PANDEMIC EYES, HEAT, DAD HEALTH

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Chad.flag

Chad, officially known as the Republic of Chad is a landlocked country in northcentral Africa. It is bordered by Libya to the northSudan to the east, the Central African Republic to the southCameroon to the south-westNigeria to the southwest (at Lake Chad), and Niger to the west.

Chad has several regions: a desert zone in the north, an arid Sahelian belt in the centre and a more fertile Sudanian Savanna zone in the south. Lake Chad, after which the country is named, is the largest wetland in Chad and the second-largest in Africa. The capital N’Djamena is the largest city. Chad’s official languages are Arabic and French. Chad is home to over 200 different ethnic and linguistic groups. While many political parties are active, power lies firmly in the hands of President Déby and his political party, the Patriotic Salvation Movement. Chad remains plagued by political violence and recurrent attempted coups d’état. Chad is one of the poorest and most corrupt countries in the world; most inhabitants live in poverty as subsistence herders and farmers. Since 2003 crude oil has become the country’s primary source of export earnings, superseding the traditional cotton industry. Chad has a poor human rights record, with frequent abuses such as arbitrary imprisonment, extrajudicial killings, and limits on civil liberties by both security forces and armed militias.

Healthcare

In 1987 Chad had 4 hospitals, 44 smaller health centers, 1 UNICEF clinic, and 239 other clinics—half under religious auspices. Many regional hospitals were damaged or destroyed in fighting, and health services barely existed in 1987. Public health care expenditures were estimated at 2.9% of GDP. As of 2004, it was estimated that there were fewer than 3 physicians, 15 nurses, and 2 midwives per 100,000 people.

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

Preterm Birth Rates – Chad

Rank: 35 –Rate: 13.1% Estimated # of preterm births per 100 live births (USA – 12 %)

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

 

COMMUNITY

Connecting with Chad from an informational standpoint has been challenging, especially in relationship to healthcare, and specifically preterm birth. The emotional connection we feel for the people living in Chad is one of great love, concern, hope and admiration for the resilience of our global family living in Chad.

earth

From 1969 to 1988, 25,000 infants were born early each year as a result of hot weather, and with global warming pushing temperatures higher, more babies will be at risk for early birth.

Hot weather increases pregnant women’s risk of giving birth early, and more babies could be born early as a result of global warming, researchers report today (December 2) in Nature Climate Change. The average reduction in gestational length is six days, they find.

“Increased exposure to hot weather with climate change is likely to harm infant health,” write coauthors Alan Barreca, an economist at the University of California, Los Angeles, and Jessamyn Schaller, an economist at Claremont McKenna College, in the study. That’s because early birth is tied to poorer physical and mental health later in life.

Reviewing county birth rates around the time of extreme heat waves in the United States from 1969 to 1988, the researchers estimated that roughly 25,000 infants per year were born earlier than their due dates as a result of heat exposure, and that the heat led to the loss of 150,000 gestational days each year. Using data from climate models for the end of this century, they calculate pregnant women in the US will lose around 253,000 gestational days per year, with an additional 42,000 early births annually.

“More study needs to be done,” Mitchell Kramer, the chair of obstetrics and gynecology at Northwell Health’s Huntington Hospital in New York who was not involved in the study, tells HealthDay, “but certainly we must help protect pregnant women from extremes of heat as well as work on the causes of climate change.”

What causes pregnant mothers to have their babies earlier in hotter weather isn’t clear, but scientists have suggested heat leads to cardiovascular stress, which can induce pregnancy, or heat increases the levels of oxytocin, a hormone plays a role in labor, Time reports.

“There may even be a third cause,” Barreca tells Time, “which is loss of sleep. Minimum temperature on a hot day occurs at night, but it can still be hot enough to disrupt sleep, and that might be an important avenue to early birth.”

Income and exposure to heat make a difference, the team notes. For instance, access to air conditioning, typically associated with higher income, cut early birth risk. And, expecting mothers in regions of the US where temperatures are typically high didn’t have as many early births as women who live where temperatures are cooler.

“Electrification and access to air conditioning should be a part of any effort to protect pregnant women and infants in developing countries,” Barreca tells The Guardian. “But developed countries, like the US or England, should be paying developing countries to electrify with renewable sources, like wind or solar, so we avoid producing more greenhouse gas emissions.”

Ashley Yeager is an associate editor at The Scientist. Email her at ayeager@the-scientist.com.

Source:www.the-scientist.com/news-opinion/rising-temperatures-expected-to-spur-more-early-births-66806

 

baby.mom

L Maintaining Safety and Service Provision in Human Milk Banking: a call to action in response to the Covid-19 pandemic.

When a mother’s own milk is not available, WHO recommends pasteurised donor human milk as the first alternative.

Human milk banks screen and recruit donors, and have wide-ranging precautions to ensure the safety of donor milk. Screened donor milk principally feeds babies of very low birthweight, protecting them from a range of complications, as well as babies with congenital anomalies or neurological conditions.

The benefits of a human milk diet highlight the importance of providing these infants with donor milk for short periods—with appropriate use in the context of optimal support for lactation, such provision can support mothers to establish their milk supply without the need for supplementation with infant formula milk.

The coronavirus disease 2019 (COVID-19) pandemic is presenting many challenges to human milk banks worldwide and highlights a range of vulnerabilities in service provision and emergency preparedness. For the first time, the global human milk bank community is coming together to share learnings, collaborate, and plan. A Virtual Communication Network of milk bank leaders started to form on March 17, 2020, and now has more than 80 members from 34 countries. Data collated from regional and country leads in the Virtual Communication Network show that more than 800 000 infants are estimated to receive donor milk worldwide annually. However, the inadequate quality of the data is a major flaw, and the true global scale of milk banking is unknown.

The group actively discusses COVID-19-specific challenges and has developed mitigation strategies to ensure donor milk safety and service continuation, which will shortly be made available as a publication. During this crucial COVID-19 response period, human milk banks are facing the logistical challenges of adequate staffing, difficulties in donor recruitment, questions around the safe handling and transportation of donor milk, and increased demand as a result of mothers and infants being separated.

The global nature of this network supports breastfeeding advice from WHO, which is appropriate in both low-income and high-income nations.

Human milk bank leaders who have lived and worked through the HIV pandemic have brought insights into the mistakes that occurred in the 1980s, with fear leading to breastfeeding cessation and costing the lives of many babies who received infant formula in unsafe conditions.

Unlike HIV, where transmission via breastfeeding was a source of infection, there is no evidence around severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from breastfeeding or human milk,  and the virus is inactivated by heat treatment.

Similar patterns have emerged during other viral outbreaks (eg, Zika in 2016), where uncertainty about donor milk use meant that milk was withheld, and then used again once pasteurisation was proven to be effective or the virus shown not to be transmissible through milk. In the meantime, vulnerable infants have received suboptimal care. This constraint does not affect similar services (eg, blood transfusion and organ transplantation) to the same extent, where oversight and rapid research are prioritised.

To avoid further straining the health system during the COVID-19 pandemic, the best chance to keep infants healthy is to promote breastfeeding and a human milk diet. WHO notes that where donor milk provision can play a part, human milk bank services should be supported. The consensus from this Virtual Communication Network is that a comprehensive approach should be implemented to maintain contact between mothers and babies, with skin-to-skin contact and breastfeeding support. If donor milk is provided during any separation linked to COVID-19, this should be for as short a time as possible as a bridge to receiving mother’s own milk. By reducing the amount of mother–infant separation time and supporting the use of mother’s own milk, the excess demand for donor milk will diminish, ensuring that the global supply can continue to be used for those who need donor milk most, when maternal breastfeeding is disrupted or not possible. This approach increases the chances that these infants will leave the neonatal intensive care unit breastfeeding exclusively, which is essential for the long-term health of mother and baby. Emphasis on the importance of human milk for infants within neonatal units creates an environment where the mother’s own milk is seen as the valuable lifesaving resource that it is.

It is imperative that human milk bank systems are not inadvertently affected by efforts to contain COVID-19, but milk banks are facing unprecedented challenges to maintain safe supplies in volatile health system infrastructures. Local issues have been deepened by the absence of globally agreed operational safety guidelines, no global mechanism for rapid communication among milk banks, with little data and infrastructure to ensure responsiveness during a crisis. The strengthening of human milk bank systems is required to ensure that safe provision of donor milk remains an essential component of early and essential newborn care during routine care or emergency scenarios, such as natural disasters and pandemics.

We therefore collectively call on global policy leaders and funding agencies to recognise and prioritise the need to address four high-impact areas: (1) ensuring neonatal nutrition is an essential focus during emergencies; (2) funding research to optimise human milk bank systems in response to new infectious threats; (3) investing in innovation across all aspects of milk banking processes to improve the responsivity, access, and quality of donor milk provision; and (4) supporting the integration of learnings and innovations by the global milk bank community during COVID-19 into newborn, nutrition, and emergency response planning for future emergencies.

The Virtual Communication Network is now focused on building a formal global alliance to enable enhanced communication, sharing of data, and maintenance of optimal practices. Human milk banks constitute a necessary but chronically under-resourced service that deserves better protection against this and future emergencies.

NS reports funding from UK Research and Innovation, as a Future Leaders Fellow at Imperial College London; and is a cofounder and trustee of the Human Milk Foundation. All other authors declare no competing interests.

Source:https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30134-6/fulltext

 

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Premature births have gone down during the pandemic — and doctors are baffled as to why

Amid the pandemic, premature births have dropped precipitously around the world.      A few scientists have theories.    Matthew Rozsa July 21, 2020 11:58PM (UTC)

Medical experts are baffled as to why that has there has been a surprising drop in the number of premature babies born during the coronavirus pandemic, as first reported by The New York Times.

At University Maternity Hospital Limerick in Ireland, a neonatologist named Dr. Roy Phillip began investigating the matter when he learned that the hospital had not ordered any of the breast milk-based fortifier that doctors feed to the tiniest premature babies, as the Times story recounts. After being told that no babies had been born who required it, Dr. Phillip and his team compared the birth weights of babies (which tends to correlate to whether a baby is premature) born in their hospital between January and April of 2001 all the way through that same period in 2020.

They found that the number of babies born under 3.3 pounds had been reduced by 75%, while none at all had been born under 2.2 pounds. Even after the Irish lockdown began to end in June, the numbers continued to stay at unprecedented lows, according to Dr. Phillip.

At the same time that Ireland was discovering its own reduced number of preemies, medical professionals in other countries were finding the same thing. A neonatologist named Dr. Stephen Patrick at Vanderbilt Children’s Hospital in Nashville discovered that roughly 20 percent fewer NICU [neonatal intensive care unit] babies were born at his hospital in March than usual. A neonatologist at the University of Calgary in Alberta, Dr. Belal Alshaikh, learned that premature births across the province dropped by nearly half during his country’s lockdown.

At the Statens Serum Institut in Copenhagen, Dr. Michael Christiansen learned that the rate of babies being born before 28 weeks had dropped by 90 percent from March 12 to April 14 in 2020 (during the main lockdown period in Denmark) compared to the rates over the previous five years. Doctors in Australia and the Netherlands made similar discoveries of their own.

According to the Times article, potential explanations for the drop in premature births tend to involve the consequences of women staying at home, including the increase in physical rest, reduced exposure to infectious diseases and reduced exposure to air pollution.

“I saw this as well. I, too, was intrigued,” Mark Mercurio, a professor of neonatology at Yale University told Salon by email. “Our NICU has been as busy as ever, and I don’t personally have the specific numbers at hand from the most recent months to tell you whether our premature birth rate, especially the very preterm ones, is down. I have contacted those who keep those stats.”

It is worth noting that the two papers discussing this phenomenon have been posted on the preprint server medRxiv but have not yet been peer reviewed. Speaking to the Australian Financial Review, Professor of Obstetrics at the University of Western Australia John Newnham said that “it would extraordinary if the described reduction had occurred. Such a quantum leap would be a major advance and may have been discovered by accident.”

He added, “But these results need to be replicated because very early preterm births have been stable over the last decades. The first explanation to be excluded is whether pregnant women have gone to a closer hospital because of the lockdown.”

The seeming drop in premature baby births is only one of the medical mysteries that has emerged from the coronavirus pandemic. There are questions about why people respond so differently to being infected with the virus, the correlation between being asymptomatic and health issues arising from the virus, where the virus originated, how much of the virus can make you sick, how long one can remain immune after infection and the role played by children in spreading it.

Source: https://www.salon.com/2020/07/21/premature-births-have-gone-down-during-the-pandemic–and-doctors-are-baffled-as-to-why/

 

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PREEMIE FAMILY PARTNERS

talk

Effective Communication in the NICU

Britt Days, MSN,RN details strategies for effective communication with families & team members in the NICU.

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Visual‐motor functions are affected in young adults who were born premature and screened for retinopathy of prematurity

Dýrleif Pétursdóttir     https://orcid.org/0000-0002-9757-1373

Institution of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden

Abstract

Aim

To assess visual‐motor integration in young adults previously included in a prospective study on the incidence of retinopathy of prematurity (ROP).

