ROMANIA

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Preterm Birth Rates – ROMANIA

Rank: 151 –Rate: 7.3% Estimated # of preterm births per 100 live births (USA – 12 %)
Source: https://www.marchofdimes.org/mission/global-preterm.aspx

Romania is a country located at the crossroads of Central, Eastern, and Southeastern Europe. It has a predominantly temperate–continental climate. With a total area of 238,397 square kilometres (92,046 square miles), Romania is the twelfth-largest country in Europe and the seventh-most populous member state of the European Union, having approximately 20 million inhabitants. Its capital and largest city is Bucharest. 

Romania has a universal health care system; total health expenditures by the government are roughly 5% of GDP. It covers medical examinations, any surgical interventions, and any post-operative medical care, and provides free or subsidised medicine for a range of diseases. The state is obliged to fund public hospitals and clinics. The most common causes of death are cardiovascular diseases and cancer. Transmissible diseases are quite common by European standards. In 2010, Romania had 428 state and 25 private hospitals, with 6.2 hospital beds per 1,000 people, and over 200,000 medical staff, including over 52,000 doctors. As of 2013, the emigration rate of doctors was 9%, higher than the European average of 2.5%.

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

COMMUNITY

Babies born prematurely can catch up their immune systems

March 9, 2020  Source: King’s College London

Researchers from King’s College London & Homerton University Hospital have found babies born before 32 weeks’ gestation can rapidly acquire some adult immune functions after birth, equivalent to that achieved by infants born at term.

In research published today in Nature Communications, the team followed babies born before 32 weeks gestation to identify different immune cell populations, the state of these populations, their ability to produce mediators, and how these features changed post-natally. They also took stool samples and analysed to see which bacteria were present.

They found that all the infants’ immune profiles progressed in a similar direction as they aged, regardless of the number of weeks of gestation at birth. Babies born at the earliest gestations — before 28 weeks — made a greater degree of movement over a similar time period to those born at later gestation. This suggests that preterm and term infants converge in a similar time frame, and immune development in all babies follows a set path after birth.

Dr Deena Gibbons, a lecturer in Immunology in the School of Immunology & Microbial Sciences, said: “These data highlight that the majority of immune development takes place after birth and, as such, even those babies born very prematurely have the ability to develop a normal immune system.”

Infection and infection-related complications are significant causes of death following preterm birth. Despite this, there is limited understanding of the development of the immune system in babies born prematurely, and how this development can be influenced by the environment post birth.

Some preterm babies who went on to develop infection showed reduced CXCL8-producing T cells at birth. This suggests that infants at risk of infection and complications in the first few months of their life could be identified shortly after birth, which may lead to improved outcomes.

There were limited differences driven by sex which suggests that the few identified may play a role in the observations that preterm male infants often experience poorer outcomes.

The findings build on previous findings studying the infant immune system.

Dr Deena Gibbons: “We are continuing to study the role of the CXCL8-producing T cell and how it can be activated to help babies fight infection. We also want to take a closer look at other immune functions that change during infection to help improve outcomes for this vulnerable group.”

King’s College London. “Babies born prematurely can catch up their immune systems.” ScienceDaily. ScienceDaily, 9 March 2020.

Source: https://www.sciencedaily.com/releases/2020/03/200309093029.htm

The Premature Association donated protective equipment and devices against COVID 19 in 5 maternity hospitals

Bucharest, 09/09/20.

The Association of Premature Babies, always with medical staff and newborns in maternity hospitals, came to an end with the project “Support for medical staff and newborns in maternity hospitals – protective equipment and apparatus against COVID 19”, funded by the program “In condition good ”, supported by Kaufland Romania and implemented by the Foundation for Civil Society Development.

The Premature Association purchased and donated 30 UV biocidal lamps for air disinfection, for use in the presence of people, 2,000 pairs of surgical gloves, 2,000 disposable gowns , 2,000 simple surgical masks , 500 disposable coveralls , 250 visors , 5,000 shoe protection boots, 1 air conditioner , 550 FFP2 medical masks , 150 liters of disinfectant surfaces with biocide approved by MS, 150 liters of disinfectant soap. These donations have already arrived and are used by the Maternity of the Bacău County Emergency Hospital, the Maternity of the Călărași County Emergency Hospital, the Maternity of the Târgoviște County Emergency Hospital, the Obstetrics-Gynecology Philanthropy Hospital of Bucharest, the Bucharest Maternity Hospital.

“It is a maxim that says that the friend in need knows himself, and you, our dear friends from the Premature Association, are with us in these moments, especially difficult, by our side. Your support in moments of balance supports us both materially and morally. We appreciate the effort of those who contributed to go through an economic crisis, not only medical and human.

We use ultraviolet lamps every day to disinfect the spaces and share them with our friends and colleagues from the obstetrics department for the rooming-in salons. Sanitary materials, masks, gowns, gloves, were extraordinarily welcome, consumption growing exponentially during this period.

Thank you very much for everything! Let’s get over this pandemic healthy! Dr. Camelia Husac, head of the neonatology department, Matenitatea of ​​the Bacău County Emergency Hospital.

The products delivered through this project are useful for over 100 medical staff, over 2,000 parents and about 2,000 newborns who have been born since July or will be born in the above-mentioned maternity hospitals in the coming months.

