Focus point of HAPP-e is an electronic cohort. Researchers will follow a group of adults born preterm over a longer period of time and study the participant’s health and life conditions.  Both recruitment and follow-up of will entirely be performed using digital tools, such as a web-platform.

This makes the study less expensive than traditional cohort studies, which rely on face-to-face interviews, and make large-scale studies possible. Moreover, this approach is more convenient, since the participants can stay at home.

If you

  • are more than 18 years old
  • were born prematurely (less than 37 weeks of gestation
  • and have an email address

please participate in this study. For more information about HAPP-e and /or registration go to: https://happ-e.inesctec.pt/

Source: https://www.efcni.org/news/new-study-happ-e-is-looking-for-participants-from-all-over-the-world/

 

EFONI

Lifeline for preterm babies – funding announced for new stem cell research

POSTED ON 20 JANUARY 2020

What role can stem cells play in regenerating a damaged brain caused by preterm birth? The new project PREMSTEM, in which EFCNI is taking part, researches if stem cells can be used to regenerate the brain damage caused by preterm birth. To ‘rebuild’ the damaged areas of the brain, scientists will use human mesenchymal stem cells (H-MSC) – those taken from umbilical cord tissue as opposed to human embryonic stem cells (hESC).

PREMSTEM, which was launched in January, consists of fifteen partners from eight countries and involves world-leading clinicians, researchers and healthcare organisations specialised in neonatology in both Europe and Australia. Together with the Cerebral Palsy Alliance from Australia EFCNI’s role is to present preterm infants and their families in this project.

PREMSTEM is funded by the European Union’s Horizon 2020 Research and Innovation program, Grant Agreement number 874721.

Source: https://www.efcni.org/news/lifeline-for-preterm-babies-funding-announced-for-new-stem-cell-research/

 

PMC

Large-for-gestational-age fetuses have an increased risk for spontaneous preterm birth.

Journal of Perinatology : Official Journal of the California Perinatal Association, 01 Apr 2019, 39(8):1050-1056

Abstract 

OBJECTIVE:

Our aim was to investigate the association between large-for-gestational-age and the risk of spontaneous preterm birth.

STUDY DESIGN: We studied nulliparous women with a singleton gestation using data from the Dutch perinatal registry from 1999 to 2010. Neonates were categorized according to the Hadlock fetal weight standard, into 10th to 90th percentile, 90th to 97th percentile, or above 97th percentile. Outcomes were preterm birth <37+0 weeks and preterm birth between 25+0-27+6 weeks, 28+0-30+6 weeks, 31+0-33+6 weeks, and 34+0-36+6 weeks.

RESULTS: We included 547,418 women. The number of spontaneous preterm births <37 weeks was significantly increased in the large-for-gestational-age group ( > p97) compared with fetuses with a normal growth (p10-p90) (11.3% vs. 7.3%, odds ratio (OR) 1.8; 95% CI 1.7-1.9). The same results were found when limiting analyses to women with certain pregnancy duration (after in vitro fertilization).

CONCLUSION: Large-for-gestational-age increases the risk of spontaneous preterm delivery from 25 weeks of gestation onwards.

Source: https://europepmc.org/article/med/30940928

 

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HEALTH CARE PARTNERS

Mild maternal thyroid dysfunction increases preterm birth risk

Cappola AR, et al. JAMA. 2019;doi:10.1001/jama.2019.10159.

Korevaar TIM, et al. JAMA. 2019;doi:10.1001/jama.2019.10931.

August 20, 2019

Pregnant women with mild thyroid dysfunction, such as subclinical hypothyroidism, isolated hypothyroxinemia or thyroid peroxidase antibody positivity, are more likely to deliver preterm when compared with euthyroid women, according to a meta-analysis of 19 cohort studies published in JAMA.

The analysis of individual patient data from more than 47,000 participants, conducted by the Consortium on Thyroid and Pregnancy — Study Group on Preterm Birth, is the largest study of its kind conducted to date, according to researchers, and suggests that subclinical hypothyroidism, isolated hypothyroxinemia and thyroid peroxidase antibody (TPOAb) positivity in pregnant women are risk factors for preterm birth.