Methods

The study encompassed 59 preterm individuals, born 1988‐1990, with a birth weight ≤1500 g, and 44 full‐term controls, aged 25‐29 years. Ophthalmological examination, including visual acuity and contrast sensitivity, and the Beery Visual‐Motor Integration (VMI) with supplemental tests of visual perception and motor coordination, were performed. A short questionnaire was filled in.

Results

The preterm individuals had significantly lower scores than the controls in all VMI tests, median values and interquartile ranges: Beery VMI 87 (21) vs 103 (11), visual perception 97 (15) vs 101 (8) and motor coordination 97 (21) vs 102 (15), respectively. Within the preterm group, no correlations were found between the VMI tests and ROP, gestational age, birth weight or visual acuity. Contrast sensitivity was correlated to visual perception. Neurological complication at 2.5 years was a risk factor for lower scores on Beery VMI. The preterm subjects reported six times as many health problems as compared to the controls.

Conclusion

Being born preterm seemed to have life‐long effects. This study shows that visual‐motor integration was affected in young adults born preterm.

Source: https://onlinelibrary.wiley.com/doi/10.1111/apa.15378

sleepy

Signs of postpartum depression in dads are often mistaken or missed, study shows

By Manas Mishra Reuters  Posted June 10, 2019

While many people can pick up on signs of postpartum depression in new mothers, the same signs are often mistaken for something else or missed entirely in fathers, a British study suggests.

There needs to be greater awareness that the mental health disorder can occur in either parent for up to a year after the birth of a child, researchers say.

In fact, a previously published research review found that one in four fathers experienced postpartum depression within three to six months after a child was born.

Study leader Viren Swami, a professor of social psychology at Anglia Ruskin University in Cambridge, UK, started researching the subject after he was diagnosed with the disorder after the birth of his son.

“Once I was diagnosed, I wanted to do more research into it and find out why so many people, like myself, think that men can’t get postnatal depression,” Swami told Reuters Health via phone.

Swami and his colleagues recruited 406 volunteers, ages 18 to 70, and had them read two vignettes describing almost identical situations where the subject suffered from postpartum depression, but one with a man and another with a woman.

Participants were initially asked if they believed anything was wrong with the subjects. Almost everyone — 97 percent — responded “yes” for the vignette with the woman, and 79.5 percent responded “yes” for the male.

Next, participants were asked what they thought was wrong. In the case of the mother, 90.1 percent correctly listed postpartum depression, postnatal depression or depression, while only 46.4 percent did so for the father.

Answers listing “baby blues” as the reason were scored as incorrect because this kind of short-lived mood swing is different from postnatal or postpartum depression and usually resolves within a week after birth, Swami and his team write in the Journal of Mental Health.

For the woman, a clear majority of 92.9 percent said depression was the problem.

Among those who did feel something was off with the man in the case study, 61 percent correctly thought it could be some form of depression. But 20.8 percent thought the father’s symptoms could be stress, 11 percent responded with tiredness and stress, and a few others said it could be anxiety, feeling neglected or “baby blues.”

The invisibility of their depression may force fathers to cope on their own instead of seeking professional help, the research team says.

One shortcoming of the study is that participants were recruited online, so they may not represent all adults, the researchers note

But some of the new results are encouraging, he said. “Although a much higher percentage of respondents recognized PND in women, there was still a substantial amount that recognized PND in father,” Eddy said via email.

“There are many fathers out there who suffer from PND who think they are alone and nobody sees their suffering. More people are beginning to recognize that paternal PND is real,” he added.

Previous research has shown that educational programs about maternal postnatal depression can improve awareness of the disease, the researchers wrote.

“Similarly rigorous programs to support new fathers and raise awareness of paternal postnatal depression are now urgently required,” they said.

Source:https://globalnews.ca/news/5375057/dads-postpartum-depression/

 

tips

Male Postpartum Depression – Tips For New Dads To Overcome It | Dad University

02/14/2019 – Dad University

Putting out a “WAKE-UP” call to Family Partners, Healthcare Providers and Educators. Late pre-term birth babies (still preemies) have challenges both medically and developmentally. Each one is unique. Late preterm infants are considered an at-risk population. So often we hear preemie parents and families “blow off” the importance of awareness related to the ongoing research, findings, and recommendations regarding late term preemie health and wellness. If you are a healthcare provider, parent/caregiver or educator attending to a late term preemie infant/child, please stay informed and empowered in order to provide dynamic proactive care for these amazing preterm birth survivors!

 

concern

Concerns About Preterm Birth Extend to the Last Few Weeks

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THE CHECKUP – Infants born at 37 or 38 weeks were more likely to have developmental delays than full-term babies.

When I was training in pediatrics, back in the 1980s, we spent a lot of time working in the newborn intensive care unit, where relatively new — and rapidly evolving — technologies made it possible to save extremely premature infants. A full-term pregnancy lasts for 40 weeks, and we were often taking care of babies born at 27 or 28 weeks, and sometimes earlier, impossibly tiny infants who were clearly not ready to exist outside the womb.

We worried less about the bigger, more clearly mature babies who were just a month or a little more early; the chief question was whether they weighed enough to go home — otherwise they had to stay in the hospital to “feed and grow.” And there was a general sense that that was also what those last weeks in the womb were mostly about.

But the thinking has shifted as new research has shown that every week that a baby stays in the womb makes a difference in health and development, even those last few.

“They’re not done yet, they’re just not done yet,” said Dr. Wanda Barfield, the director of the division of reproductive health at the Centers for Disease Control and Prevention. In that excitement over being able to save the profoundly premature infants, medicine lost sight for a while of the fact that the infants born at 34 and 35 and 36 and 37 weeks gestation “weren’t just little term babies, weren’t mature, had a lot of needs to continue their physiological maturity,” she said.

This led, in some cases, to a rather cavalier attitude toward delivering babies early, even when not medically indicated. But when researchers looked more closely at these “late preterm” infants, they found that they were at increased risk of a whole range of medical problems and developmental issues.

One important result of the research on late preterm infants was that the American College of Obstetricians and Gynecologists recommended strongly against early deliveries, unless they were medically necessary. Between 2007 and 2014, Dr. Barfield said, late preterm births declined, but since 2014, there has been an uptick. “We’re losing ground,” Dr. Barfield said. And there are also concerning disparities with higher rates of prematurity among African-American and Hispanic women.

Dr. Prachi Shah, an associate professor of pediatrics at C.S. Mott Children’s Hospital at the University of Michigan, said, “when we think about the morbidities of preterm birth, most studies have focused on the very preterm infant, less than 32 weeks, less than 28 weeks.” However, she said, from a public health point of view, late preterm births — from 34 to 37 weeks — account for the majority of preterm births — about 70 percent — and for 7 percent of all live births.

The terminology was revised in a 2007 report by the American Academy of Pediatrics: Babies born from 34 to 36 6/7 weeks gestation were classified as “late preterm,” rather than “near term.” Those born from 37 to 38 6/7 weeks are now called “early term” babies, and only those who stay inside for 39 to 40 6/7 weeks are considered full term. Early term infants represent another 26 percent of all live births.

In pediatrics, late preterm infants are now considered an at-risk population. Most immediately, they are at higher risk of medical problems in the newborn period, including poor feeding, dehydration, jaundice and hyperbilirubinemia. They may have trouble maintaining their blood sugar levels, and they may have trouble maintaining their temperatures. They are more likely to be readmitted after they go home from the hospital.

When researchers control for underlying conditions associated with early deliveries, like maternal hypertension or diabetes, late preterm infants are still at higher risk than full-term infants whose mothers have those same problems.

As they grow, the late preterm children are also at increased risk for developmental problems, Dr. Shah said. “Beyond the perinatal period, at a population level, when compared to full-term infants, there is a higher incidence of learning difficulties and minor cognitive and neurologic issues.”

In a recent study, researchers looked at data from a group of almost 6,000 children in New York (the Upstate KIDS cohort, born outside New York City from 2008 to 2010) who were regularly assessed during the first three years of life through parental questionnaires. The researchers also looked to see whether children had been found eligible for early intervention services, which are provided to those with developmental delays.

Edwina Yeung, a senior investigator at the Eunice Kennedy Shriver National Institute of Child Health and Development division of intramural population health research, who was the senior author, said, “We were trying to look at this in a longitudinal way, as a continuum of gestational age.”

Although the most marked risks were found in children born at the lower gestational ages (32 weeks and below), the relationship was consistent: The longer babies stayed in the womb, the less likely they were to show developmental delays on the questionnaires, and to qualify for early intervention services. The late preterm infants were at higher risk than the early term infants, but those born at 37 and 38 weeks gestation were also at higher developmental risk, with a greater likelihood of failing the gross motor and communication domains of the questionnaire. Even 39 weeks was not as good as 40 or 41.

“Nobody doubts that preterm delivery is a problem,” Dr. Yeung said. “The question of interest is in that small window around 40 weeks with term deliveries and early term deliveries.”

Dr. Shah, who was not involved with this study, said, “The key take-home message is that every week seems to make a difference in terms of developmental delay — the earlier you were born, the higher your risk for developmental delay.”

Dr. Shah was the first author of a 2016 study which found that at preschool and kindergarten entry, children born in the late preterm period had lower math and reading scores than children born at term. “Compared to full-term infants, there is an increased risk of developmental vulnerability, but the magnitude of effect is not as great as those born very preterm,” she said.

Still, these are children who should be identified — and helped — before they get to school. “We have missed a window to intervene,” Dr. Shah said. “If we have evidence that there are population-based differences, we should be thinking about them as a vulnerable population that may need targeted surveillance.” It may be important to look closely at which late preterm infants should be monitored most closely, she said, and to consider extending the eligibility for services like early intervention.

In terms of development, Dr. Shah said, many of the risks for late preterm and early term infants seem to be around communication and language delays, and around math. “Every week of intrauterine life makes a difference in these neurodevelopmental processes,” Dr. Shah said. “Even a week early can seem to result in structural changes.”

Dr. Barfield was the co-author of a 2019 update on the late preterm infant from the American Academy of Pediatrics, which emphasizes the importance of strategies for preventing prematurity. The A.A.P. recommends against early discharge for these newborns, and suggests that they come back for follow-up visits after discharge.

They need to be breastfeeding well, and able to maintain their body temperatures. Their families need to be clear on the rules of safe sleep and fully informed about all the other warning signs to watch for, from jaundice to lethargy to breathing problems.

“We need to understand that these babies are premature,” Dr. Barfield said. “Although they may be closer in terms of time, they are still premature infants.”

Source: https://www.nytimes.com/2020/06/08/well/family/premature-babies-preterm-birth-pregnancy-developmental-delays.html

 

doc

NICU Nurse Adopts Baby She Felt ‘Instant Connection’ With

insidSep 16, 2019

Baby Jackson is the apple of his mom’s eye. The two share a special bond, and the way it came about is even more special. Claire Mills, 25, is a NICU nurse at a hospital in Houston, Texas. When Jackson was born five weeks premature at the same hospital, he quickly became more than Mills’ patient. So when his biological mother worried she couldn’t care for him in the way he deserved, she asked Mills if she would adopt him. She said yes and has been raising the sweet little boy ever since.

 

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HEALTH CARE PARTNERSmeds

Exposure to iodine in the NICU may affect infant thyroid function

HealthDay News – JULY 7, 2020

Exposure to iodine in the neonatal intensive care unit (NICU) may increase a baby’s risk for loss of thyroid function, a new study suggests.

Iodine solutions are often used as disinfectants on the skin before surgical or other medical procedures. Iodine also is given internally for imaging procedures used in infants, researchers explained.

Investigators found higher blood levels of iodine in babies with congenital hypothyroidism (partial or total loss of thyroid function) who had a stay in the NICU. All these infants had normal thyroid function when they went to the NICU.

“Limiting iodine exposure among this group of infants whenever possible may help lower the risk of losing thyroid function,” researcher Dr. James Mills said in a news release from the U.S. National Institutes of Health.

RELATED

Mills is from the epidemiology branch of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

For babies with congenital hypothyroidism, treatment with thyroid hormone has to start within four weeks after birth or permanent intellectual disability can happen.

For the study, Mills and his colleagues compared iodine levels from more than 900 children with congenital hypothyroidism to more than 900 children who did not have the condition.

RELATED

Among the kids, 183 were cared for in the NICU. Of these, 114 had congenital hypothyroidism and 69 did not.

Children with congenital hypothyroidism were more likely to have been in a NICU than those without the condition, the researchers found.

When they looked at only kids who had been in the NICU, they found those with congenital hypothyroidism had higher iodine levels than those without the condition.

RELATED

Higher iodine levels among babies with congenital hypothyroidism and a NICU stay might be linked to exposure to iodine during treatment, although only an association was observed and the research didn’t include information on the infants’ exact medical procedures.

