BANGLADESH
Rate: 14% Rank 24 Global Average 11.1%
Bangladesh is the eighth-most populous country in the world, with a population exceeding 161 million people. In terms of land mass, Bangladesh ranks 92nd, spanning 147,570 square kilometres (56,980 sq mi), making it one of the most densely-populated countries in the world. Bangladesh shares land borders with India to the west, north, and east, Myanmar to the southeast, and the Bay of Bengal to the south. It is narrowly separated from Nepal and Bhutan by India’s Siliguri Corridor, and from China by the Indian state of Sikkim, in the north, respectively. Dhaka, the capital and largest city, is the nation’s economic, political and cultural hub. Chittagong, the largest sea port, is the second largest city. With numerous criss-crossing rivers and inland waterways, the dominant geographic feature of Bangladesh is the Ganges delta, which empties into the Bay of Bengal with the combined waters of several river systems, including the Brahmaputra river and the Ganges river. Highlands, with evergreen forests, cover the northeastern and southeastern regions, while the country’s biodiversity comprises a vast array of plants and wildlife, including the endangered Royal Bengal tiger, which is the national animal. The seacoast features the world’s longest natural sandy beach in Cox’s Bazar as well as the Sundarbans, which is the world’s largest mangrove forest.
Healthcare facilities in Bangladesh are considered less than adequate, although they have improved as poverty levels have decreased significantly. Findings from a recent study in Chakaria (a rural Upazila under Cox’s Bazar District) revealed that the “village doctors”, practicing allopathic medicine without formal training, were reported to have provided 65% of the healthcare sought for illness episodes occurring within 14 days prior to the survey. Formally-trained providers made up only four percent of the total health workforce. The Future Health Systems survey indicated significant deficiencies in the treatment practices of village doctors, with widespread harmful and inappropriate drug prescribing. Receiving health care from informal providers is encouraged.
Malnutrition has been a persistent problem in Bangladesh, with the World Bank ranking the country first in the number of malnourished children worldwide. More than 54% of preschool-age children are stunted, 56% are underweight and more than 17% are wasted. More than 45 percent of rural families and 76 percent of urban families were below the acceptable caloric-intake level.
Source: https://en.wikipedia.org/wiki/Bangladesh
Born on Time: Fathers Clubs in Bangladesh
PlanCanadaVideos Jun 4, 2019
The Born on Time project educates communities on the risk factors of preterm birth. The risk of preterm birth can be decreased by addressing unhealthy lifestyle factors and harmful gender discriminatory behaviors such as: heavy workloads for mothers, domestic violence, and child, early and forced marriage. Born on Time Fathers Clubs encourage male engagement in birth preparedness, safe pregnancy and delivery, and in preterm birth prevention. See how Born On Time supported Abdur take part in a Fathers Club in Bangladesh, transforming local gender roles and teaching dads to put family first.
COMMUNITY
One-fifth of babies born premature in Bangladesh
Published at 10:47 pm November 16th, 2019
Bangladesh has managed to curb the premature deaths in recent years, according to the United Nations (UN).
Although the deaths caused by communicable diseases have decreased over the past years, the death of premature babies is still a concern for the authorities.
Even a few years ago, Bangladesh was a country where communicable diseases were responsible for the death of many newborn babies. But with the recent awareness programs by different organizations, about how to take care of neonates, mortality rate of infants from communicable diseases have decreased noticeably.
When asked, DGHS officials said more than 3 million children are born every year in Bangladesh, and very few die of communicable diseases.
Though, death from premature birth now tops the list. Out of 3 million children born every year in Bangladesh some 0.6 million are born premature, and out of that 0.6 million premature births 20,000 infants die, said UN.
According to 2018 UN estimation, the newborn mortality rate in Bangladesh is 18 per 1000 infants.
Dr Shamim Jahan, director of Health, Nutrition & HIV/AIDS, Save the Children, said the number has decreased in comparison to 2016 as 23620 infants died due to premature birth that year.
Experts opinion
The UN estimation said that complications of premature birth is the cause for it to top the list of infant deaths.
Experts opined that this situation has not been addressed for a long time, resulting in such number of deaths in the country.
Though, experts themselves are still unaware of the real reason as to why premature birth tops the list for infant mortality.
Professor Dr Begum Sharifun Nahar, head of Neonatology department of Sir Salimullah Medical College and Mitford Hospital, said “A premature child do not live for long, as most of the time the infant’s vital organs are not completely developed, and they suffer from lung problems, which leads to breathing issues. In conjunction with low birth weight, feeding disorders and hypothermia causes the death of premature infants. But she added that many of these issues can be avoided if people are more aware of the procedure, and the baby is taken care of by proper doctors, and nurses who have good knowledge about premature birth related issues, she added.
A miracle touch keeps child breathing without stress
When Popy (25) became pregnant for the second time, her family became very cautious, as she went through a miscarriage two years back.
She was married at the age of 20 and when she first conceived at 22. In her second pregnancy she was supposed to give birth to twins.
But her joy turned into tears, as the low birth weight caused death to one of her children ten days after their birth on October 29, following their premature birth weight of only 1500 grams. The babies had breathing difficulties along with other health hazards.
Her child was given treatment at NICU of Mitford Hospital, and later given to her as part of KMC.
“You can’t explain the feelings of its breath, when it takes its food from you. It seems like the world started living on my chest,” Popy told the reporter.
Professor Dr Begum Sharifun Nahar said KMC, a method of contacting a skin–to–skin contact between a mother and her newborn facilitating frequent or exclusive breastfeeding, and early discharge from the hospital has been effective in reducing the risk of mortality among preterm, and low birth weight infants.
“KMC helps the children to be stress free, and easiest breast feeding process. We have witnessed that the child going through KMC treatment have good growth, more sleep, less infections, and control temperature lessening chances of hypothermia,” she said.
