Preterm Birth: A Marathon Community

Croatia, officially the Republic of Croatia, is a country at the crossroads of Central and Southeast Europe on the Adriatic Sea. It borders Slovenia to the northwest, Hungary to the northeast, Serbia to the east, Bosnia and Herzegovina and Montenegro to the southeast, and shares a maritime border with Italy to the west and southwest. Its capital and largest city, Zagreb, forms one of the country’s primary subdivisions, with twenty counties. Croatia has 56,594 square kilometres (21,851 square miles) and a population of 4.07 million.

sovereign state, Croatia is a republic governed under a parliamentary system. It is a member of the European Union, the United Nations, the Council of EuropeNATO, the World Trade Organization, and a founding member of the Union for the Mediterranean. An active participant in United Nations peacekeeping, Croatia has contributed troops to the International Security Assistance Force and took a nonpermanent seat on the United Nations Security Council for the 2008–2009 term. Since 2000, the Croatian government has invested in infrastructure, especially transport routes and facilities along the Pan-European corridors.

Croatia is classified by the World Bank as a high-income economy and ranks very high on the Human Development IndexServiceindustrial sectors, and agriculture dominate the economy, respectively. Tourism is a significant source of revenue, with Croatia ranked among the 20 most popular tourist destinations. The state controls a part of the economy, with substantial government expenditure. The European Union is Croatia’s most important trading partner. Croatia provides social securityuniversal health care, and tuition-free primary and secondary education while supporting culture through public institutions and corporate investments in media and publishing.

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

PRETERM BIRTH RATES –Croatia

Rank:180 –Rate: 5.5% Estimated # of preterm births per 100 live births 

  (USA – 12 %, Global Average: 11.1%)

COMMUNITY

Marathon Swimmer Dina Levačić Planning Humanitarian Swim for KBC Department of Neonatolog

By Daniela Rogulj  –  6 August 2021

While the COVID-19 situation has made things a bit more difficult, marathon swimmer Dina Levačić has not taken time to rest. In ten days, on August 13 or 14, Dina will swim a humanitarian marathon from the island of Vir to Ist – a 27-kilometer stretch. In cooperation with the Split Fire Brigade, the action ‘Heart for Little Heroes’ was launched to help the Split Clinical Hospital Center’s Department of Neonatology purchase a special device, reports Dalmatinski Portal

“For me, this season is marked by the coronavirus, just like it is for most athletes. Poljud has always been open to me. I trained without major problems. I had planned to swim across the Strait of Gibraltar, but Spain and Morocco are not in the best situation. I hope that the possibility for that will open by October,” said Levačić, and then revealed her latest goal.

“Next weekend I will swim from Vir to Ist. My late grandfather Stipe is from the island of Ist. It is a place where I learned to swim, fell in love with the sea, jumped into the depths for the first time without fear. It is an island that deserves to swim in the world’s oceans without fear.”

She also revealed plans for the future.

“I hope to swim Gibraltar, even if they let me know two days before. New Zealand, one of the big seven, is also planned. I’ve been waiting for years for my turn. I don’t know what it will be because New Zealand is closed to everyone except Australia, and it won’t open until the New Year. So I should be swimming in February or March of next year when it is summer there. I hope that their authorities will give in and that I will be able to get there.”

She follows the Olympic Games in great detail.

“It’s the only opportunity to see some sports that I don’t have a chance to watch. I know Tonči Stipanović personally. I know how humble he is and how much he lives for sailing. I am thrilled for him, but also all the other athletes. When I watch videos on Facebook, I cry. When you are an athlete, you know how much effort has been put in and how heavy that medal is. Sandra Perković was fourth. Many ‘couch experts’ will say it is a failure, but many would give a hand for such a result. I am glad to see the success of any Croatian athlete.”

On behalf of the Split Fire Brigade, Mateo Štrljić revealed how the idea for this humanitarian action was born.

“We came up with the idea to organize a humanitarian action at the fire station. A lot of us went through that department with our kids, and so the idea came to life. We got in touch with Dr. Marija Bucat and found that they need a device for nitric oxide therapy, which makes breathing easier for newborns. Such a device exists in pediatrics, but it is needed immediately after childbirth. The device costs 250,000, and we achieved two-thirds of that amount through various donations. We are grateful that Dina also got involved in the action. We hope to collect the requested amount.”

Source: https://www.total-croatia-news.com/lifestyle/55109-marathon-swimmer-dina-levacic

The beauty and emotion of music does not require verbal translation…….

LORENA – TVOJA I GOTOVO (OFFICIAL VIDEO 2021) HD

Jul 26, 2021 Tonika Records

Lorena – Tvoja i gotovo (Splitski festival 2021, Srebrni val – druga nagrada žiri

The effect of parity on obstetric and perinatal outcomes in pregnancies at the age of 40 and above: a retrospective study

Croat Med J. 2021;62:130-6 https://doi.org/10.3325/cmj.2021.62.130

University of Health Science, Okmeydani Training and Research Hospital, Obstetrics and Gynecology Department, Istanbul, Turkey

Aim

 To examine the characteristics of pregnancies at a very advanced maternal age and the effect of parity on adverse obstetric outcomes.

Methods

We retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydanı Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%).

Results

Significantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher

Conclusion

Since primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.

Source:http://www.cmj.hr/2021/62/2/33938652.htm

PTSD in the NICU and Psychological Distress in Parents of Premature Infants/APA Publishing

Mar 10, 2021

Treatment of Psychological Distress in Parents of Premature Infants: PTSD in the NICU Edited by Richard J. Shaw, M.D., and Sarah Horwitz, Ph.D. At the outset of pregnancy, most parents expect a roughly 40-week journey punctuated by the birth of a healthy baby. When a preterm birth upends these expectations, the effects extend beyond the infant; there are real psychological consequences for the parents themselves. Treatment of Psychological Distress in Parents of Premature Infants tackles these issues, shedding light on the high prevalence of symptoms of posttraumatic stress disorder (PTSD) in parents following a premature birth. More than a dozen experts lend their expertise as they examine not only the medical and neurological consequences of premature birth on infants but also recent findings on the psychological effects of premature birth on parents—including the particular issues that fathers experience, which receive their own chapter.                             

BOOK:  https://www.appi.org/PTSD-in-NICU

Neonatal care during the COVID-19 pandemic – a global survey of parents’ experiences regarding infant and family-centred developmental care

Johanna KostenzerJulia HoffmannCharlotte von Rosenstiel-PulverAisling WalshLuc J.I. Zimmermann – Silke Mader et al.

Abstract

Background

The COVID-19 pandemic restrictions affect provision and quality of neonatal care. This global study explores parents’ experiences regarding the impact of the restrictions on key characteristics of infant and family-centred developmental care (IFCDC) during the first year of the pandemic.

Methods

For this cross-sectional study, a pre-tested online survey with 52 questions and translated into 23 languages was used to collect data between August and November 2020. Parents of sick or preterm infants born during the pandemic and receiving special/intensive care were eligible for participation. Data analysis included descriptive statistics and statistical testing based on different levels of restrictive measures.

Findings

In total, 2103 participants from 56 countries provided interpretable data. Fifty-two percent of respondents were not allowed to have another person present during birth. Percentages increased with the extent of restrictions in the respondents’ country of residence (p = 0·002). Twenty-one percent of total respondents indicated that no-one was allowed to be present with the infant receiving special/intensive care. The frequency (p < 0·001) and duration (p = 0·001) of permitted presence largely depended on the extent of restrictions. The more restrictive the policy measures were, the more the respondents worried about the pandemic situation during pregnancy and after birth.

Interpretation

COVID-19 related restrictions severely challenged evidence-based cornerstones of IFCDC, such as separating parents/ legal guardians and their newborns. Our findings must therefore be considered by public health experts and policy makers alike to reduce unnecessary suffering, calling for a zero separation policy.

Funding

EFCNI received an earmarked donation by Novartis Pharma AG in support of this study.

<a href=”http://Abstract Background The COVID-19 pandemic restrictions affect provision and quality of neonatal care. This global study explores parents’ experiences regarding the impact of the restrictions on key characteristics of infant and family-centred developmental care (IFCDC) during the first year of the pandemic. Methods For this cross-sectional study, a pre-tested online survey with 52 questions and translated into 23 languages was used to collect data between August and November 2020. Parents of sick or preterm infants born during the pandemic and receiving special/intensive care were eligible for participation. Data analysis included descriptive statistics and statistical testing based on different levels of restrictive measures. Findings In total, 2103 participants from 56 countries provided interpretable data. Fifty-two percent of respondents were not allowed to have another person present during birth. Percentages increased with the extent of restrictions in the respondents’ country of residence (p = 0·002). Twenty-one percent of total respondents indicated that no-one was allowed to be present with the infant receiving special/intensive care. The frequency (p Source: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00336-9/fulltext

PREEMIE FAMILY PARTNERS

Mental Health Care is Important

If you are struggling right now, we want you to know that this is normal. It is temporary. And you can feel better.

Having a baby in the NICU can be a profoundly traumatic experience for both your baby and YOU.  It may leave you feeling sad, guilty, overwhelmed, irritable, or unable to relax and enjoy your developing relationship with your new baby.  You may feel more tired than usual yet unable to get a good night’s sleep, you may be uninterested in eating, or you may have trouble thinking clearly and making decisions. You may even experience flashbacks or nightmares about some of the more unsettling experiences you had, or find your heart racing with anxiety for reasons you don’t completely understand.

We have partnered with Mental Health America to bring you their useful, quick and easy screening tools, which are short, confidential questionnaires, to determine whether you are might be experiencing a mental health condition like depression, anxiety disorder, or post-traumatic stress disorder (PTSD).  A positive score on a screening questionnaire does not mean you have a specific diagnosis.  It just gives an idea of whether you have any of the feelings associated with the various conditions.

Having a baby in the NICU can be a profoundly traumatic experience for both your baby and YOU.  It may leave you feeling sad, guilty, overwhelmed, irritable, or unable to relax and enjoy your developing relationship with your new baby.  You may feel more tired than usual yet unable to get a good night’s sleep, you may be uninterested in eating, or you may have trouble thinking clearly and making decisions. You may even experience flashbacks or nightmares about some of the more unsettling experiences you had, or find your heart racing with anxiety for reasons you don’t completely understand.