The researchers caution NICU staff not to use disinfectants containing iodine and to avoid exposing babies to iodine unless necessary. Preemie infants absorb iodine more readily through their skin than older infants, they noted.

The report was published July 7 in the Journal of Nutrition.

Source: https://www.upi.com/Health_News/2020/07/07/Exposure-to-iodine-in-the-NICU-may-affect-infant-thyroid-function/3271594154032/

 

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Telehealth helps Mayo Clinic neonatologists better treat newborns in emergencies

The new technology connects on the first attempt 96% of the time, compared with 73% for the previous telemedicine carts; with enhanced monitoring and support, tele-neonatology availability is 99%. By Bill Siwicki -November 06, 2019

The Mayo Clinic in Rochester, Minnesota, implemented tele-neonatology six years ago. Prior to that, Mayo Clinic neonatologists were assisting community hospital care teams via telephone when a newborn required advanced resuscitation or critical care.

THE PROBLEM

“Because we were unable to visually assess the newborn, this limited our ability to closely collaborate with the local team and guide care over the phone,” said Dr. Jennifer Fang, medical director, tele-neonatology, at Mayo Clinic. “This was especially relevant when our neonatal transport team was not present for a high-risk delivery due to weather or geography, and the local team had to resuscitate and stabilize the critically ill newborn independently.”

These challenges prompted Mayo Clinic to develop a tele-neonatology program that allows neonatologists to establish a real-time audio/video telemedicine connection with care teams in community hospitals during these high-risk, low-frequency neonatal emergencies.

The tele-neonatology program is now offered at 19 community hospitals with Level I (well-baby) or Level II (special care) nurseries located in Minnesota and Wisconsin. Mayo Clinic board-certified neonatologists have performed more than 425 tele-neonatology consultations.

“During the initial pilot program, local care teams and neonatologists identified that tele-neonatology was feasible and seemed to improve the quality and safety of care provided to newborns requiring advanced resuscitation,” Fang explained. “However, we also realized that the initial technologies used for our program did not provide the level of reliability and audio/video quality that our program required.”

PROPOSAL

Previously used telemedicine technologies for Mayo Clinic’s tele-neonatology program had issues with reliability, including ability to establish and maintain a connection for the duration of the tele-neonatology consultation.

For example, when using a consumer-grade wireless tablet with HIPAA-compliant video conferencing software, neonatologists were able to connect on the first attempt during only 70% of consults. Further, 15% of consults were interrupted by an unintended disconnection.

After the initial pilot phase, Mayo Clinic transitioned to a wired telemedicine cart with a hardware CODEC. While this technology improved the ability to connect on first attempt to 83% and reduced dropped connections to 6%, it still did not meet the reliability requirements for tele-neonatology given the emergent, critical nature of the consultations.

“In addition to suboptimal reliability, previous technologies were not meeting provider expectations for audio and video quality,” Fang reported. “When assessing satisfaction with audio/video quality on a 1 (poor) to 5 (excellent) scale, the wireless tablet had a mean rating of 3.3 and 3.2 for video and audio quality, respectively. After transitioning to the wired telemedicine cart, the video and audio quality ratings significantly improved to 4.6 and 4.3, respectively.”

However, users still reported issues with device size and difficulty positioning it in a constricted care environment, lack of mobility due to the wired connection, and audio delay and fragmentation.

“Because reliability and audio/video quality of the previous technologies did not meet our programmatic goals, the Mayo Clinic tele-neonatology program sought a telemedicine product that could provide 99% reliability in rapidly establishing and maintaining a connection, a more responsive remotely controlled camera, seamless high-fidelity audio, and a mobile form factor that fit well into the typical neonatal work space, for example, the labor and delivery room, nursery, and operating room,” Fang said.

MARKETPLACE

There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, InTouch Health, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.

MEETING THE CHALLENGE

In October 2016, Mayo Clinic’s tele-neonatology program transitioned from a wired telemedicine cart with hardware CODEC to a proactively monitored, fully supported wireless telemedicine product from vendor InTouch Health.

Care teams in the community hospitals activate tele-neonatology when there is a high-risk delivery or a newborn that requires advanced resuscitation. Providers at the community hospital place the wireless telemedicine device at the newborn’s bedside and call Mayo’s Admission and Transfer Center to request a tele-neonatology consult.

A Mayo Clinic neonatologist then establishes a synchronous, audio/video connection with the care team via the telemedicine device in the room. If the newborn requires transfer to Mayo Clinic’s neonatal intensive care unit (NICU), the neonatologist can dispatch the transport team to retrieve the patient as part of the tele-neonatology workflow.

RESULTS

The objective of the Mayo Clinic tele-neonatology study (McCauley et al, Telemed and e-Health, 2019) was to compare the performance of two telemedicine technologies used to provide tele-neonatology consults.

“We hypothesized that the InTouch Health Lite Version 2 telemedicine device (ITH Lite) would provide superior reliability and a higher-quality user experience when compared with a wired telemedicine cart,” Fang said.

“When considering reliability of connection, we demonstrated that the neonatologist was able to connect on first attempt more reliably with the ITH Lite compared with the wired telemedicine cart (96% versus 73% of consults). The improved connection reliability was likely due to proactive monitoring of the device by the vendor and implementation of formal support processes by both the vendor and Mayo Clinic’s Center for Connected Care.”

With enhanced monitoring and support, product availability with the ITH Lite was 99%, Fang added. When compared to the wired telemedicine cart, Mayo Clinic found that a significantly great percentage of incidents were resolved proactively and did not impact patient care when using the ITH Lite (incidents that impacted care, ITH Lite 7% versus wired cart 32%).

The percentage of consults complicated by unplanned disconnections was not significantly different between the two technologies.

“After each tele-neonatology consult, an electronic survey is sent to the community physician and neonatologist,” Fang explained. “Providers rate the technology performance on a 1 (poor) to 5 (excellent) Likert scale. Overall user satisfaction and video quality were not significantly different between the wired cart and the ITH Lite. However, the average audio quality rating was significantly higher for the ITH Lite compared with the wired telemedicine cart: 4.6 versus 4.1.”

This is an important finding because communication is fundamental to a successful newborn resuscitation, and may be even more critical when team members are separated by time and space as is experienced during tele-neonatology consults, Fang explained. To provide high-quality care during neonatal resuscitations, the team needs to share information and communicate intentions and plan of care; for these reasons, exceptional audio quality is imperative during tele-neonatology consults, she added.

“Local providers found the wired telemedicine cart to be bulky and less maneuverable,” Fang reported. “They either had to work around the cart or the neonatologist’s view of the neonate was compromised due to obstruction by the local care team. Comparatively, qualitative data suggested that the ITH Lite was more maneuverable, particularly when moving from one location to another – for example, operating room to nursery.”

Correct positioning of the ITH Lite within the workspace was still important, however, to ensure the neonatologist could secure the necessary view of the neonate, she added.

ADVICE FOR OTHERS

“The focus of Mayo Clinic’s tele-neonatology program has always been the needs of our neonatal patients, whether they are located in Mayo Clinic Rochester or elsewhere in our region,” Fang said. “By leading with patient care and identifying unmet needs of patients or care teams, organizations can design telemedicine programs that are impactful, effective and highly utilized.”

When developing a tele-neonatology program, the multi-specialty team must consider many factors including service activation and workflow, staff education and training, team building and communication – and the telemedicine technology itself, she advised.

“Our recently published study (McCauley et al, Telemed and e-Health, 2019) focuses on one of these domains, the telemedicine technology,” she said. “We demonstrated that the ITH Lite improved audio quality and ability to connect on first attempt when compared with a wired telemedicine cart. Organizations should consider the reliability of connection, audio/video quality, and fit within the care environment when selecting a technology for their tele-neonatology program.”

In addition, proactive monitoring is broader than hardware and network monitoring, she cautioned. In this study, incidents were not only identified by vendor monitoring of the devices but also during care team and physician training, tele-neonatology simulation sessions, and physician on-call preparation activities.

“When developing a tele-neonatology program,” Fang concluded, “organizations should consider comprehensive support models for incident management and tracking.”

Source: https://www.healthcareitnews.com/news/telehealth-helps-mayo-clinic-neonatologists-better-treat-newborns-emergencies

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INNOVATIONS

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Is This My Home? A Palliative Care Journey Through Life and Death in the NICU

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Abstract – A Case Report

Background: 

With advancements in neonatology, patients in the neonatal intensive care unit (NICU) are living in the hospital with complex life-limiting illnesses until their first birthday or beyond. As palliative care (PC) becomes a standard of care in neonatology, a level IV NICU developed an interdisciplinary PC team with the mission to ease the physical, mental, and moral distress of the patients, families, and staff. This case report highlights the teamwork and long-term palliative care and ultimately end-of-life care that an infant received by this dedicated NICU palliative care team.

Clinical Findings: 

This case discusses a premature ex-27-week gestation male infant who initially presented to the emergency department at 5 months of age with significant tachypnea, increased work of breathing, and poor appetite.

Primary Diagnosis: 

The primary diagnosis was severe pulmonary vein stenosis resulting in severe pulmonary hypertension.

Interventions: 

The severity of the infant’s pulmonary vein stenosis was incurable. He required substantial life-extending surgical procedures and daily intensive care interventions. In addition to his life-extending therapies, the infant and his family received palliative care support by the NICU PC team and the hospital-wide PC team (REACH team) throughout his admission. This was specialized care that focused on easing pain and suffering while also addressing any social/emotional needs in the infant, his family, and in the hospital staff. The PC teams also focused on protecting the families’ goals of care, memory making, and providing a positive end-of-life experience for the infant and his family. The infant’s end-of-life care involved providing adequate pain and symptom management, education, and communication to his family about the dying process and allowing unlimited family time before and after his death.

Outcomes: 

After 11 months in the NICU and despite aggressive therapies, he required more frequent trips to the cardiac catheterization laboratory for restenosis of his pulmonary veins. He was dependent on iNO to treat his pulmonary hypertension and he continued to require an ICU ventilator. His parents ultimately decided to pursue comfort care. He died peacefully in his mother’s arms.

Practice Recommendations: 

The American Academy of Pediatrics and the National Association of Neonatal Nurses both have statements recommending that palliative care be standard of care in NICUs. Establishing a NICU-dedicated interdisciplinary PC team can improve outcomes for infants and families living in the NICU with complex life-limiting illnesses.

Walters, Aurora RN, BSN, RNC-NIC; Grosse, Jordan RN, BSN, RNC-NIC

Editor(s): Fortney, Christine A. PhD, RN, Section Editor

Advances in Neonatal Care: April 2020 – Volume 20 – Issue 2 – p 127-135 – doi: 10.1097/ANC.0000000000000697

Source: https://journals.lww.com/advancesinneonatalcare/Abstract/2020/04000/Is_This_My_Home__A_Palliative_Care_Journey_Through.7.aspx?context=FeaturedArticles&collectionId=3

 

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Rising Virginia Apgar (1909-1974)

If we neonatologists ever get a patron saint of our own, it will probably be Virginia Apgar. We are reminded of Dr. Apgar’s dedication, wisdom, wit, tenacity, and many contributions to infant care every time we are called to the delivery room to evaluate a baby. Dr. Apgar originally intended to become a surgeon, but to our great good fortune, ended up in anesthesia instead, where she soon turned her attention to the care of mothers and the assessment and resuscitation of newborns. Her elegant paper of 1952 established the scoring system that now bears her name, but she was also famous for her work in the March of Dimes, her love of cars and fast driving, and her construction of her owned stringed instruments — among other things.

Source: http://www.neonatology.org/pinups/apgar.html

 

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WARRIORS:

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Smiling with your eyes: Communication in a face-masked COVID-19 world

Health & WellbeingBy Rich Haridy – July 12, 2020

As the COVID-19 pandemic continues to transform the world, millions of people are suddenly wearing face masks. But for people used to relying on facial expressions to effectively communicate, how are masks changing the way we interact? And what can we do to compensate for losing that all-important smile?

In the late 1960s a psychologist named Albert Mehrabian co-authored two influential studies investigating how important the semantic meaning of words were in regards to how people communicate emotions. Mehrabian ultimately quantified his ideas into a specific ratio, occasionally referred to as the “7:38:55 rule.”

Mehrabian’s rule suggests three elements need to be effectively co-ordinated for the successful communication of feelings or emotion: words, vocal tone, and body language. Breaking down the effect of each of these elements, Mehrabian concluded only seven percent of communication is related to the actual meaning of a given word, while 38 percent relates to tone of voice, and 55 percent is body language (primarily facial).

Mehrabian’s findings have been debated, criticized and misinterpreted over the decades. Whether or not one agrees the efficacy of communication can be reduced to such specifically quantified ratios, the general observation arguably holds strong. Effective communication stems from a congruent combination of factors beyond the specific semantic meaning of words.

So how can we effectively communicate when millions of people are suddenly required to cover two-thirds of their face?