“These findings validate a reflex TPOAb measurement for women with a [thyroid-stimulating hormone level] above 4 mU/L and also imply that it is important to actively plan to assess early gestational thyroid function tests in women known to be TPOAb-positive preconception,” Tim Korevaar, MD, PhD, a translational epidemiologist at the Academic Center for Thyroid Diseases at Erasmus Medical Center in Rotterdam, the Netherlands, told Endocrine Today. “Our results showing a higher risk for very preterm birth in TPOAb-positive women, especially when the TSH is above 4 mU/L, seem to echo the current American Thyroid Association guidelines. Our results showing that isolated hypothyroxinemia is a risk factor for both preterm and very preterm birth was most surprising, although further studies are needed to identify the causality of this association.”

Korevaar and colleagues analyzed data from 19 prospective cohort studies conducted through March 2018 with unselected participants with available data on thyroid hormone and TPOAb status, as well as data on gestational age at birth (n = 47,045; mean age, 29 years; median gestational age at blood sampling, 12.9 weeks). Researchers excluded studies in which participants received treatment based on abnormal thyroid function tests. Primary authors provided individual participant data that was analyzed using mixed-effects models.

Within the cohort, 1,234 women (3.1%) had subclinical hypothyroidism, 904 women (2.2%) had isolated hypothyroxinemia and 3,043 (7.5%) were TPOAb positive. The primary outcome of preterm birth, defined as delivery at less than 37 weeks’ gestational age, occurred in 2,357 women (5%). Very preterm birth occurred in 349 women (0.7%).

Preterm birth risk

In analyses adjusted for maternal age, BMI, race, smoking status, parity, gestational age at blood sampling and fetal sex, women with subclinical hypothyroidism were 29% more likely to deliver preterm vs. euthyroid women (95% CI, 1.01-1.64; absolute risk, 6.1% vs. 5%). Women with isolated hypothyroxinemia were 46% more likely to delivery preterm vs. euthyroid women (95% CI, 1.12-1.9; absolute risk, 7.1% vs. 5%) and women with TPOAb positivity were 33% more likely to deliver preterm vs. women who were TPOAb negative (95% CI, 1.15-1.56; absolute risk, 6.6% vs. 4.9%).

In prespecified sensitivity analysis, the association between subclinical hypothyroidism and preterm birth was no longer statistically significant after additional adjustment for TPOAb positivity, the researchers wrote.

The researchers noted that the association of TPOAb positivity with preterm birth did not appear to be related to differences in thyroid function, but was modified by the TSH level, exemplified by the higher risk for preterm birth in TPOAb-positive women with a TSH level above 4 mIU/L.

“This study is probably the best evidence that we will have on the association of maternal thyroid function or TPOAb positivity and very preterm birth,” Korevaar said. “This is because very preterm birth is a rare outcome, yet the consequences on child health are enormous.”

Universal screening not justified

In commentary accompanying the study, Anne R. Cappola, MD, ScM, of the division of endocrinology, diabetes and metabolism at the Perelman School of Medicine at the University of Pennsylvania, and Brian M. Casey, MD, of the division of maternal and fetal medicine at the University of Alabama at Birmingham, wrote that the study findings should not be used to justify universal screening of pregnant women.

“Assuming that residual confounding did not affect these estimates and that the links were causal and would be completely reversed by early identification and treatment, how many additional preterm births could be prevented by screening with these three blood tests?” Cappola and colleagues wrote. “Based on this analysis of 47,045 women, an estimated 17 preterm births in those with subclinical hypothyroidism, 21 preterm births in those with isolated hypothyroxinemia and 49 preterm births in [TPOAb]-positive women might have been prevented. Even under these idealized assumptions, these estimates represent a relatively small potential yield given the very large screening effort required, especially when considering contemporary advances in obstetrical and neonatal care in managing late preterm delivery and that only 15% of preterm births in this analysis occurred at less than 32 weeks’ gestational age.”