We have partnered with Mental Health America to bring you their useful, quick and easy screening tools, which are short, confidential questionnaires, to determine whether you are might be experiencing a mental health condition like depression, anxiety disorder, or post-traumatic stress disorder (PTSD).  A positive score on a screening questionnaire does not mean you have a specific diagnosis.  It just gives an idea of whether you have any of the feelings associated with the various conditions.

Once you have taken the screening, return here for more resources.

Resources:

  • If your baby is still in the NICU, we recommend discussing results of your screening test with the NICU social worker or psychologist, or even the neonatologist or chaplain. Any of these professionals should be able to help you and direct you to further resources in your baby’s hospital or in your community.
  • If your baby is already at home, you can contact your OB/Gyn provider, your family doctor, or your child’s pediatrician. Again, they can refer you to local resources.
  • Return to our page on Mental Health resources on this site for handouts you can read and download about depression and PTSD, and other links to helpful organizations.

Source:http://support4nicuparents.org/mental_health/

Social Security Benefits for Your Premature Baby

By Cheryl Bird, RN, BSN      Medically reviewed by Lyndsey Garbi, MD     Updated on May 07, 2021

If your baby was born premature, they might be eligible to receive social security benefits. Though it’s usually modest, this monthly stipend may help defray the added costs of having a preemie, including your baby’s hospital stay, other medical bills, and child care once home.

The type of social security benefits that premature babies can receive is called supplemental security income, or SSI. The Social Security Administration provides SSI benefits for any disabled child, and some preemies with low birth weight or developmental delays are eligible.

SSI Eligibility for Preemies

Simply being born prematurely doesn’t qualify your child for social security benefits. To be eligible for SSI, a baby must have one of the following conditions:

  • Low weight at birth: Any baby who weighs less than 2 pounds, 10 ounces at birth qualifies for SSI.
  • Low birth weight for their gestational age: Babies who are very small for their gestational age—what age they are from conception, not birth—can qualify for SSI. For example, a full-term baby, born between 37 and 40 weeks, still qualifies for SSI if they weigh less than 4 pounds, 6 ounces at birth.
 Gestational AgeBirth Weight for SSI Eligibility
37–40 weeks< 4 pounds, 6 ounces
36 weeks< 4 pounds, 2 ounces
35 weeks< 3 pounds, 11 ounces
34 weeks< 3 pounds, 4 ounces
33 weeks< 2 pounds, 14 ounces
32 weeks< 2 pounds 12 ounces
Any age< 2 pounds, 10 ounces
  • Growth failure combined with a developmental delay between birth and age 3: Some preemies exhibit a “failure to thrive,” meaning they are not gaining as much weight as expected during the newborn period and infancy. If your baby’s weight or body mass index (BMI) is below the third percentile for other babies at the same height between birth and age 3, they may be able to receive SSI.

Benefit Amount for Preemies

Payments for SSI are sent monthly. While your baby is in the hospital, the maximum social security SSI benefit you can receive is $30 per month. The benefit amount may change when your baby is healthy enough to go home.

After your baby is discharged, the amount of benefit you receive will depend on your family income and how many other children you have. It will also vary by state as some states supplement SSI with additional payments. Recent data show that the average SSI monthly payment that the federal government provides to families of children with any disability is around $690.

It’s important to know that your baby is not likely to be eligible for SSI if your family earns a substantial combined income. Children receiving SSI are usually from families with a total income below or near the poverty level.

How to Apply for Social Security Benefits

If you think your baby may qualify for SSI benefits, you should apply as soon as you are able. Although it can take up to three to five months for the Social Security Administration to decide eligibility for most children with disabilities, it will grant SSI immediately to families of babies who weigh less than 2 lbs 10 oz at birth.4 However, other preemies with low birth weight or babies with growth failure after birth won’t receive SSI payments until the application and review processes are complete.

Your infant’s birth weight must be documented by an original or certified copy of the birth certificate or in a medical record signed by a physician. If your child fails to grow as expected and has developmental delays, it’s important to collect and submit regular doctor’s records with your application.

To apply for SSI benefits, you can visit your local social security office or call the Social Security Administration at 1-800-772-1213. Also, don’t hesitate to check if the hospital where you delivered your baby can help; many neonatal intensive care units (NICUs) have representatives who are pros at guiding parents through the SSI application process.

If you have applied for and received immediate SSI relief for your baby with low birth weight and it’s determined that your baby doesn’t meet all the requirements for disability benefits, after all, you won’t have to pay back any payments you received to that point.

Expiration of SSI Benefits for Preemies

Parents should know that SSI payments are intended to expire when a child is on an age-appropriate weight and development track. As welcome as a little monthly financial boost is when you’re caring for a baby with medical issues, the Social Security Administration’s decision to discontinue payments is likely recognition of something positive: Your child’s attainment of or return to good health.

If your baby receives SSI for low weight at birth, the government will review their health status and eligibility again around their first birthday. If your child isn’t gaining weight or developing as expected, benefits will continue until the next review cycle.

For children who qualify for SSI later due to growth failure and associated developmental delays, benefits personnel will review their health progress and medical records at least every three years to determine eligibility.

If your child receives SSI, you are required to report to the Social Security Administration if you or your co-parent has a change in income. If you start earning more money, your child’s benefit payments could be reduced or end altogether.5

Be sure to keep track of how you spend your child’s SSI payments since the Social Security Administration requires you to submit a form detailing these expenses every year. You must spend the SSI money in ways that specifically benefit your child, such as:5

  • Food, shelter, and safety needs (including child care)
  • Medical and dental care not covered by insurance
  • Personal needs, like clothing and enrichment programs.

Other Financial Assistance Programs

If you have a preemie or baby with weight and growth problems and lack private insurance, there are other ways to get some financial relief to help curb costs for their care. These programs include:

  • Medicaid: Depending on the state, a family who qualifies for SSI on behalf of a child may also qualify for Medicaid, a healthcare program for low-income people. Even if your child doesn’t qualify for SSI, they might be eligible for Medicaid and other state and local programs. Check with your state Medicaid office and your state or county social services.
  • CHIP: The Children’s Health Insurance Program (CHIP) covers medical and dental costs for millions of kids whose families aren’t insured otherwise. You can apply for coverage and find participating doctors on the federal Insure Kids Now website.
  • WIC: Managed by the United States Department of Agriculture (USDA), the Supplemental Nutrition Program for Women, Infants, and Children (WIC) is designed to promote the health of expecting parents along with children up to age 5. To meet WIC eligibility for these monthly food vouchers, families must have an income at or below the poverty line and have demonstrated nutritional needs or deficiencies.
  • Reference:
  • https://www.ssa.gov/disability/professionals/bluebook/100.00-GrowthImpairment-Childhood.htm

Source:https://www.verywellfamily.com/social-security-benefits-for-your-premature-baby-2748695

A Sunny Day Reveals the Dirty Windows | Everyday Health

There is value in this father’s sharing related to the loss of his child and how he was able to share this loss and grow his relationship with his wife through and following the loss. So often the experience of losing a child, and even the impact of having a child with significant medical needs, tends to divide families. Building relationships while moving through the loss of a loved one can be a difficult yet rewarding endeavor.

Father Gives Tips On How To Survive Child Loss

Parents for Window Blind Safety

It is hard to find videos of a father’s perspective on child loss. We felt it was important to film a father’s loss and give the public tips on how he coped, what helped him, what he went through the first year and what thoughts and actions helped him move through the grieving process. We hope you find this video helpful to you whether you are on your own road of grief or you’re trying to relate to a friend in need.

HEALTH CARE PARTNERS

Journal of Gynecology and Womens Health

Incidence of Cervical Cerclage and Preterm Birth Rates: A Retrospective Analysis of Data from Two Centers in Croatia

Planinic Rados G, Haller H, Zegarac Z, Duic Z, Stasenko S. Incidence of Cervical Cerclage and Preterm Birth Rates: A Retrospective Analysis of Data from Two Centers in Croatia. J Gynecol Women’s Health. 2020: 19(2): 556009. DOI: 10.19080/JGWH.2020.19.556009

Abstract

Aim of the study: In recent period significant changes in the indications for cerclage procedure have emerged. Published trials caused shift in clinical practice with the reduction in the number of procedures worldwide. Analysis was undertaken to evaluate how did the more selective approach to patients who were candidates for cervical cerclage affect the preterm birth rates.

Methods: We conducted a retrospective analysis of women who underwent cerclage for prevention of preterm birth in two Croatia’s hospitals, University hospital Merkur (Zagreb) and University hospital Rijeka (Rijeka) over a 16-year period, from 1994 to 2009. Data from medical records were used to determine the total number of cervical cerclage procedures performed on singleton pregnancies and to calculate incidence rates. Annual hospital reports were used to calculate preterm birth rates in the same period.

Results: From 1994 to 2009 in both centers there were 81800 singleton deliveries including 3847 preterm births (4.7%). Of all deliveries 977 women (1.19%) received cerclage and were included in the analysis. A significant linear decrease of cervical cerclage rate across the whole time from 1994 to 2009 was observed. Over the 16 year period there was no statistically significant change in the percentage of preterm births.

Conclusion: More appropriate selection of patients who are candidates for cervical cerclage reduced the number of unnecessary procedures from 2.71% in 1994 to 0.69% in 2009 without significant increase in preterm birth rates.

FULL STUDY:   https://juniperpublishers.com/jgwh/JGWH.MS.ID.556009.php

Burnout, Exhaustion, and … It Is Not Just COVID

Kelly Welton, RRT-NPS

I’d been waiting for the Email for days…. And there it was: The subject line, “ IT would like your feedback on your recent interaction with tech support.” My chance to be heard! There better not be any character limits on this one! My IT guy was a dream. [He} had me back in the system in no time. It’s just that….. every other day I came to work, I had to call IT to sort out some new befuddlement with my access. Whether access to log on to the computer, the blood gas machine, or access to a patient’s chart so I could document or Pyxis, this was taking time away from patient care every time I had to sit on hold while IT was experiencing higher-than-normal-call-volume. In the comments section, I wrote:

“Once, just once, I would like to come to work, log in to my computer, and get on with my day. As it is, I spend my first one to 2 hours each shift on the phone with someone to get me logged in. I find this an insane waste of time”. I sent a copy to administration with a gentle explainer that I am still expected to perform patient care whether on hold with or interacting with IT those first 2 hours.