A bigger problem for North America

Stanford psychologist Jeanne Tsai has long studied the relationship between culture and communication. She says, some cultures around the world have more experience negotiating the complexities of communication while wearing facial coverings. East Asians, for example, have long incorporated protective mask wearing into public activities. North Americans, on the other hand, in particular will likely find it very difficult to quickly learn effective communication with masks, Tsai suggests.

“The mouth seems particularly important in the United States partly because mouths are a critical part of conveying big smiles, and for Americans, bigger smiles are better,” says Tsai. “Our work finds that North Americans judge people with bigger smiles to be more friendly and trustworthy. In fact, smiles have an even stronger influence on judgments of friendliness and trustworthiness than more structural facial features associated with race or sex.”

Taking away one’s ability to smile in public settings is challenging enough but it presents particularly unique challenges in cultural contexts with pre-existing racial disparities. In the United States, for example, African American men are already expressing anxiety over being perceived as threatening while wearing face masks. A video from March showing a police officer removing two black men from a Walmart for wearing surgical masks highlighted the unique problems faced by widespread mask wearing in the United States.

“At the very least, I think people will have to learn to smile with their eyes and voices, and to read the eyes and voices of others more,” Tsai suggests.

The Duchenne Smile

In the mid-19th century French scientist Guillaume Duchenne published an iconic book titled Mecanisme de la physionomie Humaine (The Mechanism of Human Facial Expression). Duchenne was fascinated by the relationship between communication and facial anatomy and part of his research focused on the anatomical differences between a real smile and an insincere smile.

He found a simple smile involves the contraction of the zygomatic major muscle. This muscle is basically all one needs to raise the corners of their mouth. However, a truly positive, genuine and exuberant smile also involves contracting the orbicularis oculi muscle.

The orbicularis oculi muscle surrounds the eye and is primarily involved in controlling blinking. However, it also plays a role in smiling by helping raise the cheeks and create a wrinkling around the eyes. At the time, Duchenne suggested this more holistic type of smile could not be faked, and only the “sweet emotions of the soul” could lead to contraction of the orbicularis oculi.

This type of holistic smile became known as the Duchenne Smile. And, although researchers have since discovered the Duchenne Smile can indeed be faked, not everyone can easily fake it, and an exaggerated Duchenne Smile can be an effective signal someone is lying.

Interestingly, researchers have found botulinum toxin, or botox, the neurotoxin used in beauty therapies to paralyze certain facial muscles and slow the development of wrinkles, can also prevent a person from effectively contracting the orbicularis oculi muscle. A 2018 study found botox therapy does prevent a person from performing a Duchenne Smile, which not only stifles their ability to effectively communicate positive emotion, but may even induce depression as forming a facial expression has been found to strengthen the internal embodied feeling of that emotion.

Face masks are not a novel experience for everyone

While many North Americans struggle with communicating effectively in a world of newly masked faces, perhaps the best advice moving forward comes from cultures that have already adapted to this kind of behavior. For many Muslim women around the world, facial coverings, called a niqab, are normal. And both wearers and non-wearers have developed techniques to maintain effective communication.

Samar Al Zayer, a psychologist currently working in Europe, grew up in Saudi Arabia and, although she never wore a niqab, she remembers how facial coverings changed how one interpreted different social cues. Speaking to the BBC, Al Zayer recalls how communication wasn’t necessarily more difficult when one party’s face was covered, but it certainly was profoundly different.

“I would be a bit more aware of their non-verbals, keeping more eye contact to understand how they were feeling, to try and pick up on some sort of emotion,” she says. “I would be more attentive to their tone and hand gestures as well.”

The onus needs to be on both parties to overcome the limitations of communicating while wearing face masks. For those wearing masks, experts recommend using more exaggerated gestures to compensate for the loss of half of one’s face. From expressive eyebrows to a simple thumbs-up, it is suggested people amplify other elements used in communication.

“Over-communicate – use more words than you normally would, and ask more questions, to make sure you’re correctly picking up on the other person’s emotions,” says Al Zayer. “Learn how to use your other senses and body language, too.”

Source: https://newatlas.com/health-wellbeing/smiling-eyes-communication-face-mask-coronavirus/

KAT’S CORNER

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Masks…. We have to wear them. Why? Because we are smart, caring, socially conscious and efficacious survivors.

Sometimes it’s a challenge….accessing a supply, accessorizing it for the appropriate time and place, keeping one on hand (I mean-face) at all times, and ahhhh flirting? Just kidding…..

We can make wearing a mask fun through individual expression, on-going education, and by cheering our friends and family to partake in mask attire in creative or just plain practical ways. We can choose to shop and frequent business that are invested in our well-being.

I do, despite the bickering  in my head, judge people’s actions when they are not wearing a mask in Public when it is required.  I feel like they are making a pretty strong statement, and not one that values me or others.

Let’s team up and do what we can to slow down this global pandemic. We know what it takes to survive. It takes the love and commitment of others and that is why we are here.

 

No surfing in CHAD

 

Climate change is a critical factor in Lake Chad crisis conflict trap -“Shoring Up Stability” report

aJul 15, 2019- ADELPHI

Lake Chad is caught in a conflict trap. It is experiencing one of the world’s worst humanitarian emergencies with an estimated 10.7 million people in need of assistance. Now a new G7 mandated report from the Berlin based think tank adelphi shows, for the first time, how climate change is interacting with the conflict to compound the crisis and sets out how these challenges might be overcome. DOWNLOAD the report here https://www.shoring-up-stability.org The report “Shoring Up Stability” shows that climate change and conflict dynamics create a feedback loop where climate change impacts seed additional pressures while conflict undermines communities’ abilities to cope.

Nature, Dancing and a Cuddle!

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Preterm Birth Rates – Colombia

Rank: 114 –Rate: 8.8% Estimated # of preterm births per 100 live births (USA – 12 %)

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

Colombia, officially the Republic of Colombia  is a country largely in the north of South America, with territories in North America. Colombia is bounded on the north by the Caribbean Sea, the northwest by Panama, the south by Ecuador and Peru, the east by Venezuela, the southeast by Brazil, and the west by the Pacific Ocean. It comprises 32 departments and the Capital District of Bogotá, the country’s largest city. With an area of 1,141,748 square kilometers (440,831 square miles), Colombia is the fourth-largest country in South America, after Brazil, Argentina and Peru. It is also the 25th-largest country in the world, the fifth-largest country in Latin America, and the fourth-largest Spanish-speaking country.

The overall life expectancy in Colombia at birth is 74.8 years (71.2 years for males and 78.4 years for females). Healthcare reforms have led to massive improvements in the healthcare systems of the country, with health standards in Colombia improving very much since the 1980s. Although this new system has widened population coverage by the social and health security system from 21% (pre-1993) to 96% in 2012, health disparities persist.

Through health tourism, many people from over the world travel from their places of residence to other countries in search of medical treatment and the attractions in the countries visited. Colombia is projected as one of Latin America’s main destinations in terms of health tourism due to the quality of its health care professionals, a good number of institutions devoted to health, and an immense inventory of natural and architectural sites. Cities such as Bogotá, Cali, Medellín and Bucaramanga are the most visited in cardiology procedures, neurologydental treatmentsstem cell therapyENTophthalmology and joint replacements because of the quality of medical treatment.

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

 

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COMMUNITY

Cuddling Preemies Kangaroo Style Helps Into Adulthood

By Maggie Fox -Dec. 12, 2016

Cuddling small and premature babies in a style known as “kangaroo mother care” helps them in life decades later, researchers reported Monday.

They found that babies held upright and close to bare skin and breastfed, instead of being left in incubators, grew up with fewer social problems. They were far less likely to die young.

It’s a reassuring finding for parents who may worry that tiny and premature babies are safer in an incubator than in their arms, the team wrote in their report, published in the journal Pediatrics.

Kangaroo mother care was first described in Colombia, and the team of experts there who first showed it was safe did a 20-year follow-up to see how the babies fared as they grew up. They tracked down 494 of the original 716 children who were born prematurely from 1993 to 1996 and randomly assigned to get either kangaroo mother care or standard handling.

“The effects of kangaroo mother care at one year on IQ and home environment were still present 20 years later in the most fragile individuals, and kangaroo mother care parents were more protective and nurturing,” Dr. Nathalie Charpak and colleagues at the Kangaroo Foundation in Bogota, Colombia, wrote in their report.

“At 20 years, the young ex-kangaroo mother care participants, especially in the poorest families, had less aggressive drive and were less impulsive and hyperactive. They exhibited less antisocial behavior, which might be associated with separation from the mother at birth,” they added.

“Kangaroo mother care may change the behavior of less well-educated mothers by increasing their sensitivity to the needs of their children, thus making them equivalent to mothers in more favorable environments.”

Twenty million babies are born at a low birth weight every year around the globe, the World Health Organization reports. The U.S. has one of the highest rates of pre-term and low-weight births — about one in 12 births, according to the March of Dimes.

It defines low birthweight as being when a baby is born weighing less than 5 pounds, 8 ounces.

Most of these small babies are premature and they are at high risk of dying, of developing cerebral palsy, or having learning disabilities, and they can grow up more prone to a range of diseases.

High-tech care can help, but WHO promotes the simpler, low-tech approach alongside modern medical care — or instead of it in some poor settings.

“Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. Its key features are: early, continuous and prolonged skin-to-skin contact between the mother and the baby; exclusive breastfeeding (ideally); it is initiated in hospital and can be continued at home; small babies can be discharged early; mothers at home require adequate support and follow-up,” WHO said.

“It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward with preterm infants.”

And it’s safe, WHO added. “Almost two decades of implementation and research have made it clear that kangaroo mother care is more than an alternative to incubator care.”

Charpak’s team found the babies randomly assigned to get this treatment were 39 percent more likely to live into adulthood. They had stayed in school longer and earned more as adults.

It didn’t work miracles. Children with cerebral palsy were equally likely to have symptoms whether they had the kangaroo care or not, and more than half the people in the entire group needed glasses. The children given standard care had higher math and language scores in school, while IQ levels were about the same in both groups.

But overall, the findings support the benefits of kangaroo mother care, the team concluded.

“Our long-term findings should support the decision to introduce kangaroo mother care to reduce medical and psychological disorders attributable to prematurity and low birth weight,” they wrote.

“We suggest that both biology and environment together might modulate a powerful developmental path for these children, impacting until adult age,” they added.

“We firmly believe that this is a powerful, efficient, scientifically based health intervention that can be used in all settings.”

Source:https://www.nbcnews.com/health/health-news/cuddling-preemies-kangaroo-style-helps-adulthood-n694971

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Kat and I have danced Zumba for the past 13 years and are both certified instructors. Kat teaches several Zumba and Strong Nation (HITT) classes every week.  Zumba founders Alberto “Beto” Pérez (Colombian native), Alberto Perlman, and Alberto Aghion built a worldwide global health and fitness community (180 countries)  that we are grateful to be a part of.  Zumba in the streets? That’s what it’s all about! And our Neonatal Womb Community? We all need to do a little dancing. This pandemic has been challenging and we have a ways to go! Let’s move forward with curiosity, creativity, some crazy footwork and a focus on taking active care of ourselves and each other.

Colombia: Bogota Police help fight corona-virus isolation blues with dance classes

Apr 1, 2020

Colombian national police officers took to Bogota’s streets on Tuesday with loud speakers and dance tunes to encourage citizens to get some exercise and help them get through self-isolation with high spirits. “We are working at the moment on the idea of prevention to help people in everything that relates to tranquility in terms of their spiritual, physical and mental control in relation to the entire quarantine due to COVID-19,” said national police colonel Doris Manosalva. Footage shows police officers coordinating the dance operation before heading out to the streets to dance, calling on people to join them as well as reminding everybody the importance of staying inside. Police officers go to a different area of the city every day to reach as many citizens as possible.

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How California Became The Only State To Lower Its Infant Mortality Rate

Here’s how they’re saving the lives of more premature babies.

By Anna Almendrala08/08/2018

California was the only state to significantly reduce the rate of stillbirths and newborn deaths from 2014 to 2016.

In 2014, Dr. Elizabeth Rogers and her colleagues at the UCSF Benioff Children’s Hospital in San Francisco noticed a disturbing trend among the tiniest preemies in their neonatal intensive care unit: a high rate of brain bleeds among these babies born before 28 weeks’ gestation.

Rogers wondered if other NICUs had seen an increase as well or if there was something about her patient population that put them at particular risk.

Intracranial hemorrhages, caused by the rupture of immature blood vessels in the brain, are a major cause of death in very preterm babies, as well as a complication linked to developmental delays and cognitive deficits later in life. Driving down the rate of such complications is one way that hospitals can help reduce the number of early infant deaths.

