Self Empowerment, Trauma Informed Care

Preterm Birth Rates – Samoa

Rank: 181 –Rate: 5.5% Estimated # of preterm births per 100 live births (USA – 12 %)

Samoa officially the Independent State of  and until 1997 known as Western Samoa, is an island country consisting of two main islands, Savai’i and Upolu, two smaller inhabited islands, Manono and Apolima, and several small uninhabited islands including the Aleipata Islands (Nu’uteleNu’uluaFanuatapu, and Namua). The capital city is Apia. The Lapita people discovered and settled the Samoan Islands around 3,500 years ago. They developed a Samoan language and Samoan cultural identity.
Samoa is a unitary parliamentary democracy with eleven administrative divisions. The sovereign state is a member of the Commonwealth of Nations. Western Samoa was admitted to the United Nations on 15 December 1976. The entire island group, which includes American Samoa, was called “Navigator Islands” by European explorers before the 20th century because of the Samoans’ seafaring skills. The country was governed by New Zealand until its independence in 1962.
The National Health Service is the main government provider of health services for Samoa. They operate all of the hospitals and health centres and the main provider for medical imaging services, the sole provider of medical laboratory testing, and our pharmacy services cater to a significant portion of national pharmaceutical needs.


Scaling up breastfeeding policy and programs in Samoa: application of the Becoming Breastfeeding Friendly initiative

International Breastfeeding Journal volume 15, Article number: 1 (2020) Christina Soti-UlbergAmber Hromi-FiedlerNicola L. HawleyTake NaseriAnalosa Manuele-MageleJohn Ah-ChingRafael Pérez-Escamilla & on behalf of BBF Samoa Committee



Breastfeeding is a critical, evidence-based intervention that addresses malnutrition, improves early childhood development outcomes, and influences long-term maternal and infant health by reducing the non-communicable disease risk. Scaling up breastfeeding is an indisputably strong action countries can take to prevent suboptimal maternal and infant health outcomes. The Becoming Breastfeeding Friendly (BBF) initiative assists countries with scaling up breastfeeding policy and programs. BBF has been successfully implemented within Latin America, Africa, Europe and South-East Asian regions. This study assessed its application in Samoa.


In 2018, BBF was implemented in Samoa by a 20 member committee of breastfeeding experts who participated in collecting and utilizing national level data to score the degree of friendliness of Samoa’s breastfeeding environment, identify gaps, and propose policy recommendations to address those gaps. This eight-month process resulted in a public event where priority recommendations were widely disseminated to decision makers and actions agreed upon.


The total BBF Index score for Samoa was 1.6 out of 3.0, indicating a moderate breastfeeding friendly environment for scaling up policies and programs that protect, promote, and support breastfeeding. Gear total scores indicated that seven of the eight gears were moderately strong within Samoa, while the eighth gear, funding and resources, was weakest in strength. Six prioritized recommendations emerged: 1) development and implementation of a National Breastfeeding Policy and Strategic Action Plan; 2) strengthening monitoring and evaluation of all breastfeeding activities; 3) ratifying the International Labour Organization’s Maternity Protection Convention 2000 (No 183); 4) identifying high-level advocates to champion and serve as role models for breastfeeding; 5) creation of a national budget line for breastfeeding activities; and 6) hiring of a national breastfeeding coordinator and trainer. Decision makers demonstrated commitment by signing the breastfeeding policy for hospitals ahead of the BBF dissemination meeting and electing to move forward with establishing lactation rooms within government ministries.


Implementation of BBF in Samoa yielded important policy recommendations that will address current gaps in national level breastfeeding support. The BBF consultation process can be successfully applied to other countries within the Western Pacific region in order to strengthen their breastfeeding programs.


To ALL of you sharing resources with our Global Community, and there are LOTS of you,

THANK YOU (Faʻafetai)  

Hinari Access to Research for Health programme

Hinari Access to Research for Health Programme provides free or very low cost online access to the major journals in biomedical and related social sciences to local, not-for-profit institutions in developing countries. Hinari was launched in January 2002, with some 1500 journals from 6 major publishers: Blackwell, Elsevier Science, the Harcourt Worldwide STM Group, Wolters Kluwer International Health & Science, Springer Verlag and John Wiley, following the principles in a Statement of Intent signed in July 2001. Since that time, the numbers of participating publishers and of journals and other full-text resources has grown continuously. Up to 165 publishers’ content are If your institution is in a Group A (free access) country, area, or territory, then Hinari is free. If your institution is in a Group B (low-cost access) country, area, or territory, Hinari costs US$ 1500 per institution per calendar year (from January through December). All eligible institutions registering from Group B countries, areas, or territories will receive a six month trial without payment.

If your institution is in a Group B (low-cost access) country, area, or territory, and cannot or chooses not to pay the annual fee, the institution will still be eligible for free access to a small number of information resources.

Samoa is on the A lists for free access to this services.

***Refugee Camps recognized by UNRWA or categorized by UNHCR as “planned/managed camps” are eligible for free Hinari access regardless of their geographical location.


Risk of Preterm Birth and Newborn Low Birthweight in Military Women with Increased Pregnancy-Specific Anxiety

Karen L Weis, USAF, NC, PhDKatherine C Walker, MSN, RNWenyaw Chan, PhDTony T Yuan, PhDRegina P Lederman, PhD, RN, FAANMilitary Medicine, Volume 185, Issue 5-6, May-June 2020, Pages e678– e685,    Published: 06 December 2019



Prenatal maternal anxiety and depression have been implicated as possible risk factors for preterm birth (PTB) and other poor birth outcomes. Within the military, maternal conditions account for 15.3% of all hospital bed days, and it is the most common diagnostic code for active duty females after mental disorders. The majority of women (97.6%) serving on active duty are women of childbearing potential. Understanding the impact that prenatal maternal anxiety and depression can have on PTB and low birthweight (LBW) in a military population is critical to providing insight into biological pathways that alter fetal development and growth. The purpose of the study was to determine the impact of pregnancy-specific anxiety and depression on PTB and LBW within a military population.