CoVid has done a number on all of us in healthcare, no matter what our specialty. But the insidious increase in time stolen by our computers in the name of patient care has been going on for years. And we are not equipped to fight it. Or are we? As bedside patient care clinicians, can we fight back or otherwise revolt against this system and put things back the way they ought to be: Patients come first, with thorough documentation of only pertinent information. What is the correct protocol for the rebellion?

 For example, if I make a ventilator change, I should also know what other parameters need to be accounted for as a professional. If I change the PIP, I should also document returned tidal volume, any change in O2 saturations or ETCO2 , and chest rise or breath sounds. The system often requires that I document the entire ventilator check and allows a very dangerous practice of copying and pasting the last entry. Can we band together and let Clinical Informatics know this is not working for us? Several articles have shown that even ‘mature’ EHR’s require that we spend approximately 1.5-time units documenting for every 1.0 time unit in actual patient care. But no one is factoring this into our workloads.

I read accounts by my fellow CoVid RT’s in adult capacities of crazy workloads, constant codes being called, non-stop intubations, and HFNC and BiPap setups. When do they chart all of this? Did someone perhaps ingeniously develop a minimum documentation protocol for when things get crazy? Think 24-week triplets, and you are the only MD or RT on the unit. Or, a baby crumps requiring an oscillator, which needs to be found, set up, calibrated, and vents moved around. Then we must titrate to optimal settings and wait 20 min to draw the ABG. If I get called to a crash C-section in the middle of this, that will surely take priority over finishing documenting every change we made on the “crumping” baby.

Patient care always comes first, but staying late every shift to complete documentation on every last detail of every baby in the unit does not allow us the time off we need to reset and regroup.

I am reminded of my last hospital, where a critical result on a CBG required 65 ( yes, that is sixty-five) clicks of the mouse to enter a result per The Joint Commission (TJC) and College of American Pathologist (CAP) standards. I could have run to the MD and showed him the slip of paper and run back ten times by the time I met the requirement — Not to mention the delay in care. This delay was not TJC or CAP’s fault; this situation occurred because the modern ABG machine could not make a way to interface with our old, pieced-together, and patched-up EHR. How can we get back to patient care truly being our focus? Can we talk IT into giving us a SOAP button for those days when we need to focus on what the baby is doing or not doing and lose extraneous charting parameters that, although they may be related, are not affected by the changes we made?

Many healthcare personnel left the field in the Spring when the pandemic calmed down, understandably so. Nevertheless, the undercurrent of a different pandemic – the need for more information and to cover us and our health systems in case of lawsuits presents a different level of exhaustion and burnout. Instead of just allowing MDs, RNs, and RTs to leave in droves, why not start a conversation about building a better (more straightforward) system. We built it; we can un-build it. Moreover, we MUST convince administration, IT, and insurance carriers that clicking boxes is not patient care.

Source: http://neonatologytoday.net/newsletters/nt-aug21.pdf

Diversity, Inclusion and Cultural Competency in Pediatric Hospital Medicine Fellowship Programs

Gabrina Dixon, Fatuma Barqadle, Edward Gill, Whitney Okoroafor, Barrett Fromme and Jorge Ganem

Hospital Pediatrics August 2021, 11 (8) 779-785;  https://doi.org/10.1542/hpeds.2020-004515

Abstract

OBJECTIVES 

The objectives with this study were to describe the current state of Pediatric Hospital Medicine (PHM) fellowship programs with regards to (1) diversity of fellows and programs’ leadership, (2) current diversity and inclusion (D&I) programs and measures of their success, and (3) the state of cultural competency training.

METHODS

 In 2018, fellowship directors of the 35 active PHM fellowship programs were invited to participate in a survey of diversity, inclusion, and cultural competency at PHM fellowship programs. Participants were invited via in-person invitations at the annual PHM fellowship directors meeting and through e-mail invitations from July to September to complete an online survey.

RESULTS 

There was an 89% response rate of the survey. Most fellows, faculty, and program directors in PHM were female (74%, 70%, and 70%, respectively) and white (53%, 67%, and 60%, respectively). There were no African American, American Indian or Alaskan Native, or Native Hawaiian or other Pacific Islander program directors. Forty-five percent of programs reported that neither the fellowship program nor their hospital had a strategic plan that addresses D&I. Approximately 61% of programs had cultural competency training for fellows.

CONCLUSIONS 

This is the first survey to report on the state of D&I in PHM fellowship programs. There is lack of racial and ethnic diversity in programs fellows, faculty, and directors. Although most programs have cultural competency training, strategic planning to promote D&I is not widely implemented among PHM fellowship programs.

Source: https://hosppeds.aappublications.org/content/11/8/779

Optimal Crash Cart Configuration for a Surgical NICU Utilizing Human Factors Principles

Abstract

Background: 

Neonates admitted to cardiac and surgical neonatal intensive care units (NICUs) are at an increased risk of requiring emergency lifesaving interventions that require the use of both Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) algorithms. Clinicians working within the surgical NICU must be able to access emergency equipment and medications quickly in order to respond to critical situations. A crash cart that integrates human factors principles and supports both the NRP and PALS algorithms is necessary to promote patient safety for this high-risk population.

Purpose: 

A multidisciplinary quality improvement project constructed an optimal crash cart configuration that embedded human factors principles and supported clinical workflow by reflecting both the NRP and the PALS algorithms in an NICU that cares for cardiac and surgical patients.

Methods: 

A crash cart working group including frontline NICU staff, simulation experts, and a human factors specialist was formed within a surgical NICU. Human factors principles were utilized to align the organization of the cart with the NRP and PALS algorithms to increase the efficiency and intuitiveness of the cart. The new crash cart configuration was usability tested through simulation, revised on the basis of clinical feedback, and then implemented in a clinical setting. Data were collected following implementation of the new crash cart to validate that the new configuration was viewed as a significant improvement. The Plan-Do-Study-Act cycle was used to make improvements and capture outcome indicators.

Results: 

Evaluation data collected both during usability simulation testing and in situ within the NICU clinical environment indicated that the revised crash cart scored higher on Likert scale response questions than the previous crash cart.

Implications for Practice: 

Human factors science, in combination with frontline user engagement, should be utilized to create intuitive crash cart configurations, which are then tested in a simulation environment and evaluated in situ in the NICU.

Implications for Research: 

Further research around crash cart design within NICUs that use multiple lifesaving algorithms would add to the paucity of research around the impact of human factors theory in the utilization of lifesaving equipment and medications within this specific population.

Source:https://journals.lww.com/advancesinneonatalcare/Fulltext/2021/08000/Optimal_Crash_Cart_Configuration_for_a_Surgical.9.aspx

Changes in thresholds for treatment of extremely preterm infants – a study among neonatal experts in the UK

POSTED ON 06 JULY 2021

Through an online survey among UK neonatal staff, the thresholds and viability for treatment of extremely preterm infants (EPIs) were evaluated. Respondents reported a median grey zone for neonatal resuscitation between 22 and 24 weeks’ gestation. Compared with previous studies, the survey showed a shift in the threshold for resuscitation, with greater acceptance of active treatment for infants also below 23 weeks’ gestation.

Infants born before 28 weeks of pregnancy are considered EPIs, and earlier gestations are associated with worse health outcomes. However, advances in perinatal care and other circumstantial factors could impact the preterm’s prognosis. An ethical dilemma is presented in some cases, where the EPI has a very high risk of longer-term neuro-disability. An active stabilisation attempt and survival-focused care (active treatment) may not always be appropriate. New technologies and statistical improvements in EPI outcomes challenge the survival grey zone boundaries and influence decision making.

Through an anonymous online survey, researchers captured views of UK-based neonatal clinicians (consultants, neonatal registrars or fellows, and advanced neonatal nurse practitioners) on decision-making around active treatment/palliative care for EPIs. The 336 participants were asked to select the lowest gestation at which they would offer active treatment at parental request and to answer questions about the conceptual understanding of the term ‘viability’.

The majority of respondents (60%) stated a lower limit between 22 weeks and 22 weeks plus six days for engaging in active treatment. Physicians and NICU personnel chose the lowest end of the threshold, at 22 weeks. The results of the upper threshold show that more than half of those surveyed would set a limit at 24 weeks to offer palliative care at parental request, deciding to actively treat the infant past this mark. The pattern of upper limits was similar regardless of the professional group. Almost two-thirds of respondents understood the concept of “viability” to reflect possibility of survival after birth and indicated that the risk of disability was irrelevant to viability. However, the remaining 34% suggested viability should reflect survival without severe disability.

Interestingly, the vast majority of respondents (91%) agreed that the gestation at which an infant is considered viable has changed in the last decade. Before this survey, in 2008 and 2016, only the minority of UK neonatologists would resuscitate prior to 23 weeks. Participants attribute their shifted views regarding resuscitation to improvements in neonatal intensive care. Furthermore, international guidelines might have influenced their opinion as well. Changed opinions create new ethical discussions. Nevertheless, further research would help establish standards and understand the optimal way perinatal clinicians could incorporate risk factors and parental views into difficult decisions such as treatment for EPIs.

Full list of authors: Lydia Mietta Di Stefano, Katherine Wood, Helen Mactier, Sarah Elizabeth Bates, Dominic Wilkinson

Paper available at: BMJ Archives of Disease in Childhood – Fetal and Neonatal Edition

INNOVATIONS

Emerging biosensing technologies could revolutionize the diagnosis of neonatal sepsis

Reviewed by Emily Henderson, B.Sc – August 11, 2021

Source: Shoolini University

Sepsis in newborn infants can be fatal. Early diagnosis is thus key to effectively manage the infection. Conventional diagnostic methods are, however, time-consuming. Now researchers from Shoolini University, in collaboration with IIT Hyderabad and Amity University, Rajasthan, describe the current point-of-care methods for improved diagnosis of neonatal sepsis and their limitations. Their review sheds light on emerging biosensing technologies that can revolutionize diagnostics in the future and help decrease mortality associated with neonatal sepsis.

Sepsis refers to a systemic (body-wide) infection accompanied by inflammation. Newborn infants are particularly susceptible to developing sepsis, given their naïve and under-developed immune system. Their immune system reacts to the acquired pathogen by releasing inflammatory factors such as cytokines and free radicals. The heightened immune response mounted against the pathogen, if uncontrolled, can cause severe damage to other organs, which can be fatal for the newborn. The prevalence of neonatal sepsis and associated mortality rates are especially high in developing countries, owing to poor sanitation and the dearth of healthcare resources.

