Preterm Birth Rates – Nicaragua
Rank: 105 –Rate: 9.3% Estimated # of preterm births per 100 live births (USA – 12 %)
The Nicaraguan government guarantees universal free health care for its citizens. However, limitations of current delivery models and unequal distribution of resources and medical personnel contribute to the persistent lack of quality care in more remote areas of Nicaragua, especially amongst rural communities in the Central and Atlantic region. To respond to the dynamic needs of localities, the government has adopted a decentralized model that emphasizes community-based preventive and primary medical care.
Nicaragua is a country in crisis, and the press has been diminished by the current government. We were not able to access current news related to our preterm birth community in Nicaragua. To our brothers and sisters in Nicaragua we send our Love and Respect for our Neonatal Womb/preterm birth community members and hold your well-being and health in our collective consciousness.
Our goal this month is to provide time sensitive information relevant to our Global/local preterm birth community focused on supporting our preterm birth families, health care providers and community members. Wishing us all health, wellness, hope and love.
Pregnant and worried about the new corona virus
Home » Harvard Health Blog » Pregnant and worried about the new coronavirus? – Harvard Health Blog Posted March 16, 2020, 2:30 pm , Updated March 18, 2020, 10:14 Huma Farid, MD – Contributor Babar Memon, MD, MSc – Contributor
COVID-19, the disease caused by a new coronavirus, has rapidly spread globally. The World Health Organization recently labeled COVID-19 a pandemic. Many of my pregnant patients have expressed concerns, both for themselves and their babies, about the impact of COVID-19 on their health. To answer often-asked questions about pregnancy and the new coronavirus, I’ve teamed up with my husband, an infectious disease specialist and internist. Together, we reviewed the extremely limited data available to provide evidence-based responses below.
Pregnancy and the new coronavirus
As you probably know, the virus spreads through respiratory droplets sent into the air when a person who has COVID-19 coughs or sneezes. It may also spread when someone touches a surface infected by a person who has the virus.
What can I do to protect myself against catching the new coronavirus?
The most important step is to practice excellent hand hygiene by frequently washing hands with soap and water for 20 seconds. Avoid touching your eyes, mouth, and nose. You should also avoid large gatherings. Social distancing is important to limit the spread of the virus. If you have a mild cough or cold, stay at home and limit exposures to other people. Sneeze and cough into a tissue that you discard immediately, or into your elbow, to avoid making others sick. Hydration and adequate rest also are important in maintaining the health of your immune system.
As a pregnant woman, what is my risk of becoming very ill from COVID-19?
Given that this is a novel virus, little is known about its impact on pregnant women. At this point, experts think that pregnant women are just as likely, or possibly more likely, than the general public to develop symptoms if infected with the new coronavirus. Current information suggests symptoms are likely to be mild to moderate, as is true for women (and men) in this age range who are not pregnant.
If I am pregnant and have COVID-19, does this increase the risk of miscarriage or other complications?
There does not appear to be any increased risk of miscarriage or other complications such as fetal malformations for pregnant women who are infected with COVID-19, according to the Centers for Disease Control and Prevention (CDC). Based on data from other coronaviruses, such as SARS and MERS, the American College of Obstetricians and Gynecologists notes that pregnant women who get COVID-19 may have a higher risk for some complications, such as preterm birth, but the data are extremely limited and the infection may not be the direct cause of preterm birth.
If I get sick from the new coronavirus, what is the risk of passing the virus onto my fetus or newborn?
A study of nine pregnant women who were infected with COVID-19 and had symptoms showed that none of their babies were affected by the virus. The virus was not present in amniotic fluid, the babies’ throats, or in breast milk. The risk of passing the infection to the fetus appears to be very low, and there is no evidence of any fetal malformations or effects due to maternal infection with COVID-19.
I tested positive for COVID-19. Can I breastfeed my baby?
Currently, there is no evidence of the virus in breast milk. Given that the virus is spread through respiratory droplets, mothers should wash their hands and consider wearing a face mask to minimize infants’ exposure to the virus.
Can I travel for my baby-moon?
We recommend avoiding all travel at this time, given the concerns that the virus could be widespread, and the uncertainty for travel restrictions (see CDC travel advisories).
Should I reschedule my baby shower because of the new coronavirus?
While a baby shower is a joyous and important occasion, public health agencies such as the CDC recommend social distancing to limit the spread of the virus. Particularly in large gatherings, the risk of possible exposure and infection is quite high. We recommend limiting social gatherings at this time.
What should I do if I have a fever or cough, have traveled from a country in which the virus is widespread, or have been in contact with a person confirmed to have COVID-19?
Every hospital has specific rules for the best way to handle these situations. The first step is to call your doctor’s office to inform them of your symptoms, travel, or contact with someone who has a confirmed case of COVID-19. Do not simply go to your doctor’s office. It is very important to limit the spread of the virus. Particularly if you have symptoms, it is best to call your doctor first to determine whether you need testing and/or to come in for evaluation.
I am worried that doctors, even obstetricians, will be diverted in an emergency setting and may not be available when I am delivering. Will that be the case?
At this time, there is no plan for any other doctors to be pulled from their regular duties to staff other parts of the hospital. Obstetrics is an essential component of health, and it is unlikely that an ob/gyn will not be present at the time of your baby’s birth. Ask your health care team about this.
For more information about the new coronavirus and COVID-19, please see Harvard Health Publishing’s Coronavirus Resource Center.
Is it ethical to recruit doctors from countries with physician shortages?
Wendy Glauser 2019 May 6; 191(18): E512–E513.
To help address its physician shortage, Nova Scotia is recruiting doctors in the UK.
As Nova Scotia looks to the United Kingdom for doctors, and Britain comes under fire for importing more doctors than it trains, health human resource experts are calling for ethical and local solutions to Canada’s physician shortage.
Staff from the Nova Scotia Office of Immigration, the Nova Scotia Health Authority and the College of Physicians and Surgeons of Nova Scotia recently traveled to four cities in England and Scotland to meet with 36 doctors interested in working in the province. The Nova Scotia Office of Immigration launched a fast-track immigration stream for recruiting and processing doctors last year, according to Lynette MacLeod, a media relations adviser for the office.
Meanwhile, the UK is facing its own physician shortage. According to data from the General Medical Council, 53% of new physician hires at the National Health Service (NHS) come from another country, up from 39% in 2015. Simon Stevens, head of the NHS, called on Britain to stop “denuding low-income countries of health professionals they need.” Most of the recruits come from eastern Europe and India.
Ivy Bourgeault, who holds the Canadian Institutes of Health Research Chair in Gender, Work and Health Human Resources, says it is “not ethical” to recruit from the UK. “They have incredible shortages of GPs … this is being exacerbated by Brexit,” she says.
In Nova Scotia, however, the focus is on the shortage at home. Grayson Fulmer, senior director of medical affairs for the Nova Scotia Health Authority, pointed out that 5% of Nova Scotians are in need of a family doctor. “Just as Nova Scotian physicians are lured to other work environments for competitive offerings, we have a duty to our population to provide access to health care wherever possible,” Fulmer wrote in a statement. “This is a timely and complex issue.”
With 25% of its doctors educated abroad, Nova Scotia’s foreign-trained doctor ratio is in line with Ontario and other provinces. (In Saskatchewan, meanwhile, 50% of doctors are foreign-trained). Overall, data from the Canadian Medical Association show that, in 2018, around 26% of doctors working in Canada were trained abroad. That percentage has held steady over the last decade. Many come from low- and middle-income countries.