Material and Methods

Pregnancy-specific anxiety and depression were measured for 246 pregnant women in each trimester. Individual slopes for seven different measures of pregnancy anxiety and one depression scale were calculated using linear mixed models. Logistic regression, adjusted and unadjusted models, were applied to determine the impact on PTB and LBW.


For each 1/10 unit increase in the anxiety slope as it related to well-being, the risk of LBW increased by 83% after controlling for parity, PTB, and active duty status. Similarly, a 1/10 unit rise in the anxiety slope related to accepting pregnancy, labor fears, and helplessness increased the risk of PTB by 37%, 60%, and 54%, respectively.


Pregnancy-specific anxiety was found to significantly increase the risk of PTB and LBW in a military population. Understanding this relationship is essential in developing effective assessments and interventions. Results emphasize the importance of prenatal maternal mental health to fetal health and birth outcomes. Further research is needed to determine the specific physiological pathways that link prenatal anxiety and depression with poor birth outcomes.



In the NICU, both parents are essential and need to be at their child’s bedside

By Jennifer Canvasser, Kurlen Payton, and Elizabeth Rogers – July 13, 2020

Micah Canvasser, born at 27 weeks gestation, spent 299 days in a NICU. His parents were constantly at his bedside learning how to best contribute to their son’s care.

As Covid-19 surged through the United States this spring, Reina and James were told they could no longer stay with their severely ill newborn in the hospital’s neonatal intensive care unit and could visit for only a few hours — separately.

“My husband was allowed to visit for just one hour a week and had to prebook his time,” Reina (the parents’ names have been changed to protect their privacy) shared with one of us. “I was allowed to visit for two hours each day. Our baby sadly gained his wings seven days after he was born.”

The coronavirus pandemic has forced billions of people and institutions to make difficult decisions to prevent harm and save lives. Many of these decisions affected how patients experience health care. One particularly traumatizing change has been directed at parents of newborns receiving care in neonatal intensive care units (NICU).

That might be good for infection control, but it goes against everything we know about caring for sick newborns. Both parents (or a parent plus a support person) need access to their infant’s bedside often and at the same time. The risks of Covid-19 must be weighed against the known risks and harms of separating babies in the NICU from their parents.

In the NICU, parents are not visitors: They are essential members of the care team. Parents know their babies better than anyone else and are often the first to recognize when something is wrong. It is intuitive to understand that babies need their parents, yet this is also borne out in research. For vulnerable newborns, their mother’s milk is a lifesaving intervention. Infant skin-to-skin care with parents promotes growth and healthy development.

Shared decision-making is critical in the NICU, where parents and providers must work together to optimize decisions that can have lifelong health implications for the infant. Because things can change so rapidly in a sick newborn, parents need to be at their child’s bedside so they can be informed and participate in these vital health decisions. Limiting parents’ access harms the therapeutic alliance that needs to exist between NICU providers and parents.

Bonding during this developmentally fragile period is crucial. Limiting parents’ access disrupts the nurturing interactions that are necessary for an infant’s cognitive development and that are also essential to parents’ mental health. “Even though our daughter is now home, our NICU’s one-parent policy has left us with deep psychological scars,” a father shared with us.

The wide variation in Covid-19 visitor policies between hospitals fuels mistrust. NICU parents and providers have reported a range of policies: Some hospitals allow unrestricted access for two parents at the bedside, others allow just one parent to visit for only two hours a day, and there’s just about every possibility in between. Permitting just one parent at a time to be with their child is an unlikely Covid-19-reduction strategy, as most parents are in close contact outside of the hospital.

That might be good for infection control, but it goes against everything we know about caring for sick newborns. Both parents (or a parent plus a support person) need access to their infant’s bedside often and at the same time. The risks of Covid-19 must be weighed against the known risks and harms of separating babies in the NICU from their parents.

In the NICU, parents are not visitors: They are essential members of the care team. Parents know their babies better than anyone else and are often the first to recognize when something is wrong. It is intuitive to understand that babies need their parents, yet this is also borne out in research. For vulnerable newborns, their mother’s milk is a lifesaving intervention. Infant skin-to-skin care with parents promotes growth and healthy development.

Shared decision-making is critical in the NICU, where parents and providers must work together to optimize decisions that can have lifelong health implications for the infant. Because things can change so rapidly in a sick newborn, parents need to be at their child’s bedside so they can be informed and participate in these vital health decisions. Limiting parents’ access harms the therapeutic alliance that needs to exist between NICU providers and parents.

Bonding during this developmentally fragile period is crucial. Limiting parents’ access disrupts the nurturing interactions that are necessary for an infant’s cognitive development and that are also essential to parents’ mental health. “Even though our daughter is now home, our NICU’s one-parent policy has left us with deep psychological scars,” a father shared with us.

The wide variation in Covid-19 visitor policies between hospitals fuels mistrust. NICU parents and providers have reported a range of policies: Some hospitals allow unrestricted access for two parents at the bedside, others allow just one parent to visit for only two hours a day, and there’s just about every possibility in between. Permitting just one parent at a time to be with their child is an unlikely Covid-19-reduction strategy, as most parents are in close contact outside of the hospital.

We need to close this gap and ensure that all NICU families receive high-quality care by giving parents access to their medically fragile infants. Seemingly strict but malleable visitor policies are also inequitable in that families who advocate for themselves are often told that both parents can be at the bedside, while families with less ability to advocate for themselves are required to comply.

Parents’ basic rights to see and care for their own child are infringed upon when they are inaccurately categorized as visitors. Infants’ basic right to physically access both of their parents must also be considered. Health care providers and parents should work together at local and state levels to assure safe practices that honor the unique situation and needs of sick newborns.

Parents can be screened with the same protective procedures applied to all essential care team members who come in and out of the hospital every day. While certain parental restrictions may be justified in specific high-risk situations, extensive parental limitations should always be minimized. Efforts must be made to mitigate public health risks while maximizing parental rights.

Babies in the NICU need both of their parents at their bedsides, and their parents’ psychological well-being depends on being there. The way families experience care in the NICU remains with them for their lifetimes. When asymptomatic, two-parent access to their infant’s bedside should be the standard of care. Anything less is indefensible.