“Thank you for your involvement and support in these difficult times. The babies from Târgoviste Maternity Hospital, through the professionals, thank you! All the respect and good thoughts for the Premature Association and for Kaufland Romania! Preventing the transmission of infections in a maternity hospital is a safety standard for patients. Thank you again for your involvement! ” Dr. Anca Georgescu, head of the neonatology department, Maternity of the Târgoviște County Emergency Hospital.

The total value of the project “Support for medical staff and newborns in maternity – protective equipment and apparatus against COVID 19” reaches 150,000 lei, funded by the program “In good condition” 2020, supported by Kaufland Romania and implemented by the Foundation for Development Civil Society.

” Thank you from the bottom of my heart for the generous donation, the equipment is already in use and is very useful to us, especially in this difficult period!” Dr. Carmen Ștefan, head of the neonatology department, Călărași County Emergency Hospital Maternity Hospital.

About the Premature Association

The Premature Association develops in Romania programs dedicated to premature babies, parents and medical staff in neonatology and brings together experts from various disciplines, parents, media representatives and public figures, to improve the quality of public health services in Romania.

The Premature Association is the only accredited prematurity NGO in Romania, in accordance with the provisions of Law no. 197/2012 on quality assurance in the field of social services by the Romanian Ministry of Labor, Family, Social Protection and the Elderly.

The Premature Association is a member of EFCNI, European Foundation for the Care of Newborn Infants – the only pan-European organization representing the interests of premature and newborns, and brings together parents’ organizations from around the world, health professionals from different specialties, in the long term of their health, through prevention, treatment, care and support programs, they also celebrate World Prematurity Day in Romania.

Asociația Prematurilor a donat echipamente de protecție și aparatură împotriva COVID 19 în 5 maternități

Discriminatory Housing Practices Tied to Premature Births

By Traci Pedersen   Associate News Editor   Last updated: 28 Aug 2020

A new study suggests that past discriminatory housing practices may play a role in perpetuating the significant disparities in infant and maternal health faced by minorities in the United States.

For decades, banks and other lenders refused loans to people if they lived in an area the lenders deemed to be a poor financial risk. This policy, called redlining, led lenders and banks to create maps marking neighborhoods considered too risky for investment. These maps were first drawn in 1935 by the government-sponsored Home Owners’ Loan Corp. (HOLC), and labeled neighborhoods in one of four colors — from green representing the lowest risk to red representing the highest risk.

These designations were based, in part, on the race and socioeconomic status of each neighborhood’s residents.

To analyze the link between historical redlining and infant and maternal health today, a research team from the University of California (UC), Berkeley obtained birth outcome data for the cities of Los Angeles, Oakland and San Francisco between 2006 and 2015 and compared them to HOLC redlining maps.

The findings, published online in the journal PLOS ONE, show that adverse birth outcomes — including premature births, low birth weight babies and babies who were small for their gestational age — occurred significantly more often in neighborhoods with worse HOLC ratings.

“Our results highlight how laws and policies that have been abolished can still assert health effects today,” said Rachel Morello-Frosch, a professor of public health and of environmental science, policy and management at UC Berkeley and senior author of the study.

“This suggests that if we want to target neighborhood-level interventions to improve the social and physical environments where kids are born and grow, neighborhoods that have faced historical forms of discrimination, like redlining, are important places to start.”

Non-Hispanic Black women living in the U.S. are one-and-a-half times more likely to give birth to premature babies than their white counterparts and are more than twice as likely to have babies with a low birth weight. Hispanic women face similar, though less dramatic, disparities, compared to non-Hispanic white women.

While the legacy of public and private disinvestment in redlined neighborhoods has led to well-documented disparities in income level, tree canopy coverage, air pollution and home values in these communities, the long-term health impacts of redlining are just now starting to be explored.

“Children born during the time of our study would be the great-great-grandchildren of those who were alive at the time of redlining, whose options of where to live would have been determined by redlining maps,” said study lead author Anthony Nardone, a medical student in the UC Berkeley-UCSF Joint Medical Program.

“We chose to look at birth outcomes because of the stark inequities that exist across race in the U.S. today, inequities that we believe are a function of long-standing institutional racism, like historical redlining.”

Previous research led by Nardone showed that residents of neighborhoods with the worst HOLC rating were more than twice as likely to visit the emergency room with asthma than residents of neighborhoods with the highest HOLC rating. And a recent study from the Harvard School of Public Health found a link between redlining and preterm births in New York City.

In the new study, the researchers discovered that neighborhoods with the two worst HOLC ratings — “definitely declining” and “hazardous” — had significantly worse birth outcomes than those with the best HOLC rating.

However, Los Angeles neighborhoods rated “hazardous” showed slightly better birth outcomes than those with the second worst, or “definitely declining,” rating. In San Francisco and Oakland, neighborhoods with these two ratings showed similar birth outcomes.

This pattern might be due to the effects of gentrification on previously redlined neighborhoods, the authors speculated. They added that residents of the hardest hit neighborhoods may also rely more on community support networks, which can help combat the effects of disinvestment.

“We also saw different results by metropolitan area and slightly different results by maternal race,” Morello-Frosch said. “This suggests that maybe the underlying mechanisms of the effect of redlining differ by region and should be investigated further.”

Source: University of California- Berkeley

Source: https://psychcentral.com/news/2020/08/28/discriminatory-housing-practices-tied-to-premature-births/158868.html

PREEMIE FAMILY PARTNERS

Premature baby – Home at last! What next?

Jun 23, 2020    KK Women’s and Children’s Hospital

This YouTube video provided by KK Women’s and Children’s Hospital in Singapore shares preemie care practices, a Singapore preterm birth family  experience and many practical care recommendations. The video may inspire you to  talk  to your provider regarding care recommendations for your precious baby.