“Our dependency ratio on foreign-trained doctors hasn’t really shifted. It’s built into the body and soul of the Canadian health system,” says Ronald Labonté, a Canada Research Chair in Contemporary Globalization and Health Equity. “Under that sort of circumstance, I think Canada has a larger moral obligation to … make sure there are adequate resource transfers to lower- or middle-income countries.”
Numerous suggestions have been floated about how high-income countries could compensate lower-income countries for the brain drain, such as increasing foreign aid, but none have been adopted. Labonté proposes that income tax gathered from doctors from nations with severe physician shortages could be funnelled back to their home countries. No matter how compensation is structured, it should be invested in these countries’ health systems, Labonté argues, to address the common “push factors” that cause doctors to leave — namely, that they are underpaid and working in under-resourced health systems.
Bourgeault says Canada should be taking steps internally to solve its physician distribution and supply issues. “We need to be doing better at health workforce planning, which we are pathetic at,” she says. “It’s inexcusable, that as a high-income country that has invested millions in data on the patient side, we don’t invest the money [to gather and analyze] the data on the health workforce side.”
In addition to better health workforce planning, Canada should focus on increasing rural training opportunities, streamlining processes for licensure in multiple provinces, exploring how to “bring Canadian physicians back” if they are practising abroad, and better utilizing nurse practitioners and physician assistants, Bourgeault suggests.
She adds that recruiting abroad is typically not an effective measure to fill needs in rural areas in the long term. A 2012 study found that a majority of international medical graduates practising in Newfoundland left the province after gaining full licensure. “You have to look at the broader ethics of recruiting, and most people don’t,” says Bourgeault, who estimates that Canada saves about $1 million in training costs for each foreign-trained physician hired.
Heatwaves Linked to Greater Risk of Preterm Births
By Traci Pedersen Associate News Editor Last updated: 26 Feb 2020
A new study reveals that heatwave exposure during the week before birth is strongly linked to an increased risk of preterm delivery — the hotter the temperature or the longer the heatwave, the greater the risk. In particular, longer duration heatwaves are associated with the highest risk of a preterm birth.
“We looked at acute exposure to extreme heat during the week before birth, to see if it triggered an earlier delivery,” said first author Sindana Ilango, a Ph.D. student in the Joint Doctoral Program in Public Health at the University of California (UC) San Diego and San Diego State University. “We found a consistent pattern: exposure to extreme heat does increase risk. And, importantly, we found that this was true for several definitions of “heatwave”. The findings are published in the journal Environment International.
“We knew from previous studies that exposure to extreme heat during the last week of pregnancy can accelerate labor,” said senior author Tarik Benmarhnia, Ph.D., assistant professor of epidemiology at UC San Diego School of Medicine and Scripps Institution of Oceanography.
“But no one had tried to figure out exactly what kinds of conditions could trigger preterm births. Is it the temperature? Is it the combination of the temperature and the humidity? Is it the duration of the heatwave? It’s important to ask these questions to know when we need to intervene and inform pregnant people to stay inside and stay cool.”
Preterm birth is defined as birth before 37 weeks of pregnancy, which typically lasts at least 40 weeks. Early birth can cause a variety of health problems in infants, from respiratory and cardiac ailments and difficulty controlling body temperature to increased risk for brain hemorrhages and long-term health concerns such as cerebral palsy, mental health issues, learning difficulties, and vision and hearing problems.
“Identifying risk factors that can contribute to increased preterm birth rates is an important piece of improving birth outcomes,” Ilango said. While previous studies of this kind have been conducted in other countries, including Canada, China, and Australia, this is the first of its kind to be completed in the United States.
The new study also incorporated information about ambient humidity into the data, which affects the “feels like” temperature in a region.
“In coastal California, due to climate change, we’re seeing more humid heat waves,” said Benmarhnia. “Humid air holds heat longer, which can keep temperatures high overnight, contributing to longer heatwaves. This could be important for the recommendations given to pregnant people — it might not be enough to stay inside just during the day, we might have to think about what to do for night temperatures, too.”
The research team used data collected by the California Department of Public Health that included information about every single birth in the state of California between 2005 and 2013, comprising nearly 2 million live births during the summer months. Then they categorized individuals based on their zip code and compared the birth outcome data to environmental records for that area at the time the woman went into labor.
“California is an interesting region for this study because it has a very diverse population spread across a wide variety of microclimates, providing a lot of variation in the data to help us tease apart the relationship between high temperatures and preterm birth rates,” said Benmarhnia.
The researchers found that while the baseline rate of preterm birth was around 7 percent of all pregnancies, under the most conservative definition classifying a heatwave (an average maximum temperature equal to or greater than the 98th percentile, averaging 98.11 degrees and lasting at least four days), the risk of preterm birth was increased by 13 percent.
While the results were in line with the researchers’ hypothesis, “it was surprising how strong the trend was,” said Ilango. “It was so clear that as temperature and duration of a heatwave went up, so did the risk of preterm birth.”
“We were also surprised to note that the duration of the heatwave seems to be more important than the temperature threshold,” added Benmarhnia. “We thought that temperature would matter the most, but it turns out that it has more to do with how long you’re stuck with the high temperatures rather than how hot it is outside.”
These findings could be used for directly informing recommendations for families faced with high temperatures in their region, as communities use regional weather trends to determine how they define a heatwave and when to issue warnings for pregnant people to stay in air conditioned spaces.
How to protect your family’s mental health in the face of corona virus disease (COVID-19)
A conversation with adolescent psychology expert Dr. Lisa Damour.
Parents and children are facing major life disruptions with the outbreak of coronavirus disease (COVID-19). School closures, physical distancing, it’s a lot to take in and it’s difficult for everyone in the family. We sat down with expert adolescent psychologist, best-selling author, monthly New York Times columnist and mother of two Dr. Lisa Damour to learn more about how families can support each other and make the most of this new (temporary) normal.
UNICEF: How can teenagers and parents take care of their mental health during the coronavirus disease (COVID-19) outbreak?
Dr. Damour: The first thing that parents can do is actually to normalize the fact that they [teenagers] are feeling anxious. Many teenagers have the misunderstanding that anxiety is always a sign of mental illness when in fact, psychologists have long recognized that anxiety is a normal and healthy function that alerts us to threats and helps us take measures to protect ourselves. So it’s very helpful for teenagers if you say, “You’re having the right reaction. Some anxiety right now makes sense, you’re supposed to feel that way. And that anxiety is going to help you make the decisions that you need to be making right now.” Practicing social distancing, washing your hands often and not touching your face — your anxiety will help you do what needs to be done right now, so that you can feel better. So that’s one thing we can do.
Another thing we can do is actually help them look outward. Say to them, “Listen, I know you’re feeling really anxious about catching coronavirus, but part of why we’re asking you to do all these things — to wash your face, to stay close to home — is that that’s also how we take care of members of our community. We think about the people around us.” And then give them further things to do that may be of help: perhaps dropping off food to people in need or going shopping for them or figuring out what areas of our community need support and doing things to support the people around them while maintaining social distance. Finding ways to care for others will help young people feel better themselves. And then the third thing to help with anxiety is to help young people find distractions. What psychologists know is that when we are under chronically difficult conditions — and this is certainly a chronically difficult condition that’s going to go on for a while — it’s very helpful to divide the problem into two categories: things I can do something about, and then things I can do nothing about. There’s going to be a lot in that second category right now, where kids are going to have to live with a pretty difficult situation for a while. Researchers have found that finding positive distractions can help us deal with that second category: we do our homework, we watch our favourite movies, we get in bed with a novel. That is a very appropriate strategy right now. There’s probably a lot to be said for talking about coronavirus and anxiety as a way to seek relief, and there is also a lot to be said about not talking about it as a way to seek relief. Helping kids find that right balance will make a big difference.