Compared to other rich countries, the U.S. has unacceptably high rates of perinatal deaths, a category that covers stillbirths and deaths within the first week of life. And the most recent data suggest those numbers are not improving ― except in California. That state was the only one to see a decrease in perinatal deaths from 2014 to 2016, according to a report published Wednesday by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

The reason for California’s success may be a statewide data project that has been gathering information from hospitals for the past two decades. In any other state, Rogers and her colleagues would have struggled to find an answer to her initial question about the prevalence of brain bleeds. But because they were in California, Rogers was able to log into a data dashboard created by the California Perinatal Quality Care Collaborative. The easy-to-use clearinghouse of real-time information from more than 90 percent of California hospitals that treat babies in NICUs let her compare her unit’s outcomes to those at similar units.

What she found shocked her. UCSF was seeing brain bleeds in more than 15 percent of NICU babies, or nearly four times the rate at comparable hospitals of the same size and expertise.

“I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem,’” said Rogers, who is director of the hospital’s intensive-care small-baby program.

Armed with that information, she persuaded hospital administrators to allocate resources to the issue; gathered a group of doctors, nurses, therapists, technicians, janitors and parents to consider what steps to take; and produced a training manual for staffers.

I was able to go to the dashboard and say, ‘Not only do we think this is a problem, but this really is a problem.’ Dr. Elizabeth Rogers

It isn’t clear what causes brain bleeds in premature babies, so Rogers’ group tackled the issue in multiple ways. Starting in 2014, women who went into labor preterm received a shot of steroids to strengthen their babies’ brains. Immediately after birth, the clamping of a preemie’s umbilical cord was delayed 45 seconds, which is known to decrease brain bleeds.

Everyone who interacted with the babies, from X-ray techs to sanitary workers, received training on how to create a calm environment, which included intervening as little as possible and using low voices if they had to speak.

In about three years, UCSF reduced the rate of brain bleeds to 3.8 percent, just a quarter of what it had been and on par with comparable hospitals in the state. This decrease set off a cascade of other positive outcomes. Deaths in the NICU were cut almost in half, dropping from 11.9 percent to 6.8 percent over that time period. Rates of necrotizing enterocolitis ― another common complication among premature babies ― went down as well, which Rogers attributed to the hospital’s increased attention to their littlest patients.

The speed at which Rogers and her team implemented research-based change was remarkable and unusual. It takes an average of 17 years for research data to alter standard medical practice, in part because of entrenched hospital bureaucracies that favor tradition, a systemic reluctance to spend money on monitoring and prevention, and medical staff who may feel competitive and territorial.

Without the initial comparative data, Rogers is convinced she wouldn’t have been able to revamp her NICU’s systems so fast and the rates of hemorrhage would have remained high.

Hospitals in general need to become better at rapidly adjusting and refining their care when it’s lacking or when new research points to a better way of doing things, Rogers argues.

Across the rest of the country, rates of stillbirths and deaths within a week after birth remain at a standstill. In one state, Missouri, the rate has actually gone up since 2014. California has the third-lowest rate, following Washington state and Wyoming.

“To see the results … is a huge reward,” said Rogers. “It’s a huge validation that all of this effort is worth it.”

They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors. Dr. Jeffrey Gould, co-founder of the California Perinatal Quality Care Collaborative

While the larger issue of American infant mortality is now more widely recognized, it wasn’t in the public consciousness 21 years ago when Dr. Jeffrey Gould, then a researcher with the University of California, Berkeley, began to compile a single statewide database of numbers on newborn deaths and complications, paid for by the state.

The project grew as Gould convinced neonatologists, hospitals, insurance payers, public health experts and state agencies that it was in everyone’s interest to share NICU data in real time. With its wealth of information, the California Perinatal Quality Care Collaborative also develops best practice standards and toolkits to help hospitals implement those practices. It periodically launches initiatives aimed at improving care in one particular area, such as breastfeeding in the NICU, using antibiotics and reuniting these vulnerable newborns with their families.

The model of the California Perinatal Quality Care Collaborative has spread across the country, albeit only in recent years. Most states now have some kind of perinatal quality collaborative, but they aren’t created or funded equally. Because California was the first, none of the other state collaboratives has as much data or experience. And though some of them provide education on better practices, they don’t seek to help hospitals implement specific changes ― an aspect of California’s collaborative that makes membership so worthwhile. This means the gains California has seen are not guaranteed in other parts of the country.

Gould, now a professor of neonatal and developmental medicine at Stanford, is especially frustrated that hospitals still hesitate to invest real money in trying to improve the quality of care.

“One of the big drawbacks in this country is that quality improvement is not really seen by hospital administrators as a line item kind of thing,” Gould said. “They’ll pay thousands to monitor one baby’s heart rate, but there’s no money set aside to monitor the monitors.”

The annual cost of membership in the California Perinatal Quality Care Collaborative is $13,000 to $15,000, depending on the size of the hospital, and it gives them access to the data dashboard. Participation in each individual initiative is optional and costs an additional fee ― around $8,500 per hospital ― to defray the additional costs for data collection, training and network access.

Meanwhile, the average daily cost of one baby’s care in a NICU is more than $3,000.

More data may ultimately ease this problem too, Rogers said. Besides helping doctors make the case to administrators for more resources for the NICU, as she did, better information leads to more effective and efficient care, which can lead to cost savings.

When a state does decide to invest in improving outcomes for preemies, hospitals may not know where to start. Gould’s suggestion: Use the data to find the low-hanging fruit, and then build on those first successes.

That’s exactly what Rogers is doing. The doctor is now turning her attention to necrotizing enterocolitis, a bacterial infection in the gut that can destroy intestinal walls. As brain bleeds have continued to decrease, necrotizing enterocolitis has become the biggest contributor to preemie deaths in her unit.

Again, armed with data, Rogers convinced the hospital to free up some funding for her unit to take part in the California Perinatal Quality Care Collaborative’s current effort to improve nutrition in NICUs. For premature babies, this boils down to hospital policies that encourage and assist mothers to pump breast milk soon after the baby’s birth ― a difficult task for women who have just experienced a stressful and unexpected early delivery.

Because formula feeding is one of the only consistent risk factors for necrotizing enterocolitis, breast milk ― especially milk produced by the baby’s mother ― decreases the odds that a premature baby will develop the infection. It’s so good for NICU patients, Rogers said, that doctors look at it more like medicine than food.

Source:https://www.huffpost.com/entry/california-infant-mortality-premature-babies_n_5b6b650de4b0bdd062062348

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rio

Brazil changes maternity leave for mothers of premature babies – a step to a fairer and more humane scenario of the labour market for all women 

Brazil (2019): The maternity leave for mothers of premature babies is extended. Last month Brazil’s Supreme Federal Tribunal decided to prolong the period of maternity leave for mothers of premature infants. We talked to Denise Leao Suguitani, founder and executive director  of GLANCE partner parent organisation Brazilian Parents of Preemies’ Association (Prematuridade.com), member of the GLANCE advisory board, about this important adjustment in Brazilian law.

  1. Ms Suguitani, Brazil took another big step to strengthening maternal rights. What brought this change to come?

We, the organized civil society, were finally able to raise awareness for the Brazilian Governments about the challenges prematurity brings along. It seems they have understood the essentiality of protecting motherhood and childhood, especially for more delicate babies like the premature ones. Although the decision is valid only for mothers working on a formal contract, it is a huge step towards a fairer and more humane scenario of the labour market for all women.

  1. Ms Suguitani, your parent organisation spoke to the lawyers who placed the injunction that was eventually approved. What changes for mothers of premature babies in Brazil from now on?

Women in the workforce in Brazil have 120 days of standard maternity leave, which begins on the day of the delivery. From now on, mothers of premature babies can require a new beginning of maternity leave, if their baby needs to be in the hospital for more than two weeks. Once the baby is discharged, the maternity leave with its 120 days starts anew – regardless of how long the baby had to stay in hospital.

  1. The initial decision of Minister Fachin was valid until the Brazilian Federal Supreme Court plenary confirmed the new law, on April 3rd. How do you assess that victory in the Court?

We were really optimistic that the injunction would not be overturned since we have been working for the approval of this law for over 5 years now, dialoguing with politicians and decision makers. It is such a great achievement for the cause of prematurity in our country and a big step for our society.

Ms Suguitani, thank you so much for taking the time to speak with us.

Source: https://www.glance-network.org/news/details/brazil-extends-maternity-leave/

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INNOVATIONS

Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the USA Systematic Review

Bruce Bekkar, MD1Susan Pacheco, MD2Rupa Basu, PhD3,4; et alNathaniel DeNicola, MD, MSHP5 – June 18, 2020

Key Points:

Question  Are increases in air pollutant or heat exposure related to climate change associated with adverse pregnancy outcomes, such as preterm birth, low birth weight, and stillbirth, in the US?

Findings  In this systematic review of 57 of 68 studies including a total of 32 798 152 births, there was a statistically significant association between heat, ozone, or fine particulate matter and adverse pregnancy outcomes. Heterogeneous studies from across the US revealed positive findings in each analysis of exposure and outcome.

Meaning  The findings suggest that exacerbation of air pollution and heat exposure related to climate change may be significantly associated with risk to pregnancy outcomes in the US.

Abstract

Importance  Knowledge of whether serious adverse pregnancy outcomes are associated with increasingly widespread effects of climate change in the US would be crucial for the obstetrical medical community and for women and families across the country.

Objective  To investigate prenatal exposure to fine particulate matter (PM2.5), ozone, and heat, and the association of these factors with preterm birth, low birth weight, and stillbirth.

Findings  Of the 1851 articles identified, 68 met the inclusion criteria. Overall, 32 798 152 births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. A total of 57 studies (48 of 58 [84%] on air pollutants; 9 of 10 [90%] on heat) showed a significant association of air pollutant and heat exposure with birth outcomes. Positive associations were found across all US geographic regions. Exposure to PM2.5 or ozone was associated with increased risk of preterm birth in 19 of 24 studies (79%) and low birth weight in 25 of 29 studies (86%). The sub-populations at highest risk were persons with asthma and minority groups, especially black mothers. Accurate comparisons of risk were limited by differences in study design, exposure measurement, population demographics, and seasonality.

Conclusions and Relevance  This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US.

Introduction

The current climate crisis, also known as climate change or global warming, has been widely recognized as an environmental emergency that threatens many critical resources and protections including sustainable food and water supplies, natural disaster preparedness, and US national security. However, as the World Health Organization and The Lancet Countdown have identified, one of the greatest consequences of climate change is its association with human health.

Specific to women’s health, the American College of Obstetricians and Gynecologists position statement recognizes that “climate change is an urgent women’s health concern as well as a major public health challenge.” The associations of climate change with women’s health have been further outlined to include a wide range of undesirable outcomes, such as worsening of cardiac disease, respiratory disease, and mental health, and exposure to an increasing number of infectious diseases.

These adverse health effects are most consequential to at-risk populations, which include a high number of pregnant women and developing fetuses. The obstetrical literature has included numerous observational studies demonstrating an association between air pollution and heat and increased risk of adverse birth outcomes. Two components of air pollution that are exacerbated by climate change and continued use of fossil fuels are fine particulate matter less than 2.5 μm in diameter (PM2.5) and ozone.

In this review, we assessed the associations between exposure to PM, ozone, and heat and preterm birth, low birth weight, and stillbirth. Although these associations have largely been studied in a global setting, we focused specifically on the US population, in which these exposures are increasingly common.

Methods

Scope of Review

For this systematic review, we evaluated evidence of the association between air pollution and heat on the adverse obstetrical outcomes of preterm birth, low birth weight, and stillbirth. The Arskey O’Malley methodologic framework for a scoping review was used.18,19 This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Research Questions

The following specific key questions were addressed in this review. Is prenatal exposure to PM2.5 or ozone associated with increased risk of preterm birth? Is prenatal exposure to PM2.5 or ozone associated with increased risk of low birth weight? Is prenatal exposure to PM2.5 or ozone associated with increased risk of stillbirth? Is prenatal exposure to heat associated with increased risk of preterm birth? Is prenatal exposure to heat associated with increased risk of low birth weight? Is prenatal exposure to heat associated with increased risk of stillbirth?

Discussion

Studies across diverse US populations were identified that reported an association of PM2.5, ozone, and heat exposure with the adverse obstetrical outcomes of preterm birth, low birth weight at term, and stillbirth. More than 32 million births were analyzed, with a mean (SD) of 565 485 (783 278) births per study. In each analysis of climate change–related exposure and adverse obstetrical outcome, most of the studies found a statistically significant increased risk (Table). The highest number of studies were found for risk of preterm birth (29 studies) and low birth weight (32 studies), whereas limited studies were identified for stillbirth (7 studies) because of the lack of available data for health studies.

Our review contributes the largest number of recent studies (2007-2019) focusing solely on US populations and is the first, to our knowledge, to combine the increasingly common exposures of air pollutants and heat associated with a series of adverse obstetrical outcomes. Our findings are consistent with other review articles that were not included in our analysis (all included non-US participants). Reviews that examined PM2.5 found consistently positive association with preterm birth and low birth weight or continuous birth weight, and 1 systematic review and meta-analysis on stillbirth risk showed elevated effect estimates for both PM2.5 and ozone, although they did not achieve significance. Five reviews that focused on heat exposure found an association with preterm birth in most studies, as did 4 that analyzed low birth weight and 2 analyzing stillbirth risk.