Cappola and colleagues noted that subclinical hypothyroidism identified during pregnancy may not truly represent thyroid hormone inadequacy, adding, “It is time to trust the findings of the major clinical trials, move past consideration of screening for and treatment of mild thyroid testing abnormalities detected during pregnancy, and focus instead on determining their physiological context.” – by Regina Schaffer

Source: https://www.healio.com/endocrinology/thyroid/news/online/%7B59d1641c-f392-4adb-98ae-03bde28f3783%7D/mild-maternal-thyroid-dysfunction-increases-preterm-birth-risk

Series of RECAP cohorts – part 6: Follow-up of the POPS cohort in the Netherlands

Posted on 13 September 2019

Dr Sylvia van der Pal & Professor Erik Verrips

In 1983, a unique nationwide cohort of 1.338 very preterm (below 32 weeks of gestation) or VLBW (birth weight below 1500 g) infants in the Netherlands was collected and followed at several ages; the POPS (Project On Preterm and Small for gestational age infants) cohort. The studies with the POPS cohort have provided insight into how Dutch adolescents who were born very preterm or VLBW reach adulthood.

At 19 years of age a more extensive follow-up study was done for which the POPS participants visited the academic hospital closest to their home. The 19 year examination included questionnaires, tests on a computer and a full physical exam. At 19 years, 705 POPS participants participated (74% of 959 still alive).

The POPS participants showed more impairments on most outcome measures at various ages, compared to norm data. Major handicaps remained stable as the children grew older, but minor handicaps and disabilities increased. At 19 years of age, only half (47.1%) of the survivors had no disabilities and no minor or major handicaps. Especially those born small for gestational age (SGA) seemed most vulnerable.

The POPS participants were informed about the outcomes through the “POPS-19 magazine”, a glossy which also included interviews with POPS participants and advice on what health outcomes they should regularly check. At 14 years of age the POPS participants and their parents had also received a booklet with outcomes of the POPS cohort: “Even little ones grow up”. The POPS-19 magazine can also be downloaded through the website (www.tno.nl/pops) and POPS participants can also update their contact details on the website.

These long-term cohort outcomes help to support preterm and SGA born children and adolescents in reaching independent adulthood, and stress the need for long term follow-up studies and to promote prevention of disabilities and of preterm birth itself. The RECAP ICT platform, which will combine the data of 20 European cohorts of children and adults born very preterm of very low birth, will also contribute to this.

Source: https://www.efcni.org/news/follow-up-of-the-pops-cohort-in-the-netherlands/

mood

Indicators of pain, stress & its assessment- Facility Based Care of Preterm Infant 2018

dr.deborariAshok Deorari    Published on Dec 31, 2017

Different behavioral states and assessment by PIP score in premature baby

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Source: https://www.newbornwhocc.org/

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Stress during pregnancy may affect baby’s sex, risk of preterm birth

Date: October 15, 2019 Source: Columbia University Irving Medical Center

Summary: A new study has identified markers of maternal stress – both physical and psychological that may influence a baby’s sex and the likelihood of preterm birth.

Story:

It’s becoming well established that maternal stress during pregnancy can affect fetal and child development as well as birth outcomes, and a new study from researchers at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian now identifies the types of physical and psychological stress that may matter most.

“The womb is an influential first home, as important as the one a child is raised in, if not more so,” says study leader Catherine Monk, PhD, professor of medical psychology at Columbia University Vagelos College of Physicians and Surgeons and director of Women’s Mental Health in the Department of Obstetrics & Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center.

Because stress can manifest in a variety of ways, both as a subjective experience and in physical and lifestyle measurements, Monk and her colleagues examined 27 indicators of psychosocial, physical, and lifestyle stress collected from questionnaires, diaries, and daily physical assessments of 187 otherwise healthy pregnant women, ages 18 to 45.

About 17% (32) of the women were psychologically stressed, with clinically meaningful high levels of depression, anxiety, and perceived stress. Another 16% (30) were physically stressed, with relatively higher daily blood pressure and greater caloric intake compared with other healthy pregnant women. The majority (nearly 67%, or 125) were healthy.