Early diagnosis is thus cardinal for effective management of the infection and decreasing neonatal mortality. Current point-of-care (POC) methods rely on conventional blood culture and molecular techniques that may be time-consuming and often detect a single parameter or biomarker. Hence, development of rapid, sensitive, and integrated diagnostic strategies is crucial to enhance detection and improve the standard of care.

In a new Clinica Chimica Acta article, researchers from Shoolini University, in collaboration with researchers from IIT Hyderabad and Amity University, Rajasthan, India, have reviewed the latest advancements in analytical devices that enable multi-analyte detection with high sensitivity and accuracy. They also describe the limitations of currently used methods and why a combinatorial approach may be better. Speaking of why this caught their attention, lead author of the study, Dr. Anupam Jyoti, says, “Developing countries like India report an increased incidence of neonatal sepsis (50–70/1000 live births) as compared to developed countries (1–5/1000 live births), with a substantial mortality rate of 11-19%. We were thus motivated to review the field of neonatal sepsis detection and propose new directions towards effective diagnosis.”

Routinely used blood culture techniques often require two to five days to yield results. Meanwhile, the infection escalates, and the newborn is often pumped with unnecessary antibiotics that can lead to anti-microbial resistance. Techniques such as the polymerase chain reaction, which detects the genetic material of the pathogen, and mass spectrometry, which detects pathogen specific proteins, are more sensitive and require less time. However, they can yield false positive results and do not differentiate between viable and non-viable pathogens in the sample. While tests that detect serum biomarkers and immune factors, expressed in response to infection, may give a broad idea about the presence of sepsis, they cannot differentiate between specific pathogens. Together, the methods may however complement each other for robust diagnosis of sepsis.

Biosensing analytical technologies have emerged as a powerful tool in biomedical devices. Advanced biosensors that promise multi-analyte detection in a single platform are now being increasingly developed for rapid and sensitive diagnosis. Electrochemical sensors can detect various electrolytes and biomarkers based on their specific electrical properties. “Aptamers” or single stranded nucleic acid probes, given their minute size, stability, and high binding affinity, are useful for detecting bacterial traces in the blood. Next, sensors based on the surface plasmon resonance technique can detect changes in the optical properties of the sample. They are highly sensitive with low limits of detection, thus enabling the detection of small concentrations of pathogens. Finally, microfluidic devices and chip-based sensors analyze samples based on their flow or size and can thus detect bacterial and blood cells in the samples of patients with sepsis.

In addition to the above methods, integrated approaches that combine the principles of multiple techniques on a single platform are gaining popularity. Such hybrid biosensors will be capable of detecting multiple parameters in a short time from considerably small samples; all this at the bedside of the patient! Moreover, their wide applicability, cost-effectiveness, small size, and need for limited resources make them a practical and valuable tool for the diagnosis of neonatal sepsis.

Overall, the review sheds light on modern technologies that can help strengthen, and possibly replace conventional POC approaches in the future.

This is indeed a ray of hope for protecting neonatal health.

Source:https://www.news-medical.net/news/20210811/Emerging-biosensing-technologies-could-revolutionize-the-diagnosis-of-neonatal-sepsis.aspx

Plastic Drapes Reduce Hypothermia in Premature Babies

Study: Plastic Better Than Cloth for Low Birth-Weight Newborns

By Laurie Fickman  July 1, 2021

Most babies born prematurely or with health problems are quickly whisked away to the Neonatal Intensive Care Unit (NICU) where they might require assisted heating devices to regulate their temperature. A University of Houston College of Nursing researcher is reporting that the traditional use of cloth blankets and towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia. In Advances in Neonatal Care, Huong (Kelle) Phan, clinical assistant professor, reports that a plastic drape lowers the incidence of hypothermia.  

“The use of the plastic drape is a quality improvement to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement,” said Phan. “A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement.” 

When a premature baby’s body temperature drops below 36.5°C, the baby may experience cold stress, which is a cause for concern. The recommended temperature range for postnatal stabilization is between 36.5° and 37.5°C. 

Phan’s research project included implementing plastic drapes over three months, during 58 PICC procedures in a Level-3 NICU. A pre-/posttest was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort.  

“After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively). Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort,” said Phan.  

This evidence demonstrated plastic drapes reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blankets or towels.  

“Phan’s innovative nursing intervention of using the plastic drape during a PICC insertion helps some of our most vulnerable patients, those infants that must be treated in neonatal intensive care units,” said Kathryn Tart, founding dean and Humana Endowed Dean’s Chair in Nursing, UH College of Nursing. 

Phan recommends further research to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures. 

Teresa M. McIntyre, UH College of Nursing research professor, was co-author on the paper.

Source:https://uh.edu/news-events/stories/july-2021/07012021-huong-phan-nursing-plastic-drape-hypothermia-newborns.php

Parental Stress and Mental Health Symptoms in the NICU: Recognition and Interventions

Janine Bernardo, Sharla Rent, AnnaMarie Arias-Shah, Margaret K. Hoge and Richard J. Shaw

NeoReviews August 2021, 22 (8) e496-e505;DOI: https://doi.org/10.1542/neo.22-8-e496

Abstract

Parental experiences in the NICU are often characterized by psychological stress and anxiety following the birth of a critically ill or premature infant. Such stress can have a negative impact on parents and their vulnerable infants during NICU hospitalization as well as after discharge. These infants are also at increased risk for adverse developmental, cognitive, academic, and mental health outcomes. Identifying parents at risk for psychological distress is important and feasible with the use of well-validated screening instruments. Screening for psychological distress is essential for identifying families in need of referral for psychological support and resources. Numerous interventions have been implemented in the NICU to support parents. These include staff-based support such as wellness rounds and education in developmental care as well as parental-based support that includes cognitive behavioral therapy and home visitation programs. Comprehensive interventions should use a multidisciplinary approach that involves not only NICU staff but also key stakeholders such as social workers, spiritual/religious representatives, specialists in developmental care, and psychiatrists/psychologists to help support families and facilitate the transition to the home. Future efforts should include raising awareness of the psychological stresses of NICU parents and encouraging the development of programs to provide parents with psychological support.

Source: https://neoreviews.aappublications.org/content/22/8/e496

ADC Fetal and Neonatal’s Fantoms. Highlights from the May 2021 issue – ADC Podcast

ADC Fetal and Neonatal’s Associate Editor, Jonathan Davis, and the Edition Editor of the journal, Ben Stenson, discuss the highlights from the May issue.
Read the Fantoms here: fn.bmj.com/content/106/3/229 – release date: 9 June 2021

ADC Fetal and Neonatal’s Fantoms. Highlights from the May 2021 issue By BMJ talk medicine is licensed under a  Creative Commons License.

Birthweight and patterns of postnatal weight gain in very and extremely preterm babies in England and Wales 2008-2019: A cohort study

2-year outcomes of Prof Neil Marlow, DM  Prof Andreas Stahl, MD Prof Domenico Lepore, MD Prof Alistair Fielder, FRCP Prof James D Reynolds, MD Qi Zhu, PhD l.Show all authors ,:https://doi.org/10.1016/S2352-4642(21)00195-4

Summary

Background

Intrauterine and postnatal weight are widely regarded as biomarkers of fetal and neonatal wellbeing, but optimal weight gain following preterm birth is unknown. We aimed to describe changes over time in birthweight and postnatal weight gain in very and extremely preterm babies, in relation to major morbidity and healthy survival.

Methods

In this cohort study, we used whole-population data from the UK National Neonatal Research Database for infants below 32 weeks gestation admitted to neonatal units in England and Wales between Jan 1, 2008, and Dec 31, 2019. We used non-linear Gaussian process to estimate monthly trends, and Bayesian multilevel regression to estimate unadjusted and adjusted coefficients. We evaluated birthweight; weight change from birth to 14 days; weight at 36 weeks postmenstrual age; associated Z scores; and longitudinal weights for babies surviving to 36 weeks postmenstrual age with and without major morbidities. We adjusted birthweight for antenatal, perinatal, and demographic variables. We additionally adjusted change in weight at 14 days and weight at 36 weeks postmenstrual age, and their Z scores, for postnatal variables.

Findings

The cohort comprised 90 817 infants. Over the 12-year period, mean differences adjusted for antenatal, perinatal, demographic, and postnatal variables were 0 g (95% compatibility interval −7 to 7) for birthweight (−0·01 [–0·05 to 0·03] for change in associated Z score); 39 g (26 to 51) for change in weight from birth to 14 days (0·14 [0·08 to 0·19] for change in associated Z score); and 105 g (81 to 128) for weight at 36 weeks postmenstrual age (0·27 [0·21 to 0·33] for change in associated Z score). Greater weight at 36 weeks postmenstrual age was robust to additional adjustment for enteral nutritional intake. In babies surviving without major morbidity, weight velocity in all gestational age groups stabilised at around 34 weeks postmenstrual age at 16–25 g per day along parallel percentile lines.

Interpretation

The birthweight of very and extremely preterm babies has remained stable over 12 years. Early postnatal weight loss has decreased, and subsequent weight gain has increased, but weight at 36 weeks postmenstrual age is consistently below birth percentile. In babies without major morbidity, weight velocity follows a consistent trajectory, offering opportunity to construct novel preterm growth curves despite lack of knowledge of optimal postnatal weight gain.

Funding

UK Medical Research Council.

Source:https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00232-7/fulltext

Eleanor Roosevelt Wisdom…

Image.jpeg

In a few weeks I will be stepping off the plane in London. As I immerse myself in a new country across the “pond”, I am reminded that 10-12% of those I may come across may be fellow preemie survivors like myself.  

As medical research and innovation within the field of neonatology progresses, I believe that it is important that we are seen and embraced as the unique population we are; a global community deserving of targeted research and treatment solutions based not only on symptoms, but on preterm birth specific dynamics that focus  on symptom etiologies, and preemie development (cognitive, mental health, emotional, physical, behavioral, social development). We need and warrant evolving health care assessment and understanding, and deserve preterm birth specific treatments, and  solutions to address our neonatal needs. Representing more than 10% of the Global population we require recognition, investment, support of, and empowered awareness and response that includes progressive research, technologies, medical and educational specialty development. 

I encourage those of us born premature, preemie parents, family members,  healthcare professionals, health related industries, associated educators and technologists, logistics/supply chain related workforce partners, and all of our community members to engage in advocacy towards advancements in neonatal research and the promotion of new research activities in order to address our healthcare needs and wellbeing.  Big and small, all efforts to create awareness and action will make a difference.  