UNICEF: On distractions, it’s going to be tempting for a lot of teenagers to bury themselves in screens right now. How can parents and teenagers best handle that?
Dr. Damour: I would be very up front with a teenager and say, “Okay, you and I both know you’ve got a heck of a lot of time on your hands, but you and I both know that it’s not going to be a good idea to have unfettered access to screens and/or social media. That’s not healthy, that’s not smart and it may amplify your anxiety. We really don’t think you having a social media free-for-all is a good idea under any condition. So the fact that you’re not in school and your time isn’t being taken up by classes doesn’t necessarily mean that all of that time should be replaced with social media.” But I think you just say that in a very up-front way which acknowledges that, naturally, there’s no way that the time spent in school will be entirely replaced with being online. And then ask the teenager, “How should we handle this? What should our plans be? What do you propose in this new normal or new short-term normal. Your time is no longer structured in the ways you’re accustomed to, come up with a structure and show me the structure that you have in mind, and then we can think it through together.”
UNICEF: Is structure key to maintaining a sense of normalcy?
Dr. Damour: Kids need structure. Full stop. And what we’re all having to do, very quickly, is invent entirely new structures to get every one of us through our days. And so I would strongly recommend that parents make sure that there’s a schedule for the day, that there’s a plan for how time will be spent — and that can include playtime where kids can get on their phones and connect with their friends, which of course they’re going to want to do. But it also should have technology-free time, time set aside to help with making dinner, time to go outside. If you can be outside you should. We need to think about what we value and we need to build a structure that reflects that, and it will be a great relief to our kids to have a sense of a predictable day and a sense of when they’re supposed to be working and when they get to play. I would say for kids under the age of 10 or 11, the parent should come up with a structure and then negotiate from there with their child and see if there’s any feedback that makes good sense. For children 10 and 11 or older, I would ask the child to design it — and give them a sense of the kinds of things that should be part of that structure, and then work with what they create.
UNICEF: What tips would you give parents who are building a structure for younger children?
Dr. Damour: I think we have to recognize that younger kids actually do sit in class for periods of the day and tolerate the interruptions and annoyances of a lot of kids around them, and they won’t have to tolerate those when they’re at home. Which is to say that I don’t think we should underestimate their ability to work in a focused way from home. That said, every family knows their child best and it may be ideal, depending on who is supervising them (I realize that not every parent is going to be home to do this), to structure their day so that all of those things that need to get done get done before anything else happens: All of their schoolwork, all of their chores, all of their have-to-do activities versus get-to-do activities. For some families, doing that at the start of the day will work best for kids. Other families may find that it works well to start the day a little bit later, to sleep in, to enjoy a longer breakfast together, and then get rolling at 10 or 11 in the morning. Every family gets to do it their own way. I also want to add something that some people may be reluctant to voice: We’re stuck with this, so to the degree you can enjoy it — you should. If this means you’re making pancakes as a family for breakfast and that is something that was never a possibility on a normal school day and that’s something that makes everybody happy, enjoy that.
Here’s the bottom line: Kids need predictability — as much predictability as you can offer in a situation like this. So don’t wake up every day and figure out the schedule. Try a schedule, or maybe try a provisional one for a week as a family and then review it at the end of the week.
“We should remember that they are the passengers in this and we are driving the car.”
UNICEF: How important is a parent’s own behaviour in a time of crisis?
Dr. Damour: Parents, of course, are anxious too and our kids know us better than we know ourselves. They will take emotional cues from us. I would ask parents to do what they can to manage their anxiety on their own time – to not overshare their fears with their children. That may mean containing emotions, which may be hard for parents at times especially if they’re feeling those emotions pretty intensely. I would want for parents to find an outlet for their anxiety that’s not their children. We should remember that they are the passengers in this and we are driving the car. And so even if we’re feeling anxious, which of course we will be, we can’t let that get in the way of them feeling like safe passengers in our car.
UNICEF: Should parents ask their children how they’re feeling on a regular basis or does that bring up more feelings of anxiety?
Dr. Damour: I think it depends on the kid. Some kids really keep to themselves and so it may be valuable for a parent to say, “How are you doing?” or “What are you hearing?” Other kids are going to be talking and talking and talking about it. The way we want to approach these things is to find a good balance between expression and containment. You want some expression and feeling, especially at a time when we should expect kids to have some pretty intense feelings, but you also want those emotions to feel contained. So if your kid is high on expression, you’re going to work on containment, if your kid is high on containment you’re going to help them with a little bit of expression.
UNICEF: Children may worry about catching the virus, but not feel comfortable speaking to their parents about it. How should parents approach the topic with them?
Dr. Damour: Parents should have a calm, proactive conversation with their children about the coronavirus disease (COVID-19), and the important role children can play in keeping themselves healthy. Let them know that it is possible that [you or your children] might start to feel symptoms at some point, which are often very similar to the common cold or flu, and that they do not need to feel unduly frightened of this possibility. Parents should encourage their kids to let them know if they’re not feeling well, or if they are feeling worried about the virus so that the parents can be of help. Adults can empathize with the fact that children are feeling understandably nervous and worried about COVID-19. Reassure your children that illness due to COVID-19 infection is generally mild, especially for children and young adults. It’s also important to remember that many of the symptoms of COVID-19 can be treated. From there, we can remind them that there are many effective things we can do to keep ourselves and others safe and to feel in better control of our circumstances: frequently wash our hands, don’t touch our faces and engage in social distancing.
UNICEF: There’s a lot of inaccurate information about corona virus disease (COVID-19) out there. What can parents do to help counter this misinformation?
Dr. Damour: Start by finding out what they are hearing or what they think is true. It’s not enough to just give your kid facts. If your child has picked up something that is inaccurate or picked up news that is not correct they will combine the new information you give them with the old information they have into a sort of Frankenstein understanding of what’s going on. So ask them, “What are you hearing? When you see kids on social media or when you were last at the playground, what was being said?” Find out what they already know and start from there in terms of getting them on the right track. From there, adults should strongly encourage kids to trust and use reliable sources [such as UNICEF and the World Health Organization’s websites] to get information, or to check any information they might be getting through less reliable channels.
“When it comes to having a painful feeling, the only way out is through.”
UNICEF: How can parents support their children who are experiencing disappointment due to cancelled events and activities?
Dr. Damour: Let them be sad and don’t try to guilt them out of it. Don’t say, “Other people have this worse than you.” Now your kid feels sad and guilty! That doesn’t make it better. Say to them, “You are having the right reaction. This really stinks. You’re not going to get to be with your friends. You’re not going to get to spend spring on college campus. You’re not going to get to go to this convention that you spent six months preparing for.” In the scope of an adolescent’s life these are major losses. And the other thing adults have to remember is we’ve never seen anything like this, and we’ve been around for a long time. They’ve never seen anything like this and they’re much younger. The disruption of four months in the life of a 14-year-old is a very great percentage of their time they remember being alive. This is bigger for them than it is for us.