Fewer Baby Boys with Mental Stress?

The study suggested that pregnant women experiencing physical and psychological stress are less likely to have a boy. On average, around 105 males are born for every 100 female births. But in this study, the sex ratio in the physically and psychologically stressed groups favored girls, with male-to-female ratios of 4:9 and 2:3, respectively.

“Other researchers have seen this pattern after social upheavals, such as the 9/11 terrorist attacks in New York City, after which the relative number of male births decreased,” says Monk. “This stress in women is likely of long-standing nature; studies have shown that males are more vulnerable to adverse prenatal environments, suggesting that highly stressed women may be less likely to give birth to a male due to the loss of prior male pregnancies, often without even knowing they were pregnant.”

Other Impacts of Stress

  • Physically stressed mothers, with higher blood pressure and caloric intake, were more likely to give birth prematurely than unstressed mothers.
  • Among physically stressed mothers, fetuses had reduced heart rate-movement coupling — an indicator of slower central nervous system development — compared with unstressed mothers.
  • Psychologically stressed mothers had more birth complications than physically stressed mothers.

Social Support Matters

The researchers also found that what most differentiated the three groups was the amount of social support a mother received from friends and family. For example, the more social support a mother received, the greater the likelihood of her having a male baby.

When social support was statistically equalized across the groups, the stress effects on preterm birth disappeared. “Screening for depression and anxiety are gradually becoming a routine part of prenatal practice,” says Monk. “But while our study was small, the results suggest enhancing social support is potentially an effective target for clinical intervention.”

An estimated 30% of pregnant women report psychosocial stress from job strain or related to depression and anxiety, according to the researchers. Such stress has been associated with increased risk of premature birth, which is linked to higher rates of infant mortality and of physical and mental disorders, such as attention-deficit hyperactivity disorder and anxiety, among offspring.

How a mother’s mental state might specifically affect a fetus was not examined in the study. “We know from animal studies that exposure to high levels of stress can raise levels of stress hormones like cortisol in the uterus, which in turn can affect the fetus,” says Monk. “Stress can also affect the mother’s immune system, leading to changes that affect neurological and behavioral development in the fetus. What’s clear from our study is that maternal mental health matters, not only for the mother but also for her future child.”

Story Source: Materials provided by Columbia University Irving Medical Center.

Source: https://www.sciencedaily.com/releases/2019/10/191015171554.htm

 

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PREEMIE FAMILY PARTNERS

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Still a Preemie

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How to Choose the Best Pediatrician for Your Child

By Vincent Iannelli, MD  Updated on February 23, 2020 – Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.

Parents seem to go to a lot of different extremes when choosing a pediatrician. Some do almost nothing and simply choose the pediatrician on call in the hospital when their baby is born or pick a doctor randomly from a list in the phone book or their insurance directory. Others do detailed research and conduct an interview asking their potential new pediatrician everything from where they went to medical school to what their scores were on their medical boards.

When choosing a pediatrician, make sure you like your new doctor, and see if you agree on important parenting topics, such as breastfeeding, discipline, and not overusing antibiotics, etc.

The Importance of Choosing a Pediatrician

Choosing the right pediatrician is more important than most parents think. While you can simply change doctors if you don’t like the first pediatrician you see, if your newborn or older child is truly sick, the first doctor you see could be making life-changing decisions about your child. Or they could miss a potentially life-threatening problem.

So even if you have a healthy newborn or an older child with a simple cold or ear infection, you should put some thought into who cares for him, just in case his medical problems are a little more serious than you think.

Pediatrician Recommendations

A common way for parents to choose a pediatrician is to get a recommendation from their friends or family members. This is probably one of the best ways, but when someone tells you that they love going to their pediatrician, be sure to ask why before you blindly follow them to the same office.

Many parents have different needs and you may be really turned off by the reason that they like their doctor. For example, they might like that their pediatrician is really fast and they are in and out of the office quickly, while you might like someone who moves slower and spends more time during the visit, even if it means that you have to wait a little longer for your appointment. Or your friend might like that their pediatrician prescribes an antibiotic every time they walk into the office, whether or not they need one.