Jennifer Canvasser is the mother of a child who died from necrotizing enterocolitis after spending several months in the NICU and is the founder and director of the Necrotizing Enterocolitis (NEC) Society, a member of the Chan Zuckerberg Initiative’s Rare As One Network. Kurlen Payton is a neonatologist, interim director of the neonatal intensive care unit at Cedars-Sinai Medical Center in Los Angeles, and co-director of quality improvement collaboratives for the California Perinatal Quality Improvement Collaborative. Elizabeth Rogers is a neonatologist and director of the ROOTS Small Baby Program at UCSF Benioff Children’s Hospital in San Francisco. The authors thank Jochen Profit, a neonatologist and associate professor of pediatrics at Stanford University School of Medicine, for his help writing this article.


A Teen-Led, Volunteer-based NICU Reading Program: A Model for Supporting Family Reading and Family Integrated Care


NICU babies are at high risk of neurodevelopmental impairment for multiple reasons, including prematurity, critical illness, and family emotional and economic stressors associated with hospitalization in the NICU. (1) Care in single-patient-room NICUs can compound the issues of sensory deprivation and contribute to speech and language deficits in NICU graduates. (2) Reading aloud with babies creates and strengthens neural connections that “promote … social-emotional development…and language and literacy skills during this critical period of early brain and child development.” (3) Providing parents and other caregivers books and encouraging them to read to their infants in the NICU is a low-cost intervention to increase infants’ speech and language interactions. Parent reading with their baby in the NICU supports family integrated care and bonding (4) and improves the NICU experience.

Babies With Books, a teen-led volunteer organization, began its first NICU Reading Program at Randall Children’s Hospital (RCH) in 2017.  The NICU Reading Program is a collaboration between teen volunteers and NICU providers, consisting of four discrete components – Admit Reading Packets, One-on-one Book Rounds, a Family Shared Reading Library, and literacy events and celebrations.  Admit Reading Packets contain a book, bookmark, and information on how and why to read aloud with babies beginning in the NICU. Teens source and assemble these admit packets, which are given by healthcare providers to each infant at NICU admission. One-on-one Book Rounds encourage and reinforce NICU reading. During book rounds, teen volunteers meet weekly with NICU families to  talk with them about how to read with their infant and why reading aloud to their babies beginning in the NICU is important. Some of this information was developed in collaboration with Reach Out And Read® (ROR).  Families are offered their choice of 3 books from a mobile book cart to read with their infant, keep in the NICU, and bring home at NICU discharge. The Family Shared Reading Library is a library located outside of the NICU (ex. in the NICU lobby or lounge) stocked with donated, gently used books. Literacy Events & Celebrations include NICU reada-thons, book nooks at NICU reunions, and other literacy promoting events that engage families in shared reading. In BWB’s first NICU read-a-thon at RCH, 45% of families participated, and all surveyed staff and families expressed high satisfaction. BWB has also hosted a “book nook” program at the RCH NICU reunion, during which we provided more than 200 donated books to NICU graduates and their siblings and read stories with them. Through this NICU Reading Program, BWB has served more than 850 NICU babies at RCH.

Books used in the Reading Program include a variety of high contrast board books, children’s stories, and “I love you” type books. Only new books are used with babies. Donated, gently used books may be used in the Family Shared Library and in “book nooks” at NICU reunions for NICU families and graduates. Books are available in multiple languages, and picture books are available for families whose primary language is not represented and for non-reading families. We recommend books by a wide range of authors that engage and represent the diversity of the NICU patient population.  Funding is through generous foundation grants as well as individual and corporate donations. We receive donated books from a local book bank and a used bookstore.

Like all hospital-based programs, BWB has been impacted by the COVID-19 pandemic.  The BWB teens have continued to source and assemble admit reading packets but do so offsite and deliver these to the hospital where they are stored for at least 72 hours prior to being given to NICU families. To assemble and deliver admit packets, volunteers must be symptom-free, wear masks, and adhere to strict hand hygiene. One-on-one volunteer-led book rounds have been paused during COVID-19 but can be performed by personnel with continued access to the NICU. Shared Family Reading Libraries are not recommended during COVID-19. Reada-thons remain a great way to support infants and families and build NICU morale during COVID-19.

Conclusion:  By engaging motivated, passionate, and creative teen volunteers in our BWB Reading Program, we provide valuable service to NICU babies and families with limited burden and cost to healthcare providers and hospitals.


Preemie Siblings may feel abandoned, displaced, dis-empowered during and after the preterm birth experience within a family. Preterm birth changes everything for preemie families for a short or for a very long time. Preemie parents are often overwhelmed and immersed in a sea of chaos, destination unknown.  Family Partners,  please consider implementing the simple concepts shared in the article below in order to provide all family members with the support needed to move forward with purpose and intent upon a foundation of family trust. Simple inclusion of preemie siblings may dynamically and positively alter the course of their precious lives and ultimately reduce the stress the family unit experiences during this challenging time.

NICU: Helping Siblings Cope

When a baby is in the Neonatal Intensive Care Unit (NICU), the entire family can be affected. Here are some tips for helping siblings cope.

Northwestern Memorial Hospital – Patient Education – HEALTH AND WELLNESS

What Siblings Need


Help siblings maintain their regular routines as much as possible. Providing structure and normal daily activities will help siblings feel safe and supported when separated from parents and family.


Be honest and use simple words they can understand when explaining why their brother/sister is in the hospital. This will help them feel less afraid.


Talk to siblings and help them understand what is happening. Allow siblings the chance to express their feelings and ask questions.

Behaviors to Watch For

It is not uncommon to notice a change in behavior in siblings when their brother/sister is in the hospital. Here are some typical reactions to watch for:

■ Guilt – Feeling that they did something to cause their sibling’s to be in the hospital.

■ Fear–Worrying that they or another loved one will get sick and have to go to the hospital.

■ Anger –Being angry about change in routine, separation from parents, less attention.

■ Loneliness – Feeling lonely when parents visit their brother/sister without them and wondering why they’re not getting as much attention as usual.