A year in a teenager’s life is like seven years in an adult’s life. So, we have to have really high empathy for how big these losses feel. This is their one high school graduation for their whole life, this was their one sophomore spring on campus for their whole life. These are large-scale losses. Even if they’re not catastrophic, they’re really upsetting and rightly so to teenagers. So I would ask parents to expect and normalize that teenagers are very sad and very frustrated about the losses they are mourning and all kids are mourning losses right now. I happened to be around six teenagers yesterday who were leaving school who were deeply sad, and I said, “Go be sad. This is really yucky and this stinks, and you have every right to be sad.” When it comes to having a painful feeling, the only way out is through. When we allow people to feel sad, they usually feel better faster. So, empathy, empathy, support, support. Our kids deserve it. Our job as adults is to provide it. They’re having the right reaction. This is not what any of us would want.
UNICEF: What recommendations do you have for teenagers who are feeling lonely and disconnected from friends and activities?
Dr. Damour: This is where we now may appreciate social media in a whole new way! While adults can have such a jaundiced view of adolescents and social media, teenagers want to be with their friends. Under social distancing conditions: tada! They can be with their friends! Further, I would never underestimate the creativity of teenagers. My hunch is that they will find ways to play with one another online that are different from how they’ve been doing it before. And so I would not hold a dim view of all social media right now. I would just make sure that it’s not a wall-to-wall experience for kids because that’s not good for anybody.
UNICEF: What are some of the outlets teenagers can use to work through these difficult feelings and take care of their mental health?
Dr. Damour: I think every kid is going to do this in a different way. Some kids are going to make art, some kids are going to want to talk to their friends and use their shared sadness as a way to feel connected in a time when they can’t be together in person. Some kids are going to want to find ways to get food to food banks. I would just say know your kid, take your cues from your teenager, and really think a lot about balancing talking about feelings with finding distractions and allow distractions when kids need a relief from feeling very upset.
UNICEF: Some children are facing abuse at school or online around the coronavirus outbreak. What should a child do if they are experiencing bullying?
Dr. Damour: Activating bystanders is the best way to address any kind of bullying. Along these lines, all parents should tell their children that if they witness bullying, they should reach out to the victim or find an adult who can help.
UNICEF: How can parents make the most of the situation? If you’re able to be with your kids, how can you have fun together while you’re stuck at home?
Dr. Damour: In our house — I have two daughters — we’ve decided that we are going to have a dinner team every night. We’re going to create a schedule of who’s in charge of dinner and sometimes it’ll be me and my spouse and sometimes it’ll be me and one of my daughters. We’ll mix it up in pairs, and my older daughter is a teen and my younger daughter is elementary-school age, so there will be nights where the two girls are in charge of things. And so, we rotate who is in charge of making dinner for the family. We often don’t get the time to make dinner as a family. We don’t usually have the time in the day to enjoy cooking together, so we’re doing that.
I have been making a list of all of the things I want to do with myself: the books I want to read and the things that I’ve been meaning to do — I’ve been meaning to teach my younger daughter how to knit and she’s been asking, so if she’s still interested we’ll be knitting! We’re thinking about having a movie night every three or four nights and we were thinking that the dinner team gets to choose the movie. Every family has their own rhythm and culture and the challenge right now is to invent structures — to pluck them out of thin air. But we can do that, and it’s what our kids need.
PREEMIE FAMILY PARTNERS
Coronavirus – Risks for preterm born infants: An interview with Professor Doctor Christoph Bührer
Posted on 09 March 2020
The Coronavirus disease (COVID-19) and its distribution is on everyone‘s lips and speculations run high. Especially older people and persons with a pre-existing medical condition appear to be develop a serious illness more often than others (WHO). This might leave parents-to-be, parents of preterm born infants and former preterms worrying. We talked to Professor Doctor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin about the risks he sees for unborn babies, preterm born infants and preterm born adults.
Professor Bührer, can corona virus pass from pregnant woman to her unborn infant?
At present, the most likely mode of transmission in all newborn infants with COVID-19 infection analysed so far is postnatal transmission. No case of intrauterine transmission has been documented. This do not exclude the possibility that transmission before birth may happen, but it is very unlikely.
What kind of risk of corona infection do you see for preterm born infants?
Infants, as compared to adults, have a much lower risk of getting infected with the new corona virus. Moreover, they are also less likely to develop symptoms. In China, only 9 infants less than 1 year of age were identified by early February 2020, at a time when the total number of infected people had already risen to more than 50,000. None of the infants with a positive test result was seriously ill, none of them was admitted to an intensive care unit. At present, there is no specific data for preterm infants available. As manuscripts on the epidemiology of COVID-19 are published at high speed, there is reason to assume that infants, both term and preterm, are just not the prime target of this virus. If a COVID-19 infection turns into pneumonia, preterm infants with bronchopulmonary dysplasia should be expected develop more serious symptoms (such as shortness of breath, increased rates of breathing, or poor oxygenation) than those with healthy lungs, so they would be more likely to be tested for COVID-19. However, there is lack of reports on COVID-19 ravaging preterm infants which is rather reassuring.
Is the risk of an infection higher for a preterm born adult?
If a COVID-19 infection turns into pneumonia, anybody with a chronic lung condition (such asthma, cystic fibrosis, or former preterm infants who had bronchopulmonary dysplasia) will have more trouble coping with the disease. These people may need more medical help than somebody who is completely healthy. As COVID-19 and flu (notably H1N1) have a similar attack rates, adults and adolescents born very preterm are advised to get vaccinated against influenza.
We would like to thank Prof Bührer for taking time to give this interview.
Note: To avoid infection with COVID-19 it is advisable to frequently wash your hands. If you want to promote handwashing in your organisation, find useful materials such as posters, flyers and colouring pictures at: www.efcni.org/activities/campaigns/wash-your-hands/
World Prematurity Day 2019: How Fathers Can Take Care of Wife and Preemie
You need to comfort and support your baby and your partner and realize that you’re making a difference. Remember, the father can connect with the newborn from the very beginning.
News18.com Updated: November 17, 2019, 11:20 AM IST
As a father, you are the first point of contact for the doctors after the birth of your baby. You are the first to learn about your premature baby’s condition and inform your partner, friends and family about the same.
The father can connect with the newborn from the very beginning. It has been found that men experience a surge in “bonding” hormones around the time their children are born. The earlier you hold your premature baby and engage in her care, the more likely you’re to feel satisfaction, affection and love for your baby. No wonder why they say, it’s an evolutionary response to turn men into dads!
You’re a vital member of the team at the Neonatal, Intensive Care Unit, that’s working to make your baby stronger. Being a NICU dad can be difficult but that’s when you need to step up and do all the things proactively. You need to comfort and support your baby and your partner and realize that you’re making a difference. The more time you spend in the NICU, the better it is for your child’s development.
Remember to take kangaroo care which is a simple act of spending a lot of time with your baby, wherein you maintain a constant skin to skin contact and constant communication with them. It is important to talk to the preemie as it aids in the development of their cognitive faculties. Know that your baby recognizes your voice and touch. According to American Academy of Pediatrics, skin-to-skin or kangaroo contact improves infant’s respiratory patterns and increases the rate of infant’s ideal weight gain.
It is important to being hands on with the daily care. You want to be involved in feeding, changing nappies or settling your baby which helps create one-on-one time with your baby.
Premature babies can get stressed easily and signs such as heart rate and oxygen levels are an indication of the same. You can always check with the nurse on what you can do.
Amidst all this, it’s normal and understandable to feel lost or stretched between responsibilities at home which includes looking after other children, hospital and work. Your needs can sometimes get forgotten too, with family and hospital staff focusing on your premature baby and your partner.
You may be undergoing a plethora of emotions; sometimes anxiety and fear and other times overwhelming love and pride. You and your partner may experience the same feelings but not always at the same time. Key is to be patient and to reassure her, help with the demand of pumping milk and praise her for her efforts.