Your baby is now ready for home. The nursing and medical team will prepare you to bring your baby home and will go through the common concerns that you may encounter at home. Close follow-up of your baby’s health, development and growth is still much needed in order to ensure that your premature child achieves his / her best potential. This will be managed in the regular outpatient clinic reviews. In this video, we will highlight what is to be expected during your baby’s outpatient clinic review.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Victoria A. Grunberg  Pamela A. Geller  Chavis A. Patterson   First published: 14 February 2020

https://doi.org/10.1002/imhj.21848

ABSTRACT

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family‐focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self‐care may be effective to prevent negative psychosocial sequelae among families.

https://onlinelibrary.wiley.com/doi/abs/10.1002/imhj.21848

Track your preterm baby’s milestones

POSTED ON 02 SEPTEMBER 2020

Baby+ a baby tracking app for premature babies and their parents

©Baby+

Baby+, the popular baby tracking apps, is now offering new content particularly targeted at the questions and needs of parents of preterm babies. EFCNI is honoured to have supported the developers of the Baby+ app with 20 articles dedicated to this topic. Parents as well as family members or friends can now inform themselves about a wide range of questions concerning preterm birth via the mobile app.

Topics range from information about preterm birth, special nutritional needs of preterm babies, the rights of parents or how to bond with a baby in the NICU to name but a few.

With 1 baby out of 10 being a preterm baby, the app now acknowledges the large group of preterm parents and supports them in their journey.

The Baby+ app is available for free for iOS and Android and supports the following languages:

English, German, Spanish, French, Dutch, Portuguese, Russian and Italian.

The Award Winning Globally Inspirational Irish Neonatal Health Alliance Shares Heartfelt Inspiring Preterm Birth Family Stories. Take a peak (see link below) into the stories of our Irish family. You may find solace and inspiration within these shared experiences.

 

Our Vision: to increase awareness of preterm birth, improve pre-conceptual &
antenatal education, equitable neonatal care & better long term care for neonates in Ireland.

                                                                         

Families

Wall of Hope The Rights of Parents & Infants  INHA Family Publications

INHA NICU Milestone Cards  INHA Position Papers  INHA Angel Babies

Link: Global Premature Parent Organisations

WALL OF HOPE – Our Stories (enter link below)

HEALTH CARE PARTNERS

Every woman’s right to a companion of choice during childbirth

9 September 2020

WHO strongly recommends supporting women to have a chosen companion during labour and childbirth, including during COVID-19. 

When a woman has access to trusted emotional, psychological and practical support during labour and childbirth, evidence shows that both her experience of childbirth and her health outcomes can improve.  

In Companion of choice during labour and childbirth for improved quality of care, WHO and HRP present updated information on the benefits of labour companionship for women and their newborns, and how it can be implemented as part of efforts to improve quality of maternity care. 

The current COVID-19 pandemic is no exception. 

WHO Clinical management of COVID-19: interim guidance strongly recommends that all pregnant women, including those with suspected, probable or confirmed COVID-19, have access to a companion of choice during labour and childbirth.

Source: https://www.who.int/news-room/detail/09-09-2020-every-woman-s-right-to-a-companion-of-choice-during-childbirth

Balancing the Needs of the Patient and the Needs of the System

Rob Graham, R.R.T./N.R.C.P

I learned to drive long ago. The process began with me sitting on my maternal grandfather’s knee behind the wheel of a half-ton truck or his ’58 Oldsmobile. This progressed to the mowing down small trees in a vacant field in my uncle’s jalopy, then driving a tractor pulling a hay wagon on my grandmother’s farm at age 9. When 16 finally arrived, I took driver’s while education in a ’73 Oldsmobile Cutlass. Our family had two vehicles: a ’66 Ford ½ ton, and a ’67 Meteor Rideau 500. (Note to car buffs: Meteor was the Canadian brand of Mercury). The truck had the standard “3 on the tree” transmission, and the other was an automatic. No one was permitted to drive the automatic until they had mastered the standard. This was no small feat! If the shift between first gear to second was precisely done, the entire transmission would lock up, bringing the truck to a screeching stop. What, you may be asking about now, does this have to do with the subject at hand. There are, it seems, a few parallels.

Technology has improved the care and outcomes of all patients, be they young or old. Graphics give us information about lung compliance and over-distention; transilluminators make finding and cannulating veins and arteries easier; fiber-optic laryngoscopes provide brighter light, and fiber optic laryngoscopes aid in the visualisation of the airway and placement of the endotracheal tube. There are many more aids and adjuncts available to modern clinicians that were not available when many of us were training. These and other devices constitute a double-edged sword. In the adult world, “old school” anesthetists complain the skill of laryngoscopy is quickly becoming a lost art. With the relatively recent availability of video laryngoscopy devices in the N.I.C.U., there is fear the same may happen in the world of neonatology. This fear is justified, although experience with the video laryngoscope recently purchased for teaching purposes by the unit in which I work has demonstrated that new devices also have a learning curve. Just how steep that learning curve is, and whether video laryngoscopy becomes standard practice in the N.I.C.U., remains to be seen.

With fewer and fewer babies being intubated for invasive ventilation or even resuscitation, and the advent of “minimally invasive” surfactant administration, there are fewer and fewer opportunities for trainees to learn this very basic yet essential skill. Even babies born with meconium are now rarely intubated.