Dr Shamim Jahan director – Health, Nutrition & HIV/AIDS, Save the Children said: “As part of their objectives to make Bangladesh controlling deaths from premature birth, Save the Children is providing assistance in capacity building, establishing a monitoring system, and by providing technical assistance to the government for effective implement of KMC.”
Government initiatives to end premature birth
Dr Shamim Jahan said Bangladesh is at the seventh position among the top 10 countries with the largest numbers of preterm births, and deaths.
In the course of changing paradigm of diseases that are causing neonatal deaths, without controlling premature deaths, achieving SDGs new global target to end preventable newborn, and child deaths by 2030 (SDG 3.2) would never be possible, he said, adding that the theme for World Prematurity Day 2019 has put forth our course of action rightly — ‘’Born Too Soon: Providing the right care, at the right time, in the right place.”
Recognizing premature birth and death as a matter of concern, Dr Shamsul Haque, line director of Mother Neonatal Care and Adolescent Health (MNC&AH) under Directorate General of Health Services (DGHS) said, under the fourth sectoral program DGHS has established some 42 Special Care Newborn Units (SCANU) in tertiary, and district level hospitals.
Besides, as part of keeping the child alive, government has taken KMC as a trusted way, and have already established 132 centres in tertiary, district, and upazila level government hospitals. Besides, the private hospitals have also been asked to use the method.
The government started the programme (January 2017-June 2022) with an aim to reduce the newborn mortality rate to under 12 per 1,000 live births by 2030.
Directorate General of Family Planning (DGFP) and Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare are implementing the programme at a cost of around Tk 422 crore.
To meet the manpower problem, necessary training is being provided to pediatric specialists, and nurses in the hospitals, as many as they can. So that, wherever the doctors are transferred, they could continue the process.
“The government has planned to establish SCANU in every district, and all the upazila would have the facility of KMC treatment within 2022,” the line director stressing the need for creating awareness among rural people regarding premature births.
About KMC he said it is a very low cost treatment, and costs almost nothing. Besides, it takes only Tk 85,000 to set up a two bed unit.
The early result of KMC methods has made them hopeful of the fact that it would play a key role in preventing premature birth, and infant death in the country within the timeline they targeted, he added.
Rohingya Refugee Children Are in Desperate Need of Help
Enter here 
Perinatal health of refugee and asylum-seeking women in Sweden
2014–17: a register-based cohort study
Published: 04 July 2019 Can Liu, Mia Ahlberg, Anders Hjern, Olof Stephansson
European Journal of Public Health, Volume 29, Issue 6
Source: https://doi.org/10.1093/eurpub/ckz120
Abstract
Background
An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.
Methods
Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.
Results
Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).
Conclusion
Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.
Source: https://academic.oup.com/eurpub/article/29/6/1048/5528507
Taking care of premature babies with Kangaroo Mother Care
UNICEF Bangladesh Sep 1, 2019
Learn how to take care of premature babies with Kangaroo Mother Care
INNOVATIONS
Successfully leveraging mobile technology to reduce preterm births
A maternal population risk study
Mary E. Cramer PhD, RN, FAAN – Elizabeth K. Mollard PhD, APRN‐NP – Amy L. Ford DNP, RN – Kevin A. Kupzyk PhD, Fernando A. Wilson PhD
In Nebraska, nearly half of the counties on average – mostly rural – have a higher percentage of preterm births than the March of Dimes national average of 8.1%. Many of these rural counties are home to 30% or more soon-to-be mothers who receive inadequate prenatal care. Access to prevention and resources are rural barriers in Nebraska that contribute to preterm births.
Through a pilot study conducted under the direction of the University of Nebraska Medical Center (UNMC) and with funding from Blue Cross Blue Shield of Nebraska, we sought to positively impact these issues within Nebraska’s prenatal patient population. GoMo Health collaborated with Dr. Amy Ford and Dr. Mary Cramer from UNMC to develop a program with specialized content to help reduce preterm births.
Abstract
Objectives: (1) Assess feasibility of a smartphone platform intervention combined with Community Health Worker (CHW) reinforcement in rural pregnant women; (2) Obtain data on the promise of the intervention on birth outcomes, patient activation, and medical care adherence; and (3) Explore financial implications of the intervention using return on investment (ROI).
Sample: A total of 98 rural pregnant women were enrolled and assigned to intervention or control groups in this two‐group experimental design.
Intervention: The intervention group received usual prenatal care plus a smartphone preloaded with a tailored prenatal platform with automated texting, chat function, and hyperlinks and weekly contact from the CHW. The control group received usual prenatal care and printed educational materials.
Measurements: Demographics, health risk data, interaction with platform, medical records, hospital billing charges, Client Satisfaction Questionnaire‐8, satisfaction comments, and the Patient Activation Measure.
Results: A total of 77 women completed the study. The intervention was well‐received, showed promise for improving birth outcomes, patient activation, and medical care adherence. Financial analysis showed a positive ROI under two scenarios.
Conclusions: Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at‐risk population to appreciate the impact of the intervention.
Source: https://gomohealth.com/resource/unmc/
New preclinical study shows promise for treating necrotizing enterocolitis
Reviewed by James Ives, M.Psych. (Editor)May 6 2020
Necrotizing enterocolitis (NEC), a rare inflammatory bowel disease, primarily affects premature infants and is a leading cause of death in the smallest and sickest of these patients. The exact cause remains unclear, and there is no effective treatment.
No test can definitively diagnose the devastating condition early, so infants with suspected NEC are carefully monitored and administered supportive care, such as IV fluids and nutrition, and antibiotics to fight infection caused by bacteria invading the gut wall. Surgery must be done to excise damaged intestinal tissue if the condition worsens.