It therefore becomes important to take some time out to spend with your partner. Couples therapy is a way to go about it. Couples should make it a point to spend time with each other as it not only strengthens their bond but also helps the baby to become accustomed to both the parents. If you’re in the NICU, it can also help your partner feel more confident about the situation. Your support can be of encouragement to her, for her well-being and mental health.
(Dr Preeti Gangan, IBCLC certified consultant, Pediatrician)
Preterm babies are more likely to be diagnosed with reactive attachment disorder
Date: March 12, 2020 Source: University of Turku
Premature birth, low birth weight, and neonatal intensive care are associated with the risk of being diagnosed with reactive attachment disorder (RAD). The disorder causes problems in emotional bonding, social interaction, and expression of emotions, and it can lead to severe and expensive consequences later in life. The disorder will impair child’s social interactions and it is connected with later child protection issues, psychiatric and substance use disorders, and social exclusion.
A new study by the Research Centre for Child Psychiatry of the University of Turku, Finland, suggests that premature babies have the risk of reactive attachment disorder that can impair child’s ability to function in normal situations and their social interactions and it is connected with later child protection issues, psychiatric and substance use disorders, and social exclusion.
“The study showed that children’s risk of being diagnosed with reactive attachment disorder increases by three times if their gestational age at birth is less than 32 weeks. The risk was twofold if the birth weight was less than 2.5 kilos, or if the newborn required monitoring in a Neonatal Intensive Care Unit, says lead author,” researcher Subina Upadhyaya.
The results acknowledged parental age and psychiatric and substance abuse diagnoses, and mother’s socioeconomic status and smoking. Therefore, the association between attachment disorder and early preterm birth is not due to differences in these parental background or lifestyle differences between the diagnosed and the control group.
This is the first population study to report perinatal and obstetric risk factors for RAD. Previously, the research group discovered an association between parental mental health diagnosis, parental substance abuse and RAD.
Results support family-centered treatment
According to Professor in Child Psychiatry Andre Sourander from the University of Turku, the results benefit the planning of preventive and early mental health services.
“The fact that premature birth is so strongly associated with reactive attachment disorder is an important finding. It indicates that family-centered support of early parent-infant interactions and need for care should be taken into account when treating premature babies, says Sourander,” who led the study.
Sourander says that most of the children in the study were born in the 1990s and early 2000s. Treatment practices have changed since then in many countries.
“The management of premature infants should be multidisciplinary and personalised. Parent-infant interaction and family-centered care have recently received attention, and the care of premature infants has become increasingly comprehensive. The practice of skin-to-skin care is increasingly becoming popular worldwide. Early parental-infant closeness should be encouraged in centers that care for preterm infants.
“In the future, it is important to determine whether the independent relationship of prematurity to RAD has decreased as treatment practices have changed,” Professor Sourander concludes.
All the children who were born in Finland between 1991-2012 and diagnosed with RAD were included in the study. There were a total of 614 cases and 2423 controls. The study was part of Inequalities, Interventions, and New Welfare State research flagship funded by Academy of Finland.
More internationally educated nurses in hospitals may result in a stable nursing workforce
Having more nurses trained outside of the United States working on a hospital unit does not hurt collaboration among healthcare professionals and may result in a more educated and stable nursing workforce, finds a new study by researchers at NYU Rory Meyers College of Nursing published in the journal Nursing Economic$.
Internationally educated nurses–who receive their primary nursing education outside of the country where they currently work–have become an important part of the nursing workforce in many countries. In the U.S., recruiting internationally educated nurses has been used to address nursing shortages. While the true number of internationally educated nurses in the U.S. is difficult to capture, it is estimated that 5.6 to 16 percent–or 168,000 to 480,000–of the country’s more than 3 million nurses were educated in another country.
Internationally educated nurses often face challenges when transitioning to practice in the U.S. because of cultural, language, and healthcare system differences. While internationally educated nurses can help mitigate nursing workforce shortages, there is little research on their impact on quality of care and patient outcomes, and the findings have been mixed.
In this study, the researchers looked at the proportion of internationally educated nurses on hospital units and evaluated whether this affects collaboration among health professionals and other factors of hospital units. They used 2013 survey data from the National Database of Nursing Quality Indicators, analyzing responses from 24,045 nurses (2,156 of whom were trained outside the U.S.) working on 958 units across 160 U.S. acute care hospitals. Collaboration on a unit was measured using a nurse-nurse interaction scale and a nurse-physician interaction scale.
The researchers found having more internationally educated nurses did not lead to decreased collaboration among nurses and between nurses and physicians. This is important because collaboration among healthcare professionals is a fundamental aspect of quality work environments and can result in positive patient outcomes and satisfaction.
Interestingly, units with higher proportions of internationally educated nurses had notable differences, including factors that could both help and hurt patient care. For example, units with more internationally trained nurses had nurses with higher levels of education, which may be because internationally educated nurses are more likely to have a baccalaureate degree in order to qualify for and pass the U.S. nursing licensure exam.
“Research shows that having more nurses with bachelor degrees improves patient safety, so it is possible that internationally educated nurses are contributing to improved health outcomes,” said Ma.
Units with more internationally trained nurses also had less turnover, as these nurses are likely to stay in a job longer than their U.S.-educated peers.
“In other words, units with more internationally educated nurses have a more stable nursing workforce. Not only can lower turnover rates reduce recruiting and hiring expenses, but they are also linked to fostering collaborative environments among nurses,” said Ma.
In contrast, units with more internationally trained nurses had worse nurse staffing levels or higher patient-to-nurse ratios, despite these nurses being recruited to address shortages. Worse staffing levels have been shown to hurt collaboration and could potentially worsen patient outcomes.
The researchers note that hospitals and nurse recruitment agencies can play important roles helping to integrate internationally educated nurses into the U.S. workforce–for instance, providing training on the basics of the U.S. healthcare system, creating peer mentoring programs, and running workshops on culture, communication, and teamwork.
“Given the ongoing nursing workforce shortage, especially in rural areas, nurse managers and hospital administrators should not be reluctant to hire qualified internationally educated nurses to fill vacancies,” said Ma. “In addition, nurse managers and peer nurses should recognize the contributions of their internationally educated colleagues, who are part of more stable, educated nursing teams. Recognizing the value of individual nurses can lead to a healthy work environment and workforce, which contributes to high quality patient care and outcomes.”
Severe BPD Ventilator Strategies: A Quick Guide
Prevention of bronchopulmonary dysplasia (BPD) is a primary focus of treatment when an infant is born preterm. An infant who needs ventilator support does best with low tidal volumes and short inspiratory times to try and prevent lung injury during the acute course of lung disease.
However, once lung injury has occurred and the patient is diagnosed with BPD, some patients are still taken care of as if they have acute lung disease, says Leif Nelin, MD, chief of the Division of Neonatology at Nationwide Children’s Hospital and a founder of the national Bronchopulmonary Dysplasia Collaborative. In fact, ventilator strategies and settings must change dramatically after severe BPD is established. The collaborative has published a review of best practices for the interdisciplinary care of children with severe BPD, and included recommendations for ventilator and gas exchange strategies. This chart provided is a guide, adapted from those recommendations and current clinical practice at Nationwide Children’s Hospital.