SUP-y z Padlle Surf Croatia na Baćinskich Jeziorach
Aug 20, 2019   Wakestok Wasilków

Od teraz zwiedzanie rzeki Supraśl może być jeszcze bardziej interesujące, a to wszystko za sprawą SUP-ów, które dostępne są do wypożyczenia w naszej bazie

From now on, visiting the Supraśl river can be even more interesting, thanks to SUPs that are available for rent in our database.

HEROS,PEARLS, & MED-SAFETY

Zambia,which is officially the Republic of Zambia , is a landlocked country at the crossroads of CentralSouthern and East Africa. Its neighbors are the Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the east, Mozambique to the Southeast, Zimbabwe and Botswana to the south, Namibia to the southwest, and Angola to the west. The capital city of Zambia is Lusaka, located in the south-central part of Zambia. The population is concentrated mainly around Lusaka in the south and the Copperbelt Province to the north, the core

Zambia contains abundant natural resources, including minerals, wildlife, forestry, freshwater and arable land.[13] In 2010, the World Bank named Zambia one of the world’s fastest economically reformed countries.[14] The Common Market for Eastern and Southern Africa (COMESA) is headquartered in Lusaka.

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

Healthcare: Zambia’s healthcare system is decentralized, therefore it is broken up into three different levels: hospitals, health centers and health posts. Hospitals are separated into primary (district), secondary (provincial) and tertiary (central). It offers universal healthcare for its citizens, yet the health care system in Zambia remains one of the most inadequate in the world.

Universal Health Care

Zambia is working on implementing universal health care coverage for its citizens to diminish the burden of accessing life-saving treatments. At the moment, Zambia’s government-run health facilities offer basic healthcare packages at the primary (district)level free-of-charge. Their services are under the National Health Care Package (NHCP). With this being said, due to “capacity constraints” and limited funding, the services sometimes do not reach those who need it most. Luckily, the Ministry of Health (MoH) of Zambia and Japan International Cooperation Agency (JICA) have come together in order to help restore the health care system in Zambia. They are investigating ways to effectively set priorities so that processes in health facilities can run faster and smoother.

Source: https://borgenproject.org/health-care-system-in-zambia/

PRETERM BIRTH RATES –Zambia

Rank:37 –Rate: 12.9% Estimated # of preterm births per 100 live births   (USA – 12 %, Global Average: 11.1%)

COMMUNITY

Determinants of Preterm Births at a National Hospital in Zambia: Application of Partial Proportional Odds Model

Received: 27 March 2021; Accepted: 06 April 2021; Published: 11 June 2021 Obstet Gynecol Res 2021; 4 (2): 117-130 Citation: Moses Mukosha, Choolwe Jacobs, Patrick Musonda, John Mathias Zulu, Sheila Masaku, Chipo Nkwemu, Bellington Vwalika, Kunda Mutesu Kapembwa, Patrick Kaonga. Determinants of Preterm Births at a National Hospital in Zambia: Application of Partial Proportional Odds Model. Obstetrics and Gynecology Research 4 (2021)

Abstract

Background: Preterm birth (PTB), the delivery of a baby before 37 completed weeks of gestation, is responsible for increased childhood morbidity and mortality globally. However, in most developing countries, the determinats of PTB are usually underestimated and content-specific. Therefore, we assessed the determinants of ordered preterm birth levels at the Women and Newborn Teaching Hospital, Lusaka, Zambia.

Results: The study included a total of 3243 case records of women with a median age of 26 years (IQR, 22-33), of whom 399 (12.3%) delivered very preterm infants, 914 (28.18%) delivered moderate-term infants, 957 (29.51%) delivered late-term infants and 973 (30%) delivered term infants. There were disparities across infants born to HIV uninfected and HIV infected women, with the latter being more likely to be on the lower levels of preterm birth. However, attending antenatal clinic and a unit increase in maternal age were more likely to be on the higher levels of preterm birth. Pre-eclampsia’s effect was not constant across the binary logistic regression models but generally showed a reduced odds of being in higher preterm birth levels for women with the condition.

Conclusion: HIV infection and pre-eclampsia predict lower preterm birth levels while attending antenatal care (ANC), and increased maternal age is protective. Pregnant women presenting with pre-eclampsia and HIV infection should receive special considerations. Our findings support interventions aimed at increasing ANC uptake in the Zambian and other sub-Saharan Africa settings.         

Source:  https://www.fortunejournals.com/articles/determinants-of-preterm-births-at-a-national-hospital-in-zambia-application-of-partial-proportional-odds-model.pdf

Charmaine Sipatonyana a nurse midwife at Kaoma District Hospital in Western Province attending to a client during COVID-19 pandemic Photo credit ©UNFPA Zambia 2020

How midwives are contributing to averting maternal and newborn deaths amid COVID-19

23 June 2021

As the COVID-19 pandemic continues to rage, the role of skilled midwives towards averting maternal and newborn deaths continues to be key. Unfortunately, in most underserved communities with high maternal and neonatal deaths, significant gaps in availability of well-trained health care workers remains.

Charmaine Sipatonyana is a midwife placed at Kaoma District Hospital in the Western Zambia, with support from UNFPA and funding from the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO). Prior to her arrival, the hospital was experiencing significant gaps in providing quality maternal health services due to limited availability of skilled staff.

“From the time I arrived, we have not recorded any maternal deaths, and we only had a few neonatal deaths for which we are working hard to close that gap as a matter of urgency. The Hospital is engaging with the community to continuously sensitize expectant mothers on the importance of antenatal visits and close monitoring during pregnancy and postpartum period.” says Charmaine because of the training and support she has received as part of UNFPA support to the Province, Charmaine further narrates how this has given her confidence to execute her very sensitive role of facilitating safe deliveries and saving lives.

In 2020, through the Government of Zambia/FCDO/UN Joint Programme on Health Systems Strengthening, a total of 69 midwives were mobilised and deployed to primary healthcare facilities in Western, Luapula and Central Provinces to help reduce key gaps in health workforce shortages and ensure continuity of essential service during COVID-19 pandemic. This contributed to 14,900 health facility deliveries between October and December 2020.

The role of a midwife goes beyond facilitating safe deliveries. When adequately skilled, midwives also play a critical role in delivering all other essential sexual, reproductive, maternal, and new-born health services including providing family planning and counselling services.

UNFPA Zambia | How midwives are contributing to averting maternal and newborn deaths amid COVID-19

Judy Yo – Always On My Mind

Premiered Apr 24, 2021

Judy Yo performing Always On My Mind produced by Shenky Sugah For Kalandanya Music promotions Official Video Shot By Bang Bang Media Download Always on my mind

Focus on Fathers for Promoting Safe Sleep and Breastfeeding

Alison Jacobson, Corresponding Author

In 2020 First Candle hosted a series of focus groups in Georgia, Michigan, and Connecticut to understand the impact of implicit bias, cultural norms, and socio-economic issues on individuals’ access to information about the American Academy of Pediatrics’ infant safe sleep guidelines and the choice to adopt them. We had five groups in each state: moms, breastfeeding moms, dads, grandparents, and in-home care providers.

 It was among the dads where we discovered the greatest opportunities to increase behavior change regarding safe sleep. Here are some highlights of the insights we gleaned from our focus groups:

Dads are more engaged than ever. Each of the dads spoke passionately about caring for his baby and equally sharing responsibility with mom. They shared stories with each other about how they care for their baby and want to be involved in parenting.

Dads feel marginalized by health care providers. Many dads spoke about how they felt ignored by in-home care providers and medical staff both during the birth and at the pediatrician’s office. Because of COVID-19 restrictions, most dads could not even attend prenatal and well-baby visits, but when they did, they felt the conversation and questions were directed towards mom. There was very little acknowledgment of their presence.

Dads do not have enough information. Whether it was due to COVID-19 or the inability to be present during in-home or office visits, dads do not feel they receive much information about safe sleep and breastfeeding. What they learn about safe sleep usually is what they hear from mom second-hand. Because of this, they are unsure about how to support mom in breastfeeding and how to create a safe sleep environment. One dad, an emergency medical technician who had been present at a Sudden Unexplained Infant Death (SUID) event, felt that the safe sleep guidelines are “mere opinions,” not facts, and therefore do not necessarily need to be adopted.

Dads always defer to mom. Dads have strong opinions, especially around bed-sharing, but they generally do not share this with mom. Many dads expressed that they “freak out” having a baby in bed with them, and it makes them nervous. But, they believe that “mom knows best” and that their opinions will always be second to mom. Dads want to receive information in different ways. Dads are less likely to read brochures about safe sleep or breastfeeding, as they feel the information is directed towards mom. It is generally images of mom and baby on brochures, and there is no specific information geared towards dad. They do not see themselves reflected in the materials. Dads also prefer to learn information from other dads. They are less inclined to read materials or listen to a care provider but would be open to listening to recommendations in a group setting of other men in places they frequent, such as gyms, barbershops, and men’s organizations.

PLEASE ALSO References: 1. https://firstcandle.org/straight-talk-for-infant-safe-sleep/ 2.https://neonatologytoday.net/newsletters/nt-jul21.pdf

BORN TO SOON- PREMATURE BABIES

Nov 18, 2020 ZNBC Today

At least 60 percent of babies admitted to the Neonatal Unit at the University Teaching Hospital -UTH- are premature.

HEALTH CARE PARTNERS

Neonatal Airway Monitoring System

Jun 10, 2021   Purdue Engineering

After 30 years of development, a medical device designed to continuously monitor the airways of the tiniest ventilated patients could become the standard of care for babies worldwide. Since 2016, five neonatal intensive care units in the U.S. have been using what George Wodicka and his students later invented as a solution: the first and only FDA-approved medical device that alerts nurses when a baby’s breathing tube is in the wrong position or obstructed. To make the device available to babies in every NICU, one of the world’s largest medical technology companies, Medtronic, recently added the Purdue invention to its product line as the SonarMedTM Airway Monitoring System. The company adopted the technology through its acquisition of SonarMed Inc. in December 2020, a startup Wodicka co-founded to bring the device to market.

NANN has provided a comprehensive Medication Position Statement addressing medication safety in the NICU. We strongly recommend this article for review by our esteemed healthcare provider community serving our preterm birth babies.