■ Confusion– Feeling confused about what will happen to their brother/sister, why they are there and when their life will return to “normal.” These feelings may be expressed in your child’s behavior.

Watch for:

■ Aggressive play or behavior

■ Increased need for attention/clinginess

■ Returning to younger behavior (bed wetting, temper tantrums, thumb sucking)

■ Changes in routine (sleeping and eating patterns)

How You Can Help

Siblings need lots of love and support when their brother or sister is in the NICU. Try to include your children as much as possible to answer questions and decrease fears.

Here are some resources and activities to use with siblings while supporting them.

Activities to Promote Positive Coping

■ Before visiting the hospital, make sure siblings know what to expect and remind them that it’s okay to ask questions.

■ Have the sibling choose a special item to bring to their sibling in the hospital (such as a favorite teddy bear, blanket or book).

■ Draw pictures or make decorations for the baby’s room (at home or in the NICU).

■ Write a letter to take to the baby.

■ Have the child draw a picture that they would like to share with their sibling.

■ Display a chart with different emotions or feelings on it in your home (you and your child can choose where to hang it). Ask the child each day how they are feeling and talk to them about why they are feeling that way. Always let them know that it is okay to talk and express all types of feelings.

Books You Can Read Together

■ “No Bigger Than A Teddy Bear” by Valerie Pankow

     A book for 3 to 7 year olds about what it is like to have a sibling in the NICU.

■ “My Brother is a Preemie” or “My Sister is a Preemie” by Joseph Vitterito

A book for 3 to 7 year olds that discusses what it is like to have a premature sibling in the NICU.

■ “What About Me? When Brothers and Sisters Get Sick” by Allan Peterkin

     A book for 5 to 10 year olds with hospitalized siblings.

■ “When Someone Has a Very Serious Illness” by Marge Eaton Heegaard

      A workbook for 7 to 13 year olds who have a sibling that is hospitalized or

     chronically ill.

■ “The Kissing Hand” by Audrey Penn

     A book about separation– this book is helpful if siblings are having a difficult time

     coping with separation from parents while they visit their child in the NICU.

■ “In My Heart” by Jo Witek

A book about emotions.file:///C:/Users/sacre/Downloads/northwestern-medicine-nicu-helping-siblings-cope-nmh%20(2).pdf


Vanderbilt develops computational method to explore evolution’s influence on preterm birth

by Marissa Shapiro Jul. 24, 2020

Human pregnancy can easily be taken for granted as a natural and regularly occurring event, but it is the product of the complex, coordinated function of two bodies, mother and baby, that has evolved side by side with other important human adaptations. For the first time, researchers have established how a complex disorder associated with pregnancy – spontaneous preterm birth (sPTB) – has been shaped by multiple evolutionary forces.

The article, “Accounting for diverse evolutionary forces reveals mosaic patterns of selection on human preterm birth loci” was published in the journal Nature Communications on July 24.

Preterm or premature birth, medically defined as labor starting at 37 weeks of gestation or earlier (instead of the usual 40 weeks), affects more than 15 million pregnancies each year and is the leading cause of infant mortality worldwide. Both the associated medical conditions of the mother which cause sPTB and the outcomes of sPTB on an infant’s health have been well-defined. It is not well understood, however, how and why genetic factors influence sPTB and birth timing. A team of scientists led by Antonis Rokas, Cornelius Vanderbilt Chair in Biological Sciences and director of the Vanderbilt Evolutionary Studies Initiative and Tony Capra, associate professor of biological sciences, set out to demystify this element of pregnancy and human life.

The research, co-led by postdoctoral scholar Abigail LaBella and by M.D./Ph.D. candidate Abin Abraham, developed a computational approach to detect how evolution has shaped genomic regions associated with complex genetic traits, such as height or obesity. “Our approach integrates techniques developed in labs from all over the world to quantify how natural selection has influenced genomic regions involved with complex diseases,” said Capra. “We hypothesized that parts of our genome involved in disease might experience contrasting evolutionary pressures due to their involvement in multiple and different traits.”

This work was done in cooperation with Louis J. Muglia, co-director of the Perinatal Institute at Cincinnati Children’s and president and CEO of the Burroughs Wellcome Fund and Ge Zhang, associate professor at Cincinnati Children Hospital Medical Center and collaborator at the March of Dimes Prematurity Research Center-Ohio Collaborative. Zhang and Muglia recently completed the largest genome-wide association study (GWAS) on sPTB which identified multiple genomic regions associated with this complex disease. “Preterm birth is a global health concern, affecting ten percent of pregnancies in the United States. Understanding the evolution of genomic regions associated with spontaneous preterm birth is a major step forward in how we understand the foundations of human life and provide the best possible care to mother and child,” said Muglia.

Using this GWAS, the researchers found that genomic regions associated with sPTB have experienced multiple types of natural selection. From this information researchers can hypothesize why these risk-related genomic regions remain in human populations and what their potential functions may be. “While we knew of a few examples of selection like negative selection acting on genes associated with spontaneous preterm birth, we uncovered that every type of selection we tested had acted on at least one genomic region. Our initial figures looked like a mosaic made up of all the different metrics we had tested,” says Rokas.

The team’s results suggest that genomic regions associated with sPTB have experienced diverse evolutionary pressures, such as population-specific selection, and provide insights into the biological functions some of these regions. “It is difficult to study pregnancy in humans and we lack good models for laboratory studies,” LaBella explains. “We still have much to learn about the mechanisms through which human pregnancy is initiated.” For example, the group uncovered differences in a region near the gene OPRL1, involved in both the relaxation of maternal tissues and pain perception during childbirth, that are specific to certain human populations. Population-specific differences in this region may contribute to the uneven risk of sPTB between human populations. “This work is a part of a burgeoning field of evolutionary medicine, one of the types of interdisciplinary research that many of the investigators of the Vanderbilt Evolutionary Studies Initiative are engaged in,” says Rokas.

Both Abraham and LaBella plan to continue to foster collaboration between medicine and evolution in their future research. “Having this pipeline at our disposal opens up a range of new, exciting questions such as asking whether diseases of pregnancy, which involve two genomes, that of mom and baby, experience different evolutionary pressures than other complex genetic diseases,” says Abraham.