This chart, adapted from the Bronchopulmonary Dysplasia Collaborative, shows the differences in strategies between the first week of life, when prevention is the goal, and later, when severe BPD has been established ENTER HERE: https://www.nationwidechildrens.org/for-medical-professionals/tools-for-your-practice/connect-with-nationwide-childrens/pediatrics-online/severe-bpd-ventilator-strategies
Babies born prematurely can catch up their immune systems, study finds
by King’s College London – March 9, 2020
Researchers from King’s College London & Homerton University Hospital have found babies born before 32 weeks’ gestation can rapidly acquire some adult immune functions after birth, equivalent to that achieved by infants born at term.
In research published today in Nature Communications, the team followed babies born before 32 weeks gestation to identify different immune cell populations, the state of these populations, their ability to produce mediators, and how these features changed post-natally. They also took stool samples and analysed to see which bacteria were present.
They found that all the infants’ immune profiles progressed in a similar direction as they aged, regardless of the number of weeks of gestation at birth. Babies born at the earliest gestations—before 28 weeks—made a greater degree of movement over a similar time period to those born at later gestation. This suggests that preterm and term infants converge in a similar time frame, and immune development in all babies follows a set path after birth.
Dr. Deena Gibbons, a lecturer in Immunology in the School of Immunology & Microbial Sciences, said: “These data highlight that the majority of immune development takes place after birth and, as such, even those babies born very prematurely have the ability to develop a normal immune system.”
Infection and infection-related complications are significant causes of death following preterm birth. Despite this, there is limited understanding of the development of the immune system in babies born prematurely, and how this development can be influenced by the environment post birth.
Some preterm babies who went on to develop infection showed reduced CXCL8-producing T cells at birth. This suggests that infants at risk of infection and complications in the first few months of their life could be identified shortly after birth, which may lead to improved outcomes.
There were limited differences driven by sex which suggests that the few identified may play a role in the observations that preterm male infants often experience poorer outcomes.
The findings build on previous findings studying the infant immune system.
Dr. Deena Gibbons: “We are continuing to study the role of the CXCL8-producing T cell and how it can be activated to help babies fight infection. We also want to take a closer look at other immune functions that change during infection to help improve outcomes for this vulnerable group.”
Emotional First Aid for Those on the Front Lines of COVID-19
By Nicholette Leanza, MEd, LPCC-S Last updated: 31 Mar 2020
The stress that COVID-19 has placed on our health care workers is immense. Exhaustion, frustration and feeling overwhelmed has become a daily norm for many of our beloved medical professionals who are on the frontlines fighting COVID-19. Hospitals struggle to find space to help those with the virus while at the same time continuing to care for all their other patients too. “All hands on deck” is not just a term used for a crew of a ship but can now also be used for a crew of a hospital.
During this very difficult time, it’s more important than ever that we take care of our doctors, nurses and other health care professionals as we battle this pandemic. Since these are unprecedented times, typical stress management techniques are not enough to help these caring professionals deal with their stressful jobs. They need an emotional first aid kit to promote a resilient mindset as they battle this devastating virus.
Here are some emotional first aid tips to help those on the front-lines battling COVID-19:
You are not alone.
At times, it can feel like a lonely and uphill battle fighting COVID-19, especially after a long and grueling shift. Remember you are not alone; you are part of a medical team and system fighting this pandemic and can also feel confident that your loved ones and your community are behind you in this fight. The duty to care and to protect others is probably part of what drives you to get up and go to work every day, but just remember you are not doing it alone. You are part of a band of brothers and sisters combatting this virus. We are truly all in this together.
Compassion for Yourself
It’s more important than ever to remember to be kind to yourself during this challenging time. You are dealing with frustration and grief everyday especially as we continue to understand and get ahead of this virus.
You are probably surrounded by the virus every moment of your day as you care for your patients at work and then come home where your loved ones are talking about it as well. You may not even be able to escape it as the media inundates us with information about COVID-19 throughout the day. The ultimate compassion you can show yourself is to soothe your stress in whatever way that works best for you.
Find moments throughout your day where you take a mental break and decompress. Self-care is key! Sleep, hydrate, exercise, connect with family/friends, play video games, watch Netflix. Pamper yourself. Don’t forget to enjoy your pets, they miss and love you too.
Know Your Worth
You may already know that you do a very important job but now more than ever, you will be a part of history as we battle this epic virus. You are brave and courageous. You persevere even when you’re so exhausted both mentally and physically. Be proud of the work you do each day and who you are. Society salutes you and stands behind you and let this be the motivation that helps keep you going.
Know that this is not going to last forever.
There are so many unknowns related to COVID-19 which is what instills a lot of collective anxiety but do know that this pandemic will end. There will be a point when we will be able to breathe easier and slow down. We will have learned so much not just about COVID-19 but about ourselves and our resilience as a species on this planet. We may only initially remember the dire effects of the pandemic, such as the grief and loss it brought to us, the loss life as well as the limits to our freedom as we abided by the safety measures to contain the virus. But do believe that ultimately, we will prevail as we always do to overcome hardship as a collective human spirit.
Please use this emotional first aid kit as a tool for yourself as you care for those with COVID-19. Please remember to be grateful for your team as you are not alone in this fight, to be compassionate and gentle with yourself as you are such an important soldier in this battle that will not last forever because we will win the war. Thank you for all that you do
5 ways to bridge the global health worker shortage
A shortage of health workers is pervasive across most countries – and the most worrying aspect is that this gap is increasing. Aggravating the issue is the unmet need for upskilling and reskilling that new disease patterns and emerging technology in healthcare continuously demand.
This shortfall is captured by the following statistics:
- A Global Burden of Disease Study (2017) estimates that only half of all countries have the requisite health workforce required to deliver quality healthcare services, critical to achieving Universal Health Coverage (UHC). For instance, the US requires 1 million nurses and Japan 2.5 million by 2020 and 2025 respectively, and India faces a shortage of over 3.9 million doctors and nurses.
- The global health workforce is unevenly and inequitably distributed. The WHO region of the Americas, with 10% of the global burden of disease, has 37% of the world’s health workforce, whereas the African region, with a 24% disease burden, has only 3%.
Add to this the rising incidence of non-communicable diseases (NCDs) and growing geriatric population – these will generate a demand for 40 million additional health workers globally by 2030. This would require doubling our current global health workforce.
This is a formidable target, unless steps to correct the situation are implemented with a sense of urgency. Without timely action, a shortfall of 18 million workers is predicted by 2030, along with a resultant annual cost to healthcare of $500 billion, due to health workforce inefficiency.
It is therefore imperative to address the shortage of healthcare workforce across the gamut – doctors, nurses, allied health professionals, community outreach workers. We must be on a war footing if we are to meet the UHC targets within set timelines.
There is no alternative to investing in human resources for health; sustainable funding models have to be a critical part of the strategy. A report by the High-Level Commission on Health Employment and Economic Growth reveals return on investment in health at a ratio of 9:1. A further one extra year of average life expectancy has been shown to raise GDP per capita by about 4%.
Addressing the global health workforce shortage has to be a key priority area in national development agendas. Useful steps in a multi-stakeholder participation would include:
- Strengthening governance frameworks
Setting up strong governance frameworks to guide medical education, health employment, international exchange of medical services, migration of health workers, and innovative partnership models is crucial. Fostering sustainable PPPs would require strengthening of institutional models with high-quality and accessible cross-sectoral inputs, such as finance, education, training, among others.
- Harnessing technology
The healthcare industry is fast-tracking use of e-health and e-learning techniques, AI, VR simulation and the internet of things to train, upskill and empower health workers. From personalized wearable devices for home-based care, to point of care, drone technology and telemedicine strategies for outreach remote healthcare, all are revolutionizing healthcare delivery. The scaling-up is rapid, based on big data and analytics, and these emerging technologies are also generating more demand for new skills, increasing the potential to employ more in digital healthcare delivery.