A new preclinical study by researchers at the University of South Florida Health (USF Health) Morsani College of Medicine and Johns Hopkins University School of Medicine offers promise of a specific treatment for NEC, one of the most challenging diseases confronting neonatologists and pediatric surgeons.
The team found that inhibiting the inflammatory and blood-clotting molecule thrombin with targeted nanotherapy can protect against NEC-like injury in newborn mice.
Their findings were reported May 4 in the Proceedings of the National Academy of Sciences.
Our data identified the inflammatory molecule thrombin, which plays a critical role in platelet-activated blood clotting, as a potential new therapeutic target for NEC. We showed that anti-thrombin nanoparticles can find, capture and inactivate all the active thrombin in the gut, thereby preventing or reducing the small blood vessel damage and clotting that accelerates NEC.”
Samuel Wickline, MD, Study Co-Author and Professor of Cardiovascular Sciences, Morsani College of Medicine. Dr Wickline is also the director of the USF Health Heart Institute.
PNAS paper’s senior author is Akhil Maheshwari, MD, professor of pediatrics and director of neonatology at the Johns Hopkins University School of Medicine.
Before joining Johns Hopkins Medicine (Baltimore) in 2018, Dr. Maheshwari’s group at USF Health was the first to demonstrate that platelet activation is an early, critical event in causing NEC, and therapeutic measures to block these platelets might be a new way to prevent or reduce intestinal injury in NEC.
The nanotherapy platform created by Dr. Wickline and USF Health biomedical engineer Hua Pan, PhD, delivers high drug concentrations that specifically inhibit thrombin from forming blood clots on the intestinal blood vessel wall without suppressing the (clotting) activity needed to prevent bleeding elsewhere in the body.
This localized treatment is particularly important for premature infants, Dr. Wickline said, because the underdeveloped blood vessels in their brains and other vital organs are still fragile and susceptible to rupture and bleeding.
For this study the researchers used a model they created — infant mice, or pups, induced to develop digestive tract damage resembling human NEC, including the thrombocytopenia commonly experienced by premature infants with NEC.
Thrombocytopenia is characterized by low counts of blood cell fragments known as platelets, or thrombocytes, which normally stop bleeding from a cut or wound by clumping together to plug breaks injured blood vessels.
The molecule thrombin plays a key role in the bowel inflammation driven by overactive platelets. While investigating role of platelet depletion in NEC-related thrombocytopenia, the USF-Johns Hopkins researchers were surprised to find that thrombin mediates platelet-activated blood clotting early in the pathology of NEC-like injury – before bacteria leaks from inside the gut to circulating blood or other organs.
This clotting clogs small blood vessels and restricts blood flow to the inflamed bowel. Eventually, the lining of the damaged intestinal wall can begin to die off.
The investigative therapy essentially works “like a thrombin sponge” that is exponentially more potent than current agents used to inhibit clotting, Dr. Wickline explained. “It literally puts trillions of nanoparticles at that damaged (intestinal wall) site to sponge up all the overactive thrombin, which tones down the clotting and inflammation processes promoted by thrombin.”
“We are so excited about finding this new way to attenuate intestinal injury in NEC,” Dr. Maheshwari said.
The same approach has also been shown in preclinical studies to inhibit the growth of atherosclerotic plaques and certain kidney injuries without causing systemic bleeding problems. Dr. Wickline added. “The nanoparticles can be tailored to other inflammatory diseases highly dependent on thrombin for their progression.”
The study authors conclude that their experimental targeted treatment for NEC merits further evaluation in clinical trials.
Source: University of South Florida (USF Health)
Journal reference: Namachivayam, K., et al. (2020) Targeted inhibition of thrombin attenuates murine neonatal necrotizing enterocolitis. Proceedings of National Academy of Sciences.
Source: doi.org/10.1073/pnas.1912357117.
Climate change is causing an increase in preterm births: Study
Myupchar Dec 12, 2019
With the change in climate, the emergence of vector-borne diseases (insects-bearing diseases) like dengue and chikungunya, has spiked. This is subsequently leading to more than 7 lakh deaths annually.
That’s just the beginning though. The increase in temperature directly affects health by compromising the body’s ability to regulate its internal temperature. With the inability to control the internal temperature of the body, we become more prone to a cascade of illnesses like heat cramps, heat exhaustion, heatstroke, and hyperthermia during extreme heat and hypothermia and frostbite in extremely cold temperatures.
And now we find that climate change is having an insidious effect on pregnant women.
Studies have claimed that, with the rise in temperature, the cases of preterm delivery have increased. Any birth that occurs at least three weeks before the due date is considered by doctors to be a premature delivery. Some of the complications that this could lead to are slow weight gain, immature lungs, poor feeding, etc.
Heat and preterm labour
Long span research was conducted by Alan Barreca, an associate professor at UCLA’s Institute of Environmental Sustainability, and economist Jessamyn Schaller of Claremont McKenna College in a two-decade window, i.e., from 1969 to 1988, to find out the link between the change in temperature and preterm deliveries.
The researchers found that when the temperature exceeded or reached 32.2ºC (90ºF), the premature birth rate per 100,000 women increased by 0.97. It was also noted that on days when the temperature was hot but not extreme, the premature births increased by 0.57.
They further concluded that with an increase in temperature, the gestation period was decreased by two weeks. The gestation period is the time period of 40 weeks that it takes for fetal development, starting right from the conception till the day before the delivery.
Across the entire 20-year period of the study, around 25,000 infants were born prematurely every year, leading to the loss of more than 150,000 gestational days, all because of exposure to an exceptionally hot environment.
Another long span study was conducted by scientists led by Dr Lyndsay A. Avalos in Northern California for a time window of 14 years, i.e., between January 1, 1995, to December 31, 2009, to investigate the impact of apparent temperature on spontaneous preterm delivery.