The adverse obstetrical outcomes examined in this study are known to be complex, heterogeneous, and multifactorial in origin; several animal studies suggested that both air pollutant and heat exposure may contribute to adverse obstetrical outcomes. Regarding preterm birth, mechanisms that implicate toxic fine particulates include maternal hematologic transport of inhaled noxious chemicals, the triggering of systemic inflammation, or alterations in function of the autonomic nervous system. Low birth weight may be associated with air pollutants by direct toxic effects from fetal exposure, altered maternal cardiac or pulmonary function, systemic inflammation from oxidative stress, placental inflammation, altered placental gene expression, or changes in blood viscosity; multiple effects may operate simultaneously. Mechanisms for the association of air pollutants with stillbirth may involve alterations in oxygen transport, DNA damage, or placental injury. The cause-specific analysis by Ebisu et al of stillbirths reinforces the apparent association of injury to the fetal-placental unit with air pollutant exposure compared with other possible causes.

Heat exposure may contribute to prematurity through labor instigation from dehydration (via prostaglandin or oxytocin release), from altered blood viscosity, and/or by leading to inefficient thermoregulation; it may also trigger preterm premature rupture of membranes and thus preterm birth during the warm season. Likewise, heat exposure may impair fetal growth by reducing uterine blood flow and altering placental-fetal exchange. Mechanisms associated with elevated temperatures and stillbirth include the initiation of premature labor (as noted above), lowering amniotic fluid volume, damaging the placenta, or causing abruption.

Biologic plausibility is further supported by other recent studies not included in this review. The study by Casey et al of preterm birth rates in California before and after coal power plant closures showed a 27% reduction during the 10-year period after closure. Currie et al found that among 1.1 million live births in Pennsylvania, the risk of low birth weight was higher within 3 km of a fracking site compared with the background risk and increased by 25% within 1 km of a site.

This review revealed a disproportionate effect on populations defined as pregnant women with certain medical conditions or specific race/ethnicities. Women with asthma may be particularly susceptible to adverse outcomes, such as preterm birth and stillbirth, in association with PM2.5 exposure during gestation. Among racial/ethnic groups, our findings suggest that black mothers are at greater risk for preterm birth and low birth weight. Social determinants of health, including residence in urban areas with higher exposure to air pollutants and long-term high levels of stress, are known to contribute to adverse obstetrical outcomes. A recent study from California suggested that PM2.5 exposure alone was associated with an equivalent amount of the racial disparity (black vs white) in preterm birth rates as did other demographic and social factors. Our research suggests that these environmental exposures further exacerbate that background risk and could be included among these social determinants.

Regarding both air pollutant and heat exposure, associations with adverse birth outcomes were found across the continental US. For example, studies on air pollution and low birth weight found an association in 19 states in the Northeast (10), Southeast (5), Midwest (2), Mountain (1), and West (1) regions. California, known for both high temperatures and unhealthy particulate and ozone levels, was included in the greatest number of studies showing a positive association (13), followed by Massachusetts (6), Georgia (5), and Florida (4). The exposures are complex; even within 1 state, the weather patterns, geography, and urbanization may create zones with widely different pollution risks, as shown by Tu et al in Georgia.

Future research is needed to further identify at-risk populations, high-exposure geographic areas, and effects of seasonality. This ongoing research may be enhanced by improved geographic information systems that can be mapped onto existing US public health data-banks such.

Conclusions

This review suggests that increasingly common environmental exposures exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes across the US. It appears that the medical community at large and women’s health clinicians in particular should take note of the emerging data and become facile in both communicating these risks with patients and integrating them into plans for care. Moreover, physicians can adopt a more active role as patient advocates to educate elected officials entrusted with public policy and insist on effective action to stop the climate crisis.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260

hat.stop

Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep

Fulmer, Megan BSN, RN-NIC; Zachritz, Whitney MSN, CPNP-BC, RN; Posencheg, Michael A. MD

Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC, Section Editor

Advances in Neonatal Care: June 2020 – Volume 20 – Issue 3 – p 229-232

Abstract

Background: 

Although the incidence of sudden unexplained infant deaths has decreased over time with the use of safe sleep practices, one area that remains unclear is the safety of hats during infant sleep.

Purpose: 

Decrease the risk of overheating or suffocation by removing NICU infants’ hats during sleep without increasing the relative risk of hypothermia during transition to an open crib.

Methods: 

Removal of hats for routine thermoregulation, beyond the initial infant resuscitation and stabilization of NICU infant was implemented in 2015. Retrospective chart audits were conducted on all NICU infants between February 2015 and December 2016. Hypothermia (≤ 97.6°F) data during transition to an open crib was collected. Exclusion criteria included concurrent diagnosis of: sepsis, hyperbilirubinemia, congenital anomaly inhibiting infants thermoregulation and noncompliance with unit guideline for weaning infant to open crib.

Findings: 

Over 18 months, 2.7% of infants became hypothermic (≤ 97.6°F) during transition to open crib, requiring return to isolettes.

Implications for Practice: 

Hats were found to be unnecessary in maintaining thermoneutrality after weaning infants to an open crib in our NICU. By avoiding the use of hats in an open crib, it’s possible infants will avoid overheating and a risk of suffocation, creating a safer sleep environment.

Implications for Research: 

The removal of hats during sleep to promote infant health should be considered for all infants.

Source:https://journals.lww.com/advancesinneonatalcare/Abstract/2020/06000/Intensive_Care_Neonates_and_Evidence_to_Support.9.aspx

columbia.baby

PREEMIE FAMILY PARTNERS

Premature Baby Makes Full Recovery After Experimental Coronavirus Treatment | NBC News NOW

newsJun 22, 2020

Born premature at just 27 weeks, one baby is finally on his way home after battling both sepsis and COVID-19. NBC News’ Helena Humphrey spoke with the baby’s mother about his 47-day battle.

 

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Preemie Parent Perspective: Addressing Health Equity and Cultural Competency in the NICU

Jenné Johns, MPH

In 2016, I published Once Upon A Preemie, a first- of its kind children’s book written to comfort parents of premature infants during their journey through the Neonatal Intensive Care Unit (NICU). During my journey, I discovered that reading to my micropreemie was the one activity as a mother that I could offer my son that helped normalize my overwhelming and traumatic NICU experience. During our nearly three-month stay in the NICU, I read to my son every day as research studies suggest that reading stimulates healthy brain development in preemies, and also helps to form a bond between parent and baby. Many of the bedtime stories that we read ended with a parent tucking the child into bed at home with Mommy and Daddy. That wasn’t our reality for three months. There were no books about us. Little did I know that in publishing my deepest emotions carried during and post NICU would lead me to become an author and speaker, but also an advocate and advisor for the needs of preemie parents, especially African Americans. As the mother of a micro-preemie and miracle baby born at 26 weeks and weighing 1 lb 15.3 ounces, I found myself advocating for his needs as I knew his life depended on it. Despite my 10-year career working to eliminate racial and ethnic disparities in health care, nothing prepared me for the heart-wrenching experience of my son’s premature birth. “Disparity” became real for me as my son joined the ranks of the nearly 500,000 premature babies born in the United States, nearly half to African American and Hispanic mothers. It was through this dual role that I experienced the NICU, one as a vulnerable micro-preemie mother, and the other as a health equity professional.

At birth, my son required life-saving medical interventions; oxygen, photo-therapy lights, feeding tubes, a heart monitor, medication, vitamins, and even caffeine. Over our nearly three-month stay in the NICU, I traveled through snowstorms and blizzards, to parent and nurture my baby. I only missed three days (two due to inclement weather and one self-care day). A typical day in the NICU lasted from 7 am until midnight, with many breaks to pump breast milk. My lactation consultant promised that my breast milk was liquid medicine. Midway through our NICU journey, I had to return to work, unlike many of my new NICU parent friends who were Caucasian. My advocacy skills were tested daily, as his life depended on how well I could speak “neonatology” language, I had to be his voice and articulate his needs. This was challenging because, after all, “I’m just a Mom,” an African American Mom, and not a doctor.

As a mother, my NICU journey was traumatic and filled with a sea of emotions, including fear, anxiety, helplessness, and isolation. Much of which NICU parents are facing due to the current COVID-19 pandemic. Many of my fears, concerns, and feelings of isolation were due to the NICU environment, which was not as culturally friendly and supportive, as I assumed it would be. I’m being generous by saying there was little cultural diversity; it was dismal at best. There were times when the lack of cultural sensitivity and bedside manner caused more pain than my son’s actual health status, and it made me very uncomfortable because as the end of each night, I had to trust my most prized possession with nurses and doctors who I did not always trust. Another challenge I faced as an African American preemie parent, was that although our larger hospital system had active and robust NICU parent support groups, these resources were not made available at the smaller hospital where I delivered my son. This hospital served more African American and lower-income families than the other hospitals. Many of the parents I developed a relationship with, felt as if our socio and emotional needs did not matter and were oftentimes dismissed because of this missing resource.

Lastly, I experienced inconsistent positive communication and relationships with many of the NICU staff. Although I now believe that all of the members of my son’s care team, held his safety and the quality of care they delivered to him with the utmost regard, our daily communication and interaction lacked humility, respect, and sensitivity. I will admit, I was not always the easiest or most cheerful mother to deal with, I now believe, that with trauma-informed and implicit bias training among hospital staff, the professional staff would have been better equipped to communicate and support my delicate and fragile nature.

Overall, a good deal of our NICU experience was positive; some experiences left permanent and negative memories that, to this day, cannot be erased. As much as I tried checking my professional credentials at the door before entering the NICU, my interactions with the NICU staff begged, yelled, and warranted us to have those tough cultural sensitivity conversations. Not in a negative way, but as an opportunity for forming better communication, respect, and, most importantly, trust. In my professional view, the NICU is a microcosm of the larger hospital system on steroids, particularly NICU’s serving low income and racially, ethnically, and linguistically diverse populations. Health disparities impacting the NICU are also a reflection of a larger hospital ecosystem. Below are my preemie parent and professional recommendations for integrating health equity and cultural competency in the NICU:

1. Prioritize health equity and cultural competency as strategic priorities and goals. Establishing opportunities for integrating and addressing health equity in short and long terms strategies ensures layers of accountability, allocation of funding, measurement, and documentation of outcomes. One example of an important health equity priority includes staff diversity. Peer-reviewed studies have shown that cultural congruence among patients and providers yields better health outcomes, better communication, and trust.

2.Make health equity, cultural competency, and implicit bias training mandatory for all NICU Staff. Participating in an annual training program is a great start to begin addressing and delivering equitable care to all NICU families. However, one-time training is not sufficient. Integrating health equity and implicit bias content into clinical rounds, staff development, and training opportunities are critical to reducing racial and ethnic disparities in the NICU.

3.Communicating in lay terms should be standard in every NICU. Literacy and health literacy levels are important considerations for family-centered and culturally appropriate care in the NICU. Regardless of one’s educational level, the NICU terminology is overwhelming and confusing for a new parent entering the NICU. Literacy and health literacy considerations are also important factors for families who are limited or non-English speaking. Break the communication barriers by speaking the same language and utilizing interpreters even if everyone speaks English. I had a great deal of respect and appreciation for the NICU staff who used lay terms and avoided NICU jargon when communicating with me. In time, I began understanding the NICU language; however, that wasn’t my job as a preemie parent. Preemie parents should be made to feel as comfortable speaking and interacting with NICU staff regardless of their literacy and health literacy levels.

4.Partner with parents to address the cultural competency, spiritual diversity, and unconscious biases that exist in the NICU. Listen to the voices of parents with multicultural backgrounds to be more sensitive to racial, ethnic, language, income, education, transportation, and spiritual needs. Encourage preemie parents to speak up. Staff should value their input. Allow parents to give their insights on their baby’s health status, and any gut feelings they may have about a diagnosis or new development. This is extremely important for minority parents who assume their voice and parental role is undervalued.

5.Engage and establish culturally congruent NICU family supports. Many minority parents may not immediately express a need for mental or emotional help while in the NICU for fear of being labeled. Where and when possible, make culturally congruent resources available to support these parents, even if the supports are outside of the NICU.

6.Make digital technology and virtual solutions available to parents with transportation, competing work schedules, or other barriers to delivering care to their preemies. This is most critical during the current COVID season, where parental fears and social distancing may prohibit them from visiting their baby. Creating safe opportunities for parents to connect with their babies is vital bonding via smart devices or other safe technology solutions.