 In many NICUs, respiratory therapists (RRTs) are the ones doing most of the intubations; thus, RRT trainees are also in the training queue. This would not be such a problem were it not for the fact that many of our fellows in training will never again work in a level 3 or 4 facility, but rather a level 2 facility or even a hospital with only a well-baby unit. Why does this present a problem?

n a world experiencing increasingly shrinking health care budgets, it is unlikely that a facility without higher-level neonatal care will invest in the technology we find commonplace in our level 3 and 4 units. Should a patient in one of these facilities require intubation, the ability of the clinician to perform this procedure, “the old-fashioned way” is essential. That clinician may be the only person with neonatal intubation skills available. As well, there are facilities that do not have in-house anesthesia overnight. Similarly, there is likely a dearth of other technological aids; ultrasound, for instance, available for inserting intravenous, arterial, or umbilical lines. Ventilators may be limited to “jack of all” machines primarily used for adult ventilation but with pediatric and neonatal functionality.

What we take for granted is simply not widely available in lower functioning facilities. In addition, many foreign trainees return to their home countries and facilities, where the level of technological assistance available to us in the “first world” may be non-existent. The problem is obvious. Without learning basic skills, the training we provide for these future neonatologists is incomplete.

Simulations and simulators offer some mitigation, but as anyone who has intubated a mannequin can attest to, they are not a perfect substitute for the real thing. Anatomical anomalies, secretions, and extremely anterior airways are common challenges that a mannequin is unable (to the best of my knowledge) to duplicate. This should not be construed as an “anti-sim” opinion piece. As in the field of aviation, simulations hold great promise in medical training. They are a safe place to make mistakes, practice judgment, and decision-making skills, and offer a degree of skill development. Perhaps it is neonatology that poses a bigger challenge to simulations. There are situations that cannot be adequately taught in a simulation setting.

Simulators ranging from 25-weeks (“micro-preemie”) are available. These offer a chance to practice oral intubation, umbilical line placement, IV placement, nasogastric tube placement, and can present a variety of birth defects. To the best of my knowledge, these devices do not offer experience with false-tracking umbilical lines or femoral artery or hepatic catheterisation. There are clinical signs of these occurrences in real life that a simulator can’t simulate. These devices are a great start, but they are not a true substitute for a real patient, nor are they a complete substitute for clinical practice.

This is of concern as simulation sessions become an increasingly large part of basic training and substitution for real-life experience for trainees. Anecdotally, there is a subtle difference observed in students with extensive simulator training; however, literature does not support these observations1 . It is worth noting that the amount of clinical time replaced by simulation in this study was limited to 50%. While there was no difference in pass rates or educational outcomes, passing does not always equate to real-world competence. Every trainee I have worked with has passed their didactic and clinical programs. The real test might be how many of the simulator group actually pass orientation in a critical care setting. It is also interesting that there is some evidence that higher fidelity simulations do not necessarily improve learning objectives, including neonatal resuscitation program learning.

As real as simulations are, there is no substitute for the adrena line-fueled panic that can ensue in real life (although I have witnessed just that during simulations). There is no “time out” function in the resuscitation room. Simulators do offer opportunities to experience a variety of clinical situations that a trainee may never see during a typical rotation.2 Whatever one’s personal views are, it is undeniable that simulation training has become an integral part of medical education and is here to stay.

I recall attending a lab session during my training, where we practiced intubating anesthetized cats. I learned two things: cats are easy to intubate, and cats are not babies. While in my adult training program, we were also encouraged, where possible, to practice laryngoscopy on cadavers post unsuccessful resuscitation to improve competency. The ethics of doing this today may be called into question, but the experience gained cannot be disputed.

The micro-premature infant presents another quandary. It is generally accepted where I practice that the most experienced person present at resuscitation is the one who manages the airway. Compounding the problem in the unit in which I practice is we intubate nasally wherever and whenever possible. I have yet to find a mannequin that allows for nasal endotracheal tube placement. How then are trainees to learn these skills? Clearly, when it comes to patient care, we want what is best for our babies, and the needs of trainees are secondary. The question here is, how does this philosophy serve future patients and those destined to be treated by those trainees? Where is the balance? What are the ethical implications?

 Perhaps it is time that we, as practitioners, should be addressing these issues to improve training as a whole. Perhaps the same technology creating these problems will, with evolution and innovation, create needed solutions. Some higher end mannequins have anatomy with a range of adjustments (the size of the palate, for instance). While I have faith in the ability of technology to save us from technology, it comes with a price and a very high one at that. The cost of furnishing a complete simulation suite is steep. The question of whether cash strapped institutions will be amenable to this investment remains. Until that time, we must make do with what is available to us as teachers.

The one place where endotracheal intubation is still commonplace is the operating room. This could be the ideal venue for learning laryngoscopy and intubation in a controlled environment and under the watchful eyes of a skilled, experienced pediatric anesthetist. This would require liaising with our anesthesia colleagues but could also have an impact on the training of new anesthetists who also must have excellent intubation skills. There are only so many trainee vacancies on their roster and only so many patients for neonatology trainees on whom to practice. Therefore, the limited opportunity the N.I.C.U. affords trainees to learn intubation skills could, at present, leave us with no choice but simulation.

Finally, I believe that neonatal fellowship programs should offer a respiratory rotation. While RRTs are the primary drivers of ventilation in some units, outside North America, this is a profession that does not exist. When foreign trainees return to their native lands, it is they who must run the ventilators. Who better to learn the intricacies of ventilators and mechanical ventilation from than those who have made it their life’s work? A four-week rotation acting as an RRT orientee could prove invaluable, especially to our foreign trainees.