A clear roadmap to align technology and the workforce is critical. In India, for instance, the thinktank NITI Aayog, in the National Strategy for Artificial Intelligence and Strategy for New India @75, has already set out plans to bring technology and innovation at the core of healthcare & related policy formations, a crucial step for augmenting healthcare resources.
- Rebalancing healthcare tasks
As per an OECD global survey, 79% of nurses and 76% of doctors were found to be performing tasks for which they were over-qualified. Given the global evidence for the poor distribution of skills, we must rationally re-organize our workforce for effective management of high-burden diseases, particularly NCDs, which are responsible for 71% of the global mortality and, unless addressed, could cost the world $30 trillion by 2030.
Nurses and GPs can be trained with the essential skill set that enables them to perform select live-saving procedures, recognize acute conditions in time, and make referrals to relevant specialists. This will not only reduce high dependency on limited specialists available worldwide, but also reduce cost and time needed to scale up additional workforce.
- Developing new care models
Health systems designed around hospitals and clinics need to shift focus towards preventive care, and encourage a holistic health approach encompassing all socio-economic determinants of health. New care models should be created, with a “hub and spoke” arrangement of assets, and workforce trained to provide high-quality, community-based, integrated healthcare, focused on disease surveillance, prevention & ambulatory care. This will not just help avoid unnecessary in-patient and emergency room visits, but will also result in better health outcomes for the community at large.
- Creating a sustainable and gender-balanced workforce
Evidence points towards gender imbalance and disparities in health employment and the medical education system. According to the WHO, globally only 30% of doctors are females and more than 70% of nurses are females. A similar trend is seen in India, where the majority of the nursing workforce is comprised of women, but only 16.8% of allopathic doctors are females. As per ILO data, gender wage gaps are also a cause for concern. We need pro-active steps to create a balanced healthcare workforce that addresses the issue of gender inequity and ensure equal pay for work of equal value, a favorable working environment, and targets investments towards training the female workforce.
Globally, too there needs to be better mapping of healthcare resources to facilitate collaborations in medical education and exchange programs between countries. For instance, several countries have similar course curriculums for nursing; however, cultural aspects sometimes pose problems. For instance, Sweden and India have a similar nursing curriculum, and there is great potential to encourage exchange of nurses, but the potential for exchange is restricted due to linguistic barriers. This can be easily overcome, and more conducive arrangements put in place to facilitate exchange of healthcare workers.
It is time for all stakeholders in healthcare, be it in the domains of policy, medical education, training or financing, to align with each other on specific issues and targets, and implement steps to augment healthcare workforce productivity towards creating a population-centric workforce.
EXPANSION OF THE SAVING MATERNAL AND NEWBORN LIVES IN REFUGE SETTINGS (CAMAROON- NIGER- CHAD): SUMMARY OF BASELINE ASSESSMENT
Published 10 Jan 2020
Access to quality health services is essential for women and newborns in refugee contexts. In times of conflict, displacement, or humanitarian emergency, neonatal and maternal health is often compromised and the availability of maternal, newborn, and family planning services becomes even more important.
In line with UNHCR’s mandate and with support from the Bill and Melinda Gates Foundation (BMGF), UNHCR has extended the “Saving Maternal and Newborn Lives in Refugee Settings” project to three further refugee situations in Cameroon, Niger and Chad. With the aim to improve newborn and maternal health, the two-year project is focusing on low cost, high impact maternal and newborn interventions, ensuring that every refugee mother and newborn has the chance to live a healthy life.
Following successful interventions to strengthen maternal and newborn health services in Jordan, South Sudan and Kenya, UNHCR has launched “Expansion of the Saving Maternal and Newborn Lives in Refugee Contexts” in selected refugee operations in Niger, Cameroon and Chad. The project aims to scale up and to consolidate lifesaving newborn, maternal, and family planning interventions. This also includes quality family planning services, recognizing the important role of family planning in reducing maternal and neonatal morbidity and mortality, preventing unwanted pregnancies, reducing rates of abortion (including unsafe abortion), and reducing the risks of adolescent pregnancy.
A baseline assessment was conducted in the targeted refugee sites, including health facility assessments; interviews of program managers and front-line health providers to gather in-depth information about their practices, needs, and perceived gaps in care; and focus group discussions with community members which provided valuable insight into community perceptions of health services as well as traditional beliefs and practices.
Chad, Cameroon and Niger were chosen for this project due to their poor reproductive health indicators as well as high burden of refugee populations in the countries. Each of the three countries are facing similar challenges, including poorly funded health systems and under resourced and under staffed health facilities, particularly at the district hospital level. Remote locations, poor roads, and regular influxes of new refugees further complicate operations. Insecurity and violent attacks limit access and care provision, particularly in the Malian camps of Niger and Sudanese camps of Eastern Chad, some of which are only accessible with a military escort.
A fundus image shows an eye with aggressive posterior retinopathy of prematurity (AP-ROP). The i-ROP DL deep learning system quantified the dilation and tortuosity of the retinal vessels, which both occur to a high degree in AP-ROP.
AI may help spot newborns at risk for most severe form of blinding disease
NEI-funded device under FDA review; AI-based metrics bring clarity to aggressive posterior retinopathy of prematurity diagnosis – March 4, 2020
An artificial intelligence (AI) device that has been fast-tracked for approval by the Food and Drug Administration may help identify newborns at risk for aggressive posterior retinopathy of prematurity (AP-ROP). AP-ROP is the most severe form of ROP and can be difficult to diagnose in time to save vision. The findings of the National Eye Institute-funded study published online February 7 in Ophthalmology.
“Artificial intelligence has the potential to help us recognize babies with AP-ROP earlier. But it also provides the foundation for quantitative metrics to help us better understand AP-ROP pathophysiology, which is key for improving how we manage it,” said the study’s lead investigator, J. Peter Campbell, M.D., M.P.H., Casey Eye Institute, Oregon Health and Science University in Portland.
Babies born prematurely are at risk for retinopathy. That is, they have fragile vessels in their eyes, which can leak blood and grow abnormally. If left untreated, vessel growth can worsen and cause scarring, which can pull on and cause detachment of the retina, the light-sensing tissue at the back of the eye. Retinal detachment is the main cause of vision loss from ROP. Each year, the incidence of ROP in the United States is approximately 0.17%. Most cases are mild and resolve without treatment.
Upon birth, the eyes of preemies are screened and closely watched for signs of retinopathy. But ROP-related changes occur along a spectrum of severity. AP-ROP can elude diagnosis because its features can be more subtle and harder to appreciate than typical ROP. AP-ROP was formally recognized as a diagnostic entity in 2005. Yet in everyday practice there’s significant variation in how clinicians interpret whether fundus images taken of the inside of the eye show signs of AP-ROP. “Even the most highly experienced evaluators have been known to disagree about whether fundus images indicate AP-ROP,” said Campbell.
In a previous study, deep learning, a type of AI used for image recognition, was more accurate than experts at detecting subtle patterns in fundus images and at classifying ROP. Using the automated deep learning ROP classifier, researchers devised a quantitative vascular severity score (1-9 scale) for evaluating newborns, monitoring disease progression and response to treatment. The study, however, did not specifically address AP-ROP detection.
For the current study, nine neonatal care centers used deep learning to determine how well it detected AP-ROP. The 947 newborns in the study were followed over time and fundus images from a total of 5945 eye examinations were analyzed both by the deep learning system and a team of expert fundus image graders.