On the other hand, you might get a negative report on a pediatrician only to find that they don’t like the doctor because he doesn’t over-prescribe antibiotics, which is actually keeping to the guidelines of the American Academy of Pediatrics.

Always try to get the reason or an explanation behind a recommendation to make sure you understand why someone likes or dislikes their pediatrician.

Your own doctor can also be a good source for a recommendation for a pediatrician, especially if you are having a new baby.

Choosing a Pediatrician

Although we like to think that things like cost and convenience should be secondary when making such an important decision, they can be very important when choosing a pediatrician. If the pediatrician you would like to see is not on your insurance plan or is an hour away, it may not be very practical to go to her office.

Important practical matters to consider when choosing a pediatrician, most of which you can ask the office staff, include:

  • Is the pediatrician on your insurance plan? If you don’t have insurance or have a high deductible, then be sure to ask how much each visit costs and maybe compare it to other pediatric offices in the area.
  • Where are you located and do you have a satellite office?
  • Do you offer same day sick appointments?
  • Do you have any late or weekend hours?
  • What happens if I need advice after hours? Is a nurse or doctor available on-call to talk to me? Will I be charged for these calls?
  • What hospitals is the pediatrician affiliated with? This is especially important if you have a Children’s Hospital in your area and you would like a doctor that will see you if you have to go there.
  • Are there any extra charges for advice calls during the day, after hours advice calls, refilling medicines, or requests to fill out forms, etc.?
  • How many doctors are in the office? Will I always see my own doctor?
  • Are the doctors all board-certified?
  • How long is a typical appointment?
  • Are there separate sick and well waiting rooms?

Another practical matter to consider is whether you want to go with a group practice or a solo practitioner. The benefit of a solo practitioner or a pediatrician who is in an office by himself is that you can be sure that you will always see your own doctor. The biggest downside is that if your pediatrician takes some time off, either for a vacation or if he takes an afternoon off, then you may have to wait for an appointment or go to another office.

In a group practice, you usually see your own pediatrician when they are in the office and have the benefit of seeing another doctor if they are out. Larger offices often have the benefit of sharing expenses and may have more equipment in the office, such as a lab, so that you don’t have to go somewhere else to get blood work done.

Once you find a pediatrician you think you might like, consider scheduling a “new mom” consult to interview them. These appointments work for new dads, too.

Interviewing Pediatricians

Although you can typically narrow down your choice of pediatricians by figuring out who is on your insurance plan and in your area, who is accepting new patients and getting some recommendations from friends and family, the best way to find a good pediatrician is to actually set up an appointment and meet with a few.

Keep in mind that while most parents like to think that they are looking for a good pediatrician, you are mostly looking for a pediatrician who is good for you and your family. And that often comes down to how well your personalities fit together.

A couple of good questions to ask during this interview to help figure out if you have found a good fit include:

  • What are good reasons to get a second opinion from a specialist? (A good answer is because either the pediatrician or the parent wants one. A parent should be able to get a second opinion if they think it is important.)
  • How long should I breastfeed my baby?
  • What is your basic philosophy on discipline, potty training, immunizations, prescribing antibiotics, etc.?
  • What is your opinion on alternative medicine, attachment parenting, co-sleeping, etc.?

Also, setting up an appointment to interview a pediatrician is just not something you can do when you are pregnant. If you already have children and have moved to a new area or are simply changing doctors, it can still be a good idea to meet with a few doctors before choosing a new pediatrician.

Most importantly, remember that it doesn’t necessarily matter whether or not your pediatrician went to the best medical school or finished first in her class, so those aren’t very important things to ask about. You are really looking for someone who is going to care about your child, listen to and respond to your needs, and be available when you need her. And while you may have to initially trust your instincts that you found the right pediatrician, it may take several visits or even several years to know for sure.