To use the driving analogy, we all should learn standard before availing ourselves of the luxury of an automatic. By the way, to this day, my vehicles have standard transmissions. I also intubate the “standard” way. When Armageddon comes, I will be doing it the “old fashioned way.” How about you?

Source:

Click to access nt-sep20.pdf

What is a Neonatal Nurse Practitioner?

Jan 15, 2016

National Association of Neonatal Nurses

Learn what goes into being a Neonatal Nurse Practitioner (NNP) as well as the excitements, rewards, and challenges that comes with this profession.

Assessment of Neonatal Intensive Care Unit Practices and Preterm Newborn Gut Microbiota and 2-Year Neurodevelopmental Outcomes

Original Investigation Pediatrics  September 23, 2020

Key Points

Question  What are the long-term outcomes associated with dysbiosis of gut microbiota in very preterm newborns?

Findings  In this cohort study of 577 very preterm newborns across 24 neonatal intensive care units from a French nationwide cohort, gut microbiota at week 4 after birth showed 6 bacterial patterns that varied according to gestational age, perinatal characteristics, individual treatments, and neonatal intensive care unit strategies. Three clusters were associated with 2-year outcomes after adjustment for these confounders.

Meaning  Modifying strategies associated with alterations in microbiota, such as promoting enteral nutrition, reducing sedation use, promoting early extubation, or skin-to-skin practice, may be correlated with outcomes in preterm newborns.

Abstract

Importance  In very preterm newborns, gut microbiota is highly variable with major dysbiosis. Its association with short-term health is widely studied, but the association with long-term outcomes remains unknown.

Objective  To investigate in preterm newborns the associations among practice strategies in neonatal intensive care units (NICUs), gut microbiota, and outcomes at 2 years.

Design, Setting, and Participants  EPIFLORE is a prospective observational cohort study that includes a stool sample collection during the fourth week after birth. Preterm newborns of less than 32 weeks of gestational age (GA) born in 2011 were included from 24 NICUs as part of the French nationwide population-based cohort, EPIPAGE 2. Data were collected from May 2011 to December 2011 and analyzed from September 2016 to December 2018.

Exposures  Eight NICU strategies concerning sedation, ventilation, skin-to-skin practice, antibiotherapy, ductus arteriosus, and breastfeeding were assessed. A NICU was considered favorable to a practice if the percentage of that practice in the NICU was more than the expected percentage.

Main Outcomes and Measures  Gut microbiota was analyzed by 16S ribosomal RNA gene sequencing and characterized by a clustering-based method. The 2-year outcome was defined by death or neurodevelopmental delay using a Global Ages and Stages questionnaire score.

Results  Of 577 newborns included in the study, the mean (SD) GA was 28.3 (2.0) weeks, and 303 (52.5%) were male. Collected gut microbiota was grouped into 5 discrete clusters. A sixth cluster included nonamplifiable samples owing to low bacterial load. Cluster 4 (driven by Enterococcus [n = 63]), cluster 5 (driven by Staphylococcus [n = 52]), and cluster 6 (n = 93) were significantly associated with lower mean (SD) GA (26.7 [1.8] weeks and 26.8 [1.9] weeks, respectively) and cluster 3 (driven by Escherichia/Shigella [n = 61]) with higher mean (SD) GA (29.4 [1.6] weeks; P = .001). Cluster 3 was considered the reference. After adjustment for confounders, no assisted ventilation at day 1 was associated with a decreased risk of belonging to cluster 5 or cluster 6 (adjusted odds ratio [AOR], 0.21 [95% CI, 0.06-0.78] and 0.19 [95% CI, 0.06-0.62], respectively) when sedation (AOR, 10.55 [95% CI, 2.28-48.87] and 4.62 [1.32-16.18], respectively) and low volume of enteral nutrition (AOR, 10.48 [95% CI, 2.48-44.29] and 7.28 [95% CI, 2.03-26.18], respectively) was associated with an increased risk. Skin-to-skin practice was associated with a decreased risk of being in cluster 5 (AOR, 0.14 [95% CI, 0.04-0.48]). Moreover, clusters 4, 5, 6 were significantly associated with 2-year nonoptimal outcome (AOR, 6.17 [95% CI, 1.46-26.0]; AOR, 4.53 [95% CI, 1.02-20.1]; and AOR, 5.42 [95% CI, 1.36-21.6], respectively).

Conclusions and Relevance  Gut microbiota of very preterm newborns at week 4 is associated with NICU practices and 2-year outcomes. Microbiota could be a noninvasive biomarker of immaturity.

Jean-Christophe Rozé, MD, PhD¹; Pierre-Yves Ancel, MD, PhD^2,3; Laetitia Marchand-Martin, MSc, PhD²; et alClotilde Rousseau, PharmD, PhD^4,5,6; Emmanuel Montassier, MD, PhD⁷; Céline Monot, BS⁸; Karine Le Roux, BS⁸; Marine Butin, MD, PhD⁹; Matthieu Resche-Rigon, MD, PhD¹⁰; Julio Aires, PhD^4,5; Josef Neu, MD¹¹; Patricia Lepage, PhD⁸; Marie-José Butel, PharmD, PhD^4,5; for the EPIFLORE Study Group

JAMA Netw Open. 2020;3(9):e2018119. doi:10.1001/jamanetworkopen.2020.18119

FULL ARTICLE

Source:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770943?resultClick=1

INNOVATIONS

Obesity Among Former Extremely Premature Infants: From Too Small to Too Big?