Medication Safety in the NICU Position Statement #3073 NANN Board of Directors June 2021 As the professional voice of neonatal nurses, the National Association of Neonatal Nurses (NANN) recommends a comprehensive approach to medication safety in the NICU that integrates available technology, focused healthcare provider medication safety education, standardized medication processes, and robust medication error reporting and prevention efforts. NICU patients are uniquely vulnerable to medication errors and require additional safeguards embedded within the medication-use process to reduce medication errors and mitigate harm. NICU healthcare providers should be proactive in evaluation and implementation of safe medication practices.

Please review full statement

http://nann.org/uploads/About/PositionPDFS/Final_MedicationInfo.pdf

Transition to a Safe Home Sleep Environment for the NICU Patient

Michael H. Goodstein, Dan L. Stewart, Erin L. Keels and Rachel Y. Moon; COMMITTEE ON FETUS AND NEWBORN, TASK FORCE ON SUDDEN INFANT DEATH SYNDROME Pediatrics July 2021, 148 (1) e2021052045; DOI: https://doi.org/10.1542/peds.2021-052045

Abstract

Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (ie, weight <2500 g) and 10% were born preterm (ie, gestational age of <37 weeks). Ten to fifteen percent of infants (approximately 500 000 annually), including low birth weight and preterm infants and others with congenital anomalies, perinatally acquired infections, and other diseases, require admission to a NICU. Every year, approximately 3600 infants in the United States die of sudden unexpected infant death (SUID), including sudden infant death syndrome (SIDS), unknown and undetermined causes, and accidental suffocation and strangulation in an unsafe sleep environment. Preterm and low birth weight infants are 2 to 3 times more likely than healthy term infants to die suddenly and unexpectedly. Thus, it is important that health care professionals prepare families to maintain their infant in a safe home sleep environment as per recommendations of the American Academy of Pediatrics. Medical needs of the NICU infant often require practices such as nonsupine positioning, which should be transitioned as soon as medically possible and well before hospital discharge to sleep practices that are safe and appropriate for the home environment. This clinical report outlines the establishment of appropriate NICU protocols for the timely transition of these infants to a safe home sleep environment. The rationale for these recommendations is discussed in the accompanying technical report “Transition to a Safe Home Sleep Environment for the NICU Patient,” included in this issue of Pediatrics.

COMMITTEE ON FETUS AND NEWBORN, TASK FORCE ON SUDDEN INFANT DEATH SYNDROME

Source: https://pediatrics.aappublications.org/content/148/1/e2021052045

Hero Nurse Who Saved Preemie Babies After Beirut Blast Speaks Out | TODAY

TODAY Aug 13, 2020

More than a week after a deadly explosion shook Beirut, Pamela Zaynoun, a NICU nurse, describes how she saved three babies from the rubble of a hospital and ran three miles with them in her arms. Her heroic act was captured in images that have gone viral. NBC’s Molly Hunter reports for TODAY.

PREEMIE FAMILY PARTNERS

Love is not Enough

Jun 1, 2013   Child Health BC

Your Own Happiness is a Gift to Your Child. Parents may need to put their life goals on hold and look after their own emotional needs so that they can create an environment where their child is connected and secure. Babies are not blank slates but rather, born with tremendous potential for self-realization. Or self-negation. Parents may need to deal with their own stress and seek support as needed. Attachment Patterns have a Multigenerational Aspect When parents focus on the comfort, security and happiness of their young child, the child benefits and so do future generations. The human brain develops, not only according to genetics, but largely in response to input from the environment. In other words, a baby’s capacity for intimate relationships, connection, self-regulation, attention and stress regulation are directly shaped by the emotional availability of the parents. During the critical first three months the right conditions need to be met for healthy brain development. Babies need caregivers who are non-stressed, non-depressed, emotionally available and consistently available. Babies and toddlers need a safe and low-stress environment. Featuring: Dr. Gabor Maté

When Extreme Preemies Get to School, Check Their Screen Time

Study suggests extra cognitive and behavioral risk for those with heavy device use by John Gever, Contributing Writer, MedPage Today July 12, 2021

Young schoolchildren who had been born very early and who logged “screen time” in excess of 2 hours daily were more likely also to show neurobehavioral problems than similar children spending less time with electronic devices, researchers found.

In a follow-up study conducted with a cohort of extremely premature infants, those with high screen time showed significant deficits in IQ, executive function, inhibition, and attention relative to the low screen-time children, according to Betty R. Vohr, MD, of Women & Infants Hospital of Rhode Island in Providence, and colleagues.

Having a television or computer in the bedroom was also associated with certain problems, the researchers reported in JAMA Pediatrics.

The 414 children in the study were about 6 to 7 years old at evaluation; all were born at less than 28 weeks gestation with a mean of 26 weeks. Just under 240 of the children logged screen time of at least 2 hours daily, and 266 had a TV or computer in the bedroom. Some 55% of the cohort were boys.

Overall, according to Vohr and colleagues, the results add to the already substantial literature connecting electronic device use to a variety of adverse outcomes. How a history of prematurity might play into this, however, is less clear. The researchers cited another study published in 2019 that linked high levels of screen time to abnormal “microstructural integrity” in white matter in preschool-age children.

Vohr and colleagues noted that several other groups have found a variety of structural brain defects in children born at extreme prematurity, and these in turn are “associated with cognitive, behavior, and language outcomes.” Thus, it’s not a great stretch to see a causal chain between birth prior to 28 weeks and neurobehavioral deficits associated with screen time, such that the risk with device use is “amplified,” the researchers suggested.

Study Details

Participants had been enrolled from 2005 to 2009 in an NIH study called SUPPORT NEURO, itself a secondary analysis of another cohort study called NEURO designed to evaluate short-term management strategies for extreme preemies. In the NEURO substudy, participants underwent cranial ultrasonography up to first or second grade, with clinical parameters evaluated as well.

Numerically, deficits in the high screen time group reached 3.92 points for full-scale IQ (SE 1.64, P=0.02) and 0.79 points for inhibition as assessed with the Developmental Neuropsychological Assessment (SE 0.38, P=0.03). Scores for inattention on the Conners 3rd Edition Parent Short Form were 3.32 points greater (SE 1.67, P<0.05).

Executive function was measured for different domains with the Behavior Rating Inventory of Executive Function. Scores for metacognition and global executive function were significantly lower among children with more than 2 hours/day of screen time, at 8.81 and 7.49 points, respectively (both P=0.01).

These figures included adjustments for a host of covariates, including sex, gestational age, and social determinants of health. Among the latter were maternal age and education, race, and public insurance; kids who were Black, on Medicare or Medicaid, or with mothers younger than age 20 when delivering — all were more likely to have high screen time and to have a TV or computer in the bedroom. Children whose mothers hadn’t completed high school were also more likely to have these devices in the bedroom, but not to have more screen time than those with more educated mothers.

Postpartum Depression… in Dads! – PediaCast 493

Posted by Dr. Mike on June 16, 2021

Parents have questions. PediaCast has answers.

Each episode of our award-winning audio program provides trustworthy, detailed and up-to-date answers to your questions. How do we do it? We start by searching the latest peer-reviewed journals. We find current evidence-based answers. Then we work a little translation magic, turning scientist-talk into parent-talk. The result is an entertaining listen that’s not elementary.

Of course, your child’s doctor is the best source of information for specific questions regarding your child’s health. We believe in keeping the practice of medicine in the examination room. But we also know parents have many questions that don’t get answered. Why do kids get so many ear infections? Is a fever dangerous? When should tonsils come out? Many parents think about these questions AFTER leaving the doctor’s office. Others remember to ask, but get the short answer instead of details.

Enter PediaCast–a supplemental source of educational information you can trust. We also provide a healthy dose of news parents can use and lively interviews with pediatric and parenting experts.

Please enjoy the example podcast below and note the abundance of Pod Casts available for your review and for future interactive participation.

Topic: Depression and Anxiety in Fathers after the Birth of a Baby Guest: Dr David Levin Pediatrician, Atlantic Medical Group Director of Professional Outreach Postpartum Support International Links to Empowering Resources are listed on website

Please enjoy the example podcast below and note the abundance of Pod Casts available for your review and for future interactive participation.

Source:https://www.pediacast.org/

INNOVATIONS

Preemies’ Blood Type Tied to Risk for Serious Intestinal Infections

AB blood group associated with risk of necrotizing enterocolitis and focal intestinal perforation-by Zaina Hamza, Staff Writer, MedPage Today July 7, 2021

AB blood type was associated with a higher risk for necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in preterm infants, as compared with other blood types, a German population-based study found.

Among very low birth weight infants enrolled in a prospective study, surgery for NEC/FIP was more likely to be performed in those with blood group AB versus all other blood groups in both univariate (OR 1.51, 95% CI 1.07-2.13, P=0.017) and multivariate analyses (OR 1.58, 95% CI 1.10-2.26, P=0.013), reported Illya Martynov, MD, of the University of Leipzig in Germany, and colleagues.

AB blood type was associated with a higher risk for necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in preterm infants, as compared with other blood types, a German population-based study found.

Among very low birth weight infants enrolled in a prospective study, surgery for NEC/FIP was more likely to be performed in those with blood group AB versus all other blood groups in both univariate (OR 1.51, 95% CI 1.07-2.13, P=0.017) and multivariate analyses (OR 1.58, 95% CI 1.10-2.26, P=0.013), reported Illya Martynov, MD, of the University of Leipzig in Germany, and colleagues.

“Blood group AB may be considered as a novel risk factor for developing NEC/FIP in very low birth weight infants besides the well-known factors including gestational age, hemodynamically relevant PDA [patent ductus arteriosus], and male gender,” wrote Martynov and co-authors in Nature Scientific Reports.

Factors that proved protective against NEC/FIP needing surgery included greater gestational age (OR 0.73, 95% CI 0.68-0.78), female sex (OR 0.68, 95% CI 0.55-0.83), and higher birth weight (OR 0.89, 95% CI 0.83-0.94; P<0.0001 for all), according to their findings. While use of ibuprofen or indomethacin for PDA showed a higher risk for NEC/FIP requiring surgery (OR 1.50, 95% CI 1.21-1.85, P<0.0001).

For their study, the researchers aimed to identify the associated risk factors of NEC/FIP in preterm infants with birth weights less than 1,500 grams (3.3 lb), where early diagnosis and intervention could be initiated. The two conditions typically affect infants born at 22 to 28 weeks of gestation and present within the first few weeks after birth. NEC/FIP can cause necrosis in the intestinal mucosa, leading to bowel perforation.

