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.



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

  (USA – 12 %, Global Average: 11.1%)


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.”


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


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

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


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


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%).


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


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.


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.                             


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.



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.


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.


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.


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.


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:


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.


  • 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.


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:


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.


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


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.


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.


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;



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.


 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.


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.


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.


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



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.


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.


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.


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.


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


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


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.


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.


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:


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.


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: – 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 ,:



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.


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.


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.


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.


UK Medical Research Council.


Eleanor Roosevelt Wisdom…


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.

Author: Kathy Papac and Kathryn (Kat) Campos

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

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