Lydia Furman, MD, Associate Editor, Pediatrics – October 26, 2018

In a recently released article in Pediatrics, Dr. Charles Wood and colleagues (10.1542/peds.2018-0519) examined the antecedents of obesity among infant born extremely premature. The study team used data gained prospectively from the ELGAN (Extremely Low Gestational Age Newborn) Study, which enrolled infants born prior to the 28^th week of gestation, and followed them to age 10 years. Of the original cohort of 1,506 infants, 871 former premature infants had height and weight data at age 10 years, representing a remarkable 74% of survivors.  Full neonatal and perinatal information, infant weight at birth and ages 1 and 2 years, as well as maternal characteristics including pre-pregnancy BMI (body mass index), were available for the analysis. The authors took this treasure trove of data and used a “TORM” or “time-oriented risk model” to conduct the analysis; the statistics are explained very clearly and non-statisticians will feel comfortable that they have grasped the essence of the approach throughout.

The initial examination identified multiple factors potentially associated with overweight and obesity at age 10 years, but the final model which took these variables into account showed that just a few of these factors were significantly associated with the overweight and obesity outcomes. While I hope you will enjoy learning what these key significant factors are, I’d like to focus on the one I think is most potentially modifiable: rate of weight gain in the first and second years.

Since by age 1-2 years most infants are receiving well child care from primary providers in the community, we as providers have a great opportunity to make a difference. It’s hard not to initially celebrate every ounce of weight gain outside of the hospital as a major achievement! What we can do, though, is then introduce parents to the same thinking we apply to the routine well care of former full term infants. For infants, we can focus on cue-based feeding: what are the signs the baby is giving that he or she is hungry, and just as importantly, what are the signs that he or she is getting full?¹ The signs of satiety may be subtle and include shorter sucking bursts with fewer sucks, hand relaxing and fist opening, a milk drizzle at the corner of the mouth and outright sucking pauses. Rather than urging the baby on to an “empty plate” (i.e. empty bottle), parental attentiveness to satiety cues may build self-regulation skills for eating, which may mitigate risk for future overweight and obesity. Additional research in this fascinating area of infant-to-parent feeding cue communication is needed.² The toddler years give additional opportunity for supporting healthy eating habits, for example, turning the television off during meals, and neither using food as a reward nor pressuring the child to eat.³ I agree with the study authors that “…attention [should] be paid to rapid growth in the first years of life, even in this vulnerable population of children.”  This simple yet elegant ELGAN follow up is a terrific example of how a well-designed and large prospective study can bear fruit well beyond what was initially expected.

Source: https://www.aappublications.org/news/2018/10/26/obesity-among-former-extremely-premature-infants-from-too-small-to-too-big-pediatrics-10-26-18

Developmental care for little patients – FINE trainings in Romania

POSTED ON 13 NOVEMBER 2018 – A guest article by Corina Croitoru, President of the Association Unu și Unu

Preterm babies, and ill newborns are properly treated from the medical point of view, but, the human dimension is often neglected. They are ‘just’ patients and the parents are ‘just’ visitors. By supporting FINE training in Romanian hospitals, Unu si Unu Association aims to change this situation. 

The aim: “Through this project we want to support the babies and their parents. At birth, both the baby and the mother are very vulnerable and they need each other. The experience of the countries who applied the concept of infant- and family-centred developmental care showed us that this is the way to change the neonatal units. Because the units following the family-centred care concept have a huge impact on the neurological development level of the child, it could prevent disabilities and raise the bond and attachment between mother and child”, says Corina Croitoru, the president of the Association Unu și Unu. She initiated the project and her goal is to introduce these kind of centres where parents can take care of their babies in all neonatal units in Romania within the next five to ten years.

The project “Little human in therapy” offers the chance that the little patient can be taken care by his or her own family. This approach respects one of the fundamental rights that every newborn has the right to not be separated from his parents (United Nations Convention, Children Rights, 1989). In this way, the parents will not only be accepted in neonatal intensive care units, but they also will be able to practice Kangaroo care, to take care of their babies, to feed them, taking them into their arms during the painful procedures. All this will take place, of course, after the children are stabilised and while respecting babies’ needs.

Details of the project: Unu si Unu Association started the project “Little human in therapy” in 2 maternities: Polizu, National Institute for Health of Mother and child Bucharest and Maternity Dominic Stanca, Emergency Hospital Cluj-Napoca. 110 participants (20% doctors and 80% nurses) from both maternities attended the FINE LEVEL 1 training (3 sessions of 2 days each) by Inga Warren, Senior Trainer NIDCAP, UK NIDCAP from the University College London Hospital. Additional 12 guests from other maternities from Romania joined the course, in preparation of a future expansion of the project. 

The feedback received from the medical staff was very positive: “The approach according to FINE principles will enhance the quality of medical care procedures with impact on neuro-development on short and long term for this category of newborns. The change of experience with the founder team from Great Britain, helped us with the implementation of the project in Polizu maternity. Our goal is to apply as many of the methods that we have learned as the position of the new born, building “nests” adequate for the needs of the preterm baby and create a special environment for the sensory development by respecting the epidemiological rules.” said Corina Datu neonatologist doctor in I.N.S.M.C. – maternity Polizu.