Source:http://www.neonatologytoday.net/newsletters/nt-jun20.pdf

dance

Coastal Sunrise Father dances on TikTok for his son in NICU

3waveWSAV3 – Feb 5, 2020

 

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HEALTH CARE PARTNERS

Using Neonatal Intensive Care Units More Wisely for At-Risk Newborns and Their Families

DeWayne M. Pursley, MD, MPH1,2John A. F. Zupancic, MD, ScD1,2   June 18, 2020

Escalating US health care expenditures, including estimates that 20% to almost 50% of these costs involve processes, products, and services that do not improve outcomes, have brought renewed attention to the need to improve value in health care.1 Among the 6 waste categories outlined by Berwick and Hackbarth, there has been considerable focus on opportunities to reduce overtreatment, “the waste that comes from subjecting patients to care that… cannot possibly help them… rooted in outmoded habits, supply-driven behaviors, and ignoring science.”

Neonatal intensive care unit (NICU) services are at particularly high risk of overuse. Hospital and professional services reimbursements, reflecting the acute and highly technical nature of intensive care, are favorable and remain closely linked to admission volume and patient days in most regions. Both a legacy of intervention and a fear of litigation in caring for an at-risk population can also contribute to ineffective testing and treatments. The neonatology community is, however, starting to recognize the potential for improving care and controlling resource utilization. A 2015 study describing a systematic process to identify ineffective or harmful neonatal tests and treatments yielded a “Choosing Wisely Top Five” list in part to guide these efforts. In recent years, the neonatal care value literature has evolved to also focus more broadly on trends relating to NICU utilization—specifically, increasing admission rates and longer lengths of stay.

In the study by Braun et al,3 investigators from Kaiser Permanente share a population-based study describing a decline in NICU utilization—both admission rates and patient days—during a 9-year period. This is an important study, as it describes a trend that is counter to several recent reports of unexplained increasing NICU utilization, particularly for more mature and higher birth-weight infants, using a clinical rather than administrative data set. It is also important because the results may have been associated with several intercurrent performance improvement initiatives. Kaiser Permanente is a large, integrated health care system with a diverse population and a population-based financial payment structure and is in many ways uniquely suited (and motivated) to undertake a project to identify and characterize potential approaches to safely reduce neonatal care that is costly, may be ineffective, separates families, and is potentially harmful. The authors used a risk-adjustment model to ensure that the improvements were associated with postnatal care practices and not with changes in case mix reflecting patients less in need of acute neonatal care. They were also careful to include balancing measures, such as readmission and mortality, among the outcomes. Also important is the residual practice variation, which may hint at future opportunities for reduction in NICU utilization.

In the study by Braun et al, 12% of more than 300 000 liveborn infants were admitted to the NICU. Contrary to public perceptions of NICUs as prematurity colonies, more than two-thirds of these admissions were infants born after 34 weeks gestational age with birth weights more than 2000 g. The risk-adjusted NICU admission rate, accounting for socioeconomic, prenatal, and delivery room variables to control for independent factors that might affect admission or length of stay, decreased 25% over the study period to 10.9% of births, with 92% of the decline represented by infants with greater gestational age and higher birth weights. Importantly, these changes occurred without evidence of higher 30-day readmission or mortality rates.

There are compelling reasons that these results might not have been a random occurrence, as the health care system’s clinical leadership had implemented several concurrent performance improvement initiatives associated with decreased NICU admissions. A revised policy raised the threshold for NICU admission by lowering the gestational age (<35 weeks) and birth weight (<2000 g) for which well-appearing preterm infants were routinely admitted. A decision support tool based on individual infant estimates of early onset sepsis risk was introduced to guide laboratory testing and empirical antibiotic treatment. Finally, obstetric policies to decrease the rate of nonmedically indicated deliveries before 39 weeks of gestation and to reduce nonmedically indicated nulliparous, term, singleton, and vertex cesarean births were introduced.

The findings by Braun et al3 stand in contrast to a national trend documented in a 2015 population-based study. In that study using a public data set, birth-weight–specific NICU admission rates of US neonates were examined over a 6-year period (2007-2012). During this time, despite adjustment for maternal and neonatal characteristics, NICU admissions increased by 23%. These increases were generally represented by larger and less premature infants, such that by the end of the study period, most NICU admissions were for infants with birth weight more than 2500 g.

Although not population-based, observations by NICU member collaboratives, such as the California Perinatal Quality Care Collaborative and the Vermont-Oxford Network, have documented substantial variations in NICU admission and length-of-stay profiles. One California Perinatal Quality Care Collaborative study from 2018 observed that 79% of NICU admissions in 2015 were among infants born at or after 34 weeks gestation, while 10% of infants with 34 or more weeks gestation were admitted to the NICU. Schulman et al5 documented a 40-fold variation among member hospitals in the proportion of NICU admissions meeting high acuity definitions. In a Vermont-Oxford Network6 study involving approximately 500 000 infants hospitalized for nearly 10 million days in 381 NICUs from 2014 to 2016, 74% of NICU admissions were infants at 34 or more weeks gestation and only 15% of admissions met high acuity criteria. The proportion of admissions, patient days, high acuity, and short stays varied significantly both within and between different NICU types.

The origins of NICUs go back a half century, and NICUs have contributed substantially to reductions in US infant mortality during this time, a period during which rates of prematurity and low birth weight have actually increased. In 1967, the infant mortality rate was 22.4 per 1000 live births.  Fifty years later, in 2017, the rate had declined to 5.8 per 1000 live births, a remarkable 74% reduction. Neonatal intensive care is highly effective and has achieved these outcomes and corresponding reductions in morbidity by mitigating the effects of prematurity, congenital anomalies, and pregnancy and perinatal complications. In the early days, NICUs were in short supply and public health entities mobilized to develop regionalized perinatal systems to ensure that obstetric and neonatal patients at high risk had access to specialized services when indicated. As the neonatology workforce and NICU bed capacity increased, hospitals and hospital systems, seeking to become full-service systems, contributed to deregionalization, and there was increasing reliance on economic forces to regulate growth and distribution. In some areas, infants at high risk were distributed more broadly, including to smaller, lower-level units, resulting in less favorable outcomes. Because NICUs are high-margin services, there are significant pressures to expand capacity and maintain volume. This can lead to overuse, including more frequent admission of infants at low risk or a failure to focus sufficiently on care practices that could potentially reduce demand.

There is a cost to these practices. Although NICUs are effective, they are also expensive. Health care system costs are largely borne by government and business, and unwarranted increases may potentially compromise funding of other essential services. Importantly, there may be hidden financial harms for families as well, including costs associated with transportation or lost work days. There are also risks. Short NICU stays by infants at low risk may interfere with breastfeeding, expose them to infection, or increase antibiotic exposure. Additionally, family-infant separation may contribute to emotional risk.

It is not clear that increases in short term, low acuity, and high gestational age and birth-weight NICU admissions have benefited these infants and their families. In fact, the study by Braun et al suggests that it may be possible to reverse these trends without compromising and even potentially enhancing care. Rigorous adoption of evidence-based clinical practices, such as use of early onset sepsis decision support and obstetric policies to reduce non-medically indicated early deliveries and low-risk cesarean delivery rates is a start. There is also a need to examine the opportunities demonstrated by the enormous variation in NICU utilization and in specific NICU practices. These include gestational age thresholds for NICU admission; preferred sites of clinical evaluation, intravenous placement, and antibiotic administration for well-appearing infants with sepsis risk; preferred sites for monitoring and treatment and guidance for length of treatment for opiate withdrawal; and duration of apnea monitoring of preterm infants nearing discharge.

Neonatal intensive care is one of the major achievements of the last half century, and it has resulted in substantial reductions in mortality and long-term morbidity that benefit infants at high risk, including those born to mothers at substantial social risk. If the neonatology community is to successfully achieve the Triple Aim goal for neonatal intensive care—improved neonatal health, better family experience, and reduced cost—we must intensify efforts to learn how to use NICUs more wisely.

Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.5693

Corresponding Author: DeWayne M. Pursley, MD, MPH, Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (dpursley@bidmc.harvard.edu).

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767254

welcome.home

Why The Trauma Parents Experience In The NICU Follows Them Home

By COURTNEY COLLINS  FEB 14, 2020

Parents who’ve spent time in the neonatal intensive care unit (NICU) carry anxiety with them even after their baby is released.

The NICU’s constant barrage of doctors and beeping monitors is traumatic — and that trauma lingers.

Kepley Wakefield approaches life with typical 13-month-old vigor. A lot of smiling, excellent crawling acceleration and a fair amount of shrieking.

Her parents Courtney and Hollis Wakefield cherish her. They were by her side for each of the 95 days Kepley spent in the NICU.

“I had some bleeding at 21 weeks. So at that point, they put me on bed rest and we were having really difficult conversations,” Hollis said. “Viability is considered 24, so we had like two-and-a-half or three weeks to get through — which was a really, really scary time.”

Giving Birth At 24 Weeks

Hollis knew her pregnancy was going to be high risk. She was a 39-year-old cervical cancer survivor, so she and her wife had a plan for early labor. Even they weren’t prepared for delivery at 24 weeks, five days. But that’s when Kepley arrived, at 1 lb 10 ounces. The NICU team braced the Dallas couple for a long and frustrating road.

“They told us it would be like a roller coaster,” Hollis said. “They were like it’s going to be, you know, minute-to-minute some days. It’s not a straight line at all.”

Kepley started out in the NICU at UT-Southwestern’s Clements University Hospital, but eventually moved to the higher level NICU just down the road at Children’s Medical Center in Dallas. She was on a ventilator for three months.

When she was discharged, she still was tiny not even five pounds. She still needed supplementary oxygen and had weekly doctors appointments. Courtney says the stress from the NICU followed them home.

“I’m anxious all the time,” she said. “I have said, I have not been myself since Kepley was born.”

At-Home Risks

Because Kepley was born so early, her lungs weren’t fully developed. And because a ventilator helped her breathe for so long, those tiny lungs were also damaged. So even though Kepley is now thriving, flu season is a real threat. Her parents second guess every public outing, even quick trips to the store.

“And you’re thinking, do we risk it? Are we both going to be home where one of us could stay home?” Courtney said. “Just kind having to deal with that, even just for day-to-day tasks that we might normally bring a baby to. We’re having to kind of think twice.”

That’s not an overreaction. Doctors say catching a respiratory virus like RSV or the flu might put a premature baby right back in the hospital, which could re-traumatize those parents who’ve already spent time in the NICU.

Dr. Rashmin Savani is the chief of neonatal medicine at Children’s Health and UT Southwestern. He says even just the noise of endlessly beeping NICU monitors can overwhelm parents.

“The medical team and the nursing team they’re phenomenal, they understand what all these beeps are and when to respond, when to not respond.” Savani said. “But the family is bombarded with this sort of cacophony of alarms that are all designed to say ‘hey, pay attention to me.’ But for the family, it’s really scary.”

Children’s Health has a support crew in place to handle everything but the medicine. Every family has access to a team that includes a social worker, a psychologist and a chaplain.

‘Cutting The Umbilical Cord The Second Time’

Dr. Savani says Children’s Health also has a team devoted to helping a family transition to home — learning the ins and outs of complicated equipment and medication, as well as making sure the house is set up for a preemie, without the constant surveillance of doctors and nurses.

“And I actually call it you’re cutting the umbilical cord the second time,” he said. “And it’s a very scary thing for parents to go through.”

Hollis and Courtney Wakefield have been there. And while some things about caring for a preemie are old hat by now, they say some of those visceral NICU memories will never fade. There’s a visual reminder in the house too — a strand of colorful beads, so long it could wrap around Kepley’s tiny waist a dozen times. Courtney says each bead stands for something different Kepley went through in the NICU, for example: blood draws, surgeries and overnight stays.

One day, Kepley might decide to hang these beads on the wall — a memento of her earliest triumph.

For now though, she’s happy to use them as a teething toy.

Source: https://www.keranews.org/post/why-trauma-parents-experience-nicu-follows-them-home

WARRIORS:

Cultura de surf hecho en Chocó – Surf culture made in Chocó

  Apr 10, 2017

Nestor Tello, Termales, Chocó, Colombia, 2015. Directed by Guillaume Parent y Sina Ribak Suport: masartemasaccion.org Fundación Buen Punto: clubdesurfdelchoco.com In this mini video series we meet with some persons from the Colombian Chocó region who live on the Pacific Coast, south of Nuquí. In Chocó exists a big contrast between the wealth of natural resources and the few opportunities of what we call development for its population. Same as in many rural areas in Colombia, corruption and violence are reality. Nevertheless, the visitor experiences an impression of freedom, tranquility and solidarity. Here, you (re-)connect with nature – you almost dissolve into it – and you feed on the philosophy and dreams of the Chocó people.

KAT’S CORNER

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We need these articles to inspire, guide and support our precious community

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Survival of the littlest: the long-term impacts of being born extremely early

nature

Babies born before 28 weeks of gestation are surviving into adulthood at higher rates than ever, and scientists are checking in on their health.

Amber Dance- NEWS FEATURE  – 02 JUNE 2020

preemies

Scientists are watching out for the health of adults born extremely premature, such as these people who took part in a photography project. Credit: Red Méthot

They told Marcelle Girard her baby was dead.