Dr Lyndsay concluded the research by stating that with the increase in temperature by 10 °F (5.6 °C) during warm seasons, the cases of spontaneous preterm delivery increased by 11.6%.
All the preterm deliveries in this study took place between 28 and 37 weeks of gestational period, instead of 40.
The uncertain reason
Scientists have not been able to find the exact cause, but have laid down some possible reasons that could lead to premature labour:
- Scientists believe that due to the increased heat, the mother could have cardiovascular stress that in turn could trigger the body to go into labour early.
- The second theory proposed by the scientists is that the high temperatures could trigger an increase in the levels of the hormone oxytocin, which plays a role in inducing labour.
- The third theory stated that because of the hot temperature the mother might unable to sleep properly. This could increase the chances of preterm labour and preeclampsia (complication in pregnancy marked with high BP) in the mother.
The alarming situation
It’s time to realize that climate change is real. And not only is it adversely affecting the environment but it has serious health implications as well, especially for the coming generation.
For more information, please read our article on Preterm Labour.
Microfluidic Systems for Sweat Analysis and Neonatal Care
Apr 24, 2020: In this interview, Professor John Rogers talks to News-Medical Life Sciences about his research and work in developing biocompatible electronics and microfluidic systems with skin-like properties.
Biological systems are traditionally mechanically soft however modern electronic and microfluidic technologies are rigid, meaning the layouts are completely different. Eliminating this mismatch will create huge opportunities in man-made systems that can be used for diagnostics, therapeutics and in clinical and healthcare. Can you tell us about the new opportunities these man-made systems will create?
There are all kinds of interesting and compelling opportunities that could come from thinking about how to reformulate the kinds of systems that form the core foundations of devices that you see in consumer gadgetry, so computer chips, integrated circuit chips that are flat and rigid and planar, into forms that are more naturally biocompatible – compatible with the soft surfaces of the human body. And integrated circuits are not the only kind of man-made technology that has those kinds of physical characteristics and geometrical shapes.
You see the same type of thing in optoelectronic devices, lab-on-a-chip type technologies and microelectromechanical systems. The goal behind our research, and that of a growing community of researchers, is to create new ideas in material science and manufacturing, mechanical engineering and electrical engineering that will allow us to reformulate those sorts of technologies, without sacrificing the performance or capabilities, into platforms with geometries and mechanical properties that are inherently biocompatible and can be interfaced with soft tissue systems — the skin, the brain, the heart, the peripheral nervous system, the bladder, and the kidneys. And the idea is to develop those technologies into system that can ultimately enhance human health and extend life.
Can you tell us more about these ‘biocompatible’ electronic and microfluidic systems with skin-like physical properties?
The skin-like devices that we have developed are specifically designed to interface with the skin and to use the skin as a window for measuring clinical-grade physiological status parameters associated natural processes of the human body. For example, looking at cardiac activity, respiratory activity, flow properties associated with blood through near-surface arteries and veins; to reproduce what’s done in the hospital, but in platforms that can be worn continuously for wireless streaming of data outside of the hospital in the home setting, to develop a deep foundational basis of information on health status. This information can be used with artificial intelligence algorithms to assess a person’s well-being at any given moment and to make predictive assessments of health trajectories over time. This kind of personalized, digitally oriented model for healthcare enabled by these kinds of skin-like platforms will be a very powerful way that healthcare will evolve into the future for reduced costs and improved outcomes.
You presented the Wallace. H. Coulter Lecture this year at Pittcon 2020 in Chicago. What did you discuss in your talk?
In this talk, I will focus on skin-interfaced systems, devices that provide not only this electronic monitoring functionality but those that also embed tiny networks of microchannels. The microchannels along with very small reservoirs and valves that are designed to capture sweat that is pumped to the surface of the skin through the Eccrine glands and the connective ducts for capture and analysis of biomarkers in sweat.
Sweat is a relatively under-explored but very potentially important class of bio-fluid that could provide information content to substitute for blood draws. The idea is to use sweat and the noninvasive ability to collect sweat to do biochemical based assessments of health status to complement the sort of physics-based measurements that we can achieve with our electronic devices.
What sparked your interest in ‘soft’ materials?
My core expertise is in electronic materials, and I like to think about novel electronic materials in the context of technologies with capabilities that go beyond what is currently supported with conventional sorts of electronic materials. We got our start in this area thinking about flexible displays, so paper-like displays that could replace the kind of liquid crystal and organic light-emitting diode displays that you see in consumer devices today. So, thinking about thin paper-like systems, lightweight, mechanically rugged, capable of rolling up in storage when they’re not being used. And so that was interesting for us for a while, and it remains a major focus at most large display companies.
I happened to be giving a talk at the University of Pennsylvania on that kind of technology. It turned out that a couple of curious neuroscientists were in the audience and they came up to me after the talk and asked whether we could take those kinds of flexible electronic devices and put them on the brain to study the electrical activity of the brain. That was the first suggestion that these kinds of devices could be brought to bear to important problems in human health and in research around the fundamental mechanisms that govern the behavior of living systems. That interaction catalyzed a whole new set of research opportunities for us and it has been a sustained area of activity now in the group for the last 10 years.
What extra levels of functionality do soft electronics provide? How were they discovered?
Soft electronics allow you to intimately and persistently integrate advanced biosensors, radios, stimulators, microprocessors and digital memory technologies with the human body, in ways that go far beyond what’s possible with conventional wearable technologies that you see on the market today. Commercial devices are dominated by bulky, clunky pieces of electronics, loosely strapped to the body, typically at the wrist. That kind of technology approach can allow you to measure certain parameters, qualitative assessments of health and wellbeing, you can count steps, you can get a rough estimate of heart rate, but those are parameters that physicians can’t readily interpret and act upon.