“Although FIP and NEC have been recognized as distinct entities, the clinical features and timing of presentation are frequently overlapping, making both diseases clinically indistinguishable in many cases,” the authors wrote.

In cases requiring surgery, neonatal mortality is higher in premature infants with NEC compared to those with FIP (35% vs 21%, respectively). A prior retrospective study had found a higher mortality risk for premature infants with NEC and type AB blood.

NEC risk factors can include formula feeding (after exposure to cow’s milk), immune system dysregulation, or any change to the microbiota.

“Blood group antigens are not only on the surface of red blood cells but also occur in other tissues, including the intestinal surface,” explained Martynov and coauthors, adding that these antigens are released into the lumen of the intestines and can serve as receptors for toxins or bacteria.

In the current study, data on the premature infants came from the German Neonatal Network, and included 10,257 infants with very low birth weight, 441 of whom required surgery for NEC/FIP. Most infants had type A blood (46.5%), followed by type O (34.5%), type B (13%), and type AB (6%). In regards to birth weight, mode of delivery, gestational age, gender, and corticosteroid exposure, no differences were reported according to blood type.

Most infants had an average gestational age of 28.5 weeks, and the average birth weight was 1,051 grams (2.3 lb) for the AB blood group and 1,037 grams (2.3 lb) for the non-AB group (P=0.26).

NEC/FIP requiring surgery was observed in 6.2% of infants with AB blood versus 4.2% of those with non-AB blood and 4.4% of those with type O blood. Mortality from NEC/FIP was 7.7% for the AB blood type group and 6.8% for the non-AB blood groups (P=0.385).

Multivariate analyses included gestational age, multiple birth, sex, and PDA medical/surgical treatments as covariates.

Limitations of the study included the small number of patients in the cohort who required surgery for FIP/NEC, as well as the low prevalence of AB blood type in infants with NEC/FIP (5.9%). Variability also may have existed among unrecognized confounders, such as donor milk availability and center protocols for feeding advancement.

Source:https://www.medpagetoday.com/gastroenterology/generalgastroenterology/93461

Gestational Weight Gain and Its Effects on Maternal and Neonatal Outcome in Women With Twin Pregnancies: A Systematic Review and Meta-Analysis

Front. Pediatr. | https://doi.org/10.3389/fped.2021.674414

Wei Zhong1†, Xiaojiao Fan2†, Fang Hu1, Meiqin Chen1 and Fanshu Zeng3*

Background: The incidence of twin pregnancies has risen recently. Such pregnancies are associated with an increased risk for poor maternal and infant outcomes. Gestational weight gain, particularly in singleton pregnancies, has been well-linked with maternal and infant outcomes. The aim of the current meta-analysis was to evaluate the effects of gestational weight gain on maternal and fetal outcomes in women with twin pregnancies.

Methods: A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies, either retrospective or prospective in design, evaluating the effects of gestational weight gain (defined using Institute of Medicine (IOM) guidelines) maternal and/or fetal/neonatal outcomes in women with twin pregnancies were included. Statistical analysis was performed using STATA software.

Results: Eleven studies were included in the meta-analysis. Mothers with inadequate weight gain had increased risk for gestational diabetes mellitus (OR 1.19; 95% CI: 1.01, 1.40) and decreased risk for gestational hypertension (OR 0.58; 95% CI: 0.49, 0.68) and cesarean section (OR 0.94; 95% CI: 0.93, 0.96). Neonates born to mothers with inadequate weight gain were susceptible to increased risk for preterm delivery (OR 1.17; 95% CI: 1.03, 1.34), very preterm delivery (gestational age <32 weeks) (OR 1.84; 95% CI: 1.36, 2.48), small for gestational age status (OR 1.41; 95% CI: 1.15, 1.72), low birth weight status (<2,500 g) (OR 1.27; 95% CI: 1.17, 1.38), and neonatal intensive care unit (NICU) admission (OR 1.16; 95% CI: 1.08, 1.24). The pooled findings indicate an increased risk for gestational hypertension (OR 1.82; 95% CI: 1.60, 2.06) and cesarean section (OR 1.07; 95% CI: 1.05, 1.08) among mothers with excessive weight gain. Neonates born to mothers with excessive weight gain were susceptible to increased risk for preterm delivery and very preterm delivery but were associated with a decreased risk for low birth weight status and small for gestational age status.

Conclusions: Gestational weight gain in twin pregnancy, either lower or higher than IOM recommended guidelines, is associated with poor maternal and neonatal outcomes. Our findings call for incorporating counseling on optimal weight gain during pregnancy as part of routine antenatal visits.

https://www.frontiersin.org/articles/10.3389/fped.2021.674414/full

Clinical Pearl: Age is just a number: Evidence of Accelerated Biological Aging in Adults Born Extremely Low Birthweight (ELBW)

Melanie Wielicka, MD, PhD, Joseph R Hageman, MD

With the increasing rates of preterm birth and survival worldwide, a number of studies have started to focus not only on the immediate consequences of prematurity seen in the neonatal intensive care units but also on its long-term effects on adult health. There is now evidence that individuals with a history of preterm birth are at a greater risk of developing hypertension, strokes as well as type 1 and type 2 diabetes (1, 2). These chronic medical conditions have been classically associated with increasing age, raising whether ex-preemies are at risk for accelerated aging.

The extent of DNA methylation increases with chronological age. Various “epigenetic clocks” are available to quantify the relationship between methylation and chronological age to determine an individual’s “epigenetic” or “biological” age. Increased biological age has been linked to a greater risk of age-related morbidities (3). In their study, Van Lieshout and colleagues collected buccal cells from 45 extremely low birth weight (ELBW) survivors and 49 normal birthweight controls at 30-35 years of age. Epigenetic age was calculated from the weighted average of DNA methylation at 353 cytosine-phosphate-guanine sequences within the DNA methylation sites. The technique used is called the Illumina Infinium Human Methylation EPIC 850k BeadChip array devised by Horvath. They found that men born at ELBW demonstrated accelerated biological aging when compared to age-matched adults born at normal birth weight. The authors suggest that these findings could potentially be related to the increased psychological and physiologic stress premature infants endure (4, 5).

At this time, further studies are still needed to establish the link between accelerated cellular aging in individuals with a history of prematurity and specific outcomes, as well as to identify which subgroups are at the highest risk. Van Lieshout and colleagues point out that male preterm infants are susceptible to worse outcomes, and thus, are at risk for increased stress, which could potentially explain why the differences were only found in males (4, 5). Their findings appear to be supported by Parkinson et al., who used a different molecular marker, telomere length, to study cellular aging in patients with a history of prematurity. They have demonstrated a greater proportion of shorter telomeres in preterm men when compared to term men but were unable to find similar differences in women (6). Interestingly, in a recent study by Raffington et al., the authors analyzed DNA methylation to determine a methylation-based “pace of aging” in children. They have found that a greater socioeconomic disadvantage among white and Hispanic children was associated with a significantly faster pace of aging. This topic should be explored further. It would be imperative to determine if racial and socioeconomic disparities enhance the risk of accelerated aging in individuals with a history of prematurity (7).

All the emerging evidence has important implications for clinicians, researchers, and policymakers. At the policy level, more data is still needed to establish appropriate screening and preventative guidelines. However, when caring for children, adolescents, and adults with a history of prematurity, physicians should closely monitor blood pressure and weight and encourage appropriate nutrition and physical activity. They should also be reminded of the importance of inquiring about preterm birth when obtaining routine medical history, even when encountering patients later in life. Lastly, family members of children born preterm should be counseled on the risk for accelerated aging and increased risk of cardiovascular and metabolic disorders.

Source:https://neonatologytoday.net/newsletters/nt-jul21.pdf

Have neurodevelopmental outcomes improved in extremely preterm children?

July 21, 2021 Miranda Hester

As more extremely preterm infants survive delivery, a study examines whether the advances that allowed for that survival also improve neurodevelopmental outcomes.

Medical advancements in perinatal and neonatal care have led to greater survival for extremely preterm infants. A report in JAMA Pediatrics examined whether these advances had also led improvements in the neurodevelopmental outcomes in children who were born <28 weeks’ gestation.1

The investigators used 4 prospective longitudinal cohort studies that included all live extremely preterm births 22 to 27 weeks’ gestation in the state of Victoria, Australia in 1991-1992, 1997, 2005, and 2016-2017. The main outcomes looked at were survival, blindness, cerebral palsy, developmental delay, deafness, and neurodevelopmental disability at 2 years’ corrected age. Delays in development included a developmental quotient that was less than -1 SD relative to the control group averages on the Bayley Scales. A major neurodevelopmental disability involved moderate to severe cerebral palsy, blindness, deafness, or a developmental quotient less than −2 SDs.

Data were available for 1152 children across the 4 studies. The investigators found that survival to 2 years of age was highest in the 2016-2017 cohort (73% [215 of 293]) in comparison with the other cohorts: 1991-1992: 53% (225 of 428); 1997: 70% (151 of 217); 2005: 63% (170 of 270). Additionally, cerebral palsy was not as common in 2016-2017 (6%) than the other 3 time periods (1991-1992: 11%; 1997: 12%; 2005: 10%). No notable changes in the rates of developmental quotient less than -2 SDs (1991-1992: 18%; 1997: 22%; 2005: 7%; 2016-2017: 15%) or rates of major neurodevelopmental disability (1991-1992: 20%; 1997: 26%; 2005: 15%; 2016-2017: 15%) were found across the eras. Across all 4 cohorts, both blindness and deafness were not common. Furthermore, the rate of survival that was also free from major neurodevelopmental disability went up steadily over time 42% (1991-1992), 51% (1997), 53% (2005), and 62% (2016-2017) (odds ratio, 1.30; 95% CI, 1.15-1.48 per decade; P < .001).

The investigators concluded that children who are born extremely preterm are increasingly surviving to age 2 years without a major disability. Furthermore, this increased rate of survival was not linked to an increase in neurodevelopmental disability.