This work will be critical for researchers studying the genetics of pregnancy-associated disorder and is of broad interest to scientists researching human evolution, human population genomics and how evolutionary analyses relate to complex diseases like cancer and heart disease.

The research was supported by the March of Dimes Prematurity Research Center-Ohio Collaborative, the Burroughs Wellcome Fund and National Institutes of Health grants R35GM127087 and T32GM007347.


Caring For Babies And Their Families: Providing Psychosocial Support In The NICU”: An Innovative Online Educational Tool To Empower Neonatal Nurses To Support NICU Families

Hall, Sue L. MD; Sorrells, Keira BS; Eklund, Wakako Minamoto DNP, APRN, NNP-BC Editor(s): Eklund, Wakako DNP, NNP-BC, Section Editors; Smith, Heather E. PhD, RN, NNP-BC, CNS, Section Editors Advances in Neonatal Care: August 2020 – Volume 20 – Issue 4 – p 263-264

Parents whose newborns are hospitalized in the neonatal intensive care unit (NICU) nearly always experience stress. These parents have a higher prevalence of both postpartum depression (PPD) and posttraumatic stress disorder (PTSD) than new parents of infants born healthy, related in part to their perceptions of their experiences surrounding the birth of their infant or their NICU experiences that are traumatic. Prevalence of PPD among NICU mothers is 25% to 63% and for NICU fathers, approximately 36%, while rates of PTSD among NICU parents have been reported as 15% to 53% for mothers and 8% to 33% for fathers.

A comprehensive evidence-based program is now available to empower neonatal nurses to support NICU families. The program is designed to psychosocially minimize the occurrence of both PPD and PTSD, and to optimize infant and family outcomes. This online continuing education (CE) program is entitled “Caring for Babies and Their Families: Providing Psychosocial Support in the NICU,” and it represents an exemplar for interprofessional collaboration in which family and other stakeholders improve education for neonatal health professionals, and ultimately the care in neonatal settings.

My NICU Network was launched in January, 2018, with a mission of becoming the preeminent provider of compelling perinatal education on psychosocial support created with interprofessional collaboration. My NICU Network was recently expanded to become My NICU Network-My Perinatal Network (MNN-MPN), and is a collaborative endeavor between the National Perinatal Association and the NICU Parent Network. The goal is to provide online evidence-based education and “hands-on” bedside tools to empower healthcare staff working with mothers and infants. The focus of the education is to strengthen the critical parent–infant bonds and family functioning, and to improve developmental outcomes in the infant and mental health outcomes in their parents.

The 3 key guiding principles of course development are: (1) supporting NICU parents is equally as important to providing medical care to their baby; (2) healthcare staff must also be emotionally supported, so that they will have the emotional capacity to support the patients and parents in their care; and (3) interprofessional collaboration models are the foundation to fully realize family-centered care. These principles have been central to program development from inception to conclusion of this project. Stakeholders who are recipients of care (NICU parent leaders) collaborated every step of the way in designing and implementing these educational programs. The courses are rich with parent stories, audio clips, and videos that illustrate learning points. Parents helped to create the courses, conducted the surveys from which parent stories have been gleaned; contributed resources including web links and downloads to be available for the learners who take the course; have been instrumental in the development of the course’s trauma-informed care scripts. There are examples of what providers should not say to parents, how the parent interprets what the provider has said, and what is a better way to communicate the idea based on principles of trauma-informed care. Other parents have reviewed and provided feedback, which was used to refine the course content. All of this parental input has been the key to success of the program, as parents’ testimonials bring the evidence from the literature to life. As one nurse stated after taking the program: “It was very eye opening to see things through the eyes of the parents.” Few educational programs exist that include NICU parent leaders at every level from content development to content delivery, making this a truly unique and comprehensive educational experience.

All of the educational programs of MNN-MPN are based on principles of trauma-informed care, and NICU programs are based on the “Interdisciplinary Recommendations for Psychosocial Support of NICU Parents.” All are also available for CE credits. A study has demonstrated the efficacy of the initial learning program to improve nurses’ knowledge and attitudes toward providing psychosocial care. The program consists of 7 courses including: communication skills, providing emotional support, peer-to-peer support, family-centered developmental care, palliative and bereavement care, discharge planning and follow-up, and caring for the caregiver (staff support).

To date, over 700 NICU staff have completed the program, including the majority of nursing staff in 14 NICUs across the country. The goal for an entire NICU staff completing the program together is to transform the culture in the NICU to become more family-centered, and to mitigate long-term parental emotional complications such as PPD and PTSD. A condensed version of this program, called the Advanced NICU Provider Program, offers 2 CE credits for neonatologists and neonatal nurse practitioners. In mid-2020, 2 additional programs will be launched:

  1. “Caring for Pregnant Patients and Their Families: Providing Psychosocial Support During Pregnancy, Labor and Delivery” (for maternity care staff), and
  2. “Giving Birth During the Coronavirus Pandemic: Using Trauma-informed Care to Support Patients, Their Families, and Staff Through This Crisis” (for both NICU and maternity care staff).

NICU parents need, desire, and benefit from the emotional support from the nurses. Nursing interventions may mitigate the evolution of parents’ typically expected distress upon entering the NICU, preventing it from developing into full-blown depression or PTSD. Neonatal nurses who are at the bedside daily form more intimate relationships with infants and their families than other health professionals and are in a position to make a positive impact when well-equipped with strategies to address their complex psychosocial needs. NICU families value nurses; one study reported how the quality of relationship parents have with the nurses supported parental ability to cope and bond with their infants in the NICU.

One of the most critical goals for neonatal nurses is to improve the parent–infant bond in NICU to optimize families’ mental health/resilience, so that they can emerge as the empowered, confident, and knowledgeable advocates for their fragile infants who can achieve optimal development. Utilizing an innovative educational model, created through involvement of family stakeholders, can give nurses the tools they need to achieve this very important goal for the families in their care. For more information, please visit or


Decolonizing Parents Cuts NICU Staph Transmission Risk

Nicola M. Parry, DVM – January 13, 2020

Treating colonized parents of neonates hospitalized in the neonatal intensive care unit (NICU) may reduce the risk of parents spreading Staphylococcus aureus to the infants, a recent study published online December 30 in JAMA has shown.