What we’re thinking about is the next generation of wearable technology that integrates more intimately with the body, almost serving as a second skin that laminates in a physically imperceptible way on the surface of your actual skin. Almost like a temporary tattoo or a bandaid to provide ICU grade measurements of health status to allow physicians to, at a very detailed level, track health progression over time, not in an episodic way, which is currently the way that measurements are made when a patient comes to a hospital or a clinic. But now thinking about those same types of measurements performed continuously and I feel that it’s going to open up new frontiers to think about how to manage health conditions and to promote healthy living as well.
What ‘skin-like’ physical properties do biocompatible electronic and microfluidic systems have?
We target a set of physical properties that are precisely matched to the skin itself. The skin stretches somewhat, it can flex and bend and wrinkle, it has certain thermal characteristics, it has a whole set of properties, water permeability characteristics as well, thermal. And we try to embody those exact skin-like properties into electronic devices. And that’s the trick and the centroid of the research that we’ve been doing over the last decade or so. You think about a silicon-based integrated circuit, the mechanical properties are a million times different than those of the skin. So, there’s a huge chasm and a gap there. It’s perfectly flat, it really can’t conform to a natural curvature and the sort of sub-millimeter scale texture associated with the skin. So we try, to the best of our ability, to take a collection of materials and build them into an electronic system that has the same type of functionality you achieve with a silicon-based electronic platform today, but with mechanical properties, geometrical features that precisely match those of the skin.
The goal is to develop almost like a second skin that interfaces directly and naturally with your natural skin so you can wear these devices for long periods of time without even realizing they’re there because they’re matched to the skin. You don’t have a physical sensation that they’re there. And we think that that’s not just a convenience, that’s an essential characteristic of the devices because if they can’t be worn in a comfortable way that doesn’t introduce irritation at the surface of the skin, then nobody will wear the devices. The patient compliance will be unacceptably low.
That’s the goal around engineering and it turns out that with a few relatively simple ideas, we can get very close. The thickness of these devices is thinner than the epidermis, the mechanical properties almost precisely matched, the overall thermal mass is almost the same, there’s no thermal load as a result.
Could you name some of the main advantages of using soft, skin-like electronics over using conventional hospital apparatus?
What’s used in hospitals today, are primarily biosensors that are attached to the surface of the skin just with adhesive tapes. They connect via hard wires to external boxes of electronics that do all the data acquisition and storage and processing. And that works fairly well for an adult patient who’s in a hospital bed and not moving around a lot.
The wires, however, even in that kind of scenario, create a pretty serious inconvenience and in many cases, they frustrate basic operations in clinical care, surgical operations are confounded by the presence of the wires.
The idea is to go to a platform that gets rid of the wires, so it’s wireless. And the forces that are inevitably imparted through the wires to the interface between the biosensors and the skin also go away, we can get away with an adhesive that has an adhesive strength to the skin that’s a factor of 10 or a hundred times lower than that which is required for the wired based devices. And the consequence of that is that you end up with a much more comfortable interface to the skin and one that is much less prone to create skin irritation.
In the context of almost all sorts of hospital practice in terms of monitoring, these kinds of skin-like or band-aid-like devices represent an important advantage, but if you take a look at probably the most extreme scenario where those wires are problematic, it’s what you encounter in the neonatal intensive care unit.
If you consider what’s done with premature babies, they have to be monitored for all vital signs, at clinical grade quality 24/7, because they’re in a very fragile health status, but their skin is also very fragile. They don’t accommodate these strong adhesive tapes very effectively. The wires are not just a nuisance, now they frustrate the natural motions of the baby. They frustrate the ability of the parents to interact with the baby as well because you have to manage the wires.
A lot of the work that we’ve done so far is focused on that use case as the most compelling opportunity for these kinds of technologies. We’ve done a lot of work in the NICU facility at Lurie Children’s Hospital in Chicago. We tested out the devices on about a hundred neonates who’ve come through the hospital and we’ve shown equivalency in the measurements made with our wireless skin-like devices to those determined with the conventional wired based devices and external boxes of electronics.
In fact, those platforms are now deployed at scale in Africa through funding from the Gates Foundation and the Save The Children Foundation, because in the developing world there are no monitoring capabilities at all. The idea is to kind of leapfrog the old-style wired based devices, go straight to wireless and provide improved capabilities in healthcare in that context of neonatal, pediatric, maternal and fetal health.
Another application of biocompatible electronic systems is in sport and fitness research. Why is sweat an important bodily fluid to be looked at?
Sweat, in the context of athletics, athletic performance, fitness, and general well-being is sort of low hanging fruit in terms of how to think about sweat as a biofluid, that can characterize health because it’s very clear that sweat loss can lead to dehydration.
In fact, maintaining optimal sports performance requires optimal hydration management. If you go into a training scenario or you enter an athletic competition, you want to keep your body at an optimally hydrated state. So, the ability of these skin interfaced microfluidic devices to continuously monitor sweat loss locally — and that local measurement correlates to full body sweat loss — can inform an athlete precisely how much water they need to drink in order to replenish the lost water through the sweating process.
But not only that, we can also measure the electrolyte concentration in sweat – a quantity that varies depending on the individual, their genetic background, their racial background, their dietary habits, all sorts of things. So the devices measure not only sweat loss but electrolyte loss as well. In this way, they allow you to replenish not only the lost water but also the lost electrolytes so you can maintain not only perfect hydration, but you can also maintain perfect electrolyte balance as well.
For competition at the highest levels, a few percentage improvements that can result from that data-driven hydration management can be very important. We have a partnership with Gatorade, and as you might imagine that kind of capability is touching on their core product, to distribute these devices to athletes, both pro athletes and youth athletes as well, to maintain better performance and also to avoid things like cramping and injuries that can also result from poor hydration management.
Nanotechnology has become an increasingly investigated area within the science industry, also having many applications within medicine. How does nanotechnology take part in your research?