Among all eyes followed, 3% developed AP-ROP.
There was a significant level of inter-reader disagreement among the expert graders, suggesting the need for objective metrics of disease severity.
Importantly, a clearer, quantifiable AP-ROP patient profile emerged, which could help identify at-risk infants earlier. Infants who developed AP-ROP tended to be more premature. Compared with infants who needed treatment but never developed AP-ROP-, AP-ROP infants were born lighter (617 g vs. 679 g) and younger (24.3 weeks vs. 25.0 weeks). No infants born after 26 weeks developed AP-ROP in this population.
AP-ROP also tended to onset rapidly and quickly grow worse. Although rapid progression of disease has always been implied in the diagnosis of AP-ROP, to date there has been no way to measure this clinical feature. Monitoring the rate of vascular severity score changes could therefore improve detection of AP-ROP risk, according to the study findings.
Infants with AP-ROP also were more likely to have comorbidities such as chronic lung disease, compared to infants without AP-ROP. The requirement for higher oxygen concentrations among infants with lung disease may have played a role in their eye disease, said Campbell. Decades ago, researchers made a connection between the routine use of high concentrations of oxygen at birth and an increase in the development of retinopathy. Oxygen is nearly always required for survival, but is titrated very carefully to maximize survival while minimizing the risk to vision. “It’s still a balancing act,” said Campbell.
“It’s important to acknowledge that there is currently no gold standard for diagnosing AP-ROP. But having objective, AI-based metrics for detecting AP-ROP is a step in the right direction for this highly vulnerable population of infants,” said Grace L. Shen, Ph.D., who manages the retinal diseases program for the Division of Extramural Science Programs at the NEI.
The deep learning system in the clinical trial, the i-ROP DL system, was recently granted breakthrough status by the FDA, which accelerates its development and FDA review. Development of the device was supported by the NEI, part of the National Institutes of Health.
Funding for the study was provided by grants R01EY19474, K12EY027720, T15LM007088, and P30EY10572
Preemie for a Day
Article by: Diane Hudson-Barr, PhD, RN, Clinical Nurse Specialist, Neonatal Developmental Care Specialist; Sarah Kenney, March of Dimes NICU Family Support Specialist; and Jennifer Flippin, RN, BSN, RNC-NIC, Nurse Manager, Newborn Critical Care Center
An interactive, multisensory workshop simulating the premature birth experience from the baby’s point of view has our Newborn Critical Care Center nurses rethinking how to provide the best care to our tiniest, most fragile patients.
First it’s quiet. You’re in a warm, safe, comfortable environment. Then, in an instant, you’re thrust into complete chaos. Bright lights. Loud noises. People touching you.
This is how premature babies experience birth. Nurses from the Newborn Critical Care Center (NCCC) at N.C. Children’s Hospital recently participated in a simulated premature birth experience during “Preemie for a Day,” sponsored by the March of Dimes. The four-hour workshop gave the nurses a unique opportunity: experiencing delivery from the baby’s point of view.
“The presenters, a NICU registered nurse and pediatric occupational therapist, began the program with a review of the baby’s normal development in utero and how exposure to the light, sounds, smells and healthcare provider touch can alter ongoing development of a premature baby,” explains Jennifer Flippin, RN, BSN, RNC-NIC, NCCC nurse manager. “The presenters facilitated discussion about strategies that could be used in everyday practice to promote optimal neurosensory development for the babies.”
After the introductory discussion, nurses moved to the hands-on session of the workshop. Five nurses volunteered to play the role of newborn preemies. These nurses went into a different room with dimmed lights and listened to sounds recorded from the womb. They were asked to curl up in their most comfortable position. The other participants formed five care teams. They were instructed to mimic the admission process, and dramatically interrupted the calm and quiet environment of the volunteer preemies.
The adult preemies were first restrained, their arms and legs taped to the mattress. Then came the “intubation” with straws taped to their faces. The nursing teams prepared IVs with cold alcohol wipes and “inserted” a straw IV taped to a board for securing. The preemies had their temperature taken under the arm using a cold metal rod that had not been pre-warmed. Their heartbeats were assessed using a cold stethoscope.
All every day things done for a baby admitted to an ICU.
After the hands-on activity, each of the preemies took a turn to tell the other participants how the experience felt to them. They described how startled they were, how overwhelmed they felt and how threatening the experience was to them.
“Hearing those feelings from the preemie volunteers helped the nurses to better understand how traumatic the admission process is for critically ill babies,” says Jennifer Flippin. “As participants left the workshop, you could hear them talking about ways they would change their practice to be more developmentally supportive of the babies. This is exactly the outcome that the organizers had hoped for.”
Comfort & Reassurance: Guided Sleep Talkdown for Uncertain Times
Mar 31, 2020
This guided visualization will gently take you into a place of peace and comfort. It guides you softly down into sleep with reassurances that all will be well in your life. To aid sleep, the visuals dim as the recording progresses.
Two Weeks in Nicaragua | SURF | Early Season
Feb 3, 2015
Nicaragua is without a doubt one of the greatest places in the world to go surfing! Subscribe Here for daily XTreme surfing videos: http://goo.gl/fXjZeb Two weeks in Nicaragua during one of the beautiful swell of the year. Riders: Dimitri Ouvre David Leboulch Naum Ildefonce Edited & Filmed by: M.Darrigade
Over the last month we have observed and witnessed the diverse International Community response to the Covid-19 pandemic. A number of international countries have responded strongly and urgently, employing well thought out emergency preparedness and contingency planning with the safety of their healthcare worker community and citizens/residents as a priority. In the USA we have struggled to coordinate, uphold, and prioritize the safety of citizens/residents and our healthcare community members in a timely and well-planned out manner. In short, we have much to learn, share and teach each other as a global community.
In the face of this global crisis an increased effort to serve community, care for others, and global collaboration is what is leading us to productive solution building strategies. In the USA we have a broad community of healthcare workers, providers and researchers working diligently with our global community to build ways to safely provide care, form treatment solutions and potential vaccinations. It is essential to recognize the conscious choice to connect with a global community is what will lead to the best outcomes for our local to global community. It has been inspirational to see the ways healthcare providers are courageously speaking up about the reality of their situations and their urgent needs in order to safely serve us. Our hearts soar as we witness communities like that in Italy singing in unison on their balconies in order to comfort each other. We are inspired and hopeful as nations, NGOs, and organizations come together to move beyond political agendas and send aid to our global families in places like Iran where there is extreme need. When we care for each other in times of despair, panic, greed, and suffering we foster empowerment and together we will rise out of crisis. The pandemic shows us how we can build better health and wellness, stronger economies, and a life-sustainable planet through Global/local collaboration. Whether we choose this or not, we are all in this together!
Let’s empower ourselves with the gifts we all have to share!
Volcano Surfing or Volcano Boarding in Cerro Negro, Nicaragua
Apr 19, 2013 Rafa Ocón
Volcano Boarding o volcano surfing en Cerro Negro, Nicaragua, el único volcán activo del mundo donde se puede hacer volcan surfing, o lo que es lo mismo bajar por pendientes de hasta el 40% de desnivel con una tabla de snowboard o un trineo diseñado para este tipo de superficie. // Volcano surfing in Cerro Negro, Nicaragua, the only active volcano in the world where you can practise volcano boarding on a snowboard. Volcano Boarding or volcano surfing in Cerro Negro, Nicaragua, the only active volcano in the world where you can surf surfing, or what is the same down slopes up to 40% uneven with a snowboard or sled designed for this type of surface.