“Treating parents of neonates in the NICU with intranasal mupirocin and 2% chlorhexidine-impregnated cloths compared with placebo reduced the risk of a neonate acquiring S aureus colonization with strains that were the same as S aureus strains identified from the parent(s) at time of study enrollment,” write Aaron M. Milstone, MD, MHS, from Johns Hopkins University, Baltimore, Maryland, and colleagues.

“In this trial, more than half of neonates who acquired S aureus had the same strain as their parent(s).”

According to the authors, neonates have an immature microbiome at the time of their admission to the NICU and rarely are already colonized by S aureus. Instead, they become colonized in the NICU after exposure to the organism from colonized or infected people and contaminated objects in the environment.

Staphylococcus aureus remains a common cause of outbreaks and healthcare-associated infections in NICUs and can seriously impact affected infants, with long-term sequelae such as poor neurodevelopmental and growth outcomes.

Although infection prevention strategies in NICUs typically center on healthcare workers and the physical environment as reservoirs for exposure of infants to S aureus, parents may also serve as an important reservoir for transmission of the bacterium.

With this in mind, Milstone and colleagues conducted their double-blinded, randomized controlled trial across two tertiary care NICUs to investigate whether treating parents would reduce the risk of their infants becoming colonized with S aureus.

The Treating Parents to Reduce Neonatal Transmission of Staphylococcus aureus (TREAT PARENTS) trial enrolled 236 infants. It included infants who had not had a previous culture positive for S aureus, had at least a 5-day NICU stay, were no more than 7 days old if admitted to the NICU from an outside location, and had at least one parent who tested positive for S aureus at screening.

The study’s primary endpoint was infants’ acquisition within 90 days of the same S aureus strain that their parent had. Secondary outcomes included infants’ acquisition of any strain of S aureus and neonatal S aureus infections.

Parents in the study received 5 days of treatment. They were randomly assigned to intranasal mupirocin and topical bathing with 2% chlorhexidine-impregnated cloths (n = 117) or placebo treatment with petrolatum intranasal ointment and nonmedicated soap cloths (n = 119).

Of the 236 enrolled infants, 208 (55% male; 76% singleton births; mean birthweight 1985 grams; 76% vaginal births) were included in the analytic sample, although 18 of these were lost to follow-up.

A total of 190 infants were included in the final analysis: 89 in the intervention group and 101 in the placebo group. Of these, 74 (38.9%) acquired S aureus colonization by 90 days, 42 (56.8%) of whom had a strain concordant with a parental baseline strain.

According to the researchers, fewer (n = 13; 14.6%) infants in the intervention group than in the placebo group (n = 29; 28.7%) acquired concordant S aureus colonization (risk difference, –14.1%; hazard ratio [HR], 0.43).

Similarly, fewer infants in the intervention group acquired any S aureus strain
(n = 28; 31.4% vs n = 46; 45.5%; HR, 0.57).

One infant (1.1%) in the intervention group and 1 (1.0%) in the placebo group developed a S aureus infection before colonization. Skin reactions in parents occurred commonly in both groups (4.8% vs 6.2%).

“This trial suggests that parents are a major reservoir from which neonates acquire S aureus in the NICU,” the authors write.

“Treating colonized parents may reduce risk of S aureus transmission to neonates, but these findings are preliminary and require further research for replication and to assess generalizability.”

This study “offers a novel and promising strategy to address a highly relevant, often intractable, clinical problem”, and “provides an explanation why interventions that primarily target patients and health care workers can fail to eradicate MSSA [methicillin-susceptible S aureus] in the NICU,” pediatric infectious disease specialists Philip Zachariah, MD, MSc, and Lisa Saiman, MD, MPH, write in an accompanying editorial.

However, they highlight some features of the study that indicate a need for further investigation before this strategy could be widely adopted by other NICUs. For example, both study NICUs already used active surveillance and decolonization protocols for both MSSA and MRSA, which limits generalizability of this treatment strategy.

In addition, the study was not powered to detect differences in infections or mortality, the editorialists say. Scalability is another concern, they add, noting that the study took 4 years to complete and that 92.7% of infants who were screened for eligibility failed to meet its inclusion criteria.

“Cost-effectiveness will also need to be determined,” Zachariah and Saiman add. Zachariah is from Columbia University Irving Medical Center, New York City, and Saiman is from NewYork-Presbyterian Hospital in New York City.

Nevertheless, the editorialists conclude that regardless of whether future research will support integration of this strategy into routine care, “Milstone and colleagues have made an important advance into this difficult area with the promise of having a meaningful benefit on neonatal care.”

This study was supported by the Agency for Healthcare Research and Quality. Three authors report receiving grants from the Centers for Disease Control and Prevention, the National Institutes of Health, Sage Products Inc, Singulex Inc, Curetis Inc, Accelerate Inc, and GenMark. The same three authors report personal fees from Becton Dickinson, Novartis, Theravance, Basilea, Pattern Diagnostics, and GenMark. The remaining authors and the editorialists have disclosed no relevant financial relationships.

JAMA. Published online December 30, 2019. AbstractEditorial



How Premature Birth Shapes Future Heart Health

Meredith S. Campbell, MD, Editorial Fellow, Pediatrics, Neonatal-Perinatal Medicine Fellow, Vanderbilt University Medical Center, Nashville, TN          July 07, 2020

Advancements in neonatal care have led to a growing cohort of preterm-born individuals that have now reached adulthood. While population-based birth cohorts have provided us with a better understanding of long-term complications of premature birth such as risk for neurodevelopmental impairment, much less is known about potential cardiac consequences.