Nanotechnology is important for us, but it’s not necessarily the end goal. We’ll use nanotechnology where it makes sense. We’re focused at the system level and how you can achieve novelty in devices and construction can yield data streams that are a direct benefit for health or fitness or sports.
But nanotechnology specifically does come into play, in a pretty simple way if you think about it. A silicon wafer has a certain set of mechanical properties that are defined by the silicon itself, but also by the geometry of the wafer. It’s fairly thick, it’s about a millimeter in thickness, half a millimeter in thickness or so and it’s partly because of that thickness that the silicon wafer cannot be bent without fracturing the material. Nanotechnology comes into play then because reducing the thickness of the silicon imparts a flexibility to the silicon just due to elementary bending mechanics. So a 2 x 4 you can’t bend that. You can bend a sheet of paper. It’s the same materials just by virtue of the fact that the paper’s really thin compared to the 2 x 4 that you can bend it.
The same principles apply to silicon. We deploy silicon in nano-scale forms rather than in wafer-based forms. If you take the thickness of a wafer, half a millimeter, and you shrink that down to a hundred nanometers, the flexibility improves by a factor of 1012 or something like that. It’s absolutely transformative in terms of the way you think about the material. That’s how nanotechnology enters the systems that we’re interested in, it allows us a straightforward route to make a material like silicon flexible and skin-compatible ultimately.
If this continued research is carried out into the field of biocompatible electronic and microfluidic systems, where could this take us?
The skin interfaced devices represent the most immediate opportunity because they’re minimally invasive. It’s very easy to get approvals for using these devices on human patients. They can easily be removed if any kind of adverse effect develops, although we haven’t seen that. It’s a straightforward and natural starting point for bio-integrated electronics, as the skin as an interface, at least for use in humans. We do a lot, however, with implantable systems, primarily in animal model studies as a predicate to eventually moving into use in humans.
The frontier for us is in taking the design principles that we’ve proven out for skin interface devices and deploying the same technology on the brain or the heart to allow similar types of functionality but in the context of internal organs. Electronically enhanced organ health is the way you can think about it. So devices that wrap the outside surface of the heart have the ability to monitor basic cardiac function, but also with the capability to deliver stimulus, therapeutic stimulus, as an advanced type of pacemaker, but one that’s distributed around the outside surface of the heart. The same types of possibilities are present in the context of brain disorders as well. So I think moving these devices from the skin to internal organs in the body is a huge area of opportunity.
What is next in your research into soft, skin-like electronics?
Exploring more deeply the value and information content embedded in sweat. Sweat has not been nearly as thoroughly explored as blood or interstitial fluid as a biofluid that contains biomarkers of relevance to health status.
There’s some work to be done there, but the area is opening up because now we have microfluidic devices that allow us to capture very small, but pristine quantities of sweat that can be used for very precise chemical analysis and correlation ultimately to blood.
It’s a technology-enabled opportunity in studies of human physiology and basic biological questions around how sweat relates to blood. And if you can establish those correlations, then I think sweat becomes a compelling way to make a biochemical assessment of health that avoids the need to do a blood draw.
Can you tell us why you come to Pittcon?
There is an amazing collection of people who are interested in topics very similar to those that represent core activities in my own research group. There is a huge synergy and resonance between my interests and the topics that are covered at Pittcon. It’s also comprehensive. It’s a very large meeting with all the key experts and so it’s kind of a one-stop shop for work in this area. I think it’s a fantastic event and I’ve been to this meeting many times in the past.
What do you expect to achieve this year at Pittcon?
I’ll be delivering this special lecture at Pittcon and I expect, as occurs many times, that I’ll be able to strike up some conversations and seed some areas for collaboration. Conferences for me are successful if I make new connections and meet new people and maybe open up new opportunities for research.
Why are events like Pittcon important for your research but also important for the analytical chemistry industry?
The exchange of ideas is incredibly important as a catalyzing aspect of how science works. It’s very important to share insights and ideas. A conference of this type provides an excellent platform for doing that, and so I think it helps everyone. It helps the whole community and helps society in a sense because it just accelerates progress in research.
PREEMIE FAMILY PARTNERS
Cuddler to the Rescue! Meet NYP’s “Grandma Cuddler”
New York-Presbyterian Hospital Published on Apr 20, 2018 Visit https://healthmatters.nyp.org for more about ‘Grandma Cuddler’ and other inspiring stories.
Preterm Birth a Key Risk Factor for Development of Childhood Depression
Publish Date October 4, 2018 The study investigators observed that low level of urbanization was associated with a lower risk for depression.
Children born preterm may have an increased risk for depression compared with children born full-term, according to study results published in the Journal of Affective Disorders.
Researchers analyzed data from 21,478 preterm children and 85,903 full-term children born between 2000 and 2010 who were included in the Taiwan National Health Insurance Research Database. The mean ages of the preterm children and full-term children were 9.72 and 9.88 years, respectively.
Evaluation of the study population found that preterm birth was the key risk factor for depression.
The risk of depression among preterm children was 2.75 times higher than that seen in full-term children (95% CI, 1.58–4.79; P <.001). Depression rates in full-term children were 0.37, compared with 1.01 in preterm children, per 10,000 person-years. In female preterm children, incidence of depression was 3 times higher compared with full-term children. Preterm children whose parents had blue-collar occupations had a risk for depression 3.4 times higher than full-term children in the same demographic. Preterm children whose parents had occupations other than blue-collar positions had a 6.06-fold higher risk for depression compared with full-term children in the same demographic (blue-collar occupations: 95% CI, 1.04–11.15; P <.05; other occupations: 95% CI, 1.71–
Researchers conclude that “findings of the present study suggest that preterm infants have a significantly higher risk of depression in adolescence compared with full-term infants.” They note that limitations of the study include lack of maternal demographic data and emphasize the need for healthcare providers to recognize the potential for depression in children born prematurely.