Source: https://www.verywellfamily.com/choosing-a-pediatrician-2633444

 

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Miracle Babies | How a premature baby changes your life

WaterWipes 

 

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WARRIORS:

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Dr. Gabor Maté on How to Reframe a Challenging Moment and Feel Empowered | The Tim Ferriss Show

KAT’S CORNER

Aloha Warriors! I am swimming towards Winter quarter 2020 finals, amping up my immune system, digging through global medicine data, and coming up for “AIR” to let you know that your presence in our World feeds my soul ….. and I Thank You.  This month we are re-sharing our story, and if our story is new to you, please enter the link below! Much Love!  –https://neonatalwombwarriors.blog/our-story/

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Get easily out of breath? It may be because you were small at birth, study finds 

Date: January 31, 2020 Source: Karolinska Institutet

Babies born with low birth weights are more likely to have poor cardiorespiratory fitness later in life than their normal-weight peers. That is according to a study by researchers at Karolinska Institutet in Sweden published in the journal JAHA. The findings underscore the importance of prevention strategies to reduce low birth weights even among those carried to at term delivery.

Having a good cardiorespiratory fitness — that is ability of the body to supply oxygen to the muscles during sustained physical activity — is important for staying healthy and can reduce the risk of numerous diseases and premature death. Alarmingly, cardiorespiratory fitness is declining globally, both for youths and adults. A recent study showed that the proportion of Swedish adults with low cardiorespiratory fitness almost doubled from 27 percent in 1995 to 46 percent in 2017.

Given its implications for public health, there has been a growing interest in understanding the underlying causes of poor cardiorespiratory fitness. Researchers have identified both physical inactivity and genetic factors as important determinants. Preterm delivery, and the low birth weight associated with it, has also been linked to low cardiorespiratory fitness later in life. In this study, the researchers wanted to examine if low birth weights played a role for cardiorespiratory fitness in individuals born after pregnancy of 37-41 weeks.

They followed more than 280,000 males from birth to military conscription at age 17-24 using Swedish population-based registers. At conscription, the men underwent a physical examination that included an evaluation of their maximal aerobic performance on a bicycle ergometer. The researchers found that those born with higher birth weights performed significantly better on the cardiorespiratory fitness test. For every 450 grams of extra weight at birth, in a baby born at 40 weeks, the maximum work capacity on the bicycle increased by an average of 7.9 watts.

The association was stable across all categories of body mass index (BMI) in young adulthood and was largely similar in a subset analysis of more than 52,000 siblings, suggesting that BMI and shared genetic and environmental factors alone cannot explain the link between birth weight and cardiorespiratory fitness.

“The magnitude of the difference we observed is alarming,” says Daniel Berglind, researcher at the Department of Global Public Health at Karolinska Institutet and corresponding author. “The observed 7.9 watts increase for each 450 grams of extra weight at birth, in a baby born at 40 weeks, translates into approximately 1.34 increase in metabolic equivalent (MET) which has been associated with a 13 percent difference in the risk of premature death and a 15 percent difference in the risk of developing cardiovascular disease. Such differences in mortality are similar to the effect of a 7-centimeter reduction in waist circumference.”

The researchers believe the findings are of significance to public health, seeing as about 15 percent of babies born globally weigh less than 2.5 kilos at birth and as cardiorespiratory fitness have important implications for adult health.

“Providing adequate prenatal care may be an effective means of improving adult health not only through prevention of established harms associated with low birth weight but also via improved cardiorespiratory fitness,” says Viktor H. Ahlqvist, researcher at the Department of Global Public Health and another of the study’s authors.

Source:https://www.sciencedaily.com/releases/2020/01/200131074207.htm

 

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Surf Scheveningen, Den Haag, Holland: Top Surf Spots in Europe Ep. 2

epi

Jun 18, 2013

In this episode Dutch wonder kid Yannick de Jager gives us the low down of his home break called Scheveningen, located in the Hague, Holland. Although it’s not known for its surf, the travelling surfer who finds himself/herself there on a good day might be pleasantly surprised with the quality of ride they find. Athlete – Yannick de Jager Location – Scheveningen, Den Haag, Holland