In a newly released review article in Pediatrics (10.1542/peds.2020-0146), Dr. Fernando Telles and colleagues present the first meta-analysis to compare cardiac structure and function between former preterm and term infants from the time of birth to young adulthood. A total of 32 observational studies were included in the review to quantify the impact of preterm birth on the heart across developmental stages. The results were intriguing—former preterm individuals have persistently lower left ventricular diastolic function, right ventricular systolic impairment, and an accelerated rate of left ventricular hypertrophy. The authors proposed that these cardiac alterations may make the heart more vulnerable to secondary insults, which may explain why preterm birth is a risk factor for early heart failure and long-term risk of ischemic heart disease.

As we dig deeper into what’s different about the hearts of those born preterm, further longitudinal studies are needed to determine how cardiac remodeling in preterm infants progresses over time. This is particularly important in the adolescent age range, for which there is a paucity of data. While this article adds to our understanding of how premature birth shapes future heart health, a number of questions and research gaps regarding the long-term cardiac outcomes after preterm birth remain including the need for earlier detection of former preterm individuals at higher risk for cardiac issues, screening guidelines, preventative strategies, and a plan for better clinical monitoring. Additional research will hopefully allow us to get to the heart of the matter.


Trauma-informed Care in the NICU

Caring Essentials Collaborative, LLC – Mar 9, 2018

Mary Coughlin MS, NNP, RNC-E presents a quick overview of the biological relevance of this paradigm for hospitalized newborns, infants and families.

Premature babies experience high exposure to noise in the incubator

by Medical University of Vienna– JULY 20, 2020

What do premature babies hear while lying in an incubator? That is the question addressed by an interdisciplinary team from the Medical University of Vienna, led by Vito Giordano (neuroscientist at the Division of Neonatology, Pediatric Intensive Care and Neuropediatrics at the Comprehensive Center for Pediatrics (CCP) of Medical University of Vienna), by musicologist/acoustician Christoph Reuter and by music physiologist Matthias Bertsch from the University of Music and the Performing Arts in the recent study, “The Sound of Silence,” published in the journal Frontiers in Psychology

This study shows that premature babies are exposed to a high level of noise in the incubator, particularly if they are on respiratory support in the neonatal intensive care unit (NICU).

According to data from the World Health Organization (WHO), approximately 15 million babies a year are born prematurely, the proportion varying between 5% and 18% depending on the country of origin. Despite general improvements in intensive care medicine, many premature babies face life-long impairments. The intrauterine hearing experience differs strongly from the extrauterine auditory load encountered in a neonatal intensive care unit (NICU).

“It is primarily low frequency noises (note: below 500 Hz) that are transmitted and filtered through the mother’s body. Several studies have indicated that the noise level inside the NICU repeatedly far exceeds the recommended threshold of 35 dB. Signals from monitoring equipment, loud talking, sudden opening of doors or medical procedures result in a high level of background noise and reach peak values well above 100 dB,” explains Giordano.

However, high noise levels can lead to hearing impairment or even hearing loss—the incidence being between 2% and 10% in very premature babies, as opposed to only 0.1% -0.2% in infants born at term. “Premature babies in an incubator lack the natural filtering and absorption of background noise that occurs in the mother’s womb. New acoustic stimuli and/or noises have a marked impact upon postnatal maturation of the auditory system, as pointed out by the Medical University Vienna expert. However, silence, which leads to deprivation, a feeling of isolation, is just as harmful as loud stimuli. The problem is not essentially new: nowadays, educational concepts and visual indicators to reduce noise are already standard in neonatal wards.

The aim of the recently published study was firstly to record the dynamics of sounds inside an incubator and secondly to enable others to understand the hearing experience of premature babies. “Everyone, especially clinicians, nurses, music therapists and parents are now able to imagine what it sounds like inside the incubator by listening to examples of the sounds themselves. Inside it sounds quite different from outside, since the incubator acts as a bass booster, i.e. lower frequencies below 250 Hz are significantly louder,” explains music physiologist Matthias Bertsch.

The results of the study show that the incubator has a “protective effect,” especially against medium- and high-frequency sounds, but amplifies lower frequency sounds. Moreover, the incubator lid has practically no protective effect against noise, there is an increase in high-frequency sounds when access doors are left open, and there is a high noise level generated by a respiratory support device. “What listeners find particularly surprising is how loud these respirators can become inside the incubator, even if the air-flow is only slightly increased. At a high flow-rate with the associated roaring sound, the increase is such that it equates to the noise of a vacuum cleaner at a distance of one meter (75 dB),” the study authors explain. Neonatologists are therefore advised to set the air flow of respiratory support devices to the necessary minimum.

“We feel it is important to raise awareness of the problem, not only with acoustic noise level tables but with understandable audible results,” the authors highlight. The consequences of early exposure to noise can be wide-ranging, e.g. impaired ability to discriminate speech compared to children born at term, which was demonstrated in a parallel study of the same study group. This was conducted in July 2019 under the supervision of neurolinguist Lisa Bartha-Doering at the Comprehensive Center for Pediatrics (CCP) and published in the journal Developmental Cognitive Neuroscience.

“These study findings show that it is important to invest in new technologies,” Angelika Berger, Head of the Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, explains, “and our research teams are currently working on such new technologies in order to improve the acoustic comfort and long-term outcome of our smallest patients.”


Six Tips for Managing Stress and Improving Self-Care in a COVID-19 Environment

Duke School Of Nursing    Apr 9, 2020 Duke University School of Nursing Assistant Professor Sean Convoy discusses suggestions for managing stress and improving self-care in a COVID-19 environment.


Warriors have the capacity to capitalize on the challenges Covid-19 presents by focusing on what we choose to experience within the  containments required to support our mutual health and well-being at this time. I challenge us to recognize the value of the here and now and not only recreate our relationships with ourselves during this moment in time but affirm our intention to prosper and grow ourselves. Don’t wait! Within the quiet isolation and uprooted rhythms of our pre-Covid-19 lives there is an open door to our hearts, and our souls.  In this moment, let’s leave the longing for what was and  follow our intuition towards lives of happiness and fulfillment beyond our imaginations. Take time to let go, to heal, to replenish and re-invent (re-discover) the wholeness of each of us! We have offered many self-empowerment resources over the past (almost 5) years. Here  are a couple of additional self-empowerment resources for our older Warriors to consider.  I like the kinesthetic experience the Toltec Path to Recapitulation offers, and am looking forward to exploring the ideas and wisdom offered through the books mentioned below.