“It was an amazing experience, and the presentation was very good. Things about all of us knew are good, both for the baby’s and their parents. It is good to remember them and to try to apply as many as possible. I think is very good for the nurses to see these things and to apply them together after. Thank you so much for this experience.” Doctor Bogdana Todea, Dominic Stanca Maternity, Cluj.

The FINE Level 2 training focused on practical skills and on baby’s individual needs. This involves studying the way preterm and newborn babies behave. The baby may not speak but the way he/she reacts gives us an idea about how he/she is feeling and what kind of help he/she may need. It is important for staff and parents to understand these reactions so that they can care for the baby in the safest, most sensible and sensitive way. 6 healthcare professionals joined this level 2 training course, two doctors and two nurses from Bucharest and one doctor and one nurse from Cluj accepted the challenge of further training with the aim of introducing the family-centred care approach in their hospitals.

Outcome: Soon, the results of the course became apparent. Inga Warren declared that when she visited the intensive care neonatal unit from Polizu Maternity after finishing the course, she observed that some of the techniques from the course were already used.

After six months since the FINE Level 1 training, Kangaroo care has been practiced almost daily in Stanca Maternity. The smallest children who received Kangaroo Care weighed 800 grams, and we started to also involve fathers. In order to involve even more parents in the care of their hospitalised baby in the NICU, Association Unu si Unu supports, with the help of its voluntary team, weekly, practical workshops for parents and hand hygiene seminars, in the Maternity in Cluj.

Another result is the donation of products for the implementation: nests for a good positioning, gel positioning pillows, incubator covers, Kangaroo Care blouses and Kangaroo Care chairs, chairs for parents, baby feeding pillows, mini pacifiers, lamps with dimmer, weighing, blankets, storage boxes.

In 2018, Unu și Unu received an award by the Coalition of Patient Associations in Romania (COPAC) for the project. 

Timing: The project needed a 6 months fundraising period, 3 months for signing contracts with hospitals, 3 months for FINE Level 1 training, 1 month for donation of necessary materials for the implementation, 6 months for organizing FINE Level 2 training + seminars for parents + parents inclusion, step by step, in the NICUs.

Developmental care for little patients – FINE trainings in Romania

DJI – Delivering the Future of Healthcare

   Feb 12, 2020

Traditional methods of delivering medicine to rural communities have not been considered the most efficient solutions. Patients in smaller areas of the Dominican Republic, for example, would often go weeks without receiving the care they needed, increasing mortality rates. A reliable and cost-efficient solution became necessary. Thankfully, drone technology would answer the call. Watch how powerful equipment like the Matrice 600, and a strong collaboration between the local medical staff, Ministry of Health, WeRobotics and the Drone Innovation Center, has led to increased efficiency during important medical deliveries.

Potential preterm births in high risk women predicted to 73% accuracy, by new technique

July 29, 2020 Source: University of Warwick

A new technique that can spot a potential preterm birth in asymptomatic high-risk women, with up to 73% accuracy months before delivery, has been developed by scientists at the University of Warwick.

Utilising cutting-edge volatile organic compound analysis technology, designed to characterise airborne chemicals, the scientists ‘trained’ the device using machine-learning techniques to identify the chemical vapour patterns from preterm birth using vaginal swabs taken during routine examinations.

Their technique is detailed in a paper for Scientific Reports and could lead to a cost-effective, non-invasive, point-of-care test that could form part of routine care for women identified as being at risk of delivering prematurely. This could enable healthcare staff to better support those women during pregnancy and birth and help to reduce the risks to their baby.

Preterm birth is the leading cause of death in children under five and at present there are few accurate tools to predict who is going to deliver preterm.

The researchers initially analysed volatile organic compounds (VOCs) present in the vagina for a condition called bacterial vaginosis, in which the bacteria of the vagina have become imbalanced. Previous research has shown that bacterial vaginosis in early pregnancy is associated with an increased risk in having a preterm birth, although treating bacterial vaginosis doesn’t decrease that risk.

The technology they used works by separating the vapour molecules by combining two techniques that first pre-separates molecules based on their reaction with a stationary phase coating (a gas-chromatograph), followed by measuring their mobility in a high-electric field (an Ion Mobility Spectrometer). Using machine learning techniques, the team ‘trained’ the technology to spot patterns of VOCs that were signs of bacterial vaginosis.

The researchers then analysed vaginal swabs taken from pregnant women attending a preterm prevention clinic as part of their routine care. These women either had prior histories of preterm births or a medical condition that makes it more likely that they would deliver preterm but had shown no other indications that they would deliver preterm and were considered asymptomatic.

Vaginal swabs were taken during the second and third trimesters of pregnancy and the outcome of all pregnancies followed up. The first test had an accuracy of 66% while the second, closer to the time of delivery, had an accuracy of 73%. The test results means that 7/10 women with a positive test went on to deliver preterm. 9/10 women with a negative test delivered after 37 weeks.

Lead author Dr Lauren Lacey of Warwick Medical School and an obstetrics and gynaecology registrar at University Hospitals Coventry and Warwickshire NHS Trust said: “We’ve demonstrated that the technology has good diagnostic accuracy, and in the future it could form part of a care pathway to determine who would deliver preterm.

“Although the first test taken earlier in pregnancy is diagnostically less accurate, it could allow interventions to be put in place to reduce the risk of preterm delivery; for the test towards the end of pregnancy, high risk women can have interventions put in place to optimise the outcome for baby.