Reference
Chiu TF, Yu TM, Chuang YW. Sequential risk of depression in children born prematurely: A nationwide population-based analysis J Affect Disord. 2018; 243:42-47. doi: 10.1016/j.jad.2018.09.019
Mayo Clinic Minute: 5 signs your teenager is battling depression
May 8, 2018: It’s no secret that teenagers can be moody, but research shows that ongoing moodiness often is far more serious. Dr. Janna Gewirtz O’Brien, a Mayo Clinic pediatrician, says teen depression is much more common than most people realize.
RESOURCES For Our GRIEVING FAMILY PARTNERS:
GAPPS seeks to improve birth outcomes worldwide by reducing the burden of premature birth and stillbirths. We are working to close the knowledge gap in understanding the causes of preterm birth and stillbirth and collaborating to implement evidence based interventions to improve birth outcomes.
Parent Support
Below are some additional links to organizations with information that may be useful for those caring for preterm newborns or dealing with the loss of a baby
First Candle is one of the nation’s leading nonprofit organizations dedicated to safe pregnancies and the survival of babies through the first years of life. Their current priority is to eliminate stillbirth, Sudden Infant Death Syndrome and other Sudden Unexpected Infant Deaths through research, education, and advocacy programs.
Source: https://firstcandle.org/
International Stillbirth Alliance
The International Stillbirth Alliance is a nonprofit coalition of organizations dedicated to understanding the causes of and working on the prevention of stillbirth. Their mission is to raise stillbirth awareness, promote global collaboration in the prevention of stillbirth, and to provide appropriate care for parents who have lost a baby to stillbirth.
Source: https://www.stillbirthalliance.org/
SANDS: Stillbirth & Neonatal Death Society (UK)
SANDS supports anyone affected by the death of a baby, works in partnership with health professionals to improve the quality of care and services offered to bereaved families, and promotes research and changes in practice that could help to reduce the loss of babies’ lives.
Source: https://www.sands.org.uk/
The TEARS Foundation is a non-profit organization that seeks to compassionately assist bereaved parents with the financial expenses they face in making final arrangements for their baby who has died.
Source: https://thetearsfoundation.org/
March of Dimes helps moms have full-term pregnancies and focuses on researching problems that threaten babies’ health.
Source: https://www.marchofdimes.org/
Hayden’s Helping Hands is a non-profit foundation that assists Oregon and Washington families after the birth of a stillborn baby by paying for a portion or all of their hospital delivery medical expenses.
*** With our record-breaking success from very generous donors, we will continue to accept applications for financial assistance to ALL states within the United States.
Source: https://www.haydenshelpinghands.com/
HEALTH CARE PARTNERS
*** We 
this infographic!
Illustrative Neonatology
Praveen Chandrasekharan : An infographic application, this provides easy to understand illustrations on some of the common and rare pathophysiology in neonatal perinatal medicine. It is designed and made available for download at no cost in handheld devices to be used as a ready reckoner for all.
Download APP Here: https://apps.apple.com/us/app/illustrative-neonatology/id1220324936
Attenuated brain responses to speech sounds in moderate preterm infants at term age.
Dev Sci. 2020 May 16 François C1, Rodriguez-Fornells A2,3,4, Teixidó M3, Agut T5,6, Bosch L3,6,7.
Abstract: Recent findings have revealed that very preterm neonates already show the typical brain responses to place of articulation changes in stop consonants, but data on their sensitivity to other types of phonetic changes remains scarce. Here, we examined the impact of 7-8 weeks of extra-uterine life on the automatic processing of syllables in 20 healthy moderate preterm infants (mean gestational age at birth 33 weeks) matched in maturational age with 20 full-term neonates, thus differing in their previous auditory experience. This design allows elucidating the contribution of extra-uterine auditory experience in the immature brain on the encoding of linguistically relevant speech features. Specifically, we collected brain responses to natural CV syllables differing in three dimensions using a multi-feature mismatch paradigm, with the syllable /ba/ as the standard and three deviants: a pitch change, a vowel change to /bo/, and a consonant Voice Onset Time (VOT) change to /pa/. No significant between-group differences were found for pitch and consonant VOT deviants. However, moderate preterm infants showed attenuated responses to vowel deviants compared to full-terms. These results suggest that moderate preterm infants’ limited experience with low-pass filtered speech prenatally can hinder vowel change detection and that exposure to natural speech after birth does not seem to contribute to improve this capacity. These data are in line with recent evidence suggesting a sequential development of a hierarchical functional architecture of speech processing that is highly sensitive to early auditory experience.
Source: https://pubmed.ncbi.nlm.nih.gov/32416634/
Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults
Kara N. Goss, MD1,2; Kristin Haraldsdottir, PhD1,3; Arij G. Beshish, PhD1; et alGregory P. Barton, PhD1,4; Andrew M. Watson, MD5; Mari Palta, PhD6,7; Naomi C. Chesler, PhD1,6,7,8; Chris J. Francois, MD8,9; Oliver Wieben, PhD4,8,9; Marlowe W. Eldridge, MD1,3,8
JAMA Cardiol. Published online May 20, 2020. doi:10.1001/jamacardio.2020.1511
Key Points
Question What are the consequences of premature birth for later cardiac structure and function?
Findings In this cardiac magnetic resonance imaging–based cross-sectional cohort study, adolescents (n = 20) and young adults (n = 38) born moderately to extremely preterm (≤32 weeks) demonstrated statistically significantly smaller biventricular cardiac chamber size and lower biventricular mass compared with 52 age-matched participants who were born at term. Cardiac function was preserved, with a hypercontractile strain pattern in adults.