Recapitulation: Release your past and reclaim trapped energy

Mar 16, 2016
All Things Perceptual
Recapitulation: how to, from beginning to end, obtain a perfect recapitulation of your life, freeing you from the bonds of your life experiences, replenishing you with boundless energy and making you light and flexible in your spirit. The Legend of the perfect recapitulation and the Toltec theory of near immortality as a warrior of the third attention!

8 Self-Empowerment Books to Help You Take Back 2020

Take a break from the everyday unrest of this year to be inspired by the stories of others who have faced adversity and overcame it.

Peter Daisyme – August 28, 2020

It doesn’t matter who you ask — 2020 has been an exhausting year. Between a global pandemic, political unrest and an unprecedented economic downturn, it’s easy to feel downtrodden.

While there’s no easy way to get out of this funk, it never hurts to listen to the perspectives of others. By reading books focused on self-empowerment and overcoming adversity, you can feel prepared to take on whatever the world has to throw at you in 2020 and beyond. Here are some of the top choices out there right now.

1. Learn, Improve, Master: How to Develop Any Skill and Excel at It by Nick Velasquez

With lots of people having more free time than ever on their hands, many are taking this opportunity to pick up new skills. But doing so is often easier said than done. Learn, Improve, Master doesn’t teach the basics of any one skill; it gives you the tools you need to learn things more quickly and fully in the future. Nick Velasquez’s new book is a valuable investment for anyone looking to continually grow and evolve over time.

2. Grit: The Power of Passion and Perseverance by Angela Duckworth

The title here says it all. In Angela Duckworth’s Grit, the secret to success can be found entirely in one’s own dedication and work ethic. Duckworth looks at standouts everywhere from West Point to the National Spelling Bee and has found one thing in common: sheer determination. If you’re looking to learn how to take your career to the next level through hard work, this book is the one for you.

3. Responsibility Rebellion: An Unconventional Approach to Personal Empowerment by Kain Ramsay

It can seem like we achieve some of the greatest joys in life by avoiding responsibility — goofing off, taking vacations and ignoring the real problems at the heart of it all. Responsibility Rebellion turns this logic on its head by arguing that getting ahead in life isn’t about ignoring the underlying issues. It’s about facing them head on. Kain Ramsay’s unconventional approach to success may surprise some, but the results are hard to ignore. 

4. Across That Bridge: A Vision for Change and the Future of America by John Lewis

The death of John Lewis sent the country into a national state of mourning, but his influence doesn’t have to end there. Across That Bridge is a powerful collection of his thoughts, memories and reflections on what it was like to fight during the Civil Rights Movement and how people can use that spirit to continue to fight for justice today. The book is no easy read, but the wisdom contained therein is well worth it.

5. The Empowerment Paradox: Seven Vital Virtues to Turn Struggle Into Strength by Ben Woodward

Why is it that many of people’s biggest, most life-changing revelations often come after moments of deep pain and tragedy? There’s no easy answer to this question, but The Empowerment Paradox is a powerful look into what we might learn from it. Ben Woodward offers a unique perspective on how we might take some of the difficulties we face and turn them into personal progress.

6. Ignite Your Career!: Strategies and Tactics to Unleash Your Potential by Kris Holmes

This year’s college graduates are currently facing more uncertainty in the job market than any generation before them, and there’s no clear end in sight. Kris Holmes’s new book may have been written before the pandemic struck, but the advice is more relevant than ever. Ignite Your Career! is a must-have for any first-time job seekers.

7. Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones by James Clear

Less than two years old, Atomic Habits is already something of a modern classic. James Clear uses his book to give a clear, simple guide for remaking your life, starting with the small stuff. If you want a big change to come into your life, beginning with daily habits might just be the method that works best.

8. Boot Straps & Bra Straps: The Formula to Go from Rock Bottom Back into Action in Any Situation by Sheila Mac 

The pandemic has been hard on businesspeople of all shapes and sizes, but there’s no doubt that women have faced a particularly poignant challenge. Boot Straps & Bra Straps is a how-to guide for any woman hoping to bring her career to the next level without sacrificing any of herself in the process. Sheila Mac has already been through it all herself, meaning that her book has a lifetime’s worth of wisdom for you to glean from.

They may not have all the answers, but books are a good place to start when it comes to empowering yourself. By picking a couple of the options off of this list, you can introduce yourself to a whole world of ideas that you can use to learn and grow.


AND for our younger Neonatal Womb Warriors: Ruby Finds a Worry by Tom Percival Ruby’s Worry (Read Aloud) | Storytime

Feb 10, 2020        Toadstools and Fairy Dust

Please join us for a dramatic read of Ruby Finds a Worry, Ruby’s Worry by Tom Percival read by Miss Jill. Great story about feelings and overcoming anxiety and worry and what to do.

The Samoan Surfers

Apr 27, 2013  Iva Motusaga

The Motusaga Wave Riders

Author: Kathy Papac and Kathryn (Kat) Campos

Kathryn (Kat) Campos: Hello, I am a former 24 week gestation micro-preemie. I lost my twin brother Cruz at birth and encountered open heart surgery with no anesthesia at 3 weeks old weighing 1lb 3oz/0.58kg. I served on the University of Washington Medical Center Advisory Board Neonatal ICU Council from 2013 to 2015. I am passionate about assisting and supporting our Global NICU Community. If your a Preterm Birth/NICU Survivor this blog is dedicated to you, your family, and all members of the NICU Community. Together lets support other Preemie Survivors, Preemies, Preemie families, Preemie Community, Neonatal and related Staff, Providers, Professionals and Facilities. We ALL have stories to share and preemie journeys to help empower! Kathy Papac: Preemie Mom of surviving (Kathryn) and a deceased (Cruz) 24 week gestation twins. Neonatal Womb journeyer, counselor/legal expert with an MA certificate in Spirituality, Health and Medicine from Bastyr University. Passionate Global Community participant. Our goal is to recognize, honor and empower the Neonatal Womb community and shine light upon the presence and potentiality of the preterm birth survivors as vital community participants.

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