“There are a number of different factors that could cause a woman to go into preterm labour. Because of that, prediction is quite difficult. There are lots of things we can look at — the patient’s history, the examination, ultrasound scan, various other biomarkers that are used in clinical practice. No single test fits all.

“VOC technology is really interesting because it reflects both the microbiome and the host response, whereas other technologies look for a specific biomarker. It’s the beginning of looking at the association of VOCs with preterm delivery. We want to develop this and look at whether these patterns could be implemented into a care pathway.”

The next stage of research would see a small VOC analysis device stored at a hospital so samples could be analysed on site. The hope is that it could eventually be developed for use in a labour ward triage so tests can be administered and results obtained rapidly.

Professor James Covington from the University of Warwick School of Engineering said: “There is a strong interest around the world in the use of vapours emanating from biological waste for the diagnosis and monitoring of disease. These approaches can non-invasively measure the health of a person, detect an infection or warn of an impending medical need. For the need described in the paper, the technology can be miniaturised and be easily located in a maternity ward. The analysis only takes few minutes, the instrument needs no specialised services (just power) and is easy to use. We believe that the analysis of odours will become commonplace for this and many other diseases in the near future.”

The researchers behind this study are part of the newly established Centre for Early Life, based at Warwick Medical School at the University of Warwick, which launches on 31 July. The new Centre builds on the University’s existing expertise in early life research by aiming to pioneer research into the formative factors in our lives such as this latest research.

Professor Siobhan Quenby, Co-Director of the new Centre and Honorary Consultant at University Hospital Coventry and Warwickshire NHS Trust said: “I am delighted that the new Centre for Early Life will facilitate further interdisciplinary collaborations, to the benefits of my patients.”

Source: https://www.sciencedaily.com/releases/2020/07/200729114730.htm

WARRIORS:

If Covid -19 were a rabbit hole…. “Used especially in the phrase going down the rabbit hole or falling down the rabbit hole, a rabbit hole is a metaphor for something that transports someone into a wonderfully (or troublingly) surreal state or situation.”

We share this global pandemic experience in many similar and in unique ways.  This month we want to shine a light on mental health (awareness and resources) in our Warrior and Neonatal Womb community at large.  Our lives have all been altered in various ways, and this is a walk in the dark for most if not all of us. The light at the end of the tunnel may not be visible, and when the darkness becomes light, things may look different. Within chaos there are opportunities for positive change. An openness to new perspectives, feelings of curiosity, awareness of personal and community growth opportunities may allow us to thrive even in these tough times.  We must lead and in order to lead it is critical we listen to and acknowledge the feelings we experience along the way. It is powerful to look deeply into our emotional selves, to choose to identify, pursue and experience coping strategies that will lead to our healing and empowerment. Seek support and choose wonderful!

Pandemic having ‘astronomic’ effect on young people’s mental health: ILO

   Aug 12, 2020  CNBC International TV

Drew Gardiner, youth employment specialist for the International Labour Organization, discusses the impact of the coronavirus pandemic on education and young people’s mental health.

MENTAL HEALTH RESOURCES

Young Adults: MentalHealth.gov

https://www.mentalhealth.gov/talk/young-people

Stigma Compounds the Consequences of Clinician Burnout During COVID-19: A Call to Action to Break the Culture of Silence

By Jennifer B. Feist, J. Corey Feist, and Pamela Cipriano – August 6, 2020 | Commentary

 If you are suicidal and need emergency help, call 911 immediately or 1-800-273-8255 if in the United States. If you are in another country, find a 24/7 hotline at www.iasp.info/resources/Crises_Centres.

Resources to Support the Health and Well-Being of Clinicians During COVID-19

Preterm Birth Parents:

USA: http://www.nationalperinatal.org/

USA Regional Contact Information: https://www.preemiecare.org/supportgroups.htm

UK: https://www.bliss.org.uk/parents/support/impact-mental-health-premature-sick-baby

INTERNATIONAL SUPPORT: Please connect with your local healthcare organization for local Preterm Birth Parent Support resources

 GENERAL/USA: Take care of your mental health: You may experience increased stress during this pandemic. Fear and anxiety can be overwhelming and cause strong emotions. Get immediate help in a crisis

Source: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

KAT’S CORNER

Covid-19 has brought upon transitions for all of us. Creativity during this time has been essential in finding ways to keep up on academic knowledge, seek out work opportunities, build relationships, support our families & friends, and maintain good health. From implementing new workout routines via YouTube, forming new work habits, and incorporating mask into our daily wardrobe routine Covid-19 has challenged us all to take on our daily lives in some unfamiliar and challenging ways.  

This past month we sought to partake in the spirit of creativity by including a Covid-19 mask theme in our Annual Instagram Celebration series. In each of the photos highlighting the 13 nations we have explored this year is a mask. (Instagram Link- @katkcampos)  

As a central theme of each photo the mask is meant to symbolize our connection to each other, our resilience, our need to support each other and our responsibility to one another. As preterm birth has impacted each of us as individuals and members of a dynamic global community, Covid-19 likewise caused a significant and traumatic impact on all of us and has inspired us even more so to seek out ways to raise awareness and take action in addressing the health and wellness needs of humanity as a whole. Our resilience is what keeps us moving one foot in front of the other during this turbulent and historic time in our world.  

Kitesurf Constanta, Romania 15.02.2020 Ep. 2 Plaja 3 papuci

•Feb 18, 2020                                                Kite Inspiration

kitebeginner Prima iesire din 2020. Temperatura apa 7 grade Celsius