Meaning Adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size with preserved function, notably without a hypertrophic response, which may contribute to their increased lifetime cardiovascular risk.
Abstract
Importance Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood.
Objective To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI).
Design, Setting, and Participants This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019.
Exposures Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g.
Main Outcomes and Measures Main study outcomes included MRI measures of biventricular volume, mass, and strain.
Results Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely.
Conclusions and Relevance In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.
Source: https://jamanetwork.com/journals/jamacardiology/article-abstract/2766286
Our Feelings are Valid, Too: How Emotional Labor Affects the NICU Nurse
By Victoria Lemme, BSN RN
NANN Footprints: Stories from the NICU April 2020
To many, I have the best job in the world. I see babies take their first breaths, first baths, first bottles; but I also see the lasts for some. I am a Neonatal Intensive Care Unit nurse and yes, I have the best and worst job all wrapped up into one. I may appear put together on the outside, but on the inside, there are emotions begging to be recognized because my feelings are valid, too.
When I chose to become a nurse, I knew that I would have to contend with extenuating circumstances that often led to death. What I did not know but have come to realize is that behind the calm and collected persona of a nurse is someone who has feelings, too. Although the physical labor of working with infants is significantly less than that of working with adults, the emotional labor of building unforgettable relationships with families and babies, regardless of whether I’ve met them for a moment or had the opportunity to spend months with them, is everlasting.
Emotional labor has been defined as “the labor that requires one to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others- in this case the sense of being cared for in a convivial and safe place” (Cricco-Lizza, 2014). For those unfamiliar with the NICU environment, I encourage you to look up what the typical bedside of a neonate looks like. From ventilators and IV poles to alarming monitors, the NICU is anything but calming to new parents. This is where we as nurses come into play. We are the calm in the storm, or so we think we must be.
I vividly remember the night I lost my first patient. I walked into the unit at the start of my shift expecting my usual assignment to see that I was assigned to one baby. I walked over to the bedside to see two parents staring in at their little girl while her day nurse stared at her monitor as the baby’s oxygen saturations were in the 60s. My immediate thought was, “Why is nobody doing anything?” As I received report, I came to realize that there was not much more humanly possible to do to help this tiny girl. I felt broken for this family knowing that they would not be able to take their baby girl home but despite my feelings, I had to be the calm in the storm for them.
Right before the shift was over, I handed the precious baby girl to her mother as support was withdrawn. I fought back my tears in front of the family because I felt selfish making this moment about my emotions. When the day nurse arrived, we walked the family to a private room to spend their lasts moments with their baby. As the door shut, I began to break down.
There are still days that I believe that I am not entitled to my feelings. I’ve been asked “Are you sure this is the right job for you?” and for a moment I actually question it. I stumbled upon the article, “The Need to Nurse the Nurse: Emotional Labor in the Neonatal Intensive Care” by Roberta Cricco- Lizza and for once I felt my emotions were validated. It’s okay to be sad and angry. It’s okay not to bottle those feelings up. The emotional burden of working in the NICU is one that can no longer be ignored.
Here are a handful of quotes from fellow nurses, from the article and in my workplace, that resonated with me:
“We are always on stage in the unit…the nurse had to expend considerable emotional labor to maintain a ‘happy face’ persona, but they believed that this helped the families feel safe and calm.” (Cricco-Lizza, 2014)
“There are days your heartstrings are pulled to the point of breaking. Tears flow for babies and moms and families who don’t get a chance to feel the love a child can help grow. Sometimes I feel angry, too, for an innocent baby who wasn’t given a fair chance at life.” (M. Ouellette, 2020)
“Sometimes leaving work at work can be difficult, but realizing you did everything you could during your shift for the baby and the family is all you can do.” (S. Kaminski, 2020)
If there’s any one thing a nurse can take away from this, I want it to be that you don’t always have to put on your brave face to mask your emotions. Speak out, tell your truth and you will find that you are not alone in how you feel. Before we are healthcare professionals, we are human, and our feelings are valid too.
References: Cricco-Lizza, R. (2014). The Need to Nurse the Nurse. Qualitative Health Research, 24(5), 615–628. doi: 10.1177/1049732314528810- Kaminski, S (2020). Personal Interview – Ouellette, M (2020). Personal Interview
Source: http://nann.org/publications/april-2020-footprints
WARRIORS:
Helping a friend struggling with depression: Tips from
Dr. Randy Auerbach
Dr. Randy Auerbach, Associate Professor at Columbia Psychiatry, gives some tips on how to help a friend struggling with depression. Break the silence and be the one to prevent suicide. The National Suicide Prevention Lifeline (1-800-273-8355) provides 24/7, free and confidential support and prevention and crisis resources for people in distress.
KAT’S CORNER
Blue economies or water-friendly urban planning in Bangladesh, perhaps soil improvement and water management in Ethiopia? So many possibilities… I wonder what kinds of innovations we Warriors may generate as we face the challenges calling us into action.
Climate change drastically effects our global preterm birth community. In the video below Dr. Oppenheimer shares interesting perspectives of the why and how we may choose to prepare locally and globally in order to proactively respond as climate change rearranges our world. While progressive communities committed to protecting our planet and humanity take scientifically supported measures to reduce the effects of climate change we question if anything can be done to create sustainable economies to support and harness the capacities migrant/refugee populations have to share.
Refugees Are Fleeing Climate Change
Jan 31, 2020 The YEARS Project
Tens of millions of people could be displaced by climate change by the end of this century. Climate scientist Michael Oppenheimer explains why that matters, why he supports the right to migrate, and what governments need to do to prepare.
SURFING BANGLADESH | 2019
Dennis Sundström Aug 6, 2019 : A short movie from my trip to Cox’s Bazar, Bangladesh. Thanks to everyone that made the trip unforgettable!
The Neonatal Womb Warriors 