Reference

  1. Cheong J, Olsen J, Lee K, et al. Temporal trends in neurodevelopmental outcomes to 2 years after extremely preterm birth. JAMA Pediatr. July 19, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.2052

Source: https://www.contemporarypediatrics.com/view/have-neurodevelopmental-outcomes-improved-in-extremely-preterm-children

Rates of Neuropsychiatric Disorders and Gestational Age at Birth in a Danish Population

Yuntian Xia, MPH1Jingyuan Xiao, MPH1,2Yongfu Yu, PhD3,4; et alWan-Ling Tseng, PhD5Eli Lebowitz, PhD5Andrew Thomas DeWan, PhD1,6Lars Henning Pedersen, MD, PhD7,8,9Jørn Olsen, MD, PhD3Jiong Li, MD, PhD3Zeyan Liew, PhD, MPH1,2 Obstetrics and Gynecology-June 29, 2021: JAMA Netw Open. 2021;4(6):e2114913. doi:10.1001/jamanetworkopen.2021.14913

Key Points

Question  Are there associations between gestational age, analyzed in 6 subgroups covering the full range of gestational duration, and the rate of neuropsychiatric diagnoses?

Findings  In this Danish, nationwide, registry-based cohort study, shortened gestational duration was associated with the rate of both child-onset and adult-onset neuropsychiatric diseases. Beyond the traditional threshold of fetal maturity (≥37 weeks), the early term group (37-38 weeks) had a slightly elevated rate of multiple neuropsychiatric disorders compared with the full-term group, whereas the late-term and postterm groups had the lowest rates for most disorders except pervasive developmental disorders.

Meaning  These findings suggest that neuropsychiatric disorders might be associated with factors related to early development and that interventions focusing on perinatal risk factors and obstetric practices might lower the risk for neuropsychiatric disorders in the population.

Abstract

Importance  Nonoptimal gestational durations could be associated with neurodevelopmental disabilities, yet evidence regarding finer classification of gestational age and rates of multiple major neuropsychiatric disorders beyond childhood is limited.

Objective  To comprehensively evaluate associations between 6 gestational age groups and rates of 9 major types and 8 subtypes of childhood and adult-onset neuropsychiatric disorders.

Design, Setting, and Participants  This cohort study evaluated data from a nationwide register of singleton births in Denmark from January 1, 1978, to December 31, 2016. Data analyses were conducted from October 1, 2019, through November 15, 2020.

Exposures  Gestational age subgroups were classified according to data from the Danish Medical Birth Register: very preterm (20-31 completed weeks), moderately preterm (32-33 completed weeks), late preterm (34-36 completed weeks), early term (37-38 completed weeks), term (39-40 completed weeks, reference), and late or postterm (41-45 completed weeks).

Main Outcomes and Measures  Neuropsychiatric diagnostic records (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F00-F99) were ascertained from the Danish Psychiatric Central Register up to August 10, 2017. Poisson regression was used to estimate the incidence rate ratio (IRR) and 95% CI for neuropsychiatric disorders, adjusting for selected sociodemographic factors.

Results  Of all 2 327 639 singleton births studied (1 194 925 male newborns [51.3%]), 22 647 (1.0%) were born very preterm, 19 801 (0.9%) were born moderately preterm, 99 488 (4.3%) were born late preterm, 388 416 (16.7%) were born early term, 1 198 605 (51.5%) were born at term, and 598 682 (25.7%) were born late or postterm. A gradient of decreasing IRRs was found from very preterm to late preterm for having any or each of the 9 neuropsychiatric disorders (eg, very preterm: IRR, 1.49 [95% CI, 1.43-1.55]; moderately preterm: IRR, 1.23 [95% CI, 1.18-1.28]; late preterm: IRR, 1.17 [95% CI, 1.14-1.19] for any disorders) compared with term births. Individuals born early term had 7% higher rates (IRR, 1.07 [95% CI, 1.06-1.08]) for any neuropsychiatric diagnosis and a 31% higher rate for intellectual disability (IRR, 1.31 [95% CI, 1.25-1.37]) compared with those born at term. The late or postterm group had lower IRRs for most disorders, except pervasive developmental disorders, for which the rate was higher for postterm births compared with term births (IRR, 1.06 [95% CI, 1.03-1.09]).

Conclusions and Relevance  Higher incidences of all major neuropsychiatric disorders were observed across the spectrum of preterm births. Early term and late or postterm births might not share a homogeneous low risk with individuals born at term. These findings suggest that interventions that address perinatal factors associated with nonoptimal gestation might reduce long-term neuropsychiatric risks in the population.

Source:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781499

“From fear and freezing to trust and letting go”– an interview with Ingeborg Anna Martens on preterm birth and the consequences of separation policies

Ingeborg Anna Martens was born in gestational week 30/31 in the 1970s. As was the common practice back then, she was separated from her parents who could only “visit” their daughter at the ward and look at her from a distance, for about two months. Over the years, Ingeborg has reflected a lot on the long-term influence her preterm birth had had on herself and on her relationship with herself and to those close to her. With GLANCE, she shared how she emerged stronger from the past and looks into the future with courage and self-acceptance.

GLANCE:
Since the outbreak of the pandemic, many hospitals and neonatal intensive care units
(NICUs) have introduced the practice of separating preterm babies and otherwise sick
newborns from their parents, allowing only very limited contact or none at all.
When you as an adult who was born preterm and separated from your parents, hear or read about this practice, does it trigger anything in you?

Ingeborg:
Absolutely this triggers something in me. I understand that in a pandemic choices have to be made and safety comes before anything else. But separating parents from their child also results in insecurity, in the sense of feeling unsafe. In a child, this can leave lifelong marks.
Knowing this fills me with sadness, heartache.

G: You were separated from your parents for 2 months after your birth. Looking back, do you have the impression that this had lasting consequences? For example, on your (emotional) development or on interpersonal relationships like the one you had with your parents?

Ingeborg:

In life, we all take our own journey, with our own desires, needs and ideals.
A common thread in my life is my health. As young as I was, I often expressed ‘ how wonderful it would be if my body could be baked over again’. From an early age on, I have had a strong drive to get things done, a hard worker, wanting to do well, to prove to myself that I can do it. The urge to prove? I think so. But also the need to feel to be seen heard and understood. To know that I am loved, although I do not always believe it myself deep inside.

I found out pretty quickly that body and mind are connected. My willpower is enormous I am blessed with a strong positive mindset. And yet? Why has my body overpowered my mind several times in the past? After all these years I realise that my premature birth and my time in the incubator had a lot of impact on my life. For a long time, I didn’t want to face that.
Emotional connection and unconditional love are at the core of our basic trust and right to exist.

During the incubator period, my parents were allowed to admire me only from a distance and so they did. There was no touch, let alone skin-to-skin contact. (Except the physical contact during medical procedures, of course). So emotional nourishment was out of the question basically. Fortunately, this was later rectified and some holes in my (attachment) web were repaired.

Despite a safe home, I think that, in retrospect, I have ‘survived’ most of my life; full in my survival mode.


In the meantime, I have taken a lot of steps in this and gathered knowledge to get out of this survival mode. By immersing myself in the workings of our stress system, I have become aware of several things and have set to work. Mostly by myself, but I also called for help. After all, we don’t have to do everything on our own. I have mapped out my birth and unmet needs, tapped into my body memory, felt things through and had several conversations. Thankfully.

I became aware of various triggers, which still occasionally set my survival mechanism into motion. I then go into a kind of ‘rigidity’, in my head. With bodywork and meditation, I manage to find the connection with my heart, soul and body again and how to relax. That is very nice.

From fear and freezing to trust and letting go. Because of this, I am also able to guard my own boundaries better and I don’t let others cross them so quickly anymore. I have learned to take up my own space, without feeling guilty. I do matter as a person and I am safe because, in the end, it is all about feeling safe and comfortable with and within yourself. The result is that I feel the love in myself again, the love of others, and I feel welcome. Sometimes not yet, but every day we learn, by trial and error. For a lifetime.

G: You were born preterm in the 70s when it was very common to restrict the parents’ access to their baby. Now we observe that in many hospitals practices like this are still or again in use as they were 40 years ago. What lessons do you think neonatal units and hospitals should learn from the pandemic?

Ingeborg:

I think it’s important to think in terms of possibilities and solutions. Even in these times, full of challenges. The first 1000 days of a child’s life are decisive for the rest of their lives. A good attachment, feeling seen, heard, loved and understood. These are incredibly important building blocks for a strong bond between an infant and parent.

No matter how small you are, all the early experiences and impressions are saved in your brain. You can’t put words to it yet, but the body saves all this information. This creates stress and has an influence on your emotional and physical development.

I always say: ‘You always take yourself with you’. As a child, a parent, but also for example in your role as a professional. Be aware of your own emotions and stress.


Individual developmental care should really be key in the care of the sick and/or premature baby. It takes into account the needs of each individual baby and the relationship with his parents. (So, no separation!)

With an optimal start, you can prevent much suffering later. Not only in the period in the hospital, but also in the period when the baby comes home. Give everyone a ‘soft landing’ in this respect.

Connected, no matter what or how your start has been.

“From fear and freezing to trust and letting go” – An interview with Ingeborg Anna Martens – GLANCE (glance-network.org)

Source:https://213734.seu2.cleverreach.com/m/12911096/581525-d9357d61ab7bd9c03865e90c887f7967cb10abad39a402a74df69484caad58bd7c0e965119d2915dee877d5337d20fd9

Reflecting on the article interviewing Ingeborg Anna Martens, I felt a significant connection to the insight she shared. As a fellow preemie survivor I too have experienced challenges in interpersonal relationships in setting my boundaries, getting in touch with my emotions, and feeling safe. Always keeping myself at arm’s length to maintain control has become second nature. This is a response I am working to change as an adult empowered with access to information, an informed community, and a sense of curiosity like that of which Ingeborg has courageously shared.  

Preemie’s are impacted by the circumstances we face in our fight to survive. Survival mode as expressed by Ingeborg at such a visceral, sub-conscious level was validating for me, and empowering towards my journey.

I, too, feel a sense of sadness knowing worldwide many preemies born today and their families are experiencing an increased period of separation. While much of the knowledge Ingeborg has shared in my opinion has traditionally been met with hesitation from the medical and research community, my hope is that increased engagement with fellow preemie survivors and NICU community members may advance discussion, research, and outlets of information sharing. I hope such dialogue will support parents and families of young preemies in their awareness and ability  to positively impact their child’s long-term health and wellness. Healthcare providers and facilities have the opportunity to make this information accessible and attractive to our preemie parents, families, and survivors.

Microlight flight over Victoria Falls (Livingstone, Zambia)

Jan 11, 2018

Flying over the 7th Natural Wonder of the World : Victoria Falls (Zambia & Zimbabwe, Africa) !