Back in 1992, Girard, a dentist in Gatineau, Canada, was 26 weeks pregnant and on her honeymoon in the Dominican Republic.

When she started bleeding, physicians at the local clinic assumed the baby had died. But Girard and her husband felt a kick. Only then did the doctors check for a fetal heartbeat and realize the baby was alive.

The couple was medically evacuated by air to Montreal, Canada, then taken to the Sainte-Justine University Hospital Center. Five hours later, Camille Girard-Bock was born, weighing just 920 grams (2 pounds).

Babies born so early are fragile and underdeveloped. Their lungs are particularly delicate: the organs lack the slippery substance, called surfactant, that prevents the airways from collapsing upon exhalation. Fortunately for Girard and her family, Sainte-Justine had recently started giving surfactant, a new treatment at the time, to premature babies.

After three months of intensive care, Girard took her baby home.

Today, Camille Girard-Bock is 27 years old and studying for a PhD in biomedical sciences at the University of Montreal. Working with researchers at Sainte-Justine, she’s addressing the long-term consequences of being born extremely premature — defined, variously, as less than 25–28 weeks in gestational age.

Families often assume they will have grasped the major issues arising from a premature birth once the child reaches school age, by which time any neuro-developmental problems will have appeared, Girard-Bock says. But that’s not necessarily the case. Her PhD advisers have found that young adults of this population exhibit risk factors for cardiovascular disease — and it may be that more chronic health conditions will show up with time.

Girard-Bock doesn’t let these risks preoccupy her. “As a survivor of preterm birth, you beat so many odds,” she says. “I guess I have some kind of sense that I’m going to beat those odds also.”

She and other against-the-odds babies are part of a population which is larger now than at any time in history: young adults who are survivors of extreme prematurity. For the first time, researchers can start to understand the long-term consequences of being born so early. Results are pouring out of cohort studies that have been tracking kids since birth, providing data on possible long-term outcomes; other studies are trialing ways to minimize the consequences for health.

earl

These data can help parents make difficult decisions about whether to keep fighting for a baby’s survival. Although many extremely premature infants grow up to lead healthy lives, disability is still a major concern, particularly cognitive deficits and cerebral palsy.

Researchers are working on novel interventions to boost survival and reduce disability in extremely premature newborns. Several compounds aimed at improving lung, brain and eye function are in clinical trials, and researchers are exploring parent-support programmes, too.

Researchers are also investigating ways to help adults who were born extremely prematurely to cope with some of the long-term health impacts they might face: trialing exercise regimes to minimize the newly identified risk of cardiovascular disease, for example.

“We are really at the stage of seeing this cohort becoming older,” says neonatologist Jeanie Cheong at the Royal Women’s Hospital in Melbourne, Australia. Cheong is the director of the Victorian Infant Collaborative Study (VICS), which has been following survivors for four decades. “This is an exciting time for us to really make a difference to their health.”

The late twentieth century brought huge changes to neonatal medicine. Lex Doyle, a paediatrician and previous director of VICS, recalls that when he started caring for preterm infants in 1975, very few survived if they were born at under 1,000 grams — a birthweight that corresponds to about 28 weeks’ gestation. The introduction of ventilators, in the 1970s in Australia, helped, but also caused lung injuries, says Doyle, now associate director of research at the Royal Women’s Hospital. In the following decades, doctors began to give corticosteroids to mothers due to deliver early, to help mature the baby’s lungs just before birth. But the biggest difference to survival came in the early 1990s, with surfactant treatment.

“I remember when it arrived,” says Anne Monique Nuyt, a neonatologist at Sainte-Justine and one of Girard-Bock’s advisers. “It was a miracle.” Risk of death for premature infants dropped to 60–73% of what it was before.

Today, many hospitals regularly treat, and often save, babies born as early as 22–24 weeks. Survival rates vary depending on location and the kinds of interventions a hospital is able to provide. In the United Kingdom, for example, among babies who are alive at birth and receiving care, 35% born at 22 weeks survive, 38% at 23 weeks, and 60% at 24 weeks.

For babies who survive, the earlier they are born, the higher the risk of complications or ongoing disability (see ‘The effects of being early’). There is a long list of potential problems — including asthma, anxiety, autism spectrum disorder, cerebral palsy, epilepsy and cognitive impairment — and about one-third of children born extremely prematurely have one condition on the list, says Mike O’Shea, a neonatologist at the University of North Carolina School of Medicine in Chapel Hill, who co-runs a study tracking children born between 2002 and 2004. In this cohort, another one-third have multiple disabilities, he says, and the rest have none.

“Preterm birth should be thought of as a chronic condition that requires long-term follow-up,” says Casey Crump, a family physician and epidemiologist at the Icahn School of Medicine at Mount Sinai in New York, who notes that when these babies become older children or adults, they don’t usually get special medical attention. “Doctors are not used to seeing them, but they increasingly will.”

Outlooks for earlies

What should doctors expect? For a report in the Journal of the American Medical Association last year, Crump and his colleagues scraped data from the Swedish birth registry. They looked at more than 2.5 million people born from 1973 to 1997, and checked their records for health issues up until the end of 2015.

Of the 5,391 people born extremely preterm, 78% had at least one condition that manifested in adolescence or early adulthood, such as a psychiatric disorder, compared with 37% of those born full-term. When the researchers looked at predictors of early mortality, such as heart disease, 68% of people born extremely prematurely had at least one such predictor, compared with 18% for full-term births — although these data include people born before surfactant and corticosteroid use were widespread, so it’s unclear if these data reflect outcomes for babies born today. Researchers have found similar trends in a UK cohort study of extremely premature births. In results published earlier this year, the EPICure study team, led by neonatologist Neil Marlow at University College London, found that 60% of 19-year-olds who were extremely premature were impaired in at least one neuropsychological area, often cognition.

Such disabilities can impact education as well as quality of life. Craig Garfield, a paediatrician at the Northwestern University Feinberg School of Medicine and the Lurie Children’s Hospital of Chicago, Illinois, addressed a basic question about the first formal year of schooling in the United States: “Is your kid ready for kindergarten, or not?”

To answer it, Garfield and his colleagues analysed standardized test scores and teacher assessments on children born in Florida between 1992 and 2002. Of those born at 23 or 24 weeks, 65% were considered ready to start kindergarten at the standard age, 5–6 years old, with the age adjusted to take into account their earlier birth. In comparison, 85.3% of children born full term were kindergarten-ready.

Despite their tricky start, by the time they reach adolescence, many people born prematurely have a positive outlook. In a 2006 paper, researchers studying individuals born weighing 1,000 grams or less compared these young adults’ perceptions of their own quality of life with those of peers of normal birth-weight — and, to their surprise, found that the scores were comparable. Conversely, a 2018 study8 found that children born at less than 28 weeks did report having a significantly lower quality of life. The children, who did not have major disabilities, scored themselves 6 points lower, out of 100, than a reference population.

As Marlow spent time with his participants and their families, his worries about severe neurological issues diminished. Even when such issues are present, they don’t greatly limit most children and young adults. “They want to know that they are going to live a long life, a happy life,” he says. Most are on track to do so. “The truth is, if you survive at 22 weeks, the majority of survivors do not have a severe, life-limiting disability.”

Breathless

But scientists have only just begun to follow people born extremely prematurely into adulthood and then middle age and beyond, where health issues may yet lurk. “I’d like scientists to focus on improving the long-term outcomes as much as the short-term outcomes,” says Tala Alsadik, a 16-year-old high-school student in Jeddah, Saudi Arabia.

When Alsadik’s mother was 25 weeks pregnant and her waters broke, doctors went so far as to hand funeral paperwork to the family before consenting to perform a caesarean section. As a newborn, Alsadik spent three months in the neonatal-intensive-care unit (NICU) with kidney failure, sepsis and respiratory distress.

The complications didn’t end when she went home. The consequences of her prematurity are on display every time she speaks, her voice high and breathy because the ventilator she was put on damaged her vocal cords. When she was 15, her navel unexpectedly began leaking yellow discharge, and she required surgery. It turned out to be caused by materials leftover from when she received nutrients through a navel tube.

That certainly wasn’t something her physicians knew to check for. In fact, doctors don’t often ask if an adolescent or adult patient was born prematurely — but doing so can be revealing.

Charlotte Bolton is a respiratory physician at the University of Nottingham, UK, where she specializes in patients with chronic obstructive pulmonary disease (COPD). People coming into her practice tend to be in their 40s or older, often current or former smokers. But in around 2008, she began to notice a new type of patient being referred to her owing to breathlessness and COPD-like symptoms: 20-something non-smokers.

Quizzing them, Bolton discovered that many had been born before 32 weeks. For more insight, she got in touch with Marlow, who had also become concerned about lung function as the EPICure participants aged. Alterations in lung function are a key predictor of cardiovascular disease, the leading cause of death around the world. Clinicians already knew that after extremely premature birth, the lungs often don’t grow to full size. Ventilators, high oxygen levels, inflammation and infection can further damage the immature lungs, leading to low lung function and long-term breathing problems, as Bolton, Marlow and their colleagues showed in a study of 11-year-olds.

VICS research backs up the cardiovascular concerns: researchers have observed diminished airflow in 8-year-olds, worsening as they aged, as well as high blood pressure in young adults. “We really haven’t found the reason yet,” says Cheong. “That opens up a whole new research area.”

At Sainte-Justine, researchers have also noticed that young adults who were born at 28 weeks or less are at nearly three times the usual risk of having high blood pressure. The researchers figured they would try medications to control it. But their patient advisory board members had other ideas — they wanted to try lifestyle interventions first.

The scientists were pessimistic as they began a pilot study of a 14-week exercise programme. They thought that the cardiovascular risk factors would be unchangeable. Preliminary results indicate that they were wrong; the young adults are improving with exercise.

Girard-Bock says the data motivate her to eat healthily and stay active. “I’ve been given the chance to stay alive,” she says. “I need to be careful.”

From the start

For babies born prematurely, the first weeks and months of life are still the most treacherous. Dozens of clinical trials are in progress for prematurity and associated complications, some testing different nutritional formulas or improving parental support, and others targeting specific issues that lead to disability later on: underdeveloped lungs, brain bleeds and altered eye development.

For instance, researchers hoping to protect babies’ lungs gave a growth factor called IGF-1 — which the fetus usually gets from its mother during the first two trimesters of pregnancy — to premature babies in a phase II clinical trial reported in 2016. Rates of a chronic lung condition that often affects premature babies halved, and babies were somewhat less likely to have a severe brain hemorrhage in their earliest months.

Another concern is visual impairment.

Retina development halts prematurely when babies born early begin breathing oxygen. Later it restarts, but preterm babies might then make too much of a growth factor called VEGF, causing over-proliferation of blood vessels in the eye, a disorder known as retinopathy. In a phase III trial announced in 2018, researchers successfully treated 80% of these retinopathy cases with a VEGF-blocking drug called ranibizumab, and in 2019 the drug was approved in the European Union for use in premature babies.

Some common drugs might also be of use: paracetamol (acetaminophen), for example, lowers levels of biomolecules called prostaglandins, and this seems to encourage a key fetal vein in the lungs to close, preventing fluid from entering the lungs.

But among the most promising treatment programmes, some neonatologists say, are social interventions to help families after they leave the hospital. For parents, it can be nerve-racking to go it alone after depending on a team of specialists for months, and lack of parental confidence has been linked to parental depression and difficulties with behaviour and social development in their growing children.

At Women & Infants Hospital of Rhode Island in Providence, Betty Vohr is director of the Neonatal Follow-Up Program. There, families are placed in private rooms, instead of sharing a large bay as happens in many NICUs. Once they are ready to leave, a programme called Transition Home Plus helps them to prepare and provides assistance such as regular check-ins by phone and in person in the first few days at home, and a 24/7 helpline. For mothers with postnatal depression, the hospital offers care from psychologists and specialist nurses.

The results have been significant, says Vohr. The single-family rooms resulted in higher milk production by mothers: 30% more at four weeks than for families in more open spaces. At 2 years old, children from the single-family rooms scored higher on cognitive and language tests. After Transition Home Plus began, babies discharged from the NICU had lower health-care costs and fewer hospital visits — issues that are of great concern for premature infants. Other NICUs are developing similar programmes, Vohr says.

With these types of novel intervention, and the long-term data that continue to pour out of studies, doctors can make better predictions than ever before about how extremely premature infants will fare. Although these individuals face complications, many will thrive.

Alsadik, for one, intends to be a success story. Despite her difficult start in life, she does well academically, and plans to become a neonatologist. “I, also, want to improve the long-term outcomes of premature birth for other people.”

Source:https://www.nature.com/articles/d41586-020-01517-z

 

Cloud Surfing Roldanillo, Colombia in a Paraglider

Jan 30, 2017 Jonathan Kelley

Cloud Surfing Roldanillo, Colombia in a paraglider